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Gender differences in sex life issues – A population-based study of migraine sufferers
© Sumanen et al; licensee BioMed Central Ltd. 2008
Received: 22 October 2007
Accepted: 09 April 2008
Published: 09 April 2008
Migraine is considered to have a negative influence on sex life. The present study was to analyse the perceptions of importance of and satisfaction with sex life as well as the expression of interest in sex among people having migraines in a prospective follow-up mail survey in 1998 and 2003.
The random sample was stratified according to gender and age in four age groups (20–24, 30–34, 40–44, and 50–54 years). Altogether 25 898 individuals responded to the baseline and 19 626 to the follow-up questionnaire (75.8% response rate). We examined as to how the perceptions of sex life of those suffering from migraine changed during a 5-year follow-up. Conditional logistic regression was used to analyse the data of the responses on self-reported migraine in the baseline and follow-up surveys (N = 2 977, 79.2% women). Each person with migraine was assigned a gender- and age-matched control in the analysis.
All three outcome variables tended to decrease in value. Importance of sex life was higher among men with migraine than among their controls. Among women migraine lessened interest in sex life.
Our findings suggested that migraine has a different impact on sex life among women from that among men.
Headache has wide-ranging adverse effects and is often accompanied by considerable worry . The majority of migraine sufferers have acknowledged that migraine has a significant effect on both activity-based quality of life and on personal relationships . Most of the migraine sufferers are able to cite negative or unconstructive family situations  and/or interference with spousal relationships as a result of their migraines. Moreover, social factors during childhood are likely to be associated with migraine headaches during adulthood . In addition to headache contributing to less sexual activity or sexual activity causing headaches , some headache sufferers have reported marked sexual arousal during a migraine attack . Being involved in or having sex may in fact provide some relief for migraine sufferers . Migraine sufferers may have elevated levels of sexual desire and they may be the least likely ones to elude sexual activity .
The diagnosis of a migraine headache is a reason for other medical concerns . Lifetime prevalence of major depression has been noted approximately three times more often among migraine sufferers than among their controls . The association of serotonin and depression is well-known and connections exist between serotonin and migraine attacks [11–14]. Serotonin is also involved in libido. Already decades ago, an absolute or relative excess of serotonin in the midbrain was reported to antagonize testosterone which in turn causes decreased libido among men . The association between depression and libido has been confirmed [16–18]. Among women, the role of testosterone is perceived to be less obvious while migraines have been found to be associated with hormones. Female hormones have been suggested to have an important factor responsible for the gender differences in headache disorders [19–22]. The associations between migraines, serotonin metabolism and sex life may be explained, but does migraine affect sex life?
The present study was to analyse the perceptions of importance of and satisfaction with sex life as well as the expression of interest in sex among people having migraines in a prospective follow-up mail survey.
Health and Social Support Study (the HeSSup Study) is a prospective mail survey designed to follow up a large number of diverse issues within the Finnish working-aged population. The random sample (N = 64 797) was obtained from the Finnish Population Register Centre and stratified according to gender and four age groups (20–24, 30–34, 40–44, and 50–54 years). A total of 25 898 individuals (40% response, 59% women) returned the baseline survey questionnaire in 1998. Data were found to be representative of the Finnish working-aged people . All those who responded to the first questionnaire received the follow-up questionnaire in 2003 and this survey yielded 19 629 respondents (75.8% response rate, 61.4% women). During the 5-year follow-up period 1.9% of the random sample and 1.3% of individuals responding to the baseline survey had died.
The HeSSup study used survey data with healthy subjects. Consequently, the medical ethics committee of the Turku University Central Hospital certified that no committee approval was necessary according to the present Finnish law. The responding individuals gave their informed consent with signature so that personal information may be linked via registries. The voluntary response was adequate.
The participants were asked whether 'they presently had or had ever had migraine' as verified by a physician. This diagnosis was based on the personal perception of whether they did or did not have migraines and not obtained from the medical case history. In effort to verify the method of diagnosing self-reported migraine, we compared the prevalence of migraine among the health care staff of nurses and physicians (n = 688) and other people in the baseline data. The prevalence rates were 18.6% for the health care staff and 19.1% for the total HeSSup baseline population. The participants were also inquired as to how important sex life was to them and whether they were or were not satisfied with their sex life. These personal perceptions were examined with a Likert-type 7-point scale, but only 3 categories were used (1–2, 3–5, and 6–7 combined) [24, 25].
