1
|
Christmas MM, Reed S. Sexual Dysfunction After Menopause: Guidelines for Assessment and Management. Obstet Gynecol Clin North Am 2024; 51:341-364. [PMID: 38777488 DOI: 10.1016/j.ogc.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Female sexual dysfunction commonly occurs during the menopause transition and post-menopause due to hormonal, physiologic, and psychosocial factors. Sexuality is important to aging women; however, many are reluctant to seek treatment for their sexual concerns. Clinicians should be adept at managing and treating sexual dysfunction in this population. A multi-dimensional treatment approach that addresses modifiable mental, physical, and psychosocial factors is warranted to improve sexual function and quality of life.
Collapse
Affiliation(s)
- Monica M Christmas
- Department of Obstetrics and Gynecology, University of Chicago Medicine and Biological Sciences, University of Chicago, 5841 South Maryland Avenue, MC 2050, Chicago, IL 60637, USA.
| | - Susan Reed
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, 1959 NE Pacific, Box 359865, Seattle, WA 98195, USA
| |
Collapse
|
2
|
Coslov N, Richardson MK, Woods NF. "Not feeling like myself" in perimenopause - what does it mean? Observations from the Women Living Better survey. Menopause 2024; 31:390-398. [PMID: 38531011 DOI: 10.1097/gme.0000000000002339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
OBJECTIVE This study aimed to understand the meaning of the phrase "not feeling like myself" (NFLM) when used by those on the path to menopause by exploring the relationship of symptoms reported to ratings of NFLM. METHODS Participants responded to the item "Many women report just not feeling like themselves during this phase of life. How often was this true for you over the past 3 months?" choosing from "none of the time" to "all of the time." They rated bother associated with 61 symptoms and provided demographic information. Individual symptoms and the symptom bother scale scores were correlated with NFLM. Symptom scale scores were then entered in a two-stage multiple regression model to identify symptoms associated significantly with NFLM. RESULTS Sixty-three percent (63.3%) of participants reported NFLM 50% of the time or more over the previous 3 months. Individual symptom ratings correlated with NFLM ( r > 0.300) included the following: fatigue ( r = 0.491); feeling overwhelmed/less able to cope ( r = 0.463); low feelings ( r = 0.440); anxiety, more nervousness ( r = 0.398); being irritable ( r = 0.380); harder time concentrating ( r = 0.378); difficulty making decisions ( r = 0.357); feeling like "I can't calm down on the inside" ( r = 0.333); being more forgetful ( r = 0.332); tearfulness/crying ( r = 0.306); and worrying more ( r = 0.302). A two-stage regression analysis revealed less education completed and greater overall stress ratings as significant predictors in stage 1. In stage 2, five symptom groups met the P < 0.001 criterion: anxiety/vigilance, fatigue/pain, brain fog, sexual symptoms, and volatile mood symptoms. CONCLUSIONS NFLM was associated with anxiety/vigilance, fatigue/pain, brain fog, sexual symptoms, and volatile mood symptoms. Recognizing symptoms associated with NFLM may allow for more accurate expectations and improve perimenopause care.
Collapse
Affiliation(s)
| | | | - Nancy Fugate Woods
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA
| |
Collapse
|
3
|
Avis NE, Crawford SL, Hess R, Colvin A, Neal-Perry G, Waetjen LE. The Role of Sexual Function in Quality of Life Among Midlife and Older Women: The Study of Women's Health Across the Nation. J Womens Health (Larchmt) 2024; 33:426-434. [PMID: 38330428 PMCID: PMC11238835 DOI: 10.1089/jwh.2023.0439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Abstract
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.
Collapse
Affiliation(s)
- Nancy E Avis
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Sybil L Crawford
- Tan Chingfen Graduate School of Nursing, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Rachel Hess
- Department of Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Alicia Colvin
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Genevieve Neal-Perry
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - L Elaine Waetjen
- Department of Obstetrics and Gynecology, School of Medicine, University of California Davis, Sacramento, California, USA
| |
Collapse
|
4
|
Serati M, Espuña-Pons M, Mouton-Puglisi A, Padoa A. Iron deficiency and sexual dysfunction in women. Sex Med Rev 2023; 11:342-348. [PMID: 37433756 DOI: 10.1093/sxmrev/qead028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 07/13/2023]
Abstract
INTRODUCTION Sexual dysfunction negatively affects approximately 40% to 50% of adult women across various stages of life. Common risk factors include sexual traumas, relationship problems, chronic conditions, medication side effects, and poor physical health, including iron deficiency. OBJECTIVES This review summarizes a presentation from a symposium that discussed the types and causes of sexual dysfunction at key times in women's lives, focusing on the relationship between iron deficiency and sexual dysfunction. METHODS The symposium was held at the XV Annual European Urogynaecological Association Congress, Antibes, France, in October 2022. Symposium content was identified through literature searches of PubMed. Original research, review articles, and Cochrane analyses discussing sexual dysfunction in association with iron deficiency/anemia were included. RESULTS Iron deficiency in women is commonly caused by abnormal uterine bleeding, but women may develop iron deficiency anemia (IDA) because of increased iron needs or reduced iron intake/absorption. Treatment with oral iron supplementation has been shown to improve sexual function in women with IDA. Ferrous sulphate is considered as a standard of care for oral iron treatment; prolonged-release iron formulations have improved tolerability, enabling lower doses and better tolerability. CONCLUSION IDA and sexual dysfunction are related, so the identification of sexual dysfunction or iron deficiency in a woman should prompt an investigation of the other condition. Testing for iron deficiency is an inexpensive and simple step that can be routinely included in the workup of women with sexual dysfunction. Once identified, IDA and sexual dysfunction in women should be treated and followed to optimize quality of life.
Collapse
Affiliation(s)
- Maurizio Serati
- Urogynaecology Unit, Department of Obstetrics and Gynaecology, University of Insubria, 21100 Varese, Italy
| | - Montserrat Espuña-Pons
- Department of Obstetrics and Gynecology, University of Barcelona, 08036 Barcelona, Spain
| | | | - Anna Padoa
- Department of Obstetrics and Gynecology, Shamir Assaf Harofe Medical Center, 7033001 Tsrifin, Israel
- Sackler School of Medicine, Tel Aviv University, 6997801 Tel Aviv, Israel
| |
Collapse
|
5
|
Asadi M, Riazi H, Abbasinazari M, Majd HA, Montazeri A. Effect of folic acid on the sexual function of postmenopausal women: a triple-blind randomized controlled trial. J Sex Med 2023; 20:1180-1187. [PMID: 37409627 DOI: 10.1093/jsxmed/qdad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/26/2023] [Accepted: 06/04/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND There are reports of sexual dysfunction in postmenopausal women, and several treatment recommendations are available. AIM To investigate the effect of folic acid on postmenopausal women's sexual function. METHODS This triple-blind randomized controlled trial was conducted in Tehran, Iran, in 2020. A sample of 100 postmenopausal women was recruited from comprehensive health centers affiliated with the Shahid Beheshti University of Medical Sciences. Eligible women were randomly assigned to receive folic acid (5 mg) or placebo on an empty stomach every day for 8 weeks. Women were assessed at 3 time points: baseline and 4 and 8 weeks after the intervention. OUTCOME Sexual function was the main outcome, as measured by the Female Sexual Function Index. RESULTS The mean ± SD age of participants in the folic acid and placebo groups was 53.2 ± 3.84 and 54.4 ± 4.05 years, respectively (P = .609). The results obtained from mixed effects analysis of variance revealed a statistically significant difference between baseline and posttreatment scores and the interaction between time and group for desire, orgasm, satisfaction, arousal, pain, and total sexual function score, with the folic acid group improving more than control group. Lubrication was the only domain that showed no significant difference for the interaction between time and group. CLINICAL IMPLICATIONS Folic acid may beneficially affect sexual function in postmenopausal women. STRENGTHS AND LIMITATIONS Strengths include the novelty of the subject, the triple-blind design, the block randomization, the administration of a standard scale for sexual function (Female Sexual Function Index), and the affordability and availability of folic acid. This study was conducted with a small sample size and short follow-up time; therefore, interpretation of the results requires great caution. CONCLUSION The findings suggest that folic acid possibly improves sexual function in postmenopausal women. Larger studies are needed to confirm the findings. TRIAL REGISTRATION IRCT20150128020854N8; August 2, 2020. Iranian Registry of Clinical Trials; https://en.irct.ir/user/trial/48920/view.
Collapse
Affiliation(s)
- Mahnaz Asadi
- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran 1996835119, Iran
| | - Hedyeh Riazi
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran 1996835119, Iran
| | - Mohammad Abbasinazari
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran 1996835119, Iran
| | - Hamid Alavi Majd
- Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran 1996835119, Iran
| | - Ali Montazeri
- Population Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, Academic Center for Education, Culture and Research (ACECR), Tehran 13165-1488, Iran
- Faculty of Humanity Sciences, University of Science and Culture, Tehran 13145-1756, Iran
| |
Collapse
|
6
|
Burapakiat B, Anantapong K, Ananchaisarp T. Sexuality in Older Adults in A Primary Care Unit of Thailand during the COVID-19 Pandemic: A Cross-sectional Survey. Clin Gerontol 2023; 46:767-778. [PMID: 36111828 DOI: 10.1080/07317115.2022.2123289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To investigate sexuality in older Thai adults during the coronavirus disease (COVID-19) pandemic and the associated factors. METHODS This cross-sectional survey was conducted on older adults visiting a primary care unit (PCU) in Thailand. A hundred and ninety older adults were enrolled by convenience sampling. Multiple logistic regression analysis with a backward stepwise algorithm was used to analyze factors associated with sexual desire and activity in older Thai adults. RESULTS The median age of participants was 67.99 (60.01-88.57) years, and 63.2% were women. Overall, 37.4% of participants had sexual desires, and 54.2% were sexually active during the COVID-19 pandemic; however, more than half reported a decrease in sexual activity, fearing COVID-19 transmission as the most common reason. Men had more sexual desire and activity than women (adjusted OR [95% CI] = 13.92 [4.76, 40.73] and 6.63 [2.59, 16.94], respectively). CONCLUSIONS Older Thai adults in the PCU displayed decreased sexual desire and activity during the COVID-19 pandemic. Sexual health is a lifestyle aspect that required investigation and care during the pandemic. CLINICAL IMPLICATIONS Older Thai adults should be educated in that sexual activities can be broader than sexual intercourse, and sexual health should be cared for during an eventual new pandemic disease.
