You probably know more about flossing than managing your sexual health.

But for a satisfying sex life as you grow older, you need to know how to handle the aging reproductive system's physical changes, says Evelyn Resh, a registered nurse who educates women about health and sexuality. 

The changes of aging may catch you by surprise because you tend to get information about sexuality — both good and bad — when you're young. The early messages don't tend to include the implications of hormonal and physical changes that can begin in your 40s and 50s. 

Many of today's middle-aged and older women aren't very familiar with their own anatomy, says Resh, who will be a keynote speaker on this topic in Rochester Friday at the sold-out Speaking of Women's Health conference hosted by WXXI. 

"It's 'down there,'" jokes the certified sex counselor. "What is down there? Do you know?"

Women who didn't know much about their sexual organs at age 20 or 30 are even less likely to know decades later, says Resh, director of sexual health services for Canyon Ranch health resort in Lenox, Mass. American culture today is awash in sexual images but not necessarily in information about sexual health, especially in later life. 

The nation's first baby boomers — people who were young adults during the sexual revolution of the 1960s — turn 60 this year. They may have greater expectations for their sexual lives than did previous generations, suggests Dr. Ruth Kouides, an internal medicine physician and director of the women's health track at Rochester General Hospital. 

While previous generations may have viewed sex as a duty, more women today seek their own enjoyment from a sexual relationship, Kouides says. That can benefit both partners, she adds: "A woman needs to know what makes her happy before she can let her partner know." 

Unlike puberty, physical changes in later life happen more slowly.

The drop in estrogen levels at menopause causes women's vaginal walls to become thinner, less elastic and less lubricated. So women may need to use topical estrogen or an over-the-counter, water-based lubricant to prevent pain during sexual activity. This may be a sudden problem in a new sexual relationship after years of abstinence because of divorce, a partner's death or impotence, Kouides points out. 

Older men are more likely to experience periodic impotence than younger men. This may especially affect men with heart disease, high blood pressure or diabetes, either because of the disease or the medicines used to treat it. 

Nonphysical challenges also come up. A woman's interest in sex may wane because of problems in her relationship with her partner, Kouides says. Women typically want to feel close to their partner to be interested in sex, while men may want to have sex to feel close to their partner. 

Resh says that women also must adjust to their body's redistribution of fat with age, which can affect self-image. She says women who don't exercise regularly will have more issues. 

Arthritis, chronic pain, incontinence, surgery, drinking too much alcohol and other health issues also can affect a person's sex life, according to the National Institute on Aging. Talking with your doctor or seeing a counselor knowledgeable about sexual health can help. 

It also helps to see your sexuality as something that evolves over your lifetime, Resh says: "Who you are as a sexual person at 50 is going to look really different from who you were as a sexual person at 28." So don't compare, she says, and don't measure sexual success by whether or how often you're having intercourse. 

Resh suggests assessing your sexual relationship by asking: Does sexual intimacy feel good to your body? Do you feel emotionally met and safe?

Getting older does have potential benefits sexually. People who develop wisdom, increased self-assurance and fuller senses of humor and gratitude bring all of that to their relationships. "Intimacy, sexuality and loving take on those aspects," Resh says. Over many years, partners can learn about and be more attentive to each other. 

Some women enjoy sex more as they grow older, according to the National Institute on Aging. They may feel freer because menopause or a hysterectomy erase the risk of unplanned pregnancy. 

But years don't necessarily bring wisdom. "You can be 55 and make really stupid decisions about who you have sex with," says Resh. And the risk of sexually transmitted disease or infection or a broken heart remain. 

At any age, sexual activity or lack thereof can have consequences, Resh says. Not having sex may contribute to loneliness, lack of companionship, not enjoying your body and not feeling loved, for example. 

Talking about sexual struggles can help, Resh adds. "Even if women could open up among themselves, that can help," she says.