26th Annual Meeting of the International Academy of Sex Research

Lorraine Dennerstein, AO, MBBS, PhD, FRANZCP, DPM


July 10, 2000

In This Article


Concern about the adverse effect of hormonal changes on women's sexual function was highlighted by reports from 2 longitudinal studies. The first study evaluated the effects of exogenous hormones used in the oral contraceptive pill (OCP) on sexual function. Despite the availability of the OCP for over 4 decades and widespread use by women globally, there has been surprisingly little research on mood and sexual effects. One of the very few randomized, double-blind, placebo-controlled studies of the components of the pill indicated that the progestin component induced negative effects on mood[1] and domains of sexual function.[2] However, this study was conducted on oophorectomized women and, as it was conducted over 20 years ago, assessed higher dose pills than those currently used.

Dr. Stephanie Sanders from the Kinsey Institute for Research in Sex, Gender and Reproduction, Indiana University, Bloomington, presented preliminary findings from 76 women who took either a monophasic pill (Ortho Cyclen) or a triphasic pill (Ortho Tri-Cyclen). Sixty percent of the women either discontinued or switched to another pill. These women were more likely to report negative mood or sexual changes at the 3-month follow-up than were those who continued the pill. There was no difference between monophasic and triphasic pill use. There were few baseline predictors of negative side effects. Few of the women volunteered the negative changes they experienced, which were elicited by direct questions. Some of the women said that when they had complained about the side effects to doctors, their concerns had been trivialized.

As the negative effects on mood and sexual behavior were predictive of pill discontinuation, it is most important for clinicians to be attentive to such side effects and to offer women alternative effective contraception should side effects ensue.

The second report on the effect of hormonal changes on sexuality came from a study of the effects of the endogenous changes of the menopausal transition. The Melbourne Women's Midlife Health Project provided an interdisciplinary approach to research design and analysis.[3] This population-based, longitudinal study of 438 middle-aged Australian-born women explored the relative effects on women's sexual function of such physical factors as the hormonal changes of the menopausal transition, aging, and physical ill health as well as such psychosocial factors as relational, socioeconomic, attitudinal, and stress variables.

Previous research has established that both aging and length of the relationship between a couple adversely affected sexual function of men and women.[4] Cross-sectional research suggested an additional adverse effect of the menopause.[5] Psychosocial effects were also identified in these studies. [5,6,7] Using 6 years of annual observations, the Melbourne study[3] found that sexual responsivity, frequency of sexual activities, and libido (measured as frequency of sexual thoughts) all declined with aging. Vaginal dryness and dyspareunia and partner-related difficulties in sexual performance increased with aging.

The study used structural equation analysis to model the way in which biologic and psychosocial variables interacted to affect different aspects of sexuality during the menopausal transition. Direct effects of hormonal status were evident on vaginal dryness/dyspareunia and on the number of bothersome symptoms women experienced. Indirect hormonal effects were seen on well-being and sexual responsiveness, which in turn affected frequency of sexual activities and libido. The most powerful effect on sexual function, however, was mediated by the woman's feelings for her partner. Other psychosocial factors acted predominantly by affecting well-being or perception of symptoms.

These findings suggest the need for clinicians to take a comprehensive approach to sexual and mood complaints presented by middle-aged women. Hormone replacement therapy (HRT) is likely to be of most use in ameliorating bothersome vasomotor symptoms and vaginal lubrication difficulties, which can adversely affect sexual function. Clinicians also need to pay attention to the various psychosocial factors that affect mood and sexuality.

Using data from the French national surveys of sexuality carried out in 1970 and repeated in 1992, Dr. Christiane Delbes, of the Institut National d'Etudes Demographiques, presented further information on the powerful role of social factors in sexuality. Those older than 50 years of age in 1992 reported a better sex life than did those of the same age group in 1970, suggesting a positive cohort social effect on sexual function. When cohorts were compared, the proportion in 1992 having no sex after 50 had decreased, the frequency of sex had increased, and they reported a wider range of sex activities, such as reaching orgasm by manual or oral caresses. The proportion of women in 1992 who reported they were very satisfied in their sex life had tripled. When younger and older age groups were compared in the 1992 survey, aging effects were also evident. With aging, women were less likely to have a partner or to report very frequent sex. However, women reported more satisfaction with their sex lives as they aged.


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