The relationship between self-reported sexual satisfaction and general well-being in women

Perceived emotional and sexual satisfaction across sexual relationship contexts: Gender and sexual orientation differences and similarities

Despite general perceptions of committed romantic relationships as the most satisfying context with which to engage in sexual activity, acceptance of casual sexual contexts has increased in recent years. Yet little research has examined sexual and emotional satisfaction outside of the committed relationship context. Further, most satisfaction research has focused exclusively on heterosexual samples. The present study aimed to investigate sexual and emotional satisfaction derived from seven sexual relationship contexts and note similarities or differences based on gender and sexual orientation. Data were drawn from an online survey of 6,955 sexually diverse participants. Sexual satisfaction was stronger than emotional satisfaction within casual sex contexts (one night stand, first date, sex with a friend, and hookups) than within more committed contexts (married, living together, committed unmarried relationship). Men found all contexts except for sex in a committed unmarried relationship significantly more sexually and emotionally satisfying than women. Emotional and sexual satisfaction were significantly different across sexual orientation groups in casual sexual relationship contexts but not in more committed relationship contexts. Gay men reported gaining the most sexual and emotional satisfaction out of casual sex contexts, with lesbian women reporting the least out of casual sexual contexts. Overall, this research found that a wide variety of relationship contexts, including casual sexual contexts, can be a source of both sexual and emotional satisfaction.

Menopause prediction and potential implications

Reproductive ageing in women is characterized by a decline in both the quantity and quality of oocytes. Menopause is reached upon exhaustion of the resting primordial follicle pool, occurring on average at 51 years of age (range 40-60 years). The mean global age at natural menopause (ANM) appears robust, suggesting a distinct genetic control. Accordingly, a strong correlation in ANM is observed between mothers and daughters. Few specific genetic determinants of ANM have been identified. Substantial efforts have been made to predict ANM by using anti-Müllerian hormone (AMH) levels. AMH serum concentrations at reproductive age predict ANM, but precision is currently limited. Early ANM is associated with early preceding fertility loss, whereas late menopause is associated with reduced morbidity and mortality later in life. Menopause affects various women's health aspects, including bone density, breast, the cardiovascular system, mood/cognitive function and sexual well-being. If the current trend of increasing human life expectancy persists, women will soon spend half their life postmenopause. Unfortunately, increased longevity does not coincide with an equal increase in years spend in good health. Future research should focus on determinants of long term health effects of ANM, and efforts to improve women's postmenopausal health and quality of life.

Self-Perceptions of Sexual Attractiveness: Satisfaction With Physical Appearance is Not of Primary Importance Across Gender and Sexual Orientation

Research on self-perceived sexual attractiveness has predominantly focused on the importance of physical appearance, overlooking nonphysical traits that may contribute to these self-perceptions. The present study examined and compared the importance of a variety of traits for self-perceived sexual attractiveness. Self-identified heterosexual, gay, and bisexual men (N = 1,801) and heterosexual, lesbian, and bisexual women (N = 1,092) completed an online questionnaire examining self-perceived sexual attractiveness, body esteem, sexual esteem, adherence to gender norms, and sexual experience. Body esteem and sexual esteem were significant predictors of self-perceived sexual attractiveness, regardless of gender and sexual orientation. Adhering to a masculine gender norm was a significant predictor among all groups (to varying extents) but heterosexual women. Adhering to a feminine gender norm was a significant predictor among heterosexual men and bisexual women. Finally, sexual experience was a significant predictor for all men and bisexual women. Furthermore, while body esteem was a predictor across all groups, for most individuals it did not appear to be of primary importance, with either sexual esteem or masculinity proving to be of greater importance. These findings suggest the need to consider traits related to both physical and nonphysical factors for improving an individual's self-perceived sexual attractiveness.

