Sexuality among older women.

The population of the world is living longer. Currently, the average life expectancy is 78.9 and 72 years of age for women and men, respectively. By the year 2030, it is estimated that elderly people will make up approximately 17% of the total United States population. Our responsibility as physicians is, therefore, very clear. The care of this population must provide an acceptable quality of life and allow elderly people to enjoy living. This is where the question of sexuality plays an important part. Hormonal transition encompasses decreased levels of estrogen and testosterone, the latter being associated with decreased sexual libido, sensitivity, and response. Additional genitourinary effects associated with menopause include atrophic changes in the vagina, vulva, urethra, and neck of the bladder. Vaginal atrophy and diminished vaginal lubrication interfere mechanically with sexual comfort and pleasure. In addition to hormonal changes with aging, disease and associated medications may also negatively affect sexuality. Determining the impact of medications, both alone and in combination with others, on quality of life must be considered when providing comprehensive care for elderly patients.