Dyspareunia and Decreased Intercourse in Menopause
Objective: The frequency of sexual intercourse declines as women enter midlife. Whereas partner availability and function probably play a role, menopausal symptoms, such as vaginal dryness, are also present. We examine the associations among vaginal dryness, dyspareunia, and frequency of sexual intercourse.
Methods: In the second year of a longitudinal study, women completed questionnaires that included menopause status and symptoms, participation in sexual activities, dyspareunia, marital status, and race. We used univariable and multivariable ordered logistic regression models to examine the associations among the frequency of sexual intercourse, vaginal dryness, use of lubrication during sex, and dyspareunia.
Results: In multivariable analyses of the 363 sexually active women with complete data, women reporting more frequent dyspareunia, but not vaginal dryness, also reported less frequent intercourse. Advancing menopause status was associated with lower frequency of intercourse, whereas age was not. Dyspareunia and vaginal dryness were only moderately correlated (r = 0.4).
Conclusions: Women continue to participate in sexual intercourse through midlife. Women who report dyspareunia, but not vaginal dryness, report less frequent intercourse. Relief of dyspareunia should be addressed to maintain sexual functioning during midlife.
Sexual dysfunction is highly prevalent among American women, especially in middle age. Between 43% and 63% of US women report problems with sexual functioning. Understanding the causes of sexual dysfunction during menopause is important, given the advancing age of the American population and the negative effect of sexual dysfunction on health-related quality of life. Furthermore, determining the causes of sexual dysfunction during menopause and their relative contribution can help define treatments for it, which is particularly important if they are treatable with methods other than hormone therapy.
Multiple studies have shown that women report more sexual problems with increasing age. However, less clear are the causes of this decrease in function. Researchers have attempted to disentangle the contribution of factors such as increasing age, menopause status, fluctuations in hormone levels, psychosocial factors, and more. Evidence thus far has been mixed and has reinforced what we already suspected: the causes of the decline in female sexual function throughout middle age are many, varied, complex, and interrelated. The transition from premenopause to perimenopause and postmenopause has been associated with decreasing sexual function independent of age in most studies. However, menopause status alone does not tell the whole story, and age is consistently a stronger predictor. Several researchers have emphasized the important contribution of relationship status (such as attitudes toward partner, lack of partner, or partner sexual dysfunction) and psychosocial factors (ie, mental health, education level, and socioeconomic status), which trumped the effect of menopause status on sexual function in one study.
The decrease in circulating estradiol, characteristic of menopause, is associated with vaginal dryness and atrophy. Between 17% and 55% of middle-aged women complain of vaginal dryness, and reports of vaginal dryness increase fivefold as women advance through menopause. Unlike vasomotor symptoms, which eventually resolve, vaginal dryness and dyspareunia become more prominent with both advancing age and menopause status and rarely improve.
Although midlife women and their partners may engage in a variety of sexually intimate activities, in this article, we explore the associations among vaginal dryness, dyspareunia, and frequency of sexual intercourse. We hypothesized that (1) more vaginal dryness would be associated with decreased frequency of sexual intercourse, (2) dyspareunia would be associated with decreased frequency of sexual intercourse, (3) lubricant use would mitigate the impact of vaginal dryness and dyspareunia on frequency of sexual intercourse, and (4) vaginal dryness would be associated with dyspareunia and use of lubricant during intercourse.
Abstract and Introduction
Abstract
Objective: The frequency of sexual intercourse declines as women enter midlife. Whereas partner availability and function probably play a role, menopausal symptoms, such as vaginal dryness, are also present. We examine the associations among vaginal dryness, dyspareunia, and frequency of sexual intercourse.
Methods: In the second year of a longitudinal study, women completed questionnaires that included menopause status and symptoms, participation in sexual activities, dyspareunia, marital status, and race. We used univariable and multivariable ordered logistic regression models to examine the associations among the frequency of sexual intercourse, vaginal dryness, use of lubrication during sex, and dyspareunia.
Results: In multivariable analyses of the 363 sexually active women with complete data, women reporting more frequent dyspareunia, but not vaginal dryness, also reported less frequent intercourse. Advancing menopause status was associated with lower frequency of intercourse, whereas age was not. Dyspareunia and vaginal dryness were only moderately correlated (r = 0.4).
Conclusions: Women continue to participate in sexual intercourse through midlife. Women who report dyspareunia, but not vaginal dryness, report less frequent intercourse. Relief of dyspareunia should be addressed to maintain sexual functioning during midlife.
Introduction
Sexual dysfunction is highly prevalent among American women, especially in middle age. Between 43% and 63% of US women report problems with sexual functioning. Understanding the causes of sexual dysfunction during menopause is important, given the advancing age of the American population and the negative effect of sexual dysfunction on health-related quality of life. Furthermore, determining the causes of sexual dysfunction during menopause and their relative contribution can help define treatments for it, which is particularly important if they are treatable with methods other than hormone therapy.
Multiple studies have shown that women report more sexual problems with increasing age. However, less clear are the causes of this decrease in function. Researchers have attempted to disentangle the contribution of factors such as increasing age, menopause status, fluctuations in hormone levels, psychosocial factors, and more. Evidence thus far has been mixed and has reinforced what we already suspected: the causes of the decline in female sexual function throughout middle age are many, varied, complex, and interrelated. The transition from premenopause to perimenopause and postmenopause has been associated with decreasing sexual function independent of age in most studies. However, menopause status alone does not tell the whole story, and age is consistently a stronger predictor. Several researchers have emphasized the important contribution of relationship status (such as attitudes toward partner, lack of partner, or partner sexual dysfunction) and psychosocial factors (ie, mental health, education level, and socioeconomic status), which trumped the effect of menopause status on sexual function in one study.
The decrease in circulating estradiol, characteristic of menopause, is associated with vaginal dryness and atrophy. Between 17% and 55% of middle-aged women complain of vaginal dryness, and reports of vaginal dryness increase fivefold as women advance through menopause. Unlike vasomotor symptoms, which eventually resolve, vaginal dryness and dyspareunia become more prominent with both advancing age and menopause status and rarely improve.
Although midlife women and their partners may engage in a variety of sexually intimate activities, in this article, we explore the associations among vaginal dryness, dyspareunia, and frequency of sexual intercourse. We hypothesized that (1) more vaginal dryness would be associated with decreased frequency of sexual intercourse, (2) dyspareunia would be associated with decreased frequency of sexual intercourse, (3) lubricant use would mitigate the impact of vaginal dryness and dyspareunia on frequency of sexual intercourse, and (4) vaginal dryness would be associated with dyspareunia and use of lubricant during intercourse.
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