Sexual Health

We need to define for ourselves just what we mean by sexual health. It can be defined subjectively as simply a feeling of satisfaction with our sexuality. Sexual dysfunction, however, has been medically defined. In the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, IV (the main source of information for mental disorders in the USA) sexual dysfunction includes lack of sexual desire, lack of response to sexual stimulation, an inability to reach orgasm, and pain during intercourse.

Proponents of the medical perspective of menopause identify sexual dysfunction as a "symptom" of menopause and hormones as a treatment for this "dysfunction". Research, however, does not support the notion that sexual dysfunction increases for women during midlife. In fact, data from The National Health and Social Life Survey (NHSLS) (1), the most comprehensive examination of sexual behavior among U. S. adults, found that sexual problems were actually highest among the youngest women studied (aged 18 to 29). Midlife women, aged 50 to 59 (the oldest women studied) reported the least amount of problems. A comparison of the results for the two groups (younger, older) is as follows: physical pain with intercourse (21%, 8%); sex was not pleasureful (27%, 17%); sexual anxiety (16%, 6%). The only "problem" midlife women reported more often than younger women was less lubrication, something that can be easily remedied just by using an over-the-counter lubricant.

On the other hand, the data from this study for men showed that increasing age was indeed associated with an increase in reported sexual problems. Midlife men (aged 50 to 59) were more than 3 times as likely to experience erection problems and to report low sexual desire in comparison with men aged 18 to 29.

Data on sexual functioning in both women and men must be interpreted with caution, however. For example, an earlier study of men, reported in the American Journal of Psychiatry (2), also found a consistent decrease with age in sexual desire, sexual arousal, and sexual activity. Nevertheless the men in this study, all in a stable and committed relationship, reported no change in enjoyment and sexual satisfaction with age. If sexual health is subjectively defined as satisfaction, the sexual health of men in this study did not decrease with age.

Midlife and older women are encouraged to take estrogen to "improve sexual functioning". Taking estrogen, however, may actually decrease our sexual desire by inducing a relative testosterone deficiency. To offset this adverse effect of estrogen, some physicians are advising women to take testosterone, another hormone with potentially serious adverse effects, to increase sexual desire.

A woman knows that the quality of her relationship is the most important factor determining her sexual desire and pleasure, and that this is something that cannot be "fixed" by hormones. We need to define for ourselves what sexual health is, and what we find personally satisfying. Women need to question the medicalization of our sexuality.

More information on sexual health can be found in Strategies to maintain our health.


(1) Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: Prevalence and predictors. JAMA 1999; 281: 537-44.

(2) Schiavi, RC, Schreiner-Engel P, Mandeli J, Schanzer H, Cohen E. Healthy aging and male sexual function. American Journal of Psychiatry 1990; 147: 766-771.