Women's Sexuality: From Aging to Social Representations

"We're Just Tired": Influences on Sexual Activity Among Male-Partnered Women in Midlife; A Mixed Method Study

Studies into decline in sexual activity among women in midlife produce equivocal findings, some implicating hormonal and physiological changes, others psycho-social and environmental factors. Women's perspectives rarely inform interpretation of the data. Associations between sexual satisfaction, activity and function, and health and lifestyle factors were explored using data from 2133 female participants in the third British National Survey of Sexual Attitudes and Lifestyles (2010-2012). Semi-structured interviews (2012-2015) with 23 women aged 45-59 reporting sexual dissatisfaction in Natsal-3 explored their perceptions of the influences on their sexual activity. Analysis of the survey data showed sexual dissatisfaction to be less common than low frequency and function. Neither menopausal stage nor age was independently associated with any of the dimensions of sexual experience. Only relationship unhappiness was independently associated with all three and communicational difficulty with two (dissatisfaction and lower function). In-depth interviews identified influences on sexual activity not captured in the survey. Tiredness attributed to contemporary challenges of midlife was a dominant theme. Relationship quality mediated its adverse impact. Sexual experience in midlife must be interpreted in light of both life-stage and era, notably, the increasing demands on women in contemporary society and their impact on vitality. Efforts to address sexual wellbeing should take account of the wider social context.

Validation of an Arabic version of the female version of The Sexual Dysfunctional Beliefs Questionnaire: a factor analysis study

Several questionnaires have been developed to evaluate female sexual dysfunction (FSD) and sexual health problems. However, there is a lack of validated versions of these questionnaires in Arabic. One of the most used instruments is the female version of The Sexual Dysfunctional Beliefs Questionnaire (SDBQ). The current study aimed to validate an Arabic version of the SDBQ. The Arabic version of SDBQ-Female was incorporated into an online questionnaire using and distributed among Jordanian Facebook groups and women-only groups. Factor analysis was performed to investigate evidence for the validity of the questionnaire. 530 females (mean age 30 years, SD = 9) completed the questionnaire. Principal component analysis produced the final model composed of 24 items distributed across four factors: Sexual Desire & Pleasure, Affection Primacy, Sexual Conservatism and Age-Related Beliefs. Confirmatory factor analysis was conducted, and fit indices were acceptable (CMIN/DF = 2.52, GFI = 0.91, AGFI = 0.89, CFI = 0.90, SRMR = 0.05 and RMSEA = 0.05). Income level and marital status both influenced FSD beliefs, with higher scores associated with higher income and being single. The Arabic version of the SDBQ-female demonstrated evidence of validity and reliability. Additional research is necessary to explore beliefs related to FSD within an Arabic context.

Knowledge and attitudes associated with menopause among women aged 45 to 60 years: a pilot study among rural and urban women in Bangladesh

OBJECTIVE

To assess knowledge and attitudes associated with the menopause transition among women in Bangladesh.

METHODS

A cross-sectional survey was conducted among women (age range 45-60 y), 160 participants were selected from both urban and rural settings using a systematic sampling procedure. We used face-to-face interview techniques employing a semistructured questionnaire. Bivariate and multivariate regression analyses were done to assess the associated factors.

RESULTS

Around one-fourth (23%) of the participants did not have a basic understanding about symptoms of menopause. Knowledge about menopause increased proportionately with higher education levels (primary education, risk ratio [RR] = 3.91, 95% confidence interval [CI] = 0.66-22.92; secondary education, RR = 6.10, 95% CI = 1.26-29.41; higher education, RR = 6.74, 95% CI = 1.33-34) and was more common among urban than rural women (P = 0.001). In addition, women who were service holders had greater knowledge about menopause compared with women who worked in the home (RR = 8.67, 95% CI = 1.94-38.58). Most of the women (96%) suffered from different kinds of depression during the menopause transition. Key barriers to gaining knowledge about menopause included access to information (63%), social stigma (57%), and shame (52%).

CONCLUSIONS

Menopause is a neglected issue in Bangladesh. Accurate and appropriate information regarding premenopause and menopause can help women cope with this life transition. Social and familial support may also play a role in minimizing isolation and depression. Public health messaging to increase awareness and knowledge about menopause should be undertaken to overcome the stigma and shame associated with menopause in Bangladesh. : Video Summary:http://links.lww.com/MENO/A556.

