Regardless of the causes of erectile difficulty, there is always a psychological effect on the male. Men who experience an inability to achieve or sustain an erection on several occasions may be so anxious about inadequacy that a self-defeating process is initiated that causes them to avoid sexual situations and sexual arousal. Other psychological factors, including depression, lowered self-esteem associated with overall loss of physical strength and the onset of physical signs of aging, anxiety, and substance abuse can all contribute to male impotence. The capacity for sexual reproduction begins earlier in females than in males, often two years earlier. However, the commencement of puberty varies among girls and may not begin until age 14 or 15.
Women differ from men in that the decline in sexual responsiveness with aging is quite gradual.
As women age, hormonal production diminishes, the lining of the vaginal wall begins to thin and becomes more rigid, and the production of vaginal lubrication drops. The latter change, in particular, can contribute to discomfort during intercourse, but a woman's capacity to achieve orgasm can remain at near peak levels well into her senior years, even though the length of time needed to achieve orgasm may increase. Women who remain sexually active, in fact, may be less likely to experience a drop in available vaginal lubrication. These changes are quite minimal until menopause - the most dramatic organic change that a woman undergoes as she ages. Menopause usually occurs between 45 and 55 years of age, although it may begin earlier in women who have had a hysterectomy.