Skip to main content

Advertisement

SpringerLink
Log in

Interactions of Sleep and Female Sexual Function: a Review

  • Female Sexual Dysfunction and Disorders (T Lorenz and R Nappi, Section Editors)
  • Published:
Current Sexual Health Reports Aims and scope Submit manuscript

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

Purpose of Review

Sleep disturbance and sexual function complaints are common in women, particularly during midlife. The current review describes the literature on associations between sleep and sexual function in women with a focus on obstructive sleep apnea (OSA), insomnia, and other self-reported sleep complaints.

Recent Findings

Multiple studies demonstrate associations between OSA and sexual problems in both pre- and postmenopausal women. Recent studies show decreased sexual function associated with shorter sleep durations and insomnia in postmenopausal women, as well as with daytime sleepiness, poor sleep quality, and insomnia in premenopausal women.

Summary

An association exists between sleep disturbance and sexual dysfunction in women, which may indicate a direct interaction between these common complaints. However, equally or perhaps more important, are the independent determinants that influence both sleep and sexual function in women, such as obesity, mental health problems, and hormonal changes. Derangements in these factors have the potential to impact both sleep and sexual function.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Institute of Medicine. Sleep disorders and sleep deprivation: an unmet public health problem. Washington, DC: National Academies Press; 2006.

    Google Scholar 

  2. Bixler EO, Vgontzas AN, Lin HM, Have TT, Rein J, Vela-Bueno A, et al. Prevalence of sleep-disordered breathing in women: effects of gender. Am J Repir Crit Care Med. 2001;163:608–13.

    Article  CAS  Google Scholar 

  3. Zhang B, Wing YK. Sex differences in insomnia: a meta-analysis. 2006;29(1):85–93.

  4. Baker FC, de Zambotti M, Colrain IM, Bei B. Sleep problems during the menopausal transition: prevalence, impact, and management challenges. Nat Sci Sleep. 2018;10:73–95.

    Article  Google Scholar 

  5. Blumel JE, Cano A, Mezones-Holquin E, et al. A multinational study of sleep disorders during female mid-life. Maturitas. 2012;72(4):359–66.

    Article  Google Scholar 

  6. Ameratunga D, Goldin J, Hickey M. Sleep disturbance in menopause. Intern Med J. 2012;42(7):742–7.

    Article  CAS  Google Scholar 

  7. Joffe H, Massler A, Sharkey KM. Evaluation and management of sleep disturbance during the menopause transition. Semin Reprod Med. 2010;28(5):404–21.

    Article  Google Scholar 

  8. National Institutes of Health State-of-the-Science Conference statement Management of menopause-related symptoms. Ann Intern Med 2005;142(12 Pt 1):1003–1013.

  9. North American Menopause Society. The 2017 hormone therapy position statement of The North American Menopause Society. Menopause. 2017;24(7):728–53.

    Article  Google Scholar 

  10. •• Ciano C, King TS, Wright RR, Perlis M, Sawyer AM. Longitudinal study of insomnia symptoms among women during perimenopause. JOGNN. 2017;46:804–13 This study highlights the high rates of insomnia in perimenopausal women.

    Article  Google Scholar 

  11. •• Mirer AG, Young T, Palta M, Rm B, Rasmuson A, Peppard PE. Sleep-disordered breathing and the menopausal transition among participants in the sleep in midlife women study. Menopause. 2016;24(2):157–62 This study shows associations between sleep disordered breathing and menopausal women.

    Article  Google Scholar 

  12. Dennerstin L, Guthrie JR, Hayes RD, DeRogatis LR, Lehert P. Sexual function, dysfunction, and sexual distress in a prospective, population-based sample of mid-aged, Australian-born women. J Sex Med. 2008;5(10):2291–9.

    Article  Google Scholar 

  13. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA. 1999;281(6):537–44.

    Article  CAS  Google Scholar 

  14. Shifren JL, Monz BU, Russo PA, Segreti A, Johannes CB. Sexual problems and distress in United States women. Obstet Gynecol. 2008;112(5):970–8.

    Article  Google Scholar 

  15. Faubion SS, Rullo JE. Sexual dysfunction in women: a practical approach. Am Fam Physician. 2015;92(4):281–8.

    PubMed  Google Scholar 

  16. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed); 2013. https://doi.org/10.1176/appi.books.9780890425596.

