Holly N. Thomas

Correlates of Sexual Activity and Satisfaction in Midlife and Older Women.

PURPOSE Sexual activity is an important component of quality of life for women across their lifespan. Prior studies show a decline in sexual activity with age, but these studies often fail to consider the role of sexual satisfaction. The aim of this study is to give updated prevalence estimates of sexual activity among women and to elucidate factors associated with sexual activity and sexual satisfaction. METHODS We report a cross-sectional analysis of the second wave of a nationally representative sample of US adults aged 28 to 84 years, the Survey of Midlife Development in the United States. The survey used self-administered questionnaires to assess demographic data, self-rated physical and mental health, medical problems and medication use, relationship factors, and sexual activity and satisfaction. RESULTS Of 2,116 women who answered the questions regarding sexuality, 1,345 (61.8%) women were sexually active in the previous 6 months. The proportion of women who were sexually active decreased with advancing age. Women who were married or cohabitating had approximately 8 times higher odds of being sexually active (odds ratio = 7.91, 95% CI, 4.16–15.04; P <.001). Among women aged 60 years and older who were married or cohabitating, most (59.0%) were sexually active. Among women who were sexually active, higher relationship satisfaction (P <.001), better communication (P = .011), and higher importance of sex P = .040) were related to higher sexual satisfaction, but age was not (P = .79). CONCLUSIONS A considerable proportion of midlife and older women remain sexually active if they have a partner available. Psychosocial factors (relationship satisfaction, communication with romantic partner, and importance of sex) matter more to sexual satisfaction than aging among midlife and older women.

Sexual Activity in Midlife Women: Importance of Sex Matters

Discussion | Fungal contamination of MgSO4 required extensive pharmacy, laboratory, infection control, and hospital administrative support; substantial hospital resources for patient and physician notification; ongoing surveillance; and prophylactic treatment of high-risk patients. Inclusion of lot numbers in medication barcodes would have greatly simplified notification and surveillance efforts by identifying only those patients who were exposedtocontaminatedlots.Ourexperienceaddstotheincreasing body of evidence that improved oversight of compounding pharmacies by the FDA is needed.5,6

A biopsychosocial approach to women's sexual function and dysfunction at midlife: A narrative review

A satisfying sex life is an important component of overall well-being, but sexual dysfunction is common, especially in midlife women. The aim of this review is (a) to define sexual function and dysfunction, (b) to present theoretical models of female sexual response, (c) to examine longitudinal studies of how sexual function changes during midlife, and (d) to review treatment options. Four types of female sexual dysfunction are currently recognized: Female Orgasmic Disorder, Female Sexual Interest/Arousal Disorder, Genito-Pelvic Pain/Penetration Disorder, and Substance/Medication-Induced Sexual Dysfunction. However, optimal sexual function transcends the simple absence of dysfunction. A biopsychosocial approach that simultaneously considers physical, psychological, sociocultural, and interpersonal factors is necessary to guide research and clinical care regarding womens sexual function. Most longitudinal studies reveal an association between advancing menopause status and worsening sexual function. Psychosocial variables, such as availability of a partner, relationship quality, and psychological functioning, also play an integral role. Future directions for research should include deepening our understanding of how sexual function changes with aging and developing safe and effective approaches to optimizing womens sexual function with aging. Overall, holistic, biopsychosocial approaches to womens sexual function are necessary to fully understand and treat this key component of midlife womens well-being.

Antihypertensive medications and sexual function in women: baseline data from the SBP intervention trial (SPRINT).

Objectives: Hypertension is a risk factor for the development of cardiovascular and kidney disease, but treatment can substantially reduce risks. Many patients avoid antihypertensive medications because of fear of side-effects. Although associations between antihypertensives and sexual dysfunction in men have been documented, it remains unclear whether antihypertensives are associated with sexual dysfunction in women. We conducted a cross-sectional analysis of baseline data from women in the Systolic Blood Pressure Intervention Trial (SPRINT) to evaluate the relations among class of antihypertensive medication and the outcomes: sexual activity and sexual function. Methods: SPRINT enrolled individuals 50 and older with hypertension at high risk for cardiovascular disease. A subset of participants completed questionnaires regarding quality of life, including sexual function. Antihypertensive class was determined by medications taken at baseline. Results: Of 690 women in the quality of life subset of SPRINT, 183 (26.5%) were sexually active. There were no significant differences in sexual activity among women taking one or more antihypertensives and women not taking any. Women taking an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker had higher odds of sexual activity [odds ratio 1.66 (1.12–4.27), P = 0.011]. Among sexually active women, the prevalence of sexual dysfunction was high (52.5%). No class of medication was associated with sexual dysfunction in the multivariable model. Conclusion: Angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use was associated with higher odds of sexual activity. Although prevalence of sexual dysfunction was high, no single class of antihypertensive medication was associated with sexual dysfunction.

