Psychosocial factors in declining sexual activity in women — large analysis

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CoupleThe number of women regularly having sex declines with age, and the number of women enjoying sex post-menopause is even lower. Although these facts are not surprising, the causes for these declines may be because previous research focused largely on biological causes only. However, a UK study by researchers at Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, MRC Clinical Trials Unit at University College London (UCL), EGA Institute for Women’s Health, UCL and University of New South Wales, identifies psycho-social contributors.

It’s hard to pick up a woman’s magazine or ob/gyn journal anymore without reading an article about how and why a woman’s libido and level of sexual satisfaction decline during and after menopause. Substantial research has been conducted into biological reasons such as hot flashes, sleep disruption, vaginal dryness, and painful intercourse.

Much less is known about the effect of various psycho-social changes that are common post-menopause. These include body image concerns, self-confidence and perceived desirability, stress, mood changes, and relationship issues.

Of the research that has been conducted regarding psychological influences, most of it has focused on quantitative results. A study of nearly 4,500 post-menopausal women involved in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS), however, looked at free-text data to better understand why women felt a certain way and the depth of those feelings.

Among other things, the UKCTOCS sexual activity data showed that, at baseline, before the start of annual screening, approximately half of the women were sexually active. A decrease in all aspects of sexual activity was observed over time: sexual activity was less frequent, not as pleasurable, and more uncomfortable. The primary reason for absence of sexual activity was the lack of a partner, mainly because of widowhood.

Other commonly cited reasons for decreased activity included (in rank order) a partner’s medical condition, a partner’s sexual dysfunction, the woman’s own physical health problems, menopause-related symptoms, and prescribed medication. Contributing most often to low libido were relationship problems, logistics, and perceptions of aging. Only 3% of participants described positive sexual experiences, whereas only 6% sought medical help for sexual problems.

“Sexual health challenges are common in women as they age, and partner factors play a prominent role in women’s sexual activity and satisfaction, including the lack of a partner, sexual dysfunction of a partner, poor physical health of a partner, and relationship issues,” says Dr Stephanie Faubion, North American Menopause Society (NAMS) medical director. “In addition, menopause-related problems such as vaginal dryness and pain with sex have been identified as problems affecting sexual function, yet few women seek treatment for these issues, despite the availability of effective therapies.”

Abstract
Objective: Sexual well-being can contribute significantly to the overall quality of women’s lives. This qualitative study aimed to examine sexual activity, functioning, and satisfaction in a large sample of postmenopausal women from the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS)
Methods: Thematic analysis was used to evaluate the free-text data of the Fallowfield Sexual Activity Questionnaire (FSAQ) completed by UKCTOCS participants at baseline before annual screening.
Results: A total of 24,305 women completed the baseline FSAQ and 4,525 (19%) provided free-text data, with 4,418 comments eligible for analysis. Median age was 64 years; 65% had a partner and 22.5% were sexually active. Four interrelated themes were derived: partner availability, physical and sexual health, mental well-being, and interpersonal relationships. Primary reason for absence of sexual activity was lack of a partner, mainly due to widowhood (n ¼ 1,000). Women discussed how partner’s medical condition (27%) or sexual dysfunction (13.5%), their own physical health (18%) or menopause-related symptoms (12.5%), and prescribed medication (7%) affected sexual activity. Impact of low libido in self (16%) or partner (7%), relationship problems (10.5%) or logistics (6%), and perceptions of ageing (9%) were also mentioned. Few (3%) referred to positive sexual experiences or had sought medical help for sexual problems (6%).
Conclusions: This qualitative analysis explored postmenopausal women’s perspective on their sexual functioning. Having an intimate partner and good physical health are key factors for continuation of sexual activity and satisfaction. Further sexual education for healthcare professionals is needed to raise awareness about sexuality and sexual difficulties in later life

Authors
Helena Harder; Rachel Starkings; Lesley Fallowfield; Usha Menon; Ian Jacobs; Valerie Jenkins

 

North American Menopause Society material
Menopause abstract


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