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Abstract and Introduction
Abstract
Objective. This study aims to examine baseline and longitudinal associations between body mass index (BMI) and sexual functioning in midlife women.
Methods. Midlife women (N=2,528) from the Study of Women's Health Across the Nation reported on sexual functioning and underwent measurements of BMI annually beginning in 1995-1997, with follow-up spanning 13.8 years. Associations between baseline levels and longitudinal changes in BMI and sexual desire, arousal, intercourse frequency, and ability to climax were assessed with generalized linear mixed-effects models. Models were adjusted for demographic variables, depressive symptoms, hormone therapy use, alcohol intake, menopause status, smoking status, and health status.
Results. Mean BMI increased from 27.7 to 29.1 kg/m, whereas all sexual functioning variables declined across time (P values ≤ 0.001). Higher baseline BMI was associated with less frequent intercourse (P=0.003; 95% CI, −0.059 to −0.012). Although overall change in BMI was not associated with changes in sexual functioning, years of greater-than-expected BMI increases relative to women's overall BMI change trajectory were characterized by less frequent intercourse (P<0.001; 95% CI, −0.106 to −0.029) and reduced sexual desire (P=0.020; 95% CI, −0.078
to −0.007).
Conclusions. Although women's overall BMI change across 13.8 years of follow-up was not associated with overall changes in sexual functioning, sexual desire and intercourse frequency diminished with years of greater-than-expected weight gain. Results suggest that adiposity and sexual functioning change concurrently from year to year. Further research should explore the impact of weight management interventions as a strategy for preserving sexual functioning in midlife women.
Introduction
Obesity has been linked to impaired health-related quality of life. One important aspect of quality of life is sexual functioning. Female sexual dysfunction (psychophysiological disturbances associated with sexual desire, arousal, orgasm, and pain disorders) affects approximately 40% of the female population, with even greater prevalences in perimenopausal and postmenopausal women. It is estimated that 20% to 30% of adult women experience sexual desire disorders, 15% experience arousal disorders, and 25% demonstrate difficulty with orgasm. Furthermore, approximately 40% of midlife women who reportedly engaged in sex within the past 6 months indicated low levels of participation in sexual intercourse. Within general populations of women, a clear association between menopause and sexual functioning (controlling for covariates such as chronological aging and menopausal symptoms) has not been found; however, specific aspects of sexual functioning, such as desire and arousal, have been found to decline at various stages of the menopausal transition. A myriad of factors, such as relationship quality, partner availability, psychological functioning, overall health, age, and race/ ethnicity, have been shown to impact sexual functioning in midlife women. Current evidence regarding the association between weight status and female sexual dysfunction remains inconclusive.
In multiple cross-sectional studies involving representative nonclinical populations, women's sexual functioning and frequency of intercourse have not been associated with obesity, defined as a body mass index (BMI) of 30 kg/m or higher. Consistent associations between BMI and sexual difficulties have, however, been documented in women seeking routine medical care, weight-loss treatment, or bariatric surgical operation. Furthermore, successful response to weight-loss treatment has been linked to improvements in sexual functioning. Given that weight gain and sexual dysfunction are often experienced by women traversing menopause, a better understanding of these potential associations during this phase of life remains an important goal. Regarding the menopausal transition, cross-sectional research involving 171 postmenopausal women suggests that greater body weight and greater levels of subcutaneous fat tissue are significantly related to a more severe decrease in sexual interest after menopause.
Although some pieces of evidence support a link between obesity and sexual functioning in treatment-seeking populations, it remains unclear whether weight status or weight change affects sexual functioning across time, specifically across the menopausal transition, in the general female population. The objective of this study was to determine whether BMI was associated with level of sexual functioning and whether changes in BMI were associated with changes in sexual functioning measured within a 14-year period among midlife women involved in the Study of Women's Health Across the Nation (SWAN).
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