Document Type : Original Article
Authors
1 Department of Health Promotion and Education, Ardabil University of Medical Sciences, Ardabil, Iran
2 PhD Student of Health Education and Health Promotion, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
3 Antai College of Economics and Management, Shanghai Jiao Tong University, Shanghai, China
4 Department of Public Health, School of Health, Ardabil University of Medical Science, Ardabil, Iran
5 Department of Nutrition, Khalkhal University of Medical Sciences, Khalkhal, Iran
Abstract
INTRODUCTION: The world’s population is aging and this trend continues. Older adults are living
healthier and longer than in the last decades and their sexual function should also be considered
along with their general health. This study aimed to examine the correlation between general health
and sexual function in elderly women.
MATERIALS AND METHODS: In this cross‑sectional correlation study, 1245 women over 60 years
old were selected in Ardabil health‑care centers by a convenient sampling method. Demographic
data of all participants were noted and general health and sexual function were evaluated by the
Goldberg General Health Questionnaire and Female Sexual Function Index (FSFI) Questionnaire.
RESULTS: The participants’ mean ± standard deviation age was 75.1 ± 7.2 years, most of the
women (40.08%) were illiterate, and the majority of them were living with their married (44.81%)
or single children (27.14%). The general health score for 380 older women (30.52%) was under
22 (healthy). About 60% of the women had engaged in sexual activity during the past 4 weeks,
and the total mean score of FSFI was 17.36 ± 1.44. In addition, 84.33% of the women had
sexual dysfunction (FSFI < 26.55). The age (P < 0.05), educational level (P < 0.001), living with
children (P < 0.01), and general health status (P < 0.01) were found to be significantly related to
sexual function. The total scores for FSFI and the scores for all domains except for satisfaction
were in positive correlation with the score for the total and all domains of general health (P < 0.001).
CONCLUSION: Sexual function in elderly women is affected by several factors, such as general
health. Therefore, to promote successful aging in women, sexual function and general health require
more attention when implementing women’s health initiatives.
Keywords
postpartum female sexual dysfunction in breastfeeding women
referring to healthcare centers of Bandar Abbas. Iran J Obstetr
Gynecol Infert 2016;19:1‑12.
2. Ziapour A, Zokaei A, Kahrizy F. A theoretical study of the
standing of social investment in the health sector. Soc Sci
2016;11:3682‑7.
3. Ziapour A, Kianipour N. Health‑related quality of life among
University Students: The role of demographic variables. J Clin
Diagn Res 2018;12:JC1‑4.
4. Dall’Agno ML, Ferreira CF, Ferreira FV, Pérez‑López FR,
Wender MC. Validation of the Six‑item female sexual function
index in middle‑aged Brazilian women. Rev Bras Ginecol Obstet
2019;41:432‑9.
5. Starc A, Jukić T, Poljšak B, Dahmane R. Female sexual function
and dysfunction: A cross‑national prevalence study in Slovenia.
Acta Clin Croat 2018;57:52‑60.
6. Clayton AH, Harsh V. Sexual function across aging. Curr
Psychiatry Rep 2016;18:28.
7. Safari Y. Clarifying evidence‑based medicine in educational and
therapeutic experiences of clinical faculty members: A qualitative
study in Iran. Glob J Health Sci 2015;7:62‑8.
8. Kaboudi M, Dehghan F, Ziapour A. The effect of acceptance and
commitment therapy on the mental health of women patients with
type II diabetes. Ann Trop Med Public Health 2017;10:1709‑13.
9. United Nations. World Population Ageing 2015. Department of
Economic and Social Affairs, Population Division; 2015.
10. Safari Y, Afzali B, Ghasemi S, Sharafi K, Safari M. Comparing the
effect of short message service (SMS) and pamphlet instruction
methods on women’s knowledge, attitude and practice about
breast cancer (2014). Acta Med Mediterranea 2016;32:1927‑31.
11. Greenberg S. A Profile of Older Americans: 2009. Washington
DC: U.S. Department of Health and Human Services 2009.
