Journal of General Internal Medicine

, Volume 23, Issue 12, pp 2000–2009 | Cite as

Correlates of Sexual Satisfaction Among Sexually Active Postmenopausal Women in the Women’s Health Initiative-Observational Study

  • Jennifer S. McCall-Hosenfeld
  • Sarah A. Jaramillo
  • Claudine Legault
  • Karen M. Freund
  • Barbara B. Cochrane
  • JoAnn E. Manson
  • Nanette K. Wenger
  • Charles B. Eaton
  • Beatriz L. Rodriguez
  • S. Gene McNeeley
  • Denise Bonds
Original Article



Satisfaction with sexual activity is important for health-related quality of life, but little is known about the sexual health of postmenopausal women.


Describe factors associated with sexual satisfaction among sexually active postmenopausal women.


Cross-sectional analysis.


All members of the Women’s Health Initiative-Observational Study (WHI-OS), ages 50–79, excluding women who did not respond to the sexual satisfaction question or reported no partnered sexual activity in the past year (N = 46,525).


Primary outcome: dichotomous response to the question, “How satisfied are you with your sexual activity (satisfied versus unsatisfied)?” Covariates included sociodemographic factors, measures of physical and mental health, and gynecological variables, medications, and health behaviors related to female sexual health.


Of the cohort, 52% reported sexual activity with a partner in the past year, and 96% of these answered the sexual satisfaction question. Nonmodifiable factors associated with sexual dissatisfaction included age, identification with certain racial or ethnic groups, marital status, parity, and smoking history. Potentially modifiable factors included lower mental health status and use of SSRIs. The final model yielded a c-statistic of 0.613, reflecting only a modest ability to discriminate between the sexually satisfied and dissatisfied.


Among postmenopausal women, the variables selected for examination yielded modest ability to discriminate between sexually satisfied and dissatisfied participants. Further study is necessary to better describe the cofactors associated with sexual satisfaction in postmenopausal women.


sexual dysfunction physiological sexual dysfunctions psychological women menopause postmenopause cohort studies 




The Women’s Health Initiative program was funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health, US Department of Health and Human Services. Dr. McCall-Hosenfeld was supported by a Department of Veterans Affairs Special Fellowship in the Health Issues of Women Veterans when this research was performed.

Role of the Sponsor

The funding organization had representation on the steering committee, which governed the design and conduct of the study, the interpretation of the data, and the preparation and approval of manuscript. The National Heart, Lung, and Blood Institute Program Office reviewed the manuscript prior to publication.

WHI Investigators by Clinical Center

Program Office: (National Heart, Lung, and Blood Institute, Bethesda, MD) Elizabeth Nabel, Jacques Rossouw, Shari Ludlam, Linda Pottern, Joan McGowan, Leslie Ford, and Nancy Geller.

Clinical Coordinating Center: (Fred Hutchinson Cancer Research Center, Seattle, WA)

Ross Prentice, Garnet Anderson, Andrea LaCroix, Charles L. Kooperberg, Ruth E. Patterson, Anne McTiernan; (Wake Forest University School of Medicine, Winston-Salem, NC) Sally Shumaker; (Medical Research Labs, Highland Heights, KY) Evan Stein; (University of California at San Francisco, San Francisco, CA) Steven Cummings.

