Factors Affecting Sexual Function in Midlife Women: Results from the Midlife Women's Health Study

OBJECTIVE

The objective of this study was to estimate the importance of risk factors affecting sexual function in sexually active midlife women.

MATERIALS AND METHODS

A cohort of 780 women undergoing the menopausal transition was surveyed each year for up to 7 years. Data were collected from sexually active women on sexual function, including frequencies of enjoyment, arousal, orgasm, passion for partner, satisfaction with partner, pain, lack of lubrication, fantasizing, and sexual activity. Data were also collected on a large number of potential risk factors for sexual dysfunction, including behaviors (smoking and alcohol use), health status (overall and frequency of different disorders), and demographic information (race, education, income, etc.). Height and weight were measured at an annual clinic visit; serum hormone concentrations were assayed using blood samples donated annually. Data on individual outcomes were examined with ordinal logistic regression models using individual as a random effect. An overall sexual function score was constructed from individual outcome responses, and this score was examined with linear regression. All factors with univariate associations of p < 0.1 were considered in multivariate model building with stepwise addition.

RESULTS

A total of 1,927 women-years were included in the analysis. Women with much more physical work than average had higher sexual function scores and higher rates of enjoyment, passion, and satisfaction. Higher family income was associated with lower sexual function score and more frequent dry sex. Married women had significantly lower sexual function scores, as did those with frequent irritability or vaginal dryness. A higher step on the Ladder of Life was associated with a higher sexual function score and higher frequency of sexual activity.

CONCLUSIONS

The factors associated with sexual outcome in menopausal women are complex and vary depending on the sexual outcome.

Transcutaneous Temperature Controlled Radiofrequency (TTCRF) for the Treatment of Menopausal Vaginal/Genitourinary Symptoms

OBJECTIVE

The aim of this study was to evaluate the effects of non-ablative, monopolar transcutaneous temperature controlled radiofrequency (TTCRF) technology in the treatment of postmenopausal women suffering from genuine stress urinary incontinence (SUI) related to menopause and to evaluate histological changes vaginally associated with the treatment.

MATERIALS AND METHODS

Subjective and objective symptoms of SUI were assessed in study subjects before and after TTCRF, (1 treatment every 30 days, for 3 months; n=10) and compared with the effects of a placebo treatment on a control group of demographically similar women (n =10). SUI was subjectively evaluated with subjective Urogenital Distress Inventory (UDI-6) and with the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) before and after TTCRF treatments and objectively with cough stress test. Vaginal health was evaluated with the Vaginal Health Index (VHI) score and visual analogue score (VAS) for dyspareunia and dryness. Punch biopsies were obtained at the urethra-vesical junction in the anterior compartment, before and at the end of the treatment protocol. Basic and histochemical staining methods were used.

RESULTS

In subjects suffering SUI, TTCRF treatment was associated with a significant (p<0.01) improvement of ICIQ-SF and UDI-6 scores. Seven of 10 patients (70%) had a negative cough stress test after the treatment protocol. Improvements were maintained up to the 12th week of follow-up. The results were supported by the positive histologic changes seen vaginally in women suffering from postmenopausal vaginal atrophy. TTCRF was well tolerated with no complications reported in study patients.

CONCLUSION

TTCRF treatment in postmenopausal women suffering from SUI showed significant improvement in both objective and subjective symptoms. Vaginal health scores also improved as did VAS for dryness and dyspareunia. We feel these improvements were related to histological changes related to improvement in vaginal atrophy that were not observed in placebo patients.

Vulvodynia

Vulvar pain and discomfort are common conditions which can truly make the patient's life miserable. It is relatively common, but can be a difficult condition to evaluate and treat. This article serves to give the primary care physician a basic framework with which to begin treatment for such patients.

Seeking help for sexual function complaints: what gynecologists need to know about the female patient's experience

OBJECTIVE

To further explore the patient experience of seeking help for a sexual function complaint.

DESIGN

Survey administered on a Web-based instrument.

SETTING

Healthy volunteers visiting an online Website.

PATIENT(S)

The majority of participants were married (73%), Caucasian (88%), and premenopausal (67%). Most commonly reported sexual complaints included low desire (77%), low arousal (62%), and difficulty achieving orgasm (56%).

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Patient experience survey on a women's sexual health website.

RESULT(S)

Although 40% of the women reported that they did not seek help from a physician for sexual function complaints, 54% reported that they would like to. Although only a minority of the women internalized their experience with extremely negative emotions like shame, devaluation, or disgust, the experience was not a particularly emotionally positive one along the lines of relief, optimism, or confidence, and a great deal of frustration and anxiety about treatment was reported.

