Factors Affecting Sexual Function in Midlife Women: Results from the Midlife Women's Health Study

Abstract

Objective: The objective of this study was to estimate the importance of risk factors affecting sexual function in sexually active midlife women.

Materials and methods: A cohort of 780 women undergoing the menopausal transition was surveyed each year for up to 7 years. Data were collected from sexually active women on sexual function, including frequencies of enjoyment, arousal, orgasm, passion for partner, satisfaction with partner, pain, lack of lubrication, fantasizing, and sexual activity. Data were also collected on a large number of potential risk factors for sexual dysfunction, including behaviors (smoking and alcohol use), health status (overall and frequency of different disorders), and demographic information (race, education, income, etc.). Height and weight were measured at an annual clinic visit; serum hormone concentrations were assayed using blood samples donated annually. Data on individual outcomes were examined with ordinal logistic regression models using individual as a random effect. An overall sexual function score was constructed from individual outcome responses, and this score was examined with linear regression. All factors with univariate associations of p < 0.1 were considered in multivariate model building with stepwise addition.

Results: A total of 1,927 women-years were included in the analysis. Women with much more physical work than average had higher sexual function scores and higher rates of enjoyment, passion, and satisfaction. Higher family income was associated with lower sexual function score and more frequent dry sex. Married women had significantly lower sexual function scores, as did those with frequent irritability or vaginal dryness. A higher step on the Ladder of Life was associated with a higher sexual function score and higher frequency of sexual activity.

Conclusions: The factors associated with sexual outcome in menopausal women are complex and vary depending on the sexual outcome.

Keywords: cohort study; menopause; sexual function.

FIG. 1.

Flowchart of women enrolled in the study. The summary is a calculated value to summarize scores across all outcomes.

FIG. 2.

Bonferroni-corrected p-values from univariate analyses for sexual factors among sexually active women, by risk factor. Red values are highly significant (p ≤ 0.01), yellow values are moderately significant (p ≤ 0.05), gray values are borderline significant (p ≤ 0.1), and white values are nonsignificant (p > 0.1). Dendrograms are based on Euclidean distance. BMI, body mass index; HRT, hormone replacement therapy.