12. Depp C, Vahia IV, Jeste D. Successful aging: Focus on cognitive
and emotional health. Annu Rev Clin Psychol 2010;6:527‑50.
13. Sinković M, Towler L. Sexual aging: A systematic review of
qualitative research on the sexuality and sexual health of older
adults. Q Health Res 2019;29:1239-54.
14. Fileborn B, Thorpe R, Hawkes G, Minichiello V, Pitts M, Dune T.
Sex, desire and pleasure: Considering the experiences of older
Australian women. Sex Relation Ther 2015;30:117‑30.
15. Griebling TL. Re: Sexual health and positive subjective well‑being
in partnered older men and women. J Urol 2017;198:228.
16. Safari Y, Yoosefpour N. Dataset for assessing the professional
ethics of teaching by medical teachers from the perspective
of students in Kermanshah University of Medical Sciences,
Iran (2017). Data Brief 2018;20:1955‑9.
17. MontemurroB, ChewningL. Unscripted: Exploring representations
of older unpartnered women’s sexuality. J Women Aging
2018;30:127‑44.
18. Beckman N, Waern M, Östling S, Sundh V, Skoog I. Determinants
of sexual activity in four birth cohorts of Swedish 70-year-olds
examined 1971‑2001. J Sex Med 2014;11:401‑10.
19. Erens B, Mitchell KR, Gibson L, Datta J, Lewis R, Field N, et al.
Health status, sexual activity and satisfaction among older people
in Britain: A mixed methods study. PLoS One 2019;14:e0213835.
20. Fortenberry JD. The evolving sexual health paradigm:
Transforming definitions into sexual health practices. AIDS
2013;27 Suppl 1:S127‑33.
21. Wellings K, Johnson AM. Framing sexual health research:
Adopting a broader perspective. Lancet 2013;382:1759‑62.
22. Rosen CB, Heiman J, Leiblum S, Meston C, Shabsigh R,
Ferguson D, et al. The Female Sexual Function Index (FSFI):
A multidimensional self‑report instrument for the assessment of
female sexual function. J Sex Marital Therap 2000;26:191‑208.
23. Mitchell KR, Mercer CH, Ploubidis GB, Jones KG, Datta J, Field N,
et al. Sexual function in Britain: Findings from the third National
Survey of Sexual Attitudes and Lifestyles (Natsal‑3). Lancet
2013;382:1817‑29.
24. Corona G, Lee DM, Forti G, O’Connor DB, Maggi M, O’Neill TW,
et al. Age-related changes in general and sexual health in middleaged and older men: Results from the European male ageing
study (EMAS). J Sex Med 2010;7(4pt1):1362‑80.
25. Trompeter SE, Bettencourt R, Barrett‑Connor E. Sexual activity
and satisfaction in healthy community‑dwelling older women.
Am J Med 2012;125:37‑430.
26. Fileborn B, Lyons A, Hinchliff S, Brown G, Heywood W,
Minichiello V. Learning about sex in later life: Sources of education
and older Australian adults. Sex Edu 2017;17:165‑79.
27. Freak‑Poli R, Kirkman M, De Castro Lima G, Direk N, Franco OH,
Tiemeier H. Sexual activity and physical tenderness in older
adults: Cross‑sectional prevalence and associated characteristics.
J Sex Med 2017;14:918‑27.
28. Træen B, Hald GM, Graham CA, Enzlin P, Janssen E, Kvalem IL,
et al. Sexuality in older adults (65+) – An overview of the literature,
Part 1: Sexual function and its difficulties. Int J Sex Health
2017;29:1‑10.
29. Træen B, Hald G, Graham C, Enzlin P, Janssen E, Kvalem I, et al.
An overview of the literature on sexuality in older adults (65+),
Part 1: Sexual function and its difficulties. Int J Sex Health
2017;29:1‑10.
30. Nazari B, Bakhshi S, Kaboudi M, Dehghan F, Ziapour A,
Montazeri N. A comparison of quality of life, anxiety and
depression in children with cancer and healthy children,
Kermanshah‑Iran. Int J Pediatr 2017;5:5305‑14.
