Q&A with Dr. Alison Huang: Studying the Sexuality of Older Women 

As women age they may experience dwindling interest in sex, but that doesn’t mean they aren’t doing it or have lost all desire.

A new study published in the Journal of the American Geriatrics Society—“Sexual Function and Aging in Racially and Ethnically Diverse Women”—revealed that of the nearly two thousand women, age forty-five to eighty, who responded to a questionnaire, 43 percent experienced at least moderate sexual desire and 60 percent had been sexually active in the previous three months.

Moreover, while the most common reasons for inactivity were lack of interest and lack of a partner, partner health and interest were also significant factors. Indeed, among women who were sexually inactive, 23 percent cited the physical problem of the partner as the cause compared to just 9 percent who blamed their own health issues.

The study—in which representation of African American, Latina, and Asian American women was about 20 percent each—also looked at racial and ethnic differences in sexual desire, activity, and satisfaction. Among the findings: African American women were more likely than white women to report at least moderate desire but less likely to report weekly sexual activity; sexually active Latina women were more likely than white women to report at least moderate sexual satisfaction.

Lead author Dr. Alison Huang, a professor of internal medicine at University of California, San Francisco, answers some questions about her work.

How did your interest in this topic evolve? Had you worked with seniors previously or in the area of sexuality?

I see patients in the Mount Sinai general medicine practice, and I think just by virtue of being a Chinese American woman, I tend to have a lot of older Chinese American patients in my clinic. . . . I had multiple encounters with women who initially denied any kind of complaints during their clinic visits and at the end of their visit would pull out a request for authorization for incontinence pads or diapers.

It led me to wonder: Is incontinence a more common problem among Asian women versus white women; are there differences in the way women feel about incontinence? After doing a little research in that area, I became interested in all kinds of problems that are related to urogenital health and urogential function in older women. I think it’s a very understudied area. And as women are living longer and longer, and older women are more diverse in this country than they used to be, there’s a lot of need for research in this area.

What were the main objectives of this study?

First, we wanted to gather more information about trends in sexual activity and sexual functioning among older women in general, and how sexual function, satisfaction, problems change as women grew older.

We also wanted to get a sense of possible differences in self-reported activity, satisfaction, problems by race and ethnicity because the limited studies that have been done have not tended to have very diverse populations of women.

Your study suggests further research, but do you postulate any reasons for the differences you found between women of different ethnicities and races?

We do need to do more research, research that isn’t just performed by survey but involves more in-depth qualitative discussions with women. I suspect that . . . some of this does lie in cultural attitudes about whether sexual activity is appropriate in older age, beliefs about whether sexual activity is supposed to play a satisfying role in women’s lives when they’re older.

During the research process what was the most surprising thing you learned?

I wasn’t expecting partner issues to be so dominant in whether women were sexually active. Obviously, I could expect that lack of an available partner would be a reason for not being sexually active, but the fact that women’s own physical problems with sex should actually be so low on the list for why they’re not active was surprising to me. I think this does reinforce findings from some qualitative work that I’ve done with older women who have urogenital atrophy symptoms—symptoms of dryness, soreness, pain during sex—which is that many women who have these symptoms try to remain sexually active with their partner or continue to have vaginal intercourse, even if they have very extreme discomfort where they can’t enjoy the activity at all, just because they feel it’s important for their relationships or important for their lives in other ways. They want to remain sexually active even if the experience is more painful than pleasurable. I think part of this shows that older women have different priorities about their sexual activity than might be thought.

What were some of the conclusions of your study that may interest the lay audience?

First, despite the fact that the prevalence of sexual activity did decrease with increase in age group, overall 37 percent of the women who were sixty-five and older were sexually active in the past three months and about that percentage were moderately or highly interested in sex. That provides more information about norms of sexual activity in older women. A very significant proportion of older women are recently sexually active. . . .

Also, I don’t think this is a big surprise, but that women’s attitudes and satisfaction in sexual activity are influenced by their ethnic or cultural background. Clinicians need to be aware this when discussing sexual problems with their patients. And I think solutions to address sexual problems in one racial-ethnic group may not work in another.

Now that this study is over, how do you hope to continue to research this topic?

We hope to follow women longitudinally over time to get a sense of what affects change in sexual activity and function with aging. Is it change in women’s overall health and their living situations? Is it change in partner status? Is it change in their other mental health state? I think that will provide important information because what little work has been done in this area has only been done in studies that give a single snapshot of a woman’s sexual activity and function at a given time.

I am myself interested in, like I said, both the physical process of aging or atrophy in the urogenital tissues and how it causes symptoms for women and affects their quality of life, including sexual quality of life. There is reason to believe that changes in a woman’s estrogen levels or atrophy in the genital tissues that is associated with aging have different implications for different women. For some women it can have a major impact on their well-being and sexual and other functioning; and other women find ways of coping or don’t experience symptoms of quality of life impacts—and why that’s the case, I think that’s important for us to figure out.

What groups were able to cope and how did they cope?

Not so much from this study—we didn’t ask about coping strategies—that’s more related to the focus group work that I’ve done with older women of different racial-ethnic backgrounds who had symptoms that I mentioned such as pain during sexual activity, urogenital soreness or dryness. Sometimes a woman’s ability to cope was dependent on their partners. For example, women who were able to be frank when discussing their symptoms with their partners or had partners who were willing to accommodate their symptoms—prefacing sexual activity with using lubricant, or preface vaginal intercourse with stimulation or oral sex, something that would help promote lubrication—those women found it much easier to maintain sexual activity and to report less impact of their symptoms on their daily lives.

In this economic climate are you concerned about getting funding for this type of research in the future?

I’m a fairly young researcher, so I don’t have a lifetime perspective on funding and its trends and the difficulties. I do think that often the top funding priorities are health problems that result in mortality, and I understand that. Sexual functioning and urogenital health conditions, these are quality of life issues.

I think, though, that as women and men are living longer than ever before and are caring about not only further prolonging their life but also maintaining functioning and well-being in older age, that the whole medical community is beginning to appreciate these issues more and more. It’s not just about making sure that women live to be 90, but that the lives that they live in older age are as fulfilling as possible. That is increasingly being recognized as an important goal of health research and of clinical care. So I’m hopeful that there will be ongoing funding for these issues in the future.

What do you tell your parents about the research you’re doing since they are in that age group that you’re studying?

I often tell them that I do research on older women’s health in general and that I have a focus on urogenital health problems, including urinary incontinence and urogenital atrophy. It’s true I haven’t gone into detail discussing sexual problems of older women with, say, my mother or my grandmother. But I think not just my parents but many people in general are uncomfortable discussing some of these topics socially. I suppose I would have more dinner table discussions about my work if I studied, say, heart disease … This reinforces the fact that urogenital and sexual-health conditions, because sometimes people are uncomfortable talking about them, they’re understudied and there’s room for really good work.