The questionnaire contained an item from the Beck Depression Inventory (BDI) . The single question measured interest in sex with four response alternatives (1 = no recent change in interest in sex, 2 = less interested, 3 = much less interested, 4 = lost interest completely). We considered it acceptable to make use of this item; it has been used in two previous studies [24, 25]. The responses were grouped into two new categories (2–4 combined) to establish whether interest in sex did or did not decrease.
We analysed the responses of those who affirmatively replied to the question on self-reported migraine in both the baseline and follow-up questionnaires. Altogether 2 977 respondents indicated migraine in both questionnaires (79.2% women). One age- and gender-matched control was selected for every individual with migraine from among those who reported having migraine in neither questionnaire.
Conditional regression analysis was used to treat the data. The results were expressed as odds ratios with 95% confidence intervals. Associations with p-values <0.05 were interpreted as statistically significant. In the perceptions of importance of and satisfaction with sex life, the response options of 'fairly' and 'not important/satisfied' were combined and they were compared with the response options of 'very important/satisfied'. The statistical analyses were performed using the SAS System for Windows (release 9.1.3.).
Proportions (%) of answers to questions on sex life issues to migraine patients in the years 1998 and 2003.
Women (N = 2358)
Men (N = 619)
Importance of sex life
Satisfaction with sex life
Interest in sex life
No recent change
Age- and gender-matched ORs with 95% CI in conditional logistic analysis in the years 1998 and 2003 to questions on sex life issues to migraine patients and controls. Statistical significant results in bold.
Importance of sex life
Not or fairly important vs very important
0.94 (0.84 – 1.06)
1.03 (0.92 – 1.16)
0.70 (0.55 – 0.89)
0.78 (0.62 – 0.98)
Satisfaction with sex life
Not or fairly satisfied vs very satisfied
0.98 (0.87 – 1.10)
1.03 (0.92 – 1.16)
0.88 (0.70 – 1.10)
0. 91 (0.73 – 1.14)
Interest in sex life
No recent change vs decreased interest
0.84 (0.74 – 0.95)
0.83 (0.74 – 0.94)
0.85 (0.65 – 1.12)
0.82 (0.64 – 1.05)
The present study was to analyse the perceptions of importance of and satisfaction with sex life as well as the expression of interest in sex among men and women suffering from migraine in a prospective follow-up mail survey. There was decreasing interest in sex life among women and increasing importance of sex life among men.
The method of assessment was based on a question that inquired the personal perception of having or not having migraine, a type of headache, in the mail survey. Frequency or intensity of the migraine attacks was not known. We did not study the other forms of headache. Responses were analysed only when the question was responded to in both the baseline and follow-up questionnaires. One person in four having migraine did not respond to the follow-up survey but the response rate may be considered high. The non-response in the follow-up data did not have a significant effect on the outcomes and the data may be considered reliable.
Being a question of self-report, it is not absolutely certain whether migraine did or did not exist as a form of headache. There is no specific test to verify the diagnosis and many people having migraines do not consult a physician , which is to underline as to how difficult it is to establish a reliable migraine diagnosis. We venture to state that people having migraines really do suffer from this type of headache and that the mail survey may be considered a valid method of data gathering since the medical staff of nurses and physicians also responded in the same manner as the rest of the participants did.
In a recent study migraine did not affect sex life . In the present study, no significant association of satisfaction with sex life was observed. Sexual satisfaction may be evident when there is a balance between what one contributes to a relationship and receives from it in return. In so doing, it may be assumed that there was equity, fair play in these relationships. On the other hand, migraine was a contributor to increasing importance of sex life among men and lessening interest in sex among women. The traditional way is to look at the biological processes and to explain sexuality issue with them while there are efforts underway to discover how behaviour and experience in turn affect the biological processes. Women's sexual behaviours are more complicated than men's sexual behaviours and influenced by relationship issues.
