Sexuality of Canadian Women at Midlife

Fraser, Julie, Maticka-Tyndale, Eleanor, Smylie, Lisa, The Canadian Journal of Human Sexuality

ABSTRACT: The sexuality of women at midlife has received insufficient attention in social scientific inquiry. This" is troubling given the number of women in this age group and the tendency to emphasize biomedical over social factors in research on the sexual health issues that may affect women at midlife. This paper reviews the literature on female sexuality at midlife including sexual behaviour measures from large scale national surveys in the United States, Great Britain and France. In the absence of comparable population studies in Canada, data from Canada's National Population Health Survey (NPHS) were used in a logistic regression analysis to determine the relative influence of sociodemographic, lifestyle, and health factors on reported sexual intercourse activity of 15,249 Canadian women 35-59 years of age. Across this sample, sociodemographic and lifestyle factors were the most consistent predictors with health factors coming into play primarily for women over the age of 50. The study was limited by the lack of complete national data on sexual behaviour measures other than intercourse. While the Canadian government regularly collects data on a wide variety of health-related factors through instruments" such as the NPHS, few if any questions ask about sexual behaviour and some provinces or health regions may opt to exclude such questions. Canada needs national surveys that give much greater priority to sexual behaviour and sexual health issues including those that affect women at midlife.

Key words: Female sexuality Midlife National Population Health Survey Social factors

INTRODUCTION

Research on gender differences in health has tended to neglect older people in comparison to the attention given to younger age groups (Arber & Cooper, 1999), a neglect that is even more apparent when the focus turns to the study of sexuality and sexual health in midlife and later. While the increasing presence of the aging "baby boom" generation in the consumer market has precipitated a change in the sexual image of older persons in advertising (Featherstone & Hepworth, 1990) and in media and popular culture (Walz, 2002), research on aging and sexuality has only begun to catch up. For some time there has been a call for more research on age-related changes in women's sexual experiences during midlife (Mooradian & Greiff, 1990) and on the unexamined stereotypical expectations implicit in some research on this topic (Gannon, 1998). A review of research literature on women at midlife in Canada is timely given the current and projected numbers of women in this age group in the Canadian population. Canada's "baby boom" generation (those born from 1947-1966) is now, in 2005, aged 39-58. In 2001 women aged 35-59 years represented just under 19% of Canada's population (Statistics Canada, 2005). These women are now in or approaching what is often identified as the midlife age category and they will be the source of the sizeable projected increases in the 45-64 and 65-69 age groups by 2011. It is thus important to have reliable information on factors likely to affect their sexual functioning and sexual health.

This paper begins with a brief review of research literature on the sexual experiences of women at midlife including a sampling of findings on women at midlife drawn from three large national surveys from France, Great Britain and the United States. We then use data from Canada's National Population Health Survey (NPHS) to document the socioeconomic and general health characteristics of Canadian women in younger and older age categories from 35 to 59 and to identify associations between these characteristics and available data on their sexual behaviour, also obtained in the NPHS.

SEXUALITY AT MIDLIFE: INCREMENT OR DECREMENT?

Do women experience a decrease in sexual function at midlife? A straightforward answer to this question is confounded by the difficulty of finding studies that share a similar understanding and operationalization of what constitutes sexual function. Measures used range from occurrence of sexual intercourse in the past year (or month), frequency of intercourse or other sexual behaviours, occurrence and frequency of sexual interest and orgasm, prevalence of sexual difficulties or dysfunctions, impact of changes associated with menopause, and occurrence of age-related changes in physical or emotional health or social circumstances, including relationship status, that may impact on sexuality.

Studies that do not support the conclusion that there is a decline in women's sexual function at midlife date back to Kinsey who found no decrease in the frequency of orgasm without a partner (Kinsey, Pomeroy, Martin et al., 1953). More recent research has not found decreases in sexual interest (Bachman, Leiblum, Sandler et al., 1985), sexual responsivity (Cutler, Garcia & McCoy, 1987), or in the broad concept of "sexual functioning" (Kernoff Mansfield, Barthalow Koch, & Voda, 1998). Studies used to conclude that there is a decline in sexual functioning at midlife cite declines in frequency of intercourse and interest (Pfeiffer, Verwoerdt, & Davis, 1972), and in weekly intercourse rates, sexual fantasies, vaginal lubrication and sexual satisfaction with a partner (McCoy & Davidson, 1985). In reviewing these apparently contradictory findings, Gannon (1998) identified inconsistencies and methodological shortcomings between some studies, but also a persistent assumption that one should expect to find a decline in women's sexuality both with age and with declining estrogen levels. Citing a range of studies (e.g., Hallstrom & Samuelson, 1980; Hunter, 1990; Kahn & Holt, 1987; Kinsey et al., 1953; Runciman, 1978), Gannon (1998) concluded that the only thing known with certainty is that there is great variability in the sexual activity of women at midlife. Gannon points to this variability as a reason to go beyond biological and hormonal factors to consider the impact of contextual factors on sexual activity in midlife.

Based on data from a survey of both men and women conducted by the American Association of Retired Persons, DeLamater and Sills (2003) also concluded that neither hormonal nor medical status had an appreciable influence on reported sexual activity, either alone or with a partner. The factors that did have an influence, for both men and women, were attitudes toward the relationship and the perceived limitations of one's partner. Despite findings that call for a greater focus on psychosocial factors that impact on women's sexuality at midlife, the explanatory variables most often addressed in research continue to be age, hormonal status, and menopausal status.

ROLE OF HORMONES IN SEXUAL FUNCTIONING AT MIDLIFE

Based on their review of a number of studies of the sexual effects of HRT in post-menopausal women, Walling, Anderson & Johnson (1990) concluded that estrogen is better than placebo for treating women with decreased vaginal lubrication but that estrogen did not increase sexual activity, sexual desire, or sexual satisfaction. These latter measures of sexual functioning were also unaffected by estrogen/ progesterone combinations. In contrast, several studies suggested that estrogen in combination with androgen enhanced sexual desire in post-menopausal women who were experiencing loss of libido. More recent reviews have also identified hormonal factors, including androgen reduction and replacement, as a contributing although not necessarily central factor associated with sexual functioning in postmenopausal women (Myers, 1995; Dennerstein, Alexander, & Kotz, 2003). In a meta-analysis involving 33 empirical studies that addressed the effects of different factors on sexuality in peri-/postmenopausal women, Myers (1995) found that mean effect size across studies suggested that hormones play a role in some aspects of postmenopausal sexuality, but that the amount of variance that could be accounted for by hormonal factors was very small. In their review of population-based studies on menopause and sexual functioning, Dennerstein et al. (2003) concluded that "... hormonal change is only one aspect of the many factors that impact on sexual functioning" (p. 80) and that others factors such as "... stress level, physical and psychological health, and changes in partner status, as well as the woman's feelings towards her partner" (p. 80) should also be considered. In short, the legitimate interest in endocrine factors should not overshadow investigation of other important social and contextual factors.

CONTEXTUAL FACTORS IMPACTING ON SEXUALITY AT MIDLIFE

Researchers have considered contextual factors and life stressors that may be as, or more, significant than menopausal status in predicting psychological, sexual, and somatic conditions in women at midlife (Kernoff Mansfield, Barthalow Koch, & Voda, 1998). McQuaide (1998) found that having one's psychological needs met (e.g., feeling valued, productive, loved, accepted, understood, attractive, independent, and having inner resources) is related to positive feelings about appearance and satisfaction with one's sex life for some women at midlife. For couples, the quality and nature of the marital relationship is another important variable (Kingsberg, 2002) although marriage in itself may not guarantee sexual enjoyment. For example, Kernoff-Mansfield, Voda and Bathalow Koch (1995) found that married midlife women in their study reported lower interest in, and enjoyment of sex compared to single participants. Among married couples, however, Hawton, Gath, and Day (1994) found that frequency of sexual intercourse and orgasm, enjoyment of sexual activity, finding sex pleasant or unpleasant, and overall satisfaction with the sexual relationship were all closely associated with better marital adjustment and marital satisfaction. Since such studies on contextual influences often employed a cross-sectional design, the direction of the relationship between sexual variables and marital satisfaction cannot be established.

Developmental factors at midlife such as caring for elderly relatives, changing employment or financial status, or confronting illness or death, may have a …

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Publication information: Article title: Sexuality of Canadian Women at Midlife. Contributors: Fraser, Julie - Author, Maticka-Tyndale, Eleanor - Author, Smylie, Lisa - Author. Journal title: The Canadian Journal of Human Sexuality. Volume: 13. Issue: 3-4 Publication date: Fall-Winter 2004. Page number: 171+. © 1999 SIECCAN, The Sex Information and Education Council of Canada. COPYRIGHT 2004 Gale Group.

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