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Ebirim et al: Postmenopausal sexual experience
and perception in a Nigerian population, 70-75.
85
Journal of Health Sciences and Technology, Vol. 1 (2010)
POSTMENOPAUSAL SEXUAL EXPERIENCE AND PERCEPTION IN A NIGERIAN
POPULATION.
EBIRIM C.I.C, MORAKINYO O. M. AND ABANOBI O. C.
Dept. of Public Health Technology,
Federal University of Technology Owerri, Nigeria.
ABSTRACT
Menopause is experienced as a process by individual women who reach mid life. However,
the accompanying signs and effects that occur during menopause can disrupt daily activities
and sense of well-being. Hence, this study document women’s postmenopausal sexual
experience and perception in Owerri, South-East Nigeria. A descriptive cross-sectional
survey was conducted among 698 women who had ceased menstruation for at least twelve
months in Owerri of Imo State. A close-ended interviewer administered questionnaire was
used in eliciting information from respondents. The women were interviewed in their homes
and work places. Data from questionnaire was analysed using descriptive statistics. The
mean age at menopause is 47.2±4.2 years. Amongst the 698 respondents, 44 (6.3%)
reached menopause at <40 years, Majority of 512 (73.4%) between 40 to 50 years and
20.3% after 50 years of age. The most commonly reported symptoms of menopause were
hot flushes (n= 216, 14.3%), Insomnia (n= 128, 8.5%), Joint/bone pain (n= 272, 18.0%),
Urinary incontinence (n= 36, 2.4%), decreased libido (n= 92, 6.1%), forgetfulness (n= 156,
10.3%), Irritability (n= 51, 3.4%), palpitations (n=154, 10.2%) among others. Reaction to
cessation of menstruation differs among respondents. While 184 (26.4%) were not worried
about it, 90 (12.9%) had lost interest in sex, 138 (19.8%) felt cessation heralds the onset of
illness, and others 286 (41%) were indifferent about it. At menopause, 64.2% of the women
experienced difficulty in having sex. Nature of difficulties experienced includes pain during
sex, dryness of vagina, bleeding after intercourse and rejection by spouse. Sexuality
difficulties are experienced by respondents. It would be helpful if women are able to learn
what to expect and what options are available in assisting their transition from reproductive
to non-reproductive life.
Key words: Postmenopausal symptoms, Women’s sexual experience, Nigeria.
INTRODUCTION
Menopause is a physiological process
which takes place in all women who reach
midlife. It is a feminine milestone that
marks the transition to another period is a
term used to describe the permanent
cessation of ovarian function which results
in the cessation of ova release, uterine
lining creation, and subsequent uterine
lining shedding (Austad, 1994; Reynolds &
Obermeyer, 2001).
Menopause can be officially declared (in
an adult woman who is not pregnant, is
not lactating, and who has an intact
uterus) when there has been amenorrhea
for one complete year. However, there are
many signs and effects that led up to this
point, many of which may extend well
beyond it too. These include: irregular
menses, vasomotor instability (hot flashes
and night sweats), atrophy of genitourinary
tissue, increased stress, breast
tenderness, vaginal dryness,
forgetfulness, mood changes, and in
certain cases osteoporosis and or heart
disease (Freeman, Grisso & Berlin, 2001).
The transition from reproductive to non-
reproductive is the result of a major
reduction in female hormonal production
by the ovaries. This transition is normally
not sudden or abrupt, tends to occur over
a period of years, and is a natural
consequence of aging. Menopause is an
unavoidable change that every woman will
experience, assuming she reaches middle
age and beyond. It is helpful if women are
able to learn what to expect and what
options are available to assist the
JOURNAL OF
HEALTH SCIENCES
AND TECHNOLOGY
Ebirim et al: Postmenopausal sexual experience
and perception in a Nigerian population, 70-75.
86
Journal of Health Sciences and Technology, Vol. 1 (2010)
transition, if that becomes necessary
(Minkin, 1997).
However, for some of women, the
accompanying signs and effects that can
occur during the menopause transition
years can significantly disrupt their daily
activities and their sense of well-being.
Hence, this study documents women’s
postmenopausal experience in Orlu,
South-East, Nigeria.