Changes in sexual function among midlife women: "i'm older... and I'm wiser"

Objective: Women experience a variety of changes at midlife that may affect sexual function. Qualitative research approaches can allow a deeper understanding of womens experiences. We conducted 20 individual interviews and three focus groups among sexually active women aged 45 to 60 years (total n = 39) to explore how sexual function changes during midlife. Methods: Interviews and focus groups were conducted by a trained facilitator using a semistructured guide. All data were audio-recorded and transcribed. Two investigators used a subsample of data to iteratively develop a codebook. The primary investigator coded all data. A second investigator coded a randomly selected 25% of interviews. Codes regarding changes in sexual function were examined and key themes emerged. Results: The mean age was 52, and most women were peri- or postmenopausal. Fifty-four per cent of women were white, 36% black, and 10% of another race. Participants discussed positive and negative changes in sexual function. The most common negative changes were decreased frequency of sex, low libido, vaginal dryness, and anorgasmia. Participants attributed negative changes to menopause, partner issues, and stress. Most participants responded to negative changes with adaptation, including changing sexual behavior and prioritizing different aspects of sex. Participants also reported positive changes, attributed to higher self-confidence, increased self-knowledge, and better communication skills with aging. Conclusions: In this qualitative study, women described experiencing both positive and negative changes in sexual function during midlife. When negative changes occurred, women often adapted behaviorally and psychologically. Providers should recognize that each womans experience is unique and nuanced, and they should provide tailored care regarding sexual function at midlife.

Female Sexual Function at Midlife and Beyond

Sexual function is an important component of quality of life for women. Midlife poses several challenges to optimal sexual function and intimacy for women. In addition to anatomic factors related to estrogen deficiency, such as genitourinary syndrome of menopause, vulvovaginal atrophy, and pelvic organ prolaps, psychosocial factors, including prior sexual trauma, play an important role in sexual function in women. Several treatments have emerged for female sexual dysfunction; long-term studies and head-to-head comparisons are lacking.

Body Image, Attractiveness, and Sexual Satisfaction Among Midlife Women: A Qualitative Study

BACKGROUND Women often undergo physical changes during the menopause transition, but the relationship between body image and sexual function in midlife is unclear. We used a qualitative approach to explore how body image relates to sexual function and satisfaction in midlife women. MATERIALS AND METHODS We conducted 19 individual interviews and 3 focus groups (total N = 39) among sexually active women 45-60 years of age using a semistructured guide. Sessions were audiorecorded and transcribed. Two investigators developed a codebook using an iterative process; the primary investigator then coded all data. Codes relating to body image were examined to identify key themes. RESULTS The mean age was 58 (range 46-59); 54% were White, 36% Black, and 10% were of another race. Most (72%) were peri- or postmenopausal. All but two women identified as heterosexual. Feeling attractive was an important reason for sexual activity. Changes in appearance, especially weight gain and breast changes, were common among these women. Womens body image impacted their sexual satisfaction; women who felt self-conscious about their bodies reported that these concerns had a negative impact on their sexual satisfaction, whereas women who felt confident discussed better sexual satisfaction, even in the face of bodily changes. Black women were more likely to discuss feeling confident than White women. CONCLUSIONS Feeling attractive is important to sexual satisfaction in midlife women. Bodily changes, especially weight gain, are common during midlife. While many women are self-conscious about their appearance, some women develop increased self-acceptance. Supporting positive body image may help midlife women maintain sexual satisfaction with aging.

Capsule commentary on Kimerling et al., Prevalence of intimate partner violence among women veterans who utilize Veterans Health Administration primary care

T he authors used a nationally representative sample (N=6287) of women receiving primary care through the Veterans Health Administration (VHA) to (1) assess prevalence of intimate partner violence (IPV) in the past 12 months and (2) identify patient demographic, military, and health services utilization factors associated with pastyear IPV. Prevalence of past-year IPV was 18.5 %. Factors associated with IPV included economic hardship, sexual minority status, being a parent/guardian, past military sexual trauma, fewer years of military service, use of VHA as usual provider, higher health services utilization, and poorer continuity of care. The authors achieved a response rate of 84 % and performed sensitivity analyses for non-response. They used a well-validated screening tool and included important covariates. Limitations include lack of data on veterans not using VHA and use of a telephone interview. Additionally, in studies estimating past-year rates, telescoping can result in inaccuracies. In contrast to prior studies, rates of past-year IPV among female veterans were similar to the general population. This analysis may underestimate true prevalence. This survey only included women who had at least one primary care visit in the prior year; women experiencing IPVmay be less likely to seek care. Additionally, women who are experiencing IPV may be more likely change contact information, making them more difficult to reach. This analysis highlights the significant relationship between socioeconomic hardship and IPV. Nearly 40 % of homeless women reported past-year IPV. Financial stressors may make it more difficult for these women to distance themselves from an abusive partner, yet providers may not be aware of a patient’s socioeconomic situation. It is important for VHA to identify socioeconomic risk factors, screen for IPV among these at-risk women, and provide supportive services to help women safely leave abusive situations. Women using VHA as a usual provider, as well as women with more frequent visits, were more likely to report IPV. This means VHA has frequent opportunities to screen and provide services. VHA should work to build trusting relationships between patients and providers, as trust is a major factor in whether women who are screened disclose IPV.