Predictors of female sexual dysfunction: a systematic review and qualitative analysis through gender inequality paradigms

Predictive Factors for the Risk of Sexual Dysfunction in Climacteric Women: Population-based Study

BACKGROUND

It is known that sexual problems increase with age but little is known about the predictors of female sexual dysfunction (FSD) in Brazilian climacteric women.

AIM

To identify predictive factors for FSD in climacteric women.

METHODS

This is a cross-sectional population-based study carried out through a household survey.

OUTCOMES

The measures investigated were sociodemographic characteristics, depressive symptoms, level of physical activity, presence of FSD, self-rated health and sleep satisfaction.

RESULT

A total of 381 climacteric, sexually active women were included, with a mean age of 55.04 (±7.21) years. The prevalence of FSD was 38.3%. All variables investigated were associated with FSD (P < .05). In the final model, the predictors for FSD were low satisfaction with sleep (OR 4.20; 95% CI 2.32-7.62), advanced age (OR 1.04; 95% CI 1.00-1.08), low education level (OR 0.90; 95% CI 0.85-0.97) and having a partner (OR 0.35; 95% CI 0.16-0.76).

CLINICAL IMPLICATION

These aspects deserve attention from the health team to prevent and identify FSD early in life in climacteric women.

STRENGTHS & LIMITATIONS

This study support existing data about risk factors for FSD in climacteric women. However, it is not possible to attribute causality to any of the correlates identified, which is a limitation of cross-sectional studies.

CONCLUSION

Dissatisfaction with sleep, senility, insufficient income, low education, not having a partner, complaints of depression, and the worse perception of global health are predictive factors for FSD in climacteric women.

Female sexual function in bladder cancer: A review of the evidence

Background

Bladder cancer (BC) treatments are known to be invasive; nevertheless, research into the long-term effects is limited and in the context of sexual function often male focussed. Female sexual dysfunction (FSD) has been reported in up to 75% of female patients. This systematic scoping review examines the literature on sexual consequences of BC in female patients.

Objective

This study aimed to systematically evaluate the evidence on female sexual function in BC to identify areas of unmet need and research priorities.

Evidence Acquisition

We performed a critical review of PubMed, PsychMed, CINAHL, MEDLINE and the Cochrane Library in March 2020 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) extension for Scoping Reviews statement following Levac et al. methodology. Identified reports were reviewed according to the Critical Appraisal Skills Programme (CASP) criteria. 45 publications were included.

Evidence Synthesis

There was an inconsistent use of patient-reported outcome measures (PROMs), with commonly used PROMs having a narrow symptom focus. However, common symptoms emerged: loss of desire, orgasmic disorders, vaginal dryness, dyspareunia, difficult intromission, reduced clitoral sensation, psychological concerns related to diagnosis, fear of contamination and body image. Sexual activity was reduced in most groups, despite women expressing a motivation to retain sexual function. The degree of symptom distress associated with FSD is underreported. Evidence emerged regarding a gap for women in clinician counselling and follow-up.

Conclusions

The patient's perspective of FSD in BC patients is poorly understood and under-addressed in clinical practice. There have been very few qualitative studies of FSD in BC. Any intervention designed to address the problem must start with greater understanding of both the patients' and clinicians' perspective.

Lay Summary

We examined the evidence on sexual consequences of BC in women. It is apparent that despite common themes of sexual dysfunction emerging, the problem is poorly understood and addressed in clinical practice.

Sexual Dysfunction in Women with Nonpsychotic Disorders: A Cross-sectional Hospital-based Study

BACKGROUND

Sexual dysfunction among female psychiatric patients is zcommon and can be affected by various bio-psycho-social factors. The clinician's or patient's reluctance to actively inquire or spontaneously report these sexual difficulties creates a lacuna in our understanding of this association. This study aimed to assess the proportion of women with nonpsychotic psychiatric disorders reporting sexual dysfunction and evaluate its association with sociodemographic and clinical variables.

METHODS

This cross-sectional study conducted over six months included 113 women attending the psychiatry outpatient department of a tertiary care hospital. Sociodemographic and clinical variables, including diagnosis based on International Classification of Diseases 10th version (ICD 10) criteria, were assessed using a specially designed proforma. Sexual functioning was measured by Female Sexual Functioning Index (FSFI) and the Change in Sexual Functioning Questionnaire-Female Version (CSFQ-FV).

RESULTS

Sexual dysfunction was reported by 67.3% of patients. Among patients on psychotropics, 49% reported worsening of sexual dysfunction after treatment initiation. Sexual dysfunction was associated with increasing age (χ² = 7.86, P = 0.04), lower educational qualification (χ² =3.41, P = 0.04), skilled occupation (χ2 = 4.49, P = 0.03), lower socioeconomic status (χ² = 4.27, P = 0.03) and presence of ongoing psychosocial stressor (χ² = 4.49, P = 0.03).

CONCLUSIONS

Difficulties in different domains of sexual functioning are prevalent among women with nonpsychotic disorders. Sociodemographic and relational factors, along with treatment status, can influence sexual dysfunction in these patients. Clinicians should be vigilant of this association and should plan treatment to enhance compliance and outcome.

Pelvic floor dysfunctions in women with systemic lupus erythematosus: A cross-sectional study

INTRODUCTION AND HYPOTHESIS

As a result of the impairment of the musculoskeletal system, the pelvic floor muscles are likely compromised in women with systemic lupus erythematosus (SLE). We hypothesized that women with SLE would report more symptoms of pelvic floor dysfunction (PFD) and there will be an association between SLE and PFD.

METHODS

An online cross-sectional survey was conducted. Data were collected on demographic and anthropometric characteristics, PFD (urinary incontinence, nocturia, anal incontinence, genital-pelvic pain/penetration disorder and pelvic organ prolapse) and obstetric history using a web-based questionnaire. The groups were compared using the Mann-Whitney test for quantitative variables and the chi-squared test for categorical variables. The association between SLE and PFD was tested using logistic regression analysis.

RESULTS

A total of 196 women answered the questionnaire (102 with SLE and 94 healthy controls). Women with SLE reported significantly more urinary incontinence, nocturia, anal incontinence, pelvic organ prolapse and genital-pelvic pain/penetration disorder than the healthy controls (p ≤ 0.05). Women with SLE were 2.8- to 3.0-fold more likely to report genital-pelvic pain/penetration disorder than healthy women.

CONCLUSIONS

The prevalence of PFD was significantly higher in women with SLE compared to healthy women. Thus, PFD seems to be an important problem in women with this disease. An in-depth investigation of these disorders could contribute to the understanding of how SLE impacts pelvic floor function.

Prevalence and factors associated with sexual dysfunction among middle-aged women in a multi-ethnic country: A cross sectional study in Malaysia

INTRODUCTION

This study aimed to determine the prevalence and factors associated with female sexual dysfunction in an outpatient clinic in Malaysia.

METHODS

The study was conducted among female patients aged 50 years and older who attended the outpatient clinic of a public hospital in Malaysia. A self-administered questionnaire was used that was based on the Malay version of the Female Sexual Function Index questionnaire. The predictors of female sexual dysfunction were identified using multivariate logistic regression analysis.

RESULTS

A total of 263 females were recruited in this study, with a mean age of 60.6 ± 6.7 years. The distribution of the respondents' ethnicities was mostly Malay (42.2%), followed by Chinese (41.8%) and Indian (16.0%). The prevalence of female sexual dysfunction among participants was 68.8%. The prevalence of the subscales of female sexual dysfunction was as follows: desire (85.2%), satisfaction (74.9%), arousal (71.1%), lubrication (66.9%), pain (61.2%), and orgasm (60.8%). According to multivariate logistic regression, patients of Indian ethnicity had an increased risk of female sexual dysfunction (0R=16.60, 95% CI=2.54-108.63), and a higher frequency of sexual intercourse was correlated with a lower risk of female sexual dysfunction (0R=0.13, 95% CI=0.08-0.24).

CONCLUSION

Seven-tenths of the middle-aged female patients attending the outpatient clinic suffered from female sexual dysfunction. Indian ethnicity and having a lower frequency of sexual intercourse were predictors of female sexual dysfunction. Future intervention studies are needed to address this problem.