Collapse
Affiliation(s)
- Bongkot Burapakiat
- Division of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Kanthee Anantapong
- Division of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Thareerat Ananchaisarp
- Division of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| |
Collapse
|
7
|
Samuel S, Manokaran K, Nayak K, Rao GM, Kamath U S. Vitamin B status and its impact in post-menopausal women: A review. Biomedicine (Taipei) 2022. [DOI: 10.51248/.v42i4.1679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Menopause is an age-related naturally occurring phenomenon in women. Women generally attain menopause between the 40-58 years of age, during which they undergo several physiological changes that have an impact on their daily activities. The deficiency of B vitamins occurs mainly due to the dietary pattern, absorption and blood loss which may leads to health problems such as cognitive decline, osteoporosis, physical and mental imbalance. This review evaluated the published evidence on the vitamin B status and its impact in post-menopausal women. Selected data sources were searched for relevant literature (2010-2020) and included as per the set criteria using Prisma guidelines. The NIH quality questionnaire tool was used to rate the articles. Finally eleven articles were included for full length review having reports on the impact of B vitamins on bone loss, cognitive decline and physical activity. Existing evidences show that there is no association between B vitamins and bone loss. Very few studies are available which concluded association of B vitamin with cognitive decline and physical health. More studies are required to address this research gap.
Collapse
|
8
|
Cipriani S, Simon JA. Sexual Dysfunction as a Harbinger of Cardiovascular Disease in Postmenopausal Women: How Far Are We? J Sex Med 2022; 19:1321-1332. [DOI: 10.1016/j.jsxm.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 05/04/2022] [Accepted: 06/09/2022] [Indexed: 10/17/2022]
|
9
|
Changes in satisfaction with female genital self-image and sexual function after a Qigong exercise intervention in Spanish postmenopausal women: a randomized-controlled trial. Menopause 2022; 29:693-699. [PMID: 35446303 DOI: 10.1097/gme.0000000000001967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze the effectiveness of a Qigong exercise program on satisfaction with female genital self-image and female sexual function in postmenopausal Spanish women. METHODS A total of 49 women were randomly assigned to an experimental group (n = 22) that carried out training based on Qigong exercises for 12 weeks and a control group (n = 27) that did not carry out any type of intervention. Female genital self-image was measured through the Female Genital Self-Image Scale and female sexual function through the Female Sexual Function Index; both variables were measured before and just after the intervention. RESULTS Results showed that women who participated in the Qigong exercise program showed significant improvements with respect to female genital self-image, as well as in the domains of desire, arousal, lubrication, satisfaction, and pain and the total score of the Female Sexual Function Index, but, on the contrary, were not found in the orgasm domain. CONCLUSIONS Our results suggest that Qigong has the potential to improve female genital self-image and female sexual function among postmenopausal Spanish women.
Collapse
|
10
|
Maseroli E, Vignozzi L. Are Endogenous Androgens Linked to Female Sexual Function? A Systemic Review and Meta-Analysis. J Sex Med 2022; 19:553-568. [PMID: 35227621 DOI: 10.1016/j.jsxm.2022.01.515] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The benefits of treatment with testosterone (T) in women with loss of desire suggest that low androgens may distinguish women with sexual dysfunction (SD) from others; however, evidence on this point is lacking. AIM To answer the question: is there an association between endogenous levels of androgens and sexual function in women? METHODS An extensive search was performed in MEDLINE, Embase and PsycInfo. Four separate meta-analyses were conducted for total T, free T, Free Androgen Index (FAI), and Dehydroepiandrosterone sulphate (DHEAS). Cohort, cross-sectional, and prospective studies were included. OUTCOMES The main outcome was the association between endogenous androgens and sexual desire. Global sexual function was considered as a secondary outcome. The effect measure was expressed as standardized mean difference (SMD). RESULTS The meta-analysis on total T included 34 studies involving 3,268 women, mean age 36.5 years. In 11 studies, a significant association was found between sexual desire, measured by validated psychometric instruments, and total T (SMD = 0.59 [0.29;0.88], P < 0.0001), with a moderate effect. The association with global sexual function (n = 12 studies) was also significant (SMD = 0.44 [0.21;0.67], P <0.0001). Overall, total T was associated with a better sexual function (SMD = 0.55 [0.28;0.82)], P < 0.0001), with similar results obtained when poor quality studies were removed. Age showed a negative relationship with the overall outcome. No differences were found when stratifying the studies according to menopausal status, type of menopause, age at menopause, use of hormonal replacement therapy, relationship status, method for T measurement, phase of the menstrual cycle or use of hormonal contraception. The meta-analysis of T derivatives (free T and FAI) also showed a significant, moderate association with sexual desire. In contrast, DHEAS seems not to exert any significant influence on desire, whilst showing a positive association with global sexual function. CLINICAL IMPLICATIONS Endogenous androgens show a moderate association with a better sexual function in women; however, the role of psychological, relational and other hormonal factors should not be overlooked. STRENGTHS & LIMITATIONS This represents the first attempt at meta-analyzing data available on the topic. A significant publication bias was found for total T. CONCLUSION There appears to be a moderate association between total T and sexual desire/global sexual function, which is confirmed, although weak, in studies employing liquid chromatography-mass spectrometry (LC-MS). Similar results on desire were obtained for free T and FAI. DHEAS only showed a positive association with global sexual function. More research is needed. Maseroli E and Vignozzi L. Are Endogenous Androgens Linked to Female Sexual Function? A Systemic Review and Meta-Analysis. J Sex Med 2022;19:553-568.
Collapse
Affiliation(s)
- Elisa Maseroli
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Linda Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; Department of Experimental Clinical and Biomedical Sciences "Mario Serio," University of Florence, Italy; I.N.B.B. (Istituto Nazionale Biostrutture e Biosistemi), Rome, Italy.
| |
Collapse
|
11
|
Tang R, Luo M, Fan Y, Peng Y, Wang Y, Liu G, Wang Y, Lin S, Chen R. Menopause-specific quality of life during ovarian aging among Chinese women: A prospective cohort study. Maturitas 2022; 157:7-15. [DOI: 10.1016/j.maturitas.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/26/2021] [Accepted: 11/03/2021] [Indexed: 11/30/2022]
|
12
|
Reed SD, Carpenter JS, Larson J, Mitchell CM, Shifren J, Heiman J, Woods NF, Lindau ST, LaCroix AZ, Guthrie KA. Toward a better measure of midlife sexual function: pooled analyses in nearly 1,000 women participating in MsFLASH randomized trials. Menopause 2022; 29:397-407. [PMID: 35102098 PMCID: PMC8976731 DOI: 10.1097/gme.0000000000001940] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/30/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Evaluate appropriateness of the current Female Sexual Function Index (FSFI)-19 value of <26.6 to designate female sexual dysfunction (FSD) in postmenopausal women, using the Female Sexual Distress-Revised (FSDS-R) scale to measure distress. METHODS Participant-level data containing standardized measures from five completed Menopause Strategies: Finding Lasting Answers for Symptoms and Health trials was pooled. Baseline characteristics and FSFI-19 scores were compared across trials (F-test, homogeneity). FSFI-19 score associations with the FSDS-R were described. Receiver operating characteristic (ROC) curves were plotted to illustrate the choice of optimal FSFI-19 value to predict sexual distress. ROC curves were also estimated adjusting for trial number, clinical center, age, education, race, smoking, and BMI. RESULTS Nine hundred ninety eight women (79.2% postmenopausal), mean age 55.9 (SD 4.8) had complete FSFI-19, FSDS-R, and covariate data. Baseline mean FSFI-19 score among all participants and sexually active participants was 18.7 (SD 9.5) and 22.0 (SD 7.2), respectively. There was a consistent pattern across the trials of inverse association between poorer sexual function (FSFI-19) and greater sexual distress. Based on the ROC curve showing the likelihood of FSDS-R frequent or greater distress according to cut points of FSFI, the optimal cut point for FSD was FSFI-19 <21 for all participants. This cut point corresponded to sensitivity 87.2% (95% CI, 83.4-91.0), specificity 57.9% (95% CI, 54.3-61.6) and adjusted area under the ROC curve 78.8% (95% CI, 75.8-81.8). CONCLUSIONS A new FSFI-19 cut point of ≥21 should be considered to describe normal sexual function in periand postmenopausal women as opposed to the standard cut point of >26.6. VIDEO SUMMARY http://links.lww.com/MENO/A915.
