Abstract
Women experience multiple changes in social and reproductive statuses across the life span which can affect sexual functioning. Various phases of the sexual response cycle may be impacted and can lead to sexual dysfunction. Screening for sexual problems and consideration of contributing factors such as neurobiology, reproductive life events, medical problems, medication use, and depression can help guide appropriate treatment and thereby improve the sexual functioning and quality of life of affected women. Treatment options include psychotropic medications, hormone therapy, and psychotherapy.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance
McCabe M, Althof SE, Assalian P, Chevret-Measson M, Leiblum SR, Simonelli C, et al. Psychological and interpersonal dimensions of sexual function and dysfunction. J Sex Med. 2010;7:327–36.
Basson R. Women’s sexual dysfunction: revised and expanded definitions. CMAJ. 2005;172(10):1327–33.
Edwards WM, Coleman E. Defining sexual health: a descriptive overview. Arch Sex Behav. 2004;33(3):189–95.
Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA. 1999;281:537–44.
Clayton AH. Epidemiology and neurobiology of female sexual dysfunction. J Sex Med. 2007;4:260–8.
Pfaus JG. Neurobiology of sexual behavior. Curr Opin Neurobiol. 1999;9(6):751–8.
Stovall DS, Scriver JL, Clayton AH, Williams CD, Pastore LM. Sexual function in women with polycystic ovary syndrome. J Sex Med. 2012;9(1):224–30.
Wahlin-Jacobsen S, Pedersen AT, Kristensen E, Laessoe NC, Lundqvist M, Cohen AS, et al. Is there a correlation between androgens and sexual desire in women? J Sex Med. 2015;12:358–73. Changes in androgen levels are an important consideration in women, particularly the decline that occurs with aging. Total and free testosterone, androstenedione, DHEAS declined significantly with age in premenopausal women and free testosterone and androstenedione levels were correlated with sexual desire. Traditional androgens assays may not be accurate in detection of lower levels of androgens in women, alternative measurement approaches are discussed.
Clayton AH, Clavet GJ, McGarvey EL, Warnock JK, Weihs K. Assessment of sexual functioning during the menstrual cycle. J Sex Marital Ther. 1999;25(4):281–91.
Burri A, Greven C, Leupin M, Spector T, Rahman Q. A multivariate twin study of female sexual dysfunction. J Sex Med. 2012;9:2671–81.
Bly M, Bishop J, Thomas K, Ellingrod V. P-glycoprotein (PGP) polymorphisms and sexual dysfunction in female patients with depression and SSRI-associated sexual side effects. J Sex Marital Ther. 2013;39(3):280–8.
Bishop J, Moline J, Ellingrod V, Schultz S, Clayton A. Serotonin 2A–1438 G/A and G-protein Beta3 subunit C825T polymorphisms in patients with depression and SSRI-associated sexual side-effects. Neuropsychopharmacology. 2006;31(10):2281–8.
Perlis R, Laje G, Smoller J, Fava M, Rush J, McMahon F. Genetic and clinical predictors of sexual dysfunction in citalopram-treated depressed patients. Neuropsychopharmacology. 2009;34:1819–28.
Abler B, Seeringer A, Hartmann A, Gron G, Metzger C, Walter M, et al. Neural correlates of antidepressant-related sexual dysfunction: a placebo-controlled fMRI study on healthy males under subchronic paroxetine and bupropion. Neuropsychopharmacology. 2011;36:1837–47.
Metzger C, Walter M, Graf H, Abler B. SSRI-related modulation of sexual functioning is predicted by pre-treatment resting state functional connectivity in healthy men. Arch Sex Behav. 2013;42:925–47.
Halpern CT, Udry JR, Suchindran C. Testosterone predicts initiation of coitus in adolescent females. Psychosom Med. 1997;59(2):161–71.
McCoy NL, Matyas JR. Oral contraceptives and sexuality in university women. Arch Sexual Behav. 1996;25(1):73–90.
Safarinejad MR, Kolahi AA, Hosseini L. The effect of the mode of delivery on the quality of life, sexual function, and sexual satisfaction in primiparous women and their husbands. J Sex Med. 2009;6:1645–67.
