Norma L. McCoy

A longitudinal study of the effects of menopause on sexuality

From an initial group of 39, 16 cycling peri-menopausal women completed a longitudinal study in which they recorded menstrual and sexual behavior daily and were interviewed at roughly 4-mth intervals until 1 yr or more without cycling. At each interview women gave 20-ml blood samples, completed sexuality questionnaires, and rated themselves for menopausal symptoms. As predicted, the difference in weekly rate of sexual intercourse before and after the cycle showed a significant decline (P less than 0.05). For each subject, mean weekly rates of sexual intercourse for 13-wk periods over the entire transition period were plotted and the slope of the line was calculated. Overall, the mean slope was negative, as predicted, and was significantly different from zero (P less than 0.05). The questionnaire data showed that compared with their pre-menopause data, the women had fewer sexual thoughts or fantasies (P less than 0.01), suffered more from lack of vaginal lubrication during sex (P less than 0.01), and were less satisfied with their partners as lovers (P less than 0.05) after menopause. While estradiol (E) and testosterone (T) levels showed significant declines (P less than 0.02), testosterone showed the most consistent association with coital frequency. The findings generally supported our initial hypothesis of a decline in sexual interest and coital frequency after menopause.

Sexual interest and behavior in healthy 80- to 102-year-olds

Sexual interest and behavior of 100 white men and 102 white women ranging in age from 80–102 were studied using an anonymous 117-item questionnaire. Subjects were healthy and upper middle-class, and living in residential retirement facilities; 14% of the women and 29% of the men were presently married. For both men and women, the most common activity was touching and caressing without sexual intercourse, followed by masturbation, followed by sexual intercourse. Of these activities, only touching and caressing showed a significant decline from the 80s to the 90s, with further analyses revealing a significant decline in this activity for men but not for women. Except for past enjoyment of sexual intercourse and of touching and caressing without sexual intercourse, all analyses revealed sex differences reflecting more activity and enjoyment by men. Current income and past guilt over sexual feelings showed very low but significant correlations with some frequency and enjoyment measures, and marital status, extramarital sex, and church attendence were significantly associated with continuing to perform and enjoy some sexual behaviors. Past importance of sex was significantly correlated with present frequency and enjoyment of both sexual intercourse and touching and caressing without sexual intercourse. Correlations between past and present frequency of sexual behaviors were substantial and significant for all but frequency of sexual intercourse, suggesting that current physical and social factors play an overriding role in this area.

Oral contraceptives and sexuality in university women.

The relationship between use of oral contraceptives and sexuality in university women who completed the McCoy Female Sexuality Questionnaire was examined. Pill users reported sexual intercourse earlier, were less likely to be virgins, more likely to have a sex partner, more apt to be engaging in petting and intercourse than nonusers, and reported more frequent intercourse than sexually active nonusers. Nonusers reported a greater frequency and enjoyment of anal intercourse than pill users. The prediction that pill users would have less vaginal lubrication than nonusers was supported. Contrary to prediction, pill users reported a higher frequency of sexual thoughts and fantasies, and level of sexual interest than active nonusers. Triphasic Orthonovum 7/7/7 (OR7/7/7) users reported more sexual thoughts and fantasies and had higher Sexual Interest (Factor 1) scores than monophasic Orthonovum 1/35 (OR1/35) users. Triphasic users as a group enjoyed sexual activity more, were more aroused during sexual activity, and had higher Sexual Interest factor scores than monophasic users. Triphasic users reported more sexual thoughts and fantasies, sexual interest and had higher Sexual Interest factor scores than nonusers, while monophasic users did not. Monophasic users reported less vaginal lubrication than nonusers, whereas triphasic users did not. Comparisons of OR7/7/7 and OR1/35 users with nonusers revealed the same findings. Results suggest that women using triphasic pills experience greater sexual interest and response than those using monophasics. Possible reasons for these differences are discussed.

