Demographic and clinical characteristics of the 1,977 participants are summarized in . The mean (± SD) age was 57 (± 9) years, with a range of 45 to 80 years. Over half (n=1,100) were of non-white race/ethnicity, including 20% Black, 18% Latina, and 19% Asian women. Of the 365 Asian women, 70% (n=256) self-identified as East Asian, 21% (n=75) as Filipina, 5% (n=20) as Indian Subcontinent, 2% (n=6) as Southeast Asian, and 2% (n=8) as other or combination. Over two thirds of participants (n=1,331) were married or living as married.
Demographic and Clinical Characteristics of Participants
Overall, 43% (n=850) of participants indicated that their level of sexual desire or interest in the past 3 months was “moderate” to “very high.” The proportion of women with at least moderate desire or interest decreased significantly with increasing age (P for trend by age category < .001) (). Nevertheless, 29% (n=131) of women aged 65 or older described their level of desire or interest as at least moderate, and 6% (n=28) of these women described their desire or interest as high or very high. Self-reported desire also varied by race/ethnicity, with Black and Latina women tending to report higher levels of desire compared to White and Asian women (P for overall difference by race/ethnicity = .01; ).
Figure 1 Self-reported sexual desire and interest by A) age group and B) race/ethnicity. P for linear trend in the prevalence of at least moderate sexual desire by age < .001. P for difference in the prevalence of at least moderate sexual desire by race/ethnicity (more ...)
In multivariable analysis, women were more likely to report at least moderate sexual desire or interest if they were African American versus White (OR=1.65, 95%CI=1.25-2.17), were married or living as married (OR=1.38, 95%CI=1.10-1.73), had higher scores on the physical (OR=1.17, 95%CI=1.10-1.29, per 5-point increase) or mental (OR=1.25, 95%CI=1.14-1.37, per 5-point increase) components of the SF-12, or were using systemic estrogen (OR=1.78, 95%CI=1.30-2.44); women were less likely to report at least moderate desire if they were older (OR=0.78, 95%CI=0.73-0.84) or postmenopausal (OR=0.61, 95%CI=0.45-0.82). Household income, diabetes status, hysterectomy, oophorectomy, SSRI use, total number of medications, and body mass index were not significantly associated with sexual desire or interest, although these variables were included in our model (P > .10 for all).
Sexual desire or interest was significantly associated with overall level of sexual satisfaction in the cohort. Seventy-eight percent (n=644) of women reporting at least moderate desire or interest indicated that they were at least moderately sexually satisfied, compared to only thirty-seven percent (n=321) of women reporting low, very low, or no desire or interest (P < .01).
Overall, 60% (n=1180) of women reported some sexual activity in the previous 3 months. The proportion of women who were sexually active decreased significantly with increasing age (P for trend in weekly sexual activity by age category < .01; ). Nevertheless, 37% (n=170) of women aged 65 years or older reported some sexual activity, and 12% (n=53) of these women reported at least weekly activity. Frequency of sexual activity also varied by race/ethnicity, with Black and Asian women tending to report less frequent activity, and Latina women tending to report more frequent activity, compared to White women (P for overall difference in weekly sexual activity by race/ethnicity < .01; ).
Self-reported frequency of sexual activity by A) age group and B) race/ethnicity. P for linear trend in at least weekly activity by age group < .001. P for difference in at least weekly activity by race/ethnicity < .001.
Among women who reported no sexual activity in the previous 3 months (n=751), the most commonly cited reason for being inactive was lack of interest in sex (39%, n=273), followed by lack of a sexual partner (36%, n=249), physical problem of the partner (23%, n=160), and then lack of interest in sex by the partner (11%, n=76). The least commonly cited reason was a physical problem of the participant herself that interfered with sexual activity (9%, n=60). Most reasons for being sexually inactive did not differ significantly by age group; however, the proportion of women reporting that a physical problem of their partner interfered with sex increased with age (33% [n=86] of women aged 65 years or older, versus 12% [n=25] of women aged 45 to 54 years; P for trend by age category < .0001).
In multivariable analysis, women were more likely to report at least weekly sexual activity if they were married or living as married (OR=3.24, 95%CI=2.40-4.37), had higher scores on the physical (OR=1.16, 95%CI=1.03-1.30, per 5-point increase) or mental (OR=1.22, 95%CI=1.10-1.37, per 5-point increase) components of the SF-12, had previously undergone hysterectomy (OR=1.92, 95%CI=1.08-3.43), or were currently using oral or transdermal estrogen (OR=1.65, 95%CI=1.17-2.33). They were less likely to report weekly activity if they were older (0.72, 95%CI=0.66-0.78), if they were African-American (OR=0.78, 95%CI=0.48-0.96) or Asian (OR=0.65, 95%CI=0.46-0.90) as opposed to white, or if they had undergone bilateral oophorectomy (OR=0.40, 95%CI=0.19-0.86). Weekly sexual activity was not significantly associated with income, diabetes status, menopausal status, SSRI use, total number of medications, or body mass index, although these variables were retained in our model (P > .10 for all).
Overall, over half of participants (n=969) indicated that they were “moderately” or “very” sexually satisfied (). The proportion of women who reported at least moderate satisfaction decreased with age, in that 55% (n=533) of those aged 45 to 54 years were moderately or very satisfied, compared with 18% (n=178) of those aged 65 years or older (P for trend with increasing age = 0.04).
Overall Level of Sexual Satisfaction by Sexual Activity Status, No. (%)*
Among sexually active participants, multivariate analysis yielded several independent correlates of sexual satisfaction, including being married (OR=1.44, 95%CI=1.06-1.97), being Latina (OR=1.75, 95%CI=1.20-2.55), and having higher mental functioning scores (OR=1.16, 95%CI=1.03-1.32 per 5-point increase). Postmenopausal women were less likely to be at least moderately satisfied (OR=0.63, 95%CI=0.44-0.91), but no independent associations were observed with age, income, physical functioning, hysterectomy or oophorectomy, medication use, or body mass index (P < .10 for all).
Among sexually inactive participants, older age was associated with greater sexual satisfaction after adjusting for other characteristics (OR=1.18, 95%CI=1.03-1.36 per 5-year increase in age). Sexually inactive women also were more likely to be at least moderately satisfied if they were African-American (OR=2.24, 95%CI=1.32-3.81), had higher mental functioning scores (OR=1.25, 95%CI=1.11-1.42 per 5-point increase), or had undergone bilateral oophorectomy (OR=4.16, 95%CI=1.13-15.3). Diabetes was associated with decreased sexual satisfaction in this subset of women (OR=0.49, 95%CI=0.27-0.89), but no significant associations were observed for income, marital status, physical functioning, menopausal status, hysterectomy, medication use, or body mass index (P > .10 for all).
Over forty percent (N=496) of sexually active women reported problems with sexual activity, including low level of sexual arousal, difficulty with lubrication, difficulty with orgasm, or discomfort with vaginal penetration (). Difficulty with lubrication was more common in older versus younger sexually active women (28% of women aged 65 or older versus 17% for women under age 65 (P for trend <.0001), but the prevalence of other problems did not differ significantly by age.
Prevalence of Different Types of Sexual Problems Among Sexually Active Women, by Age Group