METHODOLOGY
From August to November 2009 a
descriptive cross-sectional survey was
conducted among 698 women who had
ceased menstruating for at least twelve
months in Owerri South-East of Imo State.
The women were interviewed in their
homes and work places. A close-ended
interviewed administered questionnaire
was used in eliciting information from
respondents. The questionnaire
incorporates demographic characteristics,
age at menarche, age at menopause,
gravidity, parity, social habits, pattern of
cessation, reaction to cessation among
other information.
Six hundred and ninety-eight women were
recruited into the study. The data collected
was edited and coded. It was thereafter
entered into the computer for analysis
using SPSS version 16.0 statistical
package. Frequency tables were
generated for demographic characteristics
of the respondents.
RESULTS
The socio-demographic information of the
studied women is presented in Table 1.
Most of the women, 290 (41.5%), are in
the age group 55 – 64 years compared to
8 (1.1%) who falls below 45 years of age.
Educational levels attained by
respondents are presented in table 1. A
major proportion, 266 (38.1%), of the
respondents had no form of educational
qualification; 220 (31.5%) had primary
school education; 126 (18.1%) attended
secondary education and 86 (12.3%) had
tertiary education.
Table 1: Demographic characteristics of post menopausal women
Variable
s
Frequency
(N =
698
)
%
Age of respondent
<45
45-54
55-64
65-74
≥75
8
232
290
150
18
1.1
33.2
41.5
21.5
2.6
Educational level
None
Primary
Secondary
Tertiary
266
220
126
86
38.1
31.5
18.1
12.3
Occupation
House wife
Trader
Farmer
Civil servant
106
260
206
116
15.2
38.6
29.5
16.6
In women life, menarche is considered as
an important physiological episode
because at this stage female are
biologically capable to conceive.
According to Table 2, it was observed that
the age at menarche of the women was
14.5±1.90 years with their age ranging
between 10 and 19 years. The mean age
of women at menopause in Orlu South
East was 47.2±4.20 years. Information
about their gravida, parity and number of
children is shown in Table 2.
Ebirim et al: Postmenopausal sexual experience
and perception in a Nigerian population, 70-75.
87
Journal of Health Sciences and Technology, Vol. 1 (2010)
Table 2: Characteristics of Menopausal Women
Variable
s
Frequency
(N = 698)
%
Age at menarc
he
10 – 14
15 – 19
348
350
49.9
50.1
Age at menopause
< 40
41 – 45
46 – 50
51 – 55
≥ 56
44
166
346
134
8
6.3
23.8
49.6
19.2
1.1
Gravidity
Primigravida
Multigravida
Grand multigravida
4
54
640
0.2
7.7
91.7
Parity
Primipara
Multipara
Grand multipara
8
80
610
1.1
11.5
87.4
Number of children
None
1 – 4
5 – 9
10 – 14
4
158
514
22
0.6
22.6
73.6
3.2
Presented in Table 3 are the signs and
symptoms that respondents experienced
before the start of menopause. Some of
the symptoms include hot flush, insomnia,
forgetfulness, weight gain among others.
Table 3: Symptoms of sexual menopause
Symptoms
Frequency
%
Hot flush 216 14.3
Insomnia
128 8.5
Joint/bone pain 272 18.0
Urinary incontinence 36 2.4
Frequent urination 33 2.2
Irritability 51 3.4
Lethargy/fatigue 93 6.1
Depression 46 3.0
Headache 148 9.8
Forgetfulness 156 10.3
Weight gain 52 3.4
Palpitations 154 10.2
Crying spells 13 0.9
Constipation 19 1.3
Dysuria 4 0.3
Decreased libido 92 6.1
Multiple response questions
Ebirim et al: Postmenopausal sexual experience
and perception in a Nigerian population, 70-75.
88
Journal of Health Sciences and Technology, Vol. 1 (2010)
The pattern of cessation of menstruation
among the studied group at menopause is
shown in Table 4. The reported patterns
include abruptly ended 230 (33.0%),
period of amenorrhea/oligomenorrhea in
276 (39.5%) while 192 (27.5%) experience
irregular bleeding. At menopause, about
90 (12.9%) of the women said they lost
interest in sex; 138 (19.8%) said
menopause heralds the onset of illness;
184 (26.4%) did not bother about their
present situation while 286 (41.0%) were
neutral about it.
