Sexual dysfunction is prevalent among older men and women. Age-related decline in sexual response occurs at the same time that levels of the reproductive hormones testosterone and estrogen decrease. However, previous research has not determine how decrements in gonadal hormones affect sexual response. The proposed studies will address this research gap by determining effects of reproductive hormones on sexual functioning in older men and women. The long-term objective of this proposal are to aid in understanding the role of estrogen and testosterone in sexual functioning and to provide better clinical management of older patients. In the proposed research sexual responses of older men and women will be determined by psychophysiological measures of genital tumescence, psychophysical ratings of subjective pleasure, and behavioral records. Two groups of older men will be compared, those with normal testosterone level (greater than 400 mg/100 ml) and those with borderline or subnormal testosterone levels (less than 400 mg/100 ml). It is hypothesized that testosterone will be more related to perceptions of pleasure associated with genital response than with magnitude of genital response. In women a hormone replacement therapy study is proposed to test the effects of estrogen, estrogen plus androgen, or placebo on sexual functioning. Four groups of women will be studied: those who have undergone natural vs. surgical menopause, and those who are 1-2 vs. 5-10 years postmenopause. It is believed that women in these groups will show differential responses to hormone replacement therapy because they will have different basal levels of estrogens and androgens. It is hypothesized that estrogen will play a more significant role in determining amount of vaginal lubrication (important in preventing painful intercouse) than in determining amount of vaginal vascongestion, a measure often used to define sexual arousal. It is furthermore a goal to develop procedures for simultaneous measurement of vaginal lubrication and vascongestion in women. The importance of this research lies in a determination of the significance of gonadal hormone decrements in sexual response. By determining whether hormones contribute to sexual dysfunctions, it will be possible to provide improved treatment for these problems.