    Book  Google Scholar 

  17. Rosen R, Brown C, Heiman J, et al. The female sexual function index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26(2):191–208.

    Article  CAS  Google Scholar 

  18. Derogatis L, Clayton A, Lewis-D’Agostino D, Wunderlich G, Fu Y. Validation of the female sexual distress scale-revised for assessing distress in women with hypoactive sexual desire disorder. J Sex Med. 2008;5(2):357–64.

    Article  Google Scholar 

  19. •• Goldstein I, et al. Hypoactive sexual desire disorder: International Society for the Study of Women’s Sexual Health (ISSWSH) expert consensus panel review. Mayo Clin Proc. 2017;92(1):114–28 This consensus paper defines HSDD and FSD and describes options for treatment.

    Article  Google Scholar 

  20. Biddle AK, West SL, D’Aloisio AA, Wheeler SB, Borisov NN, Thorp J. Hypoactive sexual desire disorder in postmenopausal women: quality of life and health burden. Value Health. 2009;12(5):763–72.

    Article  Google Scholar 

  21. Kingsberg SA. Attitudinal survey of women living with low sexual desire. J Women's Health. 2014;23(10):817–23.

    Article  Google Scholar 

  22. Leiblum SR, Koochaki PE, Rodenberg CA, Baron IP, Rosen RC. Hypoactive sexual desire disorder in postmenopausal women: US results from the Women’s International Study of Health and Sexuality (WISHes). Menopause. 2006;13(1):46–56.

    Article  Google Scholar 

  23. Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society. Menopause. 2013; 20 (9):888–902.

  24. Gracia CR, Freeman EW, Sammel MD, Lin H, Modul M. Hormones and sexuality during transition to menopause. Obstet Gynecol. 2007;109(4):831–90.

    Article  CAS  Google Scholar 

  25. Woods NF, Mitchell ES, Smith-Di Julio K. Sexual desire during the menopausal transition and early postmenopause: observations from the Seattle Midlife Women’s Health Study. J Women's Health. 2010;19(2):209–18.

    Article  Google Scholar 

  26. George LK, Weiler SJ. Sexuality in middle and late life. The effects of age, cohort and gender. Arch Gen Psychiatry. 1981;38(8):919–23.

    Article  CAS  Google Scholar 

  27. American Academy of Sleep Medicine, editor. International classification of sleep disorders, 3rd ed. Darien: American Academy of Sleep Medicine; 2014.

    Google Scholar 

  28. Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008;4(5):487–504.

    PubMed  PubMed Central  Google Scholar 

  29. Epstein LJ, Kristo D, Strollo PJ Jr, et al. Clinical guidelines for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5(3):263–76.

    PubMed  Google Scholar 

  30. Bromberger JT, Kravitz HM, Youk A, Schott LL, Joffe H. Patterns of depressive disorders across 13 years and their determinants among midlife women: SWAN mental health study. J Affect Disord. 2016;206:31–40.

    Article  Google Scholar 

  31. Zaslavsky O, LaCroix AZ, Hale L, Tindle H, Shochat T. Longitudinal changes in insomnia status and incidence of physical, emotional, or mixed impairment in postmenopausal women participating in the Women’s Health Initiative (WHI) study. Sleep Med. 2015;16(3):364–71.

    Article  Google Scholar 

  32. Nowakowski S, Matthews KA, von Kanel R, Hall MH, Thurston RC. Sleep characteristics and inflammatory biomarkers among midlife women. SleepJ. 2018:1–9.

  33. Cappuccio FP, Stranges S, Kandala NB, Miller MA, Taggart FM, Kumari M, et al. Gender-specific associations of short sleep duration with prevalent and incident hypertension: the Whitehall II study. Hypertension. 2007;50(4):693–700.

    Article  CAS  Google Scholar 

  34. Dong J-Y, Zhang Y-H, Qin L-Q. Obstructive sleep apnea and cardiovascular risk: meta-analysis of prospective cohort studies. Atherosclerosis. 2013;229:489–95.

    Article  CAS  Google Scholar 

  35. •• Shokri-Kojori E, Wang GJ, Wiers CE, et al. β-Amyloid accumulation in the human brain after one night of sleep deprivation. Neuroscience. 2018. https://doi.org/10.1073/pnas.1721694115 This study demonstrates potential increased with of Alzheimer’s disease with sleep deprivation.

