Some of these changes include weight gain or obesity, and a generalized decrease in tone, strength and elasticity of tissues. Problems surrounding intimacy are their primary concern, unlike the male who tends to be preoccupied with the physical aspects. Sexuality in the ageing female is not only influenced by physical changes, but also by psychological, emotional and sociocultural factors and how these factors interact to affect the woman's total perception of herself. Physiological changes As previously stated, hormonal and ageing processes affect sexuality. Ovarian hormonal decline at the menopause has direct effects on the external and internal genital organs, most of the changes being the result of a decrease in pelvic blood flow.
Pubic hair decreases, the labia majora atrophy, and the labia minora and clitoris shrink in size.
The vaginal changes are often more marked than the external genital changes. This increases the risk of vaginal infection. The vaginal epithelium also thins, becoming friable, and may easily bleed. The muscular layers may be replaced by fibrous tissue resulting in a loss of elasticity. With all these changes, the vagina becomes vulnerable to mechanical injury, pale, shorter in length and narrower in diameter, and loses its rugosity.