Merck Manual

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Spotlight on Aging: Sexual Dysfunction in Older Women

Spotlight on Aging: Sexual Dysfunction in Older Women

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

As women age, less estrogen is produced.

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 Cancer of the Uterus (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.