Sexual behaviors and function during menopausal transition-does menopausal hormonal therapy play a role?

OBJECTIVES

The menopausal transition is a biological adaptation to the variety of life changes (body, comorbidities, relationship), but that biology is not an "end all" in the context of sexual function and overall sexual health. The aim of this study is to evaluate determinants altering the risk of female sexual dysfunction (FSD) and other sexual problems and to establish whether menopausal hormonal therapy (MHT) decreases that risk and modifies sexual behaviors.

METHODS

A cross-sectional observational study was conducted in 210 women between the ages of 45 and 55. Two groups were identified: MHT users (n = 107) and controls-MHT non-users (n = 103). Diagnostic and Statistical Manual of Mental Disorders -five criteria were used to assess sexual dysfunction. Sexual problems were evaluated by the Changes in Sexual Function Questionnaire (CSFQ), body image by Body Exposure during Sexual Activity Questionnaire, and quality of relationship by the Well-Match Relationship Questionnaire. Logistic regression was used to determine the risk factors for FSD and sexual problems.

RESULTS

Women using MHT had higher body esteem during sexual activities, better sexual function (CSFQ) in all domains except desire/interest, better quality of relationship, and lower prevalence of FSD and sexual complaints (CSFQ) except arousal/excitement problems. However, self-rated effects of MHT on sexual behaviors showed that MHT did not play a major role. Women with secondary and higher education (OR = 0.09, CI: 0.02-0.4; P < 0.01 and OR = 0.2, CI: 0.05-1.0; P < 0.05, respectively) and with a higher number of lifetime sexual partners (OR = 0.6, CI: 0.4-0.9; P < 0.01) were less likely to have FSD. In contrast, individuals with more anxious behaviors during sexual activity (OR = 3.2, CI: 1.3-7.3; P < 0.01) and with more severe menopausal symptoms (OR = 1.1, CI: 1.0-1.2; P < 0.001) were more likely to have FSD. Using MHT was not associated with that risk nor with sexual function.

CONCLUSION

In women during menopausal transition, sexual behaviors were different in MHT users compared with non-users. However, in this cross-sectional observational study conducted in 210 women between the ages of 45 to 55 years, using MHT was not associated with modification of sexual function, decreasing the risk of sexual dysfunction, nor sexual problems.

Factors Associated with Sexual Activity for Women with Pelvic Floor Dysfunction - A Cross-Sectional Study

OBJECTIVE

 To examine women with pelvic floor dysfunction (PFDs) and identify factors associated with sexual activity (SA) status that impacts quality of life (QoL).

METHODS

 We conducted a cross-sectional study that included women > 18 years old who presented with at least one PFD symptom (urinary incontinence [UI] and/or pelvic organ prolapse [POP]), in outpatient clinics specializing in urogynecology and PFD in Fortaleza, state of Ceará, Brazil, using a service evaluation form and QoL questionnaires.

RESULTS

 The analysis of 659 women with PFD included 286 SA (43.4%) women and 373 non-sexually active (NSA) (56.6%) women, with a mean age of 54.7 (±12) years old. The results revealed that age (odds ratio [OR] = 1.07, 95% confidence interval [CI] 1.03-1.12) and post-menopausal status (OR = 2.28, 95% CI 1.08-4.8) were negatively associated with SA. Being married (OR = 0.43, 95% CI 0.21-0.88) was associated with SA. Pelvic organ prolapse (OR = 1.16, 95% CI 0.81-1.68) and UI (OR = 0.17, 95% CI 0.08-0.36) did not prevent SA. SF-36 Health Survey results indicated that only the domain functional capacity was significantly worse in NSA women (p = 0.012). Two King's Health Questionnaire domains in NSA women, impact of UI (p = 0.005) and personal relationships (p < 0.001), were significantly associated factors. Data from the Prolapse Quality-of-life Questionnaire indicated that NSA women exhibited compromised QoL.

CONCLUSION

 Postmenopausal status and age negatively affected SA. Being married facilitated SA. Presence of POP and UI did not affect SA. However, NSA women with POP exhibited compromised QoL.

