Abstract
Background
Infertility has been linked with an increased risk of sexual dysfunction in reproductive-aged women, with longer periods of infertility associated with a greater risk.
Aim
The study’s aim was to examine whether a history of infertility treatment in women is linked to sexual dysfunction during midlife.
Methods
The cross-sectional study was conducted among sexually active women, between the ages of 45 and 65 years, who sought consultation at the women’s health clinics at a US tertiary care center. History of infertility treatment was assessed with a single question that asked participants if they were treated for infertility in the past. The association between a history of infertility treatment and sexual dysfunction—which was diagnosed by a combination of Female Sexual Function Index score ≤26.55 and Female Sexual Distress Scale–Revised score ≥11—was assessed in a multivariable logistic regression model that adjusted for multiple confounders.
Outcomes
The primary outcome was sexual dysfunction in midlife women.
Results
The analysis included 5912 women, with a mean age of 54.1 years. Nearly 16% of women reported receiving treatment for infertility. More than half the women (55%) had sexual dysfunction: 56.3% of those with previous fertility treatments and 54.4% of those without any fertility treatment (P = .3). Receiving treatment for infertility in the younger years did not significantly increase the odds of sexual dysfunction in midlife in univariate (odds ratio, 1.08; 95% CI, 0.94-1.24; P = .3) and multivariable analyses (odds ratio, 1.11; 95% CI, 0.96-1.29; P = .17).
Clinical Implications
While infertility is known to be predictive of sexual dysfunction in women during their reproductive years, there was no association between a history of infertility treatment and sexual dysfunction in midlife women in the current study.
Strengths and Limitations
The study used validated questionnaires accounting for sexual complaints and distress and adjusted for multiple confounding factors. Limitations include the selection bias introduced by the study of women presenting for evaluation of sexual dysfunction, which may have been a result of factors stronger than the influence of infertility. Other limitations include the study’s cross-sectional nature with suboptimal racial and ethnic representation.
Conclusion
Although infertility is commonly associated with female sexual dysfunction in women of reproductive age, the association was not present in midlife women in the current study.
Keywords: infertility, female sexual dysfunction, midlife women, sexual satisfaction
Introduction
Infertility is the failure of conception after 12 months of regular and unprotected sexual intercourse. Its prevalence is 6% among couples with a previous birth and 19% among those without.1 The World Health Organization has identified infertility as a disability due to its association with a large psychological burden for both partners, especially because it threatens the reproductive autonomy of individuals.2 The long expensive treatments, the uncertainty of the outcome, and the social pressure can all contribute to compromised well-being in women with infertility.3,4 Infertility in women is also associated with lower self-esteem and confidence, negative perception of their sexual attractiveness, and doubt about their sexual abilities.5 These issues can increase their risk of sexual dysfunction.6 Not surprising, reproductive-aged women with infertility have high rates of sexual problems and poor sexual function. The prevalence of sexual dysfunction in women with infertility varies widely in the literature (30%-90%),7,8 but there is a consistently higher prevalence of poor sexual function among them in comparison with counterparts without fertility problems.9–12 As such, women with infertility may be 2.6 times more likely to have female sexual dysfunction (FSD) than those without infertility.10 The prevalence rates may be even higher in women with longer duration of infertility. A recent study showed that women with an infertility duration ≥8 years were 5 times more likely to have sexual dysfunction than those with a shorter duration.13 However, it is not known whether sexual dysfunction persists in women as they get older and enter their midlife years (40-60 years). The existing data on the subject are mixed, partly because of the heterogeneity in the assessment of sexual dysfunction. The ICD-11 criteria require the presence of sexual complaints and distress to make the diagnosis of sexual dysfunction in women.14 Previous studies have used variable methods for assessment of sexual complaints and inconsistently accounted for the “distress” component, thereby leading to potential inaccuracies in assessing the frequency of FSD among those with a history of infertility. The goal of the present study was to use validated tools to evaluate whether there is a link between a history of receiving fertility treatments by women in their younger years and sexual dysfunction in midlife.
