Sexual dysfunction in women at midlife explored by largest study of its kind

Almost 50% of women in midlife surveyed in a Monash University-led study had poor sexual well-being, including a doubling of the likelihood of desire and arousal dysfunction in early perimenopausal women from premenopause.

Published in The Lancet Obstetrics, Gynaecology, & Women’s Health, the study, believed to be the largest of its kind, explored the prevalence of sexual difficulties and sexually related personal distress experienced in midlife women.

It identified early perimenopause as a time of change in sexual well-being, highlighting the need for therapeutic options and best practice guidelines at that life stage.

Senior author Professor Susan Davis AO, who heads the Monash University Women’s Health Research Program in the School of Public Health and Preventive Medicine, said there has been substantial uncertainty regarding the prevalence of female sexual dysfunction (FSD) at midlife in women aged 40–69 and the effect the stages of menopause has on the different domains of sexual function.

“The importance of sexual well-being to overall health is often overlooked. One cannot dismiss the impact that sexual health has, not only on a woman’s intimate relationship, but most importantly on a woman’s general well-being,” Professor Davis said.

The study involved 5,468 Australian women aged 40–69 years. Of the 5,468 participants, 2,583 had sexually related personal distress; 1 in 4 had a sexual dysfunction and 1 in 4 had sexually related distress without an identified sexual dysfunction.

FSD encompasses sexual difficulties that cause personal distress. These are classified by the International Classification of Disease 11th Revision (ICD-11) as issues with desire, arousal and orgasm, or non-specified dysfunctions. FSD is associated with impaired well-being and quality of life, such that affected women are more likely to be depressed, and to report emotional and relationship stress and breakdown.

In this study, low sexual desire (13.3%), impaired arousal (13.1%), and poor sexual self-image (12.8%) were the most prevalent sexual dysfunctions.

“Although our study revealed low desire and arousal to be the most prevalent sexual difficulties, participants with poor sexual self-image had the greatest likelihood of having associated distress,” Professor Davis said.

Dr. Yuanyuan Wang, also from the School of Public Health and Preventive Medicine, was first author on the study. “After taking into account ancestry, partner status, BMI, vaginal dryness during intercourse, moderate-to-severe depressive symptoms, current use of anxiolytic or antidepressant, and experience of psychological abuse or sexual abuse, we found that as age increased there was a general increase in sexual difficulties, whereas sexually related distress declined,” Dr. Wang said.

“This resulted in the greatest likelihood of estimated FSD in participants aged 55–59 years, suggesting increasing age could be a key contributing factor to these associations.”

Professor Davis said, “The two-fold increase in the prevalence of desire, arousal and sexual self-image dysfunction among early perimenopausal participants, compared with premenopausal participants, highlights early perimenopause as a vulnerable period for the development of FSD.

“However, best practice guidelines for FSD in perimenopause are scarce. Additionally, regulator-approved treatments for FSD are restricted to desire dysfunction and confined to either premenopausal or postmenopausal women. Given the observed prevalence of FSD in perimenopausal women, best practice guidelines and treatment options for perimenopausal women are much needed.”