Clinical Centers: (Albert Einstein College of Medicine, Bronx, NY) Sylvia Wassertheil-Smoller; (Baylor College of Medicine, Houston, TX) Aleksandar Rajkovic; (Brigham and Women’s Hospital, Harvard Medical School, Boston, MA) JoAnn Manson; (Brown University, Providence, RI) Annlouise R. Assaf; (Emory University, Atlanta, GA) Lawrence Phillips; (Fred Hutchinson Cancer Research Center, Seattle, WA) Shirley Beresford; (George Washington University Medical Center, Washington, DC) Judith Hsia; (Los Angeles Biomedical Research Institute at Harbor- UCLA Medical Center, Torrance, CA) Rowan Chlebowski; (Kaiser Permanente Center for Health Research, Portland, OR) Evelyn Whitlock; (Kaiser Permanente Division of Research, Oakland, CA) Bette Caan; (Medical College of Wisconsin, Milwaukee, WI) Jane Morley Kotchen; (MedStar Research Institute/Howard University, Washington, DC) Barbara V. Howard; (Northwestern University, Chicago/Evanston, IL) Linda Van Horn; (Rush Medical Center, Chicago, IL) Henry Black; (Stanford Prevention Research Center, Stanford, CA) Marcia L. Stefanick; (State University of New York at Stony Brook, Stony Brook, NY) Dorothy Lane; (The Ohio State University, Columbus, OH) Rebecca Jackson; (University of Alabama at Birmingham, Birmingham, AL) Cora E. Lewis; (University of Arizona, Tucson/Phoenix, AZ) Tamsen Bassford; (University at Buffalo, Buffalo, NY) Jean Wactawski-Wende; (University of California at Davis, Sacramento, CA) John Robbins; (University of California at Irvine, CA) F. Allan Hubbell; (University of California at Los Angeles, Los Angeles, CA) Lauren Nathan; (University of California at San Diego, LaJolla/Chula Vista, CA) Robert D. Langer; (University of Cincinnati, Cincinnati, OH) Margery Gass; (University of Florida, Gainesville/Jacksonville, FL) Marian Limacher; (University of Hawaii, Honolulu, HI) David Curb; (University of Iowa, Iowa City/Davenport, IA) Robert Wallace; (University of Massachusetts/Fallon Clinic, Worcester, MA) Judith Ockene; (University of Medicine and Dentistry of New Jersey, Newark, NJ) Norman Lasser; (University of Miami, Miami, FL) Mary Jo O’Sullivan; (University of Minnesota, Minneapolis, MN) Karen Margolis; (University of Nevada, Reno, NV) Robert Brunner; (University of North Carolina, Chapel Hill, NC) Gerardo Heiss; (University of Pittsburgh, Pittsburgh, PA) Lewis Kuller; (University of Tennessee, Memphis, TN) Karen C. Johnson; (University of Texas Health Science Center, San Antonio, TX) Robert Brzyski; (University of Wisconsin, Madison, WI) Gloria E. Sarto; (Wake Forest University School of Medicine, Winston-Salem, NC) Mara Vitolins; (Wayne State University School of Medicine/Hutzel Hospital, Detroit, MI) Susan Hendrix.

Conflict of Interest

None disclosed.