Methods
Study design and participants
This study included sexually active women between the ages of 45 and 65 years who sought consultation from May 2015 to May 2022 at the women’s health clinics at 1 of the 3 main Mayo Clinic sites (Rochester, MN; Scottsdale, AZ; Jacksonville, FL). These women were evaluated by experts in the field for menopause and sexual health. As part of their care, the women completed questionnaires that provided extensive medical information. The data from the women who provided informed consent to use their responses and medical records for research were included in the Data Registry on the Experiences of Aging, Menopause, and Sexuality.15 By May 2022, 8037 women had completed the questionnaires, 5912 of whom reported being sexually active and were included in the current cross-sectional analysis. The study was approved by the Institutional Review Board at Mayo Clinic.
Outcome measures
Infertility
To assess the history of infertility, patients were asked if they had ever been treated for infertility (yes/no). Women were also asked how many births they had.
Sexual activity
Sexual activity was assessed with a single question that asked the participants if they were currently sexually active (yes/no). Women who had an affirmative response were included in the analysis.
Sexual dysfunction
Sexual function was assessed with 2 questionnaires: the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale–Revised (FSDS-R). Women meeting the criteria for abnormal scores on both questionnaires (FSFI score ≤26.55 and FSDS-R score ≥11) were diagnosed as having FSD.
FSFI questionnaire
The FSFI questionnaire consists of 19 items that describe sexual activity within the last 4 weeks and covers 6 domains of sexual function: desire, arousal, lubrication, orgasm, satisfaction, and pain. A points system is used: 1 to 5 points are assigned to questions 1 and 2 (sexual desire questions), and 0 to 5 points are assigned to questions 3 to 19 (remainder of the sexual function domains). The sum of scores for each domain is multiplied by the domain factor, and the scores are added. Scores range from 2 to 36 points, and a total score ≤26.55 is considered abnormal.16
FSDS-R questionnaire
The FSDS-R questionnaire consists of 13 items that evaluate personal distress related to sexual complaints in women. Every item asks about a certain negative feeling associated with sexual activity, and each item has a score of 0 to 4 (0, never; 1, rarely; 2, occasionally; 3, frequently; 4, always). The scores for all items are added up. A score ≥11 is considered abnormal, implying significant sexual distress.17
Mood
Mood was assessed with the Patient Health Questionnaire–9, a 9-item screening tool for depression. A score ≥5 is suggestive of depression, and higher scores imply a greater severity of depression.18
Anxiety
The Generalized Anxiety Disorder–7 is a 7-item screening tool for anxiety. A score ≥5 is suggestive of anxiety, and higher scores imply greater severity.19
Relationship satisfaction
The 3-item Kansas Marital Satisfaction Scale assesses relationship satisfaction. A points system is used with 1 to 7 points for each item, providing a total score of 3 to 21. A higher score signifies greater relationship satisfaction, with a score <17 implying low satisfaction.20
Covariates
Other relevant variables—such as demographics, reproductive stage, body mass index (BMI), current hormone therapy use, and frequency of alcohol use—were obtained from the electronic medical record.
Data analysis
Median and IQR were used to report continuous data while frequency and percentage were used for categorical data. Women were classified into 2 groups: those with a history of infertility treatment and those without. The association between previous use of infertility treatment and current sexual dysfunction was assessed with univariate and multivariable nominal logistic regression models. Multivariable models were adjusted for multiple confounders: age, BMI, reproductive stage, hormone therapy use, anxiety, depression, relationship satisfaction, alcohol use, education, and employment status. We calculated an odds ratio (OR) and 95% CI for the infertility treatment group as compared with the group receiving no infertility treatment. All tests were 2-sided, and P ≤ .05 was considered statistically significant. All analyses were performed with SAS version 9.4 (SAS Institute).
Results
Participants
Of the 8037 women who completed the questionnaires, 5912 (mean age, 54.1 years) reported being sexually active and were included in the analysis. Table 1 summarizes the demographic features of the participants. The majority of the participants were either postmenopausal or in the menopause transition, and 15.8% reported a history of infertility treatment. Women with and without a history of infertility treatment were comparable with respect to several variables, such as BMI, menopause status, and rates of anxiety and depression. Data on number of births was missing in half the participants. In those who provided an answer, 90.4% of women with a history of infertility treatment had at least 1 birth, as compared with 96.3% of women with no history of infertility treatment (P < .001).
