Health Care for Women International

ISSN: 0739-9332 (Print) 1096-4665 (Online) Journal homepage: http://www.tandfonline.com/loi/uhcw20

Sexual life of women in the climacterium: A

community-based study

Tugba Andac & Ergul Aslan

To cite this article: Tugba Andac & Ergul Aslan (2017): Sexual life of women in the
climacterium: A community-based study, Health Care for Women International, DOI:
10.1080/07399332.2017.1352588

To link to this article: http://dx.doi.org/10.1080/07399332.2017.1352588

Accepted author version posted online: 25

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Published online: 25 Jul 2017.

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 HEALTH CARE FOR WOMEN INTERNATIONAL
https://doi.org/10.1080/07399332.2017.1352588

Sexual life of women in the climacterium:

A community-based study
Tugba Andaca and Ergul Aslanb
a
lu Aile Sag
Kemal Haciy€uzbaşıog lıg
ı Merkezi Kartal, Istanbul, Turkey; bIstanbul University Florence
Nightingale Faculty of Nursing Abide-i Hurriyet Cad. 34381 Sisli, Istanbul, Turkey

ABSTRACT ARTICLE HISTORY

Our purpose of conducting this community-based study was to Received 2 February 2017
determine sexual functions of women in climacterium and Accepted 5 July 2017
effects of menopausal symptoms on sexual functions. It was
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descriptive, cross-sectional, and community-based. The study

sample consisted of 282 climacteric women. Menopause Rating
Scale (MRS), Female Sexual Function Index (FSFI), and Sexual
Satisfaction Scale for Women (SSS-W) were used for data
collection. The total score was 13.42 § 8.82 for MRS, 18.73 §
9.79 for FSFI, and 82.56 § 18.07 for SSS-W. Seventy-nine-point
four percent of the women had sexual dysfunction. While
complaints typical of the climacteric period increased, sexual
functions and satisfaction decreased.

Introduction
Climacterium involving menopause due to loss of ovarian activity is a transition
period from sexual maturity to old age (WHO, 1996; Palacios, Tobar, & Menendez,
2002). It is an important period that affects not only women but also their families
and the general population (Ringa, Diter, Laborde, & Bajos, 2013).
In the climacteric period, physiological changes, middle-age-related difficulties,
and cultural characteristics affect emotional balance of women. Vasomotor,
cardiovascular, musculoskeletal, digestive, urogenital system, and mood changes
with menopause also cause difficulties in sexual life (Dennerstein, Randolph, Taffe,
Dudley, & Burger, 2002).
Depressed mood, irritability, decreased self-confidence, feeling worthless,
difficulty in making decisions, anxiety, forgetfulness, difficulty in focusing, fatigue,
and decreased sexual desire and arousal are psychological symptoms of menopause
(Amore et al., 2007).
Decreased ovarian activity with increasing age and changes in estrogen,
progesterone, and androgen levels affect sexual functions in the climacteric

CONTACT Ergul Aslan, Assoc. Prof., RN ergul34tr@hotmail.com Istanbul University Florence Nightingale
Faculty of Nursing Abide-i Hurriyet Cad. 34381 Sisli, Istanbul, Turkey.
© 2017 Taylor & Francis Group, LLC
 2 T. ANDAC AND E. ASLAN

