Changes in Sexual Activity After Menopause Unrelated To Gynecologic Conditions

D. Hollander

First published online:

| DOI: https://doi.org/10.1363/4406812_1

Half of participants in a large study of postmenopausal women were sexually active when they entered the study, and these women were largely satisfied with their level of sexual activity.1 One year later, 10% of those reporting sexual activity at baseline had stopped having sex. The strongest predictor of sexual activity at the one-year follow-up was having been sexually active at study entry; discontinuation of sexual activity was unrelated to most physical changes and gynecologic conditions that are common after menopause, or to use of hormone therapy.

The study was based on data from more than 27,000 women who enrolled in the Women’s Health Initiative hormone therapy trials in 1993–1998. Participants, who were aged 50–79 when they entered the study, were randomly assigned to receive hormone therapy (either estrogen or a combination of estrogen and progestogen) or placebo. At baseline and one year after randomization, all participants completed questionnaires covering demographic and health characteristics; a random subsample of women completed additional questionnaires three and six years after study entry. All participants had a pelvic exam and Pap test at baseline; those receiving combined hormones had these procedures repeated annually. Data from the questionnaires and the clinical exams were used in the analyses of sexual activity.

At baseline, 62% of women were married or were in an intimate relationship; 50% overall (70% of those with a partner) had been sexually active within the last year. The proportion sexually active was 61% among those in their 50s and declined with women’s age, to 28% among participants in their 70s. Most women with a partner were satisfied or very satisfied with their current sexual activity and its frequency (63% and 55%, respectively), as were substantial minorities of women with no partner (42% and 32%). In the sample overall and the subsample with more extensive follow-up, levels of sexual activity and of satisfaction with sexual activity declined over time in all age-groups.

Results of chi-square analysis show that the prevalence of sexual activity at baseline was related to a wide variety of characteristics. It was positively related to income level, was inversely related to a history of several health conditions and was higher among women who were satisfied with their quality of life than among those who were not. Most common postmenopausal conditions were not related to the prevalence of sexual activity; however, women with vulvovaginal atrophy reported a lower prevalence of sexual activity than others, and those who had moderate or severe vaginal or genital dryness were more likely than others to be having sex. The proportion sexually active was significantly lower among women whose partner had died in the previous year, and among those whose marriage or relationship had dissolved, than among participants who had not experienced these events.

One year after baseline, 10% of participants who had initially reported sexual activity no longer were having sex. In bivariate analyses, most gynecologic conditions were not related to continuation of sexual activity, but several health measures were. Levels of continuation were significantly lower among women with depression, those who considered their health fair or poor, and those who were not satisfied with their quality of life (83–85%) than among those not giving these responses (90–91% of each). Adverse life events were strong predictors of whether women were still having sex. Notably, 57% of women whose partner had died during the year reported sexual activity at one year, compared with 91% of those who had not suffered such a loss. A partner’s illness, divorce or relationship dissolution, and major accidents also were negatively related to continuation of sexual activity.

In multivariate analysis, use of combined hormone therapy—which may reduce the discomfort of sexual activity associated with certain postmenopausal genital changes—was not related to the likelihood that women who had been married or in a relationship at baseline were having sex one year later. By far the strongest predictor of sexual activity a year after study enrollment was sexual activity at baseline (odds ratio, 96.7). Women’s likelihood of being sexually active was inversely related to their age and body mass index (0.8 and 0.9 per five-unit increase); it was also reduced among past and current smokers (0.8 and 0.7).

The researchers acknowledge that their findings must be understood in light of several limitations, including the small number of questionnaire items addressing sexual activity and potential differences in the way participants interpreted the term "sexual activity." Nonetheless, they suggest that their findings "illustrate the complexity of factors related to the prevalence of sexual activity and satisfaction."—D. Hollander