Table 1.
Participant demographics and characteristics.
| History of infertility treatment, No. (%) | ||||
|---|---|---|---|---|
| No (n = 4977) | Yes (n = 935) | Total (N = 5912) | P value | |
| Age, y, mean ± SD | 54.2 ± 5.1 | 53.7 ± 5.1 | 54.1 ± 5.1 | .004 |
| Obesity: body mass index >30 kg/m2 | .99 | |||
| Missing | 157 | 34 | 191 | |
| No | 3756 (77.9) | 702 (77.9) | 4458 (77.9) | |
| Yes | 1064 (22.1) | 199 (22.1) | 1263 (22.1) | |
| Race | .58 | |||
| White | 4434 (89.1) | 829 (88.7) | 5263 (89.0) | |
| Asian | 77 (1.5) | 15 (1.6) | 92 (1.6) | |
| Black | 81 (1.6) | 15 (1.6) | 96 (1.6) | |
| Hispanic | 210 (4.2) | 38 (4.1) | 248 (4.2) | |
| Other | 56 (1.1) | 7 (0.7) | 63 (1.1) | |
| Unknown | 119 (2.4) | 31 (3.3) | 150 (2.5) | |
| Menopause status | .30 | |||
| Missing | 561 (11.3) | 111 (11.9) | 672 (11.4) | |
| Unknown | 191 (3.8) | 29 (3.1) | 220 (3.7) | |
| Premenopausal | 236 (4.7) | 44 (4.7) | 280 (4.7) | |
| Perimenopausal | 865 (17.4) | 186 (19.9) | 1051 (17.8) | |
| Postmenopausal | 3124 (62.8) | 565 (60.4) | 3689 (62.4) | |
| Marital status | .005 | |||
| Married/partnered | 4336 (87.1) | 841 (89.9) | 5177 (87.6) | |
| Single | 287 (5.8) | 41 (4.4) | 328 (5.5) | |
| Widowed | 35 (0.7) | 4 (0.4) | 39 (0.7) | |
| Separated/divorced | 301 (6.0) | 40 (4.3) | 341 (5.8) | |
| Unknown | 18 (0.4) | 9 (1.0) | 27 (0.5) | |
| Alcohol use | .015 | |||
| Never | 823 (16.5) | 126 (13.5) | 949 (16.1) | |
| Monthly or less | 990 (19.9) | 220 (23.5) | 1210 (20.5) | |
| 2-4 times a month | 1087 (21.8) | 216 (23.1) | 1303 (22.0) | |
| 2-3 times a week | 1155 (23.2) | 213 (22.8) | 1368 (23.1) | |
| ≥4 times a week | 641 (12.9) | 100 (10.7) | 741 (12.5) | |
| Unknown | 281 (5.6) | 60 (6.4) | 341 (5.8) | |
| Education | <.001 | |||
| High school graduate/GED or less | 288 (5.8) | 38 (4.1) | 326 (5.5) | |
| Some college or 2-y degree | 1176 (23.6) | 169 (18.1) | 1345 (22.8) | |
| 4-y college graduate | 1554 (31.2) | 295 (31.6) | 1849 (31.3) | |
| Postgraduate studies | 1257 (25.3) | 278 (29.7) | 1535 (26.0) | |
| Unknown | 702 (14.1) | 155 (16.6) | 857 (14.5) | |
| Employment | .062 | |||
| Disabled | 109 (2.2) | 16 (1.7) | 125 (2.1) | |
| Employed | 2485 (49.9) | 493 (52.7) | 2978 (50.4) | |
| Full-time homemaker | 296 (5.9) | 65 (7.0) | 361 (6.1) | |
| Other | 39 (0.8) | 7 (0.7) | 46 (0.8) | |
| Retired | 447 (9.0) | 57 (6.1) | 504 (8.5) | |
| Unemployed | 328 (6.6) | 68 (7.3) | 396 (6.7) | |
| Unknown | 1273 (25.6) | 229 (24.5) | 1502 (25.4) | |
| Systemic hormone therapy use | 846 (17.2) | 169 (18.2) | 1015 (17.3) | .43 |
Abbreviation: GED, General Education Development
History of infertility treatment and sexual dysfunction
The rate of sexual dysfunction in our cohort was 54.7%, and there was a lack of a significant difference in the rates between the women with and without a history of infertility treatment (56.3% vs 54.4%, respectively; Table 2). In univariate analysis (OR, 1.08; 95% CI, 0.94-1.24) and multivariable analysis (OR, 1.11; 95% CI, 0.96-1.29), women with history of infertility treatment did not have increased odds of FSD (Table 3).