period (Graziottin & Leiblum, 2005). Hormonal changes result in atrophy in

the genital region (Nappi, Kingsberg, Maamari, & Simon, 2013). Vaginal atro-
phy causes dyspareunia, which may change women’s approach to their part-
ners or may decrease their sexual responses to their partners (Levine,
Williams, & Hartmann, 2008). Pruritus in the vulvae, frequent urination,
pelvic organ prolapses, stress, incontinence, and constipation negatively affect
sexual functions and postmenopausal complaints show further progression
(Pastore, Carter, Hulka, & Wells, 2004). In the climacteric period, there is a
decrease in lubrication and libido, lack of orgasm in the cycle of sexual
responses, and sexual dysfunction (Rosen et al., 2000; Nappi et al., 2013).
Community-based studies suggest that the prevalence of sexual dysfunction in
all women ranges between 25% and 63%. The prevalence of sexual dysfunction
in postmenopausal women ranges from 68% to 86.5% (Addis et al., 2006).
Decreased frequency of coitus, less sexual satisfaction, decreased sexual desire,
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and dyspareunia may cause partners to estrange from each other (Nappi et al.,
2013). Sexual dysfunction in the climacteric period affects women more in terms
of self-respect, the quality of life, mental health, and relationships with sexual
partners. The sexual desire incompatibility between women and their partners
may cause dissatisfaction in their relationship and unhappy marriage. Communi-
cation problems between partners, anger and ire, self-neglect may also cause low
libido and sexual dissatisfaction (Davis & Jane, 2011). Sexual partners of women in
the climacteric period also have changes in their sexual functions depending on
their ages. Thus, the women may assume that their spouses would lose their inter-
est in them (Graziottin & Leiblum, 2005).
In the climacteric period which occupies time from the reproductive period to
old age, which is an important transition period in women’s life and during which
there is a change in the hormonal balance and symptoms affecting the quality of
life appear, socio-demographic features, obstetrics/gynecological characteristics,
and general health status of women influence their sexual functions.
We focused on effects of menopausal symptoms on the quality of life and sexual
functions and investigated how menopausal symptoms affected sexual functions
and sexual satisfaction.
We included the climacteric women aged 45–65 years, having a regular sexual
life and sufficient education and mental capability, volunteering to participate in
the study by randomly visiting them at their homes in a district of Istanbul,
Turkey. Istanbul is a metropole which people from many parts of the country
migrate to and which hosts many people with different socio-cultural features. We
conducted face-to-face interviews lasting 30 minutes on average at the participants’
homes by taking care of their privacy and ethical principles.
Data obtained in accordance with the aim of the study will contribute to raising
awareness about promotion of sexual health, early detection of sexual problems,
treatment of sexual dysfunctions, and creation of education programs and care
plans to increase sexual satisfaction.
 HEALTH CARE FOR WOMEN INTERNATIONAL 3

The notable sides of the study are that it had a large sample size, was conducted
by using face-to-face interviews, and was community-based.
Expected prolongation of life expectancy throughout the world and long years
of the postmenopausal period underline the importance of sexual health in terms
of maintenance of the quality of life in women. The findings of this study about
menopause and sexuality will provide guidance for members of multidisciplinary
health teams in Turkey (physicians, nurses, psychologists, and family counselors,
etc.) about education, counseling, and treatment options.

Methods
We designed a descriptive, cross-sectional, and community-based study in Turkey.
Approval was obtained from the ethical committee of a university and from an
institution of the Ministry of Health (approval number: 64222187/030.03/6639
and approval date: January 21, 2015). Written and oral informed consent was
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obtained from all the participants.

The women resided in a district in the Anatolian side of Istanbul, Turkey, and
the study was conducted between January and May 2015.

Sample
The study sample consisted of 329 climacteric women. Thirty women declined to
participate in the study since they found the research topic quite private; 17 women
withdrew from the study without completing the questionnaire when they read the
questions in The Female Sexual Function Index (FSFI); and the study was
completed on 282 women.
Inclusion criteria were being at the age of 45–65 years, having a regular sexual
life, and the ability to communicate and volunteering to participate in the research.

Data collection tools

Diagnosis form
The form was composed of 45 questions about socio-demographic and obstetric
characteristics, general health status, and sexuality.

Menopause Rating Scale (MRS)

The scale was developed by Schneider and his colleagues in Germany in 1992 to
determine the severity of menopausal symptoms and their effects on the quality of
life. Then in 1996, the scale was adapted to English and its reliability and validity
were tested. It is a five-point Likert scale consisting of 11 items and 0 corresponds
to none, 1 mild, 2 moderate, 3 severe, and 4 very severe for each item containing
menopausal complaints. The lowest and the highest scores for the scale are 0 and
44, respectively. High scores indicate an increase in the severity of the complaints
experienced. The scale consists of three subscales: Somatic complaints subscale
 4 T. ANDAC AND E. ASLAN

containing items 1, 2, 3, and 11, psychological complaints subscale containing

items 4, 5, 6, and 7, and urogenital complaints subscale items containing 8, 9, and
10. A score 35 shows very severe symptoms, scores 20–34 severe symptoms,
scores 15–19 moderate symptoms, scores 1–14 mild symptoms, and 0 absence of
symptoms (Heinemann, Potthoff, & Schneider, 2003). Cronbach’s alpha reliability
coefficient of MRS was found to be 0.88 in this study.

FSFI
The index was developed by Rosen et al. in 2000 to evaluate female sexual func-
tions (Rosen et al., 2000). A total score of >26.55 shows normal sexual function
and a total score of 26.55 shows sexual dysfunction. FSFI scores >30 indicate
good sexual functions, scores 23–29 moderate sexual functions, and scores <23
poor sexual functions (Wiegel, Meston, & Rosen, 2005). FSFI is a Likert scale com-
posed of 19 items and 6 sections, i.e. sexual desire, arousal, lubrication, orgasm, sat-
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isfaction, and pain. A total score of >22.7 means normal sexual function and a
score of 22.7 means sexual dysfunction. A sexual desire subscale score of 3.6
(range: 1.2–6), an arousal subscale score of 3.9 (range: 0–6), a lubrication sub-
scale score of 3.6 (range: 0–6), an orgasm subscale score of 3.6 (range: 0–6), a
satisfaction subscale score of 3.6 (range: 0–6), and a pain subscale score of 4.4
(range: 0–6) show sexual dysfunction. Cronbach’s alpha coefficient of FSFI was
0.97 in the present study.

Sexual Satisfaction Scale for Women (SSS-W)

It was developed by Meston and Trampnell in 2005 to evaluate women’s sexual
satisfaction. SSS-W is a 30-item Likert scale which involves 5 subscales, that is,
contentment, communication, compatibility, relational concern, and personal con-
cern. For 29 items of the scale, 5 corresponds to strongly disagree, 4 partly disagree,
3 neither agree or disagree, 2 partly agree, and 1 strongly agree and for one item, 5
corresponds to completely satisfactory, 4 very satisfactory, 3 reasonable satisfac-
tion, 2 not very satisfactory, and 1 not satisfactory at all. The total score of the scale
is calculated by using the following formula: Contentment C Communication C
Compatibility C (Relational concern C Personal concern/2). The lowest and the
highest scores for the scale are 30 and 150, respectively, and there is no cut-off
point. Higher scores indicate better sexual satisfaction (Meston & Trapnell, 2005).
Cronbach’s alpha reliability coefficient of SSS-W was found to be 0.94 in this study.

Data collection
The women who accepted to participate in the study were interviewed face-to-face
by visiting their homes. They were given information about the aim and the dura-
tion of the study, and questions in the data collection tools. Diagnostic form, MRS,
FSFI, and SSS-W were filled at home by providing an appropriate environment.
 HEALTH CARE FOR WOMEN INTERNATIONAL 5

Data were gathered by paying attention to privacy and following ethical rules. Each
interview lasted 30 minutes on average.

Evaluation of data
Data were analyzed by using SPSS 20.0 and frequencies and mean. Analysis of vari-
ance, Pearson’s Chi-square test, Mann Whitney U test, t-test, Spearman correlation
analysis, and post-hoc test were used to assess differences between the variables
tested. The statistical significance was set at p < .05.

Results
Socio-demographic characteristics of the climacteric women included in the study
(n D 282) are presented in Table 1. The mean age of the women was 53.84 §
5.48 years (range: 45–65 years) and the mean age of their spouses was 58.59 §
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7.15 years (range: 44–84 years). The mean age at marriage was 22.73 § 4.76 years
(range: 13–45 years) and the mean body mass index (BMI) was 27.60 § 5.27 (over-
weight) (range: 16.37–33.28).
Of all the climacteric women included in the study, 28.2% had hypertension,
22.0% had high cholesterol levels, 19.5% had thyroiditis, 19.1% had diabetes,
16.3% had depression, and 70.2% had a chronic health problem. Sixty-two-point
eight percent of the women stated that they used medicine continuously.