  1. 1.
    Rosen, R, Brown C, Heiman J, et al. The Female Sexual Function Index (FSFI): a multidimensional self--report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26(2):191–208.PubMedCrossRefGoogle Scholar
  2. 2.
    Rosen, RC, Lobo RA, Block BA, Yang H-M, Zipfel LM. Menopausal Sexual Interest Questionnaire (MSIQ): a unidimensional scale for the assessment of sexual interest in postmenopausal women. J Sex Marital Ther. 2004;30(4):235–50.PubMedCrossRefGoogle Scholar
  3. 3.
    Rust, J, Golombok S. The GRISS: A Psychometric Instrument for the Assessment of Sexual Dysfunction. Arch Sex Behav. 1986;15(2):157–65.PubMedCrossRefGoogle Scholar
  4. 4.
    Nicolosi, A, Laumann EO, Glasser DB, et al. Sexual behavior and sexual dysfunctions after age 40: the global study of sexual attitudes and behaviors. Urology. 2004;64(5):991–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Laumann, EO, Nicolosi A, Glasser DB, et al. Sexual problems among women and men aged 40–80 y: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors. Int J Impot Res. 2005;17(1):39–57.PubMedCrossRefGoogle Scholar
  6. 6.
    Laumann, EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA. 1999;281(6):537–44.PubMedCrossRefGoogle Scholar
  7. 7.
    Salonia, A, Munarriz RM, Naspro R, et al. Women’s sexual dysfunction: a pathophysiological review. BJU Int. 2004;93(8):1156–64.PubMedCrossRefGoogle Scholar
  8. 8.
    Nazareth, I, Boynton P, King M. Problems with sexual function in people attending London general practitioners: cross sectional study. BMJ. 2003;327(7412):423.PubMedCrossRefGoogle Scholar
  9. 9.
    Dennerstein, L, Smith A, Morse C. Sexuality and the menopause. J Psychosomatic Obstet Gynecol. 1994;15:59–66.CrossRefGoogle Scholar
  10. 10.
    Maas, CP, Weijenborg PTM, ter Kuile MM. The effect of hysterectomy on sexual functioning. Annu Rev Sex Res. 2003;14:83–113.PubMedGoogle Scholar
  11. 11.
    Dennerstein, L, Koochaki P, Barton I, Graziottin A. Hypoactive sexual desire disorder in menopausal women: a survey of Western European women. J Sex Med. 2006;3(2):212–22.PubMedCrossRefGoogle Scholar
  12. 12.
    Dennerstein, L, Lehert P. Modeling mid-aged women’s sexual functioning: a prospective, population-based study. J Sex Marital Ther. 2004;30(3):173–83.PubMedCrossRefGoogle Scholar
  13. 13.
    Dennerstein, L, Hayes RD. Confronting the challenges: epidemiological study of female sexual dysfunction and the menopause. J Sex Med. 2005;2(Suppl 3):118–32.PubMedCrossRefGoogle Scholar
  14. 14.
    Hayes, R, Dennerstein L. The impact of aging on sexual function and sexual dysfunction in women: a review of population-based studies. J Sex Med. 2005;2(3):317–30.PubMedCrossRefGoogle Scholar
  15. 15.
    Cain, VS, Johannes CB, Avis NE, et al. Sexual functioning and practices in a multi-ethnic study of midlife women: baseline results from SWAN. J Sex Res. 2003;40(3):266–76.PubMedGoogle Scholar
  16. 16.
    Howard, BV, Kuller L, Langer R, et al. Risk of cardiovascular disease by hysterectomy status, with and without oophorectomy: the Women’s Health Initiative Observational Study. Circulation. 2005;111(12):1462–70.PubMedCrossRefGoogle Scholar
  17. 17.
    Hsia, J, Aragaki A, Bloch M, LaCroix AZ, Wallace R, Investigators WHI. Predictors of angina pectoris versus myocardial infarction from the Women’s Health Initiative Observational Study. Am J Cardiol. 2004;93(6):673–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Langer, RD, White E, Lewis CE, Kotchen JM, Hendrix SL, Trevisan M. The Women’s Health Initiative Observational Study: baseline characteristics of participants and reliability of baseline measures. Ann Epidemiol. 2003;13(9 Suppl):S107–21.PubMedCrossRefGoogle Scholar
  19. 19.
    Hays, J, Hunt JR, Hubbell FA, et al. The Women’s Health Initiative recruitment methods and results. Ann Epidemiol. 2003;13(9 Suppl):S18–77.PubMedCrossRefGoogle Scholar
  20. 20.
    Stefanick, ML, Cochrane BB, Hsia J, Barad DH, Liu JH, Johnson SR. The Women’s Health Initiative postmenopausal hormone trials: overview and baseline characteristics of participants. Ann Epidemiol. 2003;13(9 Suppl):S78–86.PubMedCrossRefGoogle Scholar
  21. 21.
    Valanis, BG, Bowen DJ, Bassford T, Whitlock E, Charney P, Carter RA. Sexual orientation and health: comparisons in the women’s health initiative sample. Arch Fam Med. 2000;9(9):843–53.PubMedCrossRefGoogle Scholar
  22. 22.
    Brunner RL, Gass M, Aragaki A, et al. Effects of conjugated equine estrogen on health-related quality of life in postmenopausal women with hysterectomy: results from the Women’s Health Initiative Randomized Clinical Trial. Arch Intern Med. 2005:1976–86.Google Scholar
