Systematic review of sexual function in older women

Coital Incontinence: A Multicentre Study Evaluating Prevalence and Associations

INTRODUCTION AND HYPOTHESIS

Coital incontinence (CI) is common, with a significant impact on quality of life and sexual function. This multicentre study was aimed at measuring the association between overactive bladder (OAB), stress urinary incontinence (SUI) and different aspects of CI including orgasm and penetration incontinence.

METHODS

Following ethical approval, data from the electronic Personal Assessment Questionnaire-Pelvic Floor patient-reported outcome measure was collated for Urogynaecology outpatients from seven participating UK Hospitals between April 2018 and January 2022. Data were anonymised and analysed centrally using Excel.

RESULTS

A total of 12,877 responses were obtained, of which 4,843 were valid for inclusion. 79.3% of women presented with urinary incontinence of whom 41.6% also reported CI. 96.8% of women with CI reported mixed OAB and SUI, with 2.1% and 1.1% reporting pure OAB and SUI respectively. There was a small subset (2.4%) with no overt urinary incontinence who occasionally experienced CI. Spearman's rank-order correlation demonstrated a statistically significant association between CI symptom score with both SUI (R = 0.57, p < 0.001) and OAB (R = 0.40, p < 0.001); orgasm incontinence with SUI (R = 0.49, p < 0.001) and OAB (R = 0.36, P < 0.001); penetration incontinence with SUI (R = 0.48, p < 0.001) and OAB (R = 0.35, p < 0.001).

CONCLUSIONS

Coital incontinence is experienced by 42% of women with urinary incontinence. There is a statistically significant association between both SUI and OAB with orgasm incontinence and penetration incontinence, suggesting (a) common underlying mechanism(s). Limitations of this study include the large amount of missing data and the NHS outpatient setting that limit the conclusions that can be drawn from the data.

Sexual well-being among partnered adults and couples over 60: a scoping review

INTRODUCTION

Although society still holds age-related stereotypes dismissing the sexuality of aging individuals, older adults remain sexually active and find sexuality to be an important part of their quality of life. Primarily oriented toward a biomedical and dysfunctional lens, prior research neglected the subjective well-being of elderly individuals, especially partnered adults and couples aged 60 years or more. Shedding a more positive light on this area of life could promote older individuals' and couples' sexual well-being.

OBJECTIVES

This scoping review aimed to synthetize the studies including community samples of partnered adults or couples over 60 who reported on various indicators of subjective sexual well-being including sexual satisfaction, distress, and function using validated measures.

METHODS

Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMAScR), the electronic literature search was conducted using PubMed, PsycINFO, Medline, and CINAHL for peer-reviewed journal articles published before July 2023.

RESULTS

Results showed how relational variables such as relationship satisfaction and intimacy emerge as important correlates of older adults' sexual well-being.

CONCLUSION

Avenues for future research arising from gaps in the studies identified thorough this scoping review, including the underrepresentation of sexual/gender diverse individuals and the use of single and/or non-validated items to assess sexual well-being, are discussed.

Sexual Activity, Function, and Satisfaction in Reproductive-Aged Females Living with Chronic Kidney Disease

Up to 80% of women living with chronic kidney disease (CKD) experience sexual dysfunction, though its link with sexual activity and sexual satisfaction is not well understood. Among older women with CKD treated with hemodialysis, the majority report sexual inactivity, though few describe sexual difficulty and most report high sexual satisfaction. Whether this applies to reproductive-aged females living with CKD is yet unknown. This study aimed to assess the sexual activity, function, and satisfaction of reproductive-aged females living with CKD. Self-identified females aged 18-51 years with CKD were recruited from nephrology clinics in Calgary, Canada. Sexual activity, function, and satisfaction were assessed with a modified version of the Female Sexual Function Index. Fifty-seven participants were recruited (35% CKD without kidney replacement therapy, 44% CKD treated with hemodialysis, 9% CKD treated with peritoneal dialysis, 12% CKD treated with kidney transplant) and nearly half (47%) reported sexual activity. Among sexually active participants, there was a high prevalence of sexual dysfunction (67%) and only 25% of participants reported sexual satisfaction. A strong relationship between sexual function and satisfaction was identified. Reproductive-aged females living with CKD are sexually active, though experience high rates of sexual dysfunction and dissatisfaction. These findings emphasize the importance of recognition and management of sexual dysfunction in this important population.