High Emotional and Sexual Satisfaction Among Partnered Midlife Canadians: Associations with Relationship Characteristics, Sexual Activity and Communication, and Health

Despite midlife adults accounting for a substantial and growing segment of the population, few large-scale studies have investigated factors which distinguish highly satisfying relationships from less satisfying ones in midlife. In a subsample of partnered 40-59-year-old Canadians (705 men, 743 women), relationship characteristics, sexual activity and communication, and health were investigated individually and simultaneously as predictors of high emotional and sexual satisfaction. Though the vast majority of participants reported being at least somewhat satisfied in their current relationship, less than half reported high satisfaction. For men and women, high emotional and sexual satisfactions were strongly linked. Logistic regressions indicated that longer relationships, dating relationships, and greater subjective overall health predicted high emotional satisfaction for men, whereas older age, married or cohabiting relationships, and frequent sexual communication predicted high emotional satisfaction for women. All types of sexual activities (minus penile-anal intercourse) were bivariately related to high emotional and sexual satisfaction. More frequent partnered sexual activity predicted high emotional and sexual satisfaction for men and women in regression analyses. More frequent sexual communication predicted high emotional satisfaction for women and high sexual satisfaction for both men and women. Newer relationships were more sexually satisfying for men. Postmenopausal women were less likely to be highly sexually satisfied. Findings suggest that physical health conditions are not generally related to high levels of satisfaction in midlife couples and that frequently discussing sex and engaging in (any) sexual activity with a partner are key components of highly satisfying relationships.

[Contraception for women after 40: CNGOF Contraception Guidelines]

INTRODUCTION

Choosing contraception for women over 40 can be sometimes difficult but it is crucial since fertility and pregnancy's risks still exist. It requires a thorough evaluation of the situation, in order to identify any vascular and metabolic risk factors, along with the uterine and mammary benign pathologies already diagnosed.

OBJECTIVE

The objective of this review was to elaborate some guidelines for clinical practice regarding contraception's prescription for women over 40.

METHODS

A systematic review of the French and English existing literature was conducted. Pubmed and the Cochrane library were used to identify studies about contraception for perimenopausal women. International guidelines published by scientific societies were also reviewed (RCOG, FSRH, ESHRE, ACOG, WHO, HAS).

RESULTS

No contraceptive methods are contraindicated on the sole basis of age alone. However, because age is a risk factor for vascular and metabolic diseases, combined hormonal contraception and DMPA should not be prescribed at first intention. Copper IUD and progestin-only contraceptives (pill, implant, intrauterine device) should primarily be considered, since they offer good efficacy with lower risks.

CONCLUSIONS

Contraception for women over 40 should not be put aside. Long acting reversible contraception and progestin-only pill have to be prescribed as first-ine. Contraception is no longer needed for women over 50 who use non-hormonal contraception, after a 12 month-amenorrhea. Patients treated with combined hormonal contraception must stop using it over 50. Measuring hormonal levels while using hormonal contraception is not recommended. An hormonal-contraception-free interval must be considered, while using barrier contraception method. If an ovarian activity persists, a non-hormonal contraception or progestin-only contraception (except for DMPA) should be (re-)established.

Vivências e perceções de sexualidade de portuguesas com mais de 65 anos

Resumo: Este estudo objetiva compreender as vivências e perceções sexuais de mulheres portuguesas com mais de 65 anos. Foram realizadas entrevistas individuais semiestruturadas a 13 mulheres (sete casadas e seis viúvas), com idades compreendidas entre os 66 e os 85 anos, e a informação obtida foi analisada através do método da análise temática. Desta análise foram construídos 5 (cinco) temas - Perceções sobre papéis de género, Sexo “obrigação”, Sexualidade e envelhecimento, Medos do casamento e da sexualidade e Educação sexual. Para as participantes deste estudo, encarar as alterações provocadas pelo envelhecimento como fim da obrigação sexual ou como uma oportunidade de readaptação sexual está inteiramente relacionado com a relação conjugal em si e com as ideologias que os membros do casal têm.

Bilateral plication of the puborectal muscles: A new surgical concept for treating vulvar widening

OBJECTIVES

This study describe a new myorraphy technique by bilateral plication of the puborectalis bundles (PRP) of the levator ani muscle to treat vulvovaginal widening. The aim of this work was to report our preliminary experience in terms of morbidity and results (anatomical and functional) in the short and medium term.

