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Researchers at the University of Pittsburgh and the VA Pittsburgh Healthcare System learned that middle aged women who think sexual activity is important have more sex, and their sexual activity is associated with "health-related quality of life."
This study offers an example of why all research must be read with an eye toward not only what is being studied but how. The eight-year study asking, Do Stage Transitions Result in Detectable Effects was conducted on women aged 40 to 65 who were patients in a general internal medicine practice. Annually, they answered questions on demographic variables, menopausal status, and medical conditions.
In the fourth year of the study, the women completed the Female Sexual Function Index, a self-report assessment of sexual function. The FSFI is often used to determine how satisfied women are with their sexual experiences, but because it focuses on vaginal lubrication and generic "satisfaction" during vaginal intercourse, the assessment's value isn't as strong for women who are older, who lack partners, or who prefer non-vaginal forms of sexual activity. In response to the study's publication in JAMA Internal Medicine, Ricki Lewis, PhD noted about the FSFI assessment scores that "women who think that foreplay is more important [than penetrative intercourse] may artificially lower these scores."
Another problem with the FSFI is that it equates a woman's vaginal lubrication with an indication of her sexual arousal. This makes the instrument an odd choice for assessing women who may be in peri-menopause or menopause. These women may be highly sexually aroused and yet lack sufficient natural lubrication for comfortable sex play. Also, the FSFI's focus on vaginal penetrative sex belies the fact that around two-thirds of women require direct clitoral stimulation to experience orgasm. Women can be easily assessed as sexually dysfunctional when sex education and a bottle of personal lubricant would address their problems.
At the four-year mark, the women assessed as "moderately/quite/extremely" sexually active were more likely to be younger, white, highly educated, farther away frm menopause, and partnered. By the eighth year, about 85.4% of those women were still sexually active. That group was predominently white, with a lower body mass index, and they placed higher importance on sex. Interestingly, the amount of sex they had wasn't associated with their FSFI score; in other words, sexual function or dysfunction wasn't a relevant factor in whether women had sex.
The finding that women who believe sex is important have more sex is perhaps the least interesting part of the study because that's simple common sense. Of more interest are related questions:
- Why did these women think sex is important, even if sexual dysfunction was present? Emotional closeness? To keep a partner happy? To boost their own self-esteem? For the health benefits of sexual activity? Or because sexual activity has intrinsic value unrelated to a partner?
- Were these women including masturbation as sexual activity, even though the FSFI doesn't invite them to do so? Would the results be the same in a study of solo sex versus partnered sex?
- Were the sexually active women primarily white because they made up most of the medical practice's patient base; otherwise, how might race or other solciological variables factor into the findings?
- Given that the women having the most sex had lower body mass index, what role might body image, comfort and sexual self esteem play in remaining sexually active?
Other studies have explored some of these questions, so I have no quarrel with the limitations on this one. And any study that takes women's sexuality seriously is helpful. But I am disappointed in this team's choice to use a survey instrument that doesn't take normal age-related physiological changes into account when studying aging women.
The strongest finding in this study may be that satisfying sexual activity is associated with "health-related quality of life." Can we get that message across to politicians and judges and justices at the state and federal levels who make it more difficult every day for sexually active women to protect their sexual health?
