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Patterns and predictors of sexual activity among women in the Hormone Therapy trials of the Women's Health Initiative

Gass, Margery L.S. MD, NCMP1; Cochrane, Barbara B. PhD, RN2; Larson, Joseph C. MS3; Manson, JoAnn E. MD, DrPH, NCMP4; Barnabei, Vanessa M. MD, PhD, NCMP5; Brzyski, Robert G. MD, PhD6; Lane, Dorothy S. MD, MPH7; LaValleur, June MD8; Ockene, Judith K. PhD, MEd, MA9; Mouton, Charles P. MD, MS10; Barad, David H. MD, MS11

doi: 10.1097/gme.0b013e3182227ebd
Original Articles

Objective: The aim of this study was to determine the patterns and predictors of sexual activity in the Hormone Therapy (HT) Trials of the Women's Health Initiative (WHI).

Methods: Sexual activity questions were administered to 27,347 women ages 50 to 79 years at baseline and at year 1 and to a random 8.6% subsample at years 3 and 6. The associations with demographic and health characteristics were determined.

Results: Sexual activity at baseline was 60.7%, 44.9%, and 28.2% in the 50- to 59-, 60- to 69-, and 70- to 79-year-old age groups, respectively. Most of the participants were satisfied with their current sexual activity (63.2%). Of those dissatisfied, 57% preferred more sexual activity. Vaginal atrophy correlated with sexual inactivity at baseline (P < 0.001). The correlates associated with stopping sexual activity at year 1 included poor/fair self-rated health, lack of satisfaction with quality of life, depression, and loss of partner (P < 0.001). The strongest predictor of sexual activity at year 1 was sexual activity at baseline (odds ratio, 96.71; 95% CI, 81.90-114.20). A subset analysis of women adherent with HT or placebo at years 3 and 6 suggested that HT was associated with a higher percentage of participants reporting sexual activity (P = 0.01).

Conclusions: Most women in the WHI HT Trials were satisfied with their sexual activity. Of those who were dissatisfied, the majority preferred more, rather than less, sexual activity. Vaginal atrophy at baseline correlated with sexual inactivity, and sexual activity at baseline was the strongest identified predictor of sexual activity at year 1. HT use was not predictive of ongoing sexual activity in the intent-to-treat analysis. This report further characterizes the participants in the WHI HT trials and reveals the complexity of factors related to the prevalence of sexual activity and satisfaction.

From the 1The North American Menopause Society, Mayfield Heights, OH; 2University of Washington School of Nursing, Seattle, WA; 3Fred Hutchinson Cancer Research Center, Seattle, WA; 4Brigham and Women's Hospital, Harvard Medical School, Boston, MA; 5Medical College of Wisconsin, Milwaukee, WI; 6University of Texas Health Science Center-San Antonio, San Antonio, TX; 7Stony Brook University School of Medicine, Stony Brook, NY; 8University of Minnesota, Minneapolis, MN; 9University of Massachusetts, Worcester, MA; 10Howard University, Washington, DC; and 11Albert Einstein College of Medicine, Bronx, NY.

Received December 31, 2010; revised and accepted March 30, 2011.

Funding/support: The Women's Health Initiative (WHI) program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, and the US Department of Health and Human Services through contracts N01WH22110, 24152, 32100-2, 32105-6, 32108-9, 32111-13, 32115, 32118-32119, 32122, 42107-26, 42129-32, and 44221. The active study drug and placebo were supplied by Wyeth (Radnor, PA).

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Margery L.S. Gass, MD, The North American Menopause Society, 5900 Landerbrook Drive, Suite 390, Mayfield Heights, OH 44124. E-mail:

©2011The North American Menopause Society