Until recently there has been a paucity of factual data on the effects of the climacteric upon women's sexuality. The basic questions here are: do changes occur in sexual behaviour, sexual interest or responsiveness during the climacteric years? If so, what are the variations and how are they caused?

Two variables used extensively as a measure of sexuality are coital frequency and orgasmic frequency. Kinsey et al. (1953) showed that the degree of sexual activity remained fairly constant in unmarried women up to 55 years of age. By contrast, sexual activity in unmarried men declined gradually from puberty onwards. For married men and women they found that the frequency of sexual outlets declined during the life span. Kinsey et al. emphasized that the decreasing frequency of sexual intercourse and orgasm in marriage does not prove that the sexual capacity of the woman is influenced by her own ageing but could instead be a result of her husband's ageing. These authors were of the opinion that there is little evidence of any ageing in the sexual capacity of the female until late in her life.

Among the conflicts of modern life is that faced by many educated women between the desire to pursue a professional career and the demands of their potential maternal role. Some resolve this by deferring having children. This deferment, coupled with an increased awareness of birth defects generally and of the problems faced by older mothers, leads to an increasing number of queries to genetic advisory services, family doctors, obstetricians, and family planning centres, as to the specific risks in reproduction by older parents. The appreciable risk of death in childbed of earlier days is no longer with us, thanks to modern obstetric techniques. But the child morbidity due to congenital and genetic disorders, already appreciable (Roberts, Chavez & Court, 1970; Roberts, 1975) and increasing both proportionately and absolutely, and the evidence that some of these increase in incidence with age, mean that there is a real basis for the enquirers' concern. The following review of the ways in which parental ageing affects the incidence of such disorders, and of the mechanisms that appear to be responsible, places the increased risks in perspective.

Two American ethnic (sub-cultural) groups of Cuban and Jewish women of comparable socio-economic status were studied in New Jersey, USA in order to show how each of their cultures influences the climacteric. A wide spectrum of cultural variables, associated with each of these ethnic groups, was obtained through a questionnaire about self-image, reproductive history, attitudes toward the menopause, climacteric symptoms, the role of the physician during the climacteric and behaviour, attitudes and feelings about sex. A further differentiation of these variables, associated with each specific ethnic group, yielded an ethnic profile from which ethnic group membership could be predicted.

There is no need to have a workshop to show that fertility falls with age. Nothing works so well as it gets older. One has only to look at the progression of one's teeth, a very visible manifestation of the process of ageing, to make one wonder what goes on inside the reproductive system!

Probably there is no evolutionary disadvantage to having reduced fertility with age because by the time that there is a significant reduction in fecundity the genetic pool which will be added to subsequent generations has already been added. In biological terms, there may be a positive advantage in reduced fertility in older women, since the human infant is dependent on its parents for such a relatively long time and there may be an advantage in the mother surviving for 7, 8, 9 or 10 years after her youngest child is born. In looking for a teleological explanation of declining fertility with age and of a menopause, this is one possible explanation.