Sexual Function in Postmenopausal Women and Serum Androgens: A Review Article

Androgen signalling in the ovaries and endometrium

Currently, our understanding of hormonal regulation within the female reproductive system is largely based on our knowledge of estrogen and progesterone signalling. However, while the important functions of androgens in male physiology are well known, it is also recognized that androgens play critical roles in the female reproductive system. Further, androgen signalling is altered in a variety of gynaecological conditions, including endometriosis and polycystic ovary syndrome, indicative of regulatory roles in endometrial and ovarian function. Co-regulatory mechanisms exist between different androgens, estrogens, and progesterone, resulting in a complex network of steroid hormone interactions. Evidence from animal knockout studies, in vitro experiments, and human data indicate that androgen receptor expression is cell-specific and menstrual cycle stage-dependent, with important regulatory roles in the menstrual cycle, endometrial biology, and follicular development in the ovaries. This review will discuss the expression and co-regulatory interactions of androgen receptors, highlighting the complexity of the androgen signalling pathway in the endometrium and ovaries, and the synthesis of androgens from additional alternative pathways previously disregarded as male-specific. Moreover, it will illustrate the challenges faced when studying androgens in female biology, and the need for a more in-depth, integrative view of androgen metabolism and signalling in the female reproductive system.

Predictors of Sexual Function and Performance in Young- and Middle-Old Women

Background: Maintaining sexual life in older women might be perceived as a measure of healthy and successful aging. This study aimed to establish the prevalence of female sexual dysfunction (FSD) based on the DSM-5 criteria and predictors of sexual performance in older women. Methods: A total of 185 women between 55 and 79 years old were included in the study. Validated scales were used to assess sexual function (Changes in Sexual Function Questionnaire (CSFQ)), the propensity for sexual excitation/inhibition (Sexual Excitation/Sexual Inhibition Inventory for Women), and sexual anxiety/avoidance (Body Exposure during Sexual Activity Questionnaire (BESAQ)). Multiple regression was used to assess the factors affecting sexual function and the prevalence of FDS. Results: Sexual distress was diagnosed in 14.1% of women, and FSD in 16.2% (n = 53), whereas sexual problems (CSFQ) were diagnosed in 33.3% of women, and distressing sexual concerns in 35.1%. Women with a lower number of male sexual partners (β = −0.22), a better attitude toward sex (β = 0.25), higher importance of sex (β = 0.31), a higher level of sexual excitation (β = 0.34), and that were sexually active (β = 0.39) had better sexual function, as evaluated by CSFQ. Conclusions: Most older women remain sexually active. The diversity of sexual activity in later life should be affirmed to encourage women to be sexually active and to strengthen the response to sexual stimuli.

Sexual function in patients with idiopathic inflammatory myopathies: a cross-sectional study

OBJECTIVES

To date, there is almost no information concerning the sexual health of patients with idiopathic inflammatory myopathies (IIM). This cross-sectional study aimed to compare sexual function in patients with IIM to age-/sex-matched healthy controls (HC) and determine the potential impact of clinical features on sexual function.

METHODS

In total, 122 women (61 with IIM, 61 age-matched HC) and 22 men (11 with IIM, 11 age-matched HC) aged 18-80 years completed gender-specific selection of 7 well-established and validated questionnaires assessing sexual health and function (Female Sexual Function Index, Brief Index of Sexual Function for Women, Sexual Function Questionnaire, Sexual Quality of Life Questionnaire-Female, International Index of Erectile Function, Male Sexual Health Questionnaire, Sexual Quality of Life Questionnaire-Male). Results were compared between patients and HC and correlated with selected disease-related features.

RESULTS

The prevalence of sexual dysfunction in IIM was 59% in women (vs 40% in HC), and 64% (vs 9% in HC) in men. Men and women with IIM reported significantly impaired sexual function compared with sex-/age-matched HC. Decreased sexual function was associated with muscle weakness, disability, physical inactivity, fatigue, depression and decreased quality of life.

CONCLUSIONS

Our results suggest that sexual dysfunction is common among IIM patients and more attention should be paid to this aspect of the disease.