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Posted January 4, 2023 09:16 PM

Help for Midlife Sex Trouble NAMS 2022

New research presented at the North American Menopause Society (NAMS) Annual Meeting in Atlanta, held October 12–15, explored several issues related to the sex lives of midlife women.

“Women’s sexual health, particularly in midlife, has been under-addressed,” says Stephanie S. Faubion, MD, the medical director of the North American Menopause Society (NAMS) and the director of the Office of Women’s Health at the Mayo Clinic in Jacksonville, Florida.

Identifying, understanding, and treating women’s sexual dysfunction is an important component of overall health and well-being, she says.

Childhood Trauma and Midlife Sexual Dysfunction: What’s the Link?
Adverse childhood experiences, or ACEs, are potentially traumatic events that occur in childhood, and can include violence, abuse, and growing up in a family with mental health or substance abuse problems.

One in three children experiences at least one ACE, and 39 percent of U.S. women report experiencing two or more ACEs in their lifetime.

Not only are ACEs linked with chronic health problems and mental illness in adulthood, they are also associated with menopause symptom severity and even what age a woman experiences natural menopause.

What’s New
A new cross-sectional analysis using the Data Registry on the Experiences of Aging, Menopause, and Sexuality (DREAMS) study found that the more adverse childhood experiences a woman had, the worse sexual function they had in midlife.

“We also looked to see if ACEs would predict who wasn’t sexually active in midlife, and it did; the more ACEs a woman had in childhood, the less likely she was to be sexually active at all in midlife,” says Faubion, who coauthored the study.

Research Details
A total of 1,257 women were included in the analysis, with 53.4 percent of the women experiencing female sexual dysfunction (FSD), defined as the presence of distressing sexual problems. The women were an average age of 53 years old, 96 percent were white, 89 percent were partnered, and 93 percent had at least some college.

History of ACEs was obtained with the validated ACE questionnaire, and FSD was assessed by the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale — Revised (FSDS-R).

The association between a history of adverse childhood experiences and FSD in midlife women remained even after controlling for other factors known to correlate with ACEs that can potentially affect female sexual function, such as anxiety, depression, and severe hot flashes.

Why It Matters
We can’t ignore these childhood experiences because they impact adult health in so many different ways, says Dr. Faubion. “To know that they’re impacting midlife women’s sexual health is incredibly important,” she says.

“First of all, we need to get more providers to ask about women’s sexual health and then get down into the details of what’s impacting it, and then how can we address that. For some women, childhood adversity may be part of it,” says Faubion.

It's hoped this will help open the door for more women to be treated for past experiences later in life; women should seek therapy or counseling as needed for their history of childhood adversity, she says.

This association also underscores the need for efforts to protect children, she adds.

Mindfulness Interventions for Low Sex Drive
Women of any age can have difficulty shutting out distractions and responsibilities to be fully present and engaged when it comes to experiencing sexual pleasure with a partner or alone.

Two new studies presented at NAMS explored mindfulness as a potential intervention for women with sexual interest/arousal disorder (SIAD), the most prevalent sexual dysfunction in women.

What Is Mindfulness — and Mindful Sex?
Mindfulness is being fully present, both physically and emotionally, during all parts of sex. It’s exploration without judgment or expectation, where each thought, feeling or sensation that arises is acknowledged.

Mindfulness Training via Videoconference Works
The first study was a pilot trial of a mindfulness class delivered over Zoom for midlife and older women with bothersome low sexual desire.

What’s New
Researchers found that participants were highly satisfied with the mindfulness class; the majority reported they would recommend the class to another woman with low libido.

Research Details
Investigators randomly placed 41 midlife and older women with low libido into one of two groups, a mindfulness class and a general health education class (the control group). Women in both groups met weekly six times for 90 minutes over Zoom with either a physician and a mindfulness instructor or a physician alone (control).

Women in the intervention group received mindfulness meditation training and sexual psychoeducation, and women in the control group received general menopause health education without a focus on sexuality.

“The study wasn’t powered to detect changes in sexuality, but we did find significant improvements in sexual distress in women who participated in the mindfulness class,” says the lead author Holly N. Thomas, MD, an assistant professor of medicine and clinical and translational research at the University of Pittsburgh. Improvements in sexual distress in women who attended the general health education class were not observed, she says.

“Our next steps are to test this mindfulness intervention in a larger sample and to further explore why mindfulness is helpful for low libido,” says Dr. Thomas.

