Age should not be considered a factor that is responsible for impaired sexual function. In the elderly, certain factors affect sexual desire and sexual potency in men and women more significantly. Of the factors that may affect female and male sexual desire, we include the following [11]:

Sexual activity is influenced by blood levels of specific hormones. Testosterone stimulates sexual desire, but in individuals between 30 and 40 years old, decreased serum testosterone levels are observed. In addition, peak testosterone secretion occurs during only half of the ovarian cycle and does not occur in postmenopausal women. A lack of desire is more common in middle-aged women (45–64 years old) and increases following menopause [13].

Additionally, a progressive decrease in testosterone levels has been associated with decreased sexual activity and power and reduced levels of sexual desire in men. However, hormonal factors do not fully explain the changes that are observed in sexuality with increasing age.

Oestrogens negatively affect desire in men, but in women, they help to maintain trophism and vaginal lubrication. In postmenopausal women, decreased oestrogen levels lead to atrophy and decreased vaginal lubrication. These changes can lead to less pleasurable or painful intercourse in women (dyspareunia), which could adversely affect their motivation and sexual desire.

Organic diseases can affect desire, though they rarely fully prevent sexual activity. However, genitourinary diseases that require surgical treatment or are cancer based have a greater impact on people’s sexual health.

At this age, a frequent consumption of drugs may be responsible for decreased desire, including antihypertensives, antidepressants, opioid analgesics, and drugs used for the treatment of benign prostatic hyperplasia.

Different psychological problems can lead to decreased sexual desire. These include depressive syndrome or anxiety disorders, especially in men. During menopause, changes in mood or sleep disturbances can influence desire in women. Additionally, decreased self-esteem or changes in body images that occur as a result of a disease or its treatment may lead to a deterioration in sexual health.

Relationship problems with partners can lead to decreased libido, especially in women. A bad relationship in and of itself can cause sexual health problems.

Certain stressful life situations, especially the death of a partner, can lead to a permanent abandonment of sexual activity.

In our society, the belief that people do not have sex after a certain age is pervasive. This can unconsciously lead older adults to consider it to be normal to not have sexual relationships, motivation or desire. This myth is negated by studies showing that over 80% of people over 60 years of age continue having sex.

The cultural perception of sexuality in young people as a fiery and intense activity and attempts to enforce the social standards of youth and power could influence the sexual activity of the elderly. They leave no opportunity for a more leisurely and intimate sexuality, which could be the ideal type of sexuality for this population.

Men’s sexual power can be negatively affected by a variety of factors that influence penile erection, including the following:

On the other hand, the physical factors and physiological changes that occur with ageing do not determine the sexual activity of older people because there are other factors that determine this behaviour, including the following:

Treatments for sexual health problems should be adapted to the needs of each patient and must entail a multidisciplinary approach that involves the couple themselves in addition to their physicians, sex therapists, psychiatrists and physiotherapists. Currently, the following different treatment modalities are available that can resolve or alleviate the sexual problems that may arise with age:

In conclusion, even though sex may be constrained by the physical, psychological and social changes that accompany age, this should not disrupt sexual activity. Maturity can be an opportunity for a more intimate or relaxed type of sex. The acceptance of physical changes and a history of good sexual experiences can positively influence the maintenance of sexual health as the years pass. At any age, especially in long-term relationships, a good relationship is the most important factor that influences desire and sexual health. Pharmacological treatments should be reserved for cases in which couples therapy or changing lifestyles have not been effective at improving sexual health.

Sexual desire is a complex condition that depends on physical, psychological, social and cultural factors and has a different meaning for women and for men. The factors that can affect sexual desire include the following:

The serum levels of certain hormones, including testosterone, oestrogen, oxytocin, beta endorphins and prolactin, influence sexual activity. Testosterone is a hormone that stimulates sexual desire in both men and women, but from 30 to 40 years of age, testosterone levels decrease in the blood. Women of childbearing age have a peak secretion of testosterone and androstenedione for half of the ovarian cycle that coincides with ovulation that has been associated with an increase in spontaneous desire. Oestrogens help to maintain trophism and vaginal lubrication. Hence, they indirectly enable pleasurable sex. In postmenopausal women, a decrease in oestrogen levels results in atrophy and decreased vaginal lubrication. These changes may be responsible for less pleasurable or painful intercourse in women (dyspareunia), which could adversely affect their motivation and sexual desire [11].

