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International Journal of Nursing Practice 2015; 21: 575–583
RESEARCH PAPER
Relationship between menopausal symptoms and sexual dysfunction among married Turkish women in 40–65 age group Ayten Senturk Erenel RN Msc PhD Associate Professor, Department of Nursing, Faculty of Health Science, Gazi University, Ankara, Turkey
Zehra Golbasi RN Msc PhD Associate Professor, Department of Nursing, Faculty of Health Science, Cumhuriyet University, Sivas, Turkey
Tulay Kavlak RN Nurse, Gulhane Military Medical Academy Hospital, Ankara, Turkey
Serdar Dilbaz MD Professor, Faculty of Medicine, Düzce University, Düzce, Turkey
Accepted for publication August 2013 Senturk Erenel A, Golbasi Z, Kavlak T, Dilbaz S. International Journal of Nursing Practice 2015; 21: 575–583 Relationship between menopausal symptoms and sexual dysfunction among married Turkish women in 40–65 age group This was a cross-sectional study to analyse the relationship between menopausal symptoms and sexual dysfunction among 229 married Turkish women in the 40–65 age group. The study was carried out at a menopause clinic of a state hospital between 1 October and 31 December 2010. Data were collected with Personal Characteristics Form, Menopause Rating Scale (MRS) and the Arizona Sexual Experience Scale (ASEX). The average age of the women was 52.33 (SD = 4.80) years. The average MRS total score was 20.13(SD = 9.20). The ASEX mean score was 19.97 (SD = 5.44). It was determined that there is a positive meaningful relationship between ASEX mean score, MRS total mean score and the sub-score of women. From the results obtained from this study, it can be said that women have differing levels of menopausal symptoms, and as the severity of menopausal symptoms increases, there is an increase in sexual dysfunction. Key words: menopausal symptoms, sexual dysfunction, Turkish women.
INTRODUCTION Menopause is a physiological developmental event which is experienced universally by all women in middle age. A
Correspondence: Ayten Senturk Erenel, Department of Nursing, Faculty of Health Sciences, Gazi University, 06500 Ankara, Turkey. Email: [email protected] doi:10.1111/ijn.12309
woman in menopause has some physiological symptoms according to changes in ovary function and needs to adapt to these changes.1 In addition to these physiological changes, other social and psychological changes which occur during the period of middle age, such as retirement, children leaving home, changes in body image, chronic disease, loss of husband and so on, might influence the health and well-being of women.2,3 It is said that the © 2014 Wiley Publishing Asia Pty Ltd
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complex interaction between physiological, socialrelational and psychological changes experienced in the menopausal period have important effects on sexual function.4–6 Sexuality is a central aspect of female quality of life reflecting their bio-psycho and social well-being.7 Although sexual performance decreases with ageing, it is known that the sexual behaviours of middle-aged women are dependent on factors such as physical and mental wellbeing, quality of relationships, and living status. Moreover, factors, such as education, employment, social class, individual characteristics and stressors, socio-cultural environment, and attitude towards menopause, play important role in the sexuality of middle-aged women.6,8 Dennerstein and colleagues9 found that sexual responsiveness is adversely affected by both ageing and the menopausal transition. Moreover, vasomotor symptoms, sleep disturbance, changes in skin sensations, palpitations and headaches are frequently reported by women transitioning to menopause and these influence their motivation to be sexual and their ability to stay focused during sexual experiences.10 Varma et al.11 found that there is a relation between psychological symptoms in climacteric period and sexual problems. Lo and Kok12 found that Chinese women had fewer intimate contacts and less coitus when menopause progressed, and no lubrication was the commonest sexual dysfunction. Today, female life expectancy is increasing progressively throughout the world. So, the climacteric period comprises one third of an average woman’s life. Menopausal symptoms experienced in this period might have negative influence on all dimensions of health including sexual health and life quality. Studies show that sexual function problems are quite common among middle-aged women.7,13 Nappi and Lachowsky14 expressed that the prevalence of sexual symptoms at the menopause differs across studies depending on several factors such as sample size, design, hormonal status and country. Also, they state that the most common sexual complaints are reduced sexual desire, vaginal dryness and dyspareunia, poor arousal and orgasm, and impaired sexual satisfaction. Studies carried out in Turkey show that the prevalence of sexual dysfunction among middle-aged women range between 57.5% and 78%, which is higher than for younger adults.2,15–17 Biri et al.18 mentioned that the sexual activity of 25% of women had changed after menopause, and the most important difference was a decrease in the frequency of their sexual activity and an increase in dyspareunia. © 2014 Wiley Publishing Asia Pty Ltd
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There are many factors which influence the sexual function of climacteric women and the determination of them might be helpful in solving sexual function problems. Therefore, in this study we aimed to analyse the relation between menopausal symptoms and sexual function problems among married Turkish women in the 40–65 age group.
MATERIALS AND METHODS Participants The study was carried out at the menopause clinic of a state hospital cross-sectionally. The study included 229 women who registered for the first time at the menopause clinic for various reasons between 1 October and 31 December 2010. The criteria for inclusion in the study were registration at the menopause clinic for the first time, being married, having an active sexual life, being 40–65 years old and not currently using hormone replacement therapy. Women who met these criteria were informed about the research and those who gave verbal consent were included in the research. There were 269 women who met the inclusion criteria but 40 women did not want to participate in the study, asserting that they did not have time to fill in data collection forms (participation rate: 85.1%).
Data collection tools Personal characteristics form This form was developed by the researchers. It included questions about the basic personal characteristics of the women such as the age, education period, marriage year, total number of pregnancies and births. There were also questions which evaluated the menopausal condition, menopause duration, the way menopause started and attitude towards menopause. The attitude of women towards menopause was determined by the question: ‘If you were to express the menopausal period with a single word, what would it be?’ The answers to this question were grouped as positive, negative and neutral according to the semantic meaning of the word.
Menopause Rating Scale (MRS)
The MSR was developed by Heinemann and colleagues.19 It is composed of 11 items which includes menopausal complaints. The choices for each item are 0: none, 1: mild, 2: moderate, 3: severe and 4: extreme. This Likert-type scale has three sub-dimensions, namely: somatic, psychological and urogenital. Gürkan20 reviewed the validity and
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reliability of the scale for Turkish society. The test–retest method was used to test the reliability of the scale, and the correlation coefficient of the test–retest was 0.92 for the total score, 0.89 for somatic complaints, 0.91 for psychological complaints and 0.81 for urogenital complaints. Cronbach’s alpha reliability coefficient of MRS was 0.84 for the total score, 0.65 for somatic complaints, 0.79 for psychological complaints and 0.72 for urogenital complaints. The lowest score which can be obtained from the scale is 0 and the highest is 44. A greater total score obtained from the scale means more complaints and a negative response to the quality of life. We determined Cronbach’s alpha reliability coefficient for the MRS total score as 0.74.
