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Medical Conditions That Can Affect Sexual Function
Arthritis Painful joints can inhibit sexual activity and the partner may be concerned about causing pain. Arthritis also limits mobility and thus can have an effect on the forms of sexual expression. A woman's membranes may be dry with some forms of arthritis, resulting in a lack of vaginal lubrication. Sexual comfort can be enhanced by using positions that avoid prolonged pressure on affected joints, using vaginal lubricants, and taking pain medication and applying heat to joints before having sex.	Kidney Disease Complications of kidney disorders can cause loss of sex drive and, in men, impotence. The effects are related to hormone imbalances often associated with this condition as well as nerve damage and other medical problems that are often present. In women, careful attention should be given to possible vaginal infections that could cause discomfort during sexual activity.
Cardiovascular Disease People with a heart condition may have pain with exercise and lack circulation to the extremities. Although sexual activity may be physically and emotionally stressful, it rarely leads to severe complications in patients with a cardiac disease. The amount of energy expended during normal sexual activity is about the same as climbing a single flight of steps. A person's ability to tolerate exercise can be tested to determine the safety of sexual activity.	Spinal Cord Injury Any damage to the spinal cord can interfere with sexual function, depending on the location of the injury. It can cause paralysis and loss of sensation, resulting in lack of lubrication in women and impotence in men. Both women and men can often continue to have orgasms, however. With special preparation and devices, women and men with spinal cord injuries can maintain sexual activity.
Diabetes Nerve damage, which occurs with diabetes, can lead to difficulty having orgasms in women and impotence in men. In women, this can result in less vaginal lubrication and contraction of the uterus during orgasm. In men, the problem is compounded by lack of blood circulation and hypertension, which also contribute to impotence. Control of diabetes may result in an improvement in sexual function.	Stroke A blockage in the vessels that supply blood to the brain can result in paralysis of part of the body, muscle weakness, and less ability to move around. This can have an effect on sexual activity. Because the nerves are usually not damaged, however, sex is possible with some adjustments.
Epilepsy Epilepsy causes an electrical "short circuit" in the messages sent by nerves to the brain. It can result in loss of sex drive, decreased sexual responsiveness, and partial or complete impotence.	Thyroid Disease Any hormone imbalance can affect sexuality. In thyroid disease, changes in hormone levels can cause menstrual problems in women, impotence in men, and loss of sex drive in both. The decrease in energy and other complications can also be a factor. Sexual problems caused by the disease go away when it is treated.

Menopause
During menopause, a woman's ovaries stop producing the hormone estrogen. This can lead to changes that affect her sexual function. The main change is vaginal dryness. Lack of vaginal lubrication can make sex painful. Low levels of estrogen may also cause the walls of the vagina to thin and be more prone to sexual discomfort and injury. This can be corrected through estrogen-replacement therapy. The hormone is taken as a pill or absorbed through a patch. Locally applied vaginal cream can also be used.

Women do not lose their sexual drive during or after menopause. Most women continue to enjoy a sexually fulfilling life throughout their later years. Factors that could interfere with this include health and relationship problems, availability of partners, and emotional concerns that may accompany menopause.

The nature of a woman's sexual activity may change as she ages. She may take longer to become aroused and may need more stimulation to have an orgasm. Some older women have fewer vaginal contractions during orgasm. Older men may have difficulty getting or keeping an erection. As their sexual needs change with age, couples may move their focus away from the traditional genital-focused approach to other forms of sexual pleasure. These may include manual stimulation, oral-genital stimulation, and rubbing the external genitals against each other. For many couples, although the physical form of their lovemaking may change, the intensity, satisfaction and frequency remain unchanged.

Physiologic Changes of Menopause

Skin
Decreased activity of sweat and sebaceous glands, decreased tactile stimulation

Breasts
Decreased fat content, decreased breast swelling and nipple erectile response with sexual arousal

Vagina
Shortening and loss of elasticity of vaginal barrel, diminished physiologic secretions, rise in vaginal pH from 3.5 to 4.5 to greater than 5, thinning of epithelial layers

Internal reproductive organs
Ovaries and fallopian tubes diminish in size, ovarian follicles undergo atresia, ovarian stroma becomes fibrotic, uterine body weight decreases 30 to 50 percent, cervix atrophies and decreases mucous production

Bladder
Urethra and bladder trigone atrophy

Older couples who are not comfortable with creative diverse experiences of sexual behavior may find their sexual activity limited. At some point, couples may be content to stop having sex. If both partners are comfortable with this situation, it does not have a negative effect on their relationship.

Cancer
Cancer and its treatment can affect a woman's sexuality. In addition to the anxiety produced by the diagnosis, a woman may have concerns about its effect on her future sexual capability. Cancer can also affect a woman's appearance and self-esteem, particularly if it involves loss of an organ. Emotionally, a woman is faced with the possibility of death, disfigurement, and the possible rejection by her partner, and physically, she must confront the rigors of surgery, radiation, and chemotherapy.

Psychosocial Factors
At the same time, there is no denying the role played by psychology. In women, despite the presence or absence of organic disease, emotional and relational issues significantly effect sexual arousal.