31. Estill A, Mock SE, Schryer E, Eibach RP. The effects of subjective
age and aging attitudes on mid- to late-life sexuality. J Sex Res
2017;55:146-51.
32. Ambler DR, Bieber EJ, Diamond MP. Sexual function in elderly
women: A review of current literature. Rev Obstet Gynecol
2012;5:16‑27.
33. Hashemi S, Tehrani FR, Simbar M, Abedini M, Bahreinian H,
Gholami R. Evaluation of sexual attitude and sexual function in
menopausal age; a population based cross‑sectional study. Iran
J Reproduct Med 2013;11:631‑9.
34. Tungmunsakulchai R, Chaikittisilpa S, Snabboon T,
PanyakhamlerdK, JaisamrarnU, Taechakraichana N. Effectiveness of a low dose testosterone undecanoate to improve sexual function
in postmenopausal women. BMC Womens Health 2015;15:113.
35. Merghati‑Khoei E, Zargham‑Boroujeni A, Salehi M, Killeen TK,
Momeni G, Pasha Y, et al. Saturated love leading to sexual
pleasure: Iranian women’s narratives. Caspian. J Appl Sci Res
2015;4:20-9.
36. Gleser H. Sex, women and the menopause: Are specialist trainee
doctors up for it? A survey of views and attitudes of specialist
trainee doctors in community sexual & reproductive health and
obstetrics & gynaecology around sexuality and sexual healthcare
in the (peri) menopause. Post Reprod Health 2015;21:26‑33.
37. Bahri N, Roudsari RL, Azimi Hashemi M. Adopting self‑sacrifice:
How Iranian women cope with the sexual problems during
the menopausal transition? An exploratory qualitative study.
J Psychosom Obstet Gynaecol 2017;38:180‑8.
38. Goldberg DP, Hillier VF. A scaled version of the general health
questionnaire. Psychol Med 1979;9:139‑45.
39. Nazifi M, Mokarami H, Akbaritabar A, Kujerdi MF, Tabrizi R,
Rahi A. Reliability, validity and factor structure of the Persian
translation of general health questionnire (ghq‑28) in hospitals
of Kerman University of Medical Sciences. J Fasa Univ Med Sci
2014;3:336‑42.
40. Noorbala A, Mohammad K. The validation of general health
questionnaire‑28 as a psychiatric screening tool. Hakim Res J
2009;11:47‑53.
41. Mohammadi KH, Heydari M, Faghihzadeh S. The female sexual
function index (FSFI): Validation of the Iranian version. Health
Monitor J Iran Instit Health Scie Res 2008;7:269‑78.
42. Thompson WK, Charo L, Vahia IV, Depp C, Allison M,
Jeste DV. Association between higher levels of sexual function,
activity, and satisfaction and self-rated successful aging in older
postmenopausal women. J Am Geriatr Soc 2011;59:1503‑8.
43. Wang V, Depp CA, CeglowskiJ, ThompsonWK, Rock D, Jeste DV.
Sexual health and function in later life: A population‑based
study of 606 older adults with a partner. Am J Geriatr Psychiatry
2015;23:227‑33.
44. Chedraui P, Pérez‑López FR, Sánchez H, Aguirre W, Martínez N,
Miranda O, et al. Assessment of sexual function of mid‑aged
Ecuadorian women with the 6‑item female sexual function index.
Maturitas 2012;71:407‑12.
45. Charandabi SM, Rezaei N, Hakimi S, Montazeri A, Khatami S,
Karimi P. Sexual function of postmenopausal women and its
predictive factors: A community based study in Ilam, Iran, 2011.
Iran J Obstet Gynecol Infert 2012;15:1‑9.
46. Karraker A, Delamater J, Schwartz CR. Sexual frequency
decline from midlife to later life. J Gerontol B Psychol Sci Soc Sci
2011;66:502‑12.
47. Chedraui P, Pérez‑López FR, Mezones‑Holguin E, San Miguel G,
Avila C; Collaborative Group for Research of the Climacteric in
Latin America (REDLINC). Assessing predictors of sexual function
in mid‑aged sexually active women. Maturitas 2011;68:387‑90.