Arizona Sexual Experience Scale (ASEX)
ASEX was developed by McGahuey and colleagues21 to scan and determine the sexual problems of patients quickly and easily. The scale is composed of five items and involves a Likert-type evaluation. There are different forms for women and men. It aims to evaluate sexual function and the relationship between the couple, excluding sexual orientation. The instructions require an evaluation of the previous week. The form for women which is used in the study has questions which examine sexual urge, psychological arousal, physiological arousal (vaginal lubrication), and capacity for having orgasm and satisfaction after orgasm. The scoring of each question ranges from 1 to 6, and the total score can therefore be in the range from 5 to 30. Low scores show that sexual response is powerful, easy and satisfactory, whereas high scores indicate sexual dysfunction. The validity and reliability of the Turkish form of the scale was reviewed by Soykan.22 In our study, Cronbach’s alpha reliability coefficient for the ASEX total score was determined as 0.90.
Procedure Researchers first of all determined whether women who registered at the menopause clinic met the inclusion criteria or not (being 40–65 years old, married and having an active sexual life). Women who met these criteria were informed about the research and asked whether they were willing to participate in it or not. The women, whose participation was voluntary, were taken to a quiet meeting room for the data collection. The data collection tools were filled in by researchers using face-to-face interviewing techniques. Any identity information was not recorded on the data collection tools.
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Ethical dimension The study was confirmed by the Ministry of Health and the Ethics Board of Etlik Zübeyde Hanım Gynecology Education and Research hospital (Approval no: 127). Each woman who met the inclusion criteria was informed about the research and those who gave verbal consent were included in the study. Women were told that they would not be paid or required to make payment for participating in the research. In addition to this, written consent was obtained from the institution where the research was carried out.
Statistical analysis Data were evaluated by computer using the SPSS 15.0 program (IBM Corporation, Armonk, NY, USA). Continuous data (age, marriage year, menopause duration, MRS and ASEX score, etc.) were shown with average and standard deviation. Discontinuous data (educational status, status of menopause, working conditions, etc.) were presented as a frequency distribution. The reliability of MRS and ASEX were tested by Cronbach’s alpha. MRS scores for some independent variables were analysed by using t-test. The relation between MRS and ASEX was evaluated with correlation analysis. Table 1 Menopausal characteristics of study sample Variable
n (%)
Menopause status Premenopausal Postmenopausal Menopause style Naturally menopause Surgically menopause Duration of menopause 5 years and below 6 years and above Mean years of menopause: 5.74 (SD = 3.92) The attitude towards menopause Negative† Neutral‡ Positive§
178 (77.7) 51 (22.3) 148 (83.1) 30 (16.9) 104 (58.4) 74 (41.6)
131 (57.2) 88 (38.4) 10 (4.4)
†
Bad, very bad, end of life, disease, distress, termination, loss, death, terrible, masculinizing, no good, difficult and such. ‡ Natural, normal, a period of life and such. § Relief, maturation, good and such.
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RESULTS The average age of the women was 52.33 (SD = 4.80) and 67.7% of them were in the 50–59 age group. The average age of the women’s husbands was 56.24 (SD = 5.88). The education period of 65.1% of women and 53.3% of their husbands was 5 years or below. The average marriage duration of the women was 31.55 years, and 76.4% of them did not work. The average number of pregnancies was 4.62 (SD = 2.93), and average number of births was 2.95 (SD = 1.51). Overall, 77.7% of the women were in the premenopausal period, and the average menopause duration was
5.74 (SD = 3.92) years. Of these, 83.1% of women had entered the menopause naturally; 57.2% of women defined the menopause period with negative words such as the end of life, distress, loss and scary (Table 1). The total mean MRS score was 20.13 (SD = 9.20). When the sub-scores of MRS were analysed, the mean scores for somatic complaints, psychological complaints and urogenital complaints were, respectively, 7.49 (SD = 3.80), 7.91 (SD = 4.41) and 4.71 (SD = 3.49). When the total scores and sub-scores of MRS were analysed according to some of the independent variables, there was no statistically significant difference between
Table 2 MRS scores of study sample by some characteristics Variable
Age 40–49 50 and above t/p Years of education 5 years and below 6 years and above t/p Menopause status Postmenopausal Premenopausal t/p Menopause style Naturally Surgically t/p Duration of menopause 5 years and below 6 years and above t/p The attitude towards menopause Negative Neutral or positive t/p Total
MRS scores Somatic symptoms† X (SD)
Psychological symptoms† X (SD)
Urogenital symptoms‡ X (SD)
Total MRS Score§ X (SD)
7.06 (3.54) 7.64 (3.88) −0.99/0.321
6.89 (4.31) 8.26 (4.41) −2.04/0.042
4.15 (3.49) 4.90 (3.49) −1.41/0.158
18.12 (9.15) 20.81 (9.14) −1.93/0.054
7.93 (3.98) 6.68 (3.30) 2.38/0.018
8.52 (4.35) 6.78 (4.34) 2.87/0.004
4.73 (3.52) 4.68 (3.46) 0.09/0.928
21.18 (9.16) 18.18 (8.94) 2.39/0.017
7.60 (3.74) 7.13 (4.02) 0.76/0.444
7.93 (4.60) 7.83 (3.74) 0.135/0.893
4.91 (3.41) 4.03 (3.75) 1.57/0.117
20.44 (9.28) 19.01 (8.90) 0.97/0.329
7.52 (3.76) 7.96 (3.66) −0.58/0.559
7.95 (4.51) 7.86 (5.10) 0.09/0.926
5.06 (3.47) 4.13 (2.97) 1.37/0.172
20.54 (9.48) 19.96 (8.33) 0.31/0.756
7.65 (3.46) 7.52 (4.11) 0.22/0.824
8.05 (4.60) 7.77 (4.53) 0.41/0.683
4.72 (3.32) 5.17 (3.53) −0.87/0.382
20.43 (8.80) 20.47 (9.98) −0.02/0.977
8.61 (3.72) 6.00 (3.37) 5.47/0.001 7.49 (3.80)
9.10 (4.22) 6.32 (4.18) 4.94/0.001 7.91 (4.41)
5.39 (3.44) 3.80 (3.37) 3.48/0.001 4.71 (3.49)
23.12 (8.50) 16.13 (8.59) 6.12/0.001 20.13 (9.20)
†
Maximum score 16; higher scores indicate increased severity of symptoms. ‡ Maximum score 12; higher scores indicate increased severity of symptoms. § Maximum score 44; higher scores indicate increased severity of symptoms. Statistically significant results are shown as bold. MRS, Menopause Rating Scale; t/p, independent samples t-test/P value.