Why then does interest in sex life surface as an issue of lessening interest in sex among women and why does importance of sex life increase among men alone? Age is being indicated as a potential contributor in the prevalence of at least some of the known sexual problems. Lubrication is known to reduce in quantity with age among women and makes a difference in interest in sex. The Global Study of Sexual Attitudes and Behaviours (GSSAB) on sex and relationships of men and women for 40–80 years of age (13 882 women and 13 618 men from 29 countries) indicated that age is an important correlate of lubrication difficulties among women and of several sexual problems, including a lack of interest in sex or the inability to reach orgasm. Erectile difficulties were indicated among men. The study concluded that sexual problems tend to be more associated with physical health and aging among men than women . It is also possible that women feel more ill and suffer from a migraine attack more than men do. This may be associated with a decreasing interest in sex among women.
According to the findings of the present study, associations of migraine with sex life issues were different for men and women. In this respect our findings are new and unique. The associations may be small or perhaps even clinically insignificant but they may make a great difference when improvements are applied in the lives they touch. GP has a vital role in the comprehensive treatment of migraine patients. Sex life is an essential part of health and investing in it will increase the overall well-being. In order to diminish suspicions and false beliefs GPs should ask about the sex life issues of their patients and offer related information to them when migraines are being treated.
- Leiper DA, Elliot AM, Hannaford PC: Experiences and perceptions of people with headache: a qualitative study. BMC Family Practice. 2006, 7: 27-10.1186/1471-2296-7-27.View ArticlePubMedPubMed CentralGoogle Scholar
- Dowson A, Jagger S: The UK Migraine Patient Survey: Quality of Life and Treatment. Current Medical Research and Opinion. 1999, 15: 241-253.View ArticlePubMedGoogle Scholar
- Linde M, Dahlöf C: Attitudes and burden of disease among self-considered migraineurs-a nation-wide population-based survey in Sweden. Cephalalgia. 2004, 24: 455-465. 10.1111/j.1468-2982.2004.00703.x.View ArticlePubMedGoogle Scholar
- Sumanen M, Rantala A, Sillanmäki L, Mattila K: Childhood adversities experienced by working-age migraine patients. Journal of Psychosomatic Research. 2007, 62: 139-143. 10.1016/j.jpsychores.2006.08.010.View ArticlePubMedGoogle Scholar
- Frese A, Eikermann A, Frese K, Schwaag S, Husstedt IW, Evers S: Headache associated with sexual activity: demography, clinical features, and comorbidity. Neurology. 2003, 61: 796-800.View ArticlePubMedGoogle Scholar
- Del Bene E, Conti C, Poggioni M, Sicuteri F: Sexuality and headache. Advances in Neurology. 1982, 33: 209-214.PubMedGoogle Scholar
- Ullman D: The One-Minute (Or So) Healer: More Wisdom from the Sages, the Rosemarys, and the Times (Paperback). 2000, USA, Hay HouseGoogle Scholar
- Houle TT, Dhingra LK, Remble TA, Rokicki LA, Penzien DB: Not Tonight, I Have a Headache?. Headache. 2006, 46: 983-990. 10.1111/j.1526-4610.2006.00470.x.View ArticlePubMedGoogle Scholar
- Hamelsky SW, Lipton RB: Psychiatric comorbidity of migraine. Headache. 2006, 46: 1327-1333.View ArticlePubMedGoogle Scholar
- Breslau N, Schultz LR, Stewart WF, Lipton RB, Lucia VC, Welch KM: Headache and major depression; is the association specific to migraine?. Neurology. 2000, 54: 308-313.View ArticlePubMedGoogle Scholar
- Ferrari MD, Saxena PR: On serotonin and migraine: a clinical and pharmacological review. Cephalalgia. 1993, 13: 151-165. 10.1046/j.1468-2982.1993.1303151.x.View ArticlePubMedGoogle Scholar