Table 2.
Questionnaire data among participants.
| History of infertility treatment, No. (%) or median (IQR) | ||||
|---|---|---|---|---|
| Score | No (n = 4977) | Yes (n = 935) | Total (N = 5912) | P value |
| GAD-7 | .72 | |||
| <5 | 2843 (57.1) | 545 (58.3) | 3388 (57.3) | |
| ≥5 | 1340 (26.9) | 240 (25.7) | 1580 (26.7) | |
| Unknown | 794 (16.0) | 150 (16.0) | 944 (16.0) | |
| PHQ-9 | .91 | |||
| <5 | 2534 (50.9) | 482 (51.6) | 3016 (51.0) | |
| ≥5 | 1447 (29.1) | 271 (29.0) | 1718 (29.1) | |
| Unknown | 996 (20.0) | 182 (19.5) | 1178 (19.9) | |
| FSFI | ||||
| Total | 20.5 (12.3-26.9) | 20.7 (13.1-27.1) | 20.6 (12.4-27.0) | .70 |
| ≤26.55 | 3663 (73.6) | 679 (72.6) | 4342 (73.4) | .53 |
| FSDS-R | ||||
| Total | 14 (5-24) | 14 (5-25) | 14 (5-24) | .12 |
| ≥11 | 2972 (59.7) | 577 (61.7) | 3549 (60.0) | .25 |
| Female sexual dysfunction | ||||
| FSFI ≤26.55 and FSDS-R ≥11 | 2709 (54.4) | 526 (56.3) | 3235 (54.7) | .30 |
Abbreviations: FSDS-R, Female Sexual Distress Scale–Revised; FSFI, Female Sexual Function Index; GAD-7, Generalized Anxiety Disorder–7; PHQ-9, Patient Health Questionnaire–9.
Table 3.
Univariate and multivariable logistic regression models assessing the associations between patient/clinical characteristics and female sexual dysfunction.
| Univariate | Multivariable a | |||
|---|---|---|---|---|
| Odds ratio (95% CI) | P value | Odds ratio (95% CI) | P value | |
| Infertility treatment | 1.08 (0.94-1.24) | .30 | 1.11 (0.96-1.29) | .17 |
| Age, per decade | 1.24 (1.12-1.37) | <.001 | 1.05 (0.92-1.21) | .48 |
| Obesity | 1.20 (1.06-1.36) | .005 | 1.06 (0.92-1.21) | .43 |
| White race | 1.18 (1.01-1.39) | .044 | 1.26 (1.06-1.51) | .011 |
| Menopause status | ||||
| Missing | 1.74 (1.31-2.31) | <.001 | 1.63 (1.20-2.20) | .002 |
| Unknown | 1.93 (1.35-2.76) | <.001 | 1.95 (1.33-2.86) | <.001 |
| Premenopausal | [Reference] | [Reference] | ||
| Perimenopausal | 1.23 (0.94-1.61) | .13 | 1.22 (0.92-1.63) | .17 |
| Postmenopausal | 2.18 (1.70-2.80) | <.001 | 2.39 (1.80-3.18) | <.001 |
| Marital status | ||||
| Married/partnered | [Reference] | [Reference] | ||
| Single | 0.78 (0.63-0.98) | .032 | 0.72 (0.56-0.92) | .008 |
| Widowed | 0.70 (0.37-1.31) | .26 | 0.64 (0.33-1.27) | .20 |
| Separated/divorced | 0.98 (0.78-1.22) | .82 | 0.94 (0.74-1.20) | .62 |
| Unknown | 0.88 (0.41-1.87) | .73 | 0.66 (0.27-1.61) | .36 |
| Alcohol use | ||||
| Never | [Reference] | [Reference] | ||
| Monthly or less | 0.93 (0.78-1.10) | .37 | 1.01 (0.84-1.22) | .90 |
| 2-4 times a month | 0.80 (0.68-0.95) | .011 | 0.90 (0.75-1.08) | .26 |
| 2-3 times a week | 0.73 (0.62-0.86) | <.001 | 0.85 (0.71-1.02) | .086 |
| ≥4 times a week | 0.65 (0.53-0.79) | <.001 | 0.72 (0.59-0.89) | .003 |
| Unknown | 0.82 (0.64-1.05) | .11 | 0.92 (0.69-1.23) | .57 |
| Education | ||||
| High school graduate/GED or less | 1.39 (1.09-1.78) | .008 | 1.02 (0.79-1.33) | .86 |
| Some college or 2-y degree | 1.28 (1.11-1.49) | <.001 | 1.09 (0.93-1.28) | .28 |
