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ORIGINAL ARTICLE
Year : 2020  |  Volume : 33  |  Issue : 1  |  Page : 277-282

The effect of aging on the sexual function among Menoufia women


Department of Dermatology, Andrology and STDs, Faculty of Medicine, Menoufia University, Menoufia, Egypt

Date of Submission03-Oct-2018
Date of Decision27-Oct-2018
Date of Acceptance30-Oct-2018
Date of Web Publication25-Mar-2020

Correspondence Address:
Asmaa A Barseem
Shiben Elkom, Menoufia
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_282_18

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  Abstract 


Objective
The aim of this work was to evaluate the effect of aging on the sexual function among Menoufia women.
Background
Female sexual function does not appear to decline appreciably with age. However, a range of methodological issues limit the conclusions that can be drawn from many published studies in this area.
Patients and methods
A cross-sectional study was conducted on 240 married women between 18 and 60 years old. The calculated sample was collected from gynecology clinic at Shebin EL Kom teaching hospital. Women were interviewed by predesigned questionnaire.
Results
The evidence indicates that a woman's sexual function declines with age. Specifically, desire, frequency of orgasm, arousal, and frequency of sexual intercourse decrease with age. The prevalence of most sexual difficulties or dysfunctions changes little with age, with the exception of sexual pain, which may decrease with age.
Conclusion
Regarding our study on Menoufia women, we found there was a strong evidence that sexual activities and sexual function decline with age; however, the importance of sex does not appear to decline with age. Data in this area are limited, and more research needs to be carried out before we have a clearer idea of the processes involved.

Keywords: arousal, female sexual dysfunction, female sexual function, orgasm, sexual intercourse


How to cite this article:
Gaber MA, Barseem AA. The effect of aging on the sexual function among Menoufia women. Menoufia Med J 2020;33:277-82

How to cite this URL:
Gaber MA, Barseem AA. The effect of aging on the sexual function among Menoufia women. Menoufia Med J [serial online] 2020 [cited 2020 Jun 6];33:277-82. Available from: http://www.mmj.eg.net/text.asp?2020/33/1/277/281294




  Introduction Top


Female sexual dysfunction (FSD) is defined as persistent or recurring decrease in sexual desire (hypoactive sexual desire), decrease in sexual arousal (sexual arousal disorder), dyspareunia (sexual pain disorder), and difficulty in or inability to achieve an orgasm (orgasmic disorder)[1].

Aging has a powerful effect on the quality of relationship and sexual functioning. The psychological effect of aging after midlife is a particularly timely topic, given improved medical and psychological understanding of sexuality in both women and men as well as significant improvement in the conceptualization of female sexuality and evolving treatment advances for FSDs[2].

Female sexual satisfaction does not appear to decline appreciably with age. However, the physical changes that may occur as a result of the menopausal transition have the potential to interfere with sexual functioning[3],[4].

FSD has a major effect on quality of life and interpersonal relationship. For many women, it has been physically disconcerting, emotionally distressing, and socially disruptive[5].

Estrogen-replacement therapy, unless medically contraindicated, will often prevent genital atrophy and preserves the epithelial integrity of urogenital tissues[6].

Topical estrogen cream or a vaginal estradiol ring may also help prevent genital atrophy and vaginal dryness[7].

In response to the controversy over whether androgen deficiency exists in women, in June 2001, a panel of experts reviewed the existing literature in this area. This panel proposed that there is a clinical syndrome that they have labeled 'Female Androgen Insufficiency'. Female Androgen Insufficiency is defined as a pattern of clinical symptoms in the presence of decreased bioavailable testosterone and normal estrogen status. The clinical symptoms include impaired sexual function, mood alterations, and diminished energy and well-being[8].

The aim of this work was to evaluate the effect of aging on the sexual function among Menoufia women and review community-based studies investigating changes in women's sexual function and sexual dysfunction with age, taking into account confounders to aging and methodological limitations.


  Patients and Methods Top


This study was carried out on 240 Menoufia government women at gynecology clinic, Shebin EL Kom teaching hospital, from august 2017 to July 2018.

A cross-sectional study at the outpatient clinic was conducted. The study includes Egyptian women between 18 and 60 years and were divided into four groups depending on their age: group I, 18–30 years old; group II, 31–40 years old; group III, 41–50 years old; and group IV, 51–60 years old.

All the participants were subjected to answer the validated Arabic version of the female sexual function index questionnaire[9].

