Postmenopausal sleep disturbance and sexual dysfunction

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Sleep disturbance is a common concern. It affects 30% to 60% of women in midlife,1-3 contributes to decreased quality of life,4 and is associated with numerous adverse health outcomes.5-8 Sexual health problems also are prevalent in midlife women, with 44% reporting any sexual dysfunction and about 15% reporting sexual dysfunction associated with distress.9 Sexual dysfunction is associated with lower physical and emotional satisfaction with one's partner and with lower general happiness.10
In the current issue of Menopause, Kling et al11 report on the association between sleep disturbance and sexual dysfunction using the Women's Health Initiative Observational Study cohort consisting of 93,668 women with an average age of 63 years. The authors used a validated insomnia scale, the Women's Health Initiative Insomnia Rating Scale, asked the participants for self-reported sleep duration, and assessed sleep-disordered breathing risk using questions adapted from the Berlin Questionnaire. They focused primarily on two sexual health measures: sexual satisfaction (yes/no) and partnered sexual activity in the past year (yes/no). Overall, 26% of women reported being unsatisfied (a little or very) with their current sexual activity, either with a partner or alone, and 31% reported problems with insomnia. After multivariate adjustment, they noted an association between shorter self-reported sleep duration (<7-8 hours per night) and lower odds of partnered sexual activity (≤5 hours, odds ratio [OR] 0.88, 95% confidence interval [CI] 0.80-0.96; and 6 hours, OR 0.94, 95% CI 0.89-0.99), and less sexual satisfaction (≤5 hours, OR 0.88, 95% CI 0.81-0.95; and 6 hours, OR 0.94, 95% CI 0.90-0.98); higher insomnia scores were associated with lower odds of sexual satisfaction (OR 0.92, 95% CI 0.87-0.96). High sleep-disordered breathing scores were not significantly associated with sexual activity or sexual satisfaction.
An association between sexual problems, sleep disturbance, and depressed mood in the menopausal transition has been identified previously in the Study of Women's Health Across the Nation cohort, in which 5% of women were noted to have this symptom triad.12 Women with all three symptoms were more likely to be perimenopausal or to have undergone hysterectomy with bilateral oophorectomy; to have poorer overall health status; and to have psychosocial stressors. In an attempt to clarify these relationships, Kling et al utilized a multivariate logistic model that adjusted for mood disturbance and psychosocial stressors with the Center for Epidemiological Studies Depression scale and two items from the National Institute of Mental Health's Diagnostic Interview Schedule, the life events scale, social strain and social support constructs, self-reported physical and verbal abuse in the past year, and questions about demographics, general health status, vasomotor symptoms, and menopausal hormone therapy use. Although the associations were dampened after adjustment for these potential confounders, they remained significant.
In secondary analyses, results were stratified by menopausal hormone therapy use (never, past, or current). Never and past users, but not current users, with insomnia had lower odds of partnered sexual activity than did those without insomnia. Women with insomnia on menopausal hormone therapy had relatively higher odds of partnered sexual activity than past or never users. This is not surprising, and may relate to a decrease in sexual pain. Menopausal hormone therapy has been associated with small to moderate improvements in sexual function, particularly in pain, in symptomatic menopausal women.13
There were also differences by age, in that women 70 years or older had lower odds of being sexually active with less sleep (≤5 hours) than their younger counterparts. Sexual activity and sexual function are known to decline across the menopausal transition and with age.

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