Pharmacokinetics of a prototype formulation of sublingual testosterone and a buspirone tablet, versus an advanced combination tablet of testosterone and buspirone in healthy premenopausal women

The study aimed to compare the kinetics of two novel combination drug products for Female Sexual Interest/Arousal Disorder (FSIAD). Thirteen women received testosterone via the sublingual route followed 2.5 hours later by a buspirone tablet, versus a single combination tablet swallowed at once. The first clinical prototype consisted of a sublingual solution containing testosterone (0.5 mg) complexed with cyclodextrin and a tablet containing 10 mg buspirone, in a gelatin capsule to ensure blinding during the clinical studies. The innovative fixed-combination tablet consists of an inner-core component of 10 mg buspirone coated with a polymeric time-delay coating and an outer polymeric coating containing testosterone with hydroxypropyl-beta cyclodextrin. We observed an immediate testosterone pulse absorption from both formulations. We also demonstrated that there was adequate absorption of buspirone (>80 % relative to the conventional tablet) and a time delay in release of buspirone of 3.3 hours, close to the 3.0 hours of the reference formulation that showed clinical efficacy in early proof-of-principle studies. The newly developed combination tablet fulfils its design criteria and is a convenient tablet for further clinical studies in FSIAD.

Facilitating communication about sexual health between aging women and their health care providers

Many women experience changes in sexual health as they age, and discussing these changes with health care providers is an essential component of optimal health management. The purpose of this study was to understand aging women's perspectives about communicating with providers about sexual health. We used the integrative model of behavioral prediction as a theoretical lens to explore women's attitudes, perceived norms, and perceived self-efficacy that promote or inhibit the likelihood of communicating about sexual health. In this theory-based qualitative study, we interviewed 28 community-dwelling older women in the Midwestern United States. Through thematic analysis, we identified both positive and negative attitudes about communicating with providers. Women seemed most inclined to discuss sexual health if they perceived that important patient-provider conditions, such as trust and rapport, were in place. Despite situational obstacles and perceived norms, these women held strong beliefs about their abilities to discuss sexual health topics with providers.

The conditional importance of sex: exploring the association between sexual well-being and life satisfaction

Leaders in the field of sexuality have called for additional research examining the link between sexual well-being and life satisfaction in women in order to expand knowledge regarding the important consequences of a satisfying sex life. Participants in the present study were sexually active women reporting a wide range of sexual difficulties who completed an in-person interview, validated self-report measures, and daily online assessments for 4 weeks. Sexual well-being was related to life satisfaction both cross-sectionally and within individuals over time. In addition, high relational satisfaction and low attachment anxiety served as protective factors, decreasing the degree to which unsatisfying sexual experiences were associated with decreases in life satisfaction. These results extend previous findings by confirming a strong association between sexual well-being and overall life satisfaction within individuals over time. The strength of this association is moderated by a number of intra- and interpersonal factors. Implications for healthcare providers are discussed.

Improving sexual health communication between older women and their providers: how the integrative model of behavioral prediction can help

Talking about sexual health can be a challenge for some older women. This project was initiated to identify key factors that improve communication between aging women and their primary care providers. A sample of women (aged 60+) completed an online survey regarding their intent to communicate with a provider about sexual health. Using the integrative model of behavioral prediction as a guide, the survey instrument captured data on attitudes, perceived norms, self-efficacy, and intent to communicate with a provider about sexual health. Data were analyzed using structural equation modeling. Self-efficacy and perceived norms were the most important factors predicting intent to communicate for this sample of women. Intent did not vary with race, but mean scores of the predictors of intent varied for African American and White women. Results can guide practice and intervention with ethnically diverse older women who may be struggling to communicate about their sexual health concerns.

The impact of daily sexual desire and daily sexual desire discrepancy on the quality of the sexual experience in couples

Recent research has found associations between sexual desire, desire discrepancy, and satisfaction outcomes in individuals and couples on a broad level. The present study aimed to extend these findings to the event level through examining daily experiences of sexual desire, sexual desire discrepancy, and quality of the sexual experience in a sample of 87 mixed-sex couples (174 individuals) over a 30-day period through daily electronic report. Participants were in their relationships for an average of 9.3 years. Data were analyzed using over-time Actor Partner Interdependence Models (APIM). For women and men, higher actor daily sexual desire predicted higher actor quality of the sexual experience. In addition, higher partner daily sexual desire predicted higher actor quality of the sexual experience. Event-level desire discrepancy between the couple was also a significant predictor of actor quality of the sexual experience for women, though not for men. These results confirm that day-to-day sexual desire and desire discrepancy are important indicators of quality of the sexual relationship and emphasize the importance of considering event-level characteristics when examining sexual behaviour and couple dynamics. Implications and suggestions for future research are also discussed.

