Influence of menopause on sexuality.

Menopause is associated with anatomical, physiological and psychological changes that often influence sexuality in the aging female. The decreased estrogen levels have a multitude of effects on sexual function, including decreased support of female pelvis, loss of ability to adequately lubricate the urogenital tissue, and changes in body configuration. This situation is aggravated by the alterations in the skin, breasts, muscles and skeleton caused by estrogen loss. For many women, these changes translate into a poorer self-image, diminution of self-esteem and, eventually, a loss of sexual desire. Societal expectations also have a negative impact on sexuality, as most cultures still believe that older women become sexually retired. Although this attitude is changing, cross-sectional studies still show that there are negative sexuality changes associated with menopause and that postmenopausal women note a loss of sexual desire. Age and relationship status are also important correlates of sexual activity and sexual satisfaction. With increasing age, the frequency of most types of sexual activity decreases and sexual dysfunctions increase. Urogenital atrophy due to loss of estrogen is one of the most important contributors to the decline in sexual activity with the menopause. Partner availability and partner function are important contributors as well to the decline of sexual activity, since older men, like older women, often have sexual dysfunctions. Overall, decreased sexual desire and loss of vaginal lubrication in the female and erectile difficulties in the male, or absence of a partner, are commonly reported causes of increasing sexual difficulties for the older female. Hormone replacement therapy not only ameliorates the local anatomic and physiologic changes, but also may have positive psychological benefits.(ABSTRACT TRUNCATED AT 250 WORDS)