Prevalence of sexual dysfunctions in women in their early and middle adulthood from the Pokarpackie Voivodeship

Background: Sexual dysfunctions are disorders related to the physiology of sexual responses. Aim of the study: Our study aimed to assess the prevalence of sexual dysfunctions in women in their early and middle adulthood. Material and methods: The early adulthood group consisted of 125 women aged 20–30, and out of these 100 questionnaires qualified for the final analysis. The middle adulthood group consisted of 275 women aged 45–55 in which 200 complete questionnaires were analyzed. The study was conducted in 2016 using a diagnostic survey method and the author's own survey questionnaire, the Mell-Krat Scale for Women and the Female Sexual Function Index (PL-FSFI). Results: Only 38.0% of respondents from the early adulthood group and 25.0% from the middle-adult group interviewed with a gynecologist about their sex life, possible disorders, and problems. Additionally, only 1.0% of women in the middle adulthood group benefited from the advice of a sexologist. According to the interpretation of the Mell-Krat scale, 41.0% of respondents in the early adulthood group and 76.0% of women in the middle adulthood group had a suboptimal score. These results indicate the possibility of sexual response disorders. All women in the early adulthood group and middle adulthood group scored below normal on the PL-FSFI scale indicating that the respondents are at risk for sexual disorders. Conclusions: According to the PL-FSFI scale, all women in the study may be at risk of sexual disorders. According to the Mell-Krat scale, as many as ¾ of women might suffer from sexual response disorders or are at risk of sexual disorders. Taking into account the significance of a sex life, it is necessary to take action to provide women with professional medical and psychological help to improve their intimacy sphere of life.

The Burden on Cohabitants of Patients with Chronic Spontaneous Urticaria: A Cross-Sectional Study

Chronic Spontaneous Urticaria (CSU) has been associated with patients’ poor quality of life. Despite being a chronic disease that could alter the quality of life of the people who live with patients, the potential burden on their cohabitants has not been studied to date. The aim of this study is to analyze the relationship between the patient’s quality of life, disease control, disease duration and family quality of life and the cohabitant’s mood disturbances, sexual dysfunction, type D personality and sleep quality. A cross-sectional study including patients suffering from CSU and their cohabitants was performed. Sociodemographic variables and disease activity, quality of life, sleep, sexual disfunction, anxiety, depression and type D personality were collected using validated questionnaires. Sixty-two subjects, 31 CSU patients and 31 cohabitants, were included in the study. Worse disease control and poorer quality of life in patients were associated with poorer family quality of life and higher rates of anxiety among the cohabitants (p < 0.05). Patients’ poor quality of life was associated with reduced sexual satisfaction among the cohabitants (p < 0.05). Long disease duration (>10 years) was associated with an increased prevalence of type D personality among the cohabitants (prevalence ratio: 2.59, CI 95% 1.03−7.21). CSU seems to have an impact on the quality of life of cohabitants, especially in terms of increased rates of anxiety, poorer quality of life and reduced sexual satisfaction. The prolonged course of the disease could be associated with the increased presence of non-adaptative personality traits.

Sexual dysfunctions in female university students and the correlation with body image: a cross-sectional study

PURPOSE

This study aims to correlate female sexual dysfunctions and dissatisfaction with female university students' body image.

METHODS

276 female university students completed an online questionnaire, including sociodemographic data, the Female Sexual Function Index, and the Body Shape Questionnaire.

RESULTS

31.1% reported some degree of dissatisfaction with body image, and 39.5% had a risk of female sexual dysfunction. The majority of women with a risk of female sexual dysfunctions (69.4%) had no concerns with shape, and the majority of women without sexual problems (67.7%) had no concerns with shape. Pearson's coefficient underlined no correlation between Body Shape Questionnaire and Female Sexual Function Index domains.

CONCLUSION

The body image perception did not seem to affect the sexual function of female university students in our sample. However, it is important to further investigate these variables to improve women's quality of life.

Patterns of Sexual Activity and the Development of Sexual Pain Across the Menopausal Transition

OBJECTIVE

To examine whether patterns of sexual intercourse frequency and demographic, menopausal status, genitourinary, health, and psychosocial factors are associated with developing sexual pain across the menopausal transition.

METHODS

These were longitudinal analyses of questionnaire data from the multicenter, multiracial and ethnic prospective cohort SWAN (Study of Women's Health Across the Nation) (1995-2008). We used multivariable discrete-time proportional hazards models to examine whether incident sexual pain was associated with preceding long-term (up to 10 visits) or short-term (two and three visits) sexual intercourse frequency patterns or other factors (eg, menopause status, genitourinary symptoms, lifestyle factors, and mental health).

RESULTS

Of the 2,247 women with no sexual pain at baseline, 1,087 (48.4%) developed sexual pain at least "sometimes" up to 10 follow-up visits over 13 years. We found no consistent association between prior patterns of sexual intercourse frequency and development of sexual pain. For example, neither decreases in intercourse frequency from baseline (adjusted hazard ratio [aHR] 0.93, 95% CI 0.73-1.19) nor decreases in frequency over three prior visits (aHR 1.00, 95% CI 0.72-1.41) were associated with incident pain. Reasons for interruptions in intercourse activity at the prior visit, including lack of interest (aHR 1.64, 95% CI 0.74-3.65) and relationship issues (aHR 0.36, 95% CI 0.04-2.88), were not associated with developing pain. Being postmenopausal using hormone therapy (aHR 3.16, 95% CI 1.46-6.85), and reported vaginal dryness (aHR 3.73, 95% CI 2.88-4.83) were most strongly associated with incident sexual pain.

CONCLUSION

Long-term and short-term declines in sexual intercourse frequency across the menopausal transition were not associated with increased hazard of developing pain with intercourse. This empirical evidence does not support the common belief that a reduction in women's sexual frequency is responsible for their symptoms of sexual pain.

Frequent Cannabis Use Moderates the Relationship Between Sexual Dysfunction and Depression Among Female German Adults

BACKGROUND

Sexual dysfunction and heavy substance use (alcohol, tobacco, and cannabis) play an important role in the development of depression, while frequent substance use affects sexual dysfunction.

AIM

This study aimed to investigate the association between sexual dysfunction and depression among German adults in a nationally representative sample and the effect of alcohol, tobacco, and cannabis use on this association using moderator analysis.

METHODS

Data come from the German Health and Sexuality Survey (GeSiD) with N = 4,955 men and women aged between 18 and 75 years. We used multiple logistic regression analysis to examine the moderation effect of substance use between sexual dysfunction and depression by including an interaction term.

OUTCOMES

Self-reported diagnosed and treated depression within the last 12 months and the moderation effect of substance use on the association between sexual dysfunction and depression.

RESULTS

Men and women with at least 1 sexual dysfunction were more likely to be affected by depression as compared to those without sexual dysfunction. A moderation effect of frequent cannabis use was found between sexual dysfunction and depression among women.

CLINICAL IMPLICATIONS

Clinicians and therapists addressing addiction, depression, and dysfunction should keep the complex interactions in mind.

STRENGTHS & LIMITATIONS

This study provides new data on the association between sexual dysfunction and depression among German adults in a nationally representative sample and the moderation effect of substance use on this association. Further studies should disentangle the pathways between sexual dysfunction, cannabis use, and depression through moderated mediation analyses.

CONCLUSION

Frequent cannabis use plays a moderating role in the association between sexual dysfunction and depression among German adult women. Belau MH, Wiessner C, Becher H, et al. Frequent Cannabis use Moderates the Relationship between Sexual Dysfunction and Depression Among Female German Adults. J Sex Med 2022;19:940-949.

Sexual dysfunction in people treated with long-acting injectable antipsychotics in monotherapy or polypharmacy: a naturalistic study

Sexual dysfunction, psychosis, and antipsychotics are known to be related, but the precise association between them is still unknown. Most evidence about the prevalence of sexual dysfunction in people treated with antipsychotic drugs comes from studies with restrictive samples. That is why our main objective was to determine the prevalence of sexual dysfunction in a real-life sample of outpatients treated with antipsychotics, considering gender. A cross-sectional naturalistic study was developed, including people treated with long-acting injectable antipsychotics, with or without other psychotropic drugs. Participants were interviewed to assess sexual satisfaction through a Likert scale (0 to 10) and the presence of sexual dysfunction (the Psychotropic-Related Sexual Dysfunction Questionnaire, PRSexDQ-SALSEX). The participants also had a blood test to determine prolactin (men and women) and testosterone levels (men only). A total of 131 people participated in the study (90 men and 41 women). Some extent of sexual dysfunction was found in 62.2% of men and 51.2% of women. The most frequent sexual dysfunction symptom for both genders was the loss of libido (45%). Hyperprolactinemia was present in 56% of men and 61% of women. The presence of sexual dysfunction was associated with higher doses of antipsychotics, hyperprolactinemia, and smoking in men and with smoking and hyperprolactinemia in postmenopausal women. This study provides real-life evidence of sexual dysfunction and hyperprolactinemia in persons treated with long-acting injectable antipsychotics segregated by gender. The high rates of sexual dysfunction and hyperprolactinemia detected corroborate the need to consider these aspects in clinical practice.

Comorbidities of Female Patients with Sexual Dysfunction in a Psychiatry Clinic: A Cross-Sectional Study

Background:

Previous studies showed the association of female sexual dysfunction (FSD) with various specific organic, psychiatric, and social factors separately, but rarely evaluated the extent of association of various disorders all together in cases of FSD.