Collapse
Affiliation(s)
- Susan D. Reed
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | | | - Joseph Larson
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Jan Shifren
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Julia Heiman
- Department of Psychological and Brain Sciences, Indiana University, Bloomington IN
| | | | - Stacy Tessler Lindau
- Departments of Obstetrics and Gynecology and Medicine-Geriatrics, University of Chicago, Chicago, IL
| | - Andrea Z. LaCroix
- Department of Family and Preventive Medicine, University of California-San Diego, La Jolla, CA
| | - Katherine A. Guthrie
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| |
Collapse
|
13
|
Prairie BA, Kling JM, Buras MR, Butterfield RJ, Jenkins M. Differences in menopausal symptoms and female sexual function by region and ethnicity in West Texas and Central Arizona: a cross-sectional survey. Menopause 2021; 28:1037-1043. [PMID: 34284430 DOI: 10.1097/gme.0000000000001810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate menopausal symptoms and sexual problems in Hispanic and non-Hispanic women in two Southwest areas. METHODS An anonymous survey including the Green Climacteric Scale (GCS), Female Sexual Function Index (FSFI), and demographics was distributed to English and Spanish-speaking women age 40 to 60 in Scottsdale, Arizona, and West Texas. FSFI for sexually active women and GCS scores for the Hispanic and non-Hispanic women in Texas were analyzed with multivariable analysis and compared between Texas and Arizona for Non-Hispanic participants. RESULTS Predominantly non-Hispanic women (70%), average age 51.5 (SD = 7.25) completed questionnaires (199 West Texas, 163 Scottsdale). A majority of sexually active women (88%) were found to be at risk of sexual dysfunction. Within the Texas cohort, GCS score was estimated to be 3.49 points lower (less symptoms) in Hispanic versus non-Hispanic participants [95% CI -6.58 to -0.40, P = 0.03], and FSFI score was estimated to be 2.31 points lower (more symptoms) in Hispanic versus non-Hispanic participants [95% CI -4.49 to -0.14, P = 0.04]. Among non-Hispanic women, GCS scores were lower (less symptoms) in Texas versus Arizona by 10.25 points [95% CI -14.83 to -5.66, P < 0.01], while FSFI scores were higher overall (less symptoms) in Texas by 3.65 points [95% CI 0.53-6.77), P = 0.02]. All FSFI and GCS scores were adjusted for multiple variables. CONCLUSIONS In a group of menopausal women from the Southwest, most reported symptoms were consistent with FSD, and the degree of sexual problems appeared to be greater in the Hispanic participants from Texas.
Collapse
Affiliation(s)
- Beth A Prairie
- Women's Institute, Allegheny Health Network, Pittsburgh, PA
| | - Juliana M Kling
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | - Matthew R Buras
- Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ
| | | | - Marjorie Jenkins
- School of Medicine Greenville, University of South Carolina, Greenville, SC
- Prisma Health Upstate, Greenville, SC
| |
Collapse
|
14
|
Azar M, Bradbury-Jones C, Kroll T. Middle-aged Lebanese women's interpretation of sexual difficulties: a qualitative inquiry. BMC Womens Health 2021; 21:203. [PMID: 34001078 PMCID: PMC8127220 DOI: 10.1186/s12905-020-01132-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 11/19/2020] [Indexed: 01/16/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Mathilde Azar
- Faculty of Health Sciences - University of Balamand. St George Health Complex, Youssef Sursock Street. P.o. Box. 166378 Ashrafieh, Beirut, 1100-2807, Lebanon.
| | | | - Thilo Kroll
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, UK
| |
Collapse
|
15
|
Assessing sexual function in middle-aged sexually active Spanish women: a community-based study focusing on the intimate partner. ACTA ACUST UNITED AC 2021; 28:686-692. [PMID: 33651740 DOI: 10.1097/gme.0000000000001745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study evaluated sexual function, the influence of the relationship with the intimate partner, and the factors related to sexual function in middle-aged Spanish women. METHODS The methodology entailed a cross-sectional study of 187 sexually active women aged 40-59 years. The participants were randomly recruited from primary public health care. They completed the 6-item Female Sexual Function Index (FSFI-6), the short-form Woman Abuse Screening Tool (WAST), and a sociodemographic questionnaire. Descriptive and inferential analysis was performed. RESULTS The participants' median age was 49 years, 90.4% had a steady intimate partner, 54.5% were postmenopausal, 43.3% had chronic diseases, 12.3% reported alcohol abuse, and 35.8% smoked. The prevalence of low sexual function was 33.16% in all the women, and 44.12% in the postmenopausal women (an FSFI-6 total score ≤ 19 reflects low sexual function). WAST screening detected 17.65% cases of intimate partner violence (WAST total score ≤ 1), with low sexual function in 87.9%. Multiple linear regression analysis models revealed that the lowest total FSFI-6 scores (worst sexual function) were negatively associated with intimate partner violence (IPV), depression, hysterectomy, and associated female issues. The scores in the FSFI-6 domains (desire, arousal, lubrication, orgasm, satisfaction, and pain) were linked to IPV (P < 0.001), except for lubrication (P < 0.001 postmenopausal). CONCLUSION Low sexual function was more common in women who were positively screened for IPV. It was identified as a key factor, which contributes to deteriorating middle-aged women's sexual health.
Collapse
|
16
|
Yoldemir T, Garibova N, Atasayan K. Sexual function through decades: association with androgens and cardiometabolic features. Climacteric 2020; 23:489-495. [PMID: 32292081 DOI: 10.1080/13697137.2020.1742683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Aim: This study aimed to determine the change in sexual function among Turkish women through decades and to define the association between sexual dysfunction and androgens and cardiometabolic features.Materials and methods: A total of 206 postmenopausal women aged 50-69 years and 210 premenopausal women aged 30-49 years who applied to menopause and gynecology clinics at a university-affiliated education and research hospital were included in this prospective study. Groups were constructed according to decades (i.e., 30-39, 40-49, 50-59, and 60-69 years). Sexual function was assessed between the groups, using the Female Sexual Function Index (FSFI). Cardiometabolic features and androgen levels were also compared between the groups.Results: Sexual function determined at each decade by FSFI scores were 27.18, 23.11, 18.40, and 11.35, respectively (fourth, fifth, sixth, and seventh decade). Desire, arousal, and satisfaction domains tended to be lower in the 40s than in the 30s. As time passes after the 30s, the total FSFI score decreased until the late 60s. Serum total testosterone, androstenedione, and dehydroepiandrostenedione sulfate (DHEAS) levels decreased through the decades. There was no correlation between cardiometabolic features, androgens, and FSFI scores.Conclusion: According to our survey, sexual function decreases starting at the age of 30 and continues to drop until the late 60s among postmenopausal women. There was no association between sexual dysfunction and androgen levels in premenopausal women. The serum DHEAS level was associated with sexual dysfunction only among postmenopausal women. There was no association between sexual dysfunction and cardiometabolic features in either premenopausal or postmenopausal women.
Collapse
Affiliation(s)
- T Yoldemir
- Department of Obstetrics and Gynaecology, Marmara University Hospital, Istanbul, Turkey
| | - N Garibova
- Obstetrics and Gynaecology Clinic, Baku Medical Plaza, Baku, Azerbaijan
| | - K Atasayan
- Department of Obstetrics and Gynaecology, Maltepe University Hospital, Istanbul, Turkey
| |
Collapse
|
17
|
The analysis estradiol levels against sexual desire in perimenopause women in Makassar, South Sulawesi, Indonesia. ENFERMERIA CLINICA 2020. [DOI: 10.1016/j.enfcli.2019.07.117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
18
|
Bıldırcın FD, Özdeş EK, Karlı P, Özdemir AZ, Kökçü A. Does Type of Menopause Affect the Sex Lives of Women? Med Sci Monit 2020; 26:e921811. [PMID: 31907344 PMCID: PMC6977620 DOI: 10.12659/msm.921811] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background The aim of this study was to investigate factors affecting the sex lives of middle-aged women, and whether surgical menopause affects sexual function differently from natural menopause, by comparing effects on sexual performance of women with similar demographic features. Material/Methods The study included 151 women with surgical menopause (SM), 357 women with natural menopause (NM), and 186 perimenopausal women (PM). The women were asked to complete a 6-question survey of sexual performance parameters. The relationship between the demographic and clinical features and hormone levels of the groups and sexual function parameters were evaluated. We also compared these parameters between the 3 study groups, and paired comparisons were made between the SM group and the NM group. Results Demographic features, serum DHEA-S, total testosterone, and FSH levels were found to have statistically significant effects on sexual performance of women (p<0.05). The sexual function scores for the frequency of sexual desire, coitus, and orgasm were significantly higher in the PM group, whereas vaginal lubrication scores were lower compared to the NM and SM group (p<0.05). In paired comparison of NM and SM, the scores for the frequency of coitus, orgasm, and vaginal lubrication were significantly higher in the SM group, while sexual desire frequency scores were higher in the NM group (p<0.05). Conclusions Our study approached to this topic in an extended manner and found significant relationships between several demographic-clinical and hormonal factors. SM was found to not affect female sexual performance, except for sexual desire, more than NM.
Collapse
Affiliation(s)
| | - Emel Kurtoğlu Özdeş
- Department of Obstetric and Gynecology, Memorial Hizmet Hospital, Istanbul, Turkey
| | - Pervin Karlı
- Department of Obstetrics and Gynecology, Amasya University Research Hospital, Amasya, Turkey
| | - Ayşe Zehra Özdemir
- Ondokuz Mayis University IVF Center, Ondokuz Mayis University Hospital, Samsun, Turkey
| | - Arif Kökçü
- Ondokuz Mayis University IVF Center, Ondokuz Mayis University Hospital, Samsun, Turkey
| |
Collapse
|
19
|
Brain Morphological Changes With Functional Deficit Associated With Sexual Arousal in Postmenopausal Women. Sex Med 2019; 7:480-488. [PMID: 31606354 PMCID: PMC6963119 DOI: 10.1016/j.esxm.2019.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 06/18/2019] [Accepted: 06/25/2019] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION We have not known how menopause synchronously influences brain morphology and function associated with visually stimulated sexual arousal in postmenopausal women. AIM This study used a combination of functional magnetic resonance imaging and voxel-based morphometry to evaluate menopause-related brain morphological and functional changes in postmenopausal women. METHODS Nineteen premenopausal women and 19 postmenopausal women underwent functional and structural magnetic resonance imaging. Brain function activity was measured while the subjects viewed an erotic video clip. MAIN OUTCOME MEASURES A 2-sample t-test was used for cross-analysis of the 2 groups for comparison of gray matter volumes (corrected P < .05) and brain activation (uncorrected P < .01). RESULTS Our study revealed a relationship between sexual function and morphological changes in postmenopausal women. Compared with premenopausal women, the postmenopausal group showed significantly lower brain activations in the major parts of the limbic system and basal ganglia, including the parahippocampal gyrus, head of caudate nucleus, insula, putamen, hippocampus, hypothalamus, amygdala, and globus pallidus, which are involved in sexual behavior and emotional responses. In morphometric analyses, postmenopausal women showed significantly decreased gray matter volumes of the insula, putamen, parahippocampal gyrus, amygdala, and anterior cingulate gyrus, most of which were associated with decreased functional activity during visual sexual arousal in postmenopausal women. In addition, the premenopausal group alone showed a positive correlation between the activity of the insula and the level of estradiol (Pearson correlation r = 0.588; P = .008). CONCLUSION This study demonstrates an association between menopause-related brain function and morphological changes in postmenopausal women. This finding provides insight into the neural mechanisms associated with the sexual functional deficit in postmenopausal women. Baek H-S, Kim G-W, Sundaram T, et al. Brain Morphological Changes with Functional Deficit Associated with Sexual Arousal in Postmenopausal Women. Sex Med 2019;7:480-488.
Collapse
|
20
|
Fiacco S, Walther A, Ehlert U. Steroid secretion in healthy aging. Psychoneuroendocrinology 2019; 105:64-78. [PMID: 30314729 DOI: 10.1016/j.psyneuen.2018.09.035] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/25/2018] [Accepted: 09/26/2018] [Indexed: 01/16/2023]
Abstract
Nowadays, people spend a considerable amount of their lives as older adults, but this longer lifespan is often accompanied by an increase in chronic conditions and disease, resulting in reduced quality of life and unprecedented societal and economic burden. Healthy aging is therefore increasingly recognized as a healthcare priority. Physical and mental adaptations to changes over the life course, and the maintenance of well-being, represent pivotal challenges in healthy aging. To capture the complexity of healthy aging, we propose a specific phenotype based on body composition, cognition, mood, and sexual function as indicators of different dimensions of healthy aging. With increasing age, sex hormones as well as glucocorticoids undergo significant alterations, and different patterns emerge for women and men. This review describes age-related patterns of change for women and men, and sheds light on the underlying mechanisms. Furthermore, an overview is provided of the challenges for healthy aging resulting from these age-related steroid alterations. While clinical practice guidelines recommend hormonal treatment only in the case of consistently low hormone levels and symptoms of hormone deficiency, physical exercise and a healthy lifestyle emerge as preventive strategies which can counter age-related hormonal changes and at best prevent chronic conditions.
Collapse
Affiliation(s)
- Serena Fiacco
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland; URPP Dynamics of Healthy Aging Research Priority Program, University of Zurich, Zurich, Switzerland
| | - Andreas Walther
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland; Biopsychology, TU Dresden, Dresden, Germany
| | - Ulrike Ehlert
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland; URPP Dynamics of Healthy Aging Research Priority Program, University of Zurich, Zurich, Switzerland.
| |
Collapse
|
21
|
Abstract
OBJECTIVE Women experience a variety of changes at midlife that may affect sexual function. Qualitative research approaches can allow a deeper understanding of women's experiences. We conducted 20 individual interviews and three focus groups among sexually active women aged 45 to 60 years (total n = 39) to explore how sexual function changes during midlife. METHODS Interviews and focus groups were conducted by a trained facilitator using a semistructured guide. All data were audio-recorded and transcribed. Two investigators used a subsample of data to iteratively develop a codebook. The primary investigator coded all data. A second investigator coded a randomly selected 25% of interviews. Codes regarding changes in sexual function were examined and key themes emerged. RESULTS The mean age was 52, and most women were peri- or postmenopausal. Fifty-four per cent of women were white, 36% black, and 10% of another race. Participants discussed positive and negative changes in sexual function. The most common negative changes were decreased frequency of sex, low libido, vaginal dryness, and anorgasmia. Participants attributed negative changes to menopause, partner issues, and stress. Most participants responded to negative changes with adaptation, including changing sexual behavior and prioritizing different aspects of sex. Participants also reported positive changes, attributed to higher self-confidence, increased self-knowledge, and better communication skills with aging. CONCLUSIONS In this qualitative study, women described experiencing both positive and negative changes in sexual function during midlife. When negative changes occurred, women often adapted behaviorally and psychologically. Providers should recognize that each woman's experience is unique and nuanced, and they should provide tailored care regarding sexual function at midlife.
Collapse
|
22
|
Abstract
Background Sexuality is an important factor that completes the lives of individuals and affects people in all age groups. Objectives To examine the sexual functions of women before and after menopause. Methods This cross-sectional study was conducted at the Family Health Centers in Tunceli Turkey,\ between September 2014 and February 2015. The study data were obtained using a Questionnaire and the Female Sexual Function Index. The data were analyzed by number, percentage distribution, mean, standard deviation, t-test, and using binary logistic regression analysis. Results The mean Female Sexual Function Index score of the women was 23.8±8.0. The Female Sexual Function Index score of 59.7% of women was below the cut-off score (26.55) and was accepted indicative of sexual dysfunction. Low educational level (P < 0.01), low income (P < 0.01), and menopausal status (P < 0.0001) of the women were risk factors for sexual dysfunction. Conclusion Prevalence of sexual dysfunction in the women was very high and they indicated no effort to seek medical care. Low educational and income level and menopausal status of the women were three factors increasing the risk of sexual dysfunction. Awareness of the society and the healthcare professionals about the issue should be increased.
Collapse
Affiliation(s)
- Yurdagül Yağmur
- Faculty of Health Sciences, Inönü University, 44280-Malatya, Turkey
| | - İlksen Orhan
- High School of Nursing, Munzur University, Tunceli, Turkey
| |
Collapse
|
23
|
Chapitre 8 : Sexualité et ménopause. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41 Suppl 1:S103-S121. [DOI: 10.1016/j.jogc.2019.02.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
24
|
Palacios S, González SP, Fernández-Abellán M, Manubens M, García-Alfaro P. Impact Of Vulvovaginal Atrophy Of Menopause In Spanish Women: Prevalence And Symptoms According To The EVES Study. Sex Med 2019; 7:207-216. [PMID: 30885552 PMCID: PMC6522940 DOI: 10.1016/j.esxm.2019.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/03/2019] [Accepted: 01/12/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction The prevalence of menopausal women with confirmed vulvovaginal atrophy (VVA) oscillates between 67–98%. Aim To assess the prevalence of postmenopausal women with VVA confirmed by gynecologic clinical assessment among all women attending menopause centers in Spain, as well as to describe the impact of VVA on quality of life and sexual functioning. Methods Women aged 45–75 years old with the last menstrual period >12 months before were included in a cross-sectional study. Main Outcome Measures Women with ≥1 VVA symptoms filled out a number of questionnaires, including EuroQoL, Day-to-Day Impact of Vaginal Aging, Female Sexual Function Index, and Female Sexual Distress Scale-revised. A gynecologic examination was performed to confirm diagnosis. Results 1,177 evaluable patients were included. VVA was confirmed in 87.3% of the patients. Almost 80% of women who acknowledged being sexually active (n = 717) presented pain during intercourse. As compared with patients without confirmed VVA (n = 66), patients with confirmed VVA (n = 1,028) were significantly older (P < .0001), had lower rates of sexual activity (P < .05), and used more VVA treatments (P < .05). Severe vaginal atrophy and severe vulvar atrophy were more prevalent in VVA-confirmed women (P < .0001, in both cases). No differences regarding the confirmation of VVA were observed for EuroQoL and Day-to-Day Impact of Vaginal Aging quality-of-life questionnaires. Sexual function measured through the Female Sexual Function Index score was significantly reduced in sexually-active patients with confirmed VVA (P < .05). Conclusion VVA signs and symptoms are highly prevalent in Spanish postmenopausal women. Confirmation of VVA diagnosis was associated with impaired sexual function. The early recognition of VVA symptoms should be actively promoted in medical practice, instead of waiting until signs appear to exclude other reasons for VVA and to manage treatment effectively. Palacios S, González SP, Fernández-Abellán M, et al. Impact of Vulvovaginal Atrophy of Menopause in Spanish Women: Prevalence and Symptoms According to the EVES Study. Sex Med 2019;7:207–216.
Collapse
|
25
|
von Hippel C, Adhia A, Rosenberg S, Austin SB, Partridge A, Tamimi R. Sexual Function among Women in Midlife: Findings from the Nurses' Health Study II. Womens Health Issues 2019; 29:291-298. [PMID: 31130435 DOI: 10.1016/j.whi.2019.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 03/28/2019] [Accepted: 04/11/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Women's sexual well-being is an important determinant of overall health and quality of life across the life course. Yet the factors associated with women's levels of sexual activity and sexual function in midlife are little understood. This study sought to assess the prevalence of recent sexual activity and sexual dysfunction symptoms among middle-aged women and evaluate the associations of partner status, menopause, and health status factors with sexual dysfunction. METHODS Participants of this cross-sectional study were 68,131 women who responded to the 2013 Nurses' Health Study II observational cohort questionnaire when they were age 48-68 years. Sexual activity and dysfunction symptoms were assessed with the Female Sexual Function Index. Age-adjusted multivariable regression models estimated risk ratios for the association of health-related factors with past month sexual dysfunction symptoms among women who were sexually active over the past month, overall and stratified by partner status. RESULTS Of middle-aged women participants, 73% were sexually active (n = 49,701) and 50% of sexually active women reported symptoms of sexual dysfunction. Symptoms of sexual dysfunction were less common among unpartnered than partnered women (42% vs. 51%; p < .0001). A positive association between menopause and sexual dysfunction was greater for unpartnered women (risk ratio, 2.37, 2.99; p < .001) than partnered women (risk ratio, 1.89, 2.00; p < .001). CONCLUSIONS Difficulty with sexual function is common among women in midlife, but less so than previously estimated. Regular monitoring of women's sexual function could enable clinicians to offer women timely, supportive interventions tailored by partner status and menopausal status.