The Role of Sexual Function in Quality of Life Among Midlife and Older Women: The Study of Women's Health Across the Nation

Objective: To examine how (1) partnered sexual activity, and (2) sexual functioning, contribute to global quality of life (QOL) and health-related quality of life (HRQL) among midlife and older women, and whether importance of sex modifies these associations. Materials and Methods: Women in the Study of Women's Health Across the Nation (SWAN), a multiethnic/racial cohort study, aged 42-52 at recruitment, were followed for ∼20 years. The Ladder of Life and Short Form-36 physical component summary (PCS) and mental component summary (MCS) assessed Global QOL (N = 3,263) and HRQL (N = 2,576), respectively. Primary predictors were (1) having partnered sexual activity (yes/no), and (2) sexual functioning among those with partnered sexual activity. Sociodemographic, health, lifestyle, and psychosocial covariates were included. Results: Importance of sex modified covariate-adjusted association of having partnered sexual activity with global QOL. Adjusted associations of partnered sexual activity with PCS and MCS were not statistically significant. Sexual functioning, among women with partnered sexual activity, was positively associated with global QOL (adjusted p = 0.03), regardless of importance of sex; unrelated to PCS; but positively associated with MCS (adjusted p = 0.03), particularly when sex was "very/quite important." Conclusions: Partnered sexual activity and better sexual functioning are related to QOL for mid-aged and older women, and are stronger when sex is considered important. Partnered sexual activity and sexual functioning are less consistently related to HRQL when adjusted for covariates, and importance modifies only the association between sexual functioning and MCS. Understanding the importance of sex to midlife and older women contextualizes the impact of sex on QOL.

Predictors of social intermediate factors associated with sexual quality of life of women: systematic review and meta-analysis

BACKGROUND

Sexual problems and diminished sexual quality of life can adversely affect the physical, psychological, and emotional health of women. The present study was done to determine the social intermediate factors of health associated with sexual quality of life in women of reproductive age.

DESIGN

Systematic review and Meta-analysis.

DATA SOURCES

Embase, Web of Science, PubMed/Medline (NLM), ProQuest, and CENTRAL.

ELIGIBILITY CRITERIA

Observational studies (cross-sectional, case-control, cohort) from 2010 to 2022 with no language constraints were included. The sexual quality of life, as the main variable of the study, has been evaluated using Symonds women's sexual quality of life scale (SQOL-F). The health social determinants intermediate factors based on WHO model were considered as exposure variables.

DATA EXTRACTION AND SYNTHESIS

The data of included studies were extracted by two independent persons through a researcher-made checklist according to the study aims. Quality assessment of studies was done using Newcastle-Ottawa instrument. R software (Version R-4.2.1) were used for meta-analysis. Publication bias was evaluated by Egger & Begg tests. Sensitivity analysis was done through one-out remove approach.

RESULTS

Eventually, 15 studies were eligible to be included in this systematic review and meta-analysis. Variables of depression, quality of marital relation, body image, self-esteem, physical activity, and sexual function were among the health social intermediate factors associated with sexual quality of life. Publication bias had no effect on the obtained results; no study affecting the results was found through sensitivity analysis.

CONCLUSION

Considering the relationship between modifiable factors and sexual quality of life, it seems that identification of these factors can be an important step towards designing interventional studies to help women experience enhanced sexual quality of life.

The barriers and enablers to accessing sexual health and sexual well-being services for midlife women (aged 40-65 years) in high-income countries: A mixed-methods systematic review

Midlife, beginning at 40 years and extending to 65 years, a range that encompasses the late reproductive to late menopausal stages, is a unique time in women's lives, when hormonal and physical changes are often accompanied by psychological and social evolution. Access to sexual health and sexual well-being (SHSW) services, which include the prevention and management of sexually transmitted infections, contraception and the support of sexual function, pleasure and safety, is important for the health of midlife women, their relationships and community cohesion. The objective was to use the socio-ecological model to synthesise the barriers and enablers to SHSW services for midlife women in high-income countries. A systematic review of the enablers and barriers to women (including trans-gender and non-binary people) aged 40-65 years accessing SHSW services in high-income countries was undertaken. Four databases (PubMed, PsycINFO, Web of Science and Google Scholar) were searched for peer-reviewed publications. Findings were thematically extracted and reported in a narrative synthesis. Eighty-one studies were included; a minority specifically set out to study SHSW care for midlife women. The key barriers that emerged were the intersecting disadvantage of under-served groups, poor knowledge, about SHSW, and SHSW services, among women and their healthcare professionals (HCPs), and the over-arching effect of stigma, social connections and psychological factors on access to care. Enablers included intergenerational learning, interdisciplinary and one-stop women-only services, integration of SHSW into other services, peer support programmes, representation of minoritised midlife women working in SHSW, local and free facilities and financial incentives to access services for under-served groups. Efforts are needed to enhance education about SHSW and related services among midlife women and their healthcare providers. This increased education should be leveraged to improve research, public health messaging, interventions, policy development and access to comprehensive services, especially for midlife women from underserved groups.

Promoting sexual health in older adults: Findings from two rapid reviews

BACKGROUND

Sexual health throughout the life course is increasingly recognised as important to maintaining one's overall health, wellbeing, and relationships. We aimed to provide an overview of the evidence on sexual health needs and sexual health promotion in later life.

METHODS

We undertook two rapid reviews, drawing on systematic review evidence. Searches were conducted in Epistemonikos. Studies were eligible if they reported evidence about the sexual health needs of, or sexual health promotion interventions for, people aged 50+ years. Evidence was quality assessed and summarised in a narrative synthesis.

RESULTS

Fifteen systematic reviews were included in Review 1 (sexual health needs) and 12 in Review 2 (interventions). Key concerns and needs of older adults included the impacts of cultural stigma/misperceptions, barriers to sexual expression, and a need for tailored support in a welcoming environment. Key concerns and needs of health and social care professionals included mixed attitudes towards and knowledge of later-life sexuality and a need for more training and education. Approaches to promoting sexual health in later life included training and workshops for care home professionals, education for older people at risk of/living with HIV, and interventions to address sexual health-related symptoms of menopause. Gaps in the evidence from current reviews and methodological issues in primary studies were identified.

CONCLUSION

Older people have specific needs relating to their sexual health. Health and social care professionals working with older people may benefit from education/training around sexuality in later life. Evidence on effective interventions and strategies is limited.

Sexual activity, sexual satisfaction and their correlates among older adults in China: findings from the sexual well-being (SWELL) study

Background

Sexual activity is important to the holistic health of older adults. However, the sexual lives of older adults are understudied. We aimed to investigate the prevalence and correlates of sexual activity and sexual satisfaction among older adults in China.

Methods

In this multi-centre cross-sectional study, individuals aged 50 years and older were recruited from four regions in China between June 2020 and December 2022. An investigator-administered questionnaire was completed to collect information on socio-demographics, health status (general health and specific health), and sexual health characteristics. Sexual activity (including vaginal, oral, or anal sex) in the past year was treated as sexually active. Sexual satisfaction was measured using a validated five-point Likert scale. Logistic regression was used to assess correlates of sexual activity and sexual satisfaction.

Findings

3001 older adults (1182 women and 1819 men, mean age 60.3 ± 7.8 years) were recruited. Most participants were living in urban areas (1688, 56.2%), in a stable relationship (2531, 84.3%), and satisfied with life (2141, 71.3%). 46.8% of men and 40.7% of women were sexually active. Better self-reported general health status (good: aOR 0.53, 95% CI 0.34-0.82; fair: 0.47, 0.29-0.76; bad or very bad: 0.58, 0.35-0.96; versus very good), no difficulty walking upstairs (0.63, 0.41-0.97), diabetes (0.64, 0.42-0.98), and menopause (0.57, 0.36-0.92), were associated with sexual activity among women. Such an association was not found among men. Among sexually active participants, about three-quarters (men: 73.6%, women: 73.4%) were sexually satisfied. Self-reported general health status (men [good: 0.25, 0.12-0.53; fair: 0.17, 0.08-0.37; bad or very bad: 0.15, 0.06-0.34]; women [good: 0.27, 0.10-0.70; fair: 0.11, 0.04-0.30; bad or very bad: 0.11, 0.04-0.32]), life satisfaction (men: 1.73, 1.22-2.46; women: 2.23, 1.34-3.71) and talking about sexual preferences with a partner (men: 1.77, 1.23-2.56; women: 2.93, 1.69-5.09) were associated with sexual satisfaction.

Interpretation

Older adults who had better health status and talked easily with their partners about their sex life were more likely to report sexual satisfaction. For women, better self-reported general health status and lack of disability were associated with sexual activity. Further research should address measures that improve sexual satisfaction, especially among sexually active older adults.

Funding

This study was supported by the Natural Science Foundation of China International/Regional Research Collaboration Project [72061137001] and the Economic and Social Research Council [ES/T014547/1].

Vitagnus an estrogen-riched herbal remedy used in sexual dysfunction: A randomized clinical trial

BACKGROUND

Sexual dysfunction is a common problem in the postmenopausal period. Vitagnus is a phytoesterogen containing herb, which can bind to estrogen receptors and modulate their function. In this study, we evaluated the efficacy of oral vitagnus solution on sexual dysfunction improvement among postmenopausal women in North Khorasan Province, Iran.

