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Try out PMC Labs and tell us what you think. Learn More. Women experience a variety of changes at midlife that may affect sexual function. Interviews and focus groups were conducted by a trained facilitator using a semi-structured 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. Codes regarding changes in sexual function were examined and key themes emerged.
The mean age was 52, and most women were peri-or postmenopausal. 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. 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. Sexual function is an important aspect of quality of life for many women 1 — 4. Midlife approximately age 40—60 is a time of many changes that may impact sexual function, including physical changes e. Longitudinal studies indicate that sexual function declines during midlife, particularly during the menopausal transition. These studies typically use multiple-choice questions to assess sexual function—the investigator chooses the topics, domains, wording of the question, and the answers.
This allows for standardization of instruments across women and ease of administration with large samples. By using open-ended questions and allowing participants to speak at length, a qualitative approach lets participants use their own words to describe their experiences and allows them to discuss the facets of the subject most important to their own experience.
Researchers may then uncover concepts that they never realized existed, and the themes most relevant to the participants arise naturally. Study participants were recruited from the general population of Pittsburgh, PA using flyers, research registries, electronic newsletters, and Internet postings. Women who responded were screened for eligibility over the telephone after giving verbal assent.
Women were eligible if they were aged 45—60 and had been sexually active with a partner at least once in the prior 12 months. We included this age group in order to focus on midlife women. Women who had not been recently sexually active would be discussing more remote experiences. Women were given the option to participate in either an individual interview or a focus group.
Face-to-face interviews and focus groups were led in a private room by a facilitator with extensive experience in qualitative research methods and sexual anthropology M. Interviews and focus groups both lasted approximately 60 minutes. An introductory script encompassing the purpose of the study and all elements of informed consent, including the voluntary nature of the study and the ability to discontinue the study at any time, was read to participants at the start of each session. Women were then given the option to continue with the study or leave.
The University of Pittsburgh Institutional Review Board approved this study and recommended this informed consent process over written informed consent. We chose to use both focus groups and interviews; the former may uncover new themes due to group synergy, and the latter allow us to hear the perspectives of women who do not wish to discuss sexuality in a group context. Interviews and focus groups were guided by an semi-structured guide; however, consistent with the emergent nature of qualitative research, participants may have been asked different or additional questions not in the guide, depending on her responses see supplementary materials.
The guide was developed by the principal investigator H. Each session was audio-recorded and transcribed verbatim. Participant names, and names of any individuals they mentioned, were not transcribed. The principal investigator served as a note taker for each focus group but did not participate in discussions. Minimal notes were taken as needed by the facilitator during individual interviews.
Each interview and focus group participant also completed a demographic questionnaire, and transcriptions were linked to questionnaires using a study identification. Sample size in qualitative research is guided by the concept of thematic saturation, which means no new information or themes are uncovered in the course of ongoing interviews and focus groups.
Thematic saturation was achieved in this study. As the goal in qualitative research is more focused on understanding a phenomenon in-depth as opposed to hypothesis testing or generalizability, sample sizes tend to be smaller than in quantitative research.
Our sample size is consistent with general qualitative research norms 12 — The principal investigator read all transcripts and then met with the facilitator, who conducted all interviews and focus groups, to develop a draft codebook. Codebook development proceeded in an iterative process, with investigators reading and coding two randomly selected interviews then meeting to review agreement, until a final codebook was agreed upon.
The primary investigator then coded all data using this final codebook. Kappa score was 0. Codes relating changes in sexual function over time were examined and key themes emerged Figure. Representative quotations were selected form the transcripts to illustrate these key themes. The characteristics of the participants are summarized in Table 1. All but two participants reported their sexual orientation as heterosexual; one woman reported her orientation as homosexual and one marked both heterosexual and not sure. The themes discussed are summarized in the Figure.
Participants described experiencing both negative and positive changes in sexual function with aging, sometimes both within the same individual. Participants highlighted the changes they experienced, what they felt were the likely causes for these changes, and how they adapted to these changes.
The most common negative changes were decreased frequency of sex, low libido, vaginal dryness, and orgasm difficulties Table 2. We considered decreased frequency of sex as a negative change, as most women in this study expressed frustration and disappointment with this change. However, it should be noted that a small subset of women had noted decreased frequency in sex, but were not bothered by it.
Some participants noted these sexual problems could be interrelated. For example, one year-old woman explained how she had difficulty reaching orgasm, and as a result, her desire for and receptiveness to sexual activity eventually waned. There were some women who specifically related negative changes to physical issues, particularly menopause and bodily pain. Some women noted an abrupt change in sexual function, especially libido, with menopause. However, many other participants attributed negative changes to psychosocial issues, such as stress, family and work obligations, and changes in body image Table 3.
Many felt that they were busier and under more stress than when they were younger; they felt their multiple different social roles, as wife, daughter, mother, and worker, made it difficult for them to relax and enjoy sex. I mean, we just have so much going on, we wear so many hats. Partner issues, including relationship discord, partner health problems, and partner sexual dysfunction, were also cited as a cause of negative changes in sexual function table 3. Some participants also mentioned that their partners faced some of the same challenges they did — being too busy, tired, or stressed for sex.