Collapse
Affiliation(s)
- Christiana von Hippel
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Avanti Adhia
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Shoshana Rosenberg
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ann Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Rulla Tamimi
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
26
|
Lu W, Guo W, Cui D, Dong K, Qiu J. Effect of Sex Hormones on Brain Connectivity Related to Sexual Function in Perimenopausal Women: A Resting-State fMRI Functional Connectivity Study. J Sex Med 2019; 16:711-720. [PMID: 30956108 DOI: 10.1016/j.jsxm.2019.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/21/2019] [Accepted: 03/02/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Perimenopause is associated with increased risk of depression, vasomotor symptoms, and sexual dysfunction. AIMS To explore the effect of sex hormones on the functional connectivity (FC) of different brain regions related to sexual function in perimenopausal women. METHODS 32 premenopausal women (mean age, 47.75 ± 1.55 years) and 25 perimenopausal women (mean age, 51.60 ± 1.63 years) underwent sex hormone level measurements and resting-state fMRI. MAIN OUTCOME MEASURES Serum levels of sex hormones, including prolactin (PRL), follicle-stimulating hormone (FSH), luteotropic hormone (LH), estradiol (E2), free testosterone (free-T), and progesterone (P), were measured. 10 brain regions related to sexual function were selected according to a meta-analysis, and FCs of the selected regions of interest were calculated as Pearson's correlation coefficient. RESULTS Compared with premenopausal women, perimenopausal women showed increased FC between the right area 13 (A13_r) and the right medial superior frontal gyrus (mSFG), between the left dorsal granular insula (dIg_L) and the right superior frontal gyrus (SFG) (Gaussian random field-corrected at the voxel level, P < .001, and cluster level, P < .025). Furthermore, the PRL level was negatively correlated with the FC of A13_R with the right mSFG and the FC of dIg_L with the right SFG. CLINICAL TRANSLATION These findings may be applicable to assessing brain dysfunction with FC changes in women approaching menopause. STRENGTHS & LIMITATIONS This study is the first to evaluate a direct relationship between sex hormone levels and brain FC changes in women approaching menopause. Sexual function was not assessed, which may weaken the conclusions related to sexual function. CONCLUSIONS The results show that women approaching menopause suffered from aberrant intrinsic FC in regions related to sexual function, and reveal a direct relationship between serum sex hormone levels and FC changes related to sexual function. Lu W, Guo W, Cui D, et al. Effect of Sex Hormones on Brain Connectivity Related to Sexual Function in Perimenopausal Women: A Resting-State fMRI Functional Connectivity Study. J Sex Med 2019;16:711-720.
Collapse
Affiliation(s)
- Weizhao Lu
- Medical Engineering and Technical Center, Taishan Medcial University, Tai'an, China; Department of Radiology, Taishan Medical University, Tai'an, China
| | - Wei Guo
- Affiliated Hospital of Taishan Medical University, Tai'an, China
| | - Dong Cui
- Department of Radiology, Taishan Medical University, Tai'an, China
| | - Kejiang Dong
- Department of Radiology, Taishan Medical University, Tai'an, China
| | - Jianfeng Qiu
- Medical Engineering and Technical Center, Taishan Medcial University, Tai'an, China; Department of Radiology, Taishan Medical University, Tai'an, China.
| |
Collapse
|
27
|
Mernone L, Fiacco S, Ehlert U. Psychobiological Factors of Sexual Functioning in Aging Women - Findings From the Women 40+ Healthy Aging Study. Front Psychol 2019; 10:546. [PMID: 30918494 PMCID: PMC6424880 DOI: 10.3389/fpsyg.2019.00546] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 02/25/2019] [Indexed: 11/13/2022] Open
Abstract
Background: A variety of biological and psychosocial factors are associated with women’s sexual health in midlife and older age. Evidence suggests a decline in sexual functioning in the context of aging and the menopausal transition, including changes in sexual desire, arousal, lubrication, orgasm, pain, and/or contentment. However, not all women in midlife and older age experience such a decline, and it remains unclear how the endocrine environment and psychosocial aspects contribute to the maintenance of healthy sexual functioning. Therefore, the aim of this study was to examine psychobiological predictors of sexual functioning in healthy middle-aged and elderly females. Methods: A total of 93 healthy, sexually active women aged 40–73 years completed a battery of validated psychosocial questionnaires, including measures of sexual functioning (Female Sexual Function Index) and of protective psychological traits and interpersonal variables. The steroid hormones estrogen, testosterone, progesterone and dehydroepiandrosterone sulfate were determined in saliva samples, while follicle-stimulating hormone, luteinizing hormone and sex hormone-binding globulin were determined in dried blood spots. The findings were statistically adjusted for multiple testing. Results: Age and postmenopausal status were negatively associated with overall sexual functioning, arousal, and lubrication. Regression analyses revealed that relationship satisfaction, emotional support, self-esteem, optimism, and life satisfaction each significantly predicted overall sexual functioning or specific aspects of sexual functioning, including arousal, contentment, orgasm, and pain (all p < 0.029). For desire and lubrication, no associations were found with the tested psychosocial factors. In terms of steroid hormones, testosterone was positively linked to orgasm (p = 0.012). In this sample, 79.6% reported to have healthy sexual functioning according to the questionnaires’ cutoff. Younger age (OR = 0.911, 95% CI 0.854–0.970, p = 0.004) and a higher level of emotional support (OR = 1.376, 95% CI 1.033–1.833, p = 0.029) were associated with the presence of healthy sexual functioning. Discussion: Although aging and menopause negatively affected aspects of sexual functioning, the accompanying endocrine correlates were not predictive for sexual functioning in this healthy sample of middle-aged and older females. Instead, our findings suggest that sexual functioning is highly dependent on psychosocial aspects related to well-being. Accordingly, personality traits such as optimism, and interpersonal aspects such as emotional support and relationship satisfaction were identified as important predictors of sexual functioning.
Collapse
Affiliation(s)
- Laura Mernone
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Zurich, Zurich, Switzerland.,University Research Priority Program Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Serena Fiacco
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Zurich, Zurich, Switzerland.,University Research Priority Program Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Ulrike Ehlert
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Zurich, Zurich, Switzerland.,University Research Priority Program Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| |
Collapse
|
28
|
Zhao Y, Dong W, Sun L, Su Q, Zhu Y, Lu M, Tan C, Yang X. Analysis of factors that influence the quality of sexual life of climacteric women in China. Climacteric 2018; 22:73-78. [PMID: 30499736 DOI: 10.1080/13697137.2018.1514002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The study aimed to identify the factors associated with the sexual lives of perimenopausal and postmenopausal women in China. METHODS A total of 426 participants were approached about this study from May 2012 to August 2013. In total, 252 cases were included in this study. One hundred and ninety-seven women who filled out the Quality of Sexual Life Questionnaire for Women (QSLQW) and the modified Kupperman Menopausal Index (KMI) had an active sexual life. Pearson's coefficient index was used to determine the correlation between the KMI and different domains of the QSLQW. Multivariable statistical analysis was performed to determine the correlation between different factors and the sexual life of perimenopausal and postmenopausal women. RESULTS When the participants reported a higher KMI, they suffered lower sexual satisfaction (r = -0.16, p = 0.035), more severe sexual anxiety (r = -0.367, p = 4.9 × 10-7), and less sexual response (r = -0.21, p = 0.004). No correlation was found between the KMI and sexual communication, sexual attitude, and self-image. Multivariable statistical analysis showed that menopause status and higher KMI scores are associated with a decrease in sexual satisfaction among Chinese women (β = -9.76, 95% CI -16.89 to -2.64 and β = -0.41, 95% CI -0.68 to -0.15, respectively), and that the better the spousal relationship, the fewer deliveries and the higher the scores of sexual life quality (β = 8.86, 95% CI -0.91 to 18.63 and β = -6.65, 95% CI -11.83 to -1.48, respectively). CONCLUSION Factors including parity, spousal relationship, menopausal status, and menopausal symptoms are associated with the quality of sexual life of perimenopausal and postmenopausal women in China.
