Older women report similar sexual problems as those in midlife but less distress

Older women report similar sexual problems as those in midlife but less distress | Image Credit: © InsideCreativeHouse - stock.adobe.com.

A new cross-sectional study published in Menopause, the journal of The Menopause Society, found that sexually active women aged 65 years and older experience female sexual dysfunction (FSD) at rates comparable to women aged 50 to 64 years but report less distress related to these problems.^1,2

Researchers analyzed data from 3,465 sexually active women who presented to Mayo Clinic women’s health clinics between May 2015 and August 2022 for menopause or sexual health concerns. Of these, 2,911 were aged 50 to 64 years and 554 were aged 65 years and older. Participants completed the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale–Revised (FSDS-R) and reported specific sexual health concerns.

Prevalence and types of sexual health concerns

Rates of vaginal dryness, painful intercourse, and arousal or orgasm difficulties were similar between older and midlife women. Vaginal dryness was the most frequently reported concern, affecting about half of women in each age group. Older women were less likely to report loss of sexual desire (33.4% vs 47.6%, P<.001) and reduced genital sensation (13.0% vs 16.9%, P=.02) but more likely to report genital pain (8.1% vs 5.8%, P=.04).

Median total FSFI scores were similar between groups (21.2 in older women vs 22.2 in midlife women; P=.11), and more than 70% in both groups had scores consistent with sexual problems. The prevalence of FSD—defined as an FSFI score ≤26.55 combined with an FSDS-R score ≥11—was 51.8% in older women and 56.2% in midlife women (P=.06).

However, FSDS-R scores indicated that older women reported significantly less distress related to sexual problems (median score, 13.0 vs 15.0; P=.02). A smaller proportion of older women had clinically significant sexual distress compared with midlife women (57.0% vs 61.9%, P=.03).

Possible explanations for lower distress

The authors suggested that lower distress among older women could reflect greater acceptance of age-related changes or lower expectations regarding sexual function. These findings align with previous research indicating that aging is often associated with greater emotional resilience, life satisfaction, and stability.

Despite less distress, the authors emphasized that sexual health concerns remain clinically important in older women. "This study showed that, despite older women reporting sexual dysfunction at similar rates as their midlife female counterparts, they reported less distress about their sexual problems. It is important to address sexual health concerns at any age, and this study highlights the need to continue screening for and managing sexual health concerns throughout a woman’s entire lifespan," said Stephanie Faubion, MD, MBA, medical director for The Menopause Society and one of the study’s authors.

Potential barriers to care

The study noted that sexual health in older women remains understudied and undertreated. Factors contributing to underrecognition include social stigma surrounding sexuality in aging, misconceptions about the inevitability of sexual decline, and discomfort among patients and clinicians in discussing sexual concerns. Lack of awareness about effective treatments, such as local vaginal hormone therapy, may also play a role.

Clinician-related barriers include limited training in sexual health, personal discomfort with the topic, and assumptions that sexual function is less relevant after the reproductive years. The authors stressed that sexual function has been linked to overall quality of life and health-related quality of life in midlife and older women, underscoring the importance of screening for FSD in all patients regardless of age.

Study limitations

Limitations included the study population’s demographic homogeneity—predominantly White, educated, partnered women with access to specialized care—and the higher rate of hormone therapy use compared with the general population, which may limit generalizability. The FSFI’s validation in only sexually active women within the past 4 weeks may have excluded women who were sexually inactive due to dysfunction.

Conclusion

The findings demonstrate that older women remain sexually active and experience sexual health concerns at rates similar to those of midlife women, though with lower associated distress. The authors concluded that improving clinician training, addressing cultural stigma, and increasing patient awareness of available treatments could enhance sexual health outcomes and quality of life for older women.

References:

1. Karam J, Shufelt C, Kingsberg S, et al. Understanding the sexual concerns of older women presenting for care to women’s health clinics: a cross-sectional study. Menopause. August 12, 2025. doi:10.1097/GME.0000000000002617
2. The Menopause Society. Concerns about sexual function persist well beyond midlife. Eurekalert. August 13, 2025. Accessed August 13, 2025. https://www.eurekalert.org/news-releases/1094402