| 4-y college graduate | 1.11 (0.97-1.27) | .13 | 1.09 (0.94-1.26) | .23 |
| Postgraduate studies | [Reference] | [Reference] | ||
| Unknown | 1.01 (0.86-1.20) | .85 | 0.88 (0.73-1.08) | .23 |
| Employment | ||||
| Disabled | 2.98 (1.95-4.54) | <.001 | 2.05 (1.29-3.24) | .002 |
| Employed | [Reference] | [Reference] | ||
| Full-time homemaker | 1.02 (0.82-1.27) | .85 | 0.97 (0.77-1.23) | .82 |
| Other | 1.17 (0.65-2.10) | .60 | 1.10 (0.59-2.04) | .77 |
| Retired | 1.18 (0.98-1.43) | .089 | 1.01 (0.82-1.24) | .95 |
| Unemployed | 1.21 (0.98-1.49) | .080 | 1.13 (0.90-1.42) | .29 |
| Unknown | 1.14 (1.01-1.29) | .038 | 1.14 (0.99-1.32) | .075 |
| Systemic hormone therapy use | 0.77 (0.67-0.88) | <.001 | 0.64 (0.55-0.74) | <.001 |
| GAD-7 score | ||||
| <5 | [Reference] | [Reference] | ||
| ≥5 | 2.36 (2.08-2.68) | <.001 | 1.89 (1.63-2.18) | <.001 |
| Unknown | 1.50 (1.29-1.73) | <.001 | 1.46 (1.19-1.79) | <.001 |
| PHQ-9 score | ||||
| <5 | [Reference] | [Reference] | ||
| ≥5 | 2.36 (2.09-2.68) | <.001 | 1.90 (1.64-2.20) | <.001 |
| Unknown | 1.45 (1.27-1.66) | <.001 | 1.19 (0.98-1.44) | .076 |
Abbreviations: GED, General Education Development; GAD-7, Generalized Anxiety Disorder–7; PHQ-9, Patient Health Questionnaire–9.
Multivariable model was adjusted for age, obesity, race, menopause status, marital status, alcohol use, education, employment, systemic hormone therapy use, anxiety, and depression.
Furthermore, the odds of FSD were higher in postmenopausal women and those with more severe anxiety and depression symptoms (Table 3).
Discussion
The current study did not find an association between a history of infertility treatment and the presence of sexual dysfunction later in life in midlife women. This is in contradiction with previous studies showing a strong association between infertility and FSD. However, it is important to recognize that most of the existing literature relates to sexual dysfunction in women of reproductive age.5,6,11,21–27 The studies on sexual function in midlife women with a history of infertility are sparse.
One of the first studies that used a validated questionnaire (FSFI) to evaluate this association was a cross-sectional study involving 161 women with infertility (mean age, 35.8 years), and it revealed a statistically significant association between infertility and FSD (defined as FSFI score <26.55).21 Multiple similar studies have been done since, with most reporting consistent results.8,11,22–24,28–30 Similarly, 2 recent systematic reviews described the association between infertility treatment and the risk of sexual dysfunction.5,27 While some of these studies included midlife women (>40 years old),11,23,28,31 the results were not analyzed for this specific age group. Moreover, given the average ages reported in these studies, midlife women most likely constituted a small percentage of the participants. As such, there is a paucity of evidence relating to the long-term effects of the infertility experience on the sexual function in women.
