Patterns of Sexual Activity and the Development of Sexual Pain Across the Menopausal Transition

Abstract

Objective: To examine whether patterns of sexual intercourse frequency and demographic, menopausal status, genitourinary, health, and psychosocial factors are associated with developing sexual pain across the menopausal transition.

Methods: These were longitudinal analyses of questionnaire data from the multicenter, multiracial and ethnic prospective cohort SWAN (Study of Women's Health Across the Nation) (1995-2008). We used multivariable discrete-time proportional hazards models to examine whether incident sexual pain was associated with preceding long-term (up to 10 visits) or short-term (two and three visits) sexual intercourse frequency patterns or other factors (eg, menopause status, genitourinary symptoms, lifestyle factors, and mental health).

Results: Of the 2,247 women with no sexual pain at baseline, 1,087 (48.4%) developed sexual pain at least "sometimes" up to 10 follow-up visits over 13 years. We found no consistent association between prior patterns of sexual intercourse frequency and development of sexual pain. For example, neither decreases in intercourse frequency from baseline (adjusted hazard ratio [aHR] 0.93, 95% CI 0.73-1.19) nor decreases in frequency over three prior visits (aHR 1.00, 95% CI 0.72-1.41) were associated with incident pain. Reasons for interruptions in intercourse activity at the prior visit, including lack of interest (aHR 1.64, 95% CI 0.74-3.65) and relationship issues (aHR 0.36, 95% CI 0.04-2.88), were not associated with developing pain. Being postmenopausal using hormone therapy (aHR 3.16, 95% CI 1.46-6.85), and reported vaginal dryness (aHR 3.73, 95% CI 2.88-4.83) were most strongly associated with incident sexual pain.

Conclusion: Long-term and short-term declines in sexual intercourse frequency across the menopausal transition were not associated with increased hazard of developing pain with intercourse. This empirical evidence does not support the common belief that a reduction in women's sexual frequency is responsible for their symptoms of sexual pain.

Figure 1.

Study of Women’s Health Across the Nation (SWAN), derivation of analytic cohort. * All values include 418 women from New Jersey site who dropped out at visit 6. ^†Outside of the values imputed for visits 7 and 9 for all women.

Figure 2.

Longitudinal profiles of year prior sexual intercourse frequency score* in women who did and did not develop sexual pain over ten follow-up visits in study of women’s health across the nation (1995–2008). *Intercourse frequency score in year prior: 0=none; 1=one‒two times per month; 2=about once per week; 3=more than once per week. Figure represents raw data values. Over the 10 visits, of the women in these profiles, 483 women remained in the analytic sample, 151 women were removed from the analyses after stopping sexual intercourse activity, 875 women were removed from the analyses after developing sexual pain, 576 (418 from New Jersey site after visit 6) women dropped out of the study, and 162 women had missing data.