48. Pérez‑López FR, Fernández‑Alonso AM, Trabalón‑Pastor M,
Vara C, Chedraui P; MenopAuse RIsk Assessment (MARIA)
Research Group. Assessment of sexual function and related factors
in mid‑aged sexually active Spanish women with the six‑item
Female Sex Function Index. Menopause 2012;19:1224‑30.
49. Lavee Y, Sharlin S, Katz R. The effect of parenting stress on
marital quality: An integrated mother‑father model. J Fam Issues
1996;17:114‑35.
50. Kenny R. A review of the literature on sexual development of
older adults in relation to the asexual stereotype of older adults.
Can J Fam Youth J Can Fam Jeuness 2013;5:91‑106.
51. Gatling M, Mills J, Lindsay D. Sex after 60? You’ve got to be joking!
Senior sexuality in comedy film. J Aging Stud 2017;40:23‑8.
52. Blümel JE, Chedraui P, Baron G, Belzares E, Bencosme A, Calle A,
et al. Sexual dysfunction in middle‑aged women: A multicenter
Latin American study using the Female Sexual Function Index.
Menopause 2009;16:1139‑48.
53. Nappi RE, Albani F, Santamaria V, Tonani S, Magri F, Martini E,
et al. Hormonal and psycho‑relational aspects of sexual function
during menopausal transition and at early menopause. Maturitas
2010;67:78‑83.
54. Basson R, Berman J, Burnett A, Derogatis L, Ferguson D,
Fourcroy J, et al. Report of the international consensus
development conference on female sexual dysfunction:
Definitions and classifications. J Urol 2000;163:888‑93.
55. Sadovsky R, Basson R, Krychman M, Morales AM, Schover L,
Wang R, et al. Cancer and sexual problems. J Sex Med
2010;7:349‑73.
56. Laumann EO, Glasser DB, Neves RC, Moreira ED Jr.; GSSAB
Investigators’ Group. A population‑based survey of sexual
activity, sexual problems and associated help‑seeking behavior
patterns in mature adults in the United States of America. Int J
Impot Res 2009;21:171‑8.
57. DeLamaterJ, Karraker A. Sexual functioning in older adults. Curr
Psychiatry Rep 2009;11:6‑11.
58. Hofland SL, Powers J. Sexual dysfunction in the menopausal
woman: Hormonal causes and management issues: Women
may view changes caused by menopause as indications that
they should simply cease sexual activities, unless appropriate
management and education are available. Geriatr Nurs
1996;17:161‑5.
59. Čukljek S, Jureša V, Grgas Bile C, Režek B. Changes in Nursing
Students’ attitudes towards nursing during undergraduate study.
Acta Clin Croat 2017;56:36‑43.
60. Mašina T, Madžar T, Musil V, Milošević M. Differences in
health‑promoting lifestyle profile among croatian medical
students according to gender and year of study. Acta Clin Croat
2017;56:84‑91.
61. Zavoreo I, Gržinčić T, Preksavec M, Madžar T, Bašić Kes V. Sexual
dysfunction and incidence of depression in multiple sclerosis
patients. Acta Clin Croat 2016;55:402‑6.
62. Biddle AK, West SL, D’Aloisio AA, Wheeler SB, Borisov NN,
Thorp J. Hypoactive sexual desire disorder in postmenopausal
women: Quality of life and health burden. Value Health
2009;12:763‑72.
63. Lindau ST, Gavrilova N. Sex, health, and years of sexually active
life gained due to good health: Evidence from two US population
based cross sectional surveys of ageing. BMJ 2010;340:c810.
64. Jonusiene G, Zilaitiene B, Adomaitiene V, Aniuliene R, Bancroft J.
Sexual function, mood and menopause symptoms in Lithuanian
postmenopausal women. Climacteric 2013;16:185‑93.
65. Basson R, Berman J, Burnett A, Derogatis L, Ferguson D,
Fourcroy J, et al. Report of the international consensus
development conference on female sexual dysfunction:
Definitions and classifications. J Sex Marital Therap 2001;27:83‑94.
)