    Article  CAS  Google Scholar 

  36. • Liu L, Kang R, Zhao S, et al. Sexual dysfunction in patients with obstructive sleep apnea: a systematic review and meta-analysis. J Sex Med. 2015;12:1992–2003 Meta-analysis demonstrating association of OSA and female sexual problems.

    Article  Google Scholar 

  37. Subramanian S, Bopparaju S, Desai A, Wiggins T, Rambaud C, Surani S. Sexual dysfunction in women with obstructive sleep apnea. Sleep Breath. 2010;14(1):59–62.

    Article  Google Scholar 

  38. • Fanfulla F, Camera A, Fulgoni P, Chiovato L, Nappi RE. Sexual dysfunction in obese women: does obstructive sleep apnea play a role? Sleep Med. 2013;14:252–6 This study shows association between nocturnal hypoxia and risk of FSD.

    Article  Google Scholar 

  39. Soukhova-O’Hare GK, Ortines RV, Gu Y, Nozdrachev AD, Prabhu SD, Gozal D. Postnatal intermittent hypoxia and developmental programming of hypertension in spontaneously hypertensive rats: the role of reactive oxygen species and L-Ca2+ channels. Hypertension. 2008;52(1):156–62.

    Article  Google Scholar 

  40. Andersen ML, Alvarenga TA, Guindalini C, Perry JC, Silva A, Zager A, et al. Paradoxical sleep deprivation influences sexual behavior in female rats. J Sex Med. 2009;6:2162–72.

    Article  Google Scholar 

  41. Velazquez-Moctezuma J, Monroy E, Beyer C, Canchola E. Effects of REM deprivation on the lordosis response induced by gonadal steroids in ovariectomized rats. Physiol Behav. 1984;32(1):91–4.

    Article  CAS  Google Scholar 

  42. Andersen ML, Alvarenga TF, Mazaro-Costa R, Hachul HC, Tufik S. The association of testosterone, sleep and sexual function in men and women. Brain Res. 2011;1416:80–104.

    Article  CAS  Google Scholar 

  43. de Zambotti M, Colrain IM, Javitz HS, Baker FC. Magnitude of the impact of hot flashes on sleep in perimenopausal women. Fertil Steril. 2014;102(6):1708–15.

    Article  Google Scholar 

  44. Gao CG, Kapoor E, Lipford MC, Miller VM, Schroeder DR, Mara KC, et al. Association of vasomotor symptoms and sleep apnea risk in midlife women. Menopause. 2017;25(4):391–8.

    Google Scholar 

  45. Nazarpour S, Masoumeh S, Tehrani FR. Factors affecting sexual function in menopause: a review article. Taiwan J Obstet Gynecol. 2016;55(4):480–7.

    Article  Google Scholar 

  46. Hachul H, Andersen ML, Bittencourt LR, Santos-Silva R, Conway SG, Tufik S. Does the reproductive cycle influence sleep patterns in women with sleep complaints? Climacteric. 2010;13(6):594–603.

    Article  CAS  Google Scholar 

  47. Antunes IB, Anderson ML, Baracat EC, Tufik S. The effects of paradoxical sleep deprivation on estrous cycles of the female rats. Horm Behav. 2006;49(4):433–40.

    Article  CAS  Google Scholar 

  48. Hachul de Campos H, Brandao LC, et al. Sleep disturbances, oxidative stress and cardiovascular risk parameters in postmenopausal women complaining of insomnia. Climacteric. 2006;9(4):312–9.

    Article  CAS  Google Scholar 

  49. Sowers MF, Zheng H, Kravitz HM, Matthews K, Bromberger JT, Gold EB, et al. Sex steroid hormone profiles are related to sleep measures from polysomnography and the Pittsburgh Sleep Quality Index. Sleep. 2008;31(10):1339–49.

    PubMed  PubMed Central  Google Scholar 

  50. Stavaras C, Pastaka C, Papala M, Gravas S, Tzortzis V, Melekos M, et al. Sexual function in pre and post-menopausal women with obstructive sleep apnea syndrome. Int J Impot Res. 2012;24:228–33.

    Article  CAS  Google Scholar 

  51. Hachul H, Bittencourt LR, Andersen ML, Haidar MA, Baracat EC, Tufik S. Effects of hormone therapy with estrogen and/or progesterone on sleep pattern in postmenopausal women. Int J Gynaecol Obstet. 2008;103(3):207–12.