Table 1. Socio-demographic characteristics of the women in the climacteric period (n D 282).

n %

Age groups (years) 40–49 72 25.5

50–59 158 56
60 and above 52 18.5
Education Primary school 73 25.9
Secondary school 149 52.8
University 60 21.3
Occupation Housewife 146 51.7
Retired 113 40.1
Working 23 8.2
Income Income less than expenses 74 26.2
Income more than expenses 30 10.6
Income equal to expenses 178 63.2
Family type Nuclear 235 83.3
Extended 45 16
Broken 2 0.7
Age at marriage (years) 18 and below 49 17.4
19–24 145 51.4
25–29 65 23
30 and above 23 8.2
Number of households 2 67 23.8
3 100 35.4
4 and above 115 40.8
Body mass index Underweight (<18.5 kg/m2) 2 0.7
Normal (18.5–24.9 kg/m2) 89 31.6
Overweight (25–29.9 kg/m2) 114 40.4
Obese (30–39.9 kg/m2) 77 27.3
 6 T. ANDAC AND E. ASLAN

The mean age at climacterium was 47.21 § 4.31 years (range: 32–55 years) and
the mean duration of climacterium was 81.16 § 70 months. Eighty-five-point eight
percent of the women were in the postmenopausal period. Twenty percent of the
women were younger than 45 at climacterium. Of all the women, 65.5% experi-
enced climacterium after menstrual irregularity, 15.3% experienced it suddenly,
and 19.2% experienced it after hysterectomy. Thirty-six-point two percent of the
women presented to a health facility for menopause control. The most frequent
reason for their presentation was hot flushes at the rate of 30.4% and irregular
menstruation at the rate of 28.4%. Of all the women, 41.1% received medication
for menopausal symptoms, 17.7% for completing the deficient hormone, 8.9% for
osteoporosis, 7.1% for hot flushes, 2.8% for vaginal dryness, and 4.6% for other
distresses.
The total scores for MRS, FSFI, and SSS-W, and their subscales are shown in
Table 2.
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The severity of menopausal symptoms was mild with the mean total score of
13.42 § 8.82 for MRS. Of all the women, 48.2% experienced mild symptoms,
21.6% experienced moderate symptoms, 21.6% experienced severe symptoms,
1.8% experienced very severe symptoms, and 6.7% experienced no symptoms.
Seventy-nine-point four percent of the women got scores for the FSFI below the
cut-off value and they had sexual dysfunction. Based on the scores for the sub-
scales, of all the women, 30.5% had changes in sexual desire, 30.5% had pain,
27.3% had orgasm problems, 25.2% had lubrication problems, and 24.1% had
arousal problems.
According to the FSFI scores, of all the women, 56.4% (n D 159) had poor sex-
ual functions (<23 points), 33% (n D 93) had moderate sexual functions (23–29
points), and 10.6% had good sexual functions (>30 points).

Table 2. The women’s scores for MRS, FSFI, SSS-W, and their subscales.
Mean. § SD Min. Max.

MRS
Somatic complaints 5.00 3.45 0 16
Psychological complaints 5.36 4.08 0 16
Urogenital complaints 3.06 2.74 0 12
MRS total score 13.42 8.82 0 44
FSFI
Sexual desire 4.54 1.84 2 9
Arousal 8.87 5.87 0 20
Lubrication 10.54 6.96 0 20
Orgasm 7.72 5.19 0 15
Sexual satisfaction 9.35 3.73 2 15
Pain 8.39 5.73 0 15
FSFI total score 18.73 9.79 2 34
SSS-W
Contentment 19.20 4.85 6 30
Communication 20.24 5.55 6 30
Compatibility 20.39 6.03 6 30
Relationship concern 22.86 6.36 6 30
Personal concern 22.61 6.78 6 30
SSS-W total score 82.56 18.07 30 120
 HEALTH CARE FOR WOMEN INTERNATIONAL 7

Table 3. The relationship between scores for MRS, FSFI and SSS-W and their subscales.
MRS Somatic Psychological Urogenital
Total r p complaints r p complaints r p complaints r p

