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Sexual difficulties underreported, undertreated among postmenopausal women
Many partnered, postmenopausal women report that they are not sexually active, with sexual functioning strongly related to poor physical health of the intimate partner or the women themselves, according to findings published in Menopause.
“Health is an important factor for continued sexual activity and satisfaction in older age, but lack of communication between health care professionals, women and their partners hinders appropriate support for those who need it,” Helena Harder, PhD, a research fellow at Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, U.K., told Endocrine Today. “There is clearly still a stigma around aging and sexuality, and we know that health care conversations about sex can be difficult for both doctors and patients. However, aging in and of itself is not a barrier to healthy sexual activity, and there are things that can be done to ensure this is maintained for those who want this.”
In a thematic analysis, Harder and colleagues analyzed free-text comments from 4,418 women who completed the Fallowfield Sexual Activity Questionnaire as part of the U.K. Collaborative Trial of Ovarian Cancer Screening (UKCTOCS; mean age, 64 years; 97.6% white; 17% using hormone therapy). Researchers grouped coded content from comments into themes and subthemes, including partner availability, physical and sexual health, mental well-being and interpersonal relationships.
Within the cohort, 65.3% of women had an intimate partner (29.2% were widows), and 22.5% reported that they were sexually active. The researchers observed that approximately one-third of women with an intimate partner said they had been sexually active in the preceding month.
The primary reason for absence of sexual activity was lack of a partner, mainly due to widowhood, according to researchers. Sexually inactive women also cited medical conditions or poor health of partners, including 13.5% who reported sexual dysfunction of their intimate partner, as well as their own health-related problems impairing sexual activity (17.7%).
“Some problems were associated with menopause (12.5%), including vaginal dryness, painful intercourse, reduced libido and arousal, and difficulty achieving orgasm,” the researchers wrote.
Only 6% of women reported seeking help and treatment for sexual problems, predominantly by sexually active women, according to researchers.
The researchers noted several mental well-being-related themes, including mentions of depression, anxiety, addiction or stress (5.8%), or physical and mental fatigue (3.5%). Approximately 16% of women and 7% of partners lacked interest in sex, the researchers wrote.
The researchers noted that existing scales designed to measure sexual function likely fail to provide a nuanced picture of sexual experiences in older women and that new measures to assess the multiple aspects of sexuality in older adults are needed.
“One of the first steps that we could take is to start talking more openly about sexual matters,” Harder said. “Health care providers should be more proactive about the sexual needs of older women and their partners, and start this discussion, ideally using plain language and open questions. This could ‘open the door’ for women and might invite them to talk more willingly about possible changes or concerns associated with aging and/or menopause.” – by Regina Schaffer
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Helena Harder, PhD, can be reached at Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9RX, United Kingdom; email: h.harder@sussex.ac.uk.
Disclosures: Harder reports no relevant financial disclosures. Two of the study authors report a relationship with Abcodia, which has a license to the Risk of Ovarian Cancer Algorithm from Massachusetts General Hospital.