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Agarwal A, Thomas HN. The relationship between religious affiliation and menopause symptoms and attitudes in United States women. Maturitas 2024; 185:108010. [PMID: 38701716 DOI: 10.1016/j.maturitas.2024.108010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 04/21/2024] [Accepted: 04/23/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVES This study's aim is to examine patterns of menopause symptoms and attitudes among United States women from different religious affiliations. STUDY DESIGN We used data from a national sample of midlife and older adults. For this analysis, we included only women who were postmenopausal or had undergone hysterectomy. We constructed univariate and multivariate logistic regression models to examine the relationship between religious affiliation and menopause symptoms and attitudes while adjusting for potential confounders. MAIN OUTCOME MEASURES Menopause symptoms (hot flashes, pain in sexual interactions, pleasure in sexual interactions, trouble falling asleep) and attitudes (relief on periods stopping, regret on periods stopping, worry about becoming less attractive) measured by self-report on Likert scales. RESULTS Across denominations, 47 % of women experienced hot flashes, 48 % experienced pain in sexual interactions, 95 % experienced pleasure, and 88 % had trouble falling asleep. Regarding attitudes towards menopause and aging, 62 % felt relief in their periods stopping, while 56 % expressed worry about becoming less attractive with aging. Baptist women were more likely to experience hot flashes and trouble falling asleep compared to Catholic women. However, when adjusted for smoking status, this relationship did not persist. Unaffiliated and Spiritual women were less likely to experience trouble falling asleep and more likely to report pleasure in sexual interactions compared to Catholic women. Spiritual women were significantly more likely to feel regret on periods stopping compared to Catholics. CONCLUSIONS There is a relationship between religious affiliation and the menopause experience. These findings demonstrate the importance of considering social influences on women's health.
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Affiliation(s)
- Annika Agarwal
- Department of Anthropology, University of Pittsburgh, Pittsburgh, PA 15260, USA.
| | - Holly N Thomas
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA.
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Thomas HN, Brotto LA, de Abril Cameron F, Yabes J, Thurston RC. A virtual, group-based mindfulness intervention for midlife and older women with low libido lowers sexual distress in a randomized controlled pilot study. J Sex Med 2023:qdad081. [PMID: 37353906 PMCID: PMC10390320 DOI: 10.1093/jsxmed/qdad081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 05/22/2023] [Accepted: 05/03/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Distressing low libido is common among women and has significant negative impacts; mindfulness has shown promise to increase sexual desire in women with low libido, but existing interventions are not tailored to midlife and older women. AIM We adapted a mindfulness intervention to meet the needs of this population and conducted a pilot randomized controlled trial to assess feasibility and acceptability. METHODS Women aged ≥45 years with low libido were randomized to the mindfulness intervention or an education group that met over videoconferencing. The intervention included mindfulness instruction and practice, group discussion, and education on sexuality and aging. The education group included general information on menopause and health. OUTCOMES We defined feasibility by the number of screened women who enrolled and completed their group. We defined acceptability as satisfaction with the group and likelihood of recommending it to another woman with low libido. We assessed sexual function (Female Sexual Function Index) and sexual distress (Female Sexual Distress Scale-Revised) at 6 weeks postconclusion. RESULTS Of 81 women screened, 31 were randomized to mindfulness and 30 to education. Eighteen women in the intervention group and 23 in the control group attended at least 1 session. Time conflict was the main reason for nonattendance. Of the 41 women who started attending groups, 37 (90%) attended at least 5 sessions. In the mindfulness group, 73% of women were very or extremely satisfied. Women in the mindfulness group were more likely to recommend it to another person with low libido as compared with those in the education group (P = .031); 67% said that they would probably or definitely recommend it. There were no significant changes in sexual function in either group (mean Female Sexual Function Index score, 22.6 to 18.6 [P = .101] with mindfulness and 21.2 to 19.7 [P = .537] with education). Women in the mindfulness group had significant improvements in sexual distress (mean Female Sexual Distress Scale-Revised score, 27.1 to 19.7; P = .021) while women in the education group did not (19.0 to 15.8; P = .062). CLINICAL IMPLICATIONS Mindfulness may reduce sexual distress in older women with low libido. STRENGTHS AND LIMITATIONS This is the first trial testing mindfulness for midlife and older women with low libido. CONCLUSION A virtual mindfulness intervention for midlife and older women with low libido is feasible and acceptable and appears to improve sexual distress as compared with an education control; these findings provide data that can be used to design a larger clinical trial.
