The Glossary

Also called Late-Onset Hypogonadism (LOH), andropause refers to the gradual decline in testosterone production that occurs in men as they age — typically beginning in the mid-30s and accelerating after 50. Unlike menopause, it is not a defined biological event but a slow shift that can affect sexual desire, energy, mood, muscle mass, and erectile function. Symptoms are often dismissed or attributed to normal aging, which can delay diagnosis and treatment.

The persistent difficulty or inability to reach orgasm despite adequate stimulation and arousal. Anorgasmia can be lifelong (primary) or acquired — meaning it developed after a period of normal orgasmic function. It is more common in women and becomes more prevalent with age, as changes in hormone levels, vascular function, and nerve sensitivity affect orgasmic response. Both physical and psychological factors are typically involved.

The physiological and psychological state of sexual excitement. Physical arousal involves increased blood flow to the genitals, lubrication in the vagina, penile erection, elevated heart rate, and heightened skin sensitivity. Psychological arousal involves mental engagement and attention toward sexual stimuli. Crucially, arousal and desire are not the same thing — they can occur independently, and understanding this distinction matters for how people interpret and respond to their own sexual experience.

A framework used in sexual health research and clinical care that recognizes sexual function — and dysfunction — as shaped by three overlapping domains: biological factors (hormones, vascular health, medications, physical illness), psychological factors (anxiety, depression, past trauma, body image, beliefs about sex), and social/relational factors (partner dynamics, communication, cultural and religious messaging, relationship satisfaction). No single domain tells the whole story. Effective treatment addresses all three.

Thinning or reduced sensitivity of the clitoris due to declining estrogen levels, typically occurring after menopause. The clitoris has a high density of estrogen receptors, and as estrogen drops, the tissue can become less engorged, less sensitive, and more susceptible to irritation. Clitoral atrophy is part of the broader genitourinary syndrome of menopause (GSM) and can significantly affect arousal and orgasm. Local estrogen therapy and vaginal moisturizers can help maintain tissue health.

A bacterial sexually transmitted infection caused by Chlamydia trachomatis. It is the most commonly reported STI in North America and often has no symptoms — which means it frequently goes untreated and can cause serious complications, including damage to reproductive organs. Rates among adults over 50 have increased by more than 180% between 2007 and 2017 in the US. Chlamydia is easily diagnosed through urine testing or swab and treated with a single course of antibiotics.

A cognitive-behavioural technique that involves identifying and challenging unhelpful or distorted thoughts and replacing them with more accurate, balanced ones. In sexual health, cognitive reframing is commonly used to address performance anxiety, sexual shame, and catastrophizing — for example, shifting from "I am broken because I don't want sex spontaneously anymore" to "My desire pattern has changed, and responsive desire is a clinically recognized and valid form of desire." It is a core tool in sex therapy and psychological treatment for sexual dysfunction.

A mismatch in the level or frequency of sexual desire between two partners. It is one of the most common concerns brought to couples therapy, affecting relationships at all ages and stages. Desire discrepancy does not mean either partner is broken or that the relationship is failing — it reflects the fact that desire is shaped by different biological, psychological, and contextual factors for each person. The key question is not whose desire is "normal" but whether both partners can find a workable, respectful approach to the difference.

A research-based model of sexual response developed by Bancroft and Janssen that describes arousal and desire as regulated by two competing systems: a Sexual Excitation System (SES, often called the "accelerator") that responds to sexually relevant stimuli, and a Sexual Inhibition System (SIS, the "brakes") that responds to potential threats or concerns. Everyone has both systems, but individuals differ in the sensitivity of each. For many people — particularly women — the brakes are the primary limiting factor in sexual desire, not the accelerator. Understanding your own brake system is often more useful than trying to add more stimulation.

The clinical term for persistent or recurrent pain during or after sexual intercourse. It can occur in both men and women, though it is significantly more common in women. In postmenopausal women, the most frequent cause is genitourinary syndrome of menopause (GSM) — the thinning and drying of vaginal and vulvar tissue following estrogen decline. Dyspareunia is not a normal or acceptable consequence of aging and is a diagnosable, treatable condition. Many people never report it to a healthcare provider, which delays appropriate care.