Aim:

This study was conducted to explore the comorbidities associated with FSD from physical, psychiatric, and social perspectives.

Materials and Methods:

All female patients aged between 18 and 60 years reporting sexual problems to the psychiatry outpatient department were evaluated with Arizona sexual experiences scale for females. Their assessment included detailed medical and psychiatric history including the history of social contributing factors and medicine intake followed by physical and mental status examinations. Relevant biochemical investigations and hormonal assessments were done. Data were analyzed using Pearson correlation coefficients, linear regression analysis, and independent samples t tests.

Results:

Seventy-three females were diagnosed as cases of FSD according to the Arizona sexual experiences scale in one year. Among them, 1.37% had no comorbidity and the rest 98.63% had psychiatric comorbidities which were combined with physical comorbidities (mostly hypothyroidism, hyperprolactinemia, and abnormal menstrual cycle) in 35.62% cases and social contributing factors (mostly husbands’ substance abuses and various family-related problems) in 32.88% cases. The duration of FSD predicted its severity.

Conclusion:

The severity of FSD increased with duration. Thus, all cases of FSD should be assessed early in detail for physical, psychiatric, and social contributing factors to treat them holistically. Psychiatrists should play a key role in assessing, diagnosing, treating, and referring them to the appropriate treatment providers.

Solitary and Dyadic Sexual Desire and Sexual Satisfaction in Women With and Without Sexual Concerns

Women's sexual difficulties have been associated with sexual-related dimensions. The present study aims to analyze the differences between women with and without sexual concerns, according to the Female Sexual Functioning Index cutoff score, on dyadic and solitary sexual desire and sexual satisfaction dimensions. A total of 314 women participated in the study and answered to a sociodemographic screening, to the Sexual Desire Inventory - 2, to the Female Sexual Functioning Index, and to the Sexual Satisfaction Scale for Women. Main findings showed that women with sexual concerns revealed lower levels of global sexual desire and partner-related sexual desire, experienced lower levels of communication and compatibility with sexual partner, and have more personal and relational sexual concerns. Overall, results enhance the role of dyadic and relational dimensions that allow to differentiate between women with and without sexual concerns. Clinical implications are discussed.

Living Your Best Life: Lifestyle Medicine for All Women

In an era of ever-increasing healthcare expenditures, yet simultaneously worsening outcomes, many of our patients choose between traditional medical care or often unproven alternative therapies. While the recognition of lifestyle change in addressing cardiovascular and metabolic disease grows, there is less understanding of the impact of lifestyle change on issues facing women every day. Millions of women around the globe struggle with infertility, cancer, sexual dysfunction, and dermatologic needs. Yet, research on the benefits of lifestyle change on these conditions is scarce, and gaps exist both in our understanding of evidence-based approaches to address these issues, as well as adequate provider education when evidence exists. The Women’s Health Member Interest Group convened medical experts in these areas that affect women’s lives to provide insights and meaningful education applicable not only for our patients, but also in our own lives.

Lack of Evidence for a Relationship Between Salivary CRP and Women's Sexual Desire: An Investigation Across Clinical and Healthy Samples

BACKGROUND

Inflammation has been linked to a variety of mental and physical health outcomes that disproportionately impact women, and which can impair sexual function; thus, there is reason to expect a link between inflammation and women's sexual functioning.

AIM

To test the hypothesis that higher concentrations of C-reactive protein (CRP), a general biomarker of inflammation, would predict women's lower sexual desire.

METHOD

As 2 independent research teams, we conducted 3 separate studies (total n = 405) that assessed salivary CRP and various measurements of sexual desire in different women populations.

OUTCOMES

Female Sexual Function Index, Sexual Desire Inventory-2, Decreased Sexual Desire Screener, and Sexual Interest and Desire Inventory.

RESULTS

Regardless of the way sexual desire was measured (e.g., state vs trait; general desire vs. desire functioning) and the population sampled (i.e., healthy vs. clinically diagnosed with sexual dysfunction), all the studies revealed null results.

CLINICAL IMPLICATIONS

While exploratory, the convergence of these null results across studies and researchers suggests that if there is an association between inflammation and women's sexual desire, it is likely very subtle.

STRENGTHS & LIMITATIONS

Across 2 independent research teams, 3 unrelated studies, and various measurements of sexual desire, results were consistent. These points lend to the generalizability of the results. However, study designs were cross-sectional.

CONCLUSIONS

Future research may reveal (i) a non-linear threshold effect, such that inflammation does not begin to impact women's sexual desire until it is at a high level, (ii) inflammatory biomarkers other than CRP might be more sensitive in detecting associations between inflammation and desire, should they exist, or (iii) the mechanisms underlying sexual dysfunction may differ between sexes. Clephane K, et al. Lack of Evidence for a Relationship Between Salivary CRP and Women's Sexual Desire: An Investigation Across Clinical and Healthy Samples. J Sex Med 2022;19:745-760.

Prevalence of Female Sexual Dysfunction and Barriers to Seeking Primary Health Care Treatment in an Arab Male-Centered Regime

BACKGROUND: The prevalence of female sexual dysfunction (FSD) is a common health issue and women living in male-centered regimes are more vulnerable to have FSD. AIM: This study was conducted to estimate the prevalence of FSD in Bahrain, which is male-centered and impacted with cultural and Islamic religious standards, and the associated variables with FSD, including the barriers to seeking medical help from health-care professionals. METHODS: This study was a cross-sectional design based on interview questions of 360 married women between 18 and 60 years of age who randomly visited one of three health clinics in Bahrain. The prevalence of FSD in Bahrain and the variables associated with it was analyzed using Chi-square and multivariate logistic regression. RESULTS: Of 360 enrolled women, 43% reported having sexual problems during intercourse (p < 0.05, 95% CI 38.1–48.6%). Most of the sexual problems were related to having painful intercourse (42%) or low sexual desire (37%). Furthermore, the mean age of females with FSD was significantly higher than females with no FSD (p < 0.05). Most importantly, the multinomial logistic regression analysis showed that husband polygamy was linked to FSD with an OR of 2.469 (95% CI 1.218–5.001). On the other hand, females with low to no parity were associated lower rates of FSD with an OR of 0.482 (95% CI 0.252–0.922). Furthermore, more than 96% of females were not asked by their doctor about their sexual problems, and 87% of the participants did not dare to discuss the problem with their doctor. CONCLUSION: The prevalence of FSD in and the challenges that face women’s sexual health in Arab male-centered country were high. FSD was associated with husband polygamy, higher age, and high parity.

Differences/Disorders of Sex Development: Medical Conditions at the Intersection of Sex and Gender

Defined as congenital conditions in which development of chromosomal, gonadal, or anatomic sex is atypical, differences or disorders of sex development (DSDs) comprise many discrete diagnoses ranging from those associated with few phenotypic differences between affected and unaffected individuals to those where questions arise regarding gender of rearing, gonadal tumor risk, genital surgery, and fertility. Controversies exist in numerous areas including how DSDs are conceptualized, how to refer to the set of conditions and those affected by them, and aspects of clinical management that extend from social media to legislative bodies, courts of law, medicine, clinical practice, and scholarly research in psychology and sociology. In addition to these aspects, this review covers biological and social influences on psychosocial development and adjustment, the psychosocial and psychosexual adaptation of people born with DSDs, and roles for clinical psychologists in the clinical management of DSDs. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Sexual Satisfaction in Portuguese Women: Differences Between Women With Clinical, Self-Perceived and Absence of Sexual Difficulties

Objectives

Female sexual functioning and satisfaction are affected by the presence of sexual difficulties. The current study examines differences in sexual satisfaction according to three groups of women: (i) clinical sexual difficulties assessed by the Female Sexual Functioning Index (FSFI) cutoff; (ii) self-perceived sexual difficulties at a non-clinical level; and (iii) sexually healthy.

Methods

A convenience sample of 329 Portuguese women, with a mean age of 28.69 (SD = 8.78), answered a specific question on the presence of self-perceived sexual difficulties, the Sexual Satisfaction Scale for Women and the FSFI. From the 329 women, 56 were assigned to the group with clinical sexual difficulties, 60 were assigned to the group with self-perceived sexual difficulties at non-clinical level, and 213 constituted the sexually healthy group.

Results

Sexually healthy women were more sexually satisfied compared with women who self-perceived sexual difficulties and women who had clinical sexual difficulties according to the FSFI. In addition, women who self-perceived sexual difficulties were also more sexually satisfied compared to women with clinical sexual difficulties according to the FSFI.

Conclusions

Women's sexual satisfaction was negatively affected by sexual difficulties assessed by the FSFI cutoff. Although with less impact, self-perceived sexual difficulties also negatively affect women's sexual satisfaction.

