Sexual function and distress in postmenopausal women with chronic insomnia: exploring the role of stress dysregulation

Figures & data

Table 1 Sample characteristics for full sample and comparisons between sexually healthy vs sexually dysfunctional women

		All subjects	Sexual distressed	Sexually healthy
Sample size		150	68	77
Age		56.44±5.64 years	56.07±4.90	56.79±6.24	t(143)=0.76, P=0.45
Race
White		78; 52.0%	44; 64.7%	34; 44.2%	Black vs White risk for FSD
Black		59; 39.3%	20; 29.4%	39; 50.6%	χ^2(1)=6.84, P<0.01
Hispanic or Latinx		1; 0.7%	1; 1.5%	–	White:Black isk Ratio for
Multiracial		1; 0.7%	–	1; 1.3%	FSD=1.67
Other		2; 1.3%	–	1; 1.3%
Did not answer		9; 6.0%	3; 4.4%	2; 2.6%
Hormone replacement therapy		4; 2.7%	3; 4.4%	1; 1.3%	χ^2=1.31, P=0.25
Medical or Surgical Menopause		35; 23.3%	18; 26.5%	16; 20.8%	χ^2=0.65, P=0.42
Years since last menstruation		7.12±7.04	6.61±6.34	7.53±7.74	t(135)=−0.75, P=0.45
FSDS-R		11.29±9.96	20.04±7.31	3.56±3.39	t(143)=17.74, P<0.001, d=2.89
FSFI
Desire		2.22±1.06	2.06±0.92	2.36±1.16	t(143)=−1.70, P=0.09
Arousal		3.35±1.21	2.94±1.06	3.84±1.20	t(85)=−3.71, P<0.001, d=0.79
Lubrication		3.39±1.28	2.79±1.16	4.07±1.06	t(77)=−5.08, P<0.001, d=1.15
Orgasmic Function		3.55±1.21	3.09±1.03	4.10±1.18	t(83)=−4.21, P<0.001, d=0.91
Satisfaction		3.11±1.26	2.54±1.33	3.61±1.16	t(143)=5.56, P<0.001, d=0.86
Pain		4.00±1.27	3.54±1.44	4.49±0.83	t(72)=−3.43, P<0.01, d=0.81
ISI		15.17±3.98	16.44±4.24	13.77±3.23	t(143)=4.30, P<0.001, d=0.71
Fall asleep		1.51±1.05	1.81±1.03	1.21±0.96	t(143)=3.64, P<0.001, d=0.60
Stay asleep		2.67±0.88	2.78±0.93	2.52±0.82	t(143)=1.79, P=0.08
Early morning awakening		2.13±1.09	2.21±1.91	2.04±1.09	t(143)=0.91, P=0.37
Dissatisfaction		3.19±0.78	3.25±0.84	3.12±0.74	t(143)=1.02, P=0.31
Noticeable		2.02±0.99	2.31±0.89	1.71±1.00	t(143)=−3.77, P<0.001, d=0.63
Worried		1.29±0.97	1.44±0.95	1.13±0.95	t(143)=1.97, P=0.05
Daytime interference		2.35±1.02	2.65±1.00	2.04±0.95	t(143)=3.74, P<0.001, d=0.63
FSS		30.86±12.16	34.30±11.38	27.36±12.06	t(142)=3.53, P<0.01, d=0.59
Hot flashes, daytime		2.08±1.63	2.16±1.64	2.01±1.64	t(143)=0.53, P=0.60
Hot flashes, nighttime		1.67±1.23	1.75±1.24	1.60±1.22	t(143)=0.73, P=0.47
BDI-II		8.93±6.35	10.29±6.72	7.68±5.85	t(143)=2.50, P=0.01, d=0.41
FIRST		21.86±6.05	23.73±5.77	20.21±5.85	t(143)=3.65, P<0.001, d=0.61
DBAS		4.43±1.50	4.89±1.48	3.99±1.40	t(143)=3.74, P<0.001, d=0.62
PSWQ		46.13	48.99±13.04	43.26±13.25	t(142)=2.61, P=0.01, d=0.44
PSAS – cognitive		12.43±3.80	13.56±4.17	11.44±3.14	t(143)=3.48, P<0.01, d=0.57
PSAS – somatic		20.01±7.41	22.51±7.17	17.81±6.94	t(143)=4.01, P<0.001, d=0.67