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Affiliation(s)
- Holly N Thomas
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15217, United States
| | - Lori A Brotto
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver V5Z 4M2, Canada
| | - Flor de Abril Cameron
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15217, United States
| | - Jonathan Yabes
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15217, United States
| | - Rebecca C Thurston
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15217, United States
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Prochownik K, Jain R, Taylor-Cousar JL, Lavage DR, Stransky OM, Thomas HN, Kazmerski TM. Menopause in people with cystic fibrosis. Menopause 2023; 30:401-405. [PMID: 36720079 DOI: 10.1097/gme.0000000000002155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Abstract
This is the first study to examine the perimenopausal experiences of women with cystic fibrosis (CF) in the era of modulator therapy. As the life expectancy of people with CF continues to grow, CF care teams need to be able to address the perimenopausal needs of their female patients as well as the interactions between the menopausal transition and CF.
Objective
This study aimed to describe the menopause experience of people with cystic fibrosis (CF).
Methods
We conducted a computer-based cross-sectional survey of women with CF 25 years or older at 10 US CF centers exploring a range of sexual and reproductive health concerns, including menopause. We used descriptive statistics to analyze results.
Results
Of 460 participants, 5 (3%) were perimenopausal and 34 (7%) were postmenopausal. Of participants perimenopausal or menopausal (n = 39), 97% reported the following menopausal symptoms occurring at least once a week: most commonly early wake-up (83%); stiffness/soreness in joints, neck, or shoulders (65%); and night sweats (65%). Among menopausal participants, the median self-reported age at menopause was 48.5 years (interquartile range, 5.5 y). Thirty percent experienced worsened CF symptoms during menopause, and 42% experienced worsening CF symptoms after menopause. Twenty-four percent of menopausal participants were on estrogen therapy and 15% on estrogen and progesterone therapy. Three-fourths of participants using hormone therapy reported no change in their CF symptoms. One percent of the 460 survey participants reported discussing menopause with their CF provider, despite 19% wanting to discuss this topic with their CF team.
Conclusions
This is the first study to describe menopause symptoms of people with CF. People with CF experience a variety of menopausal symptoms and often report a worsening of their CF symptoms after menopause, suggesting an interplay between female sex hormones and CF. Larger studies are needed comparing the sexual and reproductive health experiences and care needs of people with CF in the menopause transition to the general population.
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Affiliation(s)
| | | | | | - Daniel R Lavage
- From the Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA
| | - Olivia M Stransky
- Center for Innovative Research on Gender Health Equity, University of Pittsburgh, Pittsburgh, PA
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Greco CM, Dore GA, Weinberg JM, Roth I, Thomas HN, Lawrence S, Rodriguez R, McGillis M, Morone NE. A Brief Measure of Fidelity for Mindfulness Programs: Development and Evaluation of the Concise Fidelity for Mindfulness-Based Interventions Tool. Glob Adv Integr Med Health 2023; 12:27536130231174234. [PMID: 37426338 PMCID: PMC10327996 DOI: 10.1177/27536130231174234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Background Mindfulness research and clinical programs are widespread, and it is important that mindfulness-based interventions are delivered with fidelity, or as intended, across settings. The MBI:TAC is a comprehensive system for assessing teacher competence, yet it can be complex to implement. A standardized, simple fidelity/engagement tool to address treatment delivery is needed. Objective We describe the development, evaluation, and outcomes of a brief, practical tool for assessing fidelity and engagement in online mindfulness-based programs. The tool contains questions about session elements such as meditation guidance and group discussion, and questions about participant engagement and technology-based barriers to engagement. Methods The fidelity rating tool was developed and tested in OPTIMUM, Optimizing Pain Treatment in Medical settings Using Mindfulness. The OPTIMUM study is a 3-site pragmatic randomized trial of group medical visits and adapted mindfulness-based stress reduction for primary care patients with chronic low back pain, delivered online. Two trained study personnel independently rated 26 recorded OPTIMUM sessions to determine inter-rater reliability of the Concise Fidelity for Mindfulness-Based Interventions (CoFi-MBI) tool. Trained raters also completed the CoFi-MBI for 105 sessions. Raters provided qualitative data via optional open text fields within the tool. Results Inter-rater agreement was 77-100% for presence of key session components, and 69-88% for Likert ratings of participant engagement and challenges related to technology, with discrepancies only occurring within 2 categories: 'very much' and 'quite a bit'. Key session components occurred as intended in 94-100% of the 105 sessions, and participant engagement was rated as 'very much' or 'quite a bit' in 95% of the sessions. Qualitative analysis of rater comments revealed themes related to engagement challenges and technology failures. Conclusion The CoFi-MBI provides a practical way to assess basic adherence to online delivery of mindfulness session elements, participant engagement, and extent of technology obstacles. Optional text can guide strategies to improve engagement and reduce technology barriers.
