Fifty-two percent (48,300) of the respondents reported that they had been sexually active with another person in the past year. Of these, 96% (46,525) answered the sexual satisfaction question. Overall, 77% (35,719) reported satisfaction with sexual activity.
As shown in Table , sexual satisfaction was associated with increasing age and higher family income. Marital or partnered status was associated with sexual satisfaction, with more married or partnered participants reporting sexual satisfaction, versus all other participants. Identification with certain racial or ethnic groups was associated with sexual satisfaction. Other demographic variables showed statistically significant differences, but a small absolute difference. Sexual orientation was not associated with sexual satisfaction.
Demographics by Sexual Satisfaction Status-The Women’s Health Initiative - Observational Study
To ensure that the race and age findings were not an artifact of non-response bias, all non-responders were categorized as not satisfied. There was little change in the results among the groups identifying as American Indian or Asian. Similarly, when non-responders were categorized as not satisfied by age, the results were attenuated, but consistent in direction with the results reported in Table . Thus, differential non-response by either race or age did not account for our findings.
Table shows the SF-36 subscales relating to physical and mental health. Among the physical health subscales, the effect sizes range from 0.09 to 0.14, a clinical difference that is insignificant. For the mental health subscales, the effect sizes range from 0.21 to 0.38. These differences are small but clinically meaningful.
Physical and Mental Health-Related Quality of Life by Sexual Satisfaction Status – The Women’s Health Initiative – Observational Study
Table lists the gynecologic variables, medications, and health behaviors selected for investigation. Subjects with a history of oral contraceptive use were less likely to report sexual satisfaction, but this difference was small (76% versus 78%). Sexual satisfaction was equally proportional among participants reporting a history of gynecological cancer and those who did not. There was little difference in satisfaction among subjects reporting a history of hysterectomy (76%) compared to those who had never had a hysterectomy (77%). With respect to parity, our results were statistically significant, but we did not find a clear linear trend, threshold effect, or a j- or u-shaped relationship between parity and sexual satisfaction.
Gynecologic Variables, Medications and Health Behaviors by Sexual Satisfaction Status – The Women’s Health Initiative – Observational Study
SSRI users were less likely to report sexual satisfaction than nonusers (66% versus 77%). Hormone therapy users and nonusers were equally likely to report sexual satisfaction. Satisfaction with sexual activity was associated with more exercise, never smoking, and normal body mass index (BMI). Alcohol users and nonusers reported equal rates of satisfaction.
Table shows the results of sequential models with independent variables examined for association with sexual satisfaction. Model 1 includes demographics only and yields a c-statistic of 0.559, reflecting a limited ability to discriminate between satisfied and dissatisfied participants. In model 2, the general health and pain constructs of the SF-36 met our model retention criteria. With addition of the mental health subscales in model 3, the physical health subscales were excluded, and the mental health and vitality constructs were retained. In model 4, adding gynecologic variables, parity and oral contraceptive use were retained. In model 5, SSRI use was retained. In model 6, smoking status was retained. With each sequential model, the c-statistic improves only modestly, to a final c-statistic of 0.613, reflecting a limited ability to discriminate between women who report sexual satisfaction and those that do not.
Odds of Satisfaction with Sexual Activity Among Sexually Active Postmenopausal Women–The Women’s Health Initiative–observational study
In model 6, among the demographic variables, the strongest association with sexual satisfaction was found with race or ethnicity. American Indians or Alaskan Natives were 2.7 times more likely to be sexually satisfied than whites, followed by Asian (OR
1.5) and Hispanic (OR
1.1) respondents. Being married or partnered was significantly associated with sexual satisfaction, compared to all other participants. The oldest age cohort, 70–79, had greater odds of satisfaction, compared to the younger cohorts.
Among the SF-36 subscales, two scales associated with mental health were retained, with greater odds of sexual satisfaction associated with greater mental health (OR
1.3) and greater vitality (OR
1.1). Certain parous states were associated with sexual satisfaction. No prior use of oral contraceptives was associated with greater odds of sexual satisfaction (OR
1.1), as was no SSRI use (OR
1.4). Former smokers were less likely to report satisfaction (OR
0.8) versus never smokers.
Despite excluding subjects who had not had sex with a partner in the past year, satisfaction with sexual frequency could confound the overall sexual satisfaction construct. In bivariate analysis, satisfaction with sexual frequency was highly associated (p
.0001) with satisfaction with sexual activity. Participants who would like sex less often, more often, and who preferred not to answer were more likely to be sexually dissatisfied than participants who were satisfied with current sexual frequency.
To test whether satisfaction with sexual frequency confounded our overall results with respect to sexual satisfaction, we re-ran model 6 including satisfaction with sexual frequency. All variables in the model were the same as the variables in Table , except for age and oral contraceptive use, which no longer met our retention criterion, and satisfaction with sexual frequency, which met our retention criterion and was therefore included.
Because this could indicate that age may function as a surrogate for satisfaction with sexual frequency, we assessed the bivariate association between age and satisfaction with sexual frequency. Among dissatisfied participants, a higher proportion of women aged 50–59 would like sex more often than women aged 70–79 (35% versus 20%), and a higher proportion of women aged 70–79 would like sex less often than women aged 50–59 (6% versus 5%).