Table: Spotlight on Aging: Sexual Dysfunction in Older Women

Spotlight on Aging: Sexual Dysfunction in Older Women

The main 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, disorders that can interfere with sexual function, such as diabetes Diabetes Mellitus (DM) Diabetes mellitus is a disorder in which the body does not produce enough or respond normally to insulin, causing blood sugar (glucose) levels to be abnormally high. Urination and thirst are... read more , atherosclerosis Atherosclerosis Atherosclerosis is a condition in which patchy deposits of fatty material (atheromas or atherosclerotic plaques) develop in the walls of medium-sized and large arteries, leading to reduced or... read more , urinary tract infections Overview of Urinary Tract Infections (UTIs) In healthy people, urine in the bladder is sterile—no bacteria or other infectious organisms are present. The tube that carries urine from the bladder out of the body (urethra) contains no bacteria... read more , and arthritis Osteoarthritis (OA) Osteoarthritis is a chronic disorder that causes damage to the cartilage and surrounding tissues and is characterized by pain, stiffness, and loss of function. Arthritis due to damage of joint... read more , 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.

As women age, 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.
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.
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 Pelvic Organ Prolapse (POP) Pelvic organ prolapse involves relaxation or weakening of the ligaments, connective tissue, and muscles of the pelvis, causing the bladder, urethra, small intestine, rectum, or uterus to bulge... read more ). 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 Atherosclerosis Atherosclerosis is a condition in which patchy deposits of fatty material (atheromas or atherosclerotic plaques) develop in the walls of medium-sized and large arteries, leading to reduced or... read more ) can reduce blood flow even more.

Other problems may interfere with sexual function. For example, older women may be distressed by changes in their body caused by disorders, surgery, or aging itself. They may think 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 or their own sexual performance. Many older women are interested in sex, but if their partner no longer responds to them, their interest may be slowly extinguished.

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 disorder (including depression), stopping or substituting a drug, learning more about sexual function, or talking to a health care practitioner or counselor can help.

If vulvovaginal atrophy and/or atrophic vaginitis is a problem, estrogen or testosterone can be inserted into the vagina as a cream (with a plastic applicator), as a tablet, or in a ring (similar to a diaphragm). Estrogen may be taken by mouth or applied in a patch or gel to an arm or a leg but only if menopause has just started or has lasted only a few years. These forms of estrogen affect the whole body and can thus help improve mood, lessen hot flashes and related sleep problems, keep the vagina healthy, and maintain adequate lubrication for sexual intercourse. Estrogen patches or gels are preferred over pills taken by mouth for postmenopausal women. If women have a uterus, they are also given a progestogen (a version of the hormone progesterone) because taking estrogen alone increases risk of cancer of the lining of the uterus Cancer of the Uterus The most common type of cancer of the uterus develops in the lining of the uterus (endometrium) and is called endometrial cancer. Endometrial cancer usually affects women after menopause. It... read more (endometrial cancer). Estrogen has potential risks (including 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.

Occasionally, testosterone to be taken by mouth is prescribed in addition to estrogen therapy if all other measures are ineffective, but prescribing this combination is not recommended. It is still considered experimental and long-term safety is unknown.