Maintaining sexuality in menopause

Sexual health in the menopause is a medical challenge because the progressive decline of sexual hormones interacts with the aging process and many psychosocial stressors modulate vulnerability for sexual symptoms (low sexual desire, poor arousal and lubrication, dyspareunia, orgasmic dysfunction and lack of satisfaction). In clinical practice, a coordinated approach is needed to optimally manage the risk for developing female sexual dysfunction (FSD), especially when chronic conditions are present. Biomedical and psychosocial interventions include general education, recognition of signs and symptoms, promotion of health, attention to the partner and individualization of treatment. Counselling to overcome personal and relational difficulties should be always combined with hormonal and non-hormonal strategies to maximize biological signals driving the sexual response. By enhancing women's abilities to cope with sexual changes at midlife, health care providers may significantly optimize healthy aging and partnership.

Pharmacologic therapy for female sexual dysfunction

Female sexual dysfunction (FSD) is a common health issue that can have significant negative effects on overall well-being and quality of life. The primary purpose of this article is to review commonly noted pharmacologic therapies for FSD. The pathophysiology, clinical evaluation, and selected nonpharmacologic therapies are also briefly addressed as well as recommendations for practice.

Participation changes in sexual functioning after mild stroke

The purpose of this study was to explore the extent to which people with mild stroke experience changes in participation in sexual activity post stroke. A cross-sectional study was completed with adults 6 to 18 months post mild stroke (N = 13); a brief case study was also done with one of the participants. Participants completed an assessment battery over the telephone that included the modified Quality of Sexual Function scale, the Stroke Impact Scale (SIS), and the Patient Health Questionnaire-9. The sample reported mild problems with sexual dysfunction (mean = 10.77, SD = 4.09). Sexual dysfunction post stroke was highly correlated (r(2) = -0.372 to -0.875) with all of the domains on the SIS. Several participants in this study reported that they would have liked more information about sexual functioning post stroke. These findings suggest that individuals with mild stroke are experiencing decreased participation in sexual activities post stroke and would like more information from the health care community on the potential for sexual changes.

A psychometric comparison of three scales and a single-item measure to assess sexual satisfaction

This study was designed to systematically compare and contrast the psychometric properties of three scales developed to measure sexual satisfaction and a single-item measure of sexual satisfaction. The Index of Sexual Satisfaction (ISS), Global Measure of Sexual Satisfaction (GMSEX), and the New Sexual Satisfaction Scale-Short (NSSS-S) were compared to one another and to a single-item measure of sexual satisfaction. Conceptualization of the constructs, distribution of scores, internal consistency, convergent validity, test-retest reliability, and factor structure were compared between the measures. A total of 211 men and 214 women completed the scales and a measure of relationship satisfaction, with 33% (n = 139) of the sample reassessed two months later. All scales demonstrated appropriate distribution of scores and adequate internal consistency. The GMSEX, NSSS-S, and the single-item measure demonstrated convergent validity. Test-retest reliability was demonstrated by the ISS, GMSEX, and NSSS-S, but not the single-item measure. Taken together, the GMSEX received the strongest psychometric support in this sample for a unidimensional measure of sexual satisfaction and the NSSS-S received the strongest psychometric support in this sample for a bidimensional measure of sexual satisfaction.

Attachment insecurities and women's sexual function and satisfaction: the mediating roles of sexual self-esteem, sexual anxiety, and sexual assertiveness

We examined the potential role of three mediators--sexual self-esteem, sexual anxiety, and sexual assertiveness--of the association between romantic attachment insecurities (anxiety and avoidance) and two aspects of women's sexual functioning: sexual function and sexual satisfaction. A sample of 556 women aged 18 to 30 agreed to complete an online series of validated questionnaires assessing attachment insecurities and several aspects of sexual functioning. Lower sexual self-esteem and higher sexual anxiety mediated the associations between attachment anxiety and lower sexual function and satisfaction. Lower sexual self-esteem and higher sexual anxiety also partially mediated the links between attachment-related avoidance and the two sexual functioning variables. Sexual assertiveness, however, did not mediate these associations. A significant interaction between attachment anxiety and avoidance was also found to predict sexual satisfaction, with women high in avoidance and low in anxiety being the least satisfied. Results are discussed in terms of theoretical and clinical implications.

Associations between health and sexual lifestyles in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)

BACKGROUND

Physical and mental health could greatly affect sexual activity and fulfilment, but the nature of associations at a population level is poorly understood. We used data from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) to explore associations between health and sexual lifestyles in Britain (England, Scotland, and Wales).

METHODS

Men and women aged 16-74 years who were resident in households in Britain were interviewed between Sept 6, 2010, and Aug 31, 2012. Participants completed the survey in their own homes through computer-assisted face-to-face interviews and self-interview. We analysed data for self-reported health status, chronic conditions, and sexual lifestyles, weighted to account for unequal selection probabilities and non-response to correct for differences in sex, age group, and region according to 2011 Census figures.

FINDINGS

Interviews were done with 15,162 participants (6293 men, 8869 women). The proportion reporting recent sexual activity (one or more occasion of vaginal, oral, or anal sex with a partner of the opposite sex, or oral or anal sex or genital contact with a partner of the same sex in the past 4 weeks) decreased with age after the age of 45 years in men and after the age of 35 years in women, while the proportion in poorer health categories increased with age. Recent sexual activity was less common in participants reporting bad or very bad health than in those reporting very good health (men: 35·7% [95% CI 28·6-43·5] vs 74·8% [72·7-76·7]; women: 34·0% [28·6-39·9] vs 67·4% [65·4-69·3]), and this association remained after adjusting for age and relationship status (men: adjusted odds ratio [AOR] 0·29 [95% CI 0·19-0·44]; women: 0·43 [0·31-0·61]). Sexual satisfaction generally decreased with age, and was significantly lower in those reporting bad or very bad health than in those reporting very good health (men: 45·4% [38·4-52·7] vs 69·5% [67·3-71·6], AOR 0·51 [0·36-0·72]; women: 48·6% [42·9-54·3] vs 65·6% [63·6-67·4], AOR 0·69 [0·53-0·91]). In both sexes, reduced sexual activity and reduced satisfaction were associated with limiting disability and depressive symptoms, and reduced sexual activity was associated with chronic airways disease and difficulty walking up the stairs because of a health problem. 16·6% (95% CI 15·4-17·7) of men and 17·2% (16·3-18·2) of women reported that their health had affected their sex life in the past year, increasing to about 60% in those reporting bad or very bad health. 23·5% (20·3-26·9) of men and 18·4% (16·0-20·9) of women who reported that their health affected their sex life reported that they had sought clinical help (>80% from general practitioners; <10% from specialist services).

INTERPRETATION

Poor health is independently associated with decreased sexual activity and satisfaction at all ages in Britain. Many people in poor health report an effect on their sex life, but few seek clinical help. Sexual lifestyle advice should be a component of holistic health care for patients with chronic ill health.

FUNDING

Grants from the UK Medical Research Council and the Wellcome Trust, with support from the Economic and Social Research Council and Department of Health.

Sexual Health for Older Women: Implications for nurses and other healthcare providers

This article presents findings from a review of the evidence regarding sexual health for older women from MEDLINE, SCOPUS and the Cumulative Index to Nursing and Allied Health (CINHAL) databases. A total of 10 articles based on primary studies, reporting about the sexuality or sexual health of older women (and older people), and published between 2002-2012, were deemed suitable. The major themes that emerged from the available literature suggest that the sexual health of older people is affected by factors such as physical changes, mental health, changes to their relationship with their husband, chronic ill health and other psychosocial situations. It is concluded that nurses and other healthcare providers have a range of interventions that can be adopted to promote sexual health among older women. These interventions may focus on improving the older woman's sexual health assessment; increasing awareness and knowledge about sexuality in later life; pharmacological and psychotherapeutic therapies; using alternative techniques to achieve better sexual functioning; addressing partner and relationship issues, and advocating the importance of sexual health through media and policy development.

Effects of yoga on sexual function in women with metabolic syndrome: a randomized controlled trial

INTRODUCTION

Female sexual dysfunction is an important public health issue; it has a high global prevalence, but no effective and safe treatment options. The prevalence of sexual dysfunction is higher in women with metabolic syndrome than in the general population.

AIM

The aim of this study was to investigate the efficacy of yoga as a treatment for sexual dysfunction in women with metabolic syndrome.

