An elderly woman comes into her doctor’s office. When the consultation begins, the woman complains that while she is sexually active with her husband, she is experiencing more pain. The woman has noticed that it has been getting worse and asks the physician why this is happening.

What are some of the sexual changes that occur in the elderly?

Although both men and women maintain their previous sexual interest, there are numerous physiological changes that occur in both men and women. For men, the time to erection is longer and there is a longer refractory period after ejaculation. Women begin to experience vaginal dryness, thinning, and shortening, which may be causing the pain this elderly woman is experiencing.

Describe some common medical conditions in the elderly population?

Common medical conditions include osteoporosis, heart disease, arthritis, and hypertension. Additional changes include a decrease in visual acuity, hearing, and renal, pulmonary, and gastrointestinal function. Importantly, the immune response and muscle mass also decrease.

Does intelligence decrease as one ages?

No, intelligence does not change. However, there are well-documented effects of aging on various specific cognitive domains, such as learning, memory, and particularly processing speed.

What psychiatric conditions are more prevalent in the elderly population?

There is a higher incidence of depression in the elderly population. Also, the suicide rate increases in this population. It is therefore important for a physician to ask appropriate screening questions to rule out depression, as well as other psychiatric conditions in all elderly patients.

By Rakesh Razdan Ahuja, class of 2010, Yale University School of Medicine; in association with Le TT, Takiar V, eds: First Aid Cases for the USMLE Step 1. New York: McGraw-Hill, 2009.