Abstract
Background
Women's sexual well-being is an important determinant of overall health and quality
of life across the life course. Yet the factors associated with women's levels of
sexual activity and sexual function in midlife are little understood. This study sought
to assess the prevalence of recent sexual activity and sexual dysfunction symptoms
among middle-aged women and evaluate the associations of partner status, menopause,
and health status factors with sexual dysfunction.
Methods
Participants of this cross-sectional study were 68,131 women who responded to the
2013 Nurses’ Health Study II observational cohort questionnaire when they were age
48–68 years. Sexual activity and dysfunction symptoms were assessed with the Female
Sexual Function Index. Age-adjusted multivariable regression models estimated risk
ratios for the association of health-related factors with past month sexual dysfunction
symptoms among women who were sexually active over the past month, overall and stratified
by partner status.
Results
Of middle-aged women participants, 73% were sexually active (n = 49,701) and 50% of sexually active women reported symptoms of sexual dysfunction.
Symptoms of sexual dysfunction were less common among unpartnered than partnered women
(42% vs. 51%; p < .0001). A positive association between menopause and sexual dysfunction was greater
for unpartnered women (risk ratio, 2.37, 2.99; p < .001) than partnered women (risk ratio, 1.89, 2.00; p < .001).
Conclusions
Difficulty with sexual function is common among women in midlife, but less so than
previously estimated. Regular monitoring of women's sexual function could enable clinicians
to offer women timely, supportive interventions tailored by partner status and menopausal
status.
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 accessOne-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:
Subscribe to Women's Health IssuesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Sexual activity and function in middle-aged and older women.Obstetrics & Gynecology. 2006; 107: 755-764
- Sexual function in elderly women: A review of current literature.Review of Obstetrics and Gynecology. 2012; 5: 16-27
- Diagnostic and statistical manual of mental disorders (DSM-5®).American Psychiatric Publishing, Arlington, VA2013
- Is there an association between menopause status and sexual functioning?.Menopause. 2000; 7: 297-309
- Correlates of sexual function among multi-ethnic middle-aged women: Results from the Study of Women's Health Across the Nation (SWAN).Menopause. 2005; 12: 385-398
- Origin, methods, and evolution of the three Nurses’ Health Studies.American Journal of Public Health. 2016; 106: 1573-1581
- Applying the female sexual functioning index to sexual minority women.Journal of Women's Health. 2012; 21: 401-409
- The DSM diagnostic criteria for hypoactive sexual desire disorder in women.Archives of Sexual Behavior. 2010; 39: 221-239
- Sexual functioning and practices in a multi-ethnic study of midlife women: Baseline results from SWAN.Journal of Sex Research. 2003; 40: 266-276
- Disclosure of sexual orientation and behavior in the Nurses' Health Study II: Results from a pilot study.Journal of Homosexuality. 2006; 51: 13-31
- Modeling mid-aged women's sexual functioning: A prospective, population-based study.Journal of Sex and Marital Therapy. 2004; 30: 173-183
- Sexuality.American Journal of Medicine. 2005; 118: 59-63
- Validation of the female sexual distress scale-revised for assessing distress in women with hypoactive sexual desire disorder.Journal of Sexual Medicine. 2008; 5: 357-364
- Sexual function in the elderly.Archives of Internal Medicine. 1990; 150: 197-200
- Sexuality in middle and late life. The effects of age, cohort, and gender.Archives of General Psychiatry. 1981; 38: 919-923
- Hormones and sexuality during transition to menopause.Obstetrics & Gynecology. 2007; 109: 831-840
- Sexual functioning in postmenopausal women: The postmenopausal estrogen/progestin interventions (PEPI) trial.Journal of Women's Health. 1996; 5: 445-458
- The menopausal transition: A 9-year prospective population-based study. The Melbourne Women's Midlife Health Project.Climacteric. 2004; 7: 375-389
- Clinical evaluation and management strategy for sexual dysfunction in men and women.Journal of Sexual Medicine. 2004; 1: 49-57
- The impact of aging on sexual function and sexual dysfunction in women: A review of population-based studies.Journal of Sexual Medicine. 2005; 2: 317-330
- Association of lifestyle and relationship factors with sexual functioning of women during midlife.Journal of Sexual Medicine. 2009; 6: 1358-1368
- Women's sexual satisfaction as a predictor of well-being in same-sex versus mixed-sex relationships.Journal of Sex Research. 2010; 47: 1-11
- Outcomes assessment: Development and validation of a 6-item version of the Female Sexual Function Index (FSFI) as a diagnostic tool for female sexual dysfunction.Journal of Sexual Medicine. 2010; 7: 1139-1146