Most participants responded to negative changes with adaptation, including changing sexual behavior and prioritizing different aspects of sex Table 4. Changes in sexual behavior included lengthening foreplay, trying different sexual positions or different types of sexual activity, and using sexual aids such as vibrators or lubricants. Many of these changes in sexual behavior were in response to difficulties with vaginal dryness or sexual pain.
Some noted that receiving oral sex helped with lubrication difficulties.
With regards prioritizing different aspects of sex, participants discussed how, as they got older, they placed more importance on feeling connected and intimate with their partner than the physical aspects of sex, such as reaching orgasm. While discussion of negative changes in sexual function was common, a of participants also discussed positive changes with aging.
For some, sex was actually more frequent than when they were younger. In contrast, some women noted that the frequency of sex had decreased, but they still felt that overall they were just as satisfied or even more satisfied with sex than when they were younger. Participants gave a of reasons for experiencing positive changes in sexual function with aging Table 5. They discussed that they felt more comfortable in their own skin than when they were younger, and this led them to more freely express themselves in the bedroom.
They also felt that as they got older, they had a better understanding of their own bodies and sexual needs, and also felt more empowered to communicate their sexual needs to their partners. Additionally, some discussed how as family-related concerns e. In this qualitative study of sexually active women aged 45—60, we found that participants experienced both negative and positive changes in sexual function as they aged. They attributed negative changes to physical issues, such as menopause, and psychosocial issues, such as life stressors.
Many adapted to negative changes, by either changing their sexual behavior or by prioritizing different aspects of sex. Women who experienced positive changes attributed them to increased self-confidence, better self-knowledge, and improved communication skills. While most prior longitudinal studies have documented negative changes in sexual function as women move through midlife 9 — 1116fewer studies have highlighted positive changes.
Two literature reviews regarding sexual function and aging in women concluded that many studies have shown relative stability in sexual function over time 5 The review by Dr. Hayes and Dr. They noted that this could be a real observed effect, or a result of regression to the mean or a survivor effect These findings echo the women in our study — some women experience negative changes, but others can experience positive changes. Notably, some women reported both negative and positive changes. Many of the negative changes participants described focused on more physically oriented aspects of sexual function, such as lubrication or ability to achieve orgasm, while positive changes were more likely to involve improvement in feelings of intimacy or overall sexual satisfaction.
While some women attributed negative changes in sexual function to physical issues, particularly menopause, more women attributed negative changes to psychosocial issues. Because the prevalence of female sexual dysfunction appears to peak at midlife 18much of the prior research on changes in sexual function has focused on the role of menopause and hormones.
However, our study highlights the importance of considering psychosocial factors as well. Longitudinal quantitative studies have likewise demonstrated a link between psychosocial factors including increased stress 1920mood symptoms 10111620childcare burden 10and partner issues 916 and worsening sexual function. Several women in this study noted that erectile dysfunction in male partners had a negative impact on their own sexual function.
Women reported that they themselves required longer and more intense stimulation to achieve orgasm than when they were younger; if their partner concurrently developed erectile dysfunction, he might have difficulty providing this long, intense stimulation, especially if the couple focuses on penetrative intercourse. Erectile dysfunction has been correlated with lower sexual function scores in female partners ly Some women in our study expressed frustration and disappointment with erectile dysfunction in male partners.
However, other women took action, by encouraging their partners to take pharmaceutical treatments or asking their partners to try different types of sexual activity, such as oral sex. We found that while the experience of physical changes in sexual function, such as lubrication difficulties, was common in this study, many women found ways to adapt to these physical changes in order to maintain overall sexual satisfaction.
These adaptations sometimes required women speaking up and taking action with regards to sexual behavior, such as suggesting lubricant or vibrator use, or trying different sexual activities or positions. But women also discussed changing their priorities around sex; as they aged, they de-emphasized physical sexual satisfaction and placed more importance on emotional satisfaction.
Women who experienced positive changes attributed them to several factors, most notably increased self-acceptance, self-knowledge, and self-confidence. While many women discussed changes in their bodies with aging, such as gaining weight or sagging breasts, not all were self-conscious about these changes.
Additionally, many women felt that, as they got older, they had a better understanding of their own sexual needs. Finally, as women got older, they felt more empowered and able to communicate these sexual needs to their partners.
And they have to know you. This study has several limitations. Women who respond to an advertisement about a study on sexuality, and who are willing to speak with a facilitator about sexuality may not be representative of the general population.
However, women in this study were willing to discuss both positive and negative aspects of their sex lives, so we a wide range of experiences were captured. Several women mentioned that they were interested in participating in the study precisely because they had never talked to anyone about their sexuality.
Another limitation is the exclusion of women who were not sexually active in the prior 12 months. Some women did discuss how job stress and medical issues impacted their sexual function, which have been explored in this manuscript. Future work should attend to these issues. Finally, qualitative research, which gathers rich and detailed information from a smaller of women, is typically not widely generalizable.
This study has several strengths. We used a qualitative approach to explore changes in sexual function as women moved through midlife. Qualitative approaches give women the time and space to speak their own words about their experiences. This allows novel themes to emerge that may have not been ly considered.Older woman talk sexy
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Changes in sexual function among midlife women: “I’m older… and I’m wiser.”