Sexual Function & Satisfaction| Volume 29, ISSUE 4, P299-307, July 2019

Download started.


Is Interpersonal Abuse Associated with Sexual (Dis)satisfaction among Postmenopausal Women?



      To investigate associations between past-year verbal and/or physical abuse (VA/PA) and sexual (dis)satisfaction, that is, global or frequency-related (dis)satisfactions with sexual activity, among postmenopausal women in the Women's Health Initiative.


      A cross-sectional analysis of archival data was performed from the subset of 83,329 Women's Health Initiative participants (clinical trial and/or observational study components) who reported sexual activity in the year before baseline. Associations between VA/PA and global frequency (dis)satisfactions were modeled using logistic regression.

      Main Findings

      Most participants reported sexual satisfaction (global, 77%; frequency related, 66%). Disappointment with sexual frequency, specifically a desire for more frequent sex, was the most common dissatisfaction expressed. Past-year VA/PA exposure was reported by 9,410 participants (11%). In regression models adjusted for sociodemographic, health and health risk, and menopausal symptom variables, VA/PA was associated with higher rates of global (35% VA/PA exposed vs. 22% non-exposed; adjusted odds ratio, 1.66; 95% confidence interval, 1.53–1.80) and frequency-related dissatisfactions (50% of VA/PA exposed vs. 32% of non-exposed; adjusted odds ratio, 1.73; 95% confidence interval, 1.57–1.90).


      Sexual satisfaction was common, but not universally reported by study participants. Sexual dissatisfactions were overrepresented in VA/PA-exposed participants and associated with a desire for more frequent sexual activity. Opportunities for postmenopausal women to receive clinician-led education about safe and healthy ways to increase sexual activity are needed. Further research on this topic, particularly efforts to characterize safety concerns as well as modifiable barriers to satisfying sexual activity among postmenopausal women with recent VA/PA, would ensure that these interventions are evidence based.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Women's Health Issues
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Acierno R.
        • Hernandez M.A.
        • Amstadter A.B.
        • Resnick H.S.
        • Steve K.
        • Muzzy W.
        • Kilpatrick D.G.
        Prevalence and correlates of emotional, physical, sexual, and financial abuse and potential neglect in the United States: The National Elder Mistreatment Study.
        American Journal of Public Health. 2010; 100: 292-297
        • Ambler D.R.
        • Bieber E.J.
        • Diamond M.P.
        Sexual function in elderly women: A review of current literature.
        Reviews in Obstetrics & Gynecology. 2012; 5: 16-27
        • American Psychiatric Association
        Diagnostic and statistical manual of mental disorders.
        5th ed. Author, Washington, DC2013
        • Anderson G.L.
        • Manson J.
        • Wallace R.
        • Lund B.
        • Hall D.
        • Davis S.
        • Prentice R.L.
        Implementation of the Women’s Health Initiative study design.
        Annals of Epidemiology. 2003; 13: S5-S17
        • Annon J.S.
        The PLISSIT model: A proposed conceptual scheme for the behavioral treatment of sexual problems.
        Journal of Sex Education and Therapy. 1976; 2: 1-15
        • Baker M.W.
        • LaCroix A.Z.
        • Wu C.
        • Cochrane B.B.
        • Wallace R.
        • Woods N.F.
        Mortality risk associated with physical and verbal abuse in women aged 50 to 79.
        Journal of the American Geriatrics Society. 2009; 57: 1799-1809
        • Basson R.
        Female sexual response: The role of drugs in the management of sexual dysfunction.
        Obstet Gynecol. 2001; 98 (Erratum in: Obstetrics & Gynecology 2001;98(3):522): 350-353
        • Basson R.
        • Berman J.
        • Burnett A.
        • Derogatis L.
        • Ferguson D.
        • Fourcoy J.
        • Whipple B.
        Report of the international consensus development conference on female sexual dysfunction: Definitions and classifications.
        Journal of Urology. 2000; 163: 888-893
        • Basson R.
        • Wierman M.E.
        • van Lankveld J.
        • Brotto L.
        Summary of the recommendations on sexual dysfunctions in women.
        Journal of Sexual Medicine. 2010; 7: 314-326
        • Burnam M.A.
        • Wells K.B.
        • Leake B.
        • Landsverk J.
        Development of a brief screening instrument for detecting depressive disorders.
        Medical Care. 1988; 26: 775-789
        • Burri A.
        • Spector T.
        Recent and lifelong sexual dysfunction in a female UK population sample: Prevalence and risk factors.
        Journal of Sexual Medicine. 2011; 8: 2420-2430
        • Campbell J.C.
        Health consequences of intimate partner violence.
        Lancet. 2002; 359: 1331-1336
        • Cannell M.B.
        • Weitlauf J.C.
        • Garcia L.
        • Andresen E.M.
        • Margolis K.L.
        • Manini T.M.
        Cross sectional and longitudinal risk of physical impairment in a cohort of postmenopausal women who experience physical and verbal abuse.
        BMC Womens Health. 2015; 15: 98-109
        • Capaldi D.M.
        • Knoble N.B.
        • Shortt J.W.
        • Kim H.K.
        A systematic review of risk factors for intimate partner violence.
        Partner Abuse. 2012; 3: 231-280
        • Cason D.R.
        • Resick P.A.
        • Weaver T.L.
        Schematic integration of traumatic events.
        Clinical Psychology Review. 2002; 22: 131-153
        • Coker A.L.
        • Smith P.H.
        • Bethea L.
        • King M.R.
        • McKeown R.E.
        Physical health consequences of physical and psychological intimate partner violence.
        Archives of Family Medicine. 2000; 9: 451-457
        • Curb J.D.
        • McTiernan A.
        • Heckbert S.R.
        • Kooperberg C.
        • Stanford J.
        • Nevitt M.
        • WHI Morbidity and Mortality Committee
        Outcomes ascertainment and adjudication methods in the Women’s Health Initiative.
        Annals of Epidemiology. 2003; 13: S122-S128
        • Devries K.M.
        • Mak J.Y.
        • Bacchus L.J.
        • Child J.C.
        • Falder G.
        • Petzold M.
        • Watts C.H.
        Intimate partner violence and incident depressive symptoms and suicide attempts: A systematic review of longitudinal studies.
        PLoS Med. 2013; 10 (1–11): e1001439
        • Dutton M.A.
        • Green B.L.
        • Kaltman S.I.
        • Roesch D.M.
        • Zeffiro T.A.
        • Krause E.D.
        Intimate partner violence, PTSD, and adverse health outcomes.
        Journal of Interpersonal Violence. 2006; 21: 955-968
        • Field N.
        • Prah P.
        • Mercer C.H.
        • Rait G.
        • King M.
        • Cassell J.A.
        • Sonnenberg P.
        Are depression and poor sexual health neglected comorbidities? Evidence from a population sample.
        BMJ Open. 2016; 6 (1–14): e010521
        • Gass M.L.S.
        • Cochrane B.B.
        • Larson J.C.
        • Manson J.E.
        • Barnabei V.M.
        • Brzynski R.G.
        • Barad D.H.
        Patterns and predictors of sexual activity among women in the Hormone Therapy trials of the Women’s Health Initiative.
        Menopause. 2011; 18: 1160-1171
        • Guthrie J.R.
        • Dennerstein L.
        • Taffe J.
        • Lehert P.
        • Burger H.G.
        The menopausal transition: A 9-year prospective population-based study. The Melbourne Women’s Midlife Health Project.
        Climacteric. 2004; 7: 375-389
        • Hays J.
        • Hunt J.R.
        • Hubbell F.A.
        • Anderson G.L.
        • Limacher M.
        • Allen C.
        • Roussow J.E.
        The Women’s Health Initiative recruitment methods and results.
        Annals of Epidemiology. 2003; 13: S18-S77
        • Institute of Medicine
        Crossing the quality chasm: A new health system for the 21st century.
