Middle-aged women with HIV don’t need a partner to be sexually satisfied, study affirms

In middle-aged women living with HIV (WLWH), sexual satisfaction is not necessarily tied to partnered activity, a Canadian study found. However, depression was associated with lower sexual satisfaction in this study, leading the authors to suggest that providers screen their patients for both sexual satisfaction and depressive symptoms.

About This Study

“Sexual satisfaction of midlife women living with HIV in Canada: A prospective cohort analysis” was published online on April 4, 2023, in Journal of Acquired Immune Deficiency Syndromes. The lead author is Elizabeth M. King, M.D., M.H.Sc., of the Faculty of Health Sciences at Simon Fraser University in Burnaby, B.C., Canada and of the Women’s Health Research Institute at British Columbia (BC) Women’s Hospital in Vancouver, Canada.

Key Research Findings

In this community-based study, researchers explored sexual satisfaction and activity among 508 WLWH ages 45 and older (median age 51). Participants in the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study answered survey questions in person between 2013 and 2018.

While 61% of participants said they were satisfied with their sex lives, 51% of those who reported satisfaction also said they were not sexually active with another person. Women who reported no sexual partner often said they engaged in alternate forms of intimacy, including self-pleasure and non-sexual intimate partnerships. However, concerns about HIV disclosure, transmission, and criminalization also were reasons for reporting no sexual partner.

The study authors pointed out that general population studies have shown rising sexual satisfaction and declining partnered activity in older women. They stated that menopause is often welcomed as liberating and that some women feel more comfortable with sexual experimentation as they age.

Depression is more common among women than men living with HIV. In the current study, nearly half of the women (48%) reported symptoms consistent with depression, and these symptoms were associated with lower sexual satisfaction. As symptoms worsened over time, sexual dissatisfaction grew. Unlike research findings among the general population, overall physical health was unrelated to satisfaction in this study.

Discussion Highlights and Implications for Practice

The study authors commented that the association between depression and satisfaction likely runs both ways–i.e., an unsatisfying sex life can increase depression, while depression itself (as well as side effects of antidepressants) can affect sex drive.

Results show that, for WLWH, sexual satisfaction is not necessarily defined by partnered activity–a fact that HIV providers need to consider in sexual health conversations with their patients, the authors urged. For many women, sexual abstinence was intentional. At the same time, HIV stigma and criminalization need to be addressed to remove barriers to sexual satisfaction among WLWH, the researchers observed.

WLWH may have better coping strategies for physical health issues than HIV-negative women, but the relationship between overall health and sexual satisfaction in this population should be explored further, the researchers suggested. “Providers should be aware of the diversity of sexual experiences and expressions of older women living with HIV as well as the interconnectedness between depressive symptoms and sexual health,” they wrote.

By Barbara Jungwirth