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mean scores of women according to their menopausal condition, the way they entered menopause and menopause duration (P > 0.05). The mean score for psychological complaints of women who are aged 50 and above was higher than those who were in the 40–49 age group (P < 0.05). Both the total score and the mean score for somatic complaints and psychological complaints of women whose education period was 5 years or below were higher than those whose education period was 6 years and above (P < 0.05). The MRS total scores and the average of all sub-scores of women who had a negative attitude towards menopause were higher than those whose attitude towards menopause was positive or neutral (P < 0.05; Table 2). The ASEX total mean score for women was 19.97 (SD = 5.44). As it is considered that the breakpoint is 19 in the original form of the scale, it was determined that 56.8% of the women had a sexual function problem (Table 3). When the ASEX total score and mean score of the sub-dimensions were analysed according to the specific characteristics of women, it was determined that sexual urge, psychological arousal, orgasm capacity, satisfaction and ASEX total mean score of women who were in the age group of 50 and above and whose menopause duration was more than 5 years were higher than for women in the 40–49 age group and whose menopause duration was 5 years or below (P < 0.05). The mean score for sexual urge in women whose education period was 5 years or below was higher than for those whose education period was 6 years and above (P < 0.05). The psychological arousal, physiological arousal, orgasm capacity, Table 3 ASEX scores of study sample ASEX
Mean (SD)
Drive† Arousal† Lubrication† Orgasm† Satisfaction of orgasm† ASEX total score‡ ASEX total score > 19 (%56.8)
4.47 (1.27) 3.95 (1.31) 3.46 (1.25) 4.41 (1.19) 3.65 (1.31) 19.97 (5.44)
†
Maximum score 6; higher scores indicate the presence of problems related to sexual function. ‡ Maxium score 30; higher scores indicate the presence of problems related to sexual function. ASEX, Arizona Sexual Experience Scale.
satisfaction and total ASEX mean score of women who were in the postmenopausal period were higher than for those who were in the premenopausal period (P < 0.05). Sexual urge, psychological arousal, physiological arousal, satisfaction and the total ASEX mean score of women who had a negative perception about the menopause period were higher than those who had a positive or neutral perception (P < 0.05). The way they entered menopause did not influence ASEX mean score (P > 0.05, Table 4). When the correlation between the total scores and sub-scores of MRS and ASEX of women was analysed, it was determined that there was a positive statistically meaningful relation between the total scores and sub-scores of both (P < 0.05, Table 5).
DISCUSSION Menopause is an important physiological and developmental event in the lifetime of women. Most women experience various menopausal symptoms due to physiological, social and psychological changes that occur during this transition. Studies show that although its prevalence and severity differs, most women throughout the world experience classic menopausal symptoms such as feeling hot, having night sweats and mood changes.23–25 In this study, we measured the menopausal symptoms of Turkish women in the 40–65 age group by using MRS and found that the women experienced different severities of menopausal symptoms. The score for psychological complaints of women who are 50 and above was higher. Both somatic and psychological complaint scores and total symptom scores of women with a low educational level was higher. The symptom score for the total score and all sub-scores of women who had a negative perception of menopause was significantly high. In the study by Karaçam and S¸eker,26 it was stated that women with a lower educational level experience have more menopausal symptoms. Fagulha and colleagues25 found that menopausal symptom frequency was high in women with a low education level. In the study by Çoban and colleagues,27 it was stated that women who have a positive attitude towards menopause experience fewer menopausal symptoms. A systematic review by Ayers and colleagues28 reported that women with more negative attitudes towards the menopause in general report more symptoms during the menopausal transition. According to these results, it can be said that women’s educational status and perception of the menopausal period might be effective in reducing menopausal symptoms. © 2014 Wiley Publishing Asia Pty Ltd
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Table 4 ASEX Scores of study sample by some characteristics Variable
Age 40–49 50 and above t/p Years of education 5 years and below 6 years and above t/p Menopause status Postmenopausal Premenopausal t/p Menopause style Naturally Surgically t/p Duration of menopause 5 years and below 6 years and above t/p The attitude towards menopause Negative Neutral or positive t/p
ASEX score Drive† X (SD)
Arousal† X (SD)
Lubrication† X (SD)
Orgasm† X (SD)
Satisfaction from orgasm† X (SD)
Total ASEX score‡ X (SD)
3.98 (1.29) 4.63 (1.22) 3.46/0.001
3.53 (1.36) 4.09 (1.27) 2.83/0.005
3.18 (1.24) 3.56 (1.24) 1.96/0.051
3.91 (1.34) 4.57 (1.08) 3.78/0.000
3.18 (1.33) 3.81 (1.26) 3.19/0.002
17.84 (5.66) 20.70 (5.18) 3.53/0.000
4.61 (1.23) 4.21 (1.30) 2.27/0.024
4.07 (1.31) 3.72 (1.30) 1.92/0.056
3.49 (1.22) 3.41 (1.30) 0.48/0.630
4.50 (1.20) 4.23 (1.15) 1.61/0.107
3.73 (1.29) 3.51 (1.34) 1.20/0.229
20.43 (5.43) 19.12 (5.39) 1.74/0.082
4.53 (1.28) 4.23 (1.19) 1.50/0.133
4.04 (1.31) 3.62 (1.28) 2.00/0.046
3.56 (1.22) 3.13 (1.31) 2.15/0.033
4.50 (1.16) 4.09 (1.23) 2.14/0.033
3.75 (1.24) 3.29 (1.47) 2.25/0.025
20.43 (5.26) 18.39 (5.79) 2.38/0.018
4.56 (1.29) 4.40 (1.27) 0.64/0.518
4.12 (1.30) 3.66 (1.32) 1.73/0.085
3.63 (1.22) 3.20 (1.86) 1.78/0.076
4.55 (1.13) 4.23 (1.30) 1.37/0.170
3.79 (1.27) 3.56 (1.07) 0.92/0.357
20.70 (5.29) 19.06 (4.99) 1.56/0.120
4.35 (1.29) 4.79 (1.24) 2.27/0.024
3.83 (1.35) 4.33 (1.20) 2.53/0.012
3.46 (1.28) 3.70 (1.13) 1.29/0.197
4.33 (1.21 4.72 (1.05) 2.24/0.026
3.55 (1.26) 4.04 (1.17) 2.59/0.013
19.60 (5.43) 21.59 (4.82) 2.51/0.013
4.69 (1.26) 4.17 (1.22) 3.12/0.002
4.11 (1.26) 3.73 (1.36) 2.17/0.031
3.64 (1.22) 3.22 (1.26) 2.56/0.011
4.52 (1.19) 4.25 (1.16) 1.71/0.088
3.81 (1.32) 3.43 (1.26) 2.17/0.031
20.80 (5.34) 18.86 (5.41) 2.70/0.007
†
Maximum of 6 points; higher scores indicate the presence of problems related to sexual function. ‡ Maxium of 30 points; higher scores indicate the presence of problems related to sexual function. Statistically significant results are shown as bold. ASEX, Arizona Sexual Experience Scale; t/p, independent samples t-test/P value.
