Sexuality and the menopause

Sexual behaviors and function during menopausal transition-does menopausal hormonal therapy play a role?

OBJECTIVES

The menopausal transition is a biological adaptation to the variety of life changes (body, comorbidities, relationship), but that biology is not an "end all" in the context of sexual function and overall sexual health. The aim of this study is to evaluate determinants altering the risk of female sexual dysfunction (FSD) and other sexual problems and to establish whether menopausal hormonal therapy (MHT) decreases that risk and modifies sexual behaviors.

METHODS

A cross-sectional observational study was conducted in 210 women between the ages of 45 and 55. Two groups were identified: MHT users (n = 107) and controls-MHT non-users (n = 103). Diagnostic and Statistical Manual of Mental Disorders -five criteria were used to assess sexual dysfunction. Sexual problems were evaluated by the Changes in Sexual Function Questionnaire (CSFQ), body image by Body Exposure during Sexual Activity Questionnaire, and quality of relationship by the Well-Match Relationship Questionnaire. Logistic regression was used to determine the risk factors for FSD and sexual problems.

RESULTS

Women using MHT had higher body esteem during sexual activities, better sexual function (CSFQ) in all domains except desire/interest, better quality of relationship, and lower prevalence of FSD and sexual complaints (CSFQ) except arousal/excitement problems. However, self-rated effects of MHT on sexual behaviors showed that MHT did not play a major role. Women with secondary and higher education (OR = 0.09, CI: 0.02-0.4; P < 0.01 and OR = 0.2, CI: 0.05-1.0; P < 0.05, respectively) and with a higher number of lifetime sexual partners (OR = 0.6, CI: 0.4-0.9; P < 0.01) were less likely to have FSD. In contrast, individuals with more anxious behaviors during sexual activity (OR = 3.2, CI: 1.3-7.3; P < 0.01) and with more severe menopausal symptoms (OR = 1.1, CI: 1.0-1.2; P < 0.001) were more likely to have FSD. Using MHT was not associated with that risk nor with sexual function.

CONCLUSION

In women during menopausal transition, sexual behaviors were different in MHT users compared with non-users. However, in this cross-sectional observational study conducted in 210 women between the ages of 45 to 55 years, using MHT was not associated with modification of sexual function, decreasing the risk of sexual dysfunction, nor sexual problems.

Analysis of factors that influence the quality of sexual life of climacteric women in China

OBJECTIVE

The study aimed to identify the factors associated with the sexual lives of perimenopausal and postmenopausal women in China.

METHODS

A total of 426 participants were approached about this study from May 2012 to August 2013. In total, 252 cases were included in this study. One hundred and ninety-seven women who filled out the Quality of Sexual Life Questionnaire for Women (QSLQW) and the modified Kupperman Menopausal Index (KMI) had an active sexual life. Pearson's coefficient index was used to determine the correlation between the KMI and different domains of the QSLQW. Multivariable statistical analysis was performed to determine the correlation between different factors and the sexual life of perimenopausal and postmenopausal women.

RESULTS

When the participants reported a higher KMI, they suffered lower sexual satisfaction (r = -0.16, p = 0.035), more severe sexual anxiety (r = -0.367, p = 4.9 × 10^-7), and less sexual response (r = -0.21, p = 0.004). No correlation was found between the KMI and sexual communication, sexual attitude, and self-image. Multivariable statistical analysis showed that menopause status and higher KMI scores are associated with a decrease in sexual satisfaction among Chinese women (β = -9.76, 95% CI -16.89 to -2.64 and β = -0.41, 95% CI -0.68 to -0.15, respectively), and that the better the spousal relationship, the fewer deliveries and the higher the scores of sexual life quality (β = 8.86, 95% CI -0.91 to 18.63 and β = -6.65, 95% CI -11.83 to -1.48, respectively).

CONCLUSION

Factors including parity, spousal relationship, menopausal status, and menopausal symptoms are associated with the quality of sexual life of perimenopausal and postmenopausal women in China.

