Sexual dysfunction in perimenopausal women based on a national epidemiological survey in China

Sexual experiences of postmenopausal women in China: a qualitative study

Background

Sexual dysfunction is common among postmenopausal women and can have a significant negative impact on quality of life.

Aim

This study aimed to explore perceptions, experiences, and coping strategies related to sex among postmenopausal women in China.

Methods

We used phenomenologic qualitative methods in this study. On the basis of purposive sampling and the data saturation principle, 21 volunteers from a community cohort study were selected for semistructured interviews. The data were analyzed and themes were extracted.

Outcomes

Thematic codes pertaining to sexual experiences and coping strategies were defined and assessed in this study.

Results

Four themes and 12 subthemes were extracted from the interview data. The sexual concepts were relatively conservative for most of the Chinese women; the majority experienced physical and psychological distress with respect to sex, although negative and positive psychological experiences were described. The women often passively accepted and adapted to negative changes to their sex lives during the postmenopause period.

Clinical Implications

This study highlights the importance of and need for effective dissemination of sexual health-related knowledge and the opening of appropriate communication channels.

Strengths and Limitations

By using a qualitative approach, this study provides individuals with the opportunity to describe their cognition and attitudes toward sexuality. Limitations include limited generalizability, as is true for most qualitative research. Additionally, the study is based solely on the female perspective and cannot fully reflect the sex life of couples.

Conclusion

The sexual experiences of our respondents exhibited distinct Chinese cultural characteristics. The interviews show the importance of paying attention to postmenopausal women's sexual health and providing relevant professional support and guidance to improve women's overall health-related quality of life.

Sexual dysfunction in Wilson disease: Prevalence and influencing factors

Wilson disease is a rare neurogenetic disorder that receives significant attention due to its manifestations, such as jaundice, cirrhosis, tremor, dystonia, and others. However, the impact of Wilson disease on sexual function has been overlooked. In this study, we aimed to investigate current status of sexual dysfunction in Wilson disease. In this study, we investigated the sexual function status and possible influencing factors of 245 Wilson disease patients by questionnaire. Our study identified sexual dysfunction as a prevalent issue in Wilson disease patients, with an overall prevalence of 49.0 %, of which 33.9 % in males and 63.7 % in females, both higher than the prevalence of sexual dysfunction in the normal Chinese population. Compared with non-sexual dysfunction patients, sexual dysfunction was more common in the older age group, females, less educated, rural residence, no occupation, lower income, taking sedatives/antipsychotics, and high SIS scores (P < 0.05). Our binary logistic regression analysis revealed that older age (OR: 1.103, 95 %CI: 1.058-1.151, P < 0.001), being female (OR: 5.900,95 %CI: 2.966-11.736, P < 0.001), and the use of antipsychotics or sedatives (OR: 3.277,95 %CI: 1.065-10.077, P < 0.05) were all positively linked with an increased risk of sexual dysfunction. Despite the well-known symptoms of Wilson disease, sexual dysfunction is also a frequent issue in Wilson disease patients, necessitating further attention.

A multicentre cross-sectional clinical study on female sexual dysfunction in postmenopausal Chinese women

OBJECTIVE

The aim of this study was to investigate the factors affecting the sex lives of postmenopausal Chinese women, especially the influence of body weight, climacteric symptoms and androgens.

METHODS

A total of 437 postmenopausal women were investigated in the Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University and two allied medical institutions from April 2020 to March 2021. Sociodemographic data were collected. Female sexual dysfunction was evaluated using the Female Sexual Function Index (FSFI). The modified Kupperman index was used to assess climacteric symptoms. Methods based on liquid chromatography-tandem mass spectrometry were employed to measure the serum levels of total testosterone, bioavailable testosterone, free testosterone, androstenedione and dehydroepiandrosterone. Pearson's correlation coefficient and multiple linear regression analyses were performed to determine the correlation between characteristics and FSFI scores.

RESULTS

The multivariate linear regression analysis revealed that the modified Kupperman index score and the factor unsatisfactory marital relations had the strongest negative correlations with all FSFI domains (P < 0.05); secondary education level was negatively associated with desire, arousal and orgasm (P < 0.05). Total testosterone positively affected the score for pain (P < 0.05). There was no correlation between bioavailable testosterone, free testosterone, androstenedione and dehydroepiandrosterone and all FSFI domains (P > 0.05).