FSFI Total ¡0.22 0.00 ¡0.18 0.00 ¡0.15 0.01 ¡0.26 0.00
Desire ¡0.12 0.04 ¡0.10 0.08 ¡0.06 0.30 ¡0.17 0.00
Arousal ¡0.19 0.00 ¡0.15 0.00 ¡0.14 0.01 ¡0.21 0.00
Lubrication ¡0.23 0.00 ¡0.18 0.00 ¡0.17 0.00 ¡0.26 0.00
Orgasm ¡0.22 0.00 ¡0.17 0.00 ¡0.17 0.00 ¡0.24 0.00
Satisfaction ¡0.15 0.00 ¡0.11 0.05 ¡0.09 0.11 ¡0.20 0.00
Pain ¡0.22 0.00 ¡0.21 0.00 ¡0.12 0.03 ¡0.27 0.00
SSS-W Total ¡0.22 0.00 ¡0.08 0.17 ¡0.24 0.00 ¡0.25 0.00
Contentment ¡0.23 0.00 ¡0.10 0.08 ¡0.21 0.00 ¡0.28 0.00
Communication ¡0.28 0.00 ¡0.16 0.00 ¡0.27 0.00 ¡0.29 0.00
Compatibility ¡0.13 0.01 ¡0.00 0.91 ¡0.17 0.00 ¡0.18 0.00
Relationship concern ¡0.05 0.33 0.03 0.59 ¡0.11 0.06 ¡0.06 0.29
Personal concern ¡0.10 0.09 ¡0.03 0.51 ¡0.12 0.03 ¡0.08 0.17

r D Pearson correlation analysis

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The total score for MRS and the scores for its subscales had a weak negative cor-
relation with the total score for FSFI and the scores for its subscales and with the
total score for SSS-W and the scores for its subscales (Table 3). However, the total
score for FSFI and the scores for its subscale had a weak positive correlation with
the total score for SSS-W and the scores for its subscales (Table 4).
There was a significant difference between the severity of menopausal symp-
toms and the total scores for FSFI and SSS-W. The post-hoc test results showed
that this difference in binary comparisons resulted from the symptom groups “no
symptoms-moderate symptom” and “no symptoms-severe symptoms” for FSFI
(p D .02). In the post-hoc test for SSS-W, the difference resulted from the symptom
group “minimal symptoms-severe symptoms” (p D .01, Table 5).
The results of one-way analysis of variance and the post-hoc test revealed that as
age increased, sexual function decreased (p D .00), but sexual desire did not change
(p D .10).
The women without chronic health problems got a significantly higher score
for FSFI (21.48 § 9.02) than those with chronic health problems (17.56 § 9.88)
(p D .00). They also got significantly higher scores for SSS-W (85.96 § 17.66)
than those with chronic health problems (81.12 § 18.09) (p D .03). The women
continuously receiving medication had a significantly higher score for FSFI

Table 4. The relationship between scores for FSFI and SSS-W and their subscales.
FSFI Desire Arousal Lubrication Orgasm Satisfaction Pain
Total r p rp rp rp rp rp rp

SSS-W Total 0.27 0.00 0.17 0.00 0.28 0.00 0.21 0.00 0.27 0.00 0.41 0.00 0.14 0.01
Contentment 0.35 0.00 0.27 0.00 0.34 0.00 0.30 0.00 0.34 0.00 0.44 0.00 0.23 0.00
Communication 0.32 0.00 0.20 0.00 0.33 0.00 0.28 0.00 0.33 0.00 0.37 0.00 0.23 0.00
Compatibility 0.19 0.00 0.11 0.06 0.21 0.00 0.13 0.02 0.19 0.00 0.35 0.00 0.07 0.23
Relationship concern 0.00 0.97 ¡0.03 0.58 0.00 0.90 ¡0.02 0.73 0.01 0.85 0.14 0.01 ¡0.06 0.29
Personal concern 0.05 0.36 0.00 0.97 0.06 0.27 0.03 0.57 0.03 0.51 0.18 0.00 ¡0.00 0.92

r D Pearson correlation analysis

 8 T. ANDAC AND E. ASLAN

Table 5. A comparison of SSS-W and FSFI scores according to the severity of MRS symptoms.
MRS symptom severity n Mean § SD Min. Max. x2 p