The distribution of respondents according
to their sexual experience during
menopause is presented in Table 5.
Table 4: Pattern of cessation and reaction to cessation of menopause
Characteristics
Frequency (N = 698
)
%
Pattern of cessation
Abruptly ended
Period of
amenorrhea/oligomenorrhea
Irregular bleeding
230
276
192
33.0
39.5
27.5
Reaction to cessation
Natural
Loss of sexual attraction
Heralds onset of illness
Did not bother about it
286
90
138
184
41.0
12.9
19.8
26.4
Majority of the women, 448 (64.2%) said
they longer engage in sexual intercourse
with their spouse while 250 (35.8%) still
practice sex. Among the respondents that
still practice sex, 190 (76.0%) reported
that they do not experience any difficulty
during the act while 60 (24.0%) said they
experience one form of difficulty or the
other. The reported difficulties include pain
during intercourse, 22 (36.7%); dryness of
vagina, 30 (50.0%); bleeding after
intercourse, 4 (6.7%) and rejection by
husband 4 (6.7%)
Table 5: Distribution of Sexual Experience during Menopause
Characteristics
Frequency (N = 698
)
%
Still practice sexual
intercourse
Yes
No
250
448
35.8
64.2
Ex
perience sexual
difficulty(N=250)
Yes
No
Nature of difficulty(N = 60)
Pain during intercourse
Dryness of vagina
Bleeding after intercourse
Rejection by spouse
60
190
22
30
4
4
24.0
76.0
36.7
50.0
6.7
6.7
Ebirim et al: Postmenopausal sexual experience
and perception in a Nigerian population, 70-75.
89
Journal of Health Sciences and Technology, Vol. 1 (2010)
DISCUSSION
The mean age of women at menopause
(47.2±4.20 years) found in this study is
lower than that reported by Ozumba et al.,
2004 (49.4±3 years) and those from
Western countries (Nedstrand et al., 1996;
Amigoni et al., 2000) but within ranges
quoted in sub-Saharan Africa
(Kwawukume et al., 1993). In some
countries however, such as Indonesia and
the Philippines, the median age of natural
menopause is considerably earlier, at 44
years (Ringa, 2000). The average age of
natural menopause (in Australia) is 51.7
years (Do et al., 1998), although this
varies considerably from one individual to
another.
Most frequently reported menopausal
symptoms reported were hot flushes
(14.3), Insomnia (8.5), joint/bone pain
(18.0), urinary incontinence (2.4),
irritability (3.4), fatigue (6.1) among others.
These were consistent with that of
Ozumba et al., 2004 in a study on age,
symptoms and perception of menopause
among Nigerian women. These symptoms
have been reported to occur less
frequently in Asian than Caucasian
women (Chung et al., 1996).
This study document the pattern of
cessation of menstruation among the
studied group. The reported patterns
include abruptly ended, period of
amenorrhea/oligomenorrhea and
experience irregular bleeding. Although
menopause is a universal experience,
reaction to cessation differs. While 26.4%
were not worried about it, 12.9% had lost
interest in sex, 19.8% felt cessation
heralds the onset of illness, some (41%)
were indifferent about it.
At menopause, majority (64.2%) of the
women experienced difficulty in having
sex. Nature of difficulties experienced
includes pain during sex, dryness of
vagina, bleeding after intercourse and
rejection by spouse. McMaster et al., 1997
reported that at menopause, walls of
vagina becomes thinner and loose its
elasticity. There may be irritation and
infection too. These factors causes
discomfort while having sex.
CONCLUSION
The menopausal symptoms among the
studied group are similar to those
observed in other studies. However, most
of the women had negative perception
about menopause and also experienced
sexual difficulties. It would be helpful if
women are able to learn what to expect
and what options are available in assisting
their transition from reproductive to non-
reproductive life. Access to information,
counselling and support are essential in
promoting positive attitudes towards
menopause and ameliorating the
problems.
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90
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