Third Annual Female Sexual Function Forum: New Perspectives in the Management of Female Sexual Dysfunction

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

Disclosures

December 05, 2000

In This Article

Decline in Female Sexual Function in Midlife: Aging or Menopause?

Clinicians have long been concerned about the effects of menopause on female sexual function. A high incidence of sexual problems is reported by women attending menopause clinics.[20] This would seem to suggest that menopausal status (and underlying hormonal change) may be linked to adverse effects on sexuality. However, women presenting to clinics have been shown to differ from women in the general population. Population-based studies can help address the question of a link between aging, menopause, and sexuality. The role of aging per se has to be disentangled from that of menopause, with which it is often confounded.

Aging and length of the relationship are known to affect sexual function of both men and women. For example, James[21] used cross-sectional and longitudinal data to show that coital rate halved over the first year of marriage and then took another 20 years to halve again. Interestingly, the recent study of Laumann and colleagues[4] did not find an age-related increase in the incidence of sexual dysfunction. A number of studies have found that an additional decrement in aspects of sexual function occurs in mid-age. The early work of Pfeiffer and Davies[22] from the Duke University study found a pattern of declining sexual activity in both men and women, but the decrement was larger for women than for men of the same age. The sharpest decline in sexual interest for women occurred around the mean of age of menopause.[23] The Swedish studies of Hallstrom[24,25] found a dramatic decline in sexual interest, capacity for orgasm, and coital frequency with increasing age. Oxford studies of women aged 35-59 found that the older women had less frequent intercourse, orgasm, and enjoyment of sexual activity[26] and increased sexual dysfunction.[27] A number of population surveys have reported an additional adverse effect of menopausal status on sexual function over that of aging per se.[22,24,28]

At the Boston Female Sexual Function Forum, preliminary results reported of the Kinsey survey failed to find any effect of menopausal status on the domains of sexuality assessed. It is not clear whether this may have reflected the small sample size of subjects who were in different phases of the menopausal transition, as the overall sample covered a very wide age range. The SWAN study did not find any effect of menopausal phase, but the study sample was limited to the early phases of the menopausal transition (premenopause and early perimenopause), when consistent hormonal change is likely to be minor.[29]

The Melbourne Women's Midlife Health Project (awarded first-prize essay at the meeting) is one of the few longitudinal population-based studies to follow women through the menopausal transition with validated rating scales (the Personal Experiences Questionnaire),[30,31] interviews, and physical measures, including hormone assessments. The aims of the study were to determine the effects on women's sexual function of the natural menopausal transition, vs aging and other factors.

The Melbourne Women's Midlife Health Project is a prospective, observational study of a population-based sample of 438 Australian born women who were aged 45-55 at baseline. There was a 71% response rate to the initial baseline telephone interview. After 8 annual assessments in women's own homes, 88% of the sample who entered the longitudinal phase were still retained in the study. The measure of sexuality used was the Personal Experiences Questionnaire,[30] a self-report questionnaire based on the McCoy Female Sexuality Questionnaire.[32] Women who passed through the natural menopausal transition during the 8 years of study were compared with 2 control groups of women whose menopausal phase was unchanged during the period of observation.

Summary statistics analysis of the effects of the natural menopausal transition found significant declines in the total score of female sexual functioning, sexual responsivity, frequency of sexual activities and libido, and a significant increase in partner's problems with sexual performance and vaginal dyspareunia. When the control groups were examined separately for change in any of the parameters of sexual function over the time studied, only sexual responsivity showed a significant decline. These findings strongly suggest that sexual responsivity declines significantly with aging and the other parameters of sexual function assessed -- libido (frequency of sexual thoughts), frequency of sexual activities, and vaginal dyspareunia -- are differentially affected by the menopausal transition.

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