SSS-W 0 no symptom 19 82.92 16.08 62 120 12.13 0.01

1–14 mild 136 86.03 18.78 35 120
15–19 moderate 61 80.67 14.67 47 106
20–34 severe 66 77.05 18.68 30 108
FSFI 0 no symptom 19 23.37 8.70 4.40 33.40 17.95 0.00
1–14 mild 136 20.03 10.10 2 34.50
15–19 moderate 61 17.04 8.65 2 33
20–34 severe 66 16.25 9.65 2 31.40

x2 Kruskal Wallis Test (df D 3)

(17.48 § 9.93) than those not continuously receiving medication (20.83 § 9.19)
(p D .00).
There was not a significant difference in the total scores for FSFI and in the total
score for SSS-W and its subscales in terms of BMI. However, the women with a
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normal weight had a significantly higher score for the satisfaction subscale of the
FSFI (9.96 § 3.60) than the obese women (8.40 § 3.88) (p D .02).
In the premenopausal and postmenopausal periods, there was not a significant
difference between SSS-W (MwU D ¡0.88 p D .37) and MRS (MwU D ¡1.33 p D
.18). The FSFI total score was 17.72 § 9.89 in the postmenopausal period and
24.79 § 6.38 in the premenopausal period. There was a significant difference in
the FSFI scores between the premenopausal and postmenopausal periods (MwU D
¡4.04 p D .00).

Discussion
In this community-based study, we investigated effects of menopausal symptoms
on the quality of life and sexual functions. The women with less severe menopausal
symptoms had better sexual functions and higher sexual satisfaction. This finding
will contribute to the international literature on women’s sexual health.
Menopausal age generally varies between 45 years and 55 years in the world. It
is 48 in Italy (Amore et al., 2007), and 48.7 in Thailand (Peeyananjarassri et al.,
2006). It is 50.5 on average in America and Asia and 50.1–52.8 in Europe (Palacios,
Henderson, Siseles, Tan, & Villaseca, 2010). The percentage of menopausal women
increases with age, from less than 1 percent for women in their early thirties to 49
percent for women age 48-49 in Turkey (TDHS, 2013).The menopausal age of the
climacteric women who constituted the sample of the study was 47.21 § 4.31,
which is consistent with the literature.
Menopause has been identified as an important risk factor for sexual dysfunction
(Palacios et al., 2002). In the study conducted by Levine with 1480 women aged 40–
65 in America, the incidence of female sexual dysfunction was found to be 55%
(Levine et al., 2008). In a survey conducted with 13.882 women aged 40–80 from
29 countries, it was observed that the rate of little interest to sexual intercourse for
two months or longer was 26–43% and the prevalence of arousal problems was
 HEALTH CARE FOR WOMEN INTERNATIONAL 9