In this study we did not find any meaningful difference between the age of women, menopausal condition and menopause durations. However, there are different research results in the literature. Dhillon and colleagues24 found that symptoms of fluctuation of mood, headache and feeling hot were observed more rarely among women whose menopausal duration is more than 5 years, but vaginal discomfort was rather more common. In this study we have evaluated the sexual problems of women with ASEX. By taking 19 as the breakpoint in the original form of the scale, it was determined that more than half of the women have a sexual problem. When we © 2014 Wiley Publishing Asia Pty Ltd
compared the ASEX mean score according to the specific characteristics of women, we determined that women who are 50 years and above, in the postmenopausal period, whose menopause duration is 5 years or more, and who have a negative attitude towards menopause have more sexual function problems. In the previous literature it has been stated that sexual dysfunction is quite common among climacteric women,3,14 that these problems especially increase during the postmenopausal period1,9,16,29 and that sexual satisfaction decreases.30 In their study of the sexual function problems of women Kömürcü and ˙I ¸sbilen15 found that sexual function problems increase
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Table 5 The correlation between MRS scores and ASEX scores MRS
ASEX Drive
Arousal
Lubrication
Orgasm
Satisfaction from orgazm
Total ASEX score
0.250 0.375 0.556 0.495
0.208 0.244 0.690 0.466
0.246 0.368 0.445 0.448
0.229 0.321 0.580 0.469
0.266 0.368 0.680 0.545
r† Somatic symptoms Psychological symptoms Urogenital symptoms Total MRS score †
0.209 0.272 0.632 0.457
The relationship between all variables is significant at 0.01 level. ASEX, Arizona Sexual Experience Scale; MRS, Menopause Rating Scale.
with increasing age. Nappi and colleagues31 stated that women’s attitudes towards menopause seemed to play a role in the clinical relevance of sexual dysfunction. Our results are coherent with this literature. In this study we have found a positive relation between menopausal symptoms and sexual problems. As the severity of the menopausal symptoms of women increases, so do their sexual problems. The specific research results of previous literature has shown that there is a relation between the menopausal symptoms of women and their sexual problems. In their studies which were carried on European women, Nappi and Nijland6 stated that women perceive menopause as an event which causes a decrease in sexual drive and that women who do not experience menopausal symptoms have higher sexual satisfaction. Aslan and colleagues32 found that women who regard menopause as an event which has negative effects on their sexual life experience more sexual function problems. In another study, MRS urogenital scores significantly correlated with total Female Sexual Function Index (FSFI) scores.7 In the study by Chedraui and colleagues,33 which was carried out by using FSFI, it was found that women who have hot flashes have lower sexual function. The results of a study by Valadares and colleagues34 which was carried out with Brazilian women in the 40–65 age group, showed that sexuality scores of women who experience menopausal symptoms such as insomnia, depression and having hot flashes were lower. Nappi and colleagues31 demonstrated that vasomotor and psychological symptoms were expressed significantly in women with sexual dysfunctions during menopause.
CONCLUSIONS The results obtained from this study show that married Turkish women in the 40–65 age group had different levels of menopausal symptoms. Moreover, more than half of the women had a negative attitude towards menopause. Older women in the age group, those with a lower education level and those who have a negative attitude towards menopause experience more menopausal symptoms. Most of the women had sexual dysfunction. There is a positive relation between menopausal symptoms and sexual dysfunction. According to these results, it can be said that interventions for climacteric women aimed at coping with menopausal symptoms can contribute to the decrease of their sexual problems and so increase their quality of life. In Turkey, sexuality is still taboo especially for women. Unfortunatelly, sexual problems are frequent among postmenopausal women and these problems are infrequently discussed with physicians or nurses. Undiagnosed or untreated sexual problems, or both, can lead to or occur with depression or social withdrawal. Actually, nurses have a vital role to play in helping women to cope during and after the menopause, offering individual assessment, education and support. To know the relationship between menopausal symptoms and sexual function in this group, women is one of the important factor to improving the quality of nursing care.
CONFLICT OF INTEREST The authors declare no conflict of interest. © 2014 Wiley Publishing Asia Pty Ltd
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factors associated in women 40 to 65 years old). Maltepe Üniversitesi Hems¸irelik Bilim ve Sanatı Dergisi 2009; 2: 46– 59. Çalıs¸kan E, Çorakçı A, Dog˘er E, Cos¸kun E, Özeren S, Çorapçıog˘lu A. Türk kadınlarının menopoza geçis¸ ile menopoz döneminde cinsel fonksiyonlarının ve yas¸am kalitesinin kesitsel olarak deg˘erlendirilmesi (Evaluation of sexual functionand quality of life in menopausal transition and menopause in a cohort of Turkish Women). Turkiye Klinikleri Journal of Medical Sciences 2010; 30: 1517– 1523. Biri A, Korucuoglu U, Ilhan M, Bingol B, Yilmaz E, Biri H. Turkish women’s level of knowledge on and attitude toward sexual health. Maturitas 2007; 58: 236–240. Heinemann K, Ruebig A, Potthoff P et al. The Menopause Rating Scale (MRS) scale: A methodological review. Health and Quality of Life Outcomes 2004; 2: 45. doi: 10.1186/14777525-2-45. Gürkan ÖC. Menopoz semptomları deg˘erlendirme ölçeg˘inin Türkçe formunun güvenirlik ve geçerlilig˘i. Hems¸irelik Forumu Dergisi 2005; Mayıs-Haziran: 30–35. McGahuey CA, Gelenberg AJ, Laukes CA, Moreno FA, Delgado PL. The Arizona Sexual Experience Scale (ASEX): Reliability and validity. Journal of Sex & Marital Therapy 2000; 26: 25–40. Soykan A. The reliability and validity of Arizona Sexual Experiences Scale in Turkish ESRD patients undergoing hemodialysis. International Journal of Impotence Research 2004; 16: 531–534. Bairy L, Adiga S, Bhat P, Bhat R. Prevalence of menopausal symptoms and quality of life after menopause in women from South India. Australian and New Zealand Journal of Obstetrics and Gynaecology 2009; 49: 106–109. Dhillon HK, Singh HJ, Shuib R, Hamidd AM, Mahmooda NMZN. Prevalence of menopausal symptoms in women in Kelantan, Malaysia. Maturitas 2006; 54: 213–221. Fagulha T, Gonçalves B, Ferreira A. A population-based assessment of midlife portuguese women’s experience of perimenopause and menopause. Health Care for Women International 2011; 32: 559–580. Karaçam Z, S¸eker SE. Factors associated with menopausal symptoms and their relationship with the quality of life among Turkish women. Maturitas 2007; 58: 75–82. Çoban A, Nehir S, Demirci H, Özbas¸aran F, ˙I nceboz Ü. Klimakterik Dönemdeki Evli Kadınların Es¸ Uyumları ve Menopoza ˙I lis¸kin Tutumlarının Menopozal Yakınmalar Üzerine Etkisi (The impact on menopausal symptoms of marital adjustment and attitude toward menopausal of married women in the climacteric period). Fırat Üniversitesi Sag˘lık Bilimleri Dergisi 2008; 22: 343–349. Ayers B, Forshaw M, Hunter M. The impact of attitudes towards the menopause on women’s symptom experience: A systematic review. Maturitas 2010; 65: 28–36.
