MON-165 - Sexual Inactivity Syndrome of Menopause

Sexuality, the conscious exercise of sexual pleasure, has historically been reduced to reproduction, resulting in persistent social rejection of non-reproductive sexual expression and high rates of sexual inactivity among perimenopausal and menopausal women. In menopause, this belief converges with a hypoestrogenic state, in which estrogen deficiency leads to decreased vaginal lubrication, reduced elasticity, thinning of the urogenital epithelium and weakening of pelvic support structures plus the hypoandrogenic state characterized by hypoactive sexual desire disorder, orgasmic dysfunction, lack of energy and motivation.

Objectives :
1. To highlight the high presence of asexual women in peri menopausal and menopausal women.
2. To demonstrate that sexual inactivity, by eliminating the “natural gymnasium” of the pelvic floor, leads to significant deterioration of pelvic structures and functions with a consequent increase in morbidities and potential mortality.
3. To challenge the cultural and religious myth that sexual function is irrelevant after reproductive ages.

Method :
Long term observational correlation, over 25 years (between 2000-2025), of 1726 perimenopausal and menopausal women (39 to 92 years old) sexually inactive (> 1 year and up to 35 years) vs sexually active menopausal women (6 times per year or more ) partnered or unpartnered. Both groups were analysed with and without hormone replacement therapy.

Results:
In the South Florida population studied at our two medical centers, sexually inactive perimenopausal and menopausal women (partnered or unpartnered) showed a high prevalence of asexuality, increasing with age: >45% over 40 years, >65% over 50 years, >75% over 60 years, >85% over 70 years, and >98% over 80 years. Sexually inactive women exhibited more frequent and severe genitourinary syndrome of menopause (GSM), including vulvovaginal obliteration , genital prolapse (uterine, cystocele, rectocele or total procidentia), urinary stress incontinence, anal incontinence, recurrent urinary tract infections and more false-positive Pap smears. Sexual dysfunctions (dyspareunia, arousal/orgasmic disorders, hypoactive desire, desire discrepancy) and psycho-emotional conditions (depression, low self-esteem, obesity, fatigue, social isolation, relationship breakdown, chronic comorbidities, reduced quality of life) were more commonly observed in the asexual group.

Conclusion: Sexual inactivity is associated with more severe genitourinary, musculoskeletal, and sociopsychological symptoms, particularly without hormone replacement therapy. The principle of “Use it or lose it” applies to sexual function across the lifespan. Healthcare providers should promote sexual activity with or without a partner as a key component of overall health.

Keywords: menopause, estrogen deficiency, sexual inactivity, genitourinary syndrome of menopause

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