MATERIALS AND METHODS

This single centre retrospective study concerned 69 women who underwent PRP between January 2011 and December 2014. The main criterion for judging success was the GH before and after surgery (Genital Hiatus in the POP-Q classification: Pelvic Organ Prolapse Quantification System). The secondary criteria were the quality of sexual intercourse and the morbidity.

RESULTS

The average GH post-surgery was 31, 35 and 35mm at 6 weeks, 6 and 12 months respectively compared to 65±5mm preoperatively (P<0.00001). Among the 27 patients who were sexually active prior to surgery, 18.52% deemed the quality of sexual intercourse satisfactory. After surgery, more than 88% of the patients observed an improvement (P<0.00001). After the surgery the reported rate of minor complications was under 3%.

CONCLUSION

This preliminary study of PRP confirms the feasibility of the procedure, its low morbidity and the stability of the anatomical outcomes at 12 months.

Factors associated with sexual quality of life among midlife women in Serbia

PURPOSE

To assess factors associated with better sexual quality of life (QOL) in midlife period among women who are and are not sexually active.

METHODS

Participants were 500 women aged 40-65 years from Belgrade, Serbia. Data were collected through general questionnaire (regarding socio-demographic characteristics, lifestyle habits, general medical, and gynecological history) in which one item investigated having partnered sexual activity (heterosexual intercourses). The sexual domain of the Utian Quality of Life Scale was used to assess the sexual QOL. The sexual QOL consisted of reflections on the satisfaction with frequency of sexual interactions, as well as sexual and romantic life in general. Higher scores indicated better sexual QOL.

RESULTS

Most women were sexually active in midlife (81.6%). The mean sexual QOL score for the overall sample was 9.99 (range 3-15). The level of sexual QOL did not differ between sexually active and non-active women. Factors associated with better sexual QOL in sexually active menopausal women were being married or coupled, being physically active, having more children, having hot flushes, and not having tachycardia. Factors associated with better sexual QOL in sexually inactive menopausal women were drinking alcohol, being physically active, not having insomnia or skin rash.

CONCLUSIONS

Sexual QOL among Serbian urban midlife women was good and did not differ between women who were sexually active and those who were not. Further studies are needed to determine in what manner women who are not sexually active in midlife achieve high level of satisfaction with their sexual QOL.

Menopause, the beginning of aging for Chilean women: A qualitative study

OBJECTIVES

To develop the meaning of menopause of a group of post-menopausal women and their relationship with aging.

METHODS

Qualitative descriptive study on 15 Chilean women that completed a taped face-to-face in depth interview that were interpreted according to Krippendorff.

RESULTS

A qualitative content analysis revealed the presence of two themes: (a) Cessation of women´s reproductive stage and (b) a life transition to aging.

CONCLUSIONS

Women perceived their menopause as the beginning of aging focusing on the end of fertility and the social connotation that this new role implies. Feeling old 10 years before the customary beginning of old age is an important starting point to be incorporated in women's health education.

Lebanese women and sexuality: A qualitative inquiry

OBJECTIVES

This study explores the meanings middle-aged Lebanese women attribute to sexuality and sexual life and how these constructs are shaped socially, culturally, and politically.

STUDY DESIGN

Using a qualitative design, data generation comprised semistructured individual interviews (n = 18) and one focus group (n = 5) with Lebanese women aged 40-55 years. Framework analysis was used for data analysis.

RESULTS

Inductive analysis identified four themes: Sexuality as imposed by sociocultural and gender norms; sexuality as a symbol of youthful femininity; sexual life as a fundamental human need; and sexual life as a marital unifier and family stabiliser. Findings show that women's sexual self is largely defined based on men's needs. Women sacrifice themselves to maintain family cohesiveness, which they regard as the core of society. However, some women challenged social norms and therefore bringing new meanings to their sexuality.

CONCLUSION

This study offers new contextual information about the understanding of sexuality of middle-aged women within a Lebanese context, where the topic is not openly discussed. New insights are important to provide women with professional support that is culturally sensitive and appropriate.

