Sexual Dysfunction in Some Women Can Occur Years Before Menopause, Study Says

Vaginal dryness and painful intercourse are common in women between 40 and 55 years of age.

Sexual health changes may begin during perimenopause, the lead up to menopause, which can last up to 10 years.

New
research suggests that women’s sexual function and desire can decrease
significantly after age 40 — several years before they reach menopause.
The study, published on October 31, 2019, in the journal Menopause,
found that sexual satisfaction scores decreased while sexual dysfunction
increased by about 30 percent during the perimenopause years, in large
part due to vaginal dryness.

Although previous studies have documented the impact of vaginal
atrophy and vaginal dryness on menopausal women, this new study is one
of only a few to assess impact during perimenopause, the transitional
time prior to menopause when the ovaries gradually begin to make less
estrogen, according to Stephanie Faubion, MD, internal medicine doctor
at the Mayo Clinic in Rochester, Minnesota, and medical director for the
North American Menopause Society. Dr. Faubion was not involved in this
research.

Symptoms Start During Perimenopause, the Long Lead-Up to Menopause

“These
results show that certain symptoms of menopause, such as vaginal
dryness, are much more prevalent during the menopause transition,” adds
Faubion.

Painful Intercourse, Sexual Dysfunction Are Common for Midlife Women

The
study looked at 518 women ages 40 to 55 in 30 healthcare centers
throughout Italy in order to evaluate how women’s experience of sex
changed before and during menopause, as well as the impact of vaginal
atrophy (VA). Vaginal atrophy is the thinning, drying, and inflammation
of the vaginal walls that can occur during age-related hormone flux,
when the body produces less estrogen.

According to the authors,
Italian women tend to reach menopause between ages 49 and 50. Based on
this average, women were placed into one of four groups: women in the
late fertile period, (40 to 45 years), women in the years preceding
menopause (46 to 48 years), women in menopausal years (49 to 51 years of
age), and women in early postmenopausal years (52 to 55 years of age).

Investigators identified vaginal atrophy by the coexistence of a
vaginal pH of greater than 5, a sensation of dryness experienced by the
woman, and objective signs of VA, such as color, dryness, and thinning.

Personal Sexual Function Was Measured via Questionnaire

Sexual
function was measured by the Female Sexual Function Index (FSFI), a
self-administered questionnaire. The FSFI is made up of 19 questions
that fall into six domains: desire, arousal, lubrication, orgasm,
satisfaction, and dyspareunia, also known as painful intercourse. Each
question was scored on a Likert scale from 0 to 6, with 0 meaning lack
of sexual function in that domain, and 6 corresponding to full sexual
function for that domain. The scores could range from 0 to 36, and based
on previous research on women of reproductive age, authors considered
scores under 26.55 as indicating sexual dysfunction.

Researchers observed the following trends:

70
percent of the women had sexual dysfunction according to their FSFI
results, increasing from 55 percent of women in the youngest group to
82.2 percent in the women ages 52 to 55.

Sexual dysfunction
increases by roughly 30 percent during perimenopause; vaginal dryness is
most often the problem and has the greatest impact on desire, arousal,
lubrication, and overall satisfaction.

These results indicate that
vaginal atrophy is not a late event of menopause, but rather something
that many women can start to experience in their forties, significantly
prior to menopause, according to Angelo Cagnacci, MD, PhD, professor of
obstetrics and gynecology at the University of Udine in Italy and
coauthor of the study.

“We also found that vaginal dryness and
painful intercourse is prevalent in women between 40 and 55 years old,”
Dr. Cagnacci wrote in an email message, adding that these symptoms were
present in as many as 60 percent of the women in the study.

Authors
found the number of women in the study who self-reported sexual
dysfunction to their doctor was only 25 percent — much lower than the
70.6 percent indicated by the questionnaire results. “This may be the
consequence of the embarrassment produced in women discussing sexuality
issues,” noted the authors.

The authors acknowledged that the
26.55 cutoff score on the FSFI was “probably excessive for menopausal
and postmenopausal women, whose sexuality is likely diminished with
respect to that of younger women.” The study is also limited because it
included only white women who visited the outpatient centers in Italy.

Treatments for Vaginal Dryness, Atrophy Critical for Healthy Sex Life 

These
results highlight the importance of treating vaginal dryness says
Cagnacci. “Vaginal atrophy is a progressive disease that if left
untreated can progressively evolve into a situation in which there is no
coming back,” he says. “Early and prolonged treatment is critical to
keep a healthy vagina and a healthy sexual life.”

“Symptoms such
as vaginal dryness and hot flashes that are typically associated with
menopause can begin well before the last menstrual cycle and should be
addressed early,” agrees Faubion. These findings underscore the
importance of addressing sexual health concerns during the menopause
transition, she adds.

“Women should tell their providers if they
have symptoms such as vaginal dryness, itching, burning, irritation,
pain with sex, urinary frequency or urgency, or urinary tract
infections, which women don’t always associate with the menopause
transition but can have a significant impact on quality of life and
relationships with their partners,” says Faubion. Talking about this
topic shouldn’t be taboo, but rather should be a routine part of a
health assessment, she adds.

“For treatment of genitourinary
syndrome of menopause, over-the-counter solutions include use of
lubricants for sexual activity and moisturizers used every one to three
days for maintenance of moisture,” she suggests.

If that doesn’t
address the symptoms completely, low dose vaginal hormonal preparations
are very helpful and are not linked to any adverse long-term risks,
according to Faubion. “These include vaginal estrogen in the form of
cream, rings, tablet or inserts as well as vaginal DHEA inserts, which
are all easy to use and very effective,” she says.

Use It or Lose It

Faubion
also suggests regular, painless sexual activity to help maintain sexual
function. “Sometimes working with a pelvic floor physical therapist to
treat tight, tender pelvic floor muscles can also help,” she says.

Another
potential option is vaginal laser therapies for treatment of vaginal
dryness, says Faubion. “Preliminary evidence is promising, but
longer-term studies looking at safety and effectiveness are needed
before these treatments can be widely recommended.”