Sexual Dysfunction in Older Women
Key words: Sexual dysfunction, dyspareunia, vaginal dryness, low libido, vaginismus, vaginitis, vaginal prolapse, estrogen deficiency, hormone replacement therapy.
People experience many physiological and physical changes as they age, some of which can have a negative effect on sexual function. In 1999, sexual dysfunction was estimated to affect approximately 40 million women in the United States,1 and the results of the National Health and Social Life Survey revealed that sexual dysfunction is more prevalent in women (43%) than in men (31%) and that its prevalence increases with age.2 As more baby boomers reach retirement age and life expectancy continues to increase, we expect that the percentage of women experiencing sexual dysfunction will also increase.
Although some older women are not troubled by their loss of sexual desire or their ability to engage in sexual activity, others maintain an interest in preserving their ability to maintain a satisfying sex life. In 2009, Huang and colleagues3 reported the results of their cross-sectional cohort study, which examined sexual function among 1977 women (876 white, 347 Hispanic, 351 Asian, and 388 black) aged 45 to 80 years by having them complete self-administered questionnaires. Of these participants, 43% reported moderate sexual desire and 60% had been sexually active within the 3 months preceding their completion of the questionnaire. This study demonstrates that, contrary to popular belief, many women retain an interest in or engage in sexual activity as they age. Therefore, although sexual issues can be an uncomfortable topic of discussion for both patients and healthcare providers, it is important to address such matters by enabling patients to discuss these relatively prevalent problems, enabling the provision of treatment and resources, if desired.
In women, many more factors contribute to sexual dysfunction than in men, and there are fewer targeted treatments. For example, there are no phosphodiesterase-5 inhibitor equivalents for women. Instead, treatments focus on resolving the issue contributing to or causing the sexual dysfunction, such as vaginal dryness or pelvic organ prolapse. In this article, we discuss some of the common physiological, physical, and social factors that may impact sexual health and contribute to sexual dysfunction. We also review some of the available treatment options.
Factors Affecting Women’s Sexual Health
Numerous factors may impact the ability of older women to have a satisfying sex life. Some of the most drastic changes associated with sexual activity and aging are those that accompany menopause. Estrogen, the primary female sex hormone, affects vaginal wall thickness and lubrication, and decreases in estrogen often produce vaginal dryness and can lead to vaginal atrophy. Weight gain or other body changes that commonly occur in postmenopausal women may also lead to feelings of being less desirable, resulting in avoidance of sexual encounters.
In addition, health problems such as heart disease, diabetes, and depression may contribute to a less satisfying sexual experience as women age. Vascular changes and high blood pressure, for example, can affect blood flow to the clitoris, decreasing the ability to become sexually aroused. Depression is also directly correlated with sexual dysfunction in women.4 In addition, the medications commonly used to treat these and other disorders can also negatively affect sexual arousal. Selective serotonin reuptake inhibitors, mood stabilizers, and tranquilizers are just a few of the medications that have been linked to decreased arousal.5
Another consideration is the loss of a partner or a partner’s illness, which can drastically alter relationships and have a negative impact on sexual activity for both partners. One study found that close to 50% of women aged 45 years and older are either widowed or have no partner, making it difficult for these women to engage in sexual relationships.6