Sexuality of midlife and older women: A review of theory use

The barriers and enablers to accessing sexual health and sexual well-being services for midlife women (aged 40-65 years) in high-income countries: A mixed-methods systematic review

Midlife, beginning at 40 years and extending to 65 years, a range that encompasses the late reproductive to late menopausal stages, is a unique time in women's lives, when hormonal and physical changes are often accompanied by psychological and social evolution. Access to sexual health and sexual well-being (SHSW) services, which include the prevention and management of sexually transmitted infections, contraception and the support of sexual function, pleasure and safety, is important for the health of midlife women, their relationships and community cohesion. The objective was to use the socio-ecological model to synthesise the barriers and enablers to SHSW services for midlife women in high-income countries. A systematic review of the enablers and barriers to women (including trans-gender and non-binary people) aged 40-65 years accessing SHSW services in high-income countries was undertaken. Four databases (PubMed, PsycINFO, Web of Science and Google Scholar) were searched for peer-reviewed publications. Findings were thematically extracted and reported in a narrative synthesis. Eighty-one studies were included; a minority specifically set out to study SHSW care for midlife women. The key barriers that emerged were the intersecting disadvantage of under-served groups, poor knowledge, about SHSW, and SHSW services, among women and their healthcare professionals (HCPs), and the over-arching effect of stigma, social connections and psychological factors on access to care. Enablers included intergenerational learning, interdisciplinary and one-stop women-only services, integration of SHSW into other services, peer support programmes, representation of minoritised midlife women working in SHSW, local and free facilities and financial incentives to access services for under-served groups. Efforts are needed to enhance education about SHSW and related services among midlife women and their healthcare providers. This increased education should be leveraged to improve research, public health messaging, interventions, policy development and access to comprehensive services, especially for midlife women from underserved groups.

Love (and) ageing well: A qualitative study of sexual health in the context of ageing well among women aged 50 and over

BACKGROUND

The United Nations has declared 2021-2030 the 'Decade of Healthy Ageing' and identified the need to strengthen the evidence base on interpretations and determinants of healthy ageing to inform policy.

OBJECTIVES

This study sought to interrogate a 'policy blind spot' and examine interpretations and experiences of sexuality and sexual health within the context of ageing well among women aged 50+.

DESIGN

The qualitative study design was underpinned by an interpretivist epistemology. Research was guided by principles of feminist scholarship and located in an affirmative ageing framework.

METHODS

Semi-structured individual interviews were conducted between April-June 2019 with 21 English-speaking women aged 52-76. Women were recruited through community organizations in North West England. Transcripts were analysed using a framework approach to thematic analysis, applying an inductive approach to theme generation.

RESULTS

Narratives encompassed six broad themes: reflections on 'ageing well'; age alone does not define sexuality and sexual health; interpretations of sexual health and sexuality; vulnerability and resistance in later-life sexual health; narratives of (in)visibility; and reimagining services to promote sexual health in later life. There was a dominant belief that sexual health represents a component of ageing well, despite a broad spectrum of sexual expression and health challenges. Sexual expression was diversely shaped by conflicting societal expectations within an evolving digitized environment. In clinical settings, however, sexual health discussions were often muted or framed from a disease-focussed lens. Women expressed a preference for holistic, person-centred sexual health provision from an orientation of wellness to support varied sexual expression, sensitive to wider health, life and relationship realities.

CONCLUSION

This work strengthens calls to disentangle sexual health from disease-centred narratives and legitimize sexual health as part of the healthy ageing agenda.

Context-dependent sexual changes during women's midlife transitions

For women, midlife represents an important stage of transition, including shifts in physiological, social, and sexual experiences. Prior research demonstrates that women's sexuality is more dynamic and context-dependent than men's. Most research focused on women's sexuality in mid- to later-life emphasizes physiological changes, while largely ignoring changes stemming from social, psychological, and relational contexts. The present study examined midlife women's diverse sexual experiences within the context of their lives. We conducted semi-structured interviews with 27 women, ages 39-57, and used interpretative phenomenological analysis to investigate perceptions and interpretations of midlife sexual experiences and changes. Themes included changes in sexual engagement, unwanted sexual experiences, body image, and sexual healthcare. Participants reported changes in the frequency of sex and sexual desire within the context of their diverse social roles and identities, prior intimate relationships, and sexual health. Women contrasted perceptions of their own bodies with societal perceptions of sexiness. Frequently reported negative experiences with sexual healthcare informed a distrust of healthcare systems. The diverse and changing nature of participants' experiences supports prior evidence of sexual fluidity and context-dependence. By questioning societal expectations around sexuality and body image, participants illustrated the potential of counternarratives to combat dominant beliefs and stereotypes about midlife women's sexuality. To improve sexual health and education, psychoeducational interventions for women in midlife are needed.

