A recent study published in *Menopause*, the journal of The Menopause Society, highlights that sexually active women aged 65 years and older experience female sexual dysfunction (FSD) at rates similar to those of women aged 50 to 64 but report notably less distress regarding these issues.1,2
The cross-sectional study involved 3,465 sexually active women visiting Mayo Clinic women’s health clinics between May 2015 and August 2022 for menopause or sexual health concerns. Among these participants, 2,911 were aged 50 to 64, while 554 were aged 65 and older. They completed the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale–Revised (FSDS-R), detailing their specific sexual health issues.
Understanding Sexual Health Issues Across Age Groups
The findings revealed comparable rates of common sexual health concerns—such as vaginal dryness, painful intercourse, and difficulties with arousal or orgasm—between the older and midlife groups. Vaginal dryness emerged as the most prevalent concern, affecting about half of women in each demographic. Although older women were less likely to report a loss of sexual desire (33.4% vs. 47.6%, P < .001) and reduced genital sensation (13.0% vs. 16.9%, P = .02), they did report a higher incidence of genital pain (8.1% vs. 5.8%, P = .04).
The median total FSFI scores were nearly identical in both groups (21.2 for older women compared to 22.2 for midlife women; P = .11), with over 70% exhibiting scores indicative of sexual problems. The prevalence rates of FSD were recorded at 51.8% for older women and 56.2% for midlife women (P = .06).
Notably, the FSDS-R scores signified that older women experienced significantly lower distress related to sexual issues (median score, 13.0 vs. 15.0; P = .02), with fewer older women reporting clinically significant sexual distress compared to their midlife counterparts (57.0% vs. 61.9%, P = .03).
Why Lower Distress in Older Women?
The authors of the study propose that the observed lower levels of distress among older women may stem from a greater acceptance of age-related sexual changes and reduced expectations surrounding sexual performance. This observation aligns with earlier research supporting the notion that aging often brings emotional resilience, enhanced life satisfaction, and stability.
While older women reported lower distress, the significance of sexual health concerns cannot be overlooked. “This study demonstrated that, despite older women experiencing sexual dysfunction at rates similar to younger women, they reported less distress,” remarked Dr. Stephanie Faubion, medical director for The Menopause Society and co-author of the study. “Addressing sexual health concerns is critical at any age, highlighting the necessity of consistent screening and management throughout a woman’s life.”
Challenges in Addressing Sexual Health
The research underscores that sexual health among older women remains both understudied and undertreated. Several factors contribute to this oversight, including social stigma surrounding sexuality and aging, misconceptions regarding the inevitability of sexual decline, and both patient and clinician discomfort in discussing sexual issues. Furthermore, awareness of effective treatments, such as local vaginal hormone therapy, often remains limited.
Clinician-related barriers include insufficient training in sexual health, personal discomfort with the subject matter, and assumptions that sexual function is less significant after the reproductive years. The findings emphasize that sexual health has crucial implications for overall quality of life in midlife and older women, underscoring the importance of screening for FSD across all age groups.
Limitations of the Study
While the study provides valuable insights, it is important to recognize several limitations. The participant pool demonstrated demographic homogeneity, primarily involving educated, partnered, and predominantly White women with access to specialized care. Additionally, the heightened prevalence of hormone therapy among these individuals compared to the general population may restrict the applicability of the findings. The FSFI’s validation focused solely on women who were sexually active in the preceding four weeks, potentially excluding those experiencing inactivity due to dysfunction.
Conclusion
This study reinforces the notion that older women maintain sexual activity and experience sexual health issues at rates comparable to midlife women, albeit with lower accompanying distress. The authors advocate for improved clinician training, combating cultural stigma, and fostering greater patient awareness regarding available treatments to enhance sexual health outcomes and overall quality of life for older women.
References:
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
The Menopause Society. Concerns about sexual function persist well beyond midlife. Eurekalert. August 13, 2025. Accessed August 13, 2025.