CONCLUSION

Climacteric symptoms and sociodemographic factors had a notable effect on sexual function. It is necessary to provide more attention to and intervention for their climacteric symptoms to improve the quality of life of postmenopausal women.

Predictors of female sexual problems in Shanxi, China: a population-based cross-sectional epidemiologic survey

Background

Large studies on female sexual function have been conducted globally. Nonetheless, whether the state of female sexual function in China is significantly different from that in the rest of the world is largely unknown.

Aim

In this study, we aimed to investigate the associated risk factors for sexual problems in women in Shanxi, China, by conducting a population-based cross-sectional epidemiological survey.

Methods

Using the Chinese version of the Female Sexual Function Index (CV-FSFI), we surveyed women aged 20-70 years to diagnose the sexual problems. We used multiple linear regression models to estimate the risk factors for sexual problems.

Outcomes

We used the CV-FSFI for investigating the female sexual function.

Results

Our results included 6720 women, of whom 1205 were the sexually inactive and 5515 were sexually active. The mean FSFI score for sexually active women was 25.38 ± 4.20 (99% CI 25.27-25.49). Negative numerical coefficients were found for model predictors of age (B = −0.134, P &lt; 0.001), postmenopausal status (B = −2.250, P &lt; 0.001), chronic diseases (B = −0.512, P &lt; 0.001), and gynecologic diseases (B = −0.767, P &lt; 0.001). In contrast, positive numerical coefficients were found for education (B = 0.466, P &lt; 0.001) and cesarean section (B = 0.312, P = 0.009).

Clinical Implications

It is important to pay attention to the sexual health of women and explore the factors influencing the sexual problems of women in China.

Strengths and Limitations

The present study is to our knowledge the first to evaluate the sexual function of women in Shanxi, China. Answers to questions asked in the CV-FSFI survey may be somewhat subjective, and thus additional tools and documentation are probably needed for accurate assessment.

Conclusion

Similarly to other worldwide studies, our study found that increasing age, postmenopausal status, chronic diseases, and gynecological diseases were risk factors for sexual problems, whereas high education levels and cesarean section childbirth were protective factors for sexual problems.

The Prevalence of Sexual Dysfunction in the Different Menopausal Stages: A Systematic Review and Meta-Analysis

Objectives: Despite the noticeable advances in sexual dysfunction (SD) research in the menopausal period, scientific literature showed different reports on the prevalence of SD in the menopausal stages. The primary objective of this study was to systematically review and meta-analysis the prevalence of SD in the different menopausal stages and then meta-analysis the included studies in domains of SD separately. Methods: In this systematic review and meta-analysis, keywords were retrieved through MeSH strategy and databases such as PubMed/MEDLINE, PsycINFO, Web of Science (ISI), Scopus, ScienceDirect, SID (Scientific Information Database), Magiran, and Google scholar were searched. Manual review of retrieved citations identified additional citations. The quality of the included studies was assessed using The Newcastle-Ottawa Scale. The main outcome measure in this study was the prevalence of SD in three stages of menopause such as pre, peri, and postmenopause. Results: Of 54 included studies 81,227 menopausal aged women from different menopause stages participated and the sample sizes varied from 49 to 31,581 individuals. The articles from 17 countries worldwide were included in this study. The prevalence of SD in premenopausal aged women was ranged between 22.7% and 72.2%, in perimenopausal aged women, was 37.3-78.2% and also in postmenopausal aged women was extremely reported a wide variety of prevalence ranges and was estimated between 8.7% and 89.01%. The premenopausal women had a lower prevalence of SD compared to other stages of the menopausal period. Conclusion: The results indicated that the prevalence of SD and also domains of SD in different studies were reported much widely. This study can be used as a good resource for obstetricians to understand the high possibility of recurrence of SD and assess the sexual activity of menopausal aged women in the menopause clinic. However, based on the systematic review, more standard and high-quality studies are needed to perform regarding the prevalence of SD in menopausal periods.

