title: Predictors of decreased libido in women during the late reproductive years.
abstract: OBJECTIVE
  To identify risk factors for decreased libido among women in the late reproductive years.
  
  
  METHODS
  Prospective cohort. Women aged 35 to 47 years identified through random digit dialing were prospectively followed for 4 years with serial hormone assays and standardized questionnaires. Mean hormone values, hormone trends over 4 years, and fluctuation in hormone levels were compared among women with and without a decrease in libido at the last assessment period. Total testosterone, dihydroepiandrosterone sulfate, estradiol, follicle-stimulating hormone, luteinizing hormone, body mass index, psychosocial, and socioeconomic variables were evaluated using multivariable logistic regression.
  
  
  RESULTS
  Of 326 women, 87 (27%) reported a decreased libido, whereas 239 (73%) did not. Participant-specific means for all hormone levels over the study period were similar among both groups. However, total testosterone fluctuation over the study was significantly different between groups. Women whose testosterone levels fluctuated from 3.8 to 21.5 ng/dL around a mean value of 9 ng/dL were four times more likely to report decreased libido compared with women with little fluctuation in testosterone [odds ratio (OR) 4.0; 95% CI, 1.6-10.0]. Depression (OR 3.4; 95%CI, 1.9-6.1), vaginal dryness (OR 3.5; 95%CI, 1.8-6.6), and children living at home (OR 1.4; 95%CI, 1.1-1.7) were also independently associated with decreased libido.
  
  
  CONCLUSIONS
  Decreased libido in the late reproductive years is associated with a pronounced fluctuation in total testosterone over time. Other independent risk factors for decreased libido include vaginal dryness, depression, and living with children. Sexual dysfunction is a complex disorder, related to physiological and psychosocial factors, requiring further investigation.
authors.affiliation: Department of Obstetrics/Gynecology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. cgracia@obgyn.upenn.edu
authors.forename: Clarisa R
authors.initials: CR
authors.lastname: Gracia
authors.forename: Mary D
authors.initials: MD
authors.lastname: Sammel
authors.forename: Ellen W
authors.initials: EW
authors.lastname: Freeman
authors.forename: Li
authors.initials: L
authors.lastname: Liu
authors.forename: Lori
authors.initials: L
authors.lastname: Hollander
authors.forename: Deborah B
authors.initials: DB
authors.lastname: Nelson
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002979:Climacteric; D015331:Cohort Studies; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D004958:Estradiol / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D007989:Libido; D007986:Luteinizing Hormone / Q000097:blood; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D011446:Prospective Studies; D011584:Psychology; D012307:Risk Factors; D020018:Sexual Dysfunctions, Psychological / Q000097:blood / Q000453:epidemiology* / Q000209:etiology*; D012959:Socioeconomic Factors; D013739:Testosterone / Q000097:blood
chemical_list: D013739:Testosterone; D004958:Estradiol; D019314:Dehydroepiandrosterone Sulfate; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone