Health Disparities
Sexual orientation differences in female sexual dysfunction in a large cohort of nurses in older adulthood Tabor Hoatson* Tabor Hoatson Julia Bond Colleen Reynolds Julia Marcus Brittany Charlton
Background: Female sexual dysfunction (FSD) can profoundly inhibit quality of life, but little is known about disparities across sexual orientation groups.
Aim: We assessed sexual orientation-related disparities in FSD in a large cohort of female nurses in older adulthood.
Methods: This analysis included female nurses (n=84,790) from the Nurses’ Health Study II, aged 48–69 years at the time of sexual function ascertainment in 2013. Sexual activity and FSD were measured using the Female Sexual Function Index-6 (FSFI-6). In 2017, sexual orientation identity, sexual attractions, and sexual contact were assessed. In statistical analyses, we generated prevalence ratios (PR) and 95% confidence intervals (CI) with log-binomial and multinomial models and additionally assessed effect modification by menopausal status.
Outcomes: We examined differences in past-month sexual activity, FSD, and individual FSFI-6 domains (e.g., arousal, lubrication) across sexual orientation subgroups.
Results: Compared with completely heterosexual participants, bisexual (PR:0.89, 95%CI:0.81–0.97) and lesbian (PR:0.76, 95%CI:0.72–0.82) participants had a lower prevalence of sexual activity. The point prevalence of FSD was also lower among bisexual (PR:0.81, 95%CI 0.65–1.01) and lesbian (PR:0.87, 95%CI:0.74–1.01) participants. However, the prevalence of low sexual satisfaction was greater in multiple sexual minority subgroups. Across all sexual orientation groups, menopause was associated with an increased prevalence of FSD. There was no statistical evidence of effect modification by menopause status.
Clinical Implications: Overall, sexual minority individuals were less satisfied with their sexual lives than completely heterosexual individuals; resources to support clinicians in culturally competent discussions of sexual satisfaction with sexual minority patients are needed.
Conclusion: To improve sexual function outcomes, further investigation is needed to identify what drives sexual activity and satisfaction among female sexual minority individuals in older adulthood, as well as identify protective factors against FSD for people of all sexual orientations.