MATERIALS AND METHODS

The present study was a double-blind clinical trial on 60 retired female teachers who visited the retirement center of North Khorasan Province from December 2019 until January 2021. Sampling was done in a convenience sampling. Allocation of intervention and placebo groups was done randomly by marking as A and B codes, respectively. Eligible married women aged 50-70 years had received 40 drops of vitagnus or placebo daily for 8 weeks. Female Sexual Function Index was filled on the first day, fourth, sixth, and eighth week after the intervention. Data were analyzed using SPSS V.23 and independent t-test, Mann-Whitney U, Chi-square, Fisher's exact test, and repeated measure ANOVA were used for analyzing descriptive and inferential data. P < 0.05 was considered as a statistically significant threshold.

RESULTS

Data from Bonferroni post hoc test indicated that the mean total sexual function did not differ between the two groups before and at the end of the fourth week of intervention, but scores of total sexual function showed a significant difference at the end of the sixth (P = 0/003) and eighth week (P = 0/001) of intervention.

CONCLUSION

Vitagnus drops, as a simple, cheap, and available herbal supplement, could affect the sexual function of women aged 50-70 and improve it.

Sexual Function in Pregnancy in a Nigerian Population: A Prospective Longitudinal Study

Background

Studies are abound from low- and middle-income countries (LMICs) on postpartum sexual dysfunction but very limited in pregnancy. The data will help clinicians in providing women with evidence-based information and counseling in these regards.

Aim

To determine the effects of different trimesters of pregnancy on sexual functions and the possible risk factors for sexual dysfunction in pregnancy.

Patients and Methods

The study was longitudinal in design, and study population consisted of 270 pregnant women attending antenatal care at the two largest tertiary hospitals in Enugu, Nigeria. The recruitment was in the first trimester, and each recruited participant served as her own control. Interviews were conducted at specific times in the three trimesters, and data regarding sexual functions were obtained using validated questionnaires. Analysis of variance (ANOVA) was performed to compare the mean total and domain female sexual function index (FSFI) scores between the three trimesters, and Bonferroni's test for significant association between any two trimesters as may be applicable. The risk factors were determined via multivariate logistic regression analysis. A P value ≤0.05 was considered statistically significant.

Results

The FSFI means total score decreased as pregnancy advanced. It was significantly lower in second trimester (T2) than in first trimester (T1) (P < 0.001), and significantly lower in third trimester (T3) than T1 (P < 0.001), but no difference between T3 and T2 (P = 0.759). Similarly, the mean frequency of coitus per week declined across the trimesters; lower in T2 than T1 (2.2 ± 0.7 vs. 2.4 ± 0.6; P < 0.01), and lower in T3 than T1, but no difference between T3 and T2. The overall rate of sexual dysfunction was 50.7% and the risk factors age ≥35 years (AdjOR: 1.4; 95%CI: 1.1-1.9; P: 0.01), multiparity (AdjOR: 1.7; 95%CI: 1.2-2.5; P: 0.013) and a previous history of cesarean section (AdjOR: 2.1; 95%CI: 1.7-2.6; P: 0.004).

Conclusion

Sexual function declines as pregnancy advances and the rate of sexual dysfunction is high in Enugu, Nigeria. Obstetricians are encouraged to discuss sexual health issues during antenatal care services and make more efforts towards reducing the modifying obstetric risk factors.

Postmenopausal sexual function and steroid hormone levels: a hospital-based cross-sectional study

OBJECTIVE

Steroid hormone levels, particularly androgens, play an important role in sexual function in premenopausal women, but this relationship is not so well determined after menopause. This study aimed to assess the association between steroid hormone levels and sexual function in postmenopausal women.

METHODS

A total of 84 postmenopausal women with intact ovaries, who had never used systemic hormone therapy, were enrolled in a cross-sectional study. Sexual function was assessed using the Female Sexual Function Index (FSFI) questionnaire and serum levels of steroid hormones were quantified by gas chromatography and tandem mass spectrometry. Associations between estradiol, testosterone, dehydroepiandrosterone, androstenedione and FSFI domain scores were evaluated.

RESULTS

After adjustment for confounding variables, the analysis revealed a statistically significant association between androstenedione and overall sexual function (β = 1.23, 95% confidence interval [CI] [0.37; 1.98], p = 0.010), arousal (β = 0.19, 95% CI [0.02; 0.37], p = 0.034), orgasm (β = 0.33, 95% CI [0.15; 0.45], p = 0.001) and satisfaction (β = 0.25, 95% CI [0.11; 0.36], p = 0.001). No associations were found between the other hormones and FSFI domains.

