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Association of sleep disturbance and sexual function in postmenopausal women

Kling, Juliana M. MD, MPH1; Manson, JoAnn E. MD, DrPH2; Naughton, Michelle J. PhD, MPH3; Temkit, M’hamed PhD4; Sullivan, Shannon D. MD, PhD5; Gower, Emily W. PhD6; Hale, Lauren PhD7; Weitlauf, Julie C. PhD8,9; Nowakowski, Sara PhD10; Crandall, Carolyn J. MD, MS11

doi: 10.1097/GME.0000000000000824
Original Articles

Objective: Sleep disturbance and sexual dysfunction are common in menopause; however, the nature of their association is unclear. The present study aimed to determine whether sleep characteristics were associated with sexual activity and sexual satisfaction.

Methods: Sexual function in the last year and sleep characteristics (past 4 wk) were assessed by self-report at baseline for 93,668 women age 50 to 79 years enrolled in the Women's Health Initiative (WHI) Observational Study (OS). Insomnia was measured using the validated WHI Insomnia Rating Scale. Sleep-disordered breathing (SDB) risk was assessed using questions adapted from the Berlin Questionnaire. Using multivariate logistic regression, we examined cross-sectional associations between sleep measures and two indicators of sexual function: partnered sexual activity and sexual satisfaction within the last year.

Results: Fifty-six percent overall reported being somewhat or very satisfied with their current sexual activity, and 52% reported partnered sexual activity within the last year. Insomnia prevalence was 31%. After multivariable adjustment, higher insomnia scores were associated with lower odds of sexual satisfaction (yes/no) (odds ratio [OR] 0.92, 95% CI, 0.87-0.96). Short sleep duration (<7-8 h) was associated with lower odds of partnered sexual activity (yes/no) (≤5 h, OR 0.88, 95% CI, 0.80-0.96) and less sexual satisfaction (≤5 h, OR 0.88, 95% CI, 0.81-0.95).

Conclusions: Shorter sleep durations and higher insomnia scores were associated with decreased sexual function, even after adjustment for potential confounders, suggesting the importance of sufficient, high-quality sleep for sexual function. Longitudinal investigation of sleep and its impact on sexual function postmenopause will clarify this relationship.

1Division of Women's Health, Mayo Clinic, Scottsdale, AZ

2Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA

3Division of Population Sciences, Department of Internal Medicine, Ohio State University, Columbus, OH

4Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ

5Division of Endocrinology, Medstar Washington Hospital Center and Georgetown University, Washington, DC

6Department of Epidemiology and Ophthalmology, Wake Forest School of Medicine, Winston-Salem, NC

7Program in Public Health, Department of Family, Population, and Preventive Medicine, Stony Brook University, Stony Brook, NY

8Veterans Affairs Palo Alto Health Care System, Palo Alto, CA

9Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA

10Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX

11Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA.

Address correspondence to: Juliana M. Kling, MD, MPH, 13737 North 92nd Street, Scottsdale, AZ 85260. E-mail:

Received 14 September, 2016

Revised 14 November, 2016

Accepted 14 November, 2016

Funding/support: The Women's Health Initiative program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services through contracts HHSN268201100046C, HHSN268201100001C, HHSN268201100002C, HHSN268201100003C, HHSN268201100004C, and HHSN271201100004C.

Financial disclosure/conflicts of interest: Funding from the Department of Internal Medicine at Mayo Clinic Arizona contributed to statistical support, but no other funds were utilized for this project. The authors have no conflict of interest or other financial disclosures.

© 2017 by The North American Menopause Society.