METHODS

In this randomized, controlled study, 41 women with metabolic syndrome (age 30-60 years) were assigned to a 12-week yoga exercise group (n=20) or a wait-listed control group (n=21).

MAIN OUTCOME MEASURES

Primary end points were changes in total and individual domain scores on the Female Sexual Function Index.

RESULTS

The 12-week yoga intervention resulted in significant improvement in arousal (0.74±1.18 vs. 0.16±0.82, respectively; P=0.042) and lubrication (0.72±1.12 vs. 0.06±0.87, respectively; P=0.008) compared with the control group. Systolic blood pressure showed significantly greater improvement in the yoga group than in the control group at the 12-week follow up (-3.5±13.7 vs. 2.0±14.7, respectively; P=0.040).

CONCLUSION

These findings suggest that yoga may be an effective treatment for sexual dysfunction in women with metabolic syndrome as well as for metabolic risk factors.

"I'm not just a heart, I'm a whole person here": a qualitative study to improve sexual outcomes in women with myocardial infarction

Background

Little is known about recovery of female sexual function following an acute myocardial infarction (MI). Interventions to improve sexual outcomes in women are limited.

Methods and Results

Semistructured, qualitative telephone interviews were conducted with 17 partnered women (aged 43 to 75 years) purposively selected from the Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients’ Health Status Registry to deepen knowledge of recovery of female sexual function following an acute myocardial infarction (MI) and to improve sexual outcomes in women. Sixteen women had a monogamous relationship with a male spouse; 1 had a long‐term female partner. Most women resumed sexual activity within 4 weeks of their MI. Sexual problems and concerns were prevalent, including patient and/or partner fear of “causing another heart attack.” Few women received counseling about sexual concerns or the safety of returning to sex. Most women who discussed sex with a physician initiated the discussion themselves. Inquiry about strategies to improve sexual outcomes elicited key themes: need for privacy, patient‐centeredness, and information about the timing and safe resumption of sexual activity. In addition, respondents felt that counseling should be initiated by the treating cardiologist, who “knows whether your heart is safe,” and then reinforced by the care team throughout the rehabilitation period.

Conclusions

Partnered women commonly resume sexual activity soon after an MI with fear but without directed counseling from their physicians. Proactive attention to women's concerns related to sexual function and the safety of sexual activity following an MI could improve post‐MI outcomes for women and their partners.

Gaps between actual and desired sex life: web survey of 5,665 Japanese women

To explore issues that heterosexual women have concerning their sex life and desire toward their male partner, the authors conducted an online survey on actual sex life and sexual quality of life. Survey participants included 5,665 women who were 20 years of age and older who (a) lived in or near Tokyo, (b) had a male sex partner, and (c) intended to have sexual activity. Participants were asked to respond to a wide range of questions regarding their sexual fulfillment and desires. Differences between actual and desired duration of sexual activities (foreplay, intercourse, and afterplay) and number of sexual positions were calculated. The authors performed subgroup analyses regarding pain during sexual intercourse and by degree of partner's unilateral action. In addition, the authors investigated the relation between sexual quality of life and each subgroup. Women who participated in this survey tended to desire a longer duration of foreplay and afterplay than was experienced. The greater the pain during sexual intercourse, the percentage of respondents who desired a shorter duration of intercourse and fewer numbers of sexual positions increased and the sexual quality of life decreased. The degree of partner's unilateral action during sexual activity negatively affected the woman's sexual quality of life. The present study suggests the importance of establishing good communication between sex partners.

The prospective associations between depression and sexual satisfaction among female medical students

INTRODUCTION

The direction of the relationships between depression and sexual dissatisfaction is unclear. Possibly, these relationships are influenced by different elements/components of depression represented by different measures (i.e., Center for Epidemiologic Studies Depression Scale [CES-D], which highlights mood, vs. Beck Depression Inventory version II [BDI-II], which focuses on cognition and physical symptoms). High-achieving women--such as female medical students, interns, and residents--might be particularly prone to both depression and sexual dissatisfaction.

AIM

The aim of this study is to examine the direction of the longitudinal associations between depressive symptoms and sexual dissatisfaction in high-achieving, romantically involved female Israeli medical students and interns/residents using both CES-D and BDI-II.

