Many of the age- and menopause-related hormone changes and vaginal changes that can dampen arousal around midlife can also affect women’s enjoyment of sex and ability to achieve orgasm. Here again, the vaginal atrophy and dryness related to low estrogen play a role, as does reduced blood supply to the clitoris and lower vagina. Also, the clitoris—a key center of sexual pleasure for most women—is likely to be less sensitive than in earlier years, possibly due to reduced estrogen levels and changes in the vascular and nervous systems.

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