A longitudinal study found that 5 years after infertility treatment, men and women scored lower on partnership satisfaction, regardless of the infertility treatment outcome, when compared with their baseline status and the general population.32 A small qualitative study explored the long-term effects of infertility in 14 midlife Swedish women and reported that infertility negatively affected their sexual lives, sexual desire, and sexual enjoyment, even 20 years after receiving infertility treatment.33 Women also reported symptoms of low self-esteem, inferiority, and social isolation, and for many of them, the infertility evaluations and treatments signaled the end of their sexual lives.33 However, the very small sample size and characteristics of the studied sample (all had unsuccessful infertility treatments) preclude the generalizability of these findings. Yet, one study followed couples for 10 years after undergoing medically assisted reproduction (at follow-up, 146 couples; mean age of women, 45.6 years).34 Overall no statistically significant decline in sexual satisfaction was observed in couples who remained childless when compared with those who were successful in having children.34 A key limitation of this study was the low response rate (41%) at the 10-year follow-up. The participants lost to follow up may have had a poorer outcome. Also, this study assessed only a singular aspect of sexual function (sexual satisfaction), which does not adequately represent the breadth of female sexual function.
Most published studies on the association between infertility and sexual dysfunction in women lack adjustment for confounding factors.5 Sexual dysfunction is a result of the interplay of many biological, psychological, sociocultural, and interpersonal determinants. Infertility has been shown to be strongly associated with a compromise in many of these factors, with higher rates of depression and anxiety, poor self-esteem, and low quality of life noted in women with infertility.3,35–38 Of women presenting to their first infertility clinic appointment, 40% were diagnosed with depression, anxiety, or both.35 Infertility-associated depression, anxiety, and negative body image are all associated with greater relationship tension, couple dissatisfaction, and worse marital adjustment.39,40 Therefore, the obvious question is whether the link between infertility and sexual dysfunction in reproductive-aged women is driven by these factors or is independent of them. One study found that regardless of fertility status, women with depressed mood tend to be at a greater risk for sexual dysfunction than those with no depressive symptoms.9 In another study, increased depression scores in women with infertility were associated with a number of adverse sexual health outcomes, such as actively avoiding intercourse, decreased satisfaction, decreased pleasure, vaginismus, and anorgasmia.41 Similarly, anxiety, sleep disorders, and social dysfunction could be predictors of worse sexual function in women with infertility.42
Several aspects of our study need to be highlighted in the context of the existing evidence on the impact of infertility on female sexual function in midlife. In addition to being one of the few studies to assess the link between infertility and sexual dysfunction in midlife women, other strengths include a large sized cohort, use of validated questionnaires for assessment of FSD (accounting for sexual complaints and distress), and adjustment for multiple confounding factors. However, a few nuances relating to the negative results of the study need to be acknowledged. Our study sample comprised women who presented for menopause and sexual health–related concerns. Thus, our participants had higher rates of FSD (54.7%) than the community prevalence (14.8%).43 Our participants also had greater odds of depression and anxiety (29.1% in those with infertility treatment and 26.7% in those without). The majority of our participants were peri- or postmenopausal. Since these life stages are known to be associated with higher rates of sexual dysfunction,22,23 it is highly likely that the main drivers for sexual dysfunction in our participants were factors other than infertility and its treatment. Therefore, even though we were unable to show an association between a history of infertility treatment and sexual dysfunction, that may have been a reflection of the characteristics of the selected cohort rather than the absence of a true association. This question requires further study in larger patient populations, ideally including women undergoing infertility evaluation, who are passively followed into their midlife years.
