Low sexual desire in midlife and older women: personality factors, psychosocial development, present sexuality.

OBJECTIVE: Recent population-based surveys indicate that the prevalence of sexual dysfunction, particularly low sexual desire and arousal disorders, is increasing with age. However, there seems to be greater variability of the sexual experience and functioning in midlife and older women, suggesting a higher dependence on basic conditions like general well-being, physical and mental health, quality of relationship, and life situation. DESIGN: A series of studies was conducted in the authors' Female Sexual Dysfunction research group to assess differences in (1) determinants of sexual satisfaction, (2) personality factors, and (3) present sexuality between younger and older women in both patient and nonpatient populations. RESULTS: The results of these studies highlight that in comparison with functional women, patients with hypoactive sexual desire are generally characterized by a vulnerable self-system with several rather inadequate self-regulatory mechanisms. The results of the brief sexual function questionnaire indicate that the present sexuality of women seeking professional help for low sexual desire is significantly different from the sexuality of a control group of nonpatients. These between-group effects proved to be far more important than any age effects within both groups and showed that all domains of sexuality were negatively affected and overshadowed by the sexual dysfunction. CONCLUSIONS: These results are supportive of the growing evidence against a simple model of midlife sexuality that depicts women as victims of their bodily and hormonal changes. Instead, life stressors, contextual factors, past sexuality, and mental health problems are more significant predictors of midlife women's sexual interest than menopause status itself. Evaluation and treatment approaches require consideration of the full range of contextual factors, including relationship quality, personality factors, past experience, and mental and physical health.