Chronic Pelvic Pain and Sexual Dysfunction Among Females and Males Receiving Treatment for Opioid Use Disorder

Introduction: Chronic pain brings complexity to opioid use disorder (OUD). Psychosocial and neurobiological risks for Chronic Pelvic Pain (CPP) and OUD overlap. The primary objective of this exploratory study is to compare sex-specific prevalence of CPP and sexual dysfunction between individuals receiving buprenorphine for OUD and a comparison group receiving treatment for other chronic medical conditions (CMC).

Methods: Participants from an OUD treatment (n = 154) and primary care clinic (n = 109) completed a survey between July 2019 and February 2020 assessing reproductive and sexual health. Sex-stratified CPP and pain interference measures were adapted from the Brief Pain Inventory for females, and for males, the Brief Male Sexual Function Inventory and NIH Chronic Prostatitis Symptom Index. The Male and Female Sexual Function Index assessed sexual dysfunction. Prevalence of CPP and sexual dysfunction between groups were compared using Pearson χ2 and Fisher's Exact tests.

Results: Participants were 54.4% female and 75.0% Black with almost half having a psychiatric diagnosis. Among OUD females, the highest pain severity reported was for menstrual-related pain, and for OUD males, testicular pain. CPP most interfered with mood in OUD females vs. sleep and enjoyment of life in OUD males. There were no differences in prevalence for global sexual dysfunction with 91.6% of females and 84.2% of males screening positive across groups.

Discussion/Implications: CPP and sexual dysfunction are important components of wellness and may play a role in OUD recovery trajectories. The value of addressing CPP and sexual dysfunction in tailored comprehensive, sex-informed OUD treatment approaches should be further investigated.

Female sexual function in women using LARC methods

OBJECTIVE

This study aims to assess sexual function (SF) and quality of life (QoL) among women using copper intrauterine devices (Cu-IUD), levonorgestrel-releasing intrauterine system (LNG-IUS) or etonogestrel(ENG)-releasing subdermal implant.

METHODS

This is a cross-sectional study involving 213 women who are sexually active, using Cu-IUD, LNG-IUS or ENG implant for at least one year. SF assessment was carried out through the Female Sexual Function Index (FSFI) and QoL was made through The Short Form Health Research.

RESULTS

Frequency of sexual dysfunction score in Cu-IUD users was 33.8%; 47.2% in LNG-IUS users and 47.8% in ENG-implant users, without difference between groups. Desire domain had higher score in Cu-IUD users (Cu-IUD:4.20 ± 1.15 × LNG-IUS:3.76 ± 1.17 × ENG-implant:3.63 ± 1.15; p = .009). Between Cu-IUD and LNG-IUS users there was no difference in FSFI score. Total FSFI score was higher in Cu-IUD group when compared only to ENG-implant (Cu-IUD:27.48 ± 6.14 × Implant:25.07 ± 6.89; p = .029). Regarding the QoL score, difference was found only in general health domain (Cu-IUD:65.22 ± 14.91 × LNG-IUS:62.61 ± 19.04 × Implant:58.33 ± 16.46; p = .034), with lower score for implant group.

CONCLUSION

There was no difference in the SF total score between the users of Cu-IUD, LNG-IUS and ENG implant. However, the score of the FSFI desire domain and general health status were higher among users of the Cu-IUD.

Sexual desire in Brazilian women: an integrative review of scientific literature

Abstract Women’s sexual desire is a recurring subject in gynecology and psychotherapy offices where a relevant and frequent complaint is the lack of sexual desire. This study aimed to carry out an integrative review of the scientific literature published between 2008 and 2018, on the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Scientific Eletronic Library Online, Literatura Latino-Americana e do Caribe em Ciências da Saúde platforms on the subject of sexual desire in Brazilian women. Three groups of descriptors were taken into consideration for the searches; the first included “sexual desire” the second, “woman” and the third, “Brazil”. Among the 35 articles selected, data regarding the type of research carried out; the cut-out criterion selected for sample and perspective that were used to comprehend desire were collected. The conclusion is that most articles maintain a biological perspective for understanding desire and point out a gap to be filled by psychology on this matter.

Female Sexual Dysfunction as Measured by Low Sexual Frequency is Associated with Lower Socioeconomic Status: An Analysis of the National Health and Nutrition Examination Survey (NHANES), 2007-2016

BACKGROUND

Female sexual dysfunction (FSD) is a complex disorder of biopsychosocial etiology, and FSD symptoms affect more than 40% of adult women worldwide.

AIM

In this cross-sectional study, we sought to investigate the association between FSD and socioeconomic status (SES) in a nationally representative female adult population.

METHODS

Economic and sexual data for women aged 20-59 from the 2007-2016 National Health and Nutrition Examination Survey, a United States nationwide representative database, was analyzed. Poverty income ratio (PIR), a ratio of family income to poverty threshold, was used as a measure of SES, and low sexual frequency was used as a measure of FSD. The association between FSD and SES was analyzed using survey-weighted logistic regression after adjusting for relevant social and gynecologic covariates, such as marital status and history of pregnancy, as well as significant medical comorbidities.

OUTCOMES

We found that FSD, as measured by low sexual frequency, was associated with lower SES.

RESULTS

Among the 7,348 women of mean age 38.4 (IQR 29-47) included in the final analysis, 26.3% of participants reported sexual frequency of 0-11 times/year and 73.7% participants reported sexual frequency >11 times/year. Participants of PIR <2 were 92% more likely to report sexual frequency ≤11 times/year than those of PIR ≥2 after adjusting for demographics, social history, gynecologic history and significant medical conditions (OR = 1.92; 95% CI = 1.21-3.05; P < .006).

CLINICAL IMPLICATIONS

The evaluation and treatment of FSD may benefit from a comprehensive approach that takes SES into account.

STRENGTHS & LIMITATIONS

This study is limited by its cross-sectional design, but it is strengthened by a large, nationally representative sample with extensive, standardized data ascertainment.

CONCLUSION

Lower SES and lower sexual frequency are directly correlated among female adults in the United States; future studies should focus on social determinants of health as risk factors for FSD.

Sexual Dysfunctions in Patients Receiving Opioid Agonist Treatment and Heroin-Assisted Treatment Compared to Patients in Private Practice-Identifying Group Differences and Predictors

BACKGROUND AND AIMS

Sexual dysfunctions (SDs) show a marked impact on a person's general wellbeing. Several risk-factors like physical and mental illnesses as well as alcohol and tobacco use have to date been identified to contribute to the occurrence of SDs. The impact of opioid-agonist treatment (OAT) on SDs remains unclear, with some studies demonstrating an improvement after methadone maintenance treatment (MMT) initiation. However, no studies on the prevalence and predictors of SDs in heroin-assisted treatment (HAT) exist to date.

METHODS

A cross-sectional study was conducted with patients from a MMT center (n = 57) and a center specializing in HAT (n = 47). A control group of patients with mild transient illnesses (n = 67) was recruited from a general practitioner (GP). The International Index of Erectile Function, the Female Sexual Function Index, as well as measurements for psychological distress, depressive state, nicotine dependence, and high-risk alcohol use were employed. Patients also completed a self-designed questionnaire on help-seeking behavior regarding sexual health. Mann-Whitney-U tests and chi-square tests were performed for group comparisons and binary logistic regression models were calculated.

RESULTS

Twenty-five percent of the GP sample (n = 17), 70.2% (n = 40) of the MMT sample, and 57.4% (n = 27) of the HAT sample suffered from SDs at the time of study conduction. OAT patients differed significantly from GP patients in depressive state, high-risk alcohol use, nicotine dependence, and psychological distress. Age, depressive state, and opioid dependence predicted the occurrence of SDs in the total sample. No differences between OAT and GP patients were found regarding help-seeking behavior.

DISCUSSION

Age, depressive state, and opioid dependence predicted the occurrence of SDs in the total sample. It remains unclear whether SDs are caused by opioid intake itself or result from other substance-use related lifestyle factors, that were not controlled for in this study. A lack of help-seeking behavior was observed in our sample, underlining the importance of clinicians proactively inquiring about the sexual health of their patients.

CONCLUSION

The high prevalence of SDs observed in MMT does not differ from the prevalence in HAT. Clinicians should actively inquire about their patients' sexual health in GP and OAT centers alike.

Prevalencia de disfunción sexual en gestantes en control prenatal en una institución hospitalaria en Rionegro, Colombia, 2020-2021

Objetivo:

Describir la prevalencia de la disfunción sexual en un grupo de mujeres gestantes y hacer una exploración de posibles factores asociados a la disfunción sexual en estas mujeres.