The McCoy Female Sexuality Questionnaire

The McCoy Female Sexuality Questionnaire (MFSQ) was developed from the questionnaire used in a longitudinal study of the menopausal transition and designed to measure aspects of female sexuality likely to be affected by changing sex hormone levels. The original questionnaire was revised to insure that questions were easy to understand and that labels for the Likert scales described a continuum. The revised MFSQ contains 19 questions, 18 items using 7-point Likert scales with labels at the center and endpoints and one item requesting a frequency of activity. Seven studies involving both clinical and convenience samples and two with double blind randomized controlled trials used 7, 9, 10 or 17 MFSQ items and demonstrated acceptable reliability, internal consistency, apparent face and content validity as well as considerable evidence of construct validity. Results showed selected MFSQ item ratings decreased as women progressed through the menopausal transition, varied positively with endogenous estradiol and androgen levels, were higher in postmenopausal women receiving hormone replacement therapy (HRT), and differentiated between different types of oral contraceptives and the presence or absence of ovaries. Convergent validity was demonstrated for change in 9-item MFSQ score with change in psychological general well-being (PGWB) score and the Womens Health Questionnaire (WHQ) sex life subscale.

Relationships among sexual behavior, hot flashes, and hormone levels in perimenopausal women

Forty-three perimenopausal women kept daily records of menstrual cycles and sexual activity. Data on hot flashes and plasma estradiol and testosterone levels were obtained at two points during the menopausal transition. The prospective data yielded a significant negative association between hot flash ratings and regularity of sexual intercourse at both time points. A significant negative correlation was found between estradiol (in the early part of the cycle) and hot flashes ratings at the first data point only, and positive correlations were found between hot flashes and ratio of testosterone to estradiol (T/E) at both. Frequency of sexual intercourse and level of plasma estradiol were higher, and T/E and hot flash ratings were lower in “early” perimenopausal women who were still having cycles at least once every 30 days, as compared with “late” perimenopausal women who were cycling less often. It was concluded that a close association exists between increasing irregularity of menstrual cycles, hot flashes, declining estradiol levels, and declining frequency of intercourse during the perimenopause. Causal relationships remain to be established.

Methodological problems in the study of sexuality and the menopause

Few studies have considered the effects of menopause on sexuality. Large studies with representative samples using postal questionnaires have included only a few sexual variables. More comprehensive studies have tended to employ non-representative samples that raise questions concerning generalization of findings. Major problems in existing research have been: failure to collect data on variables known to affect sexuality and/or failure to utilize such data in analyses, studying only one, sometimes two, menopausal phases, gathering retrospective data, asking subjects directly about the relationship of menopause to sexuality, gathering too few sexual data, not providing a complete description of sexual measures, neglecting to report methodology clearly and completely, failing to evaluate data statistically, and inferring causation from correlations. Evidence from existing research suggests a decline in sexual interest, frequency of sexual intercourse, and vaginal lubrication in association with the menopause. Findings for variables such as capacity for orgasm, satisfaction with sex partner, and vaginal pain or discomfort are few and mixed.

Pheromonal influences on sociosexual behavior in young women

A double-blind, placebo-controlled study of a synthesized putative female pheromone was conducted with regularly menstruating, university women (N=36, mean age=27.8). The pheromone formula was derived from earlier work investigating the underarm secretions of fertile, sexually active, heterosexual women. A vial of either synthesized pheromone or placebo was selected blindly and added to a subjects perfume. Subjects recorded seven sociosexual behaviors and reported them weekly across three menstrual cycles. Beginning with Day 8 of each cycle, the first cycle contained a 2-week baseline period followed by an experimental period of as many as 3 weeks each from the next two cycles for a maximum of 6 weeks. The 19 pheromone and 17 placebo subjects did not differ significantly in age, weight, body mass index, dating status or ethnicity nor in reported accuracy, back-filling data, perception of a positive effect or perfume use. Placebo subjects were significantly taller than pheromone subjects. Except for male approaches, subjects did not differ significantly at baseline in average weekly sociosexual behaviors. A significantly greater proportion of pheromone users compared with placebo users increased over baseline in frequency of sexual intercourse, sleeping next to a partner, formal dates and petting/affection/kissing but not in frequency of male approaches, informal dates or masturbation. Three or more sociosexual behaviors increased over baseline for 74% of pheromone users compared with 23% of placebo users. We conclude that this synthesized pheromone formula acted as a sex attractant pheromone and increased the sexual attractiveness of women to men.