        The National Academies Press, Washington, DC2001
        • Kalmbach D.A.
        • Kingsberg S.A.
        • Ciesla J.A.
        How changes in depression and anxiety symptoms correspond to variations in female sexual response in a nonclinical sample of young women: A daily diary study.
        Journal of Sexual Medicine. 2014; 11: 2915-2927
        • Kilbourne A.M.
        • Switzer G.
        • Hyman K.
        • Crowley-Matoka M.
        • Fine M.J.
        Advancing health disparities research within the health care system: A conceptual framework.
        American Journal of Public Health. 2006; 96: 2113-2121
        • Kling J.M.
        • Manson J.E.
        • Naughton M.J.
        • Temkit M.
        • Sullivan S.D.
        • Gower E.W.
        • Crandall C.J.
        Association of sleep disturbance and sexual function in postmenopausal women.
        Menopause. 2017; 24: 604-612
        • Langer R.D.
        • White E.
        • Lewis C.E.
        • Kotchen J.M.
        • Hendrix S.L.
        • Trevisan M.
        The Women’s Health Initiative Observational Study: Baseline characteristics of participants and reliability of baseline measures.
        Annals of Epidemiology. 2003; 13: S107-S121
        • Laumann E.O.
        • Waite L.J.
        Sexual dysfunction among older adults: Prevalence and risk factors from a nationally representative U.S. probability sample of men and women 57-85 years of age.
        Journal of Sexual Medicine. 2008; 5: 2300-2311
        • Lindau S.T.
        • Schumm L.P.
        • Laumann E.O.
        • Levinson W.
        • O’Muircheartaigh C.A.
        • Waite L.J.
        A study of sexuality and health among older adults in the United States.
        New England Journal of Medicine. 2007; 357: 762-774
        • MacMillan H.L.
        • Wathen C.N.
        Canadian Task Force on Preventive Health Care. Prevention and treatment of violence against women: Systematic review and recommendations.
        • Manson J.E.
        • Chlebowski R.T.
        • Stefanick M.L.
        • Aragaki A.K.
        • Roussow J.E.
        • Prentice R.L.
        • Wallace R.B.
        Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women’s Health Initiative randomized trials.
        JAMA. 2013; 310: 1353-1368
        • McCall-Hosenfeld J.S.
        • Jaramillo S.A.
        • Legault C.
        • Freund K.M.
        • Cochrane B.B.
        • Manson J.E.
        • Bonds D.
        Correlates of sexual satisfaction among sexually active postmenopausal women in the Women’s Health Initiative-Observational Study.
        Journal of General Internal Medicine. 2008; 23: 2000
        • Mouton C.P.
        • Rodabough R.L.
        • Rovi S.L.D.
        • Brzyski R.G.
        • Katerndahl D.A.
        Psychosocial effects of physical and verbal abuse in postmenopausal women.
        Annals of Family Medicine. 2010; 8: 206-213
        • Nelson H.D.
        • Nygren P.
        • McInerney Y.
        • Klein J.
        • U.S. Preventive Services Task Force
        Screening women and elderly adults for family and intimate partner violence: A review of the evidence for the U.S. Preventive Services Task Force.
        Annals of Internal Medicine. 2004; 140: 387-396
        • R Core Team
        R: A language and environment for statistical computing.
        R Foundation for Statistical Computing, Vienna, Austria2017 (Available:) (Accessed on 01/01/2019)
        • RStudio Team
        Integrated development for R. RStudio, Inc, Boston, MA2016 (Available:) (Accessed on 01/01/2019)
        • Rosen R.C.
        • Bachmann G.A.
        Sexual well-being, happiness, and satisfaction in women: The case for a new conceptual paradigm.
        Journal of Sex & Marital Therapy. 2008; 34: 291-297
        • Secretary’s Advisory Committee on Health Promotion and Disease Prevention Objectives for 2020
        Healthy People 2020: An opportunity to address the societal determinants of health in the United States.
        (Available:) (Accessed on 01/01/2019)
        • Staggs S.L.
        • Riger S.
        Effects of intimate partner violence on low-income women’s health and employment.
        American Journal of Community Psychology. 2005; 36: 133-145
        • Stefanick M.L.
        • Cochrane B.B.
        • Hsia J.
        • Barad D.H.
        • Liu J.H.
        • Johnson S.R.
        The women's health initiative postmenopausal hormone trials: Overview and baseline characteristics of participants.
        Annals of Epidemiology. 2003; 13: S78-S86
        • Steptoe A.
        • Deaton A.
        • Stone A.A.
        Subjective well-being, health, and ageing.
        Lancet. 2015; 386: 640-648
        • The WHI Study Group
        Design of the Women’s Health Initiative clinical trial and observational study.
        Controlled Clinical Trials. 1998; 19: 61-109
        • Tjaden P.
        • Thoennes N.
        Full report of the prevalence, incidence, and consequences of violence against women. (Report No. NCJ-183781).
        National Institute of Justice, Washington, DC2000
        • Tracy E.E.
        • Speakman E.
        Editorial: Intimate partner violence: Not just a concern of … the reproductive ages.
        Menopause. 2012; 19: 3-5
        • Uebelacker L.A.
        • Eaton C.B.
        • Weisberg R.
        • Sands M.
        • Williams C.
        • Calhoun D.
        • Taylor T.
        Social support and physical activity as moderators of life stress in predicting baseline depression and change in depression over time in the Women’s Health Initiative.
        Social Psychiatry and Psychiatric Epidemiology. 2013; 48: 1-11
        • van Buuren S.
        • Groothuis-Oudshoorn K.
        mice: Multivariate imputation by chained equations in R.
        Journal of Statistical Software. 2011; 45 (Available:) (Accessed on 01/01/2019): 1-67
        • Wiegel M.
        • Scepkowski L.A.
        • Barlow D.H.
        Cognitive and affective processes in female sexual dysfunctions.
        in: Goldstein I. Meston C.M. Davis S.R. Traish A.M. Women’s sexual function and dysfunction: Study, diagnosis and treatment. Taylor & Francis, London2006: 85-92
        • World Health Organization, Department of Reproductive Health and Research
        Social determinants of sexual and reproductive health Informing future research and programme implementation.
        (Available:) (Accessed on 01/01/2019)
        • Yehuda R.
        • Lehrner A.
        • Rosenbaum T.Y.
        PTSD and sexual dysfunction in men and women.
        Journal of Sexual Medicine. 2015; 12: 1107-1119


