This has resulted not only in a substantial growth in the elderly population, but also in an increasing emphasis on the normal aspects of ageing, including issues relating to changing sexuality and overall quality of life. Undoubtedly, sex and sexuality are pleasurable, rewarding and fulfilling experiences that can enhance the later years. They are also enormously complex. Studies of menopausal sexuality have been difficult because of the physiological changes associated with the ageing process and illnesses which are more common at this time of life. Nevertheless, the abrupt gonadal hormone decline associated with the menopause does adversely affect sexual function, regardless of the age at which the menopause occurs.
Sexual dysfunction relating to ovarian hormone decline can have direct or indirect effects.
The direct effects are the results of genital atrophy which may lead to dyspareunia, vaginismus, inadequate lubrication and loss of libido. The indirect effects result from changes of body contour during ageing, resulting in a perceived loss of sexual attractiveness and a poorer self-image. 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.