- Hargreaves RJ, Shepheard SL: Pathophysiology of migraine – new insights. The Canadien Journal of Neurological Sciences. 1999, S12-9. Suppl 3Google Scholar
- Tepper SJ, Rapoport AM, Sheftell FD: Mechanisms of action of the 5-HT1B/1D receptor agonists. Archives of Neurology. 2002, 59: 1084-1088. 10.1001/archneur.59.7.1084.View ArticlePubMedGoogle Scholar
- Hamel E: Serotonin and migraine: biology and clinical implications. Cephalalgia. 2007, 27: 1293-1300. 10.1111/j.1468-2982.2007.01476.x.View ArticlePubMedGoogle Scholar
- Sicuteri F, Del Bene E, Fonda C: Sex, migraine and serotonin interrelationships. Monographs in neural sciences. 1976, 3: 94-101.PubMedGoogle Scholar
- Phillips RL, Slaughter JR: Depression and sexual desire. American Family Physician. 2000, 62: 782-786.PubMedGoogle Scholar
- Greil W, Horvath A, Sassim N, Erazo N, Grohmann R: Disinhibition of libido: an adverse effect of SSRI?. Journal of Affective Disorders. 2001, 62: 225-228. 10.1016/S0165-0327(00)00150-6.View ArticlePubMedGoogle Scholar
- Csoka A, Bahrick A, Mehtonen OP: Persistent sexual dysfunction after discontinuation of selective serotonin reuptake inhibitors. The Journal of Sexual Medicine. 2008, 5: 227-233.View ArticlePubMedGoogle Scholar
- Rasmussen BK: Migraine and tension-type headache in a general population: precipitating factors, female hormones, sleep pattern and relation to lifestyle. Pain. 1993, 53: 65-72. 10.1016/0304-3959(93)90057-V.View ArticlePubMedGoogle Scholar
- Stewart WF, Lipton RB, Chee E, Sawyer J, Silberstein SD: Menstrual cycle and headache in a population sample of migraineurs. Neurology. 2000, 55: 1517-1523.View ArticlePubMedGoogle Scholar
- Martin VT, Wernke S, Mandell K, Ramadan N, Kao L, Bean J, Liu J, Zoma W, Rebar R: Defining the relationship between ovarian hormones and migraine headache. Headache. 2005, 45: 1190-1201. 10.1111/j.1526-4610.2005.00242.x.View ArticlePubMedGoogle Scholar
- Martin VT, Wernke S, Mandell K, Ramadan N, Kao L, Bean J, Liu J, Zoma W, Rebar R: Symptoms of premenstrual syndrome and their association with migraine headache. Headache. 2006, 46: 125-137. 10.1111/j.1526-4610.2006.00306.x.View ArticlePubMedGoogle Scholar
- Korkeila K, Suominen S, Ahvenainen J, Ojanlatva A, Rautava P, Helenius H, Koskenvuo M: Non-response and related factors in a nation-wide health survey. European Journal of Epidemiology. 2001, 17: 991-999. 10.1023/A:1020016922473.View ArticlePubMedGoogle Scholar
- Ojanlatva A, Helenius H, Rautava P, Ahvenainen J, Koskenvuo M: Importance of and satisfaction with sex life in a large Finnish population. Sex Roles. 2003, 48: 543-553. 10.1023/A:1023579313434.View ArticleGoogle Scholar
- Sumanen M, Ojanlatva A, Koskenvuo M, Mattila K: GPs should discuss sex life issues with coronary heart patients. Sexual and Relationship Therapy. 2005, 20: 443-452. 10.1080/14681990500228514.View ArticleGoogle Scholar
- Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J: An inventory for measuring depression. Archives of General Psychiatry. 1961, 4: 561-571.View ArticlePubMedGoogle Scholar
- MacGregor EA, Brandes J, Eikermann A: Migraine prevalence and treatment patterns: the global Migraine and Zolmitriptan Evaluation survey. Headache. 2003, 43: 19-26. 10.1046/j.1526-4610.2003.03004.x.View ArticlePubMedGoogle Scholar
- Laumann EO, Nicolosi A, Glasser DB, Paik A, Gingell C, Moreira E, Wang T, GSSAB Investigators' Group: Sexual Problems Among Women and Men Aged 40–80 y: Prevalence and Correlates Identified in the Global Study of Sexual Attitudes and Behaviors. International Journal of Impotence Research. 2005, 17: 39-57. 10.1038/sj.ijir.3901250.View ArticlePubMedGoogle Scholar
- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2296/9/19/prepub
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