According to the results, the prevalence of SD in the participating older women was 94.5%. In agreement with the present study, the prevalence of SD in Iranian women of reproductive age has been reported as 98.5%, 91%, and 80.6% in three studies (27-29). Another study conducted in Iran reported the prevalence of SD in older women group as 81.5% (28). In two studies conducted on older women in Britain and the US, the prevalence of SD was reported as 55.7% and 71%, respectively(30, 31). Also, according to community-based studies, the prevalence of SD was 25% to 63% in women of all ages(32), and 68% to 86% in postmenopausal and older women(7). The present findings showed that SD was more frequent in Iranian older women compared to other countries.
In the present study, arousal and desire were the most common dysfunctional dimensions. In agreement with the present study, in a study conducted in Iran(33) and several studies in other countries(10, 34, 35), dysfunction in sexual desire and arousal was more prevalent in older women. In contrast, in a study conducted on British older women, Mitchell et al. showed that, after sexual desire, lubrication was the more prevalent dysfunction dimension(30). In another study, Hughes et al. observed that lubrication was the more prevalent dimension of sexual dysfunction after desire in older women in the US(31). The disparity in the results appears to be due to the differences in the questionnaires used. In older women assessed using the standard FSFI, sexual desire and arousal were more prevalent than the other dysfunctions.
The present findings showed that the duration of menopause was one of the factors predicting SF in the study subjects. In agreement with these results, in the study by Lonnèe-Hoffmann et al. on postmenopausal Australian women, the SF score reduced as the duration of menopause increased(36). In another study on postmenopausal Malaysian women, Dhillon et al. showed a reduction in SF after menopause, which seems to have been due to postmenopausal dyspareunia, reduced lubrication, and sexual desire(37). In a review of literature on postmenopausal SF, Hayes & Dennerstein reported that, following menopause, sexual desire and the frequency of sexual relations reduce while SD exacerbates with increases in age and the duration of menopause(38). In another review study, Nazarpour confirmed that the hormonal and physical consequences of menopause are a predictor of SD. Clearly, many physiological, anatomic, and hormonal changes occur with age and the onset of menopause that directly and indirectly affect women’s SF(7).
In the present study, the most important and significant predictor of SD was emotional closeness and intimacy to the spouse. Women who had greater intimacy and emotional closeness to their spouse enjoyed a better SF. In their studies on women of reproductive age in Iran, Masoumi et al. and Tehrani et al. emphasized the predictive effect of satisfaction with the marriage and the relationship with the spouse on SD(39, 40). In another study, Chizari et al. showed that women who have a happier family life and love their spouse have a more favorable SF(41). In another study on older women, Mernone et al. showed that the spousal relationships, which involves intimacy and emotional support, is a major predictor of women’s SF(42). In a qualitative study, Harder et al. reported that intimacy with the spouse is a key factor in older women’s SF. In short, intimacy consists of five components, including commitment, interdependence, emotional intimacy, cognitive intimacy, and physical intimacy(43). Physical and emotional intimacy lead to sexual intimacy, and in turn, sexual intimacy is focused on physical closeness and sexual intercourse. That is, sexual intimacy does not only involve sexual intercourse, but also caressing, cuddling, and emotional and physical touch. Examining older women’s intimacy should be carried out with the knowledge that hormonal changes and physical illnesses affect women’s sexual intimacy. In general, sexual desire and physical intimacy are apparently affected by various aspects, including the quality of the relationship with the spouse and the partner’s health status (physical, psychological, and sexual), just as the spouse’s sexual function was among the predictors of sexual dysfunction in the participating older women in this study(44).
The present findings showed that depression and anxiety were among the significant predictors of SD in older women. In agreement with these findings, studies conducted on Iranian women of reproductive age have shown that psychological factors are strong predictors of women’s SD(45-47). In a review study, McCabe et al. showed that depression and anxiety and the relationship between spouses are among the confirmed risk factors of SD in women(11). Anxiety is regarded as the main component of SD in Barlow’s cognitive model(48). Research has also shown that depressed people feel persistent numbness, helplessness, worthlessness and guilt, and their SF is affected by the anticipation of failure(49). Anxiety and depression may lead to SD, and inversely, SD may cause anxiety and depression symptoms. When dealing with stressors, women are likely to experience some degrees of depression or anxiety symptoms. These neurological, physiological and cognitive processes cause changes in the expression of emotional states, which create similar changes in the person’s capacity for sexual responsiveness(50). Saberi et al. also showed that depression and anxiety directly affect Iranian women’s SF(8).
Overall, despite the reduction in sexual desire and activity in old age, the effect of psychological status and the intimacy and emotional closeness between spouses still affects older adults’ SF and is considered an important factor in older adults’ sexual relationships (44).
Strengths and Limitations
Although this is the first study on sexual dysfunction and its predictors in Iranian older women, the questions were answered in a self-reporting form, which constitutes a limitation of this study, and to resolve this limitation, the participants were trained and their ambiguities were answered. Although Karaj is a city welcoming many immigrants and though its residents have different cultures, it was not possible to examine all the different ethnicities residing there. A similar study is therefore recommended to be conducted in other geographical regions of Iran as well.