Sexual Health Before and After Menopause: A Golombok Rust Sexual Satisfaction Scale-Mediated Assessment

Abstract

Objective: Menopause is often accompanied by changes in sexual desire, arousal, orgasm, and genital pain. We aimed to examine how premenopausal sexual functioning predicts postmenopausal desire, orgasm, aversion, and vaginismus/dyspareunia, and to explore the predictive value of the Golombok-Rust Inventory of Sexual Satisfaction (GRISS).

Methods: In this cross-sectional clinic-based study, 113 postmenopausal women with DSM-V-TR–diagnosed female sexual dysfunction attending psychiatry, gynecology, or urology outpatient clinics of a university hospital were enrolled. Sociodemographic and clinical data were collected with a structured form. Using the GRISS framework, participants retrospectively rated premenopausal desire, arousal, orgasm, and attitudes, and concurrently rated current postmenopausal sexual functioning. Within-subject changes were analysed with the Wilcoxon signed-rank test; associations with clinical variables were examined by Spearman correlations and chi-square tests. Binary logistic regression estimated odds ratios (OR) for postmenopausal aversion and vaginismus/dyspareunia according to premenopausal GRISS items.

Results: Sexual desire significantly declined after menopause (p < 0.001). Higher premenopausal desire was positively associated with pre- and postmenopausal arousal and orgasm, and independently predicted maintenance of orgasm after menopause (OR = 4.02, 95% CI: 1.85–8.74, p < 0.005). Among women without premenopausal disgust, favourable responses to GRISS items on adequate foreplay and enjoyment of affection were associated with markedly reduced odds of postmenopausal aversion, whereas reporting disgust during intercourse (“always”) strongly predicted aversion (OR ≈ 24). In women without premenopausal vaginismus/dyspareunia, more positive premenopausal responses regarding foreplay, comfortable penetration, relationship satisfaction, and orgasm were associated with substantially lower odds of postmenopausal vaginismus/dyspareunia (OR range ≈ 0.04–0.17).

Conclusion: Premenopausal desire, arousal, and orgasm markedly shape postmenopausal sexual functioning. Item-level GRISS responses, especially those related to disgust, foreplay, and pain-free penetration, may help identify women at increased or decreased risk for postmenopausal aversion and vaginismus/dyspareunia and support more targeted counseling around the menopausal transition.