A 62-year-old woman presents for annual examination. Her last spontaneous menstrual period was 9 years ago, and she has been reluctant to use postmenopausal hormone replacement because of a strong family history of breast cancer. She now complains of diminished interest in sexual activity. Which of the following is the most likely cause of her complaint?

Sexuality continues despite aging. However, there are physiologic changes that must be recognized. Diminished ovarian function may lower libido, but estrogen replacement therapy (ERT) may help. Sexual dysfunction can be physiologic, e.g., from lowered libido. As with younger patients, however, lowered libido is in most cases treatable. Because aging does not alter the capacity for orgasm or produce vaginismus, a further evaluation should be initiated if these symptoms persist after a postmenopausal woman is placed on ERT.