  23. 23.
    Hays, J, Ockene JK, Brunner RL, et al. Effects of estrogen plus progestin on health-related quality of life. N Engl J Med. 2003;348(19):1839–54.PubMedCrossRefGoogle Scholar
  24. 24.
    Oksuz, E, Malhan S, Oksuz E, Malhan S. Prevalence and risk factors for female sexual dysfunction in Turkish women. J Urol. 2006;175(2):654–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Lewis, RW, Fugl-Meyer KS, Bosch R, et al. Epidemiology/risk factors of sexual dysfunction. J Sex Med. 2004;1(1):35–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Addis, IB, Ireland CC, Vittinghoff E, Lin F, Stuenkel CA, Hulley S. Sexual activity and function in postmenopausal women with heart disease. Obstet Gynecol. 2005;106(1):121–7.PubMedGoogle Scholar
  27. 27.
    Henderson AW, Lehavot K, Simoni JM. Ecological Models of Sexual Satisfaction among Lesbian/Bisexual and Heterosexual Women. Arch Sex Behav 2008.Google Scholar
  28. 28.
    Tracy, JK, Junginger J. Correlates of lesbian sexual functioning. J Women’s Health. 2007;16(4):499–509.CrossRefGoogle Scholar
  29. 29.
    Lindau, ST, Schumm LP, Laumann EO, Levinson W, O’Muircheartaigh CA, Waite LJ. A study of sexuality and health among older adults in the United States. N Engl J Med. 2007;357(8):762–74.PubMedCrossRefGoogle Scholar
  30. 30.
    Basson, R, Schultz WW. Sexual sequelae of general medical disorders. Lancet. 2007;369(9559):409–24.PubMedCrossRefGoogle Scholar
  31. 31.
    Nappi, R, Salonia A, Traish AM, et al. Clinical biologic pathophysiologies of women’s sexual dysfunction. J Sex Med. 2005;2(1):4–25.PubMedCrossRefGoogle Scholar
  32. 32.
    Ware, J, Sherbourne C. The MOS 36-Item Short-Form Health Survey (SF-36), I: conceptual framework and item selection. Medical Care. 1992;30:473–83.PubMedCrossRefGoogle Scholar
  33. 33.
    Hays, R, Sherbourne C, Mazel R. The RAND 36-Item Health Survey 1.0. Health Econ. 1993;2(3):213–5.CrossRefGoogle Scholar
  34. 34.
    Bartlik, B, Kocsis JH, Legere R, et al. Sexual dysfunction secondary to depressive disorders. J Gend Specif Med. 1999;2(2):52–60.PubMedGoogle Scholar
  35. 35.
    Kennedy, SH, Dickens SE, Eisfeld BS, et al. Sexual dysfunction before antidepressant therapy in major depression. J Affect Disord. 1999;56(2–3):201–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Dobkin, RD, Leiblum SR, Rosen RC, et al. Depression and sexual functioning in minority women: current status and future directions. J Sex Marital Ther. 2006;32(1):23–36.PubMedCrossRefGoogle Scholar
  37. 37.
    Panzer, C, Wise S, Fantini G, et al. Impact of oral contraceptives on sex hormone-binding globulin and androgen levels: a retrospective study in women with sexual dysfunction. J Sex Med. 2006;3(1):104–13.PubMedCrossRefGoogle Scholar
  38. 38.
    Andersen, BL, Woods XA, Copeland LJ. Sexual self-schema and sexual morbidity among gynecologic cancer survivors. J Consult Clin Psychol. 1997;65(2):221–9.PubMedCrossRefGoogle Scholar
  39. 39.
    Pieterse, QD, Maas CP, ter Kuile MM, et al. An observational longitudinal study to evaluate miction, defecation, and sexual function after radical hysterectomy with pelvic lymphadenectomy for early-stage cervical cancer. Int J Gynecol Cancer. 2006;16(3):1119–29.PubMedCrossRefGoogle Scholar
  40. 40.
    Botros, SM, Abramov Y, Miller J-JR, et al. Effect of parity on sexual function: an identical twin study. Obstet Gynecol. 2006;107(4):765–70.PubMedGoogle Scholar
  41. 41.
    Hensley, PL, Nurnberg HG. SSRI sexual dysfunction: a female perspective. J Sex Marital Ther. 2002;28(Suppl 1):143–53.PubMedCrossRefGoogle Scholar
  42. 42.
    Rosen, RC, Lane RM, Menza M. Effects of SSRIs on sexual function: a critical review. J Clin Psychopharmacol. 1999;19(1):67–85.PubMedCrossRefGoogle Scholar
  43. 43.
    Wassertheil-Smoller, S, Shumaker S, Ockene J, et al. Depression and cardiovascular sequelae in postmenopausal women. The Women’s Health Initiative (WHI). Arch Intern Med. 2004;164(3):289–98.PubMedCrossRefGoogle Scholar
  44. 44.
    Anderson, GL, Manson J, Wallace R, et al. Implementation of the Women’s Health Initiative study design. Ann Epidemiol. 2003;13(9 Suppl):S5–17.PubMedCrossRefGoogle Scholar
  45. 45.
    Davison, SL, Bell RJ, LaChina M, et al. Sexual function in well women: stratification by sexual satisfaction, hormone use, and menopause status. J Sex Med. 2008;5(5):1214–22.PubMedCrossRefGoogle Scholar
  46. 46.
