Contents: Original Research

Patterns of Sexual Activity and the Development of Sexual Pain Across the Menopausal Transition

Waetjen, L. Elaine MD; Johnson, Wesley O. PhD; Xing, Guibo PhD; Hess, Rachel MD, MS; Avis, Nancy E. PhD; Reed, Barbara D. MD; Dugan, Sheila A. MD; Neal-Perry, Genevieve MD, PhD; Gold, Ellen B. PhD; for the Study of Women's Health Across the Nation (SWAN)

Author Information

UC Davis School of Medicine, Sacramento, and the Department of Statistics, University of California, Irvine, Irvine, California; University of Utah School of Medicine, Salt Lake City, Utah; Wake Forest School of Medicine, Winston-Salem, and UNC School of Medicine, Chapel Hill, North Carolina; the University of Michigan Medical School, Ann Arbor, Michigan; and Rush University Medical Center, Rush Medical College, Chicago, Illinois.

Corresponding author: L. Elaine Waetjen, MD, Department of Obstetrics and Gynecology, University of California, Davis School of Medicine Sacramento, CA; email: [email protected].

The Study of Women's Health Across the Nation (SWAN) has grant support from the National Institutes of Health (NIH), DHHS, through the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR) and the NIH Office of Research on Women's Health (ORWH) (Grants U01NR004061; U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, U01AG012495, and U19AG063720). The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the NIA, NINR, ORWH, or the NIH.

Financial Disclosure Rachel Hess serves on a data safety monitoring board for Astellas Pharmaceuticals. The other authors did not report any potential conflicts of interest.

The authors thank the study staff at each site and all the women who participated in SWAN.

A list of members of the Clinical Centers, NIH Program Office, Central Laboratory, Coordinating Center, and Steering Committee is in Appendix 1 online at https://links.lww.com/AOG/C721.

Each author has confirmed compliance with the journal's requirements for authorship.

Peer reviews and author correspondence are available at https://links.lww.com/AOG/C722.

Obstetrics & Gynecology 139(6):p 1130-1140, June 2022. | DOI: 10.1097/AOG.0000000000004810

OBJECTIVE:

To examine whether patterns of sexual intercourse frequency and demographic, menopausal status, genitourinary, health, and psychosocial factors are associated with developing sexual pain across the menopausal transition.

METHODS:

These were longitudinal analyses of questionnaire data from the multicenter, multiracial and ethnic prospective cohort SWAN (Study of Women's Health Across the Nation) (1995–2008). We used multivariable discrete-time proportional hazards models to examine whether incident sexual pain was associated with preceding long-term (up to 10 visits) or short-term (two and three visits) sexual intercourse frequency patterns or other factors (eg, menopause status, genitourinary symptoms, lifestyle factors, and mental health).

RESULTS:

Of the 2,247 women with no sexual pain at baseline, 1,087 (48.4%) developed sexual pain at least “sometimes” up to 10 follow-up visits over 13 years. We found no consistent association between prior patterns of sexual intercourse frequency and development of sexual pain. For example, neither decreases in intercourse frequency from baseline (adjusted hazard ratio [aHR] 0.93, 95% CI 0.73–1.19) nor decreases in frequency over three prior visits (aHR 1.00, 95% CI 0.72–1.41) were associated with incident pain. Reasons for interruptions in intercourse activity at the prior visit, including lack of interest (aHR 1.64, 95% CI 0.74–3.65) and relationship issues (aHR 0.36, 95% CI 0.04–2.88), were not associated with developing pain. Being postmenopausal using hormone therapy (aHR 3.16, 95% CI 1.46–6.85), and reported vaginal dryness (aHR 3.73, 95% CI 2.88–4.83) were most strongly associated with incident sexual pain.

CONCLUSION:

Long-term and short-term declines in sexual intercourse frequency across the menopausal transition were not associated with increased hazard of developing pain with intercourse. This empirical evidence does not support the common belief that a reduction in women's sexual frequency is responsible for their symptoms of sexual pain.

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