1. Sexual Functioning Beyond Testosterone Rachel Hess, MD, MS hessr@upmc.edu

2. Background Sexual function changes as women age Up to 40% of US women report sexual dysfunction and 63% report difficulty Poor sexual functioning can contribute to poor overall quality of life

3. What do we know from SWAN? 79% of women are sexually active at baseline 1/3 of women report that sex is very important –African American women are more likely to consider sex very important –Japanese and Chinese women are less likely to consider sex very important

4. What do we know from SWAN? Emotional satisfaction with relationship and overall relationship quality are more closely associated with sexual desire than are hormone levels In the late perimenopause, pelvic pain increases and desire decreases

5. Objective Examine the role of the vagina in sexual functioning –Compared the vaginal mucosa of sexually active and sexually inactive postmenopausal women

6. Hypothesis Sexually active postmenopausal women would have more mature vaginal epithelium This effect would be independent of sex- steroid hormone levels

7. Definitions Sexually active: –Vaginally penetrative partnered sexual activity at least twice a week Sexually inactive: –No vaginally penetrative sexual active in the last 6 months

8. Methods: Participants 40 postmenopausal women 1)Provided self-collected vaginal samples 2)10cc of blood 3)Completed questionnaires

9. Results T-test sexually active vs. inactive women for each measure Sexually active? Yes (17)No (23)P-value VMI (mean(sd))37.7 (16.6)28.3 (8.3)0.02 Estradiol*27.1 (58.6)11.8 (29.4)0.29 Estrone41.5 (44.0)26.7 (13.9)0.14 Testosterone203.5 (111.7)165.9 (109.2)0.29 Androstendione495.5 (293.5)477.0 (270.4)0.84 * All measurements in pg/mL

10. Results Linear regression models examining the associations among VMI (outcome), sexual activity, and sex steroid hormones. Each model includes sexual activity and one (or all) sex steroid hormone(s). Cells contain standardized β (p-value) Model 1Model 2Model 3Model 4Model 5 Estradiol only Estrone only Testosterone only Androstendione only All hormones Sexually active (yes)2.1 (.04)2.0 (.06)2.4 (.02)2.3 (.3)2.0 (.06) Estradiol1.3 (.2).07 (.9) Estrone 1.5 (.1) 1.0 (.3) Testosterone -.6 (.6) -.9 (.4) Androstendione.2 (.9)-.1 (.9)

11. Conclusions Sexual activity is more strongly associated with vaginal epithelial maturity than with sex steroid hormone levels Sex steroid hormone levels are not independently associated with sexual activity

12. Questions?