      Erika L. Kelley, PhD, is a clinical psychologist at University Hospitals Cleveland Medical Center and an Assistant Professor of Reproductive Biology at Case Western Reserve University. Her clinical/research focus is on intersections of interpersonal violence and women's sexual/reproductive health.


      M. Brad Cannell, PhD, is an Associate Professor of Epidemiology, Human Genetics, and Environmental Sciences at the University of Texas Health Science Center. He has expertise in epidemiologic methods/analytics and publishes widely on disability, preservation of function, and elder abuse prevention.


      Margery S. Gass, MD, is Executive Director Emerita of The North American Menopause Society, formerly Professor of Obstetrics & Gynecology at the University of Cincinnati College of Medicine. Her research interests include menopausal hormone therapy, postmenopausal female sexual function, and osteoporosis.


      Shawnita Sealy-Jefferson, PhD, MPH, is a Social Epidemiologist and Assistant Professor in the Division of Epidemiology in the College of Public Health at Ohio State University. Her research expertise includes birth outcomes, neighborhood effects, minority health, and chronic disease epidemiology.


      Nancy Fugate Woods, PhD, RN, FAAN, is Professor and Dean Emerita of the University of Washington School of Nursing and past director of the NIH-funded UW Center for Women's Health Research.


      Chloe E. Bird, PhD, is a Senior Sociologist at RAND and a Professor within the Pardee RAND Graduate School, with expertise in women's cardiovascular health. She is also working to build a Women's Health Research and Policy Center at RAND.


      Marcia L. Stefanick, PhD, is a Professor of Medicine (Stanford Prevention Research Center) and Obstetrics & Gynecology, at Stanford School of Medicine. She is the founding Director of the Stanford Women's Health and Sex Differences in Medicine (WHSDM) Center.


      Julie C. Weitlauf, PhD, is a clinical psychologist at the VA Palo Alto Health Care System, and a Clinical Professor of Psychiatry and Behavioral Sciences at Stanford School of Medicine. Her research examines the lifelong physical/mental health consequences of women's abuse exposure.