METHODS

One hundred ninety-four female medical students from the first, fourth, and seventh (internship) years from all medical schools in Israel who were currently involved in romantic relationships were assessed twice over a 1-year interval using both CES-D and BDI-II. Cross-lagged structural equation modeling analyses were employed.

MAIN OUTCOME MEASURES

Depressive symptoms were measured by the CES-D and the BDI-II. Sexual satisfaction was assessed by the "partner-satisfaction" factor of the Pinney Sexual Satisfaction Inventory.

RESULTS

Elevated levels of CES-D-measured depression were found (26% at T1 and 13% at T2 above the stricter cutoff point). The direction of the longitudinal association between depressive symptoms and sexual dissatisfaction changed according to the depression measure used: baseline CES-D-measured depression predicted an increase in sexual dissatisfaction over time (β = 0.148, P = 0.016). Baseline sexual satisfaction predicted an increase in BDI-II-measured depression (β = 0.136, P = 0.045).

CONCLUSION

High-achieving, "fully-functioning" female medical students suffer from elevated levels of CES-D-measured depressed mood. Depressed mood might lead to sexual dissatisfaction, which in turn is likely to bring about "clinical," BDI-II-measured depression. We recommend a routine assessment of depressed mood and sexual dissatisfaction in this population, as well as increased access to tailored intervention for both clinical challenges.

An update on the pharmacological management of female sexual dysfunction

INTRODUCTION

Female sexual dysfunction (FSD) is a global health issue, with as many as 12% of women over 18 years old reporting sexual difficulties associated with distress. It is a multifaceted problem with psychological and biological causes. Affected women tend to have an impaired quality of life, a decreased level of well-being and relationship issues. Hence there is a need for management options for affected women.

AREAS COVERED

This paper focuses on current pharmacological options for the treatment of FSD, particularly estrogens and androgens, which have been extensively studied. Some investigational drugs are also described, including the centrally acting agents such as flibanserin and bupropion, and intravaginal DHEA and testosterone, which may be useful as an alternative for women with specific conditions, such as breast cancer survivors.

EXPERT OPINION

Although approval for the use of testosterone for treatment of FSD is limited to some European countries and restricted to surgically menopausal women, there is extensive off-label use for this purpose. No other product has yet achieved regulatory approval for treatment of FSD. Completion of studies of nonhormonal FSD therapies and safety studies of testosterone may result in regulatory approval of such products for the treatment of FSD in the near future.

Predicting sexual decline and dissatisfaction among older adults: the role of partnered and individual physical and mental health factors

OBJECTIVES

To target improvement in older adult sexuality by understanding how a myriad of partnered and individual physical and mental health factors, often associated with aging, affect sexual unwellness.

METHOD

Data from the Wisconsin Longitudinal Study were used to conduct a case-control study on the risk factors for sexual unwellness (i.e., lack of sexual satisfaction, inability to maintain the sexual relationship) in older adults aged 63-67.

RESULTS

Higher risk for lack of sexual satisfaction was associated with poor spousal health, a history of diabetes, and fatigue symptoms. In addition, being of male gender, being satisfied with marital support, and having better spousal health reduced the risk of being unsatisfied sexually. Also, higher risk for being unable to maintain the sexual relationship was independently associated with a higher education level, poorer self-rated health, better spousal health, a history of diabetes, prostate cancer, fatigue, sexual pain, and a history of depression.

DISCUSSION

Results show the impact of several physical and mental health risk factors on the development of sexual unwellness in older adults. A gendered pattern also emerged, suggesting that women tend to be less sexually satisfied, as compared to their male peers, who tend to report sexual unwellness that is associated with individual health.

Young women's perceived health and lifetime sexual experience: results from the national survey of family growth

INTRODUCTION

Sexuality is a component of health and well-being for all women, including adolescents. Yet relationships between young women's health perceptions and sexual behavior are unclear.

AIM

We examined associations between perceived health and lifetime sexual experiences among young U.S. women.

METHODS

We used data from 4,413 young women ages 15-24 years in the National Survey of Family Growth, 2002-2008. Descriptive, bivariate, and multivariate statistics estimated relationships between categories of perceived health and types of lifetime sexual experience.

MAIN OUTCOME MEASURES

A self-rated health Likert item and sexual history questions were administered with a computer-assisted survey instrument.