A graduated therapeutic approach to gently stretching and relaxing the vaginal muscles, used as a first-line treatment for vaginismus, pelvic floor hypertonicity, vaginal stenosis, and post-menopausal vaginal narrowing. Vaginal dilators are smooth, tube-shaped devices used in progressively larger sizes over time — always at a pace determined by the person using them, not by a treatment timeline. The goal is to retrain the pelvic floor muscles to relax in response to penetration, and to interrupt the fear-pain cycle by establishing safety through gradual, controlled exposure.

The persistent inability to achieve or maintain an erection firm enough for satisfying sexual activity. ED affects an estimated 40–70% of men over 40 and becomes more common with age. It has both physiological and psychological contributors — vascular disease, diabetes, hormonal changes, and many common medications can all impair erectile function, as can anxiety, depression, and relationship stress. ED is frequently a cardiovascular warning sign and always warrants a medical evaluation. The distinction between psychogenic ED (driven by anxiety or stress) and organic ED (driven by vascular or hormonal causes) has treatment implications.

A category of conditions affecting ejaculation, including delayed ejaculation (taking a very long time or being unable to ejaculate), premature ejaculation, anejaculation (no ejaculation at all), and retrograde ejaculation (where semen travels backward into the bladder). These conditions are common in aging men and have multiple potential causes — including neurological changes, prostate treatments, medications, diabetes, and psychological factors. They are often undertreated because men rarely bring them up with their physician.

The psychological, imaginative, and emotional dimension of sexuality — the internal landscape of fantasy, meaning, and desire. Eroticism is distinct from the mechanics of sexual function. It encompasses the stories we find arousing, the feelings we want to evoke or experience during sex, and the way we engage our imagination in sexual life. Eroticism tends to deepen rather than diminish with age and life experience, even when physical function changes. Engaging with one's erotic imagination is one of the most accessible and underutilized tools for maintaining sexual vitality.

A self-reinforcing loop in which anticipatory fear of pain leads to pelvic floor muscle guarding, which increases friction and pressure during sexual activity, which causes more pain, which deepens the fear. It is the primary maintaining mechanism in conditions like vaginismus and provoked vestibulodynia. Once established, the cycle can persist even after the original cause of pain has been treated, because the nervous system has learned to associate sexual activity with threat. Breaking the cycle typically requires simultaneous attention to physical treatment (pelvic floor physiotherapy, dilator therapy) and psychological work (CBT, acceptance-based approaches).

The umbrella clinical term — replacing the older term "vaginal atrophy" — for the constellation of genital, urinary, and sexual symptoms that result from declining estrogen following menopause. These include vaginal dryness, thinning and loss of elasticity in vaginal and vulvar tissue, urinary urgency and recurrent infections, and sexual pain. Unlike hot flashes, GSM symptoms tend to worsen over time without treatment rather than resolving on their own. GSM affects approximately 50–60% of postmenopausal women but is significantly underreported and undertreated. Effective options range from vaginal moisturizers and lubricants to local estrogen and newer non-hormonal therapies.

A bacterial sexually transmitted infection caused by Neisseria gonorrhoeae that can infect the genitals, rectum, and throat. It often causes no symptoms, particularly in women, which means it is frequently transmitted unknowingly. Untreated gonorrhea can cause serious complications and increasing antibiotic resistance makes it a growing public health concern. Rates among adults over 50 have risen substantially in recent years. It is diagnosed by swab or urine test and treated with antibiotics, though drug-resistant strains require specific regimens.

A viral infection that causes recurring outbreaks of blisters or sores on the mouth (HSV-1) or genitals (HSV-2), though either type can infect either location. HSV is extremely common and is transmitted through skin-to-skin contact — including when no visible sores are present (asymptomatic shedding). There is no cure, but antiviral medications reduce outbreak frequency and severity and significantly lower the risk of transmission. Condoms reduce but do not eliminate risk because the virus can be present on skin not covered by a condom. Many people with herpes are unaware they have it.

The most common sexually transmitted infection worldwide. Most sexually active adults will contract HPV at some point in their lives. Many strains clear on their own without symptoms; others can cause genital warts or, in some cases, cervical, anal, throat, penile, or vulvar cancers. HPV is transmitted through skin-to-skin sexual contact and cannot be fully prevented by condoms. Vaccines are highly effective at preventing the highest-risk strains, though vaccination is most commonly offered to younger age groups. Older adults who are newly sexually active or have multiple partners should discuss HPV risk and screening with their physician.