Sexual dysfunction in Chinese women at different reproductive stages and the positive effect of hormone replacement therapy in the early postmenopause

OBJECTIVES

The aims of the study were to investigate female sexual dysfunction (FSD) at different reproductive stages and the effect on FSD of hormone replacement therapy (HRT).

METHODS

Participants (N = 524) were divided into six groups according to the Stages of Reproductive Aging Workshop (STRAW + 10): reproductive age (R), early (ET)/late (LT) menopausal transition, early (EP)/late (LP) postmenopause and early postmenopause in women using HRT (EP-HRT; oestradiol sequentially combined with dydrogesterone). The Female Sexual Function Index (FSFI) was used to assess FSD. Univariate and multivariate logistic regression analysis was carried out to predict FSD risk factors.

RESULTS

There was an increase in FSD in groups EP and LP, but not in groups R, ET and LT; most FSFI scores were lower in groups EP and LP than in groups R, ET and LT (p < .05). There was no difference in FSD between groups EP and LP, but lubrication and pain scores were higher in group EP (p < .05). The prevalence of FSD was lower in group EP-HRT; most FSFI scores were higher in group EP-HRT compared with group EP as control (p < .05). Further risk factors for FSD were identified as neutral and dissatisfied marital relations, lower educational level and smoking (p < .05).

CONCLUSION

We report a clear association between deteriorating sexual function and increasing STRAW + 10 classification, suggesting the consequence of decreasing ovarian function. HRT containing 'natural hormones' was shown to have a beneficial effect on FSD. The results are reported here for the first time in Chinese women.

Female sexuality and vaginal health across the menopausal age

OBJECTIVE

The primary aim was to evaluate changes in female sexuality across the menopausal period, and the secondary objective was to test the associations of female sexuality domains with vaginal atrophy and its symptoms.

METHODS

A cross-sectional multicenter study was performed involving 518 women, 40 to 55 years of age, consulting outpatient gynecological services at 30 centers across Italy. Vaginal atrophy was identified by the contemporaneous presence of a pH >5, subjective vaginal dryness, and an objective sign. The relationships between vaginal atrophy and its main symptoms (vaginal dryness and dyspareunia), and Female Sexual Function Index (FSFI) score and its domains (desire, arousal, orgasm, dyspareunia, lubrication, and sexual satisfaction) were analyzed.

RESULTS

The prevalence of sexual dysfunction, as defined by a FSFI score <26.55, was 70.6%, increasing from 55% in the years 40 to 45, to 82.8% (P < 0.01) in the years 52 to 55 of age. Mean FSFI score decreased from 40 to 45, to 46 to 48 years of age (23.13 ± 9.76 vs 19.49 ± 9.88; P < 0.05), and from 48 to 51, to 52 to 55 years of age (21.3 ± 8.06 to 17.59 ± 9.11; P < 0.01). Independent determinants of FSFI were age, vaginal atrophy, and the presence of vaginal dryness and dyspareunia (R2 0.208; P = 0.011). FSFI score was independently correlated (R2 0.116) with weight (CR -0.067; 95% confidence interval [CI] -0.126, -0.006; P < 0.032), menopausal status (CR -2.406; 95% CI -4.180, -0.63; P < 0.008), and vaginal dryness (CR -5.647; 95% CI -7.677, -3.618; P < 0.0001). Vaginal dryness was the only variable correlated independently with each FSFI domain, including desire (also correlated with menopausal status), arousal (with age and menopausal status), lubrication (with age), orgasm (with age), satisfaction (with vaginal atrophy and being an ex-smoker), and dyspareunia (with age and spontaneously referred dyspareunia).

CONCLUSIONS

In the perimenopausal years, FSFI score decreases and sexual dysfunction increases by about 30%. Vaginal dryness is the symptom of vaginal atrophy most closely related to all domains of female sexuality.

Sexual behaviors and function during menopausal transition-does menopausal hormonal therapy play a role?

OBJECTIVES

The menopausal transition is a biological adaptation to the variety of life changes (body, comorbidities, relationship), but that biology is not an "end all" in the context of sexual function and overall sexual health. The aim of this study is to evaluate determinants altering the risk of female sexual dysfunction (FSD) and other sexual problems and to establish whether menopausal hormonal therapy (MHT) decreases that risk and modifies sexual behaviors.