RESULTS

Young women reported excellent (30%), very good (41%), good (23%), and fair-poor (6%) health. Sexual experiences included vaginal (64%), oral (64%), and anal (20%) sex. Negative experiences included involuntary sex (11%) and sexually transmitted infection (STI) history (8%). In multivariate logistic regression models, lower perceived health ("good" rather than "excellent") was positively associated with vaginal (odds ratio [OR] 1.5, confidence interval [CI] 1.1-2.1, P = 0.02), oral (OR 1.5, CI 1.1-2.1, P = 0.005), and anal (OR 1.4, CI 1.0-2.0, P = 0.03) sex. In models stratified by age, point estimates for vaginal (OR 1.8, CI 1.2-2.6, P = 0.002) and oral (OR 1.9, CI 1.4-2.6, P < 0.001) sex were higher among adolescents ages 15-19 years, but associations were insignificant among young adults ages 20-24 years. When controlling for negative sexual experiences, point estimates were stable in models including STI history but statistically insignificant when including involuntary sexual experience. Other characteristics associated with sexual experiences varied by type of experience and included age, race/ethnicity, employment situation, poverty level, insurance status, childhood family situation, religious service participation, cohabitation/marital experience, and body mass index.

CONCLUSIONS

  Further investigation is warranted to disentangle potentially negative relationships between perceived health (as well as response bias and more objective health outcomes), sociodemographic factors, and diverse sexual experiences among young women in the United States.

A higher sense of purpose in life is associated with sexual enjoyment in midlife women

OBJECTIVE

The aim of this study was to understand the association between sense of purpose in life and sexual well-being in a cohort of midlife women.

METHODS

Participation in partnered sexual activities and indicators of sexual well-being (the engagement in and enjoyment of sexually intimate activities) were measured in a longitudinal cohort of 677 eligible women aged 40 to 65 years. At a single time point, women completed the Life Engagement Test, a measure of life purpose. Univariable and multivariable mixed models were used to assess the association between the Life Engagement Test and longitudinal sexual well-being.

RESULTS

A higher sense of purpose in life was associated with higher levels of enjoyment (coefficient = 2.89, P < 0.001) but not with participation in partnered sexual activity (coefficient = 0.49, P = 0.63) or engagement in partnered sexually intimate activities (coefficient = 1.0, P = 0.30). Participation was associated with younger age, lower body mass index, being married, reporting any vaginal dryness, and better emotional well-being. Hormone therapy use approached, but did not reach significance in association with participation, with P = 0.05. Engagement in sexually intimate activities was associated with younger age, more social support, and better emotional well-being. Higher levels of enjoyment were associated with more social support, better emotional well-being, and less vaginal dryness. Menopause status was not associated with engagement or enjoyment, and only being 5 years or more postmenopausal was related to decreased participation.

CONCLUSIONS

Higher sense of purpose in life is associated with more enjoyment of sexually intimate activities, adjusting for other known factors that influence sexual well-being and independent of demographic factors and menopause or hormone therapy status.

Gender differences in sexual behaviors of AD patients and their relationship to spousal caregiver well-being

OBJECTIVES

Little is known about gender differences in sexuality among community-dwelling heterosexual couples in which one partner has Alzheimer's disease (AD). Few studies have examined gender differences in specific sexual behaviors or their associations with caregiver well-being. This study evaluated the impact of gender differences on intimacy and sexual satisfaction in marital relationships in which one partner has AD.

METHOD

Baseline measures were collected from 162 AD patients and their partners enrolled in a multi-site study between 2001 and 2009 to evaluate gender differences in measures of intimacy, caregiver well-being, and patient sexual behaviors.

RESULTS

While over 70% of all patients initiated physically intimate activities (i.e., kissing, hugging, and intercourse), most did not initiate intercourse specifically. Female caregivers reported higher levels of stress and depressive symptoms than male caregivers (p < 0.01). Satisfaction with intimacy was significantly associated with fewer stress and depressive symptoms in female caregivers (r = -0.29, p < 0.01). Caregiver gender, satisfaction with intimacy, and caring for a patient with mild AD were significant predictors of caregiver depressive symptoms (p's < 0.05).

