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PHILADELPHIA -- Female sexual dysfunction in middle age may be exacerbated by PTSD, researchers reported here.

Women who reported clinical symptoms of PTSD or had experienced interpersonal violence were more likely to have sexual dysfunction in midlife compared who did not, according to Carolyn Gibson, PhD, MPH, of the San Francisco VA Health Care System, and colleagues presenting at the annual meeting of .

In a multivariable analysis adjusted for age, race/ethnicity, and body mass index, associations with PTSD or history of interpersonal violence were as follows:

• Bothersome vaginal pain with intercourse (adjusted odds ratio 2.12, 95% CI 1.55-2.89, P<0.001)
• Vaginal irritation (aOR 2.22, 95% CI 1.68-2.95, P<0.001)
• Vaginal soreness (aOR 3.70, 95% CI 2.56-5.35, P<0.001)

Bothersome vaginal pain during intercourse, as well as vaginal irritation were both found to be significantly associated with a self-reported history of sexual assault (aOR 1.46, 95% CI 1.03-2.09, P=0.04 for pain; aOR 1.44, 95% CI 1.05-1.98, P=0.02 for irritation).

Similarly, bothersome vaginal pain during intercourse was also tied to an experience of emotional intimate violence from a partner (aOR 1.55, 95% CI 1.11-2.17, P=0.01).

"PTSD was the strongest and most consistent predictor of all outcomes," Gibson noted during a oral presentation of the findings. However, intimate partner physical violence was not significantly associated with any of these sexual dysfunction outcomes.

The cohort consisted of a multiethnic group of 2,016 women 40-80 years old, enrolled in a large Northern California healthcare system (36% non-Latina white, 22% black, 23% Latina, 20% Asian). Women responded to a structured questionnaire that included the Posttraumatic Stress Disorder Checklist-Civilian Version to determine PTSD symptoms and history of interpersonal violence, such as sexual assault, as well as physical and emotional intimate partner violence.

Nearly a quarter of the cohort were classified as having clinically significant symptoms of PTSD (n=450, 22%), with scores of 30 or higher on the Posttraumatic Stress Disorder Checklist-Civilian Version. A total of 21% reported a history of emotional intimate partner violence with 16% reporting a history of physical intimate partner violence, and 19% had experienced sexual assault, which included being fondled, groped, or raped.

Sexual dysfunction related to menopause was assessed via a questionnaire that measured prevalence and level of bother with occurrences including vaginal pain with sexual intercourse, vaginal irritation, and vaginal soreness. Nearly a third reported experience with bothersome vaginal irritation (32%), while 13% of women had experienced bothersome vaginal pain during intercourse, and 7% had bothersome vaginal soreness.

"I think this brings up a number of implications," Gibson stated. "Foremost, I want to really highlight the prevalence and importance of PTSD. I think in this setting we don't really think about it as much ... particularly among older women in the general setting. But it's incredibly toxic, and we're increasingly recognizing how common it is, and again, it's often chronic and affects all aspects of life."

She continued, "I think we need to start thinking about it in the same way that we think about depression within a primary care setting -- they often go hand in hand, and prevalence rates are often very similar."

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