For many middle-aged women, sex is still important

Most women who are sexually active when they enter middle age continue to engage sexually as they grow older, even if they were diagnosed with sexual dysfunction, new research shows.

"There's this popular public perception that as women age, sex becomes unimportant, and that women just stop having sex as they get older," lead author Dr. Holly Thomas told Reuters Health. "From our study, it looks like most women continue to have sex during midlife," she said.

"It may be detrimental to label a woman as sexually dysfunctional," said Thomas, from the University of Pittsburgh Medical Center.

Psychologists and doctors have been debating the value of diagnosing women with sexual dysfunction since soon after the 1998 release of the erectile-dysfunction pill Viagra set off a search for a female version of the blockbuster drug.

Doctors use a test called the Female Sexual Function Index to diagnose women's sexual problems. The index includes 19 questions about arousal, orgasm, vaginal lubrication and pain during intercourse.

In the current study, 354 middle-aged and older Pittsburgh women who reported being sexually active when they first took the test took it again four years later.

More than 85 percent of women reported that they remained sexually active when they took the test the second time between the ages of 48 and 73.

Nevertheless, those women generally scored low on the sexual-function index, with an average score of 22.3 - below the cutoff of 26.55 considered sexually dysfunctional.

The authors were surprised to find that sexual function, as measured by the index, failed to predict whether the women continued to have sex.

They theorized that the instrument "may be labeling women as dysfunctional when women don't have a problem," Thomas said.

The index's "focus on intercourse may not accurately reflect what constitutes satisfying sex in this population, yielding falsely low scores," she and her colleagues write.

Race, weight, relationship status and how important women deemed sex - rather than their scores on the sexual-function index - were the most important predictors of sexual activity, according to findings published in JAMA Internal Medicine.

Women who rated sex as important were three times as likely to remain sexually active as women who rated it as unimportant, Thomas said.

White women were most likely to stay sexually engaged, the researchers found.

So were thinner women. "Whether that has to do with health or body image, we don't know," Thomas said.

Prior research has shown that obese women's sexual function may return after bariatric surgery and significant weight loss.

"We've seen from other research that a healthy sex life is a predictor of longevity," Thomas said. "So understanding sex might have broader implications for overall health," she added.

"To narrowly focus on the physical symptoms and to try to look for a magic pill to me isn't going to work. I'm more interested in a holistic approach, not just physical factors, but also emotional and relationship factors," Thomas said.

Leonore Tiefer, a New York University School of Medicine psychiatry researcher, argued in a 2006 journal article in PLOS Medicine that the pharmaceutical industry concocted and promoted the notion of female sexual dysfunction "as a textbook case of disease mongering . . . to create a sense of widespread sexual inadequacy and interest in drug treatments."

Tiefer was not involved in the current study but in an email to Reuters Health praised it for resisting "simple-minded thinking and marketing pressure."

"There is continuing drug industry pressure to get some sort of ‘female Viagra' approved, despite drug dangers and ineffectiveness," she wrote.

Dr. Camelia Davtyan told Reuters Health she would welcome a better instrument than the sexual-function index. But she does use it and finds it a valuable tool.

Director of women's health at the UCLA Comprehensive Health Program, Davtyan was not involved in the current study. The results, however, resonated with her clinical experience, though the Pittsburgh patients were not as old as many of hers in Los Angeles, she said.

"A lot of our patients continue to have sex even if they have low libido or vaginal dryness," she said. "It's just that they need help."

Last week, a 79-year-old woman complained to Davtyan that she was bleeding during intercourse. The doctor prescribed daily vaginal lubricants and vaginal estrogen.

"How am I going to use these results for her?" she asked. "I can't because she's too old."