Some other study limitations need to be considered. Our study included only patients who had a history of infertility treatment, so we may have excluded women without access to reproductive health services, those who chose not to pursue treatment, or those who discontinued treatment for any reason. There is a chance that women who sought medical treatment for their infertility had better fertility outcomes, thus diminishing the long-term consequences on sexual function. The parity data are missing in about half the women in our cohort, but a considerable number of women had at least 1 child. However, we are unable to ascertain if the childbirth was prior to the diagnosis of infertility or later and whether it was the result of infertility treatment. Yet, it is also possible that women who sought treatment for infertility had more resistant infertility or struggled longer with infertility before seeking treatment; thus, infertility had a greater impact on them. While this may be possible, it has been shown that having a treatment choice, regardless of the results, associates with better life satisfaction, which could have positively affected the sexual function in these women.44 Our study additionally lacks information on the type of infertility treatment received, duration of infertility treatment, treatment outcome, and time gap between infertility treatment and assessment of sexual function, all of which can affect this association. For example, more invasive infertility treatments or treatments that cause high financial burden, such as in vitro fertilization or surgical procedures, are expected to impose increased stress on the couple and may influence sexual function more profoundly; however, previous studies addressing these questions are lacking. In addition to addressing the limitations elaborated here, future studies should focus on assessment of sexual function in midlife women in a more representative sample, including racially and ethnically diverse women, those belonging to lower socioeconomic strata, and those who were never treated for infertility.
Given the high prevalence of sexual dysfunction and its significant impact on the quality of life of midlife women, the study of factors contributing to it is important. This is essential for offering comprehensive and individualized treatment options to women with FSD or those who are at risk for it.
Conclusion
The experience of infertility is stressful for women, and its impact can last for years. Infertility is commonly associated with FSD in women of reproductive age, with a potential for a long-lasting impact on female sexual function well into the midlife years, although that was not found in our study. Further research is needed to study this association such that appropriate and comprehensive counseling can be offered to women with infertility.
Acknowledgments
Abstract presented at the International Menopause Society Annual Meeting, October 2022.
Contributor Information
Mariam Saadedine, Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, 32224, United States; Center for Women’s Health, Mayo Clinic, Rochester, MN, 55905, United States.
Stephanie S Faubion, Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, 32224, United States; Center for Women’s Health, Mayo Clinic, Rochester, MN, 55905, United States.
Juliana M Kling, Center for Women’s Health, Mayo Clinic, Rochester, MN, 55905, United States; Division of Women’s Health Internal Medicine, Mayo Clinic, Scottsdale, AZ, 85259, United States.
Carol Kuhle, Center for Women’s Health, Mayo Clinic, Rochester, MN, 55905, United States; Division of General Internal Medicine, Mayo Clinic, Rochester, MN, 55905, United States.
Chrisandra L Shufelt, Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, 32224, United States; Center for Women’s Health, Mayo Clinic, Rochester, MN, 55905, United States.
Kristin Mara, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, 55905, United States.
Felicity Enders, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, 55905, United States.
Ekta Kapoor, Center for Women’s Health, Mayo Clinic, Rochester, MN, 55905, United States; Division of General Internal Medicine, Mayo Clinic, Rochester, MN, 55905, United States; Women’s Health Research Center, Mayo Clinic, Rochester, MN, 55905, United States; Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, 55905, United States.
Author contributions
M.S.: conceptualization, formal analysis, methodology, writing–original draft. S.S.F.: conceptualization, formal analysis, investigation, methodology, supervision, writing–review and editing. J.M.K.: formal analysis, writing–review and editing. C.K.: formal analysis, writing–review and editing. C.L.S.: formal analysis, writing–review and editing. K.M.: data curation, formal analysis, methodology, resources, writing–review and editing. F.E.: formal analysis, writing–review and editing. E.K.: conceptualization, formal analysis, investigation, methodology, supervision, writing–review and editing.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sector. E.K.’s time is partially supported by the National Institute on Aging (grant U54 AG044170).
Conflicts of interest: J.M.K.: consulting for Proctor & Gamble, Triangle Insights Group, and Everyday Health. E.K. has no conflicts of interest directly related to the subject of this article. However, over the past 36 months, she has had the following conflicts of interest: she has been a consultant for Astellas and Mithra Pharmaceuticals, Scynexis, and Womaness; has received grant support from Mithra Pharmaceuticals; has received payment for development of educational content from Med Learning Group and Academy of Continued Healthcare Learning; and has received honoraria for CME activity from CogniMed, PriMed, and OBG Management.
Data availability
None.
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