CONCLUSION(S)

The extent to which health professionals currently receive exposure to training in human sexuality as well as the way in which female sexual complaints are handled in the medical setting remain ambiguous. The inflow of patients with sexual function complaints only will increase, and it is time for physicians to start to acknowledge women's sexuality with the same importance their patients do.

Experiences at menopause of women in a non-English-speaking community: a qualitative study

CONTEXT

It is important that clinicians appreciate the link between physiological disturbances and cultural meanings. The community surrounding the Baker Medical Research Institute in Melbourne, Australia includes a substantial number of women from a Greek-speaking background who attend the Menopause Clinic.

OBJECTIVE

To demonstrate how qualitative methodologies can assist with the development of clinical services by employing them to elucidate the role of cultural variables in the ways in which Greek women view menopause, aging, illness and medicine.

DESIGN

This was a qualitative study employing in-depth interviews on five separate occasions over 2 years, analyzed with thematic and ethnographic content analysis.

PATIENTS

Subjects were 40 Greek-speaking women attending the Clinic, aged 45-60 years.

RESULTS

There is an intricate association between experiences of the menopause and family relationships, problems raised by immigration and the cultural dislocation caused by it, beliefs and theories of the body, religion, and traditional approaches to healing and medicine. Many women had experienced unfavorable or unsatisfactory encounters with medicine in the past, reflecting lack of understanding of the women's experiences and failures of communication about clinical assessments and recommended treatments. Traditional therapies were often used without advising doctors.

CONCLUSIONS

The study emphasizes the potential utility of qualitative research methods for improving clinical practice by elaborating the specific requirements of particular groups, and thereby allowing doctors to deliver services that are more acceptable to patients from both a cultural and an ethical point of view, and also more effective. The process established for the evolution of our clinic may serve as a model for other clinics seeking to direct themselves to the needs of particular social groups or communities.

Factors related to sexual function in postmenopausal women with a history of breast cancer

BACKGROUND

The normal life expectancy of survivors of early-stage breast cancer (BCS) underscores the need to address long-term quality of life issues in these women. Sexual dysfunction persists after breast cancer treatment, despite recovery in other domains.

OBJECTIVE

To examine associations between a broad array of characteristics and sexuality in BCS.

PARTICIPANTS

Sixty-one postmenopausal BCS who were participants in a randomized, controlled trial of nonhormonal interventions for menopause symptoms and who had a partnered, intimate relationship.

METHODS

Cross-sectional analysis of baseline trial data. Outcomes were standardized scales of sexual interest, dysfunction, and satisfaction. Candidate predictors included demographic, anatomical, medical, psychological, sociocultural, and hormonal characteristics. Forward, stepwise regression was used.

RESULTS

Relationship quality, vaginal discomfort, education, and hot flashes were each associated with two of the three domains of sexuality assessed. Ten other factors entered predictive models: age, time since diagnosis, breast conservation, comorbidity, urinary incontinence, perceived health, body image, bioavailable testosterone, luteinizing hormone, and sex hormone binding globulin. Each of these 10 factors was associated with only one sexuality domain.

CONCLUSIONS

In this small sample of BCS, we found multiple correlates of sexuality. Most seem to impact uniquely on individual domains of sexual function. Several characteristics are modifiable and could be targets for intervention.

The diagnosis and management of infiltrating nodular recto-vaginal endometriosis

This paper reviews the history of infiltrating recto-vaginal endometriosis, its clinical and histological diagnosis, together with discussion of treatment options available. Important new work demonstrates significant serious symptomatology which patients suffer, and the relief that can be obtained by radical surgical excision. However this treatment is only available in certain specialist centres. The appropriate methods of management are yet to be subject to a proper randomized control trial, and results of treatment can only be assessed by meticulous recording of patient signs and symptomatology pre- and post-operation associated with histological confirmation of the disease.

Psychosocial factors, attitude to menopause and symptoms in Swedish perimenopausal women

OBJECTIVES

To analyze attitude to menopause from women's own accounts and to examine whether psychosocial factors and attitude are associated with symptom reporting.

METHODS

The data form part of a population-based longitudinal study of a cohort of women who have been followed annually for 5 years using psychological interviews and rating scales, health screening and hormonal characterization. The data reported here were collected at the fourth follow-up when the women (n = 148) were 53 years old.

RESULTS

Women were classified as perimenopausal (27%), postmenopausal (15%), hormone replacement therapy (HRT) users (52%) and hysterectomized (6%), based on self-reports. More than half the women (51%) had a positive attitude to menopause, 24% had a negative attitude and 25% had a neutral attitude. Menopausal status was not associated with attitude to menopause. Factor analysis of symptom ratings yielded ten independent factors comprising negative mood, vasomotor symptoms, decreased sexual desire, memory problems, sleep-related symptoms, vaginal dryness, urogenital problems, joint pain, vitality and increased sexual desire. Only vasomotor symptoms and joint pain were associated with menopausal status. The other symptoms were more strongly related to psychosocial factors, life-style and attitude to menopause.

