The Impact Of Aging - Understanding Sexuality: Womens Sexual Health
Content provided by the Faculty of the Harvard Medical School
The impact of aging
Advancing years leave their mark on the body, mind, and emotions. Some of these changes are for the better, while others are less desirable. Sex is no exception. Many of the physical changes that come with age have noticeable effects on the sex organs and the sexual cycle (see Table 1). Thus, the careful lovemaking of a 70-something couple may bear little resemblance to the lusty pairings of 20-year-olds. This isn't necessarily a bad thing. Greater experience, fewer inhibitions, and a deeper understanding of your needs and those of your partner can more than compensate for the consequences of aging, such as slower arousal, softer erections, reduced vaginal lubrication, and less intense orgasms. And these physical changes can provide an impetus for developing a new and satisfying style of lovemaking — one that's based more on extended foreplay and less on intercourse and orgasm.
Table 1: Possible age-related sexual changes in women and men | ||
|
| Women | Men |
| Physical changes | Decreased blood flow to the genitals. Lower levels of estrogen and testosterone. Thinning of the vaginal lining. Loss of vaginal elasticity and muscle tone. | Decreased testosterone. Reduced blood flow to the penis. Less sensitivity in the penis. |
| Desire | Decreased libido. Fewer sexual thoughts and fantasies. | Decreased libido. Fewer sexual thoughts and fantasies. |
| Arousal | Slower arousal. Reduced vaginal lubrication and less expansion of the vagina during arousal. Less blood congestion in the clitoris and lower vagina. Diminished clitoral sensitivity. | Greater difficulty achieving an erection, maintaining an erection, or both. Erections aren't as rigid. |
| Orgasm | Delayed or absent orgasm. Less intense orgasms. Fewer and sometimes painful uterine contractions. | Longer time required to reach orgasm. Smaller volume of semen and less forceful ejaculation. Less intense orgasms. |
| Resolution | Body returns more rapidly to an unaroused state. | Body returns more rapidly to an unaroused state. More time is needed between erections. |
The role of menopause
While midlife brings many changes for women, menopause is clearly a physical milestone. Menopause and the preceding months or years (known as perimenopause) are marked by hormonal fluctuations, which can provoke a host of symptoms from insomnia and irritability to dry skin and a thicker midriff (see Table 2). Many of these effects — vaginal changes and loss of libido, in particular — can wreak havoc on a woman's sex life.
Fortunately, women don't have to be at the mercy of their hormones. Vaginal lubricants, lifestyle changes, or hormone supplements may help alleviate many of these problems.
Table 2: The rise and fall of women's sex hormones | |||
|
| Estrogen | Progesterone | Testosterone |
| What is the function of this hormone? | The "female" hormone, estrogen causes the uterine lining to thicken during the menstrual cycle. It stimulates the growth of breast tissue and maintains blood flow to the vagina. It has many other effects, including maintaining bone density, increasing HDL ("good") cholesterol, and keeping the skin and vaginal lining elastic. | Progesterone prepares the lining of the uterus for implantation of a fertilized egg and helps maintain early pregnancy. It causes the uterine lining to shed if pregnancy doesn't take place. | Commonly known as the "male" hormone, testosterone is also important to women's sexual health. It plays a key role in the production of estrogen in the woman, is responsible for libido, and helps maintain bone density and muscle mass. Testosterone receptors in the brain, nipples, clitoris, and skin cause these areas to be sensitive to sexual stimulation. |
| How do perimenopause and menopause affect this hormone? | During perimenopause, levels fluctuate and become unpredictable. Lower overall estrogen levels lead the body to overcompensate with surges of excess estrogen to stimulate ovulation. Eventually, estrogen production stops completely. | Progesterone production ceases when ovulation stops. | Testosterone production peaks in a woman's 20s, then declines gradually. By menopause, the level is at half of its peak. The ovaries continue to make testosterone even after estrogen production stops. |
| What symptoms may occur as a result? | Estrogen overproduction: bloating, breast tenderness. Estrogen withdrawal: hot flashes, night sweats, palpitations, headaches, insomnia, fatigue, bone loss, vaginal dryness. | Lack of progesterone: periods may become irregular, longer, or heavier during perimenopause. | Testosterone decline: decreased libido and arousal, mood changes, less energy, vaginal dryness, decreased muscle mass. |
Is there a male menopause?
The answer is both yes and no. In the strictest sense, men don't normally experience the precipitous drop in reproductive hormones that marks a woman's midlife. Although testosterone — the hormone responsible for a man's libido and fertility as well as his deep voice and facial hair — does taper off as a man ages, the process happens gradually. After about age 25, the level of testosterone in the blood diminishes by an average of 1% each year. But this fact means little in itself because actual levels can fluctuate dramatically from person to person. It's not impossible for a man in his 70s to be able to father a child.
That said, men may notice changes in their sex lives after they reach their 50s. Erections may require more direct stimulation, the need to ejaculate is less urgent, and the rest period between ejaculations grows longer. However, none of these effects need interfere with a satisfying sex life, provided the man and his partner understand these changes and integrate them into their lovemaking. A couple may find that less penile sensitivity means that the man may be able to enjoy a wider range of erotic sensations and maintain his erection longer. And his experience may pay off in improved sexual technique and a better understanding of what will please his partner.
An exception to the typical pattern of declining testosterone levels is a disorder called hypogonadism, which can strike at any age. In this condition, the testes don't produce enough testosterone to maintain normal male functions and characteristics. While it's clear that supplementing testosterone is an effective treatment for hypogonadism, it's not apparent whether men without hypogonadism benefit from artificially boosting testosterone to the levels of their youth. In addition, testosterone supplementation carries certain risks: It may promote prostate cancer and other prostate abnormalities, cardiovascular disease, and sleep problems.
Aging and erectile dysfunction
Although erectile dysfunction becomes more common with age, it is not an inevitable part of growing older. It's true that over the years, testosterone levels decline, and often other changes occur: Penile tissue becomes less elastic, blood flow diminishes, and nerve communication slows. But these aren't the only possible causes of erectile dysfunction. Often, erectile problems stem from illnesses that become more prevalent with age or the medications used to treat these illnesses. Many of these conditions can be prevented with good health habits such as following a healthy diet, exercising regularly, maintaining normal weight, and not smoking.
| Last updated: | January 23, 2007 |
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Medical content reviewed by the Faculty of the Harvard Medical School. Harvard Health Publications, Copyright © 2007 by President and Fellows of Harvard College. All rights reserved. Used with permission of StayWell.
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