Background: Menopause is an important life stage for women, which can bring along sex- ual and cardiac problems. Increased heart rate variability is an indicator of parasympa- thetic activity and is associated with mental and physical health and life expectancy. This study aimed to evaluate the effect of sexual activity (only penile–vaginal intercourse but not masturbation or non-coital sex with a partner) on heart rate variability in healthy menopausal women.

Methods: We evaluated 130 menopausal patients aged 45-60 years, without chronic dis- ease. The average weekly sexual activity numbers remembered in the last 1 year were questioned. The patients were divided into 2 groups according to the presence of sexual activity. The sexually active group was divided into subgroups as 1 per week and 2 or more per week. Menopause Rating Scale was applied for menopausal symptoms. Heart rate variability was analyzed from the 24-hour electrocardiography Holter recording.

Results: Heart rate variability parameters were higher in the sexually active group than in the sexually inactive group (mean of the standard deviations of all the NN intervals for each 5 min segment of a 24-hour heart rate variability recording: P =.004; root mean square of differences between adjacent normal RR intervals, expressed in ms: P=.001; number of NN intervals exceeding 50 milliseconds: P =.011; percentage of adjacent RR intervals with a difference of duration >50 ms: P =.009; low frequency: P =.011; high fre- quency: P=.008, low frequency/high frequency: P=.018). When assessed by multiple linear regression analysis by adjusting for age, body mass index, and menopause dura- tion, the variables mean of the standard deviations of all the NN intervals for each 5 min segment of a 24-hour heart rate variability recording, root mean square of differences between adjacent normal RR intervals, expressed in ms, and low frequency were inde- pendently associated with the number of sexual activities per week (B = 2.89 ± 1.02, 95% CI = 0.866-4.91, P =.005; B = 4.57 ± 1.83, 95% CI = 0.94-8.2, P =.014; and B = 1174.9 ± 592.2, 95% CI = 2.9-2346.9, P =.049, respectively).

Conclusion: In healthy menopausal women, continued sexual activity with penile–vagi- nal intercourse is associated with better health outcomes on cardiac autonomic function through higher heart rate variability, an index of parasympathetic activity.