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29 Verit FF, Verit A, Billurcu N. Low sexual function and its associated risk factors in pre- and postmenopausal women without clinically significant depression. Maturitas 2009; 64: 38–42. 30 Tomic D, Gallicchio L, Whitemana MK, Lewis LM, Langenberg P, Flawsa JA. Factors associated with determinants of sexual functioning in midlife women. Maturitas 2006; 53: 144–157. 31 Nappi RE, Veroni F, Verde JB et al. Climacteric complaints, female identity, and sexual dysfunctions. Journal of Sex & Marital Therapy 2001; 27: 567–576. 32 Aslan E, Poçan GA, Dolapçıog˘lu K, Savas¸ N, Bag˘ıs¸ T. Menopoz sonrasındaki cinsel disfonksiyonun hormonal
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durum ve sosyokültürel faktörlerle etkiles¸imi (The influence of hormonal status and socio-cultural determinants on postmenopausal sexual dysfunction). Journal of Turkish Society of Obstetric and Gynecology 2008; 5: 263–268. 33 Chedraui P, Pérez-López FR, Sánchez H et al. Assessment of sexual function of mid-aged Ecuadorian women with the 6-item Female Sexual Function Index. Maturitas 2012; 71: 407–4012. 34 Valadares AL, Pinto-Neto AM, Osis MJ, Conde DM, Sousa MH, Costa-Paiva L. Sexuality in Brazilian women aged 40 to 65 years with 11 years or more of formal education: Associated factors. Menopause (New York, N.Y.) 2008; 15: 264–269.
© 2014 Wiley Publishing Asia Pty Ltd
International Journal of Nursing Practice 2015; 21: 575–583
RESEARCH PAPER
Relationship between menopausal symptoms and sexual dysfunction among married Turkish women in 40–65 age group Ayten Senturk Erenel RN Msc PhD Associate Professor, Department of Nursing, Faculty of Health Science, Gazi University, Ankara, Turkey
Zehra Golbasi RN Msc PhD Associate Professor, Department of Nursing, Faculty of Health Science, Cumhuriyet University, Sivas, Turkey
Tulay Kavlak RN Nurse, Gulhane Military Medical Academy Hospital, Ankara, Turkey
Serdar Dilbaz MD Professor, Faculty of Medicine, Düzce University, Düzce, Turkey
Accepted for publication August 2013 Senturk Erenel A, Golbasi Z, Kavlak T, Dilbaz S. International Journal of Nursing Practice 2015; 21: 575–583 Relationship between menopausal symptoms and sexual dysfunction among married Turkish women in 40–65 age group This was a cross-sectional study to analyse the relationship between menopausal symptoms and sexual dysfunction among 229 married Turkish women in the 40–65 age group. The study was carried out at a menopause clinic of a state hospital between 1 October and 31 December 2010. Data were collected with Personal Characteristics Form, Menopause Rating Scale (MRS) and the Arizona Sexual Experience Scale (ASEX). The average age of the women was 52.33 (SD = 4.80) years. The average MRS total score was 20.13(SD = 9.20). The ASEX mean score was 19.97 (SD = 5.44). It was determined that there is a positive meaningful relationship between ASEX mean score, MRS total mean score and the sub-score of women. From the results obtained from this study, it can be said that women have differing levels of menopausal symptoms, and as the severity of menopausal symptoms increases, there is an increase in sexual dysfunction. Key words: menopausal symptoms, sexual dysfunction, Turkish women.
INTRODUCTION Menopause is a physiological developmental event which is experienced universally by all women in middle age. A
Correspondence: Ayten Senturk Erenel, Department of Nursing, Faculty of Health Sciences, Gazi University, 06500 Ankara, Turkey. Email: [email protected] doi:10.1111/ijn.12309
woman in menopause has some physiological symptoms according to changes in ovary function and needs to adapt to these changes.1 In addition to these physiological changes, other social and psychological changes which occur during the period of middle age, such as retirement, children leaving home, changes in body image, chronic disease, loss of husband and so on, might influence the health and well-being of women.2,3 It is said that the © 2014 Wiley Publishing Asia Pty Ltd
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complex interaction between physiological, socialrelational and psychological changes experienced in the menopausal period have important effects on sexual function.4–6 Sexuality is a central aspect of female quality of life reflecting their bio-psycho and social well-being.7 Although sexual performance decreases with ageing, it is known that the sexual behaviours of middle-aged women are dependent on factors such as physical and mental wellbeing, quality of relationships, and living status. Moreover, factors, such as education, employment, social class, individual characteristics and stressors, socio-cultural environment, and attitude towards menopause, play important role in the sexuality of middle-aged women.6,8 Dennerstein and colleagues9 found that sexual responsiveness is adversely affected by both ageing and the menopausal transition. Moreover, vasomotor symptoms, sleep disturbance, changes in skin sensations, palpitations and headaches are frequently reported by women transitioning to menopause and these influence their motivation to be sexual and their ability to stay focused during sexual experiences.10 Varma et al.11 found that there is a relation between psychological symptoms in climacteric period and sexual problems. Lo and Kok12 found that Chinese women had fewer intimate contacts and less coitus when menopause progressed, and no lubrication was the commonest sexual dysfunction. Today, female life expectancy is increasing progressively throughout the world. So, the climacteric period comprises one third of an average woman’s life. Menopausal symptoms experienced in this period might have negative influence on all dimensions of health including sexual health and life quality. Studies show that sexual function problems are quite common among middle-aged women.7,13 Nappi and Lachowsky14 expressed that the prevalence of sexual symptoms at the menopause differs across studies depending on several factors such as sample size, design, hormonal status and country. Also, they state that the most common sexual complaints are reduced sexual desire, vaginal dryness and dyspareunia, poor arousal and orgasm, and impaired sexual satisfaction. Studies carried out in Turkey show that the prevalence of sexual dysfunction among middle-aged women range between 57.5% and 78%, which is higher than for younger adults.2,15–17 Biri et al.18 mentioned that the sexual activity of 25% of women had changed after menopause, and the most important difference was a decrease in the frequency of their sexual activity and an increase in dyspareunia. © 2014 Wiley Publishing Asia Pty Ltd
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There are many factors which influence the sexual function of climacteric women and the determination of them might be helpful in solving sexual function problems. Therefore, in this study we aimed to analyse the relation between menopausal symptoms and sexual function problems among married Turkish women in the 40–65 age group.
