UNIVERSITY OF SOUTHERN MINDANAO

COLLEGE OF HEALTH SCIENCES

KABACAN, COTABATO

GERONTOLOGICAL CHANGES OF THE REPRODUCTIVE SYSTEM

In Partial Fulfilment of the Requirement in NCM 13 RLE:

Care of Older Adults

3 BSN-B GROUP 3

Mag-aso, Kristine Cassandra M.

Panday, Shayma Clare N.
Leonor, Christelle Sophia
Legaspi, Jenine Pearl A.
Parreñas, Ross Marl R.
Lafuente, Shanley O.
Migue, Janbenmar S.
Osano, Jess Carlos S.
Labargan, Zydhe A.
Lipura, Megan B.
Lolos, Al M.

SUBMITTED TO:
JAN LOUIE SULFELIX, RN
CLINICAL INSTRUCTOR

AUGUST 2025
 INTRODUCTION
Aging is a complex, multisystem process marked by progressive
physiological decline. At the cellular level, aging is driven by mechanisms such as
telomere shortening, oxidative stress, and diminished regenerative capacity. These
cellular changes undermine tissue homeostasis and functional resilience over time
(StatPearls, 2025). Importantly, genetic and environmental factors interact to shape
the individual trajectories of aging, with lifestyle choices playing a critical role in
modulating these processes (StatPearls, 2025).
The immune system is particularly affected by age. A well-characterized
hallmark of aging is “inflammaging”—a state of chronic, low-grade
inflammation—combined with immunosenescence, including thymic involution and
impaired T-cell function (Fulop et al., 2021). These changes reduce the body’s ability
to respond to new infections and increase susceptibility to age-related diseases,
highlighting the interplay of innate and adaptive immune decline in aging
populations.
Musculoskeletal and neurological systems also undergo significant
deterioration. Age-related loss of muscle mass and strength—sarcopenia—and
declines in neuromuscular function, known respectively as sarcopenia and
dynapenia, lead to decreased mobility and higher fall risk among older adults (Wu et
al., 2025). Concomitantly, brain aging is marked by cortical thinning, reduced white
matter integrity, and diminished neuroplasticity, contributing to cognitive decline
and reduced responsiveness to external stressors (ScienceDirect, 2023).
Other organ systems—cardiovascular, renal, endocrine, and
integumentary—experience progressive functional impairments with age. The
cardiovascular system shows increased arterial stiffness, myocardial fibrosis, and
reduced aerobic capacity; renal function declines via reduced glomerular filtration;
endocrine changes include altered circadian rhythms and insulin sensitivity; and the
skin becomes thinner and less elastic due to collagen degradation (StatPearls, 2025;
PubMed, 2020).
This narrative paper, while acknowledging these broad physiologic
alterations, will focus specifically on gerontological reproductive changes. In
particular, it will explore how aging impacts reproductive system function in older

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adults, including hormonal, structural, and cellular modifications that characterize
reproductive aging.

THE AGING REPRODUCTIVE SYSTEM

Reproductive System
The human reproductive system plays a vital role not only in the
continuation of the species but also in maintaining overall health and secondary
sexual characteristics unique to each sex. In females, the reproductive anatomy
consists of the ovaries, fallopian tubes, uterus, cervix, vagina, and external genital
structures such as the labia majora, labia minora, and clitoris, as well as the
mammary glands within the breasts. The ovaries are the primary reproductive
organs, responsible for producing oocytes and secreting hormones—primarily
estrogen and progesterone, with small amounts of androgens—that regulate the
menstrual cycle, facilitate ovulation, and support pregnancy (Santoro et al., 2023).
These hormones also influence bone health, cardiovascular function, and skin
elasticity, underscoring their systemic importance beyond reproduction.