The study was approved by the ethical committee of the Faculty of Medicine, Menoufia University. Informed consent was obtained from all participants after simple and clear explanation of the research objectives and methodology.

Data were analyzed using statistical package for the social sciences (SPSS) version 20 (IBM, Armonk, NY, USA). Qualitative data were expressed as number and percentage and analyzed applying χ2-test.

P value indicated the level of significance as follows:

  1. P > 0.05: nonsignificant
  2. P < 0.05: significant.



  Results Top


This study was carried out on 240 women recruited from gynecology clinic at Shebin EL Kom teaching Hospital.

The mean age of marriage was 20 ± 1.5 years in group I, 24 ± 2.6 years in group II, 21 ± 3 years in group III, and 19 ± 2.4 years in group IV.

The mean number of children was 2.23 ± 1.3 in group I, 3.23 ± 1.5 in group II, 3.72 ± 1.6 in group III, and 3.65 ± 1.3 in group IV. The number of women who had previous marriage was three (5%) in group I, two (3.3%) in group II, 5 (8.3%) in group III, and five (8.3%) in group IV.

In group I, 50 (83.3%) were from rural areas and 10 (16.7%) were living in urban areas; in group II, 40 (66.7%) were from rural areas and 20 (33.3%) were living in urban areas; in group III, 15 (25%) were from rural areas, and 45 (75%) were living in urban areas; and in group IV, 22 (36.7%) were from rural areas and 38 (63.3%) were living in urban areas.

In group I, 10 (16.7%) were illiterate, 15 (25%) could read and write, 30 (50%) had secondary education, and five (18%) had university degree; in group II, 15 (25%) were illiterate, 10 (16.7%) could read and write, 27 (45%) had secondary education, and eight (13.3%) had university degree; in group III, 20 (33.3%) were illiterate, 28 (46.7%) could read and write, 10 (16.7%) had secondary education, and two (3.3%) had university degree; and in group VI, 50 (83.3%) were illiterate, five (8.3%) could read and write, five (8.3%) had secondary education, and eight (13.3%) had university degree (P < 0.000) [Table 1].
Table 1: Demographic data of the study groups

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Regarding the motive for sexual intercourse, getting pleasure was the motive for having intercourse in 25 (41.7%), reported as duty in three (5%) cases, and other causes like tension relief, experience seeking, mate guarding, self-esteem boost, and utilitarian in 32 (53.3%) cases, with significant difference (P < 0.021) [Table 2].
Table 2: Desire pattern among studied group

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Frequency of sexual intercourse that was ranging from once a day to two to three times per week was reported by 35 (58.3%) cases in group I, 48 (80%) cases in group II, 10 (16.7%) cases in group III, and five (8.3%) cases in group IV, whereas frequency of every week to less than once a month was reported by 25 (41.7%) cases in group I, 12 (20%) cases in group II, 50 (83.3%) in group III, and 55 (91.7%) in group IV, with a significant difference (P < 0.0079) [Table 2].

Frequency of having sexual desire or interest was reported to be always by 10 (16.7%) cases in group I, 15 (25%) cases in group II, five (8.3%) cases in group III, and 0 (0%) cases in group IV; frequently by 25 (41.7%) cases in group I, 22 (36.7%) cases in group II, eight (13.3%) cases in group III, and five (8.3%) cases in group IV; infrequently by 11 (18.3%) cases in group I, nine (15%) cases in group II, 33 (55%) cases in group III, and 10 (16.7%) cases in group IV; to be rare by 10 (16.7%) cases in group I, seven (11.3%) cases in group II, seven (11.7%) cases in group III, and 20 (33.3%) cases in group IV; and finally, never to be by four (6.7%) cases in group I, seven (36.7%) cases in group II, seven (13.3%) cases in group III, and 25 (41.7%) cases in group IV, with significant difference (P < 0.0017) [Table 2]. P was less than 0.05, which mean a significant statistical difference. Group IV is the most significant group followed by group III, then group II, and finally group I, which means that desire decreased with aging.