CONCLUSIONS

The results support the view of the menopause as a developmental phase associated with an increased self-awareness and a stronger personal identity. More than half the women held a positive view of the menopause, whereas the remaining proportion of women had either a negative or a neutral attitude. Only vasomotor symptoms and joint pain were associated with postmenopausal status. Other symptoms were significantly related to psychosocial factors, life-style and attitude to menopause.

The menopause

Menopause is diagnosed after 12 months of amenorrhoea resulting from the permanent cessation of ovarian function. The mean age at menopause is 51 years. The perimenopause, a time of changing ovarian function, precedes the final menses by several years. The physiology and clinical manifestations of this transition to menopause are not well understood; however, some symptoms, such as hot flashes, certainly begin in the perimenopause. Causal associations between menopause and several symptoms and diseases are proposed. The evidence for these associations varies and is reviewed. Hormone replacement therapy can be directed at symptom relief or at prevention or treatment of chronic diseases. Doses and routes of hormone replacement therapy vary by indication. Complications of hormone replacement therapy depend on the regimen used. Knowing the expected vaginal bleeding pattern for each hormone replacement therapy regimen is important, since unexpected bleeding may signal endometrial hyperplasia. Postmenopausal hormone therapy is a complex intervention that produces positive and negative specific health effects. Overall, based on observational studies, postmenopausal women who use hormones have a 30-50% lower all-cause mortality rate than those who do not use hormones. It is important to recognise that the value that individual women place on various health outcomes associated with hormone replacement therapy may differ. Thus, the decision to use hormone replacement therapy should be made jointly by each woman and her health-care provider, after careful consideration of possible benefits, risks, and her personal preferences.

Oral sex and transmission of non-viral STIs

OBJECTIVES

To review the literature on the role of oral sex in the transmission of non-viral sexually transmitted infections (STIs).

METHOD

A Medline search was performed using the keywords oro-genital sex, and those specific to each infection. Further references were then taken from each article read.

CONCLUSIONS

Oral sex is a common sexual practice between both heterosexual and homosexual couples. Oro-genital sex is implicated as a route of transmission for gonorrhoea, syphilis, Chlamydia trachomatis, chancroid, and Neisseria meningitidis. Other respiratory organisms such as streptococci, Haemophilus influenzae, and Mycoplasma pneumoniae could also be transmitted by this route. Fellatio confers risk for acquisition of infection by the oral partner. Cunnilingus appears to predispose to recurrent vaginal candidiasis although the mechanism for this is unclear, while a link between oro-genital sex and bacterial vaginosis is currently being studied. Oro-anal sex is implicated in the transmission of various enteric infections. In view of the increased practice of oral sex this has become a more important potential route of transmission for oral, respiratory, and genital pathogens.

Difficult-to-treat trichomoniasis: results with paromomycin cream

Vaginal trichomoniasis poses a difficult therapeutic challenge when metronidazole is ineffective or contraindicated. We conducted a retrospective study of 6.25% paromomycin cream in the treatment of nine women referred with cases of vaginal trichomoniasis where metronidazole resistance or allergy was present. Results obtained immediately and 1 month after treatment were reviewed. The median age of the patients was 46 years; four women were nulliparous. The median symptom duration was 1 year. Five women were allergic to metronidazole. In four cases, resistance to high doses of metronidazole was demonstrated. Smears or cultures were positive immediately after treatment for three patients; a fourth relapsed 2 weeks later. Of these patients for whom treatment failed, one was cured with a 3-week course of paromomycin cream, and another was successfully treated with paromomycin cream and oral tinidazole. Three patients developed vaginal ulcerations that resolved spontaneously. Adverse effects may be a result of local formulation. Paromomycin cream was useful for treatment of cases of trichomonas infection where metronidazole resistance or allergy was encountered.

Streptococcal toxic shocklike syndrome leading to bilateral lower extremity compartment syndrome and renal failure. Report of a case

Compartment syndrome is considered a true emergency in orthopedic practice. To reduce morbidity and mortality from this condition, prompt diagnosis and appropriate treatment are absolutely essential. An unusual bilateral lower extremity compartment syndrome leading to renal failure and crush syndrome occurred in a 13-year-old girl with Streptococcal toxic shocklike syndrome. This situation seems not to have been previously reported. Early diagnosis and expeditious treatment produced minimal sequelae of the condition.