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Affiliation(s)
- Carol M. Greco
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, Pennsylvania
| | - Graham A. Dore
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania
| | - Janice M. Weinberg
- Department of Biostatistics, Boston University School of Public Health, Massachusetts
| | - Isabel Roth
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, NC, USA
| | - Holly N. Thomas
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pennsylvania
| | - Suzanne Lawrence
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania
| | | | | | - Natalia E. Morone
- Boston Medical Center, Boston, MA, USA
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
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Merriam S, Kling JM, Thomas HN, Casas RS. Female Sexual Dysfunction: A Primer for Primary Care Health Professionals. MedEdPORTAL 2023; 19:11312. [PMID: 37113246 PMCID: PMC10126124 DOI: 10.15766/mep_2374-8265.11312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 01/25/2023] [Indexed: 05/19/2023]
Abstract
Introduction Female sexual dysfunction (FSD) is common and associated with decreased quality of life, relationship satisfaction, and overall well-being. However, primary care practitioners report discomfort discussing, diagnosing, and treating FSD. Methods We delivered two sessions on the approach to evaluation and treatment of FSD: a 60-minute didactic session and a 90-minute workshop. The intended audience was primary health care professionals who care for women. The workshop utilized interactive teaching methods including a large-group discussion, case-based discussions, debrief of an observed patient-physician discussion, and language drills to develop participants' knowledge and skills. Participants were surveyed about their practice patterns and attitudes toward FSD following the sessions on a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree). Results We collected 131 evaluations from a national Veterans Health Administration 60-minute didactic and four evaluations from the Society of General Internal Medicine Annual Meeting 90-minute workshop (response rates were 60% and 15%, respectively). One hundred thirty-five interdisciplinary trainees and practitioners from both audiences highly rated the workshop content (M = 4.1) and the overall session (M = 4.3). Didactic participants (n = 131) also reported high satisfaction (M = 4.5), increased knowledge and skills (M = 4.4), and improved interprofessional collaborative practice (M = 4.4) as a result of the training. Discussion Our evaluation shows high satisfaction following interactive multimodal sessions on FSD. These adaptable resources can be used in multiple educational settings (didactic and workshop) and for multiple time frames to teach about FSD.
