A major reason older women give up on sex is lack of a sexually functional partner. However, age-related changes, particularly those due to menopause, can make women more likely to experience sexual dysfunction. Also, medical conditions that can interfere with sexual function, such as diabetes, atherosclerosis, urinary tract infections, and arthritis, become more common as women age. However, these changes need not end sexual activity and pleasure, and not all sexual dysfunction in older women is caused by age-related changes.

In older women as in younger women, the most common problem is lack of interest in sex.

After menopause, less estrogen is produced.

• The tissues around the vaginal opening (labia) and the walls of the vagina become less elastic and thinner (called vulvovaginal atrophy). Tissues can also become inflamed and irritated because production of estrogen is decreased (called atrophic vaginitis). Both of these changes can cause pain during sexual activity that involves penetration.

• Vaginal secretions are reduced, providing less lubrication during sexual intercourse.

• The acidity of the vagina decreases, making the genitals more likely to become irritated and infected.

• Lack of estrogen may contribute to age-related weakening of muscles and other supportive tissues in the pelvis, sometimes allowing a pelvic organ (bladder, intestine, uterus, or rectum) to protrude into the vagina (called pelvic organ prolapse). As a result, urine may leak involuntarily, causing embarrassment.

• With aging, blood flow to the vagina is reduced, causing it to become shorter, narrower, and drier. Blood vessel disorders (such as atherosclerosis) can reduce blood flow even more.

Less and less testosterone is produced starting when women are in their 30s, and testosterone production stops by about age 70. Whether this decrease leads to decreased sexual interest and response is unclear.

Other problems may interfere with sexual function. For example, older women may be distressed by changes in their body caused by medical conditions, surgery, or aging itself. They may have cultural views that sexual desire and fantasy are improper or shameful at an older age. They may be worried about the general health or sexual function of their partner.

Many older women are interested in sex. Older women should not assume that sexual dysfunction is normal for older age. If sexual dysfunction is bothering them, they should talk to their doctor. In many cases, treating a health condition (including depression), stopping or substituting a medication, learning more about sexual function, or talking to a health care professional or counselor can help.

Vaginal dryness or painful sex due to menopause can be treated with vaginal hormone therapy, including low-dose estrogen (as a cream, tablet, or ring) or dehydroepiandrosterone (DHEA, as a suppository). Estrogen may be taken by mouth or applied to the skin in a patch or gel, but these forms of estrogen affect the whole body and are usually only used if a woman also has other symptoms of menopause (such as hot flashes) and are usually not given to women older than 60 years. Estrogen has potential risks (including blood clots and a slightly increased risk of breast cancer) as well as benefits, so women should talk to their doctor about its risks and benefits before starting to take it.