Abbreviations: FSD, female sexual distress; FSDS-R, Female Sexual Distress Scale – revised; FSFI, Female Sexual Function Index; ISI, Insomnia Severity Index; FSS, Fatigue Severity Scale; Daytime and Nighttime Hot Flashes measured using daily diaries across 14 days with values reflecting daily means; BDI-II, Beck Depression Inventory, 2nd edition; FIRST, Ford Insomnia Response to Stress Test; DBAS, Dysfunctional Beliefs and Attitudes about Sleep scale; PSWQ, Penn State Worry Questionnaire; PSAS Cognitive, Presleep Arousal Scale, Cognitive factor; PSAS Somatic, Presleep Arousal Scale, Somatic factor; t, t-statistic; χ^2, chi-square; p, significance value; d, Cohen’s d.

Table 2 Correlations among sexual problems and menopausal insomnia symptoms

	ISI	ISI – falling asleep	ISI – staying asleep	ISI – early morning awakenings	ISI – dissatisfaction	ISI – QOL	ISI – worried about sleep	ISI – daytime impairment	FSS	Hot flashes – daytime	Hot flashes – nighttime
Sexual distress	0.25**	0.26**	0.09	−0.05	0.10	0.22**	0.14	0.27**	0.29**	0.12	0.15
Desire	−0.04	−0.08	0.02	0.24**	0.02	−0.20*	−0.08	−0.09	−0.15	−0.10	−0.06
Arousal	−0.17	−0.15	−0.18	0.21**	−0.07	−0.18	−0.16	−0.22*	−0.23**	−0.27*	−0.15
Lubrication	−0.08	−0.25*	−0.01	0.31**	−0.09	−0.05	−0.08	−0.22*	−0.24**	−0.20	−0.39**
Orgasm	−0.29**	−0.13	−0.37***	0.14	−0.24*	−0.22*	−0.15	−0.29**	−0.32**	−0.29**	−0.32
Satisfaction	−0.19*	−0.22**	0.01	0.18*	−0.10	−0.27**	−0.14	−0.24**	−0.39***	−0.30***	−0.24**
Pain	0.02	−0.13	0.09	0.15	0.06	0.07	−0.04	−0.08	−0.12	−0.22	−0.29**

Note: Sexual distress assessed by the Female Sexual Distress Scale – revised. Desire, arousal, lubrication, orgasm, satisfaction, and pain measured using the Female Sexual Function Index. *P<0.05. **P<0.01. ***P<0.001.

Abbreviations: ISI, Insomnia Severity Index; QOL, quality of life; FSS, Fatigue Severity Scale.

Table 3 Correlations among sexual problems, stress dysregulation, and hot flashes

	BDI-II	FIRST	DBAS	PSWQ	PSAS – cognitive	PSAS – somatic
Sexual distress	0.32***	0.27**	0.28**	0.28**	0.29***	0.35***
Desire	−0.25**	−0.30***	−0.04	−0.23**	−0.16	−0.12
Arousal	−0.38***	−0.33**	−0.19	−0.27*	−0.22*	−0.25*
Lubrication	−0.13	−0.14	−0.18	−0.23*	−0.23*	−0.27*
Orgasm	−0.34**	−0.21*	−0.15	−0.29**	−0.20	−0.23
Satisfaction	−0.40***	−0.23**	−0.21*	−0.21*	−0.29***	−0.22**
Pain	−0.06	−0.17	−0.01	−0.25*	−0.29*	−0.20

Note: Daytime and nighttime hot flashes measured using daily diaries across 14 days with values reflecting daily means. Sexual distress assessed by the Female Sexual Distress Scale – revised. Desire, arousal, lubrication, orgasm, satisfaction, and pain measured using the Female Sexual Function Index. *P<0.05. **P<0.01. ***P<0.001.

Abbreviations: BDI-II, Beck Depression Inventory, 2nd edition; FIRST, Ford insomnia response to stress test; DBAS, Dysfunctional Beliefs and Attitudes about Sleep scale, 16-item version; PSWQ, Penn State Worry Questionnaire; PSAS Cognitive, Presleep Arousal Scale, Cognitive factor; PSAS Somatic, Presleep Arousal Scale, Somatic factor.