Collapse
Affiliation(s)
- Y Zhao
- a Department of Gynecology and Obstetrics , Peking University People's Hospital , Beijing , P. R. China
| | - W Dong
- b Department of Gynecology and Obstetrics , The First People's Hospital of Yunnan Province , Kumming City, P. R. China
| | - L Sun
- c Department of Gynecology and Obstetrics , Tianjin Medical University Cancer Institute and Hospital , Tianjin , P. R. China
| | - Q Su
- a Department of Gynecology and Obstetrics , Peking University People's Hospital , Beijing , P. R. China
| | - Y Zhu
- a Department of Gynecology and Obstetrics , Peking University People's Hospital , Beijing , P. R. China
| | - M Lu
- a Department of Gynecology and Obstetrics , Peking University People's Hospital , Beijing , P. R. China
| | - C Tan
- a Department of Gynecology and Obstetrics , Peking University People's Hospital , Beijing , P. R. China
| | - X Yang
- a Department of Gynecology and Obstetrics , Peking University People's Hospital , Beijing , P. R. China
| |
Collapse
|
29
|
|
30
|
Zhou Y, Li C, Jin F, Shao H, Teng Y, Tao M. Prevalence and predictors of sexual function in midlife partnered Chinese women assessed by two simple indicators: Sexual frequency and sexual desire. J Obstet Gynaecol Res 2018; 45:210-216. [PMID: 30259615 DOI: 10.1111/jog.13790] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 07/28/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Yang Zhou
- Department of Gynecology and Obstetrics; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai China
| | - Changbin Li
- Center of Reproductive Medicine; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai China
| | - Feng Jin
- Department of Gynecology and Obstetrics; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai China
| | - Hongfang Shao
- Center of Reproductive Medicine; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai China
| | - Yincheng Teng
- Department of Gynecology and Obstetrics; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai China
- Center of Reproductive Medicine; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai China
| | - Minfang Tao
- Department of Gynecology and Obstetrics; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai China
| |
Collapse
|
31
|
Sexual Function of Postmenopausal Women Addicted to Alcohol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081639. [PMID: 30072650 PMCID: PMC6121656 DOI: 10.3390/ijerph15081639] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 07/28/2018] [Accepted: 08/01/2018] [Indexed: 12/03/2022]
Abstract
Introduction: Alcoholism impairs female sexual functions (decreased sex drive, reduced vaginal fluid, difficulty to experience orgasm). Aim: The aim of this study was to evaluate the course of perimenopausal period and sexual life of female alcoholics. Methods: 97 women at the age of 40–60 years were qualified with a diagnosed history of alcoholism (studied group). For the control group, 92 women at the age of 40–60 without a history of alcoholism were qualified. Questionnaires assessing female sexual function (Female Sexual Function Index—FSFI), the severity of perimenopausal symptoms (Menopause Rating Scale—MRS) and the degree of alcohol addiction (Michigan Alcoholism Screening Test—MAST) were obtained from each participant. Main outcome measures: To assess the sexual function of perimenopausal women addicted to alcohol. Results: The studied and control groups were significantly different (p = 0.00) in terms of severity of menopausal symptoms (MRS). The research showed lower quality of sexual life (FSFI) of women from the studied group. Conclusions: Population of women with diagnosed alcohol dependence enter the menopausal stage at the similar age as the population of female non-drinkers. The time of alcohol abuse is an important factor having an impact on both the course of menopause and the dynamics of the perimenopause period, leading to symptom escalation. The population of female alcoholics shows a decrease in sexual activity and the prevalence of sexual disorders.
Collapse
|
32
|
Cardiometabolic Risk and Female Sexuality-Part I. Risk Factors and Potential Pathophysiological Underpinnings for Female Vasculogenic Sexual Dysfunction Syndromes. Sex Med Rev 2018; 6:508-524. [PMID: 29730315 DOI: 10.1016/j.sxmr.2018.02.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 02/19/2018] [Accepted: 02/20/2018] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Erectile dysfunction is recognized as an opportunity for preventing cardiovascular (CV) events, and assessing the impairment of penile vascular flow by Doppler ultrasound is an important tool to ascertain CV risk. Conversely, the role of genital vascular impairment in the pathophysiology of female sexual dysfunction (FSD) remains contentious. AIM To focus on the current scientific support for an association between CV risk factors and female sexual health in the 1st part of a 2-part review. METHODS A thorough literature search of peer-reviewed publications on the associations between CV risk factors and FSD and their underlying mechanisms was performed using the PubMed database. MAIN OUTCOME MEASURES We present a summary of the evidence from clinical studies and discuss the possible mechanisms providing the pathophysiologic bases of vasculogenic FSD syndromes. RESULTS The peripheral sexual response in women is a vascular-dependent event, and evidence suggests that cardiometabolic-related perturbations in endothelial function can determine vascular insufficiency in female genital tissues. Although epidemiologic and observational studies demonstrate that the prevalence of FSD is higher in women with diabetes mellitus, a cause-effect relation between these clinical conditions cannot be assumed. Evidence on the effect of obesity, metabolic syndrome, and polycystic ovary syndrome on sexual function in women is controversial. Data on the associations of dyslipidemia and hypertension with FSD are limited. CONCLUSION Common cardiometabolic alterations could affect vascular function in the female genital tract. Based on limited data, there is an association between CV risk factors and female sexual health in women; however, this association appears milder than in men. Maseroli E, Scavello I, Vignozzi L. Cardiometabolic Risk and Female Sexuality-Part I. Risk Factors and Potential Pathophysiological Underpinnings for Female Vasculogenic Sexual Dysfunction Syndromes. Sex Med Rev 2018;6:508-524.
Collapse
|
33
|
Wong EL, Huang F, Cheung AW, Wong CK. The impact of menopause on the sexual health of Chinese Cantonese women: A mixed methods study. J Adv Nurs 2018. [DOI: 10.1111/jan.13568] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Eliza L.Y. Wong
- Faculty of Medicine; The Jockey Club School of Public Health and Primary Care; The Chinese University of Hong Kong; Sha Tin Hong Kong
| | - Fenwei Huang
- Faculty of Medicine; The Jockey Club School of Public Health and Primary Care; The Chinese University of Hong Kong; Sha Tin Hong Kong
| | - Annie W.L. Cheung
- Faculty of Medicine; The Jockey Club School of Public Health and Primary Care; The Chinese University of Hong Kong; Sha Tin Hong Kong
| | - Carmen K.M. Wong
- Faculty of Medicine; The Jockey Club School of Public Health and Primary Care; The Chinese University of Hong Kong; Sha Tin Hong Kong
| |
Collapse
|
34
|
Change in sexual functioning over the menopausal transition: results from the Study of Women's Health Across the Nation. Menopause 2018; 24:379-390. [PMID: 27801705 DOI: 10.1097/gme.0000000000000770] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The aim of the study was to identify whether there is a decline in sexual functioning related to the menopausal transition or to hysterectomy. METHODS In a cohort of 1,390 women aged 42 to 52, with intact uterus and at least one ovary, not using hormone therapy, and pre- or early perimenopausal at baseline, we fit piecewise linear growth curves to 5,798 repeated measurements (seven visits spanning 14.5 y) of a sexual functioning score (range, 5-25) as a function of time relative to date of final menstrual period (FMP) or hysterectomy. RESULTS Mean sexual functioning at baseline in women with a dateable FMP was 18.0 (SD, 3.4). There was no change in sexual function until 20 months before the FMP. From 20 months before until 1 year after the FMP, sexual function decreased by 0.35 annually (95% CI, -0.44 to -0.26) and continued to decline more than 1 year after the FMP, but at a slower rate (-0.13 annually, 95% CI, -0.17 to -0.10). The decline was smaller in African Americans and larger in Japanese than whites. Vaginal dryness, lubricant use, depressive symptoms, or anxiety did not explain decline in sexual function. Women who had a hysterectomy before the FMP did not show a decline in sexual function before hysterectomy, but scores declined afterward (0.21 annually, 95% CI, -0.28 to -0.14). CONCLUSIONS Decline in sexual function became apparent 20 months before FMP and slowed 1 year after FMP through 5 years afterward. A decline in sexual function was observed immediately after hysterectomy and persisted for the 5 years of observation.
Collapse
|
35
|
Taylor HS, Tal A, Pal L, Li F, Black DM, Brinton EA, Budoff MJ, Cedars MI, Du W, Hodis HN, Lobo RA, Manson JE, Merriam GR, Miller VM, Naftolin F, Neal-Perry G, Santoro NF, Harman SM. Effects of Oral vs Transdermal Estrogen Therapy on Sexual Function in Early Postmenopause: Ancillary Study of the Kronos Early Estrogen Prevention Study (KEEPS). JAMA Intern Med 2017; 177:1471-1479. [PMID: 28846767 PMCID: PMC5710212 DOI: 10.1001/jamainternmed.2017.3877] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
IMPORTANCE Sexual dysfunction, an important determinant of women's health and quality of life, is commonly associated with declining estrogen levels around the menopausal transition. OBJECTIVE To determine the effects of oral or transdermal estrogen therapy vs placebo on sexual function in postmenopausal women. DESIGN, SETTING, AND PARTICIPANTS Ancillary study of the Kronos Early Estrogen Prevention Study (KEEPS), a 4-year prospective, randomized, double-blinded, placebo-controlled trial of menopausal hormone therapy in healthy, recently menopausal women. Of 727 KEEPS enrollees, 670 agreed to participate in this multicenter ancillary study. Women were 42 to 58 years old, within 36 months from last menstrual period. Data were collected from July 2005 through June 2008 and analyzed from July 2010 through June 2017. INTERVENTIONS Women were randomized to either 0.45 mg/d oral conjugated equine estrogens (o-CEE), 50 µg/d transdermal 17β-estradiol (t-E2), or placebo. Participants also received 200 mg oral micronized progesterone (if randomized to o-CEE or t-E2) or placebo (if randomized to placebo estrogens) for 12 days each month. MAIN OUTCOMES AND MEASURES Aspects of sexual function and experience (desire, arousal, lubrication, orgasm, satisfaction, and pain) were assessed using the Female Sexual Function Inventory (FSFI; range, 0-36 points; higher scores indicate better sexual function). Low sexual function (LSF) was defined as an FSFI overall score of less than 26.55. Distress related to low FSFI score (required for the diagnosis of sexual dysfunction) was not evaluated. RESULTS The 670 participants had a mean (SD) age of 52.7 (2.6) years. The t-E2 treatment was associated with a significant yet moderate improvement in the FSFI overall score across all time points compared with placebo (average efficacy, 2.6; 95% CI, 1.11-4.10; adjusted P = .002). With o-CEE treatment, there was no significant difference in FSFI overall score compared with placebo (mean efficacy, 1.4; 95% CI, -0.1 to 2.8; adjusted P = .13). There was no difference in FSFI overall score between the t-E2 and o-CEE groups on average across 48 months (adjusted P = .22). In the individual domains of sexual function, t-E2 treatment was associated with a significant increase in mean lubrication (0.61; 95% CI, 0.25-0.97; P = .001) and decreased pain (0.67; 95% CI, 0.25-1.09; P = .002) compared with placebo. Overall, the proportion of women with LSF was significantly lower after t-E2 treatment compared with placebo (67%; 95% CI, 55%-77% vs 76%; 95% CI, 67%-83%; P = .04). For o-CEE there was no significant reduction in the odds of LSF. CONCLUSIONS AND RELEVANCE Treatment with t-E2 modestly improved sexual function in early postmenopausal women, but whether it relieved symptoms of distress is not known. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00154180.