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 The vaginal epithelium is particularly sensitive to estrogen levels, which help
maintain its thickness, elasticity, and lubrication, as well as sustain a low pH that
inhibits pathogenic bacterial growth (Davis & Baber, 2022). This hormonal
regulation ensures optimal conditions for sperm viability and reduces the risk of
infections. Disruptions in estrogen levels, such as those occurring during
menopause, can lead to atrophic changes that compromise vaginal health and
sexual comfort (Ebersole & Hess, 2020). The
uterus, with its muscular walls and
specialized endometrium, undergoes cyclic
changes under hormonal influence to
prepare for possible implantation and
pregnancy, while the fallopian tubes
facilitate the transport of oocytes from the
ovaries to the uterus.

In males, the reproductive system comprises the testes, epididymis, vas

deferens, prostate gland, seminal vesicles, penis, and associated ducts. The testes
serve a dual role in producing sperm (spermatogenesis) and secreting testosterone,
the principal male sex hormone. Testosterone drives not only the development of
primary and secondary sexual characteristics—such as increased muscle mass,
deepening of the voice, and facial/body hair growth—but also plays a crucial role in
libido and overall energy levels (Corona et al., 2021). Sperm produced in the
seminiferous tubules mature in the epididymis before traveling through the vas
deferens to be mixed with seminal fluid from the prostate and seminal vesicles,
creating semen.
The prostate gland contributes
enzymes, zinc, and other components essential
for sperm motility and longevity, while the
seminal vesicles provide fructose to serve as an
energy source for sperm cells (Davis & Baber,
2022). Proper function of these accessory
glands is essential for fertility, and age-related

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changes—such as benign prostatic hyperplasia—can compromise urinary and
reproductive function in later life. The penis serves as both a conduit for urine and
semen, and erectile function is regulated through a complex interaction between
vascular, neurologic, and hormonal mechanisms.
The male and female reproductive systems work through intricate hormonal
and structural coordination to ensure fertility, sexual function, and the maintenance
of traits linked to reproductive health. Beyond reproduction, these systems
influence overall well-being through endocrine pathways that impact bone density,
cardiovascular health, and mental well-being. Understanding their anatomy and
physiology provides a foundation for recognizing how aging and disease can affect
sexual and reproductive health, guiding both preventive care and targeted
interventions in clinical practice (Fileborn et al., 2021).

Reproductive Changes in Women

As women age, their reproductive capacity is shaped by the gradual

depletion of their ovarian reserve—the finite pool of viable follicles established
before birth. At birth, females possess approximately one million follicles, but by
puberty, this number declines to about 300,000, with only around 3% remaining by
age 40 (Burger et al., 2012; Nelson, 2009). Menopause typically occurs around the
average age of 51, when follicles are nearly exhausted, marking the permanent
cessation of menstruation after 12 consecutive months without a menstrual period
(Harlow et al., 2012). The transitional phase leading to menopause, known as
perimenopause, is characterized by irregular menstrual cycles and fluctuating
hormone levels, particularly in estrogen and progesterone, which significantly
influence systemic and reproductive physiology.

The hormonal changes of perimenopause and menopause disrupt

hypothalamic thermoregulation, leading to vasomotor symptoms such as hot
flashes and night sweats (Freeman et al., 2014). These symptoms not only cause
physical discomfort but also often impair sleep and reduce quality of life. Estrogen
decline has also been associated with negative cardiovascular changes, including
alterations in vascular tone and lipid metabolism, contributing to increased

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 cardiovascular risk (Muka et al., 2016).
These changes underscore the broader
systemic role of reproductive hormones
beyond fertility, affecting multiple organ
systems.

Estrogen loss also directly impacts the

genitourinary tract. The vaginal
epithelium becomes thinner and less
elastic, lubrication decreases, and vaginal
pH rises, leading to vulvovaginal atrophy
(Portman & Gass, 2014). These changes increase susceptibility to infection, cause
dyspareunia, and contribute to sexual dysfunction. Systemically, reduced estrogen
contributes to unfavorable fat redistribution toward central adiposity, elevated
blood pressure, impaired glucose tolerance, dyslipidemia, and reduced bone mineral
density, thereby heightening the risk of metabolic syndrome, cardiovascular
disease, and osteoporosis (Santen et al., 2020). Additionally, musculoskeletal
effects, including joint stiffness and sarcopenia, are common, further influencing

mobility and quality of life.

