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Predictors of decreased libido in women during the late reproductive years

Gracia, Clarisa R. MD1 3; Sammel, Mary D. ScD4; Freeman, Ellen W. PhD1 2; Liu, Li MD, MS5; Hollander, Lori BA5; Nelson, Deborah B. PhD4

doi: 10.1097/01.GME.0000082147.01218.CF

Objective To identify risk factors for decreased libido among women in the late reproductive years.

Design Prospective cohort. Women aged 35 to 47 years identified through random digit dialing were prospectively followed for 4 years with serial hormone assays and standardized questionnaires. Mean hormone values, hormone trends over 4 years, and fluctuation in hormone levels were compared among women with and without a decrease in libido at the last assessment period. Total testosterone, dihydroepiandrosterone sulfate, estradiol, follicle-stimulating hormone, luteinizing hormone, body mass index, psychosocial, and socioeconomic variables were evaluated using multivariable logistic regression.

Results Of 326 women, 87 (27%) reported a decreased libido, whereas 239 (73%) did not. Participant-specific means for all hormone levels over the study period were similar among both groups. However, total testosterone fluctuation over the study was significantly different between groups. Women whose testosterone levels fluctuated from 3.8 to 21.5 ng/dL around a mean value of 9 ng/dL were four times more likely to report decreased libido compared with women with little fluctuation in testosterone [odds ratio (OR) 4.0; 95% CI, 1.6–10.0]. Depression (OR 3.4; 95%CI, 1.9–6.1), vaginal dryness (OR 3.5; 95%CI, 1.8–6.6), and children living at home (OR 1.4; 95%CI, 1.1–1.7) were also independently associated with decreased libido.

Conclusions Decreased libido in the late reproductive years is associated with a pronounced fluctuation in total testosterone over time. Other independent risk factors for decreased libido include vaginal dryness, depression, and living with children. Sexual dysfunction is a complex disorder, related to physiological and psychosocial factors, requiring further investigation.

From the 1Department of Obstetrics/Gynecology, 2Department of Psychiatry, 3Division of Reproductive Endocrinology and Infertility, 4Department of Biostatistics and Epidemiology and Center for Clinical Epidemiology; and the 5Center for Research in Reproduction and Women’s Health, University of Pennsylvania School of Medicine, Philadelphia, PA.

This study was supported by grants from the National Institutes of Health, R01-AG-12745 and 2MO1RR-00040-37 (General Clinical Research Center).

Received March 5, 2003; revised and accepted May 22, 2003.

Address correspondence to: Clarisa R. Gracia, MD, PA Fertility Care, 3701 Market St., Suite 800, Philadelphia, PA 19104. E-mail:

©2004The North American Menopause Society