Copyright @ 2017 The North American Menopause Society. Unauthorized reproduction of this article is prohibited. Hypoactive sexual desire dysfunction in community-dwelling older women Berihun M. Zeleke, MD, MPH, 1,2 Robin J. Bell, MBBS, MPH, PhD, FAFPHM, 1 Baki Billah, BSc(Hons), MSc, MAS, PhD, 3 and Susan R. Davis, MBBS, PhD, FRACP 1 Abstract Objective: To determine the prevalence of hypoactive sexual desire dysfunction (HSDD) and its associated factors in women aged 65 to 79 years. Methods: A questionnaire-based, cross-sectional study was conducted amongst community-dwelling older women. Participants were recruited between April and August 2014 from a national database based on electoral rolls. Sexual function and sexual distress were assessed by the Female Sexual Function Index and the Female Sexual Distress Scale-Revised, respectively. HSDD was defined as the presence of both low sexual desire and sexually related personal distress. Results: The mean  SD age of the 1,548 women was 71  3.4 years and 52.6% were partnered. Among the participants, 88.0% (95% confidence interval [CI], 86.3%-89.6%) had low sexual desire, 15.5% (95% CI, 13.8%- 17.4%) had sexually related personal distress, and 13.6% (95% CI, 11.9%-15.4%) had HSDD. The HSDD was more common among partnered than among unpartnered women (23.7% vs 5.9%; P < 0.001). Being partnered (adjusted odds ratio [AOR] ¼ 4.21; 95% CI, 2.50-7.07), having vaginal dryness during intercourse (AOR ¼ 2.37; 95% CI, 1.58-3.55), having symptomatic pelvic floor dysfunction (AOR ¼ 1.92; 95% CI, 1.29-2.92), and having moderate- to-severe depressive symptoms (AOR ¼ 4.15; 95% CI, 2.16-7.96) were independently associated with having HSDD. In a subanalysis, HSDD was more common among sexually active than sexually inactive women (31.5% vs 17.3%; P < 0.001). Furthermore, 32% (95% CI, 27.7%-38.3%) of partnered sexually active women had HSDD, as did 22% (95% CI, 11.5%-37.8%) of unpartnered sexually active women. Conclusions: HSDD is common and associated with potentially modifiable risk factors in older women. It should not be assumed that unpartnered older women are sexually inactive or are not distressed by low sexual desire. Key Words: Hypoactive sexual desire dysfunction – Older women – Sexual dysfunction – Sexually related personal distress. T he proportion of women continuing to be sexually active into old age, within and beyond their seventh decade of life, has increased. 1 A Swedish study reported that in 1971, 32% of 70-year-old married women were sexually active, and that this proportion had increased to 56% by 2000. 1 In the same study, the figures for unmarried 70-year-old women in 1971 and 2000 were 1% and 12%, respectively. Similarly, the proportion of older people with a positive attitude towards ‘‘sexuality in old age’’ increased from 65% to 94% between 1971 and 2000. 1 These trends highlight the importance of understanding the sexual health of older people, as sexual difficulties have also been reported to increase with age. 2,3 To date, few studies have reported the prevalence of sexual dysfunction in older women, 4,5 in contrast to low sexual desire and associated personal distress having been extensively investigated in younger women. 6-8 Although the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) has proposed hypoactive sexual desire disorder be replaced by desire-arousal disorder, 9 no tool has been validated for the diagnosis of the latter. Furthermore, the 2016 Consensus of the International Society of Sexual Medicine was to retain hypoactive sexual desire dysfunction (HSDD) and arousal disorder as separate classifications. 10 HSDD can be identified using validated tools for self- reported low sexual desire and sexually related personal distress. 11,12 Received July 10, 2016; revised and accepted August 29, 2016. From the 1 Women’s Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; 2 Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; and 3 Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. Funding/support: The study was supported by an International Meno- pause Society Research Bursary. Financial disclosure/conflicts of interest: S.R.D. has received honoraria from Abbott and Pfizer Pharmaceuticals and has research support from Lawley Pharmaceuticals. B.M.Z. is supported by a Monash University Postgraduate Research Scholarship and S.R.D. is an Australian National Health and Medical Research Council (NHMRC) Principal Research Fellow (Grant no. 1041853). The remaining authors have no disclosures. Address correspondence to: Susan R. Davis, MBBS, FRACP, PhD, Women’s Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia. E-mail: susan.davis@monash.edu Menopause, Vol. 24, No. 4, 2017 391 Menopause: The Journal of The North American Menopause Society Vol. 24, No. 4, pp. 391-399 DOI: 10.1097/GME.0000000000000767 ß 2016 by The North American Menopause Society