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Changes in sexual function among midlife women

“I’m older… and I’m wiser”

Thomas, Holly N. MD, MS1,2; Hamm, Megan PhD1; Hess, Rachel MD, MS3; Thurston, Rebecca C. PhD2,4

doi: 10.1097/GME.0000000000000988
Original Articles

Objective: Women experience a variety of changes at midlife that may affect sexual function. Qualitative research approaches can allow a deeper understanding of women's experiences. We conducted 20 individual interviews and three focus groups among sexually active women aged 45 to 60 years (total n = 39) to explore how sexual function changes during midlife.

Methods: Interviews and focus groups were conducted by a trained facilitator using a semistructured guide. All data were audio-recorded and transcribed. Two investigators used a subsample of data to iteratively develop a codebook. The primary investigator coded all data. A second investigator coded a randomly selected 25% of interviews. Codes regarding changes in sexual function were examined and key themes emerged.

Results: The mean age was 52, and most women were peri- or postmenopausal. Fifty-four per cent of women were white, 36% black, and 10% of another race. Participants discussed positive and negative changes in sexual function. The most common negative changes were decreased frequency of sex, low libido, vaginal dryness, and anorgasmia. Participants attributed negative changes to menopause, partner issues, and stress. Most participants responded to negative changes with adaptation, including changing sexual behavior and prioritizing different aspects of sex. Participants also reported positive changes, attributed to higher self-confidence, increased self-knowledge, and better communication skills with aging.

Conclusions: In this qualitative study, women described experiencing both positive and negative changes in sexual function during midlife. When negative changes occurred, women often adapted behaviorally and psychologically. Providers should recognize that each woman's experience is unique and nuanced, and they should provide tailored care regarding sexual function at midlife.

1Department of Medicine, University of Pittsburgh, Pittsburgh, PA

2Center for Women's Health Research and Innovation (CWHRI), University of Pittsburgh, Pittsburgh, PA

3Department of Medicine, University of Utah, UT

4Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA.

Address correspondence to: Holly N. Thomas, MD, MS, 230 McKee Place Suite 600, Pittsburgh, PA 15213. E-mail:

Received 29 June, 2017

Revised 15 August, 2017

Accepted 15 August, 2017

Funding/support: Dr Thomas is funded by a grant from the Agency for Healthcare Research and Quality (5K12HS022989-03). Dr Thurston is funded by a grant from the National Heart, Lung, and Blood Institute of the National Institutes of Health (K24HL123565).

Financial disclosure/conflicts of interest: None reported.

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© 2018 by The North American Menopause Society.