"The Pleasure Is Better as I've Gotten Older": Sexual Health, Sexuality, and Sexual Risk Behaviors Among Older Women Living With HIV

There is limited research examining the sexual health and well-being of older women living with HIV (OWLH). Most studies focus on sexual dysfunction, leaving aside the richer context of sexuality and sexual health, including the effect of age-related psychosocial and interpersonal changes on sexual health behaviors. Guided by the integrative biopsychosocial model and the sexual health model, this study explored the importance of sex and sexuality among OWLH to identify their sexual health and HIV prevention needs for program planning. A purposive sample (n = 50) of OWLH was selected from a parent study (n = 2052). We conducted 8 focus groups and 41 in-depth interviews with 50 African American and Latina OWLH aged 50-69 years old in three U.S. cities. The triangulation approach was used to synthesize the data. Six salient themes emerged: sexual pleasure changes due to age, sexual freedom as women age, the role of relationships in sexual pleasure, changes in sexual ability and sexual health needs, sexual risk behaviors, and ageist assumptions about older women's sexuality. We found that sexual pleasure and the need for intimacy continue to be important for OWLH, but that changing sexual abilities and sexual health needs, such as the reduction of sexual desire, as well as increased painful intercourse due to menopause-associated vaginal drying, were persistent barriers to sexual fulfillment and satisfaction. Particular interpersonal dynamics, including low perceptions of the risk of HIV transmission as related to gender, viral suppression, and habitual condomless sex with long-term partners without HIV transmission have resulted in abandoning safer sex practices with serodiscordant partners. These findings suggest that HIV prevention for OWLH should focus on how sexual function and satisfaction intersect with sexual risk. HIV prevention for OWLH should promote ways to maintain satisfying and safe sex lives among aging women.

Longitudinal Trends in Sexual Behaviors with Advancing Age and Menopause Among Women With and Without HIV-1 Infection

We assessed changes in self-reported sexual activity (SA) over 13 years among HIV-infected and uninfected women. The impact of aging and menopause on SA and unprotected anal or vaginal intercourse (UAVI) was examined among women in the Women's Interagency HIV Study (WIHS), stratifying by HIV status and detectable viral load among HIV-infected women. Generalized mixed linear models were fitted for each outcome, adjusted for relevant covariates. HIV-uninfected women evidenced higher levels of SA and UAVI than HIV-infected. The odds of SA declined by 62-64 % per decade of age. The odds of SA in a 6-month interval for women aged 40-57 declined by 18-22 % post-menopause (controlling for age). Among HIV+/detectable women only, the odds of any UAVI decreased by 17 % per decade of age; the odds of UAVI were unchanged pre-menopause, and then decreased by 28 % post-menopause. Elucidating the factors accounting for ongoing unprotected sex among older women should inform interventions.

Sex and the menopausal woman: A critical review and analysis

Medical discourse has positioned the menopausal transition as a time of sexual atrophy and loss of femininity, with hormonal replacement as the solution. In contrast, feminist critics have argued that women’s experience of sexual embodiment during menopause is culturally and relationally mediated, tied to discursive constructions of aging and sexuality, which are negotiated by women. The aim of this article is to present a critical examination of women’s experiences of sexuality during and after the menopausal transition, drawing on previous research in this field, as well as qualitative research we have conducted with women at midlife, and women who have experienced premature menopause as a consequence of cancer treatment. We aim to challenge myths and misconceptions about the inevitability of sexual decline at menopause, as well as normalise the embodied changes that some women experience – whether menopause is premature, or occurs at midlife. We argue that sexual difficulties or disinterest reported by women during and after menopause are more strongly associated with psycho-social factors than hormonal status, in particular psychological well-being, relationship context and a woman’s negotiation of cultural constructions of sex, aging and femininity. However, sexuality can continue to be a positive experience for women throughout adult life and into old age, with many menopausal women reporting increased sexual desire and response. This undermines the biomedical construction of menopause as a time of inevitable sexual atrophy and decay.

