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Sexual functioning in 4,418 postmenopausal women participating in UKCTOCS

a qualitative free-text analysis

Harder, Helena PhD1; Starkings, Rachel M.L. MSc1; Fallowfield, Lesley J. DPhil1; Menon, Usha MD2; Jacobs, Ian J. MD3,4; Jenkins, Valerie A. DPhil1 on behalf of the UKCTOCS trialists

doi: 10.1097/GME.0000000000001377
Original Study: PDF Only

Objective: Sexual well-being can contribute significantly to the overall quality of women's lives. This qualitative study aimed to examine sexual activity, functioning, and satisfaction in a large sample of postmenopausal women from the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS)

Methods: Thematic analysis was used to evaluate the free-text data of the Fallowfield Sexual Activity Questionnaire (FSAQ) completed by UKCTOCS participants at baseline before annual screening.

Results: A total of 24,305 women completed the baseline FSAQ and 4,525 (19%) provided free-text data, with 4,418 comments eligible for analysis. Median age was 64 years; 65% had a partner and 22.5% were sexually active. Four interrelated themes were derived: partner availability, physical and sexual health, mental well-being, and interpersonal relationships. Primary reason for absence of sexual activity was lack of a partner, mainly due to widowhood (n = 1,000). Women discussed how partner's medical condition (27%) or sexual dysfunction (13.5%), their own physical health (18%) or menopause-related symptoms (12.5%), and prescribed medication (7%) affected sexual activity. Impact of low libido in self (16%) or partner (7%), relationship problems (10.5%) or logistics (6%), and perceptions of ageing (9%) were also mentioned. Few (3%) referred to positive sexual experiences or had sought medical help for sexual problems (6%).

Conclusions: This qualitative analysis explored postmenopausal women's perspective on their sexual functioning. Having an intimate partner and good physical health are key factors for continuation of sexual activity and satisfaction. Further sexual education for healthcare professionals is needed to raise awareness about sexuality and sexual difficulties in later life.

Video Summary: Supplemental Digital Content 1,

1Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom

2MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom

3EGA Institute for Women's Health, University College London, London, United Kingdom

4University of New South Wales, Sydney, Australia.

Address correspondence to: Helena Harder, PhD, SHORE-C, Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9RX, United Kingdom. E-mail:

Received 7 February, 2019

Revised 26 March, 2019

Accepted 26 March, 2019

Funding/support: Funding for the psychosocial study in UKCTOCS was received from the Medical Research Council (G0000735) and the Eve Appeal. The main trial of UKCTOCS was funded by Medical Research Council (G9901012 and G0801228), Cancer Research UK (C1479/A2884), Department of Health, and the Eve Appeal. UM was supported by the NIHR University College London Hospitals (UCLH) Biomedical Research Centre. Funders had no involvement in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

Financial disclosure/conflicts of interest: IJJ and UM declare a relationship with Abcodia LTD which has a license to the Risk of Ovarian Cancer Algorithm from Massachusetts General Hospital. IJJ has a potential royalty stream from the license. HH, RMLS, LJF, and VAJ have no relevant interests to declare.

Data sharing statement: The datasets used and analyzed during the present study are available from the corresponding author on reasonable request.

Trial registration: this study is registered as an International Standard Randomised Controlled Trial (ISRCTN22488978).

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This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2019 by The North American Menopause Society.