The existence of organic disease can decrease sexual desire, although it rarely fully prevents sexual activity. However, neurological diseases have a greater significance and can reduce the motivation for sex. The use of certain medications , including antihypertensives, antidepressants, opioid analgesics, anti-androgens and oral contraceptives, may also be responsible for decreased desire [14].

Different psychological problems, including depression and anxiety, can lead to a decreased sex drive. Psychological disorders that are specifically related to sexual behaviour, such as sexual aversion disorder or hypoactive sexual desire disorder, can also have this effect [11].

Hypoactive sexual desire disorder is characterized by a deficiency or absence of sexual fantasies or the desire for sexual activity, which can cause marked distress in women and difficulties in their relationships with their partner [15].

Additionally, decreased self-esteem and body image changes can occur as a result of certain diseases, and the side effects of some treatments for these conditions can deteriorate sexual health in women [11].

Relationship problems with partners can lead to a decrease in libido, especially in women. A good relationship is fundamental because a stable and harmonious relationship promotes the prompt and satisfactory resolution of any sexual conflicts that may arise. Conversely, a bad relationship itself can cause problems in a couple’s sexual life [16]. Additionally, drugs can affect sexual experiences and lead to risky sexual behaviour and social conflicts within the couple [11].

Continued stressful situations facilitate the production of prolactin, and increased in serum prolactin levels decrease sexual desire [17].

In our society, models of education that do not encourage the acceptance of sexuality can have negative effects on sexual desire. Additionally, the false belief that older women do not have sex can unconsciously cause a loss of motivation and desire [11].

The sexual response of men progresses linearly and usually begins with desire. This desire can be triggered by sexual thoughts and fantasies or the urgency to experience sexual satisfaction. However, the female sexual response resembles that of males only occasionally, in particular at the beginning of romantic relationships, after which, women require more stimulation. In general, spontaneous sexual desire decreases with women’s increasing age [11].

According to Rosemary Basson, the progression of the sexual response in women is cyclical, and the phases of the female sexual response (desire, excitement, plateau, orgasm and resolution) do not necessarily follow this order but can overlap with each other or progress in an order that can vary according to the situation. Therefore, desire does not usually mark the start of the female sexual response. This entire cycle can be influenced by emotional intimacy, sexual stimulation and the woman’s satisfaction with the relationship [18].

The human sexual response to exciting stimuli involves a cycle of motivation that is based on incentives and that comprises the physiological changes and subjective experiences of the individual. Psychological and biological factors influence the processing of sexual stimuli in the brain, causing it to allow or not allow the activation of the next phase of sexual response. The results obtained during both sexual and non-sexual intercourse influence an individual’s future motivation to seek intimacy [14].

In conclusion, more so than desire , increasing emotional closeness and commitment to the couple are more frequent motivators for women to initiate a sexual relationship. Once initiated, continuous stimulation can cause an increase in sexual arousal, which can then lead to desire [19]. The fact that sex can be initiated without desire is normal and in no way should be considered a disorder of female sexuality .

Treatment for women who experience problems with sexual desire depends on their phase in reproductive life. Different treatment recommendations can be made, including the following:

Drug therapy may be useful in postmenopausal women who are experiencing problems with sexual desire and in premenopausal women with hypoactive sexual desire disorder. In postmenopausal women, the use of a drug (tibolone) with an effect similar to oestrogen and testosterone has been shown to resolve problems with desire and to improve symptoms [20]. It is also beneficial for treating vaginal atrophy when administered as an oestrogen cream. In women with surgical menopause, treatment with testosterone patches has been shown to improve sexual desire and orgasms [11].

Moreover, in seeking a “female Viagra”, different drugs that increase sexual desire in women have been tested or are being tested, including flibanserin (initially investigated as an antidepressant drug and approved in the USA only for the treatment of hypoactive sexual desire in premenopausal women), ORL101 (a synthesized melatonin that increases sexual desire for 2 h that is in the research phase) and Lybrido (an experimental drug that acts on the brain to increase dopamine secretion and inhibit serotonin, thereby enhancing relaxation and activating sexual desire).