Materiales y métodos:

Estudio descriptivo y trasversal en mujeres gestantes cuyas edades son de 15 años o más, con actividad sexual en la gestación, que asistieron al control prenatal en el Hospital San Juan de Dios de Rionegro entre los meses de enero y marzo del 2021. Se excluyeron pacientes con limitaciones o discapacidad cognitiva, o clasificadas con trastorno mental según la Organización Mundial de la Salud (OMS), gestantes con patologías crónicas, placentarias, ovulares, hemorrágicas e infecciosas, y las pacientes cuya gestación fue resultado de violencia sexual. Se aplicó el cuestionario Índice de Función Sexual Femenina (FSFI), se midieron variables sociodemográficas y de salud sexual y reproductiva. Los resultados se expresan en frecuencias absolutas y relativas para las variables cualitativas y medianas, y rangos intercuartílicos para las variables cuantitativas.

Resultados:

La mediana de edad fue de 27,5 años (RIC: 21,3-31,0); de edad gestacional 28,5 semanas (RIC: 21,3-34,8). Tras la aplicación del FSFI, 37 mujeres (37,7%) tuvieron disfunción sexual (puntaje < 26,5). La mediana del puntaje de las participantes sin disfunción sexual fue de 29,4 (RIC 26,8-32), mientras que por el lado de las que tienen disfunción sexual fue de 22,3 (RIC 20-24). La media del puntaje para cada dominio fue: deseo: 3,6 (RIC: 3,0-4,2); excitación: 4,5 (RIC: 3,6-5,1); lubricación: 4,8 (RIC: 3,9-5,4); orgasmo: 4,4 (RIC: 3,6-5,2); dolor: 4,4 (RIC: 3,6-6,0); y satisfacción: 5,4 (RIC: 4,8-6,0). Fueron factores protectores no tener hijos ni cesáreas previas. La ausencia de compañero y menor edad estuvieron asociados a disfunción sexual.

Conclusión:

La disfunción sexual se presenta en por lo menos un tercio de las gestantes, especialmente en el tercer trimestre. En la práctica clínica diaria se hace necesario abordar la disfunción sexual, ya que se puede contribuir desde el abordaje de la educación a un problema que puede afectar las relaciones de pareja y la calidad de vida. Es fundamental generar nuevas investigaciones que incluyan la evaluación de la efectividad y seguridad de estrategias educativas en este grupo poblacional con disfunción sexual.

Screening autonomic functions in patients with restless legs syndrome: A case-control study in a tertiary care hospital

PURPOSE

The clinical importance of autonomic involvement in patients with restless legs syndrome (RLS) remains unclear. To our knowledge, no study has explored the relationship between autonomic dysfunction and disease-related variables in patients with RLS. Therefore, this study aimed 1) to determine the presence of autonomic symptoms in drug-naïve patients with RLS in comparison with healthy controls using Scales for Outcomes in Parkinson's disease-Autonomic (SCOPA-AUT) questionnaire and 2) to evaluate the possible associations of autonomic dysfunction with clinical factors in RLS.

METHODS

A total of 70 drug-naïve patients with RLS and 85 healthy volunteers were enrolled. The SCOPA-AUT questionnaire and Epworth Sleepiness Scale (ESS) scores were used to determine autonomic functions and sleep propensity, respectively. Moreover, the International Restless Legs Syndrome Study Group rating scale was used to evaluate disease severity in the patient group.

RESULTS

Compared with the control group, the RLS group had significantly higher subscale scores (gastrointestinal, urinary, cardiovascular, thermoregulatory, pupillomotor, and sexual [women]) and total scores of the SCOPA-AUT questionnaire (p < 0.05). In the patient group, there was a significant correlation between the total scores and subscale scores (gastrointestinal, cardiovascular, and thermoregulatory subscales) of the SCOPA-AUT questionnaire and disease severity. Moreover, ESS was positively correlated with the total scores and subscale scores (urinary, cardiovascular, and pupillomotor) of the SCOPA-AUT questionnaire.

CONCLUSION

Disease severity and daytime sleepiness may be related to autonomic dysfunction in RLS. Further studies focusing on autonomic functions in RLS are required to improve management strategies and clinical outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov. NCT04906486; May 28, 2021.

Prevalence and associated risk factors for sexual dysfunction among postmenopausal women: a study from Iran

BACKGROUND

Female Sexual Dysfunction (FSD) is a distressing condition linked to menopause. This study aimed to determine the prevalence and contributing factors for FSD among postmenopausal women.

METHODS

This was a cross-sectional study. A convenience sample of postmenopausal women attending a gynecology clinic in a teaching hospital affiliated with Tehran University of Medical Sciences was enrolled into the study. The Female Sexual Function Index (FSFI) was used to assess sexual function. In addition, demographic and psychosocial information were recorded. The association between sexual function and anxiety and depression were examined to explore the data.

RESULTS

In all 162 postmenopausal women were studied. We performed general linear regression analysis to assess the relationship between sexual function and anxiety while including demographic variables in the model. The results showed that the model could explain about 46% of the variance observed in sexual function (adjusted R2 = 0.467). The analysis indicated that among independent variables, age (p <  0.001), sexual frequency (p <  0.001), and anxiety (p = 0.003) were significant contributing factors associated with sexual function. A similar analysis evaluating the relationship between sexual function and depression in menopausal women found that age (p <  0.001), sexual frequency (p <  0.001), and depression (p = 0.003), were significant contributing factors associated with sexual function; explaining about 46% of the variance observed (adjusted R2 = 0.466).

CONCLUSION

The findings showed that nearly half of menopausal women had sexual dysfunction in this convenience sample of women seeking gynecologic care. Women reporting sexual dysfunction also reported a higher prevalence of anxiety and depression. Indeed, recognition of such factors requires a holistic therapeutic approach to sexual dysfunction among postmenopausal women.

Evaluation of Couple's Sexual Function after Childbirth with the Biopsychosocial Model: A Systematic Review of Systematic Reviews and Meta-Analysis

BACKGROUND

After childbirth, sexual dysfunction refers to a chain of psychiatric, physiological, social changes and a couple's experiences. The purpose of our Systematic Review (Syst.Rev.) is to evaluate available high-quality evidence and construct a Bio Psycho Social (BPS) model of couple's sexual function after childbirth.

MATERIALS AND METHODS

A systematic search was done with MeSH terms in databases, including PubMed, Web of Science, Scopus, and Science direct. A total number of 9 Syst.Rev. were evaluated from 2009 to 2019 years. The quality of extracted articles was evaluated based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist of contents using two qualified reviewers. Data synthesis was performed using the thematic analysis.

RESULTS

Biopsychosocial Model of Postpartum Couple's Sexual Function (BMPCSF) is proposed as a developmental process similar to Bronfenbrenner's Bioecological Systems Model. Studies showed a significant relationship among the type of childbirth, trauma of perineum, breastfeeding, mood swings, fears, changes in the self-body image, spousal support, and Postpartum Sexual Dysfunction (PSD). Hence, the evidence about male sexuality in the postpartum period doesn't seem sufficient.

CONCLUSIONS

The information from this study will help health policymakers develop the appropriate guidelines to inform couples and healthcare professionals about the BPS changes after childbirth and PSD. Besides, BMPCSF can be used in postpartum sexual counseling to improve sexual health and marital relationships. We propose comprehensive original study on couples' postpartum sexuality, especially men's conduct, emphasizing socio-cultural factors.

Clinical Considerations of the Evangelical Purity Movement's Impact on Female Sexuality

Evangelical Protestant Christianity is the most prevalent religion in America, with women being the dominant practitioners. The Evangelical Purity Movement that gained prominence in the 1990s sought to provide moral and religious based sexual education through private and public policies to both Christian and non-religious youth. This movement directly stressed the concept of abstinence-only until marriage education, while covertly spreading sexual scripts promoting sexual double standards, the mind-body split, female objectification, and sexual shame. The needs and concerns of women raised in this subculture are identified and explored for clinicians unfamiliar with their context. Although the intent of this movement claims to provide moral structure, research related to the main objectives reveal that they also created a negative effect on females that result in physical, emotional, and sexual dysfunction and dissatisfaction. This article provides context and articulates these concerns while calling for a significant increase in research to provide more resources for counselors and clients alike.

