Menopause and Sexual Functioning: A Review of the Population-Based Studies, The

Does Dysfunction Cause Distress?

Bancroft, Loftus, and Long (2003), in a cross-sectional national probability sample survey of American women aged 20 to 65 years, found that 25% reported marked distress about their sexual relationship and/or their own sexuality. These authors reported that although "sexual problems" tended to be more common in older women, it was younger women who were more likely to be troubled by them.

In the 11th year of the Melbourne Women's Midlife Health Project (2002), the SPEQ and the Female Sexual Distress Scale were administered to participants (Dennerstein, Randolph, Taffe, & Clark, 2003). In a preliminary analysis of 48 women who had current sexual partners, we found that 81.2% of women had sexual dysfunction as determined by a PEQ score of less than, or equal to, 7. Sexual Distress was reported in 16.7% of the group as defined as a score of greater than 15 on the Female Sexual Distress Scale (FSDS), whilst 25% of the group had scores of zero. The Spearman's correlation coefficient between the sexual distress (FSDS) and sexual function (SPEQ scores) was -0.44 (p = .01) demonstrating that there is an inverse relationship between scores on the SPEQ and scores on the Female Sexual Distress Scale. However, not all women with low sexual functioning scores were distressed. This may reflect the women's changing feelings towards their partners as they progress through the menopausal transition (Dennerstein, Randolph, et al., 2002). A qualitative content analysis was conducted, based on comments made by women in the study (Dennerstein, Lehert, Burger, Garamszegi, & Dudley, 1999). The following statements were illustrative of the group of women who reported decreased sexual interest:

"The last five years have been quieter in the sex department than were the previous years."

"We seldom have sex. Our relationship is good but not sexual these days."

"Sexual intercourse is less exciting now than earlier years and I seem to find other things take [from the] time [my] partner & I spend together e.g., children, friends, work. [And we seem to] put less effort into making it fun."

"At 47 I don't feel like instigating sex."

Summary

Population-based studies find a decline in several aspects of female sexual functioning associated with the midlife years. There is growing evidence that this reflects hormonal changes of the menopausal transition and specifically declining estradiol levels. The research is still pending on the impact of lowered testosterone levels on the population as a whole versus that of selected clinical trial populations (Bachmann et al., 2002; Burger, Hailes, Nelson, & Menelaus, 1987; Davis, McCloud, Strauss, & Burger, 1995; Floter, Nathorst-Boos, Carlstrom, & von Schoultz, 2002; Sherwin, Gelfand, & Brender, 1985). However, hormonal change is only one aspect of the many factors that impact on sexual functioning. These include the woman's own premorbid level of sexual functioning, her personality, educational level, stress, physical and psychological health status, and changes in partner status, as well as the woman's feelings towards the partner.