Sexual function after menopause may decline due to both physical and
neuroendocrine changes. Decreased vaginal lubrication and increased pain during
intercourse can reduce sexual activity, while diminished estrogen and androgen
levels may impair sexual arousal and orgasmic response (Kingsberg et al., 2019).

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However, menopause also represents a broader biopsychosocial transition.
Emotional responses may range from relief at the end of reproductive potential to
distress over perceived aging, influenced by cultural, relational, and personal
factors. These transitions highlight that reproductive aging is not solely a biological
process but also a multifaceted life-stage shift encompassing physical,
psychological, and social dimensions.

Reproductive Changes in Men

As men age, the reproductive system
undergoes gradual yet significant
physiological changes. While
spermatogenesis may continue into
advanced age, structural and functional
declines become evident. The testes tend to
atrophy, and the seminiferous tubules—the
site of sperm production—thicken and can
become fibrotic. These histological changes
are associated with a reduction in sperm
motility and an increase in structural
abnormalities, which collectively diminish
fertility potential (Elsevier eLibrary, n.d.). Despite these changes, complete
infertility is uncommon solely due to aging, but the efficiency and quality of

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reproductive function steadily decline.
One notable endocrine change in aging males is the gradual reduction in
circulating testosterone, often termed “andropause.” Unlike the abrupt hormonal
shift experienced by women during menopause, testosterone decline is slower and
may remain within the low-normal range for many men. However, when combined
with comorbidities such as obesity, metabolic syndrome, or chronic illness, the
reduced testosterone levels can contribute to symptoms including reduced libido,
decreased muscle mass, fatigue, and mood changes (Elsevier eLibrary, n.d.).
Importantly, significant sexual or reproductive dysfunction in older men is often
multifactorial rather than purely age-driven.
Erectile function also progressively declines with age. Older men commonly
experience decreased penile rigidity, delayed ejaculation, prolonged refractory
periods, and an increased need for direct stimulation to achieve and maintain
erections (Elsevier eLibrary, n.d.). These changes are partly vascular in origin, as
endothelial function declines with age, reducing penile blood flow, and are
compounded by hormonal and neurogenic alterations. Erectile dysfunction (ED)
becomes increasingly prevalent, affecting approximately half of men at age 65 and
up to three-quarters by age 80, representing both a physiological and quality-of-life
concern (Elsevier eLibrary, n.d.).

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 Urinary tract health is also impacted by male reproductive aging, most
notably through benign prostatic hyperplasia (BPH). By age 80, about 80% of men
develop some degree of BPH, in which non-cancerous enlargement of the prostate
gland obstructs urinary flow (Elsevier eLibrary, n.d.). This condition can lead to
symptoms such as hesitancy, weak stream, incomplete bladder emptying, and an
increased risk of urinary tract infections due to residual urine. The interplay between
BPH and ED is clinically significant, as both conditions may share vascular,
hormonal, and neurologic contributors.
In male, reproductive aging is characterized by a gradual but multifactorial
decline in endocrine, vascular, and structural functions. While men maintain the
ability to produce sperm late in life, age-related changes in the testes, prostate,
hormonal environment, and vascular system collectively reduce reproductive
efficiency and sexual performance. Early recognition of these changes and proactive
management can help maintain sexual health and overall quality of life in aging
men.

Summary of the Reproductive Changes

Sex Age-Related Physiologic Changes Later-Life / Elderly Problems (Common

(Gradual, start of “getting old”) conditions)

Men - Ovarian follicle depletion → ↓ - Atrophic vaginitis

estrogen & progesterone production - Dyspareunia (pain during intercourse)
- Irregular menstrual cycles → - Urinary incontinence
menopause (avg. age 51) - Pelvic organ prolapse
- Vaginal epithelium thinning & ↓ - Increased UTI risk
elasticity - Osteoporosis risk (postmenopausal estrogen
- ↓ vaginal lubrication loss)
- Pelvic floor muscle weakening - Higher cardiovascular risk post-menopause