Quality of life of postmenopausal women and their spouses: a community-based study

BACKGROUND

Most women spend more than one-third of their lives after menopause. Due to physiologic changes in that period, menopause can cause a series of symptoms such as vasomotor symptoms, psychologic problems, and sexual dysfunction, which can affect the women's quality of life (QoL) and other family members, especially their spouse.

OBJECTIVES

The present study aimed to determine the association between the QoL of postmenopausal women and their husbands.

PATIENTS AND METHODS

This descriptive-inferential cross-sectional study was conducted according to the census of 2006 in Iran. A total of 400 postmenopausal women aging 50 to 59 years and their spouses in 80 cluster heads of Ilam City residents were selected and studied in collaboration with the Statistical Center of Iran. The required data were gathered using the short-form health survey (SF-36) questionnaire and demographic questionnaire developed by the researcher-trained interviewers. Data were analyzed by SPSS 18 through Kruskal Wallis test, Wilcoxon signed ranks test, and correlation.

RESULTS

The participants' mean age was 54.2 ± 2.8 years for women and 61.1 ± 6.1 years for their spouses. More than half of the women (57%) and about one-third of men (32.8%) were illiterate. The employed educated women aging 50 to 54 years had a higher mean score of SF-36 domains. The difference in education was significant in all domains except for mental health. There was a significant difference in age in all domains except in general health. The mean score of all domains of QoL was significantly less in the illiterate men than in the literate ones (P < 0.05). The results of the present study showed a significant correlation (P < 0.05) between the couples' QoL, vasomotor symptoms, and aging. Spearman test showed a significant positive correlation in all domains of QoL between postmenopausal women and their spouses (correlation coefficient, 0.48-0.63).

CONCLUSIONS

Based on the results of the present study and other performed studies in this regard, menopause, aging, vasomotor symptoms, and education had significant association with the QoL of postmenopausal women. The reduced QoL in postmenopausal women could eventually lead to the reduced QoL of their spouses. Therefore, it is necessary to plan for the education of these women and their husbands to broaden their understanding of the changes of menopause and ways to improve their QoL.

Cultural issues and the menopause

Culture is a rather amorphous concept yet has a huge impact on our attitudes to diet, lifestyle, religion, sexuality and, via its influence on society, attitudes to education and health care. The midlife is a time of emotional and hormonal upheaval for any woman so defining the effects on culture on her response is challenging. Much depends on the value she places on her fertility and sexuality together with her own goals and aspirations, yet these are also influenced by culture. Very few traditional cultures survive in isolation for comparison. Shifting populations mean counter influences and transitional societies can be ambivalent. Emigrants and refugees transplanted into a different environment may struggle with the concept of acculturation. In time, all cultures evolve regardless. Finally, there may be biological and hormonal differences between races. This article seeks to place these different forces into context.

Sexual dysfunction in women with obstructive sleep apnea

BACKGROUND

Female sexual dysfunction is vastly under-recognized but has been previously described in chronic disease states. Sexual dysfunction in male patients with obstructive sleep apnea (OSA) is well described, but not in females.

OBJECTIVE

The objective of this study was to assess the prevalence of sexual dysfunction in women with OSA.

METHODS

We studied 21 consecutive pre-menopausal women with OSA, referred to our sleep lab, and who had a positive study for sleep apnea (respiratory disturbance index (RDI) > 5), and 11 healthy pre-menopausal women were included as the control group. Subjects were administered the Female Sexual Function Index (FSFI) questionnaire and a mood scale-Profile of Mood States.

RESULTS

Of the study group, 11 women (52.4%) had FSFI scores in the poor range (<23) as compared to the control group, in which none of the women (0%) had FSFI scores in the poor range (<23). Negative mood domain scores were not different in patients with poor FSFI compared to patients with normal FSFI scores. There was no correlation between obesity, severity of sleep apnea, or mood disorders on overall scores of sexual dysfunction. Among individual domains, there was a correlation between RDI and arousal scores.

CONCLUSION

In our study, we have found that prevalence of sexual dysfunction is high among women with OSA. Physicians should routinely screen and evaluate women with OSA for sexual dysfunction.