Aging alone does not diminish female sexual interest or the potential of the woman to be sexually responsive if her general health is good. Specific physiological changes do occur, however, in the sexual response cycle of postmenopausal women. These changes do not appear abruptly or in exactly the same fashion in each woman.Typically, there is little or no increase in breast size accompanying sexual arousal, although breast sensitivity to stimulation continues. The sex flush occurs less often and less extensively than at younger ages, but this change has absolutely no effect on sexual feelings or functioning. Less muscle tension develops during sexual arousal, particularly in the plateau phase, which is not surprising since this corresponds to the usual decrease in muscle size and strength that occurs with aging. This reduced muscular tension may account (at least in part) for the reduced intensity of orgasm that is sometimes experienced by women in late adulthood.While clitoral response is not affected by aging, vaginal function changes in two different ways. First, reduced elasticity in the walls of the vagina leads to less expansion during sexual arousal. Second, vaginal lubrication generally begins more slowly than at younger ages and vaginal dryness may create some problems as the quantities of lubrication are somewhat reduced. This condition can be overcome if it causes discomfort either by estrogen replacement therapy or by the use of an artificial lubricant such as K-Y Jelly.Recent research has shown that the decrease in vaginal lubrication in postmenopausal women is the direct result of diminished vaginal blood flow that, in turn, is caused by low estrogen. In another recent investigation, Leiblum and co-workers found that sexually active postmenopausal women had less shrinkage of the vagina and higher levels of androgens and pituitary gonadotropins (LH and FSH) than sexually inactive women. This suggests that regular sexual activity may provide at least some protection against the physiologic changes of aging in relation to female sexual anatomy.The normal pattern of reproductive aging in men is quite different from women because there is no definite end to male fertility. Although sperm production slows down after age forty, it continues into the eighties and nineties. Similarly, while testosterone production declines gradually from age fifty-five or sixty on, there is usually no major drop in sex hormone levels in men as there is in women.About 5 percent of men over sixty experience a condition called the male climacteric, which resembles the female menopause in some ways. (Using the term “male menopause” to describe the male climacteric is incorrect since men do not have menstrual periods.) This condition is marked by some or all of the following features: weakness, tiredness, poor appetite, decreased sexual desire, reduction or loss of potency, irritability, and impaired ability to concentrate. These changes occur because of low testosterone production, and they can be reversed or improved by testosterone injections. It should be stressed that most men do not have a recognizable climacteric as they age.The physiology of male sexual response is affected by aging in a number of ways. The following changes have been noted in men over fifty-five:It usually takes a longer time and more direct stimulation for the penis to become erect;Erections tend to be less firm, on average, than at earlier ages;The testes elevate only partway up to the perineum, and do so more slowly than in younger men;The amount of semen is reduced, and the intensity of ejaculation is lessened;There is usually less physical need to ejaculate;The refractory period — the time interval after ejaculation when the male is unable to ejaculate again — becomes longer.In addition, the sex flush usually does not occur in aging men, and muscle tension during sexual arousal is reduced, as in women, since muscle mass and strength generally decrease with aging.Although the changes in male sexual physiology described above do not usually occur abruptly or represent an impairment of function, men who are uninformed about these patterns may be frightened into thinking something is wrong with them. In other instances, a man’s partner may be the one to become alarmed. For example, while many men find that they enjoy sex in their later years without ejaculating at every opportunity, partners who don’t realize this may think it reflects poorly on their attractiveness or skill as lovers.Some men have completely unrealistic expectations about what their sex lives should be as they age. While they wouldn’t expect to run a mile as fast at age sixty-five as they did at age twenty-five (or to recuperate from their exertion as quickly), they expect to get rock-hard erections instantly in all sexual situations and are worried when they can’t make love twice in one evening. The aging male, by misinterpreting these changes, is particularly vulnerable to performance anxiety.*101\342\2*