    Article  CAS  Google Scholar 

  52. Bixler EO, Vgontzas AN, Lin HM, et al. Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med. 2001;163(3 Pt 1):608–13.

    Article  CAS  Google Scholar 

  53. Sharer E, Redline S, Young T, et al. Hormone replacement therapy and sleep-disordered breathing. Am J Respir Crit Care Med. 2003;167(9):1186–92.

    Article  Google Scholar 

  54. •• Galvan T, Camuso J, Sullivan K, Kim S, White D, Redline S, et al. Association of estradiol with sleep apnea in depressed perimenopausal and postmenopausal women: a preliminary study. Menopause. 2016;24(1):112–7 This study highlights possible explanations for link between sleep and OSA, lower estradiol levels.

    Article  Google Scholar 

  55. Dennerstein L, Randolph J, Taff J, Dudley E, Burger H. Hormones, mood, sexuality, and the menopausal transition. Fertil Steril. 2002;77(4):S42–8.

    Article  Google Scholar 

  56. Fernandez RC, Moore VM, Van Ryswyk EM, Varcoe TJ, Rodgers RJ, March WA, et al. Sleep disturbances in women with polycystic ovary syndrome: prevalence, pathophysiology, impact and management strategies. Nat Sci Sleep. 2018;10:45–64.

    Article  Google Scholar 

  57. Lobo RA. Androgens in postmenopausal women: production, possible role, and replacement options. Obstet Gynecol Surv. 2001;56(6):361–76.

    Article  CAS  Google Scholar 

  58. Abdallah RT, Simon JA. Testosterone therapy in women: its role in the management of hypoactive sexual desire disorder. Int J Impot Res. 2007;19(5):458–63.

    Article  CAS  Google Scholar 

  59. Simon J, Braunstein G, Nachtigall L, Utian W, Katz M, Miller S, et al. Testosterone patch increases sexual activity and desire in surgically menopausal women with hypoactive sexual desire disorder. J Clin Endocrinol Metab. 2005;90(9):5226–33.

    Article  CAS  Google Scholar 

  60. Hubayter Z, Simon JA. Testosterone therapy for sexual dysfunction in postmenopausal women. Climacteric. 2008;11(3):181–91.

    Article  CAS  Google Scholar 

  61. Cappelletti M, Wallen K. Increasing women’s sexual desire: the comparative effectiveness of estrogens and androgens. Horm Behav. 2016;78:178–93.

    Article  CAS  Google Scholar 

  62. Roney JR, Simmons ZL. Hormonal predictors of sexual motivation in natural menstrual cycles. Horm Behav. 2013;63(4):636–45.

    Article  CAS  Google Scholar 

  63. Davis SR, Davison SL, Donath S. Circulating androgen levels and self-reported sexual function in women. JAMA. 2005;294(1):91–6.

    Article  CAS  Google Scholar 

  64. van Anders SM. Testosterone and sexual desire in healthy women and men. Arch Sex Behav. 2012;41(6):1471–84.

    Article  Google Scholar 

  65. Krapf JM, Simon JA. A sex-specific dose-response curve for testosterone: could excessive testosterone limit sexual interaction in women? Menopause. 2017;24(4):462–70.

    Article  Google Scholar 

  66. Reed SD, Newton K, LaCroix AZ, Grothaus LC, Ehrlich K. Night sweats, sleep disturbance, and depression associated with diminished libido in late menopausal transition and early postmenopause: baseline data from the Herbal Alternatives for Menopause Trial (HALT). Am J Obstet Gynecol. 2007;593:e1–7.

    Google Scholar 

  67. Eraslan D, Ertekin E, Ertekin BA, Ozturk O. Treatment of insomnia with hypnotics resulting in improved sexual functioning in post-menopausal women. Pychiatria Danubina. 2014;26(4):353–7.

    CAS  Google Scholar 

  68. • Kalmbach DA, Arnedt JT, Pillai V, Ciesla JA. The impact of sleep on female sexual response and behavior: a pilot study. J Sex Med. 2015;12:1221–32 This study demonstrates a possible physiologic link between sleep and sexual function in young women.

    Article  Google Scholar 

  69. Costa R, Costa D, Pestana J. Subjective sleep quality, unstimulated sexual arousal, and sexual frequency. Sleep Sci. 2017;10(4):147–53.