Fehniger JF, Brown JS, Creasman JM, Van Den Eeden SK, Thom DH, Subak LL, et al. Childbirth and female sexual function later in life. Obstet Gynecol. 2013;122:988–97. This study of 1,094 women over 40 years of age describes the sequelae of childbirth that impacts on sexual functioning in this population. While vaginal delivery, perineal trauma, episiotomy have been associated with short-term sexual dysfunction, childbirth factors such as vaginal delivery, perineal trauma, episiotomy, spinal anesthesia, post-term delivery, and macrosomia were not major predictors of long-term sexual dysfunction. Demographic, psychosocial, and health issues were more important associations for long-term sexual functioning than childbirth issues.
Leeman LM, Rogers RG. Sex after childbirth: postpartum sexual function. Obstet Gynecol. 2012;119:647–55.
Freeman EW, Sammel MD, Liu L, Gracia CR, Nelson DB, Hollander L. Hormones and menopausal status as predictors of depression in women in transition to menopause. Arch Gen Psychiatry. 2004;61:62–70.
Cohen LS, Soares CN, Joffe H. Diagnosis and management of mood disorders during the menopausal transition. Am J Med. 2005;118(Suppl 12B):93–7.
Prarie BA, Wisniewski SR, Luther J, Hess R, Thurston RC, Wisner KL, et al. Symptoms of depressed mood, disturbed sleep, and sexual problems in midlife women: cross-sectional data from the Study of Women’s Health Across the Nation. J Women's Health. 2015;24(2):119–26. Data from the SWAN study that show 5 % of perimenopausal women studied have the symptoms of depressed mood, sleep disturbance, and sexual problems. Women with this triad of symptoms were more often in stages of the perimenopause that have more prolonged periods of hypogonadism: the late perimenopause and onset of abrupt hypogonadism as in surgical menopause.
Kingsberg SA. Postmenopausal sexual functioning: a case study. Int J Fertil Menopausal Stud. 1998;43(2):122–8.
Chiechi LM, Granieri M, Lobascio A, Ferreri R, Loizzi P. Sexuality in the climacterium. Clin Experimental Ob Gyn. 1997;24(3):158–9.
Chen C-Y, Lee C-P, Chen Y, Jiang J-R, Chu C-L, Chen C-L. The correlation between emotional distress and aging males’ symptoms at a psychiatric outpatient clinic: sexual dysfunction as a distinguishing characteristic between andropause and anxiety/depression in aging men. Clin Interv Aging. 2013;8:635–40.
Meston CM. Aging and sexuality. West J Med. 1997;167(4):285–90.
Wang V, Depp CA, Ceglowski J, Thompson W, Rock D, Jeste D. Sexual health and function in later life: a population-based study of 606 older adults with a partner. Am J Geriatr Psychiatry. 2015;23(3):227–33.
Diagnostic and statistical manual of mental disorders fourth edition. Washington, DC: American Psychiatric Association; 2000.
Diagnostic and statistical manual of mental disorders fifth edition DSM-5TM. Arlington: American Psychiatric Association; 2013.
Shifren JL, Monz BU, Russo PA, Segreti A, Johannes CB. Sexual problems and distress in United States women: prevalence and correlates. Obstet Gynecol. 2008;112(5):970–8.
Johannes CB, Clayton AH, Odom DM, Rosen RC, Russo PA, Shifren JL, et al. Distressing sexual problems in United States women revisited: prevalence after accounting for depression. J Clin Psychiatry. 2009;70(12):1698–706.
Atlantis E, Sullivan T. Bidirectional association between depression and SD: a systematic review and meta-analysis. J Sex Med. 2012;9:1497–507.
Clayton AH, Kennedy SH, Edwards JB, Gallipoli S, Reed CR. The effect of vilazodone on sexual function during the treatment of major depressive disorder. J Sex Med. 2013;10(10):2465–74.