16.1–37.9% (Laumann et al., 2005). Lindau et al. in a study on 1550 women and
1455 men aged 57–85 years found that the most common sexual problems in the
women were loss of desire (43%), loss of lubrication (39%), and difficulty in reach-
ing orgasm (34%) (Lindau et al., 2007). The rate of sexual dysfunction in our study
was 79.4%, which is higher than the ones reported in the literature. In the present
study, the women had sexual desire problems (30.5%), pain during sexual inter-
course (30.5%), inability to reach orgasm (27.3%), reduction in lubrication (25.2%),
difficulty in arousal (24.1%), and difficulty in sexual satisfaction (9.9%), which is
compatible with the literature. In the climacteric period, depression, anxiety, psy-
chological problems such as irritability, fatigue, insomnia, forgetfulness, and loss of
libido may appear. Depression and anxiety in the climacteric period can negatively
affect sexual satisfaction (Borissova, Kovatcheva, Shinkov, & Vukov, 2001). Even
though menopausal problems negatively affect the quality of life and sexual life
(Borissova et al., 2001; Dennerstein et al., 2002), the exactly opposite findings exist.
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Consistent with the literature, the present study showed that as menopausal symp-
toms increased, sexual function decreased; there was not a relation between somatic
and psychological complaints, and between psychological complaints and satisfac-
tion. Psychological complaints were accompanied by problems with lubrication
and arousal, loss of orgasm, and increased pain.
With the increased age in the climacteric period, changes such as a rise in
menopausal symptoms, loss of sexual functions and sexual desire, a decrease
in the frequency of sexual intercourse, pain during sexual intercourse, difficul-
ties in reaching orgasm, and difficulties in genital arousal can be observed
(Basson, 2001). The incidence of female sexual dysfunction increasing with
age was observed in the present study. In a study by Schimpf and colleagues
on 505 women aged 40 years and above, the loss of sexual function increased
with age and women aged 55 and older had the lowest mean score (Schimpf
et al., 2010). It has also been reported in the literature that sexual satisfaction
is not affected by age (Laumann, Paik, & Rosen, 1999). In a study by Leiblum
and her colleagues on the women aged 20–70 years, hypoactive sexual desire
disorder was found to increase with age (Leiblum, Koochaki, Rodenberg,
Barton, & Rosen, 2006), which is compatible with the present study. Accord-
ing to Hayes and his colleagues, loss of desire escalates with age (Hayes et al.,
2007). In a similar cross-sectional study by H€allstr€ om and his colleagues on
800 randomly selected Swedish women aged 38–54 years, a dramatic reduction
was found in sexual intercourse, orgasm, and coital excitation associated with
age and menopause (H€allstr€ om & Samuelsson, 1985). Congruent with the lit-
erature, in our study, there was loss of desire, arousal, lubrication, orgasm and
satisfaction, and increased dyspareunia with age. However, sexual satisfaction
was not affected by age.
The presence of chronic illnesses requiring continuous medication, the
pathophysiological causes of chronic illnesses, and the chronic process with
impaired general health and well-being may decrease sexual function and it is
 10 T. ANDAC AND E. ASLAN

considered as an important risk factor for sexual dysfunction. As the number

of health problems decreases, sexual functions get better (Kaiser, 2003). In
fact, Kaiser reported that sexual functions frequently decreased in patients
with hypertension (Kaiser, 2003) and that libido, lubrication, and orgasm
decreased in diabetic patients (Palacios et al., 2002). According to the results
of a study by Martelli and his colleagues, the prevalence of women with sexual
dysfunction was found to be higher in patients with metabolic syndrome than
that of the control group. There is a strong relation between high triglyceride
levels and the risk of sexual dysfunction (Martelli et al., 2012). Compatible
with the literature, the presence of chronic health problems and continuous
drug use negatively affected sexual functions, and FSFI and SSS-W scores
were significantly lower in the patients with chronic health problems and
continuous drug users in the present study.
In a study by Mirzaiinjmabadi and colleagues on 1500 postmenopausal women
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aged 45–60 years in Australia, there was not a statistically significant difference
between obese and normal weight women in vasomotor symptoms and sexual
functions (Mirzaiinjmabadi, Anderson, & Barnes, 2006). Similarly, in our study,
although sexual satisfaction decreased with increased BMI, menopausal symptoms,
sexual function, and contentment were not affected.

Conclusions
We found that the rate of sexual dysfunction in the climacteric period was 79.4%
and that sexual desire at the rate of 30.5% and pain at the rate of 30.5% were the
most affected subscales. The severity of menopausal symptoms, increased age,
chronic illnesses, and continuous drug use negatively affected sexual functions and
reduced sexual satisfaction. Good sexual functioning of women increases sexual
satisfaction. In light of the results of the study, it can be recommended that pro-
spective studies on special patient groups (patients with diabetes mellitus, heart
disease, and multiple sclerosis etc.), women with spouses, and women with sexual
dysfunction in different cultures should be performed. In addition, multidisciplin-
ary interventional studies could be designed to prevent sexual dysfunction in
climacteric women.

Study limitations
One limitation of the study was that sexual functions and sexual satisfaction levels
before the climacteric period were unknown. In addition, spouses of the women
were not interviewed about the extent to which they were satisfied with their rela-
tionship. In fact, it may not be possible to completely reveal relationship satisfac-
tion without interviewing both women and their spouses.
 HEALTH CARE FOR WOMEN INTERNATIONAL 11

Acknowledgments
This study was presented as a poster at the 7th Urogynecology Congress held on October
14–October 17, 2015, in Istanbul, Turkey.

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