    Article  Google Scholar 

  70. Costa RM, Oliveira TF. Poorer subjective sleep quality is related to higher fantasy-induced sexual arousal in women of reproductive age. J Sex Marital Ther. 2016;42(8):740–8.

    Article  Google Scholar 

  71. •• Kling JM, Manson JE, Naughton MJ, Temkit M, Sullivan SD, Gower EW, et al. Association of sleep disturbance and sexual function in postmenopausal women. Menopause. 2017;24(6):604–12 This large study shows associations between sleep and sexual function in postmenopausal women.

    Article  Google Scholar 

  72. •• Afsahri P, Salehnejad Z, Hekmat K, Abedi P, Fakhri A, Haghighizadeh M. Do sleeping disorders impair sexual function in married Iranian women of reproductive age? Results from a cross-sectional study. Hindawi Psychiatry J. 2018. https://doi.org/10.1155/2018/1045738 This study shows associations between sleep and sexual function in premenopausal women.

    Article  Google Scholar 

  73. Lindau ST, Schumm LP, Laumann EO, Levinson W, O’Muicheartaigh CA, Waite LJ. A study of sexuality and health among older adults in the United States. NEJM. 2007;357:762–74.

    Article  CAS  Google Scholar 

  74. Kripke DF, Brunner R, Freeman R, Hendrix SL, Jackson RD, Masaki K, et al. Sleep complaints of postmenopausal women. Clin J Womens Health. 2001;1(5):244–52.

    Article  Google Scholar 

  75. Gass M, Cochrane B, Larson J, et al. Patterns and predictors of sexual activity among women in the women in the hormone therapy trials of the Women’s Health Initiative. Menopause. 2011;18(11):1160–71.

    Article  Google Scholar 

  76. Barclay NL, Eley TC, Rijsdijk FV, Gregory AM. Dependent negative life events and sleep quality: an examination of gene-environment interplay. Sleep Med. 12(4):403–9.

    Article  Google Scholar 

  77. Bodenmann G, Ledermann T, Blattner D, Galluzzo C. Associations among everyday stress, critical life events and sexual problems. J Nerv Ment Dis. 2006;194:494–501.

    Article  Google Scholar 

  78. Shumaker SA, Hill DR. Gender differences in social support and physical health. Health Psychol. 1991;10(2):102–11.

    Article  CAS  Google Scholar 

  79. Troxel WM, Buysse DJ, Monk TH, Begley A, Hall M. Does social support differentially affect sleep in older adults with versus without insomnia? J Psychosom Res. 2010;69(5):459–66.

    Article  Google Scholar 

  80. Vegunta S, Kuhle C, Kling JM, Files JA, Kapoor E, David PS, et al. The association between recent abuse and menopausal symptom bother: results from the data registry on experiences of aging, menopause and sexuality (DREAMS). Menopause. 2016;23(5):494–8.

    Article  Google Scholar 

  81. • Prairie BA, Wisniewski SR, Luther J, et al. Symptoms of depressed mood, disturbed sleep, and sexual problems in midlife women: cross-sectional data from the study of Women’s Health Across the Nation. J Womens Health. 2015;24:119–26 This study shows associations between sleep, sexual function and depression in menopausal women.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Women’s Health Internal Medicine, Mayo Clinic, 13737 North 92nd Street, Scottsdale, AZ, 85260, USA

    Juliana M. Kling

  2. Division of Endocrinology, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA

    Ekta Kapoor

  3. Women’s Health Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA

    Ekta Kapoor & Stephanie S. Faubion

Authors
  1. Juliana M. Kling
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ekta Kapoor
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stephanie S. Faubion
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Juliana M. Kling.

Ethics declarations

Conflict of Interest

Juliana M. Kling and Ekta Kapoor each declare no potential conflicts of interest.

Stephanie Faubion is a consultant for Mithra Pharmaceuticals and Procter and Gamble.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Topical Collection on Female Sexual Dysfunction and Disorders

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kling, J.M., Kapoor, E. & Faubion, S.S. Interactions of Sleep and Female Sexual Function: a Review. Curr Sex Health Rep 10, 339–344 (2018). https://doi.org/10.1007/s11930-018-0180-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11930-018-0180-3

Keywords

Search

Navigation