At midlife and beyond, both men and women face organic changes that can affect sexual functioning. For women, ovarian exhaustion causes estrogen deficiency, leading to genitourinary syndrome of menopause, which may include vaginal dryness, irritation/itching, inadequate lubrication, and dyspareunia. Hypoactive sexual desire disorder also can result from biopsychosocial factors. For men, erectile dysfunction prevalence increases with age, and some men develop testosterone deficiency.