METHODS

A cross-sectional observational study was conducted in 210 women between the ages of 45 and 55. Two groups were identified: MHT users (n = 107) and controls-MHT non-users (n = 103). Diagnostic and Statistical Manual of Mental Disorders -five criteria were used to assess sexual dysfunction. Sexual problems were evaluated by the Changes in Sexual Function Questionnaire (CSFQ), body image by Body Exposure during Sexual Activity Questionnaire, and quality of relationship by the Well-Match Relationship Questionnaire. Logistic regression was used to determine the risk factors for FSD and sexual problems.

RESULTS

Women using MHT had higher body esteem during sexual activities, better sexual function (CSFQ) in all domains except desire/interest, better quality of relationship, and lower prevalence of FSD and sexual complaints (CSFQ) except arousal/excitement problems. However, self-rated effects of MHT on sexual behaviors showed that MHT did not play a major role. Women with secondary and higher education (OR = 0.09, CI: 0.02-0.4; P < 0.01 and OR = 0.2, CI: 0.05-1.0; P < 0.05, respectively) and with a higher number of lifetime sexual partners (OR = 0.6, CI: 0.4-0.9; P < 0.01) were less likely to have FSD. In contrast, individuals with more anxious behaviors during sexual activity (OR = 3.2, CI: 1.3-7.3; P < 0.01) and with more severe menopausal symptoms (OR = 1.1, CI: 1.0-1.2; P < 0.001) were more likely to have FSD. Using MHT was not associated with that risk nor with sexual function.

CONCLUSION

In women during menopausal transition, sexual behaviors were different in MHT users compared with non-users. However, in this cross-sectional observational study conducted in 210 women between the ages of 45 to 55 years, using MHT was not associated with modification of sexual function, decreasing the risk of sexual dysfunction, nor sexual problems.

How Is the Sexual Function of Premenopausal Chinese Women Without Hyperlipidemia?

Introduction

Most premenopausal women in China have normal lipid profiles while the sexual function among them was scarcely demonstrated.

Aim

To find out the characteristics of the sexual function in premenopausal Chinese women without hyperlipidemia using the Female Sexual Function Index (FSFI) and the Golombok Rust Inventory of Sexual Satisfaction (GRISS).

Methods

This cross-sectional study was performed to find out the characteristics of sexual function in premenopausal Chinese women without hyperlipidemia. Between January 2019 and March 2019, we recruited 216 women, 25–49 years of age. Data from questionnaires and health checkups were collected and analyzed.

Main Outcome Measure

We report the prevalence of and factors related to female sexual dysfunction (FSD) in premenopausal Chinese women without hyperlipidemia in accordance with the FSFI and the GRISS.

Results

The prevalence of FSD in our study was 46.2%. The mean age was 38.07 ± 6.94 years. More highly educated women suffered from FSD than those in the control group (61.1% vs 35.2%, P < .05). Binge eating was significantly different between the groups (P = .023). Multiple logistic regression analyses demonstrated that total cholesterol level was positively associated with low desire (OR, 2.13; 95% CI, 1.10–4.13; P = .025) and so was the low-density lipoprotein level (OR, 2.18; 95% CI, 1.03–4.62; P = .0.041). The high-density lipoprotein level was inversely associated with infrequency (OR, 0.18; 95% CI, 0.06–0.59; P = .004). More women with FSD had orgasm disorder than those in the control group, for 83.3% vs 35.2% in the FSFI (P < .001), 88.9% vs 54.3% in the GRISS (P < .001), respectively. Dissatisfaction remained the most common issue for the control group in both the FSFI and the GRISS (90.50% and 58.10%, respectively).

Conclusions

FSD is frequent in premenopausal Chinese women without hyperlipidemia. Dissatisfaction as the common problem influenced over half of them and orgasm disorder is a severe sexual issue for women with FSD.

Xiang Y, Tang Y, Li J, et al. How Is the Sexual Function of Premenopausal Chinese Women Without Hyperlipidemia. J Sex Med 2019;8:65–75.