Sexual health needs and challenges among ageing women in Sub-Saharan Africa: a systematic review

Background The global ageing population is growing rapidly, with Sub-Saharan Africa undergoing a significant demographic transition. Although research on general ageing-related health outcomes in the region, such as frailty, multimorbidity, and socioeconomic deprivation, has expanded in recent years, the sexual health needs of ageing women remain comparatively understudied and inadequately addressed. This systematic review synthesizes evidence regarding the sexual health needs, challenges, and reproductive health concerns of ageing women in Sub-Saharan Africa. Methods Scopus and PubMed databases were used to search, select, and review the publication records between 1 January 2000 and 26 May 2026. Sexual or reproductive health of women framed as ageing, older, elderly, menopausal, or postmenopausal in Sub-Saharan Africa studies were included. The PRISMA 2020 guidelines were followed for study selection and reporting. Data extraction and quality assessment were performed systematically. Results A total of 358 records identified across Scopus and PubMed, 34 studies met the eligibility criteria and were included in the review. Six themes were identified: patterns and predictors of sexual activity in later life; menopausal symptom burden and sexual dysfunction; the intersection of HIV status and reproductive ageing; socio-cultural norms and the culture of silence; contraceptive needs and fertility ambivalence; and health-seeking behaviour and systemic barriers. Ageing women encounter multiple intersecting challenges, including age-related physiological changes, socio-cultural marginalisation, and inadequate responses from health systems. Conclusion Sexual health needs of ageing women in Sub-Saharan Africa remain largely overlooked in research, policy, and healthcare delivery. There is an urgent need for age-sensitive sexual and reproductive health services, training for healthcare providers, and policy frameworks that acknowledge and address the unique needs of this population. Future research should prioritise empirical studies that highlight the lived experiences of ageing women and evaluate interventions aimed at enhancing their sexual health and wellbeing.