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Affiliation(s)
- Sarah Merriam
- Clinical Assistant Professor, Department of Medicine, University of Pittsburgh School of Medicine, and Department of Medicine, VA Pittsburgh Healthcare System
- Corresponding author:
| | | | - Holly N. Thomas
- Assistant Professor, Department of Medicine, University of Pittsburgh School of Medicine
| | - Rachel S. Casas
- Associate Professor, Department of Medicine, Penn State Health Milton S. Hershey Medical Center
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Greco CM, Gaylord SA, Faurot K, Weinberg JM, Gardiner P, Roth I, Barnhill JL, Thomas HN, Dhamne SC, Lathren C, Baez JE, Lawrence S, Neogi T, Lasser KE, Castro MG, White AM, Simmons SJ, Ferrao C, Binda DD, Elhadidy N, Eason KM, McTigue KM, Morone NE. The design and methods of the OPTIMUM study: A multisite pragmatic randomized clinical trial of a telehealth group mindfulness program for persons with chronic low back pain. Contemp Clin Trials 2021; 109:106545. [PMID: 34455111 PMCID: PMC8691659 DOI: 10.1016/j.cct.2021.106545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 01/04/2023]
Abstract
Mindfulness-based stress reduction (MBSR) is an evidence-based non-pharmacological approach for chronic low back pain (cLBP), yet it is not readily available or reimbursable within primary care clinics. Primary care providers (PCPs) who wish to avoid prescribing opioids and other medications typically have few options for their cLBP patients. We present the protocol of a pragmatic clinical trial entitled OPTIMUM (Optimizing Pain Treatment In Medical settings Using Mindfulness). OPTIMUM is offered online via telehealth and includes medical group visits (MGV) with a PCP and a mindfulness meditation intervention modeled on MBSR for persons with cLBP. In diverse health-care settings in the US, such as a safety net hospital, federally qualified health centers, and a large academic health system, 450 patients will be assigned randomly to the MGV + MBSR or to usual PCP care alone. Participants will complete self-report surveys at baseline, following the 8-week program, and at 6- and 12-month follow-up. Health care utilization data will be obtained through electronic health records and via brief monthly surveys completed by participants. The primary outcome measure is the PEG (Pain, enjoyment, and general activity) at the 6-month follow-up. Additionally, we will assess psychological function, healthcare resource use, and opioid prescriptions. This trial, which is part of the NIH HEAL Initiative, has the potential to enhance primary care treatment of cLBP by combining PCP visits with a non-pharmacological treatment modeled on MBSR. Because it is offered online and integrated into primary care, it is expected to be scalable and accessible to underserved patients. Clinical Trials.gov: NCT04129450.
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Affiliation(s)
- Carol M Greco
- Department of Psychiatry and Physical Therapy, University of Pittsburgh School of Medicine and School of Health and Rehabilitation Sciences, PA, United States of America
| | - Susan A Gaylord
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Kim Faurot
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Janice M Weinberg
- Department of Biostatistics, Boston University School of Public Health, MA, United States of America
| | - Paula Gardiner
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Isabel Roth
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Jessica L Barnhill
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Holly N Thomas
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, PA, United States of America
| | - Sayali C Dhamne
- Boston University School of Public Health, Boston Medical Center, MA, United States of America
| | - Christine Lathren
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Jose E Baez
- General Internal Medicine, Boston Medical Center, MA, United States of America
| | - Suzanne Lawrence
- Department of Psychiatry, University of Pittsburgh, PA, United States of America
| | - Tuhina Neogi
- Section of Rheumatology, Department of Medicine, Boston University School of Medicine, United States of America
| | - Karen E Lasser
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States of America
| | - Maria Gabriela Castro
- Siler City Community Health Center, Piedmont Health Services, Department of Family Medicine, University of North Carolina at Chapel Hill, NC, United States of America
| | - Anna Marie White
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, PA, United States of America
| | | | - Cleopatra Ferrao
- General Internal Medicine, Boston Medical Center, MA, United States of America
| | - Dhanesh D Binda
- Boston University School of Medicine, Boston, MA, United States of America
| | - Nandie Elhadidy
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Kelly M Eason
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Kathleen M McTigue
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, PA, United States of America
| | - Natalia E Morone