A clinical diagnosis describing persistently low or absent sexual desire that causes personal distress. The key criterion is distress: a person who has low desire and does not find it problematic does not meet diagnostic criteria for HSDD. It is one of the most common sexual dysfunctions in both men and women, and its causes are biopsychosocial — hormonal, psychological, relational, and contextual factors all play a role. FSIAD (Female Sexual Interest/Arousal Disorder) is the current DSM-5 term for women; for men, "Male Hypoactive Sexual Desire Disorder" is used. Treatment may include hormone therapy, psychological therapy, or medication depending on the underlying drivers.

The clinical term for the constellation of symptoms associated with age-related testosterone decline in men, sometimes called andropause. Symptoms can include reduced libido, fatigue, depressed mood, decreased muscle mass, and erectile difficulties. Diagnosis requires both clinical symptoms and laboratory confirmation of low testosterone levels — symptoms alone are not sufficient. Not all men with low testosterone need treatment, and the decision to use testosterone replacement therapy (TRT) depends on individual symptom burden, health history, and risk profile. A physician evaluation is essential.

A form of hormone therapy applied directly to vaginal and vulvar tissue (via cream, suppository, or ring) rather than taken systemically. Because it acts locally, it delivers very little estrogen to the bloodstream — meaning it is considered appropriate for many women who cannot or prefer not to use systemic hormone therapy, including many breast cancer survivors (though this should always be discussed with an oncologist). Local estrogen is one of the most effective treatments for GSM: it reverses tissue thinning, restores lubrication, reduces pain with sex, and improves urinary symptoms. Effects take several weeks to develop.

Defined as 12 consecutive months without a menstrual period, marking the end of reproductive capacity. The average age of menopause in North America is 51, though it can occur earlier due to surgery, chemotherapy, or other medical causes. Menopause itself is a single point in time; the transition leading up to it (perimenopause) can last 4–10 years. The primary driver of menopausal symptoms is the decline in estrogen and progesterone production by the ovaries. Sexual health effects include vaginal dryness, reduced lubrication, changes in arousal and orgasm, and the development of GSM.

Deliberate, non-judgmental attention to the present moment. In a sexual context, mindfulness involves attending to physical sensations, emotional experience, and connection with a partner rather than being caught up in evaluative thought ("Am I taking too long?" "Does my body look okay?"). Research on sexual mindfulness consistently shows that greater present-moment awareness during sex correlates with higher arousal, more positive sexual affect, and better sexual satisfaction — across genders and ages. For people with sexual anxiety or who experience intrusive, self-critical thought during sex, mindfulness practices offer a clinically supported path to more embodied, enjoyable sexual experience.

The health and protective function of the mucous membranes that line the vagina, cervix, and other genital tissues. Intact, well-lubricated mucosa acts as a physical barrier against pathogens. When estrogen declines — as in menopause — mucosal tissue becomes thinner, drier, and less resilient. This is clinically significant from a sexual health standpoint because compromised mucosal integrity increases susceptibility to sexually transmitted infections, including HIV, herpes, and chlamydia. Maintaining mucosal health through moisturizers, local estrogen, and lubrication is a component of both sexual pain management and STI risk reduction.

A peak of neuromuscular response during sexual stimulation, characterized by rhythmic contractions of pelvic floor muscles, involuntary muscle tension, and the release of sexual tension accompanied by a subjective sense of intense pleasure. Orgasm typically requires adequate stimulation, sufficient psychological engagement, and a relatively relaxed state. With age, orgasms can take longer to achieve, may feel less intense, and the refractory period (recovery time before another orgasm is possible) lengthens in men. These changes are physiologically normal. They are also often reversible with appropriate attention to the contributing factors.

A condition in which the group of muscles, ligaments, and connective tissues forming the base of the pelvis are not functioning optimally. This can mean muscles that are too tight (hypertonic), too weak, or poorly coordinated. Pelvic floor dysfunction is a significant contributor to sexual pain, difficulty with penetration, urinary incontinence, and orgasm difficulty. It affects both women and men, though it presents differently across genders. Pelvic floor physiotherapy — specialized physical therapy targeting these muscles — is the evidence-based first-line treatment and is highly effective when pursued consistently.