CONCLUSION

The majority of couples dealing with AD reported engaging in intimacy, suggesting its importance in the relationship. Female caregivers who reported less sexual satisfaction reported more frequent stress and depressive symptoms. Caregiver gender, satisfaction with intimacy, and the AD patient's level of cognitive functioning significantly contributed to caregiver well-being. Gender-specific therapies to address patient sexual difficulties and caregiver well-being could potentially maintain or improve the marital relationship.

Sexual satisfaction and sexual health among university students in the United States

Despite the World Health Organization's definition of sexual health as a state of well-being, virtually no public health research has examined sexual well-being outcomes, including sexual satisfaction. Emerging evidence suggests that sexual well-being indicators are associated with more classic measures of healthy sexual behaviors. We surveyed 2168 university students in the United States and asked them to rate their physiological and psychological satisfaction with their current sexual lives. Many respondents reported that they were either satisfied (approximately half) or very satisfied (approximately one third). In multivariate analyses, significant (P < .05) correlates of both physiological and psychological satisfaction included sexual guilt, sexual self-comfort, self-esteem (especially among men), relationship status, and sexual frequency. To enhance sexual well-being, public health practitioners should work to improve sexual self-comfort, alleviate sexual guilt, and promote longer term relationships.

Association between higher levels of sexual function, activity, and satisfaction and self-rated successful aging in older postmenopausal women

OBJECTIVES

To determine whether measures of successful aging are associated with sexual activity, satisfaction, and function in older postmenopausal women.

DESIGN

Cross-sectional study using self-report surveys; analyses included chi-square and t-tests and multiple linear regression analyses.

SETTING

Community-dwelling older postmenopausal women in the greater San Diego region.

PARTICIPANTS

One thousand two hundred thirty-five community-dwelling women aged 60 to 89 participating at the San Diego site of the Women's Health Initiative.

MEASUREMENTS

Demographic information and self-reported measures of sexual activity, function, and satisfaction and successful aging.

RESULTS

Sexual activity and functioning (desire, arousal, vaginal tightness, use of lubricants, and ability to climax) were negatively associated with age, as were physical and mental health. In contrast, sexual satisfaction and self-rated successful aging and quality of life remained unchanged across age groups. Successful aging measures were positively associated with sexual measures, especially self-rated quality of life and sexual satisfaction.

CONCLUSION

Self-rated successful aging, quality of life, and sexual satisfaction appear to be stable in the face of declines in physical health, some cognitive abilities, and sexual activity and function and positively associated with each other from age 60 to 89.

Sexual function in female patients with obstructive sleep apnea

INTRODUCTION

Obstructive sleep apnea is defined as repetitive (≥5/hour) partial or complete cessation of breathing during sleep. Whereas obstructive sleep apnea is often considered to be associated with sexual problems in men, studies concerning effects of obstructive sleep apnea on female sexual function and distress are sparse.

AIM

To investigate sexual dysfunction and sexual distress in female patients with obstructive sleep apnea and to determine which factors are of importance for their sexual function.

METHODS

We investigated 80 female patients (ages 28-64) admitted to a sleep laboratory and who after investigation received a diagnosis of obstructive sleep apnea. All subjects answered questions drawn from three self-administered questionnaires on sexuality. The results were compared with a population sample (N=240).

MAIN OUTCOME MEASURE

  Data from nocturnal respiratory recordings. Female Sexual Function Index, Female Sexual Distress Scale and four questions from Life Satisfaction-11 (Lisat-11).

RESULTS

  Female Sexual Function Index indicated that obstructive sleep apnea patients were at a higher risk for having sexual difficulties. Female Sexual Distress Scale showed significantly more sexual distress in the obstructive sleep apnea group. Manifest Female Sexual Dysfunction (combined data from Female Sexual Function Index and Female Sexual Distress Scale) showed that female patients with obstructive sleep apnea also had more sexual dysfunction. Severity of sleep apnea was, however, not related to any of these indices but consumption of psychopharmaca was. In Lisat-11, we found that obstructive sleep apnea females scored lower than women in the population sample regarding life as a whole but not regarding domains of closeness.

CONCLUSIONS

  This study indicates that sexuality of women with untreated obstructive sleep apnea is negatively affected compared with a female population sample. This was not related to severity of obstructive sleep apnea, whereas psychopharmaca may act as an important confounder.