Self-Confidence, Self-Esteem, and Assumption of Sex Role in Young Men and Women

This study investigated the use of the English translation of a paper-and-pencil self-confidence scale developed in French by Garant, Charest, Alain, and Thomassin in 1995. The translated self-confidence scale measured self-confidence, or the belief that one will succeed at whatever one undertakes, as distinct from self-esteem or the feeling that one is a worthwhile person. Unlike a number of previous studies, there was no sex difference in self-confidence favoring men however, scores on the masculinity portion of Berns Sex-role Inventory (1974) were highly correlated with self-confidence for both men (r = .59) and women (r = .69).

Estrogen Levels in Relation to Self‐Reported Symptoms and Sexuality in Perimenopausal Women

While declines in sexual interest and responsiveness have been associated with the menopause,’V2 few studies have shown a clear relationship between hormones and such declines. This study exaniines the relationship between estradiol (E) and self-reported symptoms and sexuality in perimenopausal women. Thirty-nine perimenopausal women in a longitudinal study of sexuality who (a) were intact, (b) did not use hormones, and (c) had a sexual partner or partners kept records of menstrual and sexual activity and were interviewed at 4-month intervals-on cycle days 1-5, if cycling. At each interview, 20-ml blood samples were drawn and questionnaire data obtained. Subjects rated sexual experience during the previous 30 days on 7-point scales, and symptoms for the same time period on 4point scales, indicating norie, slight, moderate, or marked. Only data from subjects having estradiol levels both 530 pg/ml and >30 < 200 pg/ml during the study weIe included in the analyses. Data associated with estradiol levels greater than 200 pg/nil were excluded since such levels are abnormal for cycle days 1-5 and have been associated by de Lignieres and Vincens3 with aggression and irritability in postmenopausal women. Twenty subjects (mean age = 49.4) met the criterion. Eleven of them had reached menopause during the study and provided data from both before and after the last cycle. However, menopausal status and estradiol level wete completely confounded for only three subjects in the analyses of symptoms and two subjects in the analyses of sex questionnaire data. Each subject’s data were divided on the basis of the above estradiol levels and two mean ratings for each item for each subject were computed. One-tailed t tests were used to assess the differences. As predicted, when estradiol levels were low (low E: M = 22.8 pg/nil; High E: M = 72.4 pg/nil), hot flashes, night sweats, insomnia, vertigo, loss of pubidunderarm hair, and palpitations were all rated significantly greater (TABLE 1 ) . Sexually, wonien were more apt to have dyspareunia, lack of vaginal lubrication, decreased satisfaction with sex because of their partners’ level of sexual interest, fewer sexual thoughts, and decreased satisfaction with their partners as lovers (TABLE 2). In summary, the prospective measurement of symptoms and sexuality through self-report questionnaires demonstrated a clear relationship between hormone levels and both symptoms and sexuality in perimenopausal women. While the average changes in sexuality associated with very low estradiol levels were not great, the data showed a decline in reported sexual interest as reflected in sexual thoughts and fantasies, a decline in reported sexual responsiveness as reflected in decreased vaginal lubrication and increased dyspareunia, and a decline in reported attractiveness as reflected in decreased sexual satisfaction caused by a less-interested partner. Because testosterone as well as other sex hormone levels

Longitudinal study of menopause and sexuality.

Longitudinal study of the menopause and sexuality involves many problems that may account for the small number of such studies. In seeking subjects, the mention of sexuality is best delayed until the initial interview when subjects can be informed of the strict confidentiality of the data and be assured that having a sex partner is not a requirement for participation. It is best if subjects are required to be early perimenopausal with regular menstrual cycles but with a change in cycle length and/or flow. Important demographic variables of interest are ethnicity, education, socioeconomic status, health, and partner status. Subjects who have had reproductive surgery or use medications likely to affect sexuality are properly excluded from study or studied as a separate group. Measures include daily calendars for prospective recording of menstruation and sexual behavior as well as repeated questionnaires assessing menopausal symptoms and sexuality; questionnaires should be designed to obtain data concerning sexual interest, sexual attractiveness, and sexual response. It is desirable to measure sex hormone levels at regular intervals if possible. Technological advances have added new and better methods of data collection and have increased the chance of getting accurate prospective data. Nonetheless a good relationship with the investigator is important in obtaining subject co‐operation and avoiding attrition. Future studies need to attempt to collect data from sex partners of subjects as well as explore the effects of different sex hormone products and regimens on sexual attractiveness, sexual interest, and sexual response.