CONCLUSION

The main finding of this study is the association of androstenedione with sexual function in postmenopausal women, not verified for other steroid hormones. Further studies are necessary to determine the importance of androstenedione for postmenopausal sexual function.

Impact of laparoscopic sacrocolpopexy (LSC) on sexual function in women with advanced stages of pelvic organ prolapse (POP): A five-year prospective study

OBJECTIVE

To compare patients undergoing laparoscopic sacrocolpopexy (LSC) for pelvic organ prolapse (POP), in terms of sexual function and surgical anatomical outcomes more than 5-years follow up period.

STUDY DESIGN

This is a cohort study of prospectively collected data that includes all women who underwent LSC between July 2005 and December 2021 at a tertiary care center. A total of 228 women were enrolled in this study. Patients completed a validated quality of life questionnaires and were evaluated using the POP-Q, the PFDI-20, PFIQ-7 and the PISQ-12 scores. Patients were divided preoperatively if they are sexually active or not and postoperatively according to the sexual improvement after POP surgery.

RESULTS

There was a statistically significant improvement in the PFDI, PFIQ and POPQ score. There was no significant improvement in the PISQ-12 score with more than 5 years follow-up. 76.1 % of patients who were not sexually active preoperatively resumed their sexual activity after the surgery.

CONCLUSION

The anatomical correction of a pelvic organ prolapse and pelvic floor disorders by laparoscopic sacrocolpopexy allowed a significant proportion (over ¾) of the women to resume sexual activity whom had not previously been sexually active. However, PISQ 12 scores did not alter significantly in those who were sexually active prior to surgery. Sexual function is a very complex issue affected by multitude of factors among which prolapse seems to be less important.

Use of metaphors when treating unexplained medical symptoms

The words one chooses to describe personal pain mirror current usage, but may also hold echoes of an individual’s lived experience. They may provide clues to the origin of physical symptoms that are medically hard to explain. The aim of this commentary is to propose, on the basis of the available literature, that verbal metaphors can prove effective in the psychotherapy of such conditions. I provide a case history of a 45 year old woman referred to psychiatry because of extreme ‘burning’ pain in her mouth and tongue. She had been to numerous doctors, had undergone a variety of tests, had tried many medical treatments, and had been prescribed a number of different pharmaceutical agents. She had changed her diet, done her daily dental mouth exercises, drunk a lot of water, but the burning continued and interfered, with her job (she was a teacher), her friendships, and her everyday life. This made her angry and recalcitrant to therapy, but the metaphor ‘burning with rage,’ as applicable to her pain, worked to establish a good alliance that led to a decrease of symptoms. Burning Mouth Syndrome is a medically unexplained condition of complex etiology that psychotherapy alone cannot reverse. The literature bears out, however, that the use of metaphors can help to open avenues of psychological exploration that accelerate adaptation to pain and improve quality life.

How does colpocleisis for pelvic organ prolapse in older women affect quality of life, body image, and sexuality? A critical review of the literature

Colpocleisis is a surgical treatment for pelvic organ prolapse that results in vaginal obliteration. This review aims to systematically evaluate the quality of life, changes in body image, regret, and impact on sexual activity in women after colpocleisis. A review was conducted using the PubMed and Scopus databases with search criteria specifying pelvic organ prolapse, colpocleisis, quality of life, body image, regret, sexuality, and their synonyms. For the selection of the eligible articles, we used the PRISMA reporting system. A total of 1285 articles were found. After removing duplicates and applying the inclusion and exclusion criteria, 30 articles were reviewed in full length. Quality of life after colpocleisis was evaluated in 22 articles, and 20 authors used validated questionnaires. All concluded that quality of life improved after surgical treatment. Twenty-one articles studied regret after obliterative treatment for pelvic organ prolapse. Most of the patients reported no regret. Regret was often due to bowel and bladder symptoms. A few patients reported regret because of loss of coital function. Body image was highlighted in six studies. Three articles assessed body image using the modified Body Image scale. The body image scores demonstrated a significant improvement after surgery. Women tended to remain sexually active and some also regained sexual activities after surgery. Colpocleisis remains a viable option for pelvic organ prolapse, without compromising quality of life, body image, or sexuality, but diligent patient selection is needed. Particular concern should be given to bladder and bowel symptoms since these are the main reason for dissatisfaction after colpocleisis.