Collapse
Affiliation(s)
- Hugh S Taylor
- Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Aya Tal
- Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Lubna Pal
- Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Fangyong Li
- Yale Center for Analytical Sciences, Yale University School of Public Health, New Haven, Connecticut
| | - Dennis M Black
- Epidemiology and Biostatistics, University of California at San Francisco
| | | | - Matthew J Budoff
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Marcelle I Cedars
- Obstetrics and Gynecology, University of California at San Francisco
| | - Wei Du
- Yale Center for Analytical Sciences, Yale University School of Public Health, New Haven, Connecticut
| | - Howard N Hodis
- Atherosclerosis Research Unit, University of Southern California, Los Angeles
| | - Rogerio A Lobo
- Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York
| | - JoAnn E Manson
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - George R Merriam
- Veterans Affairs Puget Sound Health Care System, Tacoma, Washington.,Division of Metabolism, Endocrinology and Nutrition, University of Washington, Tacoma
| | - Virginia M Miller
- Department of Surgery, Mayo Clinic, Rochester, Minnesota.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | - Frederick Naftolin
- Obstetrics and Gynecology, New York University School of Medicine, New York
| | - Genevieve Neal-Perry
- Division of Reproductive Endocrinology and Infertility, University of Washington Medical School, Seattle
| | - Nanette F Santoro
- Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora
| | - Sherman M Harman
- Kronos Longevity Research Institute, Phoenix, Arizona.,Division of Endocrinology, Phoenix Veterans Affairs Medical Center, Phoenix, Arizona
| |
Collapse
|
36
|
Agaba PA, Meloni ST, Sule HM, Agaba EI, Idoko JA, Kanki PJ. Sexual dysfunction and its determinants among women infected with HIV. Int J Gynaecol Obstet 2017; 137:301-308. [PMID: 28273350 DOI: 10.1002/ijgo.12140] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 01/11/2017] [Accepted: 03/03/2017] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To describe the prevalence of female sexual dysfunction (FSD) and its determinants among women with HIV infection enrolled for care and treatment in an ambulatory care setting. METHODS A questionnaire-based cross-sectional survey was conducted among women attending the HIV clinic of Jos University Teaching Hospital, Nigeria, between March 2013 and February 2014. The self-administered Female Sexual Function Index (FSFI) was used to assess FSD; a score of less than 26.55 indicated FSD. Pearson coefficient was used to assess interdomain correlation, and multiple linear regression was used to identify factors associated with FSD. RESULTS Among 370 participants, 330 (89.2%, 95% confidence interval [CI] 85.6%-92.2%) had FSD. The overall median FSFI score was 19.2 (interquartile range [IQR] 6.4-23.9). The arousal domain had the lowest subscore (median 2.7, IQR 0.0-3.6). The highest interdomain correlations were between lubrication and orgasm (r=0.87), arousal and lubrication (r=0.84), and arousal and orgasm (r=0.81) domains. Satisfactory health (β=3.34, 95% CI 1.16-5.52) and history of alcohol use (β=2.38, 95% CI 0.28-4.47) were independently associated with FSD. CONCLUSION FSD was prevalent among women with HIV infection. Care providers need to routinely address FSD as part of a comprehensive care package in the study setting.
Collapse
Affiliation(s)
- Patricia A Agaba
- Department of Family Medicine, University of Jos, Jos, Nigeria.,APIN Centre, Jos University Teaching Hospital, Jos, Nigeria
| | - Seema T Meloni
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Halima M Sule
- Department of Family Medicine, University of Jos, Jos, Nigeria.,APIN Centre, Jos University Teaching Hospital, Jos, Nigeria
| | | | - John A Idoko
- National Agency for the Control of AIDS, Abuja, Nigeria
| | - Phyllis J Kanki
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
37
|
Associations between body mass index and sexual functioning in midlife women: the Study of Women's Health Across the Nation. Menopause 2016; 22:1175-81. [PMID: 25803669 DOI: 10.1097/gme.0000000000000452] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE This study aims to examine baseline and longitudinal associations between body mass index (BMI) and sexual functioning in midlife women. METHODS Midlife women (N = 2,528) from the Study of Women's Health Across the Nation reported on sexual functioning and underwent measurements of BMI annually beginning in 1995-1997, with follow-up spanning 13.8 years. Associations between baseline levels and longitudinal changes in BMI and sexual desire, arousal, intercourse frequency, and ability to climax were assessed with generalized linear mixed-effects models. Models were adjusted for demographic variables, depressive symptoms, hormone therapy use, alcohol intake, menopause status, smoking status, and health status. RESULTS Mean BMI increased from 27.7 to 29.1 kg/m2, whereas all sexual functioning variables declined across time (P values ≤ 0.001). Higher baseline BMI was associated with less frequent intercourse (P = 0.003; 95% CI, -0.059 to -0.012). Although overall change in BMI was not associated with changes in sexual functioning, years of greater-than-expected BMI increases relative to women's overall BMI change trajectory were characterized by less frequent intercourse (P < 0.001; 95% CI, -0.106 to -0.029) and reduced sexual desire (P = 0.020; 95% CI, -0.078 to -0.007). CONCLUSIONS Although women's overall BMI change across 13.8 years of follow-up was not associated with overall changes in sexual functioning, sexual desire and intercourse frequency diminished with years of greater-than-expected weight gain. Results suggest that adiposity and sexual functioning change concurrently from year to year. Further research should explore the impact of weight management interventions as a strategy for preserving sexual functioning in midlife women.
Collapse
|
38
|
Mitro SD, Harlow SD, Randolph JF, Reed BD. Chronic vulvar pain in a cohort of post-menopausal women: Atrophy or Vulvodynia? Womens Midlife Health 2016; 2. [PMID: 28127441 PMCID: PMC5260822 DOI: 10.1186/s40695-016-0017-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Although postmenopausal vulvar pain is frequently attributed to vaginal atrophy, such symptoms may be due to vulvodynia, a chronic vulvar pain condition. Given the limited research on vulvodynia in postmenopausal women, the objective of this study was to provide preliminary population-based data on the associations of vaginal symptoms, serum hormone levels and hormone use with chronic vulvar pain in a multiethnic sample of post-menopausal women. Methods We used data from 371 participants at the Michigan site of the Study of Women’s Health Across the Nation (SWAN) who participated in the 13th follow-up visit. Women completed a validated screening instrument for vulvodynia and provided information on additional vaginal symptoms as well as demographic characteristics, and hormone use by questionnaire. Blood samples were obtained to assess hormone levels. We compared women who screened positive for vulvodynia and women with past or short-duration vulvar pain to women without vulvar pain, using Chi-squared and Fisher’s Exact tests. Relative odds ratios and 95 % confidence intervals were calculated using multinomial logistic regression models adjusting for age, body mass index, and race/ethnicity. Results Current chronic vulvar pain consistent with vulvodynia was reported by 4.0 % of women, while 13.7 % reported past but not current chronic vulvar pain or short-duration vulvar pain symptoms. One quarter of women who reported current chronic vulvar pain did not report vaginal dryness. Women with current chronic and with past/short duration vulvar pain symptoms were more likely to have used hormones during the preceding year than women without vulvar pain symptoms (13.3 %, 17.6 %, 2.0 %, respectively; p < .01). Increased relative odds of current vulvar pain symptoms were associated with each log unit decrease in serum dehydroepiandrosterone-sulfate, estradiol and testosterone levels at the previous year’s visit. Conclusion Some women who experience chronic vulvar pain symptoms do not report vaginal dryness, and others report continued or first onset of pain while using hormones. Vulvodynia should be considered in the differential diagnosis of postmenopausal women presenting with vulvar pain symptoms.
Collapse
Affiliation(s)
- Susanna D Mitro
- Department of Epidemiology, School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - Siobán D Harlow
- Department of Epidemiology, School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - John F Randolph
- School of Medicine, University of Michigan Ann Arbor, Ann Arbor, MI, USA
| | - Barbara D Reed
- School of Medicine, University of Michigan Ann Arbor, Ann Arbor, MI, USA
| |
Collapse
|
39
|
Thomas HN, Thurston RC. A biopsychosocial approach to women's sexual function and dysfunction at midlife: A narrative review. Maturitas 2016; 87:49-60. [PMID: 27013288 PMCID: PMC4808247 DOI: 10.1016/j.maturitas.2016.02.009] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/15/2016] [Indexed: 01/21/2023]
Abstract
A satisfying sex life is an important component of overall well-being, but sexual dysfunction is common, especially in midlife women. The aim of this review is (a) to define sexual function and dysfunction, (b) to present theoretical models of female sexual response, (c) to examine longitudinal studies of how sexual function changes during midlife, and (d) to review treatment options. Four types of female sexual dysfunction are currently recognized: Female Orgasmic Disorder, Female Sexual Interest/Arousal Disorder, Genito-Pelvic Pain/Penetration Disorder, and Substance/Medication-Induced Sexual Dysfunction. However, optimal sexual function transcends the simple absence of dysfunction. A biopsychosocial approach that simultaneously considers physical, psychological, sociocultural, and interpersonal factors is necessary to guide research and clinical care regarding women's sexual function. Most longitudinal studies reveal an association between advancing menopause status and worsening sexual function. Psychosocial variables, such as availability of a partner, relationship quality, and psychological functioning, also play an integral role. Future directions for research should include deepening our understanding of how sexual function changes with aging and developing safe and effective approaches to optimizing women's sexual function with aging. Overall, holistic, biopsychosocial approaches to women's sexual function are necessary to fully understand and treat this key component of midlife women's well-being.
