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Perimenopause often signals beginning of sexual dysfunction

15 November 2019

New study documents 30% increase in sexual dysfunction furing perimenopause, with vaginal dryness identified as the primary culprit

For some women, sex becomes less satisfying with age, with a pronounced decline during perimenopause. A new study indicates that sexual dysfunction increases by nearly 30% during perimenopause, and vaginal dryness most often has the greatest effect on desire, arousal, lubrication, and overall satisfaction. Study results were published this week in Menopause, the journal of The North American Menopause Society (NAMS).

There are many factors that can negatively affect sexual function, including mental and emotional status, aging, chronic medical problems, and menopause status. Decreasing estrogen levels during the menopause transition cause a variety of biological changes in a woman's body, leading to vaginal atrophy, the thinning, drying, and inflammation of the vaginal walls.

Although previous studies have documented the effect of vaginal atrophy on menopausal women, this new study is one of only a few to assess effect during perimenopause, a transitional time before menopause when the ovaries gradually begin to make less estrogen. It shows that certain symptoms of vaginal atrophy, such as vaginal dryness, are much more prevalent during the menopause transition. Largely as a result of vaginal dryness, researchers noted that sexual satisfaction scores decreased while sexual dysfunction increased by about 30% during the perimenopause years.

Study results appear in the article "Female sexuality and vaginal health across the menopausal age."

Source: Eureka Alert



The primary aim was to evaluate changes in female sexuality across the menopausal period, and the secondary objective was to test the associations of female sexuality domains with vaginal atrophy and its symptoms.


A cross-sectional multicenter study was performed involving 518 women, 40 to 55 years of age, consulting outpatient gynecological services at 30 centers across Italy. Vaginal atrophy was identified by the contemporaneous presence of a pH >5, subjective vaginal dryness, and an objective sign. The relationships between vaginal atrophy and its main symptoms (vaginal dryness and dyspareunia), and Female Sexual Function Index (FSFI) score and its domains (desire, arousal, orgasm, dyspareunia, lubrication, and sexual satisfaction) were analyzed.


he prevalence of sexual dysfunction, as defined by a FSFI score <26.55, was 70.6%, increasing from 55% in the years 40 to 45, to 82.8% (P < 0.01) in the years 52 to 55 of age. Mean FSFI score decreased from 40 to 45, to 46 to 48 years of age (23.13 ± 9.76 vs 19.49 ± 9.88; P < 0.05), and from 48 to 51, to 52 to 55 years of age (21.3 ± 8.06 to 17.59 ± 9.11; P < 0.01). Independent determinants of FSFI were agevaginal atrophy, and the presence of vaginal dryness and dyspareunia (R2 0.208; P = 0.011). FSFI score was independently correlated (R2 0.116) with weight (CR -0.067; 95% confidence interval [CI] -0.126, -0.006; P < 0.032), menopausal status (CR -2.406; 95% CI -4.180, -0.63; P < 0.008), and vaginal dryness (CR -5.647; 95% CI -7.677, -3.618; P < 0.0001). Vaginal dryness was the only variable correlated independently with each FSFI domain, including desire (also correlated with menopausal status), arousal (with age and menopausal status), lubrication (with age), orgasm (with age), satisfaction (with vaginal atrophy and being an ex-smoker), and dyspareunia (with age and spontaneously referred dyspareunia).


In the perimenopausal years, FSFI score decreases and sexual dysfunction increases by about 30%. Vaginal dryness is the symptom of vaginal atrophy most closely related to all domains of female sexuality.


Cagnacci A, Venier M, Xholli A, Paglietti C, Caruso S; ANGEL Study. Female sexuality and vaginal health across the menopausal age. Menopause. 2019 Oct 31. doi: 10.1097/GME.0000000000001427. [Epub ahead of print]