    Meston, CM, Gorzalka BB, Meston CM, Gorzalka BB. Differential effects of sympathetic activation on sexual arousal in sexually dysfunctional and functional women. J Abnorm Psychol. 1996;105(4):582–91.PubMedCrossRefGoogle Scholar
  47. 47.
    Esposito, K, Ciotola M, Giugliano F, et al. Association of body weight with sexual function in women. Int J Impot Res. 2007;19(4):353–7.PubMedCrossRefGoogle Scholar
  48. 48.
    Covington, SS, Kohen J, Covington SS, Kohen J. Women, alcohol, and sexuality. Adv Alcohol Subst Abuse. 1984;4(1):41–56.PubMedGoogle Scholar
  49. 49.
    Peterson, JS, Hartsock N, Lawson G, Peterson JS, Hartsock N, Lawson G. Sexual dissatisfaction of female alcoholics. Psychol Rep. 1984;55(3):744–6.PubMedGoogle Scholar
  50. 50.
    Rosenthal R. Parametric measures of effect size. In: Cooper H, Hedges LV, eds. The handbook of research synthesis. New York: Russell Sage Foundation; 1994:231–44.Google Scholar
  51. 51.
    Cohen, J. Statistical power analysis for the behavioral sciences. 2Hillsdale, NJ: L. Erlbaum; 1988.Google Scholar
  52. 52.
    Kadri, N, McHichi Alami KH, McHakra Tahiri S. Sexual dysfunction in women: population based epidemiological study. Arch Womens Ment Health. 2002;5(2):59–63.PubMedCrossRefGoogle Scholar
  53. 53.
    Richters, J, Grulich AE, de Visser RO, Smith AMA, Rissel CE. Sex in Australia: autoerotic, esoteric and other sexual practices engaged in by a representative sample of adults. Aust N Z J Public Health. 2003;27(2):180–90.PubMedCrossRefGoogle Scholar
  54. 54.
    Ghetti, C, Gregory WT, Clark AL. Risk factors for surgically managed pelvic organ prolapse and urinary incontinence. Int J Gynaecol Obstet. 2007;98(1):63–4.PubMedCrossRefGoogle Scholar
  55. 55.
    Connolly, TJ, Litman HJ, Tennstedt SL, Link CL, McKinlay JB. The effect of mode of delivery, parity, and birth weight on risk of urinary incontinence. Int Urogynecol J. 2007;18(9):1033–42.CrossRefGoogle Scholar
  56. 56.
    Hendrix, SL, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A. Pelvic organ prolapse in the Women’s Health Initiative: gravity and gravidity. Am J Obstet Gynecol. 2002;186(6):1160–6.PubMedCrossRefGoogle Scholar
  57. 57.
    Heiman, JR. Sexual dysfunction: overview of prevalence, etiological factors, and treatments. J of Sex Res. 2002;39(1):73–8.CrossRefGoogle Scholar
  58. 58.
    Becklake, M, Lalloo U. The ’healthy smoker’: a phenomenon of health selection? Respiration. 1990;57(3):137–44.PubMedCrossRefGoogle Scholar
  59. 59.
    Alexander, JL, Kotz K, Dennerstein L, Kutner SJ, Wallen K, Notelovitz M. The effects of postmenopausal hormone therapies on female sexual functioning: a review of double-blind, randomized controlled trials. Menopause. 2004;11(6 Pt 2):749–65.PubMedCrossRefGoogle Scholar
  60. 60.
    Avis, NE, Stellato R, Crawford S, Johannes C, Longcope C. Is there an association between menopause status and sexual functioning? Menopause. 2000;7(5):297–309.PubMedCrossRefGoogle Scholar
  61. 61.
    Avis, NE, Zhao X, Johannes CB, Ory M, Brockwell S, Greendale GA. Correlates of sexual function among multi-ethnic middle-aged women: results from the Study of Women’s Health Across the Nation (SWAN). Menopause. 2005;12(4):385–98.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Jennifer S. McCall-Hosenfeld
    • 1
  • Sarah A. Jaramillo
    • 2
  • Claudine Legault
    • 2
  • Karen M. Freund
    • 3
  • Barbara B. Cochrane
    • 4
  • JoAnn E. Manson
    • 5
  • Nanette K. Wenger
    • 6
  • Charles B. Eaton
    • 7
  • Beatriz L. Rodriguez
    • 8
  • S. Gene McNeeley
    • 9
  • Denise Bonds
    • 10
  1. 1.Division of General Internal Medicine and Department of Public Health SciencesPennsylvania State University College of MedicineHersheyUSA
  2. 2.Division of Public Health SciencesWake Forest University School of MedicineWinston-SalemUSA
  3. 3.Women’s Health Unit, Department of Medicine and Women’s Health Interdisciplinary Research CenterBoston University School of MedicineBostonUSA
  4. 4.School of NursingUniversity of WashingtonSeattleUSA
  5. 5.Division of Preventive MedicineBrigham and Women’s Hospital Harvard Medical SchoolBostonUSA
  6. 6.Division of CardiologyEmory University School of MedicineAtlantaUSA
  7. 7.Brown UniversityMemorial Hospital of Rhode IslandPawtucketUSA
  8. 8.Departments of Geriatric Medicine, Public Health Sciences and EpidemiologyUniversity of HawaiiManoaUSA
  9. 9.Hutzel Women’s HealthWayne State UniversityDetroitUSA
  10. 10.Departments of Public Health Sciences and MedicineUniversity of VirginiaCharlottesvilleUSA

Personalised recommendations