Abstract
Background: A variety of biological and psychosocial factors are associated with women’s sexual health in midlife and older age. Evidence suggests a decline in sexual functioning in the context of aging and the menopausal transition, including changes in sexual desire, arousal, lubrication, orgasm, pain, and/or contentment. However, not all women in midlife and older age experience such a decline, and it remains unclear how the endocrine environment and psychosocial aspects contribute to the maintenance of healthy sexual functioning. Therefore, the aim of this study was to examine psychobiological predictors of sexual functioning in healthy middle-aged and elderly females.Methods: A total of 93 healthy, sexually active women aged 40–73 years completed a battery of validated psychosocial questionnaires, including measures of sexual functioning (Female Sexual Function Index) and of protective psychological traits and interpersonal variables. The steroid hormones estrogen, testosterone, progesterone and dehydroepiandrosterone sulfate were determined in saliva samples, while follicle-stimulating hormone, luteinizing hormone and sex hormone-binding globulin were determined in dried blood spots. The findings were statistically adjusted for multiple testing.Results: Age and postmenopausal status were negatively associated with overall sexual functioning, arousal, and lubrication. Regression analyses revealed that relationship satisfaction, emotional support, self-esteem, optimism, and life satisfaction each significantly predicted overall sexual functioning or specific aspects of sexual functioning, including arousal, contentment, orgasm, and pain (all p < 0.029). For desire and lubrication, no associations were found with the tested psychosocial factors. In terms of steroid hormones, testosterone was positively linked to orgasm (p = 0.012). In this sample, 79.6% reported to have healthy sexual functioning according to the questionnaires’ cutoff. Younger age (OR = 0.911, 95% CI 0.854–0.970, p = 0.004) and a higher level of emotional support (OR = 1.376, 95% CI 1.033–1.833, p = 0.029) were associated with the presence of healthy sexual functioning.Discussion: Although aging and menopause negatively affected aspects of sexual functioning, the accompanying endocrine correlates were not predictive for sexual functioning in this healthy sample of middle-aged and older females. Instead, our findings suggest that sexual functioning is highly dependent on psychosocial aspects related to well-being. Accordingly, personality traits such as optimism, and interpersonal aspects such as emotional support and relationship satisfaction were identified as important predictors of sexual functioning.
Highlights
As populations are aging rapidly all over the world, there has been a growing interest in healthy aging and associated factors
This study investigated psychobiological predictors of sexual functioning in a healthy sample of middle-aged and elderly females
We examined the associations of age, menopausal status, protective psychological and interpersonal factors, as well as endocrine factors with female sexual functioning and its various components
Summary
As populations are aging rapidly all over the world, there has been a growing interest in healthy aging and associated factors. Physical sexual response is characterized by the linear progression from excitement, to plateau, orgasm, and resolution This classical model was frequently criticized due to its sole focus on the physical (genital) response and was extended with the aspect of sexual desire preceding the excitement phase (Kaplan, 1979). Despite this adaptation, it has been debated whether this linear model of sexual response adequately reflects women’s sexual experience. Basson (2001) proposed an alternative circular model, which refers to the female’s sexual response This model emphasizes the importance of emotional intimacy (as a result of a satisfying sexual experience) for future willingness to engage in sexual activity. The aim of this study was to examine psychobiological predictors of sexual functioning in healthy middle-aged and elderly females
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