Sexual health difficulties among service women: the influence of posttraumatic stress disorder

Background Sexual health among service women remains understudied, yet is related to health and quality of life. This study examined if the associations between recent combat and sexual assault with sexual health difficulties were mediated by mental disorders and identified factors associated with sexual health difficulties among service women. Methods Data from two time points (2013 and 2016) of the Millennium Cohort Study, a large military cohort, were used. The outcome was self-reported sexual health difficulties. Mediation analyses examined probable posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) as intermediate variables between recent combat and sexual assault with the sexual health difficulties. Multivariable logistic regression modeling was used to examine the association of demographic, military, historical mental health, life stressors, and physical health factors with sexual health difficulties. Results Of the 6,524 service women, 13.5% endorsed experiencing sexual health difficulties. Recent combat and sexual assault were significantly associated with sexual health difficulties. Probable PTSD mediated the associations of recent combat and sexual assault with sexual health difficulties; probable MDD did not mediate these relationships. Other significant factors associated with sexual health difficulties included enlisted rank, historical mental disorders, childhood trauma, and disabling injury. Limitations Use of self-reported data, outcome not assessed using a standardized measure and future studies may benefit from examining other mediators. Conclusion Our findings that combat and sexual assault may have negative effects on service women's sexual health suggest that treatment options and insurance coverage for sexual health problems should be expanded.

Measurement invariance of Female Sexual Function Index: a study with heterosexual and lesbian Portuguese women

The Female Sexual Function Index is a powerful screening tool for female sexual dysfunction extensively used worldwide. Nonetheless, its factorial structure and psychometric properties have been tested almost exclusively with heterosexual samples. The current study aimed to testing the original factorial structure, reliability and temporal stability in two samples of women (heterosexual and lesbian), and to assess the measurement invariance across sexual orientation. An online sample of 752 Portuguese women (376 lesbian women and 376 heterosexual women) recruited between May 2012 and 2013 participated in the study and completed a sociodemographic questionnaire and the FSFI. For temporal stability, 30 Portuguese women were recruited online in May 2017. Confirmatory factor analysis, reliability analysis and temporal stability were assessed independently for each sample. Measurement invariance (configural, metric, and scalar) was also assessed. Main findings for both samples corroborate the six-factor structure and revealed excellent levels of temporal stability, with Cronbach alphas and McDonalds Omega of .95 for heterosexual sample, and .96 for lesbian women sample. Results corroborate measurement invariance (configural, metric, and scalar) across sample type. Overall, the FSFI revealed a good-fit for the six-factor model in both heterosexual and women sample, with excellent levels of reliability and temporal stability, and showed measurement invariance across sexual orientation. These findings support the use of the FSFI with lesbian women.

Sexual health communication in COPD: The role, contents and design of patient information leaflets

Understanding need for support and information among people with COPD is important for the delivery of patient-centred care. Especially regarding intimacy matters, many people wish to remain sexually active but may be struggling to find out how, as information and communication regarding sexual health is scarce. This is especially true when it comes to people with chronic obstructive pulmonary disease (COPD). The present review seeks to provide an overview of the role, contents and design of patient information leaflets (PILs) and discuss their application in sexual health communication for COPD. Based on the literature, a number of key points in the design of high-quality PILs are suggested, and important areas for the improvement of patients-clinician communication are highlighted. While PILs is a commonly used format to provide information in healthcare, other formats, e.g. video and podcasts, could be explored. Prioritizing the development of material to support communication in the future is necessary to address the needs of both patients and caregivers and to support clinicians in initiating conversations about sexual health and intimacy matters.

Fecundability in reproductive aged women at risk of sexual dysfunction and associated risk factors: a prospective preconception cohort study

BACKGROUND

Female sexual dysfunction (FSD) is a prevalent problem, affecting up to 41% of reproductive aged women worldwide. However, the association between female sexual function (FSF) and fecundability in women attempting to conceive remains unclear. We aimed 1) to examine the association between FSF in reproductive-aged preconception Asian women and fecundability, as measured by time-to-pregnancy in menstrual cycles, and 2) to examine lifestyle and behavioral factors associated with FSF.

METHODS

From the Singapore PREconception Study of long-Term maternal and child Outcomes (S-PRESTO) prospective cohort, we evaluated FSF using the 6-item Female Sexual Function Index (FSFI-6) and ascertained time-to-pregnancy within a year of baseline assessment. We estimated fecundability ratio (FR) and 95% confidence interval (CI) using the discrete-time proportional hazards model, accounting for left-truncation and right censoring. We used multivariable logistic and linear regression models to identify potential factors related to FSF.

RESULTS

Among 513 participants, 58.9% had low FSF as defined by a total FSFI-6 score at or below the median value of 22. Compared to women with high FSF, those with low FSF had a 27% reduction in fecundability (FR 0.73; 95% CI 0.54, 0.99), with adjustment for age, ethnicity, education, parity and body mass index. Overall, the FRs generally reduced with decreasing FSFI-6 scores. Physical activity, obesity, absence of probable depression and anxiety were independently associated with reduced odds of low FSF and increased FSFI-6 scores, after adjusting for sociodemographic characteristics.

CONCLUSIONS

Low FSF is associated with a longer time-to-pregnancy. Early evaluation and optimization of FSF through increased physical activity and optimal mental health may help to improve female fecundity. The finding of obese women having improved FSF remains uncertain which warrants further investigations on plausibly mechanisms. In general, the current finding highlights the importance of addressing FSF in preconception care service for general women, which is currently lacking as part of the fertility promotion effort in the country.

Influence of Self-Perceived Vulvar Appearance on Female Sexual Function

BACKGROUND

Female sexual function is a complex model of biological and nonbiological factors. The impact of self-perceived vulvar appearance on female sexual function is not well understood.

OBJECTIVES

The aim of this study was to determine the influence of vulvar appearance on sexual function in adult women. The primary aim was to assess the relation between self-perceived vulvar appearance and sexual function. The secondary aim was to assess the influence of prior genital procedures on vulvar appearance and sexual function.

METHODS

An observational study of adult women was conducted utilizing Amazon Mechanical Turk, an online crowdsourcing platform. The survey instrument included demographic information, subjective vulvar appearance measures, and the Female Sexual Function Index (FSFI) questionnaire.

RESULTS

Out of 398 respondents, 148 (37.2%) reported concern about their vulvar appearance and 134 (33.7%) reported a history of genital cosmetic procedures. Women who were uncomfortable with their vulvar appearance had lower FSFI scores than those comfortable with their vulvar appearance, 24.6 vs 27.0 (P = 0.01), respectively. Among women uncomfortable with their vulvar appearance, 70.9% of subjects met the criteria for sexual dysfunction. Women who were uncomfortable with their vulvar appearance were significantly more at risk of sexual dysfunction (adjusted odds ratio: 2.43; 95% CI: 1.46-4.10; P < 0.001). Women with a history of cosmetic genital procedures were significantly more at risk of sexual dysfunction (adjusted odds ratio: 2.46; 95% CI: 1.43-4.23).

CONCLUSIONS

Women who are uncomfortable with their vulvar appearance had higher rates of sexual dysfunction. Women seeking cosmetic genital procedures should be screened for sexual dysfunction to facilitate realistic expectations and optimal care.

Physical Activity and Female Sexual Dysfunction: A Lot Helps, But Not Too Much

BACKGROUND

Research on the relationship between physical activity (PA) and female sexual dysfunction (FSD) is lacking.

AIM

To investigate the clinical, psychological, and sexual correlates of PA in women with FSD.

METHODS

A non-selected series of n = 322 pre- and post-menopausal patients consulting for FSD was retrospectively studied. Regular involvement in PA and its frequency (<1 hour/week: sedentary, 1-3 hours/week: active, 4-6 hours/week: very active, >6 hours/week: extremely active) were investigated with a specific question.

OUTCOMES

FSDs, including HSDD (Hypoactive sexual desire disorder) and FGAD (Female genital arousal disorder), were diagnosed according to a structured and clinical interview. Participants underwent a physical examination and a clitoral Doppler ultrasound, and were asked to complete the Female Sexual Function Index, Female Sexual Distress Scale-Revised, Body Uneasiness Test, and Middlesex Hospital Questionnaire.

RESULTS

At multivariate analysis, women engaging in PA (67.4%, n = 217) scored significantly higher in several Female Sexual Function Index domains - including desire, arousal and lubrication - and showed lower sexual distress and lower resistance of clitoral arteries, as compared to sedentary women. A significant, inverse association between PA and HSDD was observed. Mediation analysis demonstrated that the negative association between PA and HSDD was partly mediated by body image concerns (Body Uneasiness Test Global severity index), psychopathological symptoms (Middlesex Hospital Questionnaire total score) and sexual distress (Female Sexual Distress Scale-Revised score). These latter 2 factors also partly mediated the association between PA and a reduced risk of FGAD, whilst a lower BMI was a full mediator in the relationship between PA and FGAD. Finally, extreme PA was associated with significantly worse scores in several psychosexual parameters (i,e, sexual satisfaction and histrionic/hysterical symptoms), even compared to a sedentary lifestyle.

CLINICAL IMPLICATIONS

Women consulting for FSD may gain benefits on desire, arousal, lubrication and sex-related distress from regular PA; however, physicians should remain alert to the downsides of excessive exercise.

