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This study examined the sexual practices and function of midlife women by ethnicity (African American, Caucasian, Chinese, Hispanic, Japanese) and menopausal status. Sexual behavior was compared in 3,262 women in the baseline cohort of SWAN. Participants were 42 to 52 years old, premenopausal or early perimenopausal, and not hysterectomized or using hormones. Analysis used multivariate proportional odds regression. In our sample, 79% had engaged in sex with a partner in the last 6 months, and a third considered sex to be very important. Common reasons for no sex (n = 676) were lack of partner (67%), lack of interest (33%), and fatigue (16%). Compared with Caucasians, Japanese and Chinese women were less likely, and African Americans more likely, to report sex as very important (p < 0.005). Significant ethnic differences were found for frequency of all practices. Perimenopause status was associated only with higher frequencies of masturbation and pain during intercourse.

Objective-Sexual functioning is an important component of women's lives. The extent to which the menopause transition is associated with decreased sexual functioning remains inconclusive. This study seeks to determine if advancing through the menopause transition is associated with changes in sexual functioning.Design-A prospective, longitudinal cohort study of women aged 42-52 at baseline recruited at 7 US sites (N=3302) in the Study of Women's Health Across the Nation (SWAN). Cohort eligible women had an intact uterus, at least one ovary, were not currently using exogenous hormones, were either pre-or early perimenopausal, and self-identified as one of the study's designated racial/ethnic groups. Data from the baseline interview and six annual follow-up visits are reported. Outcomes are self-reported ratings of importance of sex; frequency of sexual desire, arousal, masturbation, sexual intercourse, and pain during intercourse; degree of emotional satisfaction and physical pleasure. Address correspondence to: Nancy E. Avis, Ph.D., Wake Forest University School of Medicine, Division of Public Health Sciences, Department of Social Sciences and Health Policy, Piedmont Plaza II 2 nd floor, Winston-Salem, NC 27157-1063. Telephone: 336-716-6974, Facsimile: 336-716-7554, navis@wfubmc.edu. SWAN Clinical Centers: University of Michigan, Ann Arbor -MaryFran Sowers, PI; Massachusetts General Hospital, Boston, MARobert Neer, PI 1994-1999 Joel Finkelstein, PI 1999-present; Rush University, Rush University Medical Center, Chicago, ILLynda Powell, PI; University of California, Davis/Kaiser -Ellen Gold, PI; University of California, Los Angeles -Gail Greendale, PI; University of Medicine and Dentistry -New Jersey Medical School, Newark Gerson Weiss, PI 1994 -2004; Nanette Santoro, PI 2004 -present; and the University of Pittsburgh, Pittsburgh, PA -Karen Matthews, PI. Results-Adjusting for baseline age, chronological aging, and relevant social, health, and psychological parameters, the odds of reporting vaginal or pelvic pain increased and desire decreased by late perimenopause. Masturbation increased at early perimenopause, but declined during postmenopause. Menopausal transition was unrelated to other outcomes. Health, psychological functioning, and importance of sex were related to all sexual function outcomes. Age, race/ethnicity, marital status, change in relationship, and vaginal dryness were also associated with sexual functioning. NIH ProgramConclusions-Pain during sexual intercourse increases and sexual desire decreases over the menopausal transition. Masturbation increases during the early transition, but then declines in postmenopause. Adjusting for other factors, the menopausal transition was not independently associated with reports of the importance of sex, sexual arousal, frequency of sexual intercourse, emotional satisfaction with partner, or physical pleasure.Keywords sexual functioning; menopause; aging; diverse populations Sexual functioning is an important component of women's lives and has incr...

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