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States of America.
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Foy CG, Newman JC, Berlowitz DR, Russell LP, Kimmel PL, Wadley VG, Thomas HN, Lerner AJ, Riley WT. Blood Pressure, Sexual Activity, and Erectile Function in Hypertensive Men: Baseline Findings from the Systolic Blood Pressure Intervention Trial (SPRINT). J Sex Med 2019; 16:235-247. [PMID: 30655182 PMCID: PMC6444897 DOI: 10.1016/j.jsxm.2018.12.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/29/2018] [Accepted: 12/06/2018] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Erectile function, an important aspect of quality of life, is gaining increased research and clinical attention in older men with hypertension. AIM To assess the cross-sectional association between blood pressure measures (systolic blood pressure [SBP]; diastolic blood pressure [DBP]; and pulse pressure [PP]) and (i) sexual activity and (ii) erectile function in hypertensive men. METHODS We performed analyses of 1,255 male participants in a larger randomized clinical trial of 9,361 men and women with hypertension aged ≥50 years. MAIN OUTCOME MEASURES The main outcome measures were self-reported sexual activity (yes/no) and erectile function using the 5-item International Index of Erectile Function (IIEF-5). RESULTS 857 participants (68.3%) reported being sexually active during the previous 4 weeks. The mean (SD) IIEF-5 score for sexually active participants was 18.0 (5.8), and 59.9% of the sample reported an IIEF-5 score <21, suggesting erectile dysfunction (ED). In adjusted logistic regression models, neither SBP (adjusted odds ratio = 0.998; P = .707) nor DBP (adjusted odds ratio = 1.001; P = .929) was significantly associated with sexual activity. In multivariable linear regression analyses in sexually active participants, lower SBP (β = -0.04; P = .025) and higher DBP (β = 0.05; P = .029) were associated with better erectile function. In additional multivariable analyses, lower PP pressure was associated with better erectile function (β = -0.04; P = .02). CLINICAL IMPLICATIONS Blood pressure is an important consideration in the assessment of erectile function in men with hypertension. STRENGTHS & LIMITATIONS Assessments of blood pressure and clinical and psychosocial variables were performed using rigorous methods in this multi-ethnic and geographically diverse sample. However, these cross-sectional analyses did not include assessment of androgen or testosterone levels. CONCLUSIONS Erectile dysfunction was highly prevalent in this sample of men with hypertension, and SBP, DBP, and PP were associated with erectile function in this sample. Foy CG, Newman JC, Berlowitz DR, et al. Blood Pressure, Sexual Activity, and Erectile Function in Hypertensive Men: Baseline Findings from the Systolic Blood Pressure Intervention Trial (SPRINT). J Sex Med 2019;16:235-247.
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Affiliation(s)
- Capri G Foy
- Wake Forest School of Medicine, Division of Public Health Sciences, Department of Social Sciences and Health Policy, Winston-Salem, NC, USA.
| | - Jill C Newman
- Wake Forest School of Medicine, Division of Public Health Sciences, Department of Biostatistical Sciences, Winston-Salem, NC, USA
| | - Dan R Berlowitz
- Bedford VA Hospital, Bedford, MA, and Boston University School of Medicine and Boston University School of Public Health, Boston, MA, USA
| | - Laurie P Russell
- Wake Forest School of Medicine, Division of Public Health Sciences, Department of Biostatistical Sciences, Winston-Salem, NC, USA
| | - Paul L Kimmel
- Division of Kidney, Urologic, and Hematologic Diseases, The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Bethesda, MD, USA
| | - Virginia G Wadley
- University of Alabama at Birmingham School of Medicine, Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, Birmingham, AL, USA
| | - Holly N Thomas
- University of Pittsburgh, Division of General Internal Medicine, Section of Women's Health, Pittsburgh, PA, USA
| | - Alan J Lerner
- Case Western Reserve University School of Medicine, Department of Neurology and Brain Health and Memory Center, Cleveland, OH, USA
| | - William T Riley
- National Institutes of Health, Office of Behavioral and Social Sciences Research, Bethesda, MD, USA
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Abstract
Sexual function is an important component of quality of life for women. Midlife poses several challenges to optimal sexual function and intimacy for women. In addition to anatomic factors related to estrogen deficiency, such as genitourinary syndrome of menopause, vulvovaginal atrophy, and pelvic organ prolaps, psychosocial factors, including prior sexual trauma, play an important role in sexual function in women. Several treatments have emerged for female sexual dysfunction; long-term studies and head-to-head comparisons are lacking.
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Affiliation(s)
- Holly N Thomas
- Department of Medicine, Center for Women's Health Research and Innovation (CWHRI), University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, USA.