STRENGTHS & LIMITATIONS

The main strength lies in the novelty of the findings. The main limitations are the cross-sectional nature, the clinical setting, the small sample size of the different PA groups, and the use of self-reported instruments for the evaluation of PA.

CONCLUSION

In women with FSD, PA was associated with better sexual function and clitoral vascularization, lower sexual distress and reduced odds of HSDD and FGAD; the benefits of PA on sexuality were mediated by both psychological and organic determinants; excessive PA was related with a poor overall sexual function and with a low sexual satisfaction. Maseroli E, Rastrelli G, Di Stasi V, et al. Physical Activity and Female Sexual Dysfunction: A Lot Helps, But Not Too Much. J Sex Med 2021;18:1217-1229.

Importance of active and passive smoking as one of the risk factors for female sexual dysfunction in Chinese women

OBJECTIVE

To assess possible risk factors for female sexual dysfunction (FSD), aiming especially at smoking in China.

METHODS

Female Sexual Function Index (FSFI) for assessing FSD; 621 women (24-75 years) divided into 'group FSD' (FSFI≤ 26.55) and 'group No FSD' (FSFI > 26.55). Univariate and multivariate analysis to detect potential risk factors for FSD.

RESULTS

Active smoking was the strongest risk factor after multiple adjustments (OR= 6.226, 95%CI = 1.561 ∼ 24.822), but passive smoking also was significantly associated with a risk of FSD (OR = 1.887, 95%CI = 1.092 ∼ 3.260) (p < .05). Other risk factors included age (OR = 1.040, 95%CI = 1.005 ∼ 1.076), medical comorbidities (OR= 1.688, 95%CI =1.044 ∼ 2.729), postmenopausal stage (OR= 2.021, 95%CI = 1.073 ∼ 5.717), and dissatisfied marital relations (OR= 3.771, 95%CI = 1.768 ∼ 8.045). The prevalence of FSD for smokers regarding disorders of sexual arousal, orgasm and sexual satisfaction increased in active smokers; sexual desire disorder, sexual arousal disorder and pain in secondhand smokers (p < .05).

CONCLUSION

The risk of FSD was closely related to depletion of ovarian function. Active smokers had the highest risk, but passive smoking also had a significant relationship to FSD. Although female smokers are rare in China, 'husband smoking' is frequent. Thus, our results should have significant healthcare consequences.

Is Female Wellness Affected When Men Blame Them for Erectile Dysfunction?

Introduction

Several studies have investigated the association between erectile dysfunction (ED), its treatment, and female sexual dysfunction, but the impact of males blaming their female partners for their ED remains unknown.

Aims

To investigate whether women who are blamed by their male partners for their ED experience worse overall sexual function and satisfaction.

Methods

We performed a global, cross-sectional web-based survey to investigate female perceptions of ED. We distributed the 30-item survey via email, Reddit, Amazon Mechanical Turk, and Facebook. Women 18 years of age or older were eligible to participate and answered questions based on a 5-point Likert scale. Women were grouped by ages 18-29, 30-39, and 40 and older.

Main Outcome Measures

The survey collected data that included general demographics and questions regarding experiencing male blame for ED and its relationship with each subject's sexual health and wellness.

Results

A total of 13,617 females participated in the survey. Of the women surveyed, 79% have experienced their partner losing their erection during sexual activity and approximately 1 out of 7 women (14.7%) had experienced being blamed by their partner for loss of their erection. Women who were blamed for their partner's ED were more likely to end the sexual encounter, were less sexually satisfied, and were more likely to end relationships due to their partner's ED.

Conclusion

Approximately 1 out of 7 women have experienced male blame for their partner's ED which is associated with negative impacts on female mental health, sexual satisfaction and the success of the overall partnership. Because of its widespread impact on female wellness, male blame should be considered during evaluation of female sexual history and men must be educated on the significant impact their reactions during intimacy have on their female partners and their relationships as a whole. Dubin JM, Wyant WA, Balaji NC, et al. Is Female Wellness Affected When Men Blame Them for Erectile Dysfunction?. Sex Med 2021;9:100352.

Comparison of Sexual Dysfunction in Women Who Were or Were Not Victims of Sexual Violence

The victims of sexual violence may develop FSD. This retrospective study examined the characteristics of women victims of sexual abuse who had FSD who attended a tertiary hospital from 2004 to 2017. Patients were divided in two groups: women who were victims of sexual violence and women who were not victims (controls). One thousand and ten women (60.4%) presented with FSD and 610 of them were eligible for inclusion, 134 (21.97%) reported they were victims of sexual violence, and the abuser was mostly someone close to the victim (92.31%). Depression was more prevalent in the women who were victims (32.1% vs. 18.3%; p<0.05), 74.0% vs. 59.8% had hypoactive sexual desire disorder (HSDD) (p<0.05), 20.3% of victims vs. 7.19% of controls (p<0.05) had primary anorgasmia, and 51.15% of the victims and 39.61% of controls reported anorgasmia. The victims reported a lower sex drive (39.6% vs. 52.3%), and reduced arousal (48.8% vs. 61.3%; all p<0.05). More of the victims than controls reported that their partners had engaged in an extramarital relationship (19.0% vs. 9.25%, p<0.05).

Association of Bicycle-Related Genital Numbness and Female Sexual Dysfunction: Results From a Large, Multinational, Cross-Sectional Study

Introduction

Cycling can lead to microtrauma due to increased perineal pressure, possibly contributing to genital numbness and sexual dysfunction in female cyclists.

Aim

We aim to explore the associations between cycling characteristics, female genital numbness, and female sexual dysfunction.

Methods

We conducted a cross-sectional study on female cyclists and sexual wellness. Participants were recruited through Facebook® advertisements and online outreach at athletic clubs. Participants were asked about their cycling characteristics, genital numbness, and female sexual function using the Female Sexual Function Index (FSFI). Univariate and multivariable linear and logistic regression were used to assess risk factors for genital numbness and the association between genital numbness and the FSFI.

Outcome Measures

The outcome measures were cycling characteristics, questions regarding numbness (intensity, duration, location), and the FSFI score.

Results

Eight-hundred and seventy-five women were included in the study. Total lifetime miles cycled, biking duration, frequency, distance, speed, and biking surface were not significantly associated with genital numbness. Higher handlebar height was associated with less numbness. The prevalence of sexual dysfunction in the cohort was 52%. Genital numbness was significantly associated with sexual dysfunction (OR: 1.43, 95% CI: 1.05 – 1.95). Sub-group analysis for location of numbness demonstrated significant increase in risk for sexual dysfunction in cyclists who described numbness aro`und the perineum (OR: 2.72, 95% CI: 1.05 – 7.02) and the vulva (OR: 1.55, 95% CI: 1.13 – 2.13). There was also a significant increase in the risk of sexual dysfunction in cyclists who reported a longer duration of numbness (OR: 6.58, 95% CI: 2.27 – 19.07).

Conclusions

Genital numbness is common in women who cycle and is associated with increased risk of FSD and lower average sexual response scores on FSFI. Lui H, Mmonu N, Awad MA, et al. Association of Bicycle-Related Genital Numbness and Female Sexual Dysfunction: Results From a Large, Multinational, Cross-Sectional Study. Sex Med 2021;9:100365.

Middle-aged Lebanese women's interpretation of sexual difficulties: a qualitative inquiry

BACKGROUND

The study explores women's perception and experience of sexual difficulties. The need to address the subject was triggered by the scarcity of research that reflects on women's subjective views on sexual difficulties. This is particularly crucial for middle-aged women who frequently experience hormonal and psychosocial changes that may affect their sexual life.

METHODS

Using in-depth individual and focus groups interviews, 52 Lebanese women aged 40-55 years discussed their thoughts, feelings and behaviours concerning sexual difficulties. Women were recruited purposefully from clinical and non-clinical settings to get maximum sampling variation that provided rich information and deep understanding of the subject. Recordings were transcribed verbatim and analysed about the framework analysis. Many strategies were adopted to ensure rigour.

RESULTS

Women's narratives led to four themes: women's inability to communicate sexual desires and concerns; male sexual difficulties; marital conflicts; and sexual difficulties as context-bound. Women's sexual difficulties are driven by double standards and inhibiting sexual socialisation. Once married, many women had very challenging sexual experiences. They were obliged to silently bear their husbands' poor sexual performance to protect their masculinity and thus their social image and identity. Women's narratives also showed that marital conflicts, daily life problems as well as physical and psychological burdens further challenged their sexual wellbeing and contributed to their sexual difficulties.

CONCLUSION

The study makes a unique contribution to voicing women's views and concerns as sexuality is insufficiently researched and reported in Lebanon. It emphasises the multidimensional nature of female sexual difficulties, particularly the gender-based norms that inhibit their sexual selves and profoundly affect their sexual wellbeing and capacity to claim their sexual likes and dislikes. Findings have implications on research and practice to help women prevent and overcome their sexual difficulties.

