Why sex becomes less satisfying with age

It's hard to pick up a woman's magazine or ob/gyn journal anymore without reading an article about how and why a woman's libido and level of sexual satisfaction decline during and after menopause. Substantial research has been conducted into biological reasons such as hot flashes, sleep disruption, vaginal dryness, and painful intercourse. Much less is known about the effect of various psychosocial changes that are common postmenopause. These include body image concerns, self-confidence and perceived desirability, stress, mood changes, and relationship issues.

Of the research that has been conducted regarding psychological influences, most of it has focused on quantitative results. A study of nearly 4,500 postmenopausal women involved in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS), however, looked at free-text data to better understand why women felt a certain way and the depth of those feelings.

Among other things, the UKCTOCS sexual activity data showed that, at baseline, before the start of annual screening, approximately half of the women were sexually active. A decrease in all aspects of sexual activity was observed over time: sexual activity was less frequent, not as pleasurable, and more uncomfortable. The primary reason for absence of sexual activity was the lack of a partner, mainly because of widowhood.

Other commonly cited reasons for decreased activity included (in rank order) a partner's medical condition, a partner's sexual dysfunction, the woman's own physical health problems, menopause-related symptoms, and prescribed medication. Contributing most often to low libido were relationship problems, logistics, and perceptions of aging. Only 3% of participants described positive sexual experiences, whereas only 6% sought medical help for sexual problems.

Study results appear in the article, "Sexual functioning in 4,418 postmenopausal women participating in UKCTOCS: a qualitative free-text analysis."

"Sexual health challenges are common in women as they age, and partner factors play a prominent role in women's sexual activity and satisfaction, including the lack of a partner, sexual dysfunction of a partner, poor physical health of a partner, and relationship issues," says Dr. Stephanie Faubion, NAMS medical director. "In addition, menopause-related problems such as vaginal dryness and pain with sex have been identified as problems affecting sexual function, yet few women seek treatment for these issues, despite the availability of effective therapies."