Sexuality and the menopause.

Sexual problems are often reported to clinicians by women in the midlife years. Yet few of the epidemiological studies of women in midlife have investigated the relationship of the menopause to sexual functioning. This paper reports the results of a cross-sectional telephone survey of 2001 randomly selected Australian-born women aged between 45 and 55 years. The major outcome variables were questions relating to changes in sexual interest over the prior 12 months, reasons for any changes, occurrence of sexual intercourse, and of unusual pain on intercourse. Logistic regression was used to identify explanatory variables for change in sexual interest. The majority of women (62%) reported no change in sexual interest, although 31% reported a decrease. Decline in sexual interest was significantly and adversely associated with natural menopause (p < 0.01) rather than age, decreased well-being (p < 0.001), decreasing employment (p < 0.01) and symptomatology (vasomotor p < 0.05, cardiopulmonary p < 0.001 and skeletal p < 0.01). Eleven to twelve years of education was associated with a lowered risk of decreased sexual functioning (p < 0.01). Heterogeneous results were reported by users of hormone replacement therapies. Longitudinal studies of large and representative samples are needed to determine the etiology of adverse sexual changes with the menopause and the role of hormone replacement therapies.