Predictors of Sexual Function and Performance in Young- and Middle-Old Women

Background: Maintaining sexual life in older women might be perceived as a measure of healthy and successful aging. This study aimed to establish the prevalence of female sexual dysfunction (FSD) based on the DSM-5 criteria and predictors of sexual performance in older women. Methods: A total of 185 women between 55 and 79 years old were included in the study. Validated scales were used to assess sexual function (Changes in Sexual Function Questionnaire (CSFQ)), the propensity for sexual excitation/inhibition (Sexual Excitation/Sexual Inhibition Inventory for Women), and sexual anxiety/avoidance (Body Exposure during Sexual Activity Questionnaire (BESAQ)). Multiple regression was used to assess the factors affecting sexual function and the prevalence of FDS. Results: Sexual distress was diagnosed in 14.1% of women, and FSD in 16.2% (n = 53), whereas sexual problems (CSFQ) were diagnosed in 33.3% of women, and distressing sexual concerns in 35.1%. Women with a lower number of male sexual partners (β = −0.22), a better attitude toward sex (β = 0.25), higher importance of sex (β = 0.31), a higher level of sexual excitation (β = 0.34), and that were sexually active (β = 0.39) had better sexual function, as evaluated by CSFQ. Conclusions: Most older women remain sexually active. The diversity of sexual activity in later life should be affirmed to encourage women to be sexually active and to strengthen the response to sexual stimuli.

Dyadic Satisfaction and Shared Affectivity Are Associated with Psycho-Sexual Functioning in Elderly Men and Women

Objectives The quality of sexual life of elderly people represents an understudied topic of sexual medicine and of psycho-sexology. Hence, we aimed to evaluate the association of specific psycho-relational variables, such as intimacy, increased affective gestures towards a partner (AGtP), daily shared activities, and dyadic satisfaction, with the psychosexual wellbeing of elderly people, expressed in terms of sexual satisfaction. Methods: A cohort of elderly people was selected from a sample of a broader study evaluating the role of sexual activity in protecting the emotional wellbeing of a population subjected to quarantine due to the COVID-19 pandemic. Specifically, the presence of sexual dysfunctions, the emotional wellbeing (i.e., absence of anxiety and/or depression), and the quality of the partners’ relationships were studied. For the study’s purpose, the Sexual Health Inventory for Males (SHIM), the Female Sexual Function Index (FSFI), the Orgasmometer and the Orgasmometer-F, the Generalized Anxiety Disorder scale (GAD-7), the Patient Health Questionnaire (PHQ-9), and the Dyadic Adjustment Scale were adopted. Results: A group of 124 elderly subjects (≥60) was selected for the study’s purposes. Among these, 84% were males (120/124), and 16% were females (20/124). All the subjects declared to be in a stable relationship and to be sexually active during the first lockdown period. Gender differences were found for the Dyadic Satisfaction subscale (males: 37.04 ± 6.57; females: 32.85 ± 10.04; p < 0.05) and the Orgasmometer (males: 7.64 ± 1.30; females: 6.60 ± 2.46; p < 0.01). Linear regression analysis showed the association between higher Orgasmometer scores and: (i) the absence of sexual dysfunctions (β = −1.213; SE = 0.271; p < 0.0001), (ii) higher dyadic satisfaction (β = 0.042; SE = 0.019; p < 0.05), and (iii) reduced shared activities with partner (β = −0.463; SE = 0.143; p < 0.01) and increased affective gestures towards partner (DAS measured AGtP) (β = 0.595; SE = 0.065; p < 0.0001). Post hoc analysis of ANCOVA with the Bonferroni correction method showed a significant difference in the Orgasmometer scores between subjects with and without sexual dysfunction (mean difference: 2.102; SE = 0.340; pBonf < 0.001), with healthy subjects reporting higher scores compared to dysfunctional ones. Conclusions: It is reasonable to suppose that, beyond the presence of sexual dysfunctions, the sexual health of elderly people may benefit from the quality of the relationship, and, specifically, from the presence of affective gestures towards the partner and the dyadic satisfaction. To the contrary, the quantity of time spent together, sharing specific activities, may be considered a factor worsening relational and sexual health. These data should be considered during the evaluation of sexual health among elderly people.

Adjusting to sex and intimacy: Gynecological cancer survivors share about their partner relationships

This study describes what gynecological (GYN) cancer survivors relate about their intimate partners and adjustments in their sexual lives following diagnosis and treatment. Conventional descriptive content analysis was used to examine participant responses about partner relationships following their diagnosis. Responses revealed three clusters and 15 codes of data. Findings report the influence of cancer treatment on sexual activity and functioning, women's sex lives, and their relationships. Health-care providers have a vital role in supporting women and their partners during the cancer care trajectory and should include both the survivor and the partner in conversations focused on sexual concerns and sexual well-being.