As in the case with desire, the female orgasm is a complex process that has biological, psychological and social components. The female orgasm is accompanied by intermittent muscle contractions of the genital and pelvic floor. In addition, involuntary contractions of other muscles (e.g. the sphincter or carpopedal spasms), increases in blood pressure, respiration and heart rate and the sudden release of nervous tension occur. According to some authors, women who reach orgasms more easily have an assertive attitude with their partner (showing understanding but not submitting to their partner’s will) and have more sexual fantasies, less anxiety and a more androgynous role and are less submissive, less shy and more demanding. However, the female orgasm is more influenced by qualitative aspects such as affectivity than quantitative aspects or the duration of sexual activity. Therefore, to achieve satisfaction in a relationship, individuals are encouraged to view a sexual relationship as a relationship that is based on situations involving emotional intimacy and not one that is focused exclusively on coital activity [12].

The female orgasm may be affected by different disorders , including the following:

In women with orgasmic function disorders , different therapeutic measures can be adopted, such as:

Anorgasmia is a sexual function disorder that can affect women. Today, the term “preorgasmia ”, which assumes that all women are capable of reaching orgasms but must learn to how to do so, is preferred.

In short, the answers to the myth that “by nature, women have less desire and take longer to reach an orgasm” are that no studies support this claim and that sexual desire has a different meaning to women and men. The sexual response of women varies depending on the situation, and unlike men, in women, desire is often not the first stage of a sexual response. This is normal and should not be considered a sexual disorder because in women, motivation may be more important than desire. In women, the most common motivation for starting a sexual encounter is increasing emotional closeness and commitment to the couple. Similar to desire, women’s orgasms depend on multiple biological, psychological and social factors. However, the female orgasm is more influenced by qualitative aspects, such as affectivity.

The erect penis is a symbol of masculinity . In many cultures, it has become a symbol of different qualities, such as strength, courage, endurance, intelligence, knowledge, dominance over other men, possession of women or love and being loved. During puberty, significant growth of the penis occurs as a result of the actions of testosterone [21].

Men place more importance on penis size than women [22]. A study found that men are especially concerned about their height, their weight and the size of their penis [23]. Several factors can influence the perception that a man has of his penis. These can include self-assessment of one’s body image and the influence of the media. Two types of disorders have been described in which there is an unrealistic perception that a penis is abnormal: small penis anxiety (also small penis syndrome ) and body dysmorphic disorder, or BDD [24].

Penis size is determined by measuring various parameters, such as the flaccid length, stretched flaccid length, erect length, flaccid girth and erect girth. A variety of studies have been performed to analyse penis size. In an analysis of previous works, the following average values were found: 9–10 cm flaccid length, 12–13 cm stretched length, 14–16 cm erect length, 9–10 cm flaccid girth and 12–13 cm erection circumference. Typically, a flaccid penis is shorter than the same penis when erect by 6.5 cm. A few racial differences were also observed [21]. However, in a recent study of men over 17 years of age who were of different races and at different ages, the following average values were found: flaccid length, 9.16 cm; stretched length, 13.24 cm; erect length, 13.12 cm; flaccid circumference, 9.31 cm; and erect circumference, 11.66 cm [25].

When a penis is less than 7.5 cm in length while erect or 4 cm while in a flaccid state, it is considered a micropenis. Only 2.28% of the male population has an abnormally small penis [26].

Some studies have resulted in hypotheses concerning the relationships between penis size, physical characteristics and age. However, significant relationships have not been found between penis size and weight, body mass index, the length of the fingers, foot size, the size of the testicles or age. On the contrary, there was a relationship between height and the length of the penis when stretched or erect [27]. These findings refute various myths that continue to persist in our society.

The female orgasm is an intense feeling of pleasure that is achieved by stimulating erogenous zones and is influenced by biological, psychological and social components [7]. The work of Masters and Johnson established that women can reach orgasm using different forms of stimulation (e.g. clitoral, vaginal penetration, erotic dreams and fantasies) but that a single physiological response is common to all of them. In the vagina, the area of greatest sensitivity is the bottom of the front wall. This area is known as the G-spot ( Grafënberg spot ). If we consider the contributions of recent publications, penis size does not have an influence on the sexual pleasure of women. The satisfaction of a woman is based on orgasms and resolutions, and orgasms are always produced by a women’s erectile organ, which is effectively stimulated by sexual intercourse, masturbation or simply using a finger. Sexual arousal affects the female erectile organ, resulting in clitoral erection, congestion and the thickening of the labia minora and spongy body of the female urethra. Because these erectile bodies are the triggers for orgasms, they could be considered the female penis. Consequently, whether it is vaginal stimulation or stimulation of the G-spot should not matter when attempting to achieve an orgasm [20].