Social representations, ageing and memory: a holistic approach to cognitive assessment

This paper examines how contextual (conversational) aspects and socially shared meanings might affect the participants' performance on a standardised memory test using the theoretical framework of social representations. A total of 97 members of centres for older adults located in Rome, Italy participated in a screening using the Montreal Cognitive Assessment test. Prior to testing, a group of volunteers had organised a performance focused on events from the distant past, stimulating intergenerational reminiscence. The participants were randomly assigned to one of two conditions. In the first case, prior to administering the test, a psychotherapist talked to each participant about the performance, focusing on ageing and stressing the neutral aspects of its social representations, such as change and time. In the second case, performance was used to concentrate on positive aspects of the social representations of ageing, namely wisdom and experience. In line with the hypothesis, focusing on positive aspects of social representations of ageing (wisdom and experience) versus their neutral aspects (change and time) has resulted in improved performance on a standardised memory test. Practitioners (psychotherapists – experts in psycho-diagnostics) who administered the tests have been involved in the co-construction of the meaning of ageing, discussing a real-life situation: the common experience of intergenerational activity that involved the participants' memories of their urban environment.

Pregnant Women's Preferences for Men's Faces Differ Significantly from Nonpregnant Women

INTRODUCTION

There is evidence that women's preferences for facial characteristics in men's faces change according to menstrual phase and sexual hormones. Literature indicates that the pregnancy is characterized by a specific sexual hormonal pattern with respect to all other physiological conditions concerning the sexual hormone status during the reproductive age, configuring this physiological condition as an excellent surrogate to study how the sexual hormones may affect many of the aspects concerning the sexual behavior.

AIM

The aim of this study was to investigate pregnancy as a model of hormonal influence on women's facial preferences in short-term and long-term relationships and compare the choices of pregnant women with those of nonpregnant women.

MAIN OUTCOME MEASURES

Measurement of women's preferences for synthetic men's faces, morphed from hyper-masculine to hypomasculine shape.

MATERIALS AND METHODS

Forty-six women in the third trimester of pregnancy, and 70 nonpregnant women took part in the study. All women were shown a composite male face. The sexual dimorphism of the images was enhanced or reduced in a continuous fashion using an open-source morphing program that produced a sequence of 21 pictures of the same face warped from a feminized to a masculinized shape.

RESULTS

Pregnant women's choices differed significantly from those of nonpregnant women. In fact, in the context of both a hypothetical short- (M = -0.4 ± 0.11) and long-term relationship (M = -0.4 ± 0.07) pregnant women showed a clear preference for a less masculine man's face than the other group (short-term: M = 0.15 ± 0.13; long-term: M = -0.06 ± 0.15; P < 0.0001).

CONCLUSIONS

Women in the third trimester of pregnancy clearly prefer more feminine men's faces, distancing themselves from the choices of women in other physiological conditions concerning the sexual hormonal status during the reproductive age. However, other psychosocial variables may explain this interesting finding.

Old age from the perspective of elderly individuals of different nationalities

The study aimed to understand how elderly from several nationalities who reside in Brazil conceive the old age and experience the aging process. It was used the Symbolic Interactionism and the Grounded Theory as a theoretical and methodological strategy. The informants were 33 elderly people who reside in Foz do Iguaçu-PR. The results show an old age conception marked by chronological, physical, psychological, behavioral aspects and also by the presence of disease, dependence, inability to work and by situations experienced over the years in the Brazilian context. The way to experience the old age is influenced by the homeland culture, but is related to the quality and to the conditions of life (autonomy, physical and financial dependence), the work valorization, the religious precepts and the family ties/relationships. It was concluded that to conceive and experience the old age, besides the cultural aspects, it's focused on the experiences and singular interactions occurred over the years and that gain significant contours according to the context and the time of life.

Sex, desire and pleasure: considering the experiences of older Australian women

Older age is often associated with asexuality. That is, older individuals are not viewed as desiring of sex, nor as sexually desirable to others. Broader social and cultural norms that downplay women's sexual desire and agency further compound these phenomena. Whether this popular image accurately reflects older women's sexual desires, behaviour and capacity to experience pleasure is unclear. Drawing on semi-structured interviews with 43 partnered Australian women aged 55–81, this article considers women's sexual experiences and desires in older age. The findings of our research confirm that older women's experiences of sex and sexual desire are diverse and fluid. Some of the factors that influenced participants’ sexual behaviour and desire will be considered in this article, as will their understandings of what “counts” as sexual satisfaction and “successful sex”. The factors affecting sexual behaviour and desire also influence the way in which women are able to negotiate sexual interaction with their partners. Participants expressed a need for education and resources in order to gain greater control and to make autonomous choices over their sexual experiences, desire and ability to give and receive pleasure. The implications of these findings for practitioners are also considered.