| | - Genevieve S Neal-Perry
- Department of Obstetrics and Gynecology, University of Washington, 4245 Roosevelt Way NE, 4th Floor, Seattle, WA 98105, USA
| | - Rachel Hess
- Department of Population Health Sciences, University of Utah, 295 Chipeta Way 1N492, Salt Lake City, UT 84108, USA; Department of Internal Medicine, University of Utah, 295 Chipeta Way 1N492, Salt Lake City, UT 84108, USA
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Thomas HN, Hamm M, Borrero S, Hess R, Thurston RC. Body Image, Attractiveness, and Sexual Satisfaction Among Midlife Women: A Qualitative Study. J Womens Health (Larchmt) 2018; 28:100-106. [PMID: 30307808 DOI: 10.1089/jwh.2018.7107] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Women often undergo physical changes during the menopause transition, but the relationship between body image and sexual function in midlife is unclear. We used a qualitative approach to explore how body image relates to sexual function and satisfaction in midlife women. MATERIALS AND METHODS We conducted 19 individual interviews and 3 focus groups (total N = 39) among sexually active women 45-60 years of age using a semistructured guide. Sessions were audiorecorded and transcribed. Two investigators developed a codebook using an iterative process; the primary investigator then coded all data. Codes relating to body image were examined to identify key themes. RESULTS The mean age was 58 (range 46-59); 54% were White, 36% Black, and 10% were of another race. Most (72%) were peri- or postmenopausal. All but two women identified as heterosexual. Feeling attractive was an important reason for sexual activity. Changes in appearance, especially weight gain and breast changes, were common among these women. Women's body image impacted their sexual satisfaction; women who felt self-conscious about their bodies reported that these concerns had a negative impact on their sexual satisfaction, whereas women who felt confident discussed better sexual satisfaction, even in the face of bodily changes. Black women were more likely to discuss feeling confident than White women. CONCLUSIONS Feeling attractive is important to sexual satisfaction in midlife women. Bodily changes, especially weight gain, are common during midlife. While many women are self-conscious about their appearance, some women develop increased self-acceptance. Supporting positive body image may help midlife women maintain sexual satisfaction with aging.
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Affiliation(s)
- Holly N Thomas
- 1 Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,2 Center for Women's Health Research and Innovation (CWHRI), University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Megan Hamm
- 1 Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sonya Borrero
- 1 Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,2 Center for Women's Health Research and Innovation (CWHRI), University of Pittsburgh, Pittsburgh, Pennsylvania.,3 Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Health System, Pittsburgh, Pennsylvania
| | - Rachel Hess
- 4 Department of Population Health Sciences, University of Utah, Salt Lake City, Utah.,5 Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Rebecca C Thurston
- 2 Center for Women's Health Research and Innovation (CWHRI), University of Pittsburgh, Pittsburgh, Pennsylvania.,6 Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
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Thomas HN, Hamm M, Hess R, Borrero S, Thurston RC. Patient-Centered Outcomes and Treatment Preferences Regarding Sexual Problems: A Qualitative Study Among Midlife Women. J Sex Med 2017. [PMID: 28647404 DOI: 10.1016/j.jsxm.2017.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Sexual dysfunction is common in midlife women and can have a significant negative impact on quality of life. Although treatments exist, there is little research on which sexual function outcomes and treatments midlife women prefer. AIM To better understand the sexual function outcomes that were most important to sexually active women 45 to 60 years old and the types of treatments they would prefer from individual interviews and focus groups. METHODS Twenty individual interviews and three focus groups (N = 39) were led by a trained facilitator, audio recorded, and transcribed. Two investigators developed a codebook, and the primary investigator coded all data. A second investigator coded five randomly selected interviews to ensure intercoder reliability. Codes relating to outcomes and treatment preferences were examined to identify central themes. RESULTS The mean age was 52.8 years (range = 45-59). When asked what they would want a sexual dysfunction treatment to do, women sought solutions to specific sexual problems: low desire, vaginal pain and dryness, and decreased arousal or ability to achieve orgasm. However, when asked about the most important aspect of their sex life, most women indicated emotional outcomes, such as enhanced intimacy with their partner, were most important to them. Most women preferred behavioral over pharmaceutical treatments, citing concerns about side effects. These women felt that behavioral treatments might be better equipped to address physical and psychological aspects of sexual problems. CLINICAL IMPLICATIONS This study highlights the importance of considering not only physical but also emotional outcomes when evaluating and treating sexual dysfunction in midlife women. It also emphasizes the importance of developing behavioral treatments in addition to pharmaceutical treatments. STRENGTHS AND LIMITATIONS By using a qualitative approach, this study allowed women the time and space to speak their own words about their experiences with sexuality at midlife. In addition, different racial and ethnic groups and menopausal statuses were represented. Limitations include limited generalizability, as is true for most qualitative research. In addition, although most women did endorse sexual problems, we did not exclude women with no sexual complaints. CONCLUSIONS Midlife women value physical and emotional outcomes with regard to sexual function. Many midlife women in this sample expressed a preference for behavioral approaches over pharmaceutical approaches for the treatment of sexual dysfunction. Thomas HN, Hamm M, Hess R, et al. Patient-Centered Outcomes and Treatment Preferences Regarding Sexual Problems: A Qualitative Study Among Midlife Women. J Sex Med 2017;14:1011-1017.