Jacobsen PL, Mahableshwarkar AR, Palo WA, Chen Y, Dragheim M, and Clayton AH. Treatment-emergent sexual dysfunction in randomized trials of vortioxetine for major depressive disorder or generalized anxiety disorder: a pooled analysis. CNS Spectrums. In press.
Jacobsen PL, Mahableshwarkar AR, Chen Y, Chrones L, and Clayton AH. The effect of vortioxetine versus escitalopram on sexual functioning in adults with well-treated major depressive disorder experiencing SSRI-induced sexual dysfunction. J Sex Med. In press.
US Food and Drug Administration. FDA briefing document: joint meeting of the Bone, Reproductive and Urologic Drugs Advisory Committee (BRUDAC) and the Drug Safety and Risk Management (DSaRM) Advisory Committee.http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/DrugSafetyandRiskManagementAdvisoryCommittee/UCM449088.pdf. Accessed August 2, 2015.
Pluchino N, Carmignani A, Cubeddu A, Santoro A, Cela V, Errasti T. Androgen therapy in women: for whom and when. Arch Gynecol Obstet. 2013;288(4):731–7.
Davis SR, Moreau M, Kroll R, Bouchard C, Panay N, Gass M. Testosterone for low libido in postmenopausal women not taking estrogen. N Engl J Med. 2008;359:2005–17.
Panay N, Al-Azzawi F, Bouchard C, Davis SR, Eden J, Lodhi I. Testosterone treatment of HSDD in naturally menopausal women: the ADORE study. Climacteric. 2010;13:121–31.
Braunstein GD, Sundwall DA, Katz M, Shifren JL, Buster JE, Simon JA. Safety and efficacy of a testosterone patch for the treatment of hypoactive sexual desire disorder in surgically menopausal women: a randomized, placebo-controlled trial. Arch Intern Med. 2005;165:1582–9.
Goldstat R, Briganti E, Tran J, Wolfe R, Davis S. Transdermal testosterone therapy improves well-being, mood, and sexual function in premenopausal women. Menopause. 2003;10(5):390–8.
Sherwin BB, Gefland MM, Brender W. Androgen enhances sexual motivation in females: a prospective, crossover study of sex steroid administration in the surgical menopause. Psychosom Med. 1985;47:339–51.
Woodis CB, McLendon AN, Muzyk AJ. Testosterone supplementation for hypoactive sexual desire disorder in women. Pharmacotherapy. 2012;32(1):38–52.
Shifren JL, Davis SR, Dennerstein L, Heiman JR, Lobo RA, Simon JA. The role of testosterone therapy in postmenopausal women: position statement of the North American Menopause Society. Menopause. 2005;12:497–511.
Wierman ME, Basson R, Davis SR, Khosla S, Miller KK, Rosner W. Androgen therapy in women: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2006;91:3696–710.
Wylie K, Rees M, Hackett G, Anderson R, Bouloux PM, Cust M. Androgens, health and sexuality in women and men. Maturitas. 2010;67:275–89.
Writing group for the Women’s Health Initiative investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA. 2002;288(3):321–33.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Veronica Harsh declares that she has no conflict of interest.
Anita H. Clayton reports grants from BioSante Pharmaceuticals Inc., and Repligen Corporation. Dr. Clayton also reports personal fees and grants from Boehringer-Ingelheim, BristolMyersSquibb, Eli Lilly and Company, Forest Research Institute Inc., Palatin Technologies Inc., Sanofi-Aventis, Takeda Global Research and Development, and Trimel Pharmaceuticals. She also reports personal fees from Astra-Zeneca, Euthymics, Lundbeck, S1Biopharmaceuticals Inc., Sprout Pharmaceuticals, Arbor Scientia, Euthymics, Naurex, Otsuka, and Roche.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
This article is part of the Topical Collection on Women’s Mental Health
Rights and permissions
About this article
Cite this article
Clayton, A.H., Harsh, V. Sexual Function Across Aging. Curr Psychiatry Rep 18, 28 (2016). https://doi.org/10.1007/s11920-016-0661-x
Published:
DOI: https://doi.org/10.1007/s11920-016-0661-x