Women experience a notable
decline in sexual function approximately 20 months before and one year after their
last menstrual period, and that decrease continues, though at a somewhat slower
rate, over the following five years, according to a study led by a researcher
at Wake Forest Baptist Medical Center.
The study, published ahead of print in the current online
issue of Menopause: The Journal of the North American Menopause Society, also found
that various factors that frequently co-occur with menopause have less direct influence
on declining sexual function than menopause itself.
“Sexual functioning in women declines with age, and there
has been much debate about how much this is due to menopause, aging or other
physical, psychological or social factors,” said the study’s lead author, Nancy
Avis, Ph.D., professor of public health sciences at Wake Forest School of
Medicine, part of Wake Forest Baptist. “Our findings support that menopause has
a negative effect on sexual functioning in many women.”
Additionally, the study found that women who have a hysterectomy
before the onset of menopause do not experience a marked decline in sexual
function immediately before undergoing the procedure but do so afterward, for
as long as five years.
The researchers based their findings on information
collected from 1,390 participants in the federally funded Study of Women’s
Health Across the Nation (SWAN), which began in 1996. These women, who were
between the ages of 42 and 52 at the time of enrollment in the study and who
had a known date of final menstrual period during their participation, responded
to questionnaires dealing with various aspects of sexual function – including
desire, arousal, satisfaction and pain – between one and seven times over the
course of the study. The researchers analyzed 5,798 of these self-assessments
(4,932 from the 1,164 women in the natural menopause group and 866 from the 226
women in the hysterectomy group) and tracked the changes in the respondents’
scores on the sexual-function questionnaires relative to either their final
menstrual period among women who experienced a natural menopause or the hysterectomy.
Of note, in the natural menopause group the researchers
found that race/ethnicity played a major role in the decline of sexual function,
with African-American women experiencing a significantly smaller decline and
women of Japanese descent experiencing a much greater decline when compared
with white women.
“Sexual functioning is an important component of women’s
lives. More than 75 percent of the middle-aged women in the SWAN study reported
that sex was moderately to extremely important to them when the study began,”
Avis said. “It is important for women and their health care providers to understand
all the factors that may impact women’s experience of sex in relation to both
the natural menopausal transition and hysterectomy, and we hope our findings
will contribute to better understanding in this area.”
The SWAN project received funding from the National
Institutes of Health through the National Institute on Aging, National
Institute of Nursing Research and NIH Office on Women’s Health in grants
U01NR004061, U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546,
U01AG012553, U01AG012554 and U01AG012495.
Co-authors of the study are Alicia Colvin, Ph.D., Maria
Brooks, Ph.D., and Ping D. Tepper, Ph.D., University of Pittsburgh School of
Public Health; Arun S. Karlamangla, M.D., Ph.D., and Gail A. Greendale, M.D.,
David Geffen School of Medicine at UCLA; Sybil Crawford, Ph.D., University of
Massachusetts Medical Center, Worcester; Rachel Hess, M.D., University of Utah
School of Health Sciences; and L. Elaine Waetjen, UC Davis School of Medicine.