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Affiliation(s)
- Holly N Thomas
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Center for Women's Health Research and Innovation (CWHRI), University of Pittsburgh, Pittsburgh, PA, USA.
| | - Megan Hamm
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rachel Hess
- Departments of Population Health Sciences and Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Sonya Borrero
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Center for Women's Health Research and Innovation (CWHRI), University of Pittsburgh, Pittsburgh, PA, USA
| | - Rebecca C Thurston
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA; Center for Women's Health Research and Innovation (CWHRI), University of Pittsburgh, Pittsburgh, PA, USA
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Foy CG, Newman JC, Berlowitz DR, Russell LP, Kimmel PL, Wadley VG, Thomas HN, Lerner AJ, Riley WT. Blood Pressure, Sexual Activity, and Dysfunction in Women With Hypertension: Baseline Findings From the Systolic Blood Pressure Intervention Trial (SPRINT). J Sex Med 2017; 13:1333-1346. [PMID: 27555505 DOI: 10.1016/j.jsxm.2016.06.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 06/21/2016] [Accepted: 06/26/2016] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Sexual function, an important component of quality of life, is gaining increased research and clinical attention in older women with hypertension. AIM To assess the association between systolic blood pressure (SBP) and other variables, and sexual activity and sexual dysfunction in hypertensive women. METHODS Baseline analysis of 635 women participants of a larger randomized clinical trial of 9361 men and women. MAIN OUTCOME MEASURES Self-reported sexual activity (yes/no), and sexual function using the Female Sexual Function Inventory (FSFI). RESULTS 452 participants (71.2%) reported having no sexual activity during the previous 4 weeks. The mean (SD) FSFI score for sexually active participants was 25.3 (6.0), and 52.6% of the sample reported a FSFI score ≤26.55 designating sexual dysfunction. In logistic regression models, SBP was not significantly associated with sexual activity (AOR = 1.002; P > .05). Older age (AOR = 0.95, P < .05), and lower education (AOR for < high school vs college degree = 0.29, P < .05) were associated with lower odds of being sexually active, as was living alone versus living with others (AOR = 0.56, P < .05). Higher weekly alcohol consumption was associated with increased odds of being sexually active (AOR = 1.39; P < .05). In logistic regression models among sexually active participants, SBP was not associated with sexual dysfunction (AOR = 1.01; P > .05). Higher depressive symptoms from the Patient Health Questionnaire-9 (PHQ-9) was associated with higher odds of sexual dysfunction (AOR = 1.24, P < .05), as was increased number of physical comorbidities (AOR = 1.25, P < .05). Diuretic use was associated with lower odds of being sexually active in participants with chronic kidney disease (AOR = 0.33, P < .05). CONCLUSION Younger age, higher education, living with others, and higher weekly alcohol consumption were significantly associated with higher odds of being sexually active in a sample of middle-aged and older women with hypertension. Increased depressive symptoms and increased physical comorbidities were significantly associated with increased odds of sexual dysfunction. SBP was not significantly associated with sexual activity or sexual dysfunction.
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Affiliation(s)
- Capri G Foy
- Wake Forest School of Medicine, Division of Public Health Sciences, Department of Social Sciences and Health Policy, Winston-Salem, NC, USA.