- The social organization of sexuality: Sexual practices in the United States.University of Chicago Press, Chicago1994
- Sexual dysfunction in the United States: Prevalence and predictors.JAMA. 1999; 281: 537-544
- 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
- Vulvovaginal atrophy is strongly associated with female sexual dysfunction among sexually active postmenopausal women.Menopause. 2008; 15: 661-666
- Center for Epidemiologic Studies Depression Scale (CES-D) as a screening instrument for depression among community-residing older adults.Psychology and Aging. 1997; 12: 277-287
- The female sexual function index: A methodological critique and suggestions for improvement.Journal of Sex and Marital Therapy. 2007; 33: 217-224
- Sexual functioning throughout menopause: The perceptions of women in a British cohort.Menopause. 2006; 13: 880-890
- The impact of genitourinary syndrome of menopause on well-being, functioning, and quality of life in postmenopausal women.Menopause. 2018; 25: 1418-1423
- Sexual behavior of older women: Results of a random-digit-dialing survey of 2,000 women in the United States.Sexually Transmitted Diseases. 2003; 30: 216-220
- Sexual ramifications of medical illness.Clinical Obstetrics and Gynecology. 2009; 52: 691-701
- The Female Sexual Function Index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function.Journal of Sex and Marital Therapy. 2000; 26: 191-208
- SAS/STAT® 9.2 user's guide.SAS Institute Inc., Cary, NC2008
- Rotating night shifts and risk of breast cancer in women participating in the Nurses' Health Study.Journal of the National Cancer Institute. 2001; 93: 1563-1568
- Methods for pooling results of epidemiologic studies: The pooling project of prospective studies of diet and cancer.American Journal of Epidemiology. 2006; 163: 1053-1064
- Easy SAS calculations for risk or prevalence ratios and differences.American Journal of Epidemiology. 2005; 162: 199-200
- A brief measure for assessing generalized anxiety disorder: The GAD-7.Archives of Internal Medicine. 2006; 166: 1092-1097
- A biopsychosocial approach to women’s sexual function and dysfunction at midlife: A narrative review.Maturitas. 2016; 87: 49-60
- The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.Medical Care. 1992; 30: 473-483
- A systematic review of the literature on female sexual dysfunction prevalence and predictors.Annual Review of Sexual Research. 2004; 15: 40-172
- The Female Sexual Function Index (FSFI): Cross-validation and development of clinical cutoff scores.Journal of Sex and Marital Therapy. 2005; 31: 1-20
- Sexual desire during the menopausal transition and early postmenopause: Observations from the Seattle Midlife Women's Health Study.Journal of Women's Health. 2010; 19: 209-218
- Prevalence and predictors of low sexual desire, sexually related personal distress, and hypoactive sexual desire dysfunction in a community-based sample of midlife women.Journal of Sexual Medicine. 2017; 14: 675-686
- Hypoactive sexual desire dysfunction in community-dwelling older women.Menopause. 2017; 24: 391-399
- A modified poisson regression approach to prospective studies with binary data.American Journal of Epidemiology. 2004; 159: 702-706
Biography
Christiana von Hippel, ScD, MPH, is a Postdoctoral Research Fellow in the Wallace Center for Maternal, Child, and Adolescent Health at the University of California Berkeley School of Public Health.
Biography
Avanti Adhia, ScD, is a Postdoctoral Research Fellow in the Harborview Injury Prevention and Research Center at the University of Washington.
Biography
Shoshana Rosenberg, ScD, MPH, is an Assistant Professor in the Department of Medicine at the Harvard Medical School and the Department of Medical Oncology at the Dana-Farber Cancer Institute.
Biography
S. Bryn Austin, ScD, is a Professor in the Department of Social Behavioral Sciences at the Harvard T.H. Chan School of Public Health and in the Department of Pediatrics at the Harvard Medical School.
Biography
Ann Partridge, MD, MPH, is a Professor in the Department of Medicine at the Harvard Medical School and a Medical Oncologist at the Dana-Farber Cancer Institute.
Biography
Rulla Tamimi, ScD, is an Associate Professor of Epidemiology at the Harvard T.H. Chan School of Public Health and a Co-Investigator on the Nurses' Health Study II.
Article info
Publication history
Published online: May 23, 2019
Accepted:
April 11,
2019
Received in revised form:
March 28,
2019
Received:
September 26,
2018
Footnotes
The Nurses' Health Study II was made possible by the National Cancer Institute (grant number UM1 CA176726). Dr. von Hippel was supported by the National Cancer Institute (grant number 3R25CA057711). Dr. Austin is supported by training grants T71-MC-00009 and T76-MC-00001 from the Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services. Dr. Rosenberg is supported by the Agency for Healthcare Research and Quality (grant number K01HS023680).
Conflicts of Interest: None to disclose.
Identification
Copyright
© 2019 Jacobs Institute of Women's Health. Published by Elsevier Inc.