Dietary Approaches to Women's Sexual and Reproductive Health

Over the course of the reproductive life span, it is common for women to experience one or more of the most common gynecologic conditions, including sexual dysfunction, polycystic ovary syndrome, fibroids, endometriosis, and infertility. Although current management guidelines often turn to the established pharmaceutical approaches for each of these diagnoses, the scientific literature also supports an evidence-based approach rooted in the paradigm of food as medicine. Achieving healthy dietary patterns is a core goal of lifestyle medicine, and a plant-forward approach akin to the Mediterranean diet holds great promise for improving many chronic gynecologic diseases. Furthermore, creating an optimal preconception environment from a nutritional standpoint may facilitate epigenetic signaling, thus improving the health of future generations. This state-of-the-art review explores the literature connecting diet with sexual and reproductive health in premenopausal women.

Sexual function in women with androgen excess disorders: classic forms of congenital adrenal hyperplasia and polycystic ovary syndrome

PURPOSE

We compared the sexual function in women with classic forms of congenital adrenal hyperplasia (CAH) and polycystic ovary syndrome (PCOS) to find if the cause of androgen excess determines sexual functioning.

METHODS

Hundred and four women (21 with CAH, 63 with PCOS and 20 healthy controls) aged 18-40 years were included into the study. All participants completed a questionnaire regarding their sociodemographic background and underwent anthropometric and basic biochemical measurements. Plasma levels of total testosterone, androstenedione, and 17-hydroxyprogesterone were measured with immunoassay. To assess the sexual functions, the Female Sexual Function Index (FSFI) questionnaire was applied.

RESULTS

Apart from the higher physical activity in PCOS patients (P = 0.017), we found no significant sociodemographic differences between the studied groups. In clinical assessment, women with CAH had a lower incidence of acne (P = 0.006). Their plasma levels of 17OHP (P = 0.005) and insulin resistance index (P = 0.0248) were higher, while total testosterone (P = 0.0495) and glucose (P = 0.0061) was lower compared to the PCOS group. Significantly more women with CAH were homosexual (P = 0.003) and bisexual (P = 0.006). CAH group showed a lower total FSFI score (P = 0.0043) and lower scores in three domains: lubrication (P = 0.0131), sexual satisfaction (P = 0.0006), and dyspareunia (P < 0.0001). Higher physical activity was associated in all women with higher total FSFI score (P = 0.009) and scores in the domain of desire (P = 0.034) and sexual satisfaction (P = 0.01), while in CAH women apart from the total score (P = 0.03) and sexual satisfaction (P = 0.002) also in the domains of orgasm (P = 0.005), and pain (P = 0.03).

CONCLUSIONS

CAH women present more often homosexual and bisexual orientation, while their sexual functions are impaired compared to PCOS patients.

A cross-sectional study on pelvic floor symptoms in women living with Female Genital Mutilation/Cutting

Background

Female Genital Mutilation/Cutting (FGM/C) concerns over 200 million women and girls worldwide and is associated with obstetric trauma and long-term urogynaecological and psychosexual complications that are often under-investigated and undertreated. The aim of this study was to assess the pelvic floor distress and the impact of pelvic floor and psychosexual symptoms among migrant women with different types of FGM/C.

Methods

This cross-sectional study was conducted between April 2016 and January 2019 at the Division of Gynaecology of the Geneva University Hospitals. The participants were interviewed on socio-demographic and background information, underwent a systematic gynaecological examination to assess the presence and type of FGM/C and eventual Pelvic Organ Prolapse (POP), and completed six validated questionnaires on pelvic floor and psychosexual symptoms (PFDI-20 and PFIQ7 on pelvic floor distress and impact, FISI and WCS on faecal incontinence and constipation, PISQ-IR and FGSIS on sexual function and genital self-image). The participants’ scores were compared with scores of uncut women available from the literature. The association between selected variables and higher scores for distress and impact of pelvic floor symptoms was assessed using univariate and multivariable linear regression models.

Results

124 women with a mean age of 31.5 (± 7.5), mostly with a normal BMI, and with no significant POP were included. PFDI-20 and PFIQ-7 mean (± SD) scores were of 49.5 (± 52.0) and 40.7 (± 53.6) respectively. In comparison with the available literature, the participants’ scores were lower than those of uncut women with pelvic floor dysfunction but higher than those of uncut women without such disorders. Past violent events other than FGM/C and forced or arranged marriage, age at FGM/C of more than 10, a period of staying in Switzerland of less than 6 months, and nulliparity were significantly associated with higher scores for distress and impact of pelvic floor symptoms, independently of known risk factors such as age, weight, ongoing pregnancy and history of episiotomy.

Conclusions

Women with various types of FGM/C, without POP, can suffer from pelvic floor symptoms responsible for distress and impact on their daily life.

Trial registration. The study protocol was approved by the Swiss Ethics Committee on research involving humans (protocol n°15-224).

Sexual Dysfunction: A Neglected and Overlooked Issue in Adult GH Deficiency: The Management of AGHD Study

Context

Although sexuality influences well-being and quality of life (QoL), studies on sexual dysfunction (SD) in adult growth hormone deficiency (AGHD) patients are lacking.

Objective

To investigate the prevalence of SD in AGHD patients grouped according to recombinant human growth hormone (r-hGH) therapy.

Design

Prospective, cross-over, 24 months, monocentric study.

Setting

Real-life clinical setting in a tertiary, endocrinological center.

Patients

83 AGHD patients (31 women, 52 men, mean age 56.3 ± 14.7 years) were enrolled according to stringent criteria.

Intervention(s)

Patients already on long-term r-hGH therapy (Group 1, n = 32) vs untreated (Group 2, n = 51).

Main outcome measure(s)

Serum hormones, QoL Satisfaction in Hypopituitarism (QLS-H) and QoL Assessment of GHD in Adults (QoL-AGHDA) questionnaires for QoL, Index for Erectile Function-15 (IIEF-15) in men, and Female Sexual Function Index (FSFI) in women for SD.

Results

The overall prevalence of SD was 71.2% (60% men, 89% women). All IIEF-15 scores were lower (P = 0.001) and erectile dysfunction was more prevalent in Group 2 (75%) than Group 1 (35%). IGF-1 was correlated to scores of all IIEF-15 domains, particularly with that of erectile function (EF) (R²=0.123, P = 0.019). EF domain score correlated with QLS-H (P < 0.005) and QoL-AGHDA (P = 0.001). Despite the high prevalence of female SD also in untreated AGHD women, FSFI scores did not correlate with IGF-1 levels and QoL scores.

Conclusions

SD is highly prevalent in AGHD patients, especially in those untreated. SD represents an overlooked and neglected issue in AGHD, regardless the contribution of sexual life on QoL. The evaluation of sexual function should be integrated in the global assessment of AGHD patients.

Changes in the extracellular matrix of the clitoris caused by aging: a stereological and comparative study

INTRODUCTION

The clitoris is partially responsible for sexual arousal. The integrity of the extracellular matrix is essential for clitoral erection. Sexual dysfunction is a phenomenon associated with age.

METHODS

The clitoris of cadavers of 20- to 80-year-old women was excised and histologically processed. Stereological analysis was performed to quantify the volumetric density of collagen, elastic fibers, and smooth muscle.

RESULTS

A significant increase in collagen and a decrease in smooth muscle and elastic fibers were observed in older women.

CONCLUSIONS

In short, these changes caused by aging could contribute to female sexual dysfunction concerning clitoral orgasm.

The effect of sexual health education program on sexual function and attitude in women at reproductive age in Iran

BACKGROUND

Female sexual dysfunction is a common and often distressing public health problem. This study aimed to determine the effect of the sexual health program on female sexual function and attitude in reproductive age in the west of Iran.

MATERIALS AND METHODS

This was a field trial study. A total of 103 women attending health centers were assigned into two groups; an experiment and a control group. Data collection tool involved sociodemographic characteristics questionnaire, sexual female attitude questionnaire, and the Female Sexual Function Index (FSFI), which was completed by participants before and after the implementation of a sexual health education program. Data were analyzed using SPSS software version 22.

RESULTS

The results revealed that after the intervention, female sexual function in the experiment group based on the FSFI tool was significantly improved (P < 0.01) in the domains of desire, arousal, orgasm, satisfaction, pain, and the total score compared with the control group. Besides, there was no significant difference between posttest mean score of sexual attitude in the experiment group and control group (P > 0.05). However, a significant difference was found in the mean score of sexual attitudes in the experimental group before and after the intervention (P = 0.004).

CONCLUSION

The findings showed that sexual health program was effective in improving women's sexual function and attitude in the experiment group. It is recommended that the effect of other training methods remain to be addressed on women's sexual function and attitude.