| | - Jill C Newman
- Wake Forest School of Medicine, Division of Public Health Sciences, Department of Biostatistical Sciences, Winston-Salem, NC, USA
| | - Dan R Berlowitz
- Bedford VA Hospital, Bedford, MA and Boston University School of Public Health, Boston, MA, USA
| | - Laurie P Russell
- Wake Forest School of Medicine, Division of Public Health Sciences, Department of Biostatistical Sciences, Winston-Salem, NC, USA
| | - Paul L Kimmel
- Division of Kidney, Urologic, and Hematologic Diseases, The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Bethesda, MD, USA
| | - Virginia G Wadley
- University of Alabama at Birmingham School of Medicine, Department of Psychiatry, Birmingham, AL, USA
| | - Holly N Thomas
- University of Pittsburgh, Division of General Internal Medicine, Section of Women's Health, Pittsburgh, PA, USA
| | - Alan J Lerner
- Case Western Reserve University School of Medicine, Department of Neurology and Brain Health and Memory Center, Cleveland, OH, USA
| | - William T Riley
- National Institutes of Health, Office of Behavioral and Social Sciences Research, Bethesda, MD, USA
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Thomas HN, Thurston RC. A biopsychosocial approach to women's sexual function and dysfunction at midlife: A narrative review. Maturitas 2016; 87:49-60. [PMID: 27013288 DOI: 10.1016/j.maturitas.2016.02.009] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/15/2016] [Indexed: 01/21/2023]
Abstract
A satisfying sex life is an important component of overall well-being, but sexual dysfunction is common, especially in midlife women. The aim of this review is (a) to define sexual function and dysfunction, (b) to present theoretical models of female sexual response, (c) to examine longitudinal studies of how sexual function changes during midlife, and (d) to review treatment options. Four types of female sexual dysfunction are currently recognized: Female Orgasmic Disorder, Female Sexual Interest/Arousal Disorder, Genito-Pelvic Pain/Penetration Disorder, and Substance/Medication-Induced Sexual Dysfunction. However, optimal sexual function transcends the simple absence of dysfunction. A biopsychosocial approach that simultaneously considers physical, psychological, sociocultural, and interpersonal factors is necessary to guide research and clinical care regarding women's sexual function. Most longitudinal studies reveal an association between advancing menopause status and worsening sexual function. Psychosocial variables, such as availability of a partner, relationship quality, and psychological functioning, also play an integral role. Future directions for research should include deepening our understanding of how sexual function changes with aging and developing safe and effective approaches to optimizing women's sexual function with aging. Overall, holistic, biopsychosocial approaches to women's sexual function are necessary to fully understand and treat this key component of midlife women's well-being.
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Affiliation(s)
- Holly N Thomas
- University of Pittsburgh, Department of Medicine, United States.
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Abstract
PURPOSE Sexual activity is an important component of quality of life for women across their lifespan. Prior studies show a decline in sexual activity with age, but these studies often fail to consider the role of sexual satisfaction. The aim of this study is to give updated prevalence estimates of sexual activity among women and to elucidate factors associated with sexual activity and sexual satisfaction. METHODS We report a cross-sectional analysis of the second wave of a nationally representative sample of US adults aged 28 to 84 years, the Survey of Midlife Development in the United States. The survey used self-administered questionnaires to assess demographic data, self-rated physical and mental health, medical problems and medication use, relationship factors, and sexual activity and satisfaction. RESULTS Of 2,116 women who answered the questions regarding sexuality, 1,345 (61.8%) women were sexually active in the previous 6 months. The proportion of women who were sexually active decreased with advancing age. Women who were married or cohabitating had approximately 8 times higher odds of being sexually active (odds ratio = 7.91, 95% CI, 4.16-15.04; P <.001). Among women aged 60 years and older who were married or cohabitating, most (59.0%) were sexually active. Among women who were sexually active, higher relationship satisfaction (P <.001), better communication (P = .011), and higher importance of sex P = .040) were related to higher sexual satisfaction, but age was not (P = .79). CONCLUSIONS A considerable proportion of midlife and older women remain sexually active if they have a partner available. Psychosocial factors (relationship satisfaction, communication with romantic partner, and importance of sex) matter more to sexual satisfaction than aging among midlife and older women.
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Thomas HN, Hess R. Sexual activity in midlife women and beyond--reply. JAMA Intern Med 2014; 174:1205. [PMID: 25003897 DOI: 10.1001/jamainternmed.2014.1592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Holly N Thomas
- Center for Research on Healthcare, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania2Department of Veterans Affairs Pittsburgh Healthcare System
| | - Rachel Hess
- Center for Research on Healthcare, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Affiliation(s)
- Holly N Thomas
- Division of General Internal Medicine, Center for Research on Healthcare, University of Pittsburgh, Pittsburgh, Pennsylvania2VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Chung-Chou H Chang
- Division of General Internal Medicine, Center for Research on Healthcare, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Stacey Dillon
- Division of General Internal Medicine, Center for Research on Healthcare, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rachel Hess
- Division of General Internal Medicine, Center for Research on Healthcare, University of Pittsburgh, Pittsburgh, Pennsylvania
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