A qualitative study from a team of researchers at Monash University (Melbourne) has sought to understand the personal impact of loss of sexual interest on women and the expectations of women
seeking treatment for their problem. This is the first study to consider the real-life situation of women seeking treatment at a clinic; previous studies have actively sought out women with sexual problems, which may change the expectations and experiences
of the patients. This work is published in the December edition of the peer-reviewed journal
Climacteric*.
Loss of sexual interest is the most commonly reported sexual problem amongst women. Although researchers have identified that loss of interest in sex can be very concerning for women, there
has been little understanding as to what motivates women to seek help for this problem. There is also little known about women’s expectations of treatment for female sexual dysfunction.
The team interviewed 17 women who had been referred to the Cabrini Medical Centre (Melbourne, Australia) for specialist assessment and possible treatment. In depth face-to-face interviews
took place prior to the medical consultation, in which women were asked to talk about their sexual worries and the reasons for attending the clinic. Four major themes emerged during the course of the interviews.
1 Personal psychological distress: these feelings manifested themselves in
low self-esteem, feelings of guilt, sadness, worthlessness, inadequacy, frustration, disappointment and embarrassment:
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‘I think a feeling of guilt from my point of view and from my husband probably a feeling of not being attractive to me. A feeling of not being adequate maybe’ (Olivia, aged 43).
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Older participants also reported psychological distress. Justine, aged 70, stated: ‘I just do not feel inclined to have sex. I want to approach my husband, to be physical. There
is nothing there. I just don’t feel anything at all. You know it has been for a few years now and I just don’t think that’s normal because I am not that old. This is disappointing that I do not like to be touched. ’
2: Concern about the adverse effect of lack of sexual interest on the relationship with their sexual partner
Although most women appreciated their partner ’s support, they were concerned about the negative effects of their sexual problems on intimacy and cited this as a driving factor for seeking medical help:
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Stella, aged 47 described: ‘Physically I don’t really feel like I need to be sexually active. I do get concerned about the future and whether it is going to affect the relationship with my husband.
’
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Emma, aged 51 stated: ‘It’s not like our marriage is in trouble because of it, but it is definitely something that we both would like to enjoy and my husband would like more of. It is important for
any marriage and relationship. You still need to have that regardless of how long we’re together whether it’s 10, 20, 30 years. I guess it’s always the thought of hearing other people having regular sex and you say “what’s wrong with me?”. ’
Theme 3: A belief in a relationship between lack of sexual interest and ‘hormone deficiency ’
Many women spoke of a ‘lack of hormones in their bodies ’:
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Clara, aged 62 said ‘… But you are not dead yet, you are still functioning, your body still functions, but when we are menopausal our levels go down and of course you don’t feel like sex.
Theme 4: An expectation of treatment outcomes, which included positive physical and sexual changes
Many women viewed hormonal treatment as a ‘magic bullet’. Postmenopausal women were eager to receive menopausal hormone therapy and testosterone. Women hoped these would benefit them physically and sexually,
that they would have more energy, look younger and fitter and be healthier. They anticipated increased spontaneous sex drive, arousal, orgasm and an enjoyable sex life:
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Adele, aged 53, said ‘ … I want some energy. I feel I am a young, fit, healthy, happy woman. I am blessed, but I just would like to not feel like I’m 80 years old sometimes. I don’t recover from
exercise anymore. I am quite exhausted and I fall asleep all the time. I like to feel more energetic, to not be asleep at 9 o’ clock at night every night. That would be nice and probably to feel more spontaneous’.
3-4 months after treatment, 10 of the women were again interviewed. Treatment with vaginal estrogen alone or MHT (Menopausal Hormone Therapy) alleviated the symptoms of concern and was associated with improved sexual wellbeing.
Four women who were treated with testosterone therapy, in addition to MHT, all reported a benefit of treatment.
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Justine, 70 years, said: ‘Before I did not like to be touched and that is improved after treatment. I feel ok. I am feeling better in myself.
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Alice, a breast cancer survivor, reported only partial symptom relief with vaginal estrogen therapy said: ‘ … there is (still) some pain, but intercourse is not impossible’
Research leader, Professor Susan Davis said.
“It is important to understand that this is a qualitative study, not a clinical trial. Studies such as this help us get to the core of what women who want treatment are experiencing and inform us about what we should be looking
at, and which questions to ask in a clinical trial. A huge number of women are affected by sexual problems globally, but we don’t really know much about how it makes women feel and what they expect of treatment. The important feature about this study is that
the participants didn’t respond to an ad to be in the study. These were simply women attending a practice seeking help for their problem. This study shows that the women who are seeking help for sexual interest/arousal problems are profoundly affected by
their problem. Most of the women we interviewed were deeply concerned about intimacy and about the effect of lack of sexual interest on their relationship.
Often the distress many women feel because of this just isn’t understood”.
Commenting, Professor
Camil Castelo-Branco (Chair of the Council of Affiliated Menopause Societies**, and Professor of Obstetrics and Gynecology at Barcelona University)
said:
“This qualitative study examines the personal impact of loss of sexual interest on women, and also what were the expectations of those women who sought treatment for their
sexual problems. But data from this qualitative study may give additional clues for health care providers. If we could reproduce this work on a larger sample, we may be able to assign these patients into groups which would allow us to design specific therapies
for sexual problems and better management of this condition: in other words, to give a more personalized management of sexual problems.
Health care providers should keep in mind that the women in this study have broken through considerable personal barriers in talking about their problems. Intimacy is difficult
to talk about, and these women deserve our respect. We owe it to them, and to other women (and indeed men) suffering as a result of this problem, to help improve their quality of life”.