Practicing enough foreplay was reported by 47 (78.3%) cases in group I, 45 (75%) cases in group II, 40 (66.7%) in group III, and 5 (8.3%) in group IV, whereas other causes reported not practicing enough foreplay in 13 (21.7%) cases of group I, 15 (25%) cases in group II, 20 (33.3%) in group III, and 55 (91%) in group IV, with no significant difference (P < 0.865) [Table 3].
Table 3: Arousal pattern among studied group

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Regarding the most exciting part of the body, the clitoris, which is the most exciting part of the body in uncircumcised women, was reported by 35 (58.3%) cases in group I, 20 (40%) cases in group II, 25 (26.7%) in group III, and 20 (40%) in group IV; the breast was reported by 10 (16.7%) cases in group I, 30 (50%) cases in group II, 30 (50%) in group III, and 25 (41.7%) cases in group IV; and other sites like the feet, the areola, the nipple, the neck, and the forearm were reported by 15 (25%) cases in group I, 10 (16.7%) cases in group II, 5 (8.3%) in group III, and 15 (25%) in group IV [Table 3].

Difficulty of lubrication was reported by 5 (8.3%) cases in group I, 10 (16.7%) cases in group II, 39 (65%) in group III, and 55 (91.7%) in group IV, with a significant difference (P < 0.0018) [Table 3].

The frequency of feeling sexually aroused was reported to be always by 30 (50%) cases in group I, 18 (30%) cases in group II, 15 (25%) in group III, and 0 (0%) in group IV; frequently in 10 (16.7%) cases of group I, 19 (31%) cases in group II, 20 (33.3%) in group III and 19 (31.7%) in group IV; infrequent in 13 (21.7%) cases of group I, 12 (20%) cases in group II, 15 (25%) in group III and 15 (25%) in group IV; rare in seven (11%) cases of group I, one (1.7%) cases in group II, seven (11.7%) in group III, and six (10%) in group IV; and it was never in 0 (0%) cases of group I, 10 (16.7%) cases in group II, 3 (5%) in group III and 20 (33.3%) in group IV of circumcised women, with a significant difference (P < 0.039) [Table 3].

Difficulty to become excited was reported by 19 (31.7%) cases in group I, 35 (58.3%) cases in group II, 45 (75%) in group III, and 55 (91.7%) in group IV; no difficulty to become excited was reported by 41 (68.3%) cases in group I, 25 (41.7%) cases in group II, 15 (255%) in group III, and five (8.3%) in group IV [Table 3]. P is less than 0.05, which means significant statistical difference. Group IV is the most significant group followed by group III, then group II, and finally group I, which means that arousal decreased with aging.

Difficulty to reach orgasm was reported by five (8.3%) cases in group I, 15 (25%) cases in group II, 68.3 (68.3%) in group III and 51 (91.7%) in group IV, which was statistically insignificant (P < 0.007) [Table 4].
Table 4: Orgasm pattern among studied group

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The frequency of reaching orgasm was reported to be always by 14 (23.3%) cases in group I, 10 (16.7%) cases in group II, 25 (41.7%) in group III, and 2 (3.3%) in group IV; frequently by 43 (71.7%) cases in group I, 35 (58.3%) cases in group II, five (8.3%) in group III, and 0 (0%) in group IV; infrequent by one (1.7%) case in group I, five (8.3%) cases in group II, 20 (33.3%) in group III, and 50 (83.37%) in group IV; rare by one (1.7%) case in group I, eight (13.3%) cases in group II, eight (13.3%) in group III, and five (8.3%) in group IV; never by one (1.7%) case in group I, two (3.3%) cases in group II, two (3.3%) in group III and three (5%) in group IV, which was statistically insignificant (P < 0.0013) [Table 4].

Orgasm was reported to be reached vaginally by 53 (88.3%) cases in group I, 17 (28.3%) cases in group II, 30 (50%) in group III, and 24 (40%) in group IV; externally by four (6.7%) cases in group I, 17 (28.3%) cases in group II, 20 (33.3%) in group III, and six (10%) in group IV; and both vaginally and externally by three (5%) cases in group I, 26 (43.3%) cases in group II, 10 (43.3%) in group III, and 30 (50%) in group IV, which was statistically significant (P < 0.033) [Table 4].

P is less than 0.05, which means significant statistical difference. Group IV is the most significant group followed by group III, then group II and finally group I, which means that orgasm decreased with aging.