Women - Gradual ↓ testosterone - Benign prostatic hyperplasia (BPH) → urinary

(“andropause”) hesitancy, weak stream
- ↓ sperm production & motility - Erectile dysfunction
- Longer refractory period after - Prostate cancer
ejaculation - Hypogonadism
- ↓ penile rigidity & ↑ time to achieve - Gynecomastia (rare, often
erection medication-related)

Both - ↓ sexual responsiveness (slower - Sexual activity decline often due to illness,
arousal, fewer orgasms) medications, or partner availability—not just
- Thinning of genital skin & mucosa aging itself
- ↓ pelvic muscle tone - Psychosocial factors (widowhood, depression,
body image issues) affect sexual health

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Management of Reproductive Aging

Management of age-related reproductive changes requires a holistic

approach that addresses physical symptoms, sexual function, and emotional
well-being. For women, interventions often focus on mitigating the effects of
estrogen decline, such as vasomotor symptoms and urogenital atrophy. Systemic
hormone therapy (HT), using estrogen with or without progesterone, remains the
gold standard for managing hot flashes and improving quality of life, though its use
must be tailored to individual risk profiles due to potential adverse effects, including
increased risk of breast cancer and thromboembolism (Davis & Baber, 2022). Local
estrogen therapy—administered via creams, tablets, or vaginal rings—provides
targeted relief for genitourinary symptoms without substantial systemic absorption,
making it a safer option for many postmenopausal women (Santoro et al., 2023).
Complementary strategies such as pelvic floor muscle training can improve
continence and pelvic support, while adequate calcium and vitamin D intake,
resistance training, and balance exercises help preserve bone health and reduce
fracture risk.

For men, management strategies address both hormonal and structural

changes associated with aging. Testosterone replacement therapy (TRT) may
benefit hypogonadal men by improving libido, energy, and muscle mass; however,
this requires careful screening for prostate cancer and cardiovascular disease
(Corona et al., 2021). Benign prostatic hyperplasia (BPH), which affects the majority
of older men, can be managed pharmacologically with alpha-blockers or 5-alpha
reductase inhibitors, while minimally invasive procedures or surgery are reserved for
more severe cases. Erectile dysfunction (ED) treatment typically begins with
phosphodiesterase-5 inhibitors such as sildenafil, with mechanical devices or
surgical implants as alternatives when medications fail. Importantly, addressing
comorbidities such as diabetes, hypertension, or medication side effects can
significantly improve sexual function in both sexes.

Beyond physical treatment, effective management also integrates

psychosocial support. Reproductive aging impacts self-esteem, sexual identity, and

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intimate relationships. Open communication between patients and healthcare
providers can reduce stigma and ensure that sexual health remains a normal part of
later-life care (Fileborn et al., 2021; Gewirtz-Meydan & Ayalon, 2020). Culturally
sensitive counseling is critical, as societal norms shape how individuals perceive
menopause, andropause, and sexual activity in older adulthood (Avis & Crawford,
2021). By combining targeted medical interventions with emotional and relational
support, clinicians can help older adults maintain sexual health, physical comfort,
and quality of life well into advanced age.

CONCLUSION

Reproductive aging in both men and women is an inevitable biological

process marked by hormonal, structural, and functional changes. In women, the
depletion of ovarian follicles and the decline of estrogen and progesterone lead to
menopause, accompanied by vasomotor symptoms, urogenital atrophy, metabolic
alterations, and increased risks for osteoporosis and cardiovascular disease. In men,
testicular atrophy, reduced sperm motility, gradual testosterone decline, and
conditions such as erectile dysfunction and benign prostatic hyperplasia become
more prevalent with age.

Given these changes, proactive strategies are essential to preserve quality of

life. For women, hormone therapy, lifestyle interventions, and bone health
monitoring can mitigate menopausal symptoms and related health risks. For men,
regular prostate screening, management of testosterone levels when clinically
indicated, and cardiovascular health maintenance are recommended. Both sexes
benefit from regular physical activity, balanced nutrition, smoking cessation, and
mental health support.

Ultimately, recognizing reproductive aging as part of a broader

biopsychosocial transition allows for targeted medical interventions and informed
lifestyle adjustments, fostering healthy aging and sustained well-being throughout
later life.

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