MATERIALS AND METHODS Participants The study was carried out at the menopause clinic of a state hospital cross-sectionally. The study included 229 women who registered for the first time at the menopause clinic for various reasons between 1 October and 31 December 2010. The criteria for inclusion in the study were registration at the menopause clinic for the first time, being married, having an active sexual life, being 40–65 years old and not currently using hormone replacement therapy. Women who met these criteria were informed about the research and those who gave verbal consent were included in the research. There were 269 women who met the inclusion criteria but 40 women did not want to participate in the study, asserting that they did not have time to fill in data collection forms (participation rate: 85.1%).
Data collection tools Personal characteristics form This form was developed by the researchers. It included questions about the basic personal characteristics of the women such as the age, education period, marriage year, total number of pregnancies and births. There were also questions which evaluated the menopausal condition, menopause duration, the way menopause started and attitude towards menopause. The attitude of women towards menopause was determined by the question: ‘If you were to express the menopausal period with a single word, what would it be?’ The answers to this question were grouped as positive, negative and neutral according to the semantic meaning of the word.
Menopause Rating Scale (MRS)
The MSR was developed by Heinemann and colleagues.19 It is composed of 11 items which includes menopausal complaints. The choices for each item are 0: none, 1: mild, 2: moderate, 3: severe and 4: extreme. This Likert-type scale has three sub-dimensions, namely: somatic, psychological and urogenital. Gürkan20 reviewed the validity and
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reliability of the scale for Turkish society. The test–retest method was used to test the reliability of the scale, and the correlation coefficient of the test–retest was 0.92 for the total score, 0.89 for somatic complaints, 0.91 for psychological complaints and 0.81 for urogenital complaints. Cronbach’s alpha reliability coefficient of MRS was 0.84 for the total score, 0.65 for somatic complaints, 0.79 for psychological complaints and 0.72 for urogenital complaints. The lowest score which can be obtained from the scale is 0 and the highest is 44. A greater total score obtained from the scale means more complaints and a negative response to the quality of life. We determined Cronbach’s alpha reliability coefficient for the MRS total score as 0.74.
Arizona Sexual Experience Scale (ASEX)
ASEX was developed by McGahuey and colleagues21 to scan and determine the sexual problems of patients quickly and easily. The scale is composed of five items and involves a Likert-type evaluation. There are different forms for women and men. It aims to evaluate sexual function and the relationship between the couple, excluding sexual orientation. The instructions require an evaluation of the previous week. The form for women which is used in the study has questions which examine sexual urge, psychological arousal, physiological arousal (vaginal lubrication), and capacity for having orgasm and satisfaction after orgasm. The scoring of each question ranges from 1 to 6, and the total score can therefore be in the range from 5 to 30. Low scores show that sexual response is powerful, easy and satisfactory, whereas high scores indicate sexual dysfunction. The validity and reliability of the Turkish form of the scale was reviewed by Soykan.22 In our study, Cronbach’s alpha reliability coefficient for the ASEX total score was determined as 0.90.
Procedure Researchers first of all determined whether women who registered at the menopause clinic met the inclusion criteria or not (being 40–65 years old, married and having an active sexual life). Women who met these criteria were informed about the research and asked whether they were willing to participate in it or not. The women, whose participation was voluntary, were taken to a quiet meeting room for the data collection. The data collection tools were filled in by researchers using face-to-face interviewing techniques. Any identity information was not recorded on the data collection tools.
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Ethical dimension The study was confirmed by the Ministry of Health and the Ethics Board of Etlik Zübeyde Hanım Gynecology Education and Research hospital (Approval no: 127). Each woman who met the inclusion criteria was informed about the research and those who gave verbal consent were included in the study. Women were told that they would not be paid or required to make payment for participating in the research. In addition to this, written consent was obtained from the institution where the research was carried out.
Statistical analysis Data were evaluated by computer using the SPSS 15.0 program (IBM Corporation, Armonk, NY, USA). Continuous data (age, marriage year, menopause duration, MRS and ASEX score, etc.) were shown with average and standard deviation. Discontinuous data (educational status, status of menopause, working conditions, etc.) were presented as a frequency distribution. The reliability of MRS and ASEX were tested by Cronbach’s alpha. MRS scores for some independent variables were analysed by using t-test. The relation between MRS and ASEX was evaluated with correlation analysis. Table 1 Menopausal characteristics of study sample Variable
n (%)
Menopause status Premenopausal Postmenopausal Menopause style Naturally menopause Surgically menopause Duration of menopause 5 years and below 6 years and above Mean years of menopause: 5.74 (SD = 3.92) The attitude towards menopause Negative† Neutral‡ Positive§
178 (77.7) 51 (22.3) 148 (83.1) 30 (16.9) 104 (58.4) 74 (41.6)
131 (57.2) 88 (38.4) 10 (4.4)
†
Bad, very bad, end of life, disease, distress, termination, loss, death, terrible, masculinizing, no good, difficult and such. ‡ Natural, normal, a period of life and such. § Relief, maturation, good and such.