Experiencing pain during or following vaginal penetration was reported to be always by 0 (0%) cases in group I, two (3.3%) cases in group II, five (8.3%) in group III, and four (6.7%) in group IV; frequently by two (3.3%) cases in group I, three (5%) cases in group II, 0 (0%) in group III, and seven (11.7%) in group IV; infrequent by five (8.3%) cases in group I, four (6.7%) cases in group II, eight (13.3%) in group III, and 10 (16.7%) in group IV; rare by three (5%) cases in group I, five (8.3%) cases in group II, seven (11.7%) in group III and six (10%) in group IV; never by 50 (83.3%) cases in group I, 46 (76.7%) cases in group II, 40 (66.7%) in group III, and 33 (55%) in group IV, which was statistically insignificant (P < 0.359) [Table 5].
Table 5: Sexual pain among studied group

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The cause of this pain was reported to be vaginally in five (8.3%) cases of group I, six (10%) cases in group II, 13 (21.7%) in group III, and seven (11.7%) in group IV; was reported to be externally by three (5%) cases of group I, four (6.7%) cases in group II, five (8.3%) in group III, and 12 (20%) in group IV; was reported to be trauma by the husband in two (3.3%) cases of group I, four (6.7%) cases in group II, two (3.3%) in group III, and eight (13.3%), group IV which was statistically significant (P < 0.026) [Table 5]. P is less than 0.05, which means significant statistical difference. Group IV is the most significant group followed by group III, then group II, and finally group I, which means that pain increased with aging.


  Discussion Top


FSD is defined as a disorder of sexual desire, orgasm, arousal, and sexual pain that results in significant personal distress[10].

Aging encompasses a range of processes that have the potential to affect a woman's sexual function. Hormonal and physiological changes take place throughout a woman's life. These changes are particularly pronounced during puberty, menstrual cycles, pregnancy, postpartum, and the menopausal transition[11].

Sexual dysfunction after FGM is a very important issue in young women. FGM is considered as a cause of FSD owing to amputation of the clitoris and other sensitive tissue, which reduce women's ability to experience sexual pleasure[12].

Recent investigations and reports on late results indicate that vaginal orgasm is more the exception than the rule, so that, for a woman, preservation of clitoral sensitivity is essential to a satisfying sexual life[13].

In our study, a significant difference among the studied groups shows that there is a decline in desire and sexual interest with increasing age, where P was less than 0.000 or less than 0.05, which means significant statistical difference. Group I was the most significant group followed by group II, then group III, and finally group IV, which means that desire decreased with aging.

This result correlates with the results reported as there is general agreement that with increasing age there is a decline in desire and sexual interest[14],[15],[16].

In our study, a significant difference among the studied groups showed that there is a decline in arousal with increasing age, where P was less than 0.05, which means a significant statistical difference. Group I was the most significant group followed by group II, then group III and finally group IV, which means that arousal decreased with aging.

This result correlates with the results reported. Although research into the changes in arousal with age is very limited, arousal both decreasing with age[17] and remaining constant has been found[18].

On the contrary, a similar number of studies reported an age-related increase in arousal problems[19], and reported no change in arousal problems with age[4].

In our study, a significant difference among the studied groups shows that there is a decline in frequency of experiencing orgasm with age, where P was less than 0.05, which means significant statistical difference. Group IV is the most significant group followed by group III, then group II and finally group I, which means that frequency of experience orgasm decreased with aging; however, difficulties in achieving orgasm generally show no association with age.

This result correlates with the results which showed that the frequency of experience orgasm by women also decreases with age. Difficulties in achieving orgasm generally show no association with age[20],[21],[22].

In our study, a statistically significant difference among the studied groups was reported showing that there was increase in incidence of experiencing pain with age, were P was less than 0.05, which means a significant statistical difference. Group IV was the most significant group followed by group III, then group II and finally group I.

This result is in contrary with the results which showed that prevalence of most sexual difficulties and dysfunctions remains fairly constant with increasing age; moreover, most of the studies reported that problems with pain during intercourse decrease with age[18],[23] or at least remain constant[19],[20].

There is a general agreement that with increasing age there is a decline in desire and sexual interest. The frequency with which women experience orgasm also decreases with age[14]. Research into changes in arousal with age is very limited. In the initial search of the literature, reports of arousal both decreasing with age[17] and remaining constant[18] have been seen.

A considerable proportion of midlife and older women remain sexually active if they have a partner available. Psychosocial factors (relationship satisfaction, communication with romantic partner, and importance of sex) matter more to sexual satisfaction than aging among midlife and older women[24].


  Conclusion Top


Regarding our study on Menoufia women in the study group, we found there was a strong evidence that sexual activities and sexual function decline with age; however, the importance of sex does not appear to decline with age. Data in this area are limited, and more research needs to be carried out before we have a clearer idea of the processes involved.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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