The transitional phase leading up to menopause, typically lasting 4–10 years, during which hormone production becomes irregular before eventually declining permanently. Estrogen and progesterone fluctuate unpredictably during perimenopause, producing a range of symptoms: irregular periods, hot flashes, sleep disruption, mood changes, changes in sexual desire and arousal, and early genital tissue changes. Many people don't realize they are perimenopausal because they are still having periods. Perimenopause can begin in the early 40s, sometimes earlier. It ends 12 months after the last menstrual period.

A class of medications that improve erectile function by relaxing smooth muscle in the walls of penile blood vessels, increasing blood flow during sexual arousal. Common examples include sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra). PDE5 inhibitors do not create erections spontaneously — they enhance the response to sexual stimulation. They are effective for many forms of erectile dysfunction but are not appropriate for everyone, particularly people taking nitrate medications (a potentially dangerous drug interaction). They are one component — not a complete solution — in the treatment of erectile dysfunction.

A form of anxiety specifically focused on how one is performing sexually, rather than on the experience itself. It can manifest as intrusive evaluative thoughts during sex ("Am I taking too long?" "Is this working?"), self-monitoring, and the narrowing of attention away from sensation and toward assessment. Performance anxiety is self-defeating: the anxiety activates the sympathetic nervous system, which directly inhibits the parasympathetic response necessary for arousal, creating the very outcome it fears. It is one of the most common psychological contributors to both erectile dysfunction and difficulty with orgasm and responds well to cognitive-behavioural and mindfulness-based approaches.

The most common form of vulvodynia, characterized by pain at the vulvar vestibule (the entrance to the vagina) that is provoked by touch or pressure — including with sexual penetration, tampon insertion, gynecological examination, or even tight clothing. The pain is typically described as burning, rawness, or a cutting sensation. PVD is a complex pain condition with central (nervous system) and peripheral (local tissue) components. It is not caused by infection and is not a sign of cancer. It is treatable, though treatment typically requires a multidisciplinary approach including pelvic floor physiotherapy, topical medications, and psychological support.

A pattern of sexual desire in which arousal and interest emerge in response to erotic stimulation or context, rather than arising spontaneously out of nowhere. Responsive desire is a clinically recognized and entirely valid form of sexual motivation — not a lower or deficient version of desire. Research by Rosemary Basson demonstrated that this pattern is very common, particularly in women and in people who have been in long-term relationships. It has important practical implications: responsive desire means that waiting to feel aroused before initiating is not a reliable strategy. Starting (with sufficient interest and safety) is how the arousal arrives.

A person's subjective sense of contentment with their intimate partnership, encompassing emotional connection, communication quality, shared values, respect, trust, and sexual compatibility. Research consistently shows a bidirectional relationship between sexual satisfaction and relationship satisfaction — each reinforces the other over time. Communication about sex is one of the strongest predictors of both. In long-term relationships, relationship satisfaction tends to shift in predictable ways: dipping in the early years of parenthood and frequently shifting again at retirement and in later life. These shifts are navigable and have been extensively studied.

A structured, graduated series of touch exercises developed by Masters and Johnson in the 1960s and still one of the most evidence-supported tools in sex therapy. Sensate focus works by removing performance pressure from sexual activity: in early stages, partners explore each other's bodies through non-sexual touch, with explicit instruction to focus on sensation rather than arousal or outcome. The approach gradually reintroduces sexual touch over weeks, allowing the couple to rebuild physical intimacy without anxiety. It is used for a wide range of sexual difficulties including low desire, arousal disorder, erectile dysfunction, and recovery from painful sex.

A pervasive, internalized sense of being fundamentally defective or wrong as a sexual person — distinct from guilt, which is about specific actions. Sexual shame is typically absorbed from external sources (family, religion, culture, peer groups) before a person has the capacity to evaluate or reject those messages. It operates differently from other forms of self-criticism because it is not attached to a specific behaviour but to identity itself. Sexual shame is one of the most clinically significant barriers to sexual wellbeing and rarely resolves without direct attention. It responds to compassion-focused and cognitive approaches, and to the experience of being genuinely accepted.

How a person understands and feels about themselves as a sexual being — their sexual identity, sense of desirability, confidence, and entitlement to pleasure. Sexual self-concept is shaped by experience, cultural messages, relationship history, body image, and health. Research shows that sexual self-concept is a stronger predictor of sexual satisfaction in older adults than physical function alone. People can have satisfying sexual lives despite significant physical changes if their sexual self-concept remains positive; conversely, negative sexual self-concept can undermine sexuality even when physical function is intact.