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RESULTS The average age of the women was 52.33 (SD = 4.80) and 67.7% of them were in the 50–59 age group. The average age of the women’s husbands was 56.24 (SD = 5.88). The education period of 65.1% of women and 53.3% of their husbands was 5 years or below. The average marriage duration of the women was 31.55 years, and 76.4% of them did not work. The average number of pregnancies was 4.62 (SD = 2.93), and average number of births was 2.95 (SD = 1.51). Overall, 77.7% of the women were in the premenopausal period, and the average menopause duration was
5.74 (SD = 3.92) years. Of these, 83.1% of women had entered the menopause naturally; 57.2% of women defined the menopause period with negative words such as the end of life, distress, loss and scary (Table 1). The total mean MRS score was 20.13 (SD = 9.20). When the sub-scores of MRS were analysed, the mean scores for somatic complaints, psychological complaints and urogenital complaints were, respectively, 7.49 (SD = 3.80), 7.91 (SD = 4.41) and 4.71 (SD = 3.49). When the total scores and sub-scores of MRS were analysed according to some of the independent variables, there was no statistically significant difference between
Table 2 MRS scores of study sample by some characteristics Variable
Age 40–49 50 and above t/p Years of education 5 years and below 6 years and above t/p Menopause status Postmenopausal Premenopausal t/p Menopause style Naturally Surgically t/p Duration of menopause 5 years and below 6 years and above t/p The attitude towards menopause Negative Neutral or positive t/p Total
MRS scores Somatic symptoms† X (SD)
Psychological symptoms† X (SD)
Urogenital symptoms‡ X (SD)
Total MRS Score§ X (SD)
7.06 (3.54) 7.64 (3.88) −0.99/0.321
6.89 (4.31) 8.26 (4.41) −2.04/0.042
4.15 (3.49) 4.90 (3.49) −1.41/0.158
18.12 (9.15) 20.81 (9.14) −1.93/0.054
7.93 (3.98) 6.68 (3.30) 2.38/0.018
8.52 (4.35) 6.78 (4.34) 2.87/0.004
4.73 (3.52) 4.68 (3.46) 0.09/0.928
21.18 (9.16) 18.18 (8.94) 2.39/0.017
7.60 (3.74) 7.13 (4.02) 0.76/0.444
7.93 (4.60) 7.83 (3.74) 0.135/0.893
4.91 (3.41) 4.03 (3.75) 1.57/0.117
20.44 (9.28) 19.01 (8.90) 0.97/0.329
7.52 (3.76) 7.96 (3.66) −0.58/0.559
7.95 (4.51) 7.86 (5.10) 0.09/0.926
5.06 (3.47) 4.13 (2.97) 1.37/0.172
20.54 (9.48) 19.96 (8.33) 0.31/0.756
7.65 (3.46) 7.52 (4.11) 0.22/0.824
8.05 (4.60) 7.77 (4.53) 0.41/0.683
4.72 (3.32) 5.17 (3.53) −0.87/0.382
20.43 (8.80) 20.47 (9.98) −0.02/0.977
8.61 (3.72) 6.00 (3.37) 5.47/0.001 7.49 (3.80)
9.10 (4.22) 6.32 (4.18) 4.94/0.001 7.91 (4.41)
5.39 (3.44) 3.80 (3.37) 3.48/0.001 4.71 (3.49)
23.12 (8.50) 16.13 (8.59) 6.12/0.001 20.13 (9.20)
†
Maximum score 16; higher scores indicate increased severity of symptoms. ‡ Maximum score 12; higher scores indicate increased severity of symptoms. § Maximum score 44; higher scores indicate increased severity of symptoms. Statistically significant results are shown as bold. MRS, Menopause Rating Scale; t/p, independent samples t-test/P value.
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mean scores of women according to their menopausal condition, the way they entered menopause and menopause duration (P > 0.05). The mean score for psychological complaints of women who are aged 50 and above was higher than those who were in the 40–49 age group (P < 0.05). Both the total score and the mean score for somatic complaints and psychological complaints of women whose education period was 5 years or below were higher than those whose education period was 6 years and above (P < 0.05). The MRS total scores and the average of all sub-scores of women who had a negative attitude towards menopause were higher than those whose attitude towards menopause was positive or neutral (P < 0.05; Table 2). The ASEX total mean score for women was 19.97 (SD = 5.44). As it is considered that the breakpoint is 19 in the original form of the scale, it was determined that 56.8% of the women had a sexual function problem (Table 3). When the ASEX total score and mean score of the sub-dimensions were analysed according to the specific characteristics of women, it was determined that sexual urge, psychological arousal, orgasm capacity, satisfaction and ASEX total mean score of women who were in the age group of 50 and above and whose menopause duration was more than 5 years were higher than for women in the 40–49 age group and whose menopause duration was 5 years or below (P < 0.05). The mean score for sexual urge in women whose education period was 5 years or below was higher than for those whose education period was 6 years and above (P < 0.05). The psychological arousal, physiological arousal, orgasm capacity, Table 3 ASEX scores of study sample ASEX
Mean (SD)
Drive† Arousal† Lubrication† Orgasm† Satisfaction of orgasm† ASEX total score‡ ASEX total score > 19 (%56.8)
4.47 (1.27) 3.95 (1.31) 3.46 (1.25) 4.41 (1.19) 3.65 (1.31) 19.97 (5.44)
†
Maximum score 6; higher scores indicate the presence of problems related to sexual function. ‡ Maxium score 30; higher scores indicate the presence of problems related to sexual function. ASEX, Arizona Sexual Experience Scale.
satisfaction and total ASEX mean score of women who were in the postmenopausal period were higher than for those who were in the premenopausal period (P < 0.05). Sexual urge, psychological arousal, physiological arousal, satisfaction and the total ASEX mean score of women who had a negative perception about the menopause period were higher than those who had a positive or neutral perception (P < 0.05). The way they entered menopause did not influence ASEX mean score (P > 0.05, Table 4). When the correlation between the total scores and sub-scores of MRS and ASEX of women was analysed, it was determined that there was a positive statistically meaningful relation between the total scores and sub-scores of both (P < 0.05, Table 5).