However, other studies have focused on orgasms that are obtained by vaginal penetration without clitoral stimulation. It appears that women who are able to obtain orgasms mainly by vaginal stimulation are taught to understand that it is important to focus their attention on vaginal sensations during intercourse. Additionally, long penises are preferable for achieving orgasms using this method because they have a greater capacity for causing sexual arousal by stimulating the deep areas of the vagina [28, 29]. These women attribute more importance to sex with vaginal penetration, which presents a challenge to relationships without intercourse [30]. However, these data have been discussed because the alleged vaginal orgasms may actually be caused by the stimulation of the erectile bodies that surround the vaginal entrance [31].

Therefore, although the clitoris is the centre of the orgasmic response in women, sexual arousal is not produced exclusively by clitoral stimulation because a woman’s sexual enjoyment involves a balance between physical and emotional factors that should be enhanced [32].

In conclusion, this myth is deeply ingrained in the population, yet it has no medical basis because the most sensitive area of the vagina is the first 2 cm of its entrance, suggesting that penises as small as 6 cm in length can reach these erogenous zones. Even simple friction caused by a wider penis should be able to stimulate these areas without requiring deep penetration .

The female orgasm is a complex process that has biological, psychological and social components. From a point of view of experiencing pleasure, an orgasm is the culmination of a sexual response that is achieved as a result of the stimulation of erogenous zones . In women, this is characterized by intermittent and rhythmic contractions of the muscles of the pelvic floor and the outermost portion of the vagina (the “orgasmic platform” described by Masters and Johnson) in addition to anal and sometimes uterine contractions [12].

The myth regarding the distinction between vaginal and clitoral orgasms began in studies performed by Sigmund Freud, who considered clitoral orgasms to be a phenomenon of immature women and believed that the response of a mature woman was a vaginal orgasm without clitoral stimulation. Thus, removing the sexuality of the clitoris was a requirement for the development of femininity. In contrast, Alfred Kinsey was one of the first researchers to criticize Freud’s ideas about sexuality and the female orgasm. In 1953, he discovered that most women could not have vaginal orgasms, and he thus considered the clitoris to be the main centre of the female sexual response [33]. However, the method used in that study was later questioned [34].

In 1967, research by Masters and Johnson resolved the old psychoanalytic idea of a vaginal orgasm occurring before a clitoral orgasm. Their studies on female sexual responses led them to defend the existence of a single orgasm with different origins. They determined that clitoral structures surround and extend along and inside the vagina that most women can only have clitoral orgasms and that all orgasms involve the same stages of physical response. Based on these findings, they argued that clitoral stimulation was the basis of both types of orgasm, whether it results from either the direct or indirect stimulation of the nerve fibres through penetration (Masters and Johnson). Therefore, they determined that the routes would differ according to the type of orgasm (e.g. clitoral, penetration, erotic dreams and fantasies) but that the physiological response would be common to all of them. Hence, although one might think that there are several types of orgasm, there is actually only one type (clitoral), and what varies is the mechanism of stimulation and input.

In the 1980s, discussions concerning the G-spot ( Grafënberg spot ) arose, and this caused the controversy over the existence of different types of orgasms to re-emerge. Some authors argued for a distinction between vulvar and uterine orgasms, the latter being caused by the stimulation of the G-spot. In fact, there was not a particular point but a particularly sensitive area that was located in the anterior and inferior wall of the vagina [35].

According to other authors, the G-spot consists of a shaft located inside the vagina that coordinates the operation of the structure formed by the clitoris, urethra and vaginal wall and the associated network of nerves, muscles and glands (the clitoral-urethral-vaginal complex) [27, 36]. Stimulating this area would trigger an orgasmic response in women. There appears to be anatomical and physiological evidence supporting the existence of the G-spot or the clitoral-urethral-female orgasm [31].