Objective: The objective of this study was to describe variation in sexuality (desire, arousal orgasm, satisfaction, vaginal dryness and pain symptoms, and frequency of sexual activity for women in different menopause transition stages and to characterize factors associated with dimensions of sexuality during the menopause transition, including biological factors, perceived stress, health status and health problems, lifestyle, attitudes toward menopause, mental health, presence of a partner, and social support. Design: Participants enrolled in the longitudinal Seattle Midlife Women’s Health Study since 1990 (N=205) provided monthly first voided urine specimens analyzed for estrone, FSH, cortisol and catecholamines for four years (1997-2000), rated their symptoms and stress levels on three consecutive occasions in a monthly health diary, and completed an annual health update following an interview in their homes. Population/Sample/Settings: A subset of women with complete assay data for 1998, symptom diaries, health updates for the same period, and who indicated they had had sexual intercourse during the past month was selected for analyses (N=79). Concepts/Variables: Dimensions of sexuality (desire, arousal, orgasm, sexual frequency, vaginal dryness, and pain with sex) were indicated by responses to the Watts Sexual Functioning Scale. Menopause transition stages were classified using the method of Mitchell, Woods and Mariella. Urinary FSH, estrone, and testosterone were assayed using high performance liquid chromatography. Perceived stress, health status, and health problems, lifestyle, attitudes toward menopause, mental health, and presence of a partner were assessed in the annual health update. Findings: A subset of heterosexual women who were currently sexually active and who were in the early, middle or late menopause transition stages or using hormone therapy (n=79) provided data for these analyses. Of those not using hormones, most reported that at least some of the time they believed sex was an important part of life, enjoyed sexual activity, were too tired for sex, had daydreams or fantasies, desired sex with their partner and did not want more sex than their partner. Most reported that at least some of the time they were aware of vaginal wetness, but they did not need a long time for wetness to develop and did not experience vaginal dryness or pain. Most reported they did experience rapid breathing and heart rate and were aware of vaginal throbbing during sexual activity. Most said that at least some of the time they reached a climax, were satisfied after sexual activity and with the frequency of sex. Most denied being tense or nervous after sex. Desire, arousal, orgasm, satisfaction, frequency of sex, vaginal dryness and pain did not differ significantly in intensity across groups of women in the early, middle or late menopause transition stages or among women using hormone therapy. In addition, urinary FSH, estrone and testosterone levels were not correlated with desire, arousal, orgasm, satisfaction, frequency, vaginal dryness and pain. Age was positively associated with orgasm. Being married/partnered and smoking were negatively correlated with sexual desire, but believing that menopause was linked to an increased enjoyment of sex was positively associated. Believing that menopause was a reminder of aging was negatively associated with sexual arousal. Job stress was negatively associated with orgasm but drinking alcohol was positively associated with orgasm. Satisfaction was negatively associated with job stress and being married/partnered, but alcohol use was positively associated with satisfaction. Poor perceived health was associated with vaginal dryness and pain with sex. Negative attitudes toward menopause were associated with vaginal dryness. Conclusions: Women’s reported experiences with sexual desire, arousal, orgasm, sexual frequency, vaginal dryness or pain with sex did not differ across menopause transition stages. Moreover, FSH, estrone, and testosterone were unrelated to these indicators. Age, stress, relationships, health status, lifestyle, and attitudes toward menopause were influential in many dimensions of midlife women’s sexuality. Implications: Clinicians should consider the importance of the social factors influencing midlife women’s sexual experiences, not merely their changing biology.
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