DISCUSSION Menopause is an important physiological and developmental event in the lifetime of women. Most women experience various menopausal symptoms due to physiological, social and psychological changes that occur during this transition. Studies show that although its prevalence and severity differs, most women throughout the world experience classic menopausal symptoms such as feeling hot, having night sweats and mood changes.23–25 In this study, we measured the menopausal symptoms of Turkish women in the 40–65 age group by using MRS and found that the women experienced different severities of menopausal symptoms. The score for psychological complaints of women who are 50 and above was higher. Both somatic and psychological complaint scores and total symptom scores of women with a low educational level was higher. The symptom score for the total score and all sub-scores of women who had a negative perception of menopause was significantly high. In the study by Karaçam and S¸eker,26 it was stated that women with a lower educational level experience have more menopausal symptoms. Fagulha and colleagues25 found that menopausal symptom frequency was high in women with a low education level. In the study by Çoban and colleagues,27 it was stated that women who have a positive attitude towards menopause experience fewer menopausal symptoms. A systematic review by Ayers and colleagues28 reported that women with more negative attitudes towards the menopause in general report more symptoms during the menopausal transition. According to these results, it can be said that women’s educational status and perception of the menopausal period might be effective in reducing menopausal symptoms. © 2014 Wiley Publishing Asia Pty Ltd
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Table 4 ASEX Scores of study sample by some characteristics Variable
Age 40–49 50 and above t/p Years of education 5 years and below 6 years and above t/p Menopause status Postmenopausal Premenopausal t/p Menopause style Naturally Surgically t/p Duration of menopause 5 years and below 6 years and above t/p The attitude towards menopause Negative Neutral or positive t/p
ASEX score Drive† X (SD)
Arousal† X (SD)
Lubrication† X (SD)
Orgasm† X (SD)
Satisfaction from orgasm† X (SD)
Total ASEX score‡ X (SD)
3.98 (1.29) 4.63 (1.22) 3.46/0.001
3.53 (1.36) 4.09 (1.27) 2.83/0.005
3.18 (1.24) 3.56 (1.24) 1.96/0.051
3.91 (1.34) 4.57 (1.08) 3.78/0.000
3.18 (1.33) 3.81 (1.26) 3.19/0.002
17.84 (5.66) 20.70 (5.18) 3.53/0.000
4.61 (1.23) 4.21 (1.30) 2.27/0.024
4.07 (1.31) 3.72 (1.30) 1.92/0.056
3.49 (1.22) 3.41 (1.30) 0.48/0.630
4.50 (1.20) 4.23 (1.15) 1.61/0.107
3.73 (1.29) 3.51 (1.34) 1.20/0.229
20.43 (5.43) 19.12 (5.39) 1.74/0.082
4.53 (1.28) 4.23 (1.19) 1.50/0.133
4.04 (1.31) 3.62 (1.28) 2.00/0.046
3.56 (1.22) 3.13 (1.31) 2.15/0.033
4.50 (1.16) 4.09 (1.23) 2.14/0.033
3.75 (1.24) 3.29 (1.47) 2.25/0.025
20.43 (5.26) 18.39 (5.79) 2.38/0.018
4.56 (1.29) 4.40 (1.27) 0.64/0.518
4.12 (1.30) 3.66 (1.32) 1.73/0.085
3.63 (1.22) 3.20 (1.86) 1.78/0.076
4.55 (1.13) 4.23 (1.30) 1.37/0.170
3.79 (1.27) 3.56 (1.07) 0.92/0.357
20.70 (5.29) 19.06 (4.99) 1.56/0.120
4.35 (1.29) 4.79 (1.24) 2.27/0.024
3.83 (1.35) 4.33 (1.20) 2.53/0.012
3.46 (1.28) 3.70 (1.13) 1.29/0.197
4.33 (1.21 4.72 (1.05) 2.24/0.026
3.55 (1.26) 4.04 (1.17) 2.59/0.013
19.60 (5.43) 21.59 (4.82) 2.51/0.013
4.69 (1.26) 4.17 (1.22) 3.12/0.002
4.11 (1.26) 3.73 (1.36) 2.17/0.031
3.64 (1.22) 3.22 (1.26) 2.56/0.011
4.52 (1.19) 4.25 (1.16) 1.71/0.088
3.81 (1.32) 3.43 (1.26) 2.17/0.031
20.80 (5.34) 18.86 (5.41) 2.70/0.007
†
Maximum of 6 points; higher scores indicate the presence of problems related to sexual function. ‡ Maxium of 30 points; higher scores indicate the presence of problems related to sexual function. Statistically significant results are shown as bold. ASEX, Arizona Sexual Experience Scale; t/p, independent samples t-test/P value.
In this study we did not find any meaningful difference between the age of women, menopausal condition and menopause durations. However, there are different research results in the literature. Dhillon and colleagues24 found that symptoms of fluctuation of mood, headache and feeling hot were observed more rarely among women whose menopausal duration is more than 5 years, but vaginal discomfort was rather more common. In this study we have evaluated the sexual problems of women with ASEX. By taking 19 as the breakpoint in the original form of the scale, it was determined that more than half of the women have a sexual problem. When we © 2014 Wiley Publishing Asia Pty Ltd
compared the ASEX mean score according to the specific characteristics of women, we determined that women who are 50 years and above, in the postmenopausal period, whose menopause duration is 5 years or more, and who have a negative attitude towards menopause have more sexual function problems. In the previous literature it has been stated that sexual dysfunction is quite common among climacteric women,3,14 that these problems especially increase during the postmenopausal period1,9,16,29 and that sexual satisfaction decreases.30 In their study of the sexual function problems of women Kömürcü and ˙I ¸sbilen15 found that sexual function problems increase
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Table 5 The correlation between MRS scores and ASEX scores MRS
ASEX Drive
Arousal
Lubrication
Orgasm
Satisfaction from orgazm
Total ASEX score
0.250 0.375 0.556 0.495
0.208 0.244 0.690 0.466
0.246 0.368 0.445 0.448
0.229 0.321 0.580 0.469
0.266 0.368 0.680 0.545
r† Somatic symptoms Psychological symptoms Urogenital symptoms Total MRS score †
0.209 0.272 0.632 0.457
The relationship between all variables is significant at 0.01 level. ASEX, Arizona Sexual Experience Scale; MRS, Menopause Rating Scale.
with increasing age. Nappi and colleagues31 stated that women’s attitudes towards menopause seemed to play a role in the clinical relevance of sexual dysfunction. Our results are coherent with this literature. In this study we have found a positive relation between menopausal symptoms and sexual problems. As the severity of the menopausal symptoms of women increases, so do their sexual problems. The specific research results of previous literature has shown that there is a relation between the menopausal symptoms of women and their sexual problems. In their studies which were carried on European women, Nappi and Nijland6 stated that women perceive menopause as an event which causes a decrease in sexual drive and that women who do not experience menopausal symptoms have higher sexual satisfaction. Aslan and colleagues32 found that women who regard menopause as an event which has negative effects on their sexual life experience more sexual function problems. In another study, MRS urogenital scores significantly correlated with total Female Sexual Function Index (FSFI) scores.7 In the study by Chedraui and colleagues,33 which was carried out by using FSFI, it was found that women who have hot flashes have lower sexual function. The results of a study by Valadares and colleagues34 which was carried out with Brazilian women in the 40–65 age group, showed that sexuality scores of women who experience menopausal symptoms such as insomnia, depression and having hot flashes were lower. Nappi and colleagues31 demonstrated that vasomotor and psychological symptoms were expressed significantly in women with sexual dysfunctions during menopause.
CONCLUSIONS The results obtained from this study show that married Turkish women in the 40–65 age group had different levels of menopausal symptoms. Moreover, more than half of the women had a negative attitude towards menopause. Older women in the age group, those with a lower education level and those who have a negative attitude towards menopause experience more menopausal symptoms. Most of the women had sexual dysfunction. There is a positive relation between menopausal symptoms and sexual dysfunction. According to these results, it can be said that interventions for climacteric women aimed at coping with menopausal symptoms can contribute to the decrease of their sexual problems and so increase their quality of life. In Turkey, sexuality is still taboo especially for women. Unfortunatelly, sexual problems are frequent among postmenopausal women and these problems are infrequently discussed with physicians or nurses. Undiagnosed or untreated sexual problems, or both, can lead to or occur with depression or social withdrawal. Actually, nurses have a vital role to play in helping women to cope during and after the menopause, offering individual assessment, education and support. To know the relationship between menopausal symptoms and sexual function in this group, women is one of the important factor to improving the quality of nursing care.
CONFLICT OF INTEREST The authors declare no conflict of interest. © 2014 Wiley Publishing Asia Pty Ltd
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