Why It Matters
A virtually delivered mindfulness class could potentially be a powerful, private treatment option for low libido in midlife and older women, according to the authors. Medications for low libido may have more side effects in this patient group, and the fact that help is virtually delivered may make it more accessible for women in places without sexual health experts, they concluded.

Mindfulness and Supportive Sex Ed May Help With Low Desire
A second study compared mindfulness-based group therapy and supportive sex education.

What’s New
Researchers found that both were effective in improving the symptoms of sexual interest/arousal disorder in women. Women who reported sexual distress experienced even greater improvements, according to the lead author, Lori Brotto, PhD, the director of the University of British Columbia sexual health laboratory and the executive director of the women’s health research institute in Vancouver.

Sexual distress is a term used to describe different negative emotional responses around sex, such as worry, anxiety, frustration, bother, or feelings of inadequacy.

Research Details
Investigators placed 148 women with SIAD into one of two groups — one that received mindfulness-based cognitive therapy (MBCT) plus supportive sex education, and one that received only supportive sex education with no mindfulness therapy.

Eight sessions were held weekly, and participants completed questionnaires on sexual desire and arousal, sexual distress, relationship satisfaction, rumination, and overall impressions of change, at the start of the study, immediately after the last session, and at 6 and 12 months post-treatment.

Sexual desire and arousal significantly improved at each time point relative to baseline for both groups. Sexual distress, relationship satisfaction, and rumination about sex also improved in both arms, with the most robust results reported in the mindfulness-based cognitive therapy group.

About half the participants across both treatments reported moderate or great improvements in global indicators of desire and overall sexuality. Treatment effects from both therapies were strong to very strong and were maintained 12 months after treatment. Women reported a very high level of overall satisfaction with both treatments.

Why It Matters
Improved libido and reduced distress can have many benefits for midlife women, including overall quality of life. Mindfulness may work by teaching self-compassion and reducing the self-criticism that can stand in the way of desire, according to Dr. Brotto.

“There is now nearly two decades of empirical research evaluating mindfulness-based interventions for women’s sexual difficulties, and the research consistently shows benefits of mindfulness practice on sexual desire, sexual distress, vulvovaginal pain, and several other facets of well-being; benefits are retained when women are reassessed a year later,” she says.

Given that there are few effective and safe treatments for midlife women’s sexual dysfunction, mindfulness should be considered as a treatment option, adds Brotto.

Sexual Function Around Menopause May Differ for Women With Same-Sex Partners
Sexual function issues occur in an estimated 25 to 85 percent of postmenopausal women.

Earlier studies have suggested that sexual minority women (SMW), a term used to encompass a range of sexual orientations for women with same-sex attractions or partners, may have an increased risk of adverse mental and physical health outcomes in and after the menopause transition, including more severe menopause symptoms.

What’s New
The lead study author, Anna Blanken, PhD, a postdoctoral fellow at San Francisco VA Health Care System, and colleagues found that SMW demonstrated more resilience during the menopause transition. Midlife and older SMW veterans were also more likely to be sexually active and reported better sexual functioning and less pain during sexual activity compared with their heterosexual peers.

Research Details
The trial included 198 women veterans between ages 45 and 64; 52 of the women identified as SMW. The women with same-sex attractions or partners were more likely to have had partnered or solo sex within the previous 30 days (65 percent compared with 40 percent). SMW were also more likely to have higher sexual functioning and less likely to experience pain during sex or vaginal dryness.

“Although not tested, we believe that SMW with same-sex partners may have more favorable sexual function outcomes during the menopause transition due to greater variation in sexual behaviors, compared to heterosexual women who are likely to engage in penetrative sex with men,” Dr. Blanken explained in a press release.

“Additionally, our data suggest that psychosocial factors such as depression, anxiety, and trauma may have greater impact on sexual function of heterosexual women, compared to SMW,” she said.

Why It Matters
These findings, that women who were not heterosexual had more resilience and better sexual function at midlife, are quite interesting, says Faubion.

This sort of resilience can be hard to define or study, and it’s also challenging to parse what a person is “born with” versus what we can cultivate, she says.

In Faubion’s experience, patients who are better at practicing self-acceptance tend to do better during the menopause transition. “These women are not insistent about having a picture of themselves at 18 years old and wanting to look like that again. They’re the women who can appreciate their body at 50 and everything it can do, including being sexual,” she says.

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