A pattern of sexual desire in which interest in sex arises unprompted — often out of nowhere, without specific context or stimulation. Spontaneous desire is commonly portrayed as the "normal" or default form of libido, but this reflects cultural assumption more than clinical reality. It is more commonly reported by men and by younger adults, and tends to decrease in frequency for both genders across the lifespan. For many people — particularly those in long-term relationships — responsive desire is the more accurate description of how their desire actually operates, though they may not realize this and may interpret the shift as something being wrong.

A bacterial sexually transmitted infection caused by Treponema pallidum that progresses through stages if untreated: primary (painless sores), secondary (rash, flu-like symptoms), latent (no symptoms, but remains in the body), and tertiary (serious organ damage, including neurological complications). Syphilis was once thought to be nearly eradicated but has been rising sharply in North America, including among adults over 50 — where rates increased more than 160% between 2007 and 2017. It is diagnosed through blood tests and treated effectively with penicillin. The lack of pain with primary-stage sores means syphilis is often not recognized and not reported to a provider.

A framework from sociological and sexual health research describing the learned, often unconscious set of expectations, roles, and sequences that shape sexual behavior — who does what, in what order, and what it means. Sexual scripts are absorbed from culture, family, media, and early sexual experience, often before we have the language or awareness to examine them. In long-term relationships, couples can develop rigid shared scripts that reduce novelty and interest over time. Becoming aware of one's scripts — and questioning whether they still serve — is a clinically relevant step in addressing low desire and sexual dissatisfaction.

A sex hormone produced primarily in the testes (in men) and in smaller amounts by the ovaries and adrenal glands (in women). Testosterone is the hormone most closely associated with sexual desire in both genders. In men, levels decline gradually from the mid-30s onward; in women, they decline through the 30s and then more sharply at menopause. Low testosterone is associated with reduced libido in both men and women, though its relationship with desire is not linear — many people with low testosterone report normal desire, and many with normal testosterone report low desire. Testosterone therapy is available and evidence-supported but is not appropriate for everyone.

Physical closeness and affectionate contact that is not directed toward sexual activity — including holding hands, kissing, hugging, massage, and cuddling. Non-sexual physical intimacy is an independent predictor of relationship satisfaction and is particularly important for couples navigating sexual difficulties, pain, or significant changes in desire. Research shows that couples who maintain physical affection through periods of low sexual frequency tend to report higher overall relationship quality and are more likely to successfully renegotiate their sexual relationship over time. Sensate focus exercises are one structured way to rebuild this foundation.

An involuntary tightening or spasm of the muscles around the vaginal opening in response to attempted penetration — whether sexual, medical, or via tampon. The muscle contraction happens automatically and is not under conscious control, which is a source of significant distress and confusion for many people who experience it. Vaginismus can be lifelong (primary) or develop after a period of pain-free penetration (secondary), and can range from a generalized pelvic tightness to very localized muscle guarding. It is now classified under Genito-Pelvic Pain/Penetration Disorder (GPPPD) in the DSM-5 and is treatable with pelvic floor physiotherapy, dilator therapy, and psychological support.

The thinning, drying, and loss of elasticity in the vaginal walls and surrounding tissue that occurs when estrogen levels decline. Vaginal atrophy is a component of Genitourinary Syndrome of Menopause (GSM) and can cause pain with penetration, bleeding after sex, reduced lubrication, narrowing of the vaginal opening, and increased susceptibility to infection. The term "atrophy" is technically accurate but can feel distressing to hear; this is one reason the broader term GSM was introduced. The condition responds well to treatment and does not have to be accepted as an inevitable consequence of aging.

Chronic pain of the vulva — the external female genital area — that lasts at least three months and has no identifiable cause such as infection, skin disease, or neurological disorder. Vulvodynia can be generalized (affecting the whole vulva) or localized (confined to a specific area, most commonly the vestibule — in which case it is called provoked vestibulodynia or PVD). The pain is often described as burning, stinging, rawness, or aching. Vulvodynia is a genuine pain condition with central sensitization as an important mechanism in many cases. Treatment is multidisciplinary and can be highly effective but often requires persistence and a clinician experienced in this area.