Most men and women remain sexually active into mid-life and beyond. However, sexual functioning in peri- and postmenopausal women, and their partners, is widely variable. Somatic symptoms, psychological issues, partner's physical, psychological, and relationship status are all important to one's perceived quality of life, and may greatly affect sexuality. These wide-ranging influences complicate assessment, diagnosis, and subsequent management of sexual problems. A number of factors influence sexual functioning in menopausal women. There are age-related changes that are unrelated to menopause, which include changes in drive, body image, and general health status. Beliefs about menopause and sexuality impact sexual functioning in women. Changes in relationship status and the physical health of a partner may also influence sexuality. Physiologic changes, directly related to menopausal hormone changes, often impact sexual functioning, both directly and indirectly. Health care providers can play an important role in treating sexual problems and enhancing sexuality in aging patients. Effective evaluation will result in accurately determining the source(s) of an individual's or a couple's sexual dysfunction. Treatment may include the following: basic education about sexuality and sexual functioning, normalizing sexual activity in aging adults, medical management of symptoms or problems that are interfering with sexual desire or activity (such as HRT for vaginal atrophy or in reduction of hot flashes), referral for treatment of the partner's physical or psychological problem, and/or sex therapy to treat a sexual dysfunction or to manage a chronic physical problem that requires a change in a person's or couple's typical sexual repertoire. This paper includes a detailed case history of a couple to illustrate the concepts mentioned above.