Collapse
Affiliation(s)
- Holly N Thomas
- University of Pittsburgh, Department of Medicine, United States.
| | | |
Collapse
|
40
|
Brotto L, Atallah S, Johnson-Agbakwu C, Rosenbaum T, Abdo C, Byers ES, Graham C, Nobre P, Wylie K. Psychological and Interpersonal Dimensions of Sexual Function and Dysfunction. J Sex Med 2016; 13:538-71. [DOI: 10.1016/j.jsxm.2016.01.019] [Citation(s) in RCA: 196] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 01/16/2016] [Accepted: 01/19/2016] [Indexed: 12/11/2022]
|
41
|
Lopez-Olmos J. Diferencias en disfunciones sexuales y depresión entre mujeres premenopáusicas (de 40-50 años) y mujeres posmenopáusicas (de 50-60 años). Estudio prospectivo de un año. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2016. [DOI: 10.1016/j.gine.2014.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
42
|
Santoro N, Worsley R, Miller KK, Parish SJ, Davis SR. Role of Estrogens and Estrogen-Like Compounds in Female Sexual Function and Dysfunction. J Sex Med 2016; 13:305-16. [DOI: 10.1016/j.jsxm.2015.11.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/13/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022]
|
43
|
Cappelletti M, Wallen K. Increasing women's sexual desire: The comparative effectiveness of estrogens and androgens. Horm Behav 2016; 78:178-93. [PMID: 26589379 PMCID: PMC4720522 DOI: 10.1016/j.yhbeh.2015.11.003] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 10/21/2015] [Accepted: 11/13/2015] [Indexed: 11/24/2022]
Abstract
Both estradiol and testosterone have been implicated as the steroid critical for modulating women's sexual desire. By contrast, in all other female mammals only estradiol has been shown to be critical for female sexual motivation and behavior. Pharmaceutical companies have invested heavily in the development of androgen therapies for female sexual desire disorders, but today there are still no FDA approved androgen therapies for women. Nonetheless, testosterone is currently, and frequently, prescribed off-label for the treatment of low sexual desire in women, and the idea of testosterone as a possible cure-all for female sexual dysfunction remains popular. This paper places the ongoing debate concerning the hormonal modulation of women's sexual desire within a historical context, and reviews controlled trials of estrogen and/or androgen therapies for low sexual desire in postmenopausal women. These studies demonstrate that estrogen-only therapies that produce periovulatory levels of circulating estradiol increase sexual desire in postmenopausal women. Testosterone at supraphysiological, but not at physiological, levels enhances the effectiveness of low-dose estrogen therapies at increasing women's sexual desire; however, the mechanism by which supraphysiological testosterone increases women's sexual desire in combination with an estrogen remains unknown. Because effective therapies require supraphysiological amounts of testosterone, it remains unclear whether endogenous testosterone contributes to the modulation of women's sexual desire. The likelihood that an androgen-only clinical treatment will meaningfully increase women's sexual desire is minimal, and the focus of pharmaceutical companies on the development of androgen therapies for the treatment of female sexual desire disorders is likely misplaced.
Collapse
Affiliation(s)
- Maurand Cappelletti
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA 30322, USA.
| | - Kim Wallen
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA 30322, USA
| |
Collapse
|
44
|
Freeman EW, Sammel MD. Methods in a longitudinal cohort study of late reproductive age women: the Penn Ovarian Aging Study (POAS). Womens Midlife Health 2016; 2:1. [PMID: 30766699 PMCID: PMC6299955 DOI: 10.1186/s40695-016-0014-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 01/17/2016] [Indexed: 12/05/2022] Open
Abstract
Background This report describes the methods utilized in the Penn Ovarian Aging Study (POAS), which is a longitudinal cohort study of hormone dynamics and menopausal symptoms of women in the menopause transition. Methods/Design The cohort is a community-based sample of generally healthy women enrolled in the late reproductive years. The study population is a stratified random sample of African-American and Caucasian women, identified by random digit dialing. Of the 1427 women who were identified as potentially eligible, 578 women were eligible after full screening; 75 % of the eligible women enrolled in the study (436/578). At Period 14 (14 years after study enrollment), 67 % remained active and were fully evaluated (293/436). Attrition was non-differential with respect to the sample characteristics. The aims of the project overall are to 1) identify within-woman trends of reproductive hormones (estradiol, follicle stimulating hormone, hormone, lutinizing hormone, inhibin B, dehydroepiandrosterone, testosterone, and anti-mullerian hormone), cofactors such as race, body mass index (BMI), age, physical and behavioral symptoms, and their predictions of menopausal symptoms, and patterns around the final menstrual period; 2) identify associations of hormone dynamics with physical and behavioral symptoms that occur with ovarian aging and identify racial differences in these factors; 3) identify associations of genetic polymorphisms with levels and longitudinal trends in menopausal symptoms. The cohort consists of 436 late reproductive-age women at enrollment, and now has 18 years of approximately annual follow-up assessments. Menopausal stage based on concurrent menstrual dates is identified at each follow-up period. Discussion Studies of the cohort have shown that hot flashes can occur well before menopause and extend 10 or more years beyond menopause for sizeable numbers of women; provide evidence for new-onset depressed mood in the menopause transition and show that the final menstrual period is pivotal in the increases in depressive symptoms prior to menopause and decreases postmenopausal; suggest that poor sleep is common in the late reproductive years but increases in relation to the final menstrual period in only a small proportion of women; and show effects of obesity on reproductive hormones in the menopause transition. To date, more than 50 studies of the cohort are published in medical journals, demonstrating the relevance of these data to the clinical care of mid-life women. Electronic supplementary material The online version of this article (doi:10.1186/s40695-016-0014-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Ellen W Freeman
- 1Department of Obstetrics/Gynecology and Department of Psychiatry, 3701 Market Street, Suite 820 (Mudd Suite), Philadelphia, PA 19104 USA
| | - Mary D Sammel
- 2Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, U.S, Philadelphia, USA
| |
Collapse
|
45
|
Johnson AK, Johnson AJ, Barton D, Elkins G. Hypnotic Relaxation Therapy and Sexual Function in PostmenopausalWomen: Results of a Randomized Clinical Trial. Int J Clin Exp Hypn 2016; 64:213-24. [PMID: 26894424 DOI: 10.1080/00207144.2016.1131590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Sexual dysfunction is a common problem for postmenopausal women. This study, as part of a larger randomized controlled trial, examined the effect of hypnotic relaxation therapy on sexual dysfunction, a secondary study outcome, in postmenopausal women. Sexual function was assessed using the Sexual Activity Questionnaire (SAQ). Significant improvement in sexual pleasure and discomfort were reported following 5 weekly sessions of hypnotic relaxation therapy, compared with those receiving an attention control. Total SAQ scores showed significant improvement in the hypnotic relaxation therapy treatment group while holding baseline SAQ scores constant. Improvements showed a slight increase at the Week 12 follow-up. The results of this analysis provide initial support for the use of hypnotic relaxation therapy to improve sexual function in postmenopausal women.
Collapse
Affiliation(s)
| | | | - Debra Barton
- b University of Michigan School of Nursing , Ann Arbor , USA
| | | |
Collapse
|
46
|
Yang CF, Kenney NJ, Chang TC, Chang SR. Sex life and role identity in Taiwanese women during menopause: a qualitative study. J Adv Nurs 2015; 72:770-81. [PMID: 26708447 DOI: 10.1111/jan.12866] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2015] [Indexed: 11/28/2022]
Abstract
AIM Our goal was to examine Taiwanese women's perspectives on the way menopause affected their sexual behaviour to gain an in-depth understanding of their experiences during this transition. BACKGROUND Physical symptoms associated with menopause may affect women's sexual experiences. Little is known about how menopause-related changes in sexual behaviour may affect role identity of women living in a modernizing urban culture that is still strongly rooted in traditional beliefs and attitudes. DESIGN This was a qualitative study involving face-to-face interviews using open-ended questions. METHODS During 2011-2012, eighteen peri or postmenopausal women visiting a medical clinic for gynaecological examinations or treatment were interviewed about their sexual experiences. Responses were analysed for common themes. FINDINGS Four themes were identified about the effects of menopause on women's sex life: (1) changes in physical responses during sex; (2) the acceptance/non-acceptance of the current situation; (3) sexual pressure related to their marital role; (4) efforts to improve sexual interest or activity. Menopause-related physical changes often (but not always) made sexual interactions difficult. But women's responses to the changes varied. Some used sexual discomfort as a reason to avoid sexual intercourse. Others sought to improve their sexual encounters through behavioural modifications or hormone therapy. CONCLUSIONS Given the variety of reactions to the impact of menopause on sexual behaviour/relationships seen here, it is clear that health professionals need to assess of each woman's specific situation and be prepared to recommend a variety of behavioural or hormonal treatment options.
Collapse
Affiliation(s)
- Cheng-Fang Yang
- School of Nursing, Cardinal Tien Junior College of Healthcare & Management, Taipei, Taiwan.,School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Nancy J Kenney
- Departments of Psychology and Gender, Women & Sexuality Studies, University of Washington, Seattle, Washington, USA
| | - Ting-Chen Chang
- Department of Obstetrics and Gynecology, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Shiow-Ru Chang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| |
Collapse
|
47
|
Labrie F, Derogatis L, Archer DF, Koltun W, Vachon A, Young D, Frenette L, Portman D, Montesino M, Côté I, Parent J, Lavoie L, Beauregard A, Martel C, Vaillancourt M, Balser J, Moyneur É. Effect of Intravaginal Prasterone on Sexual Dysfunction in Postmenopausal Women with Vulvovaginal Atrophy. J Sex Med 2015; 12:2401-12. [PMID: 26597311 DOI: 10.1111/jsm.13045] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Previous data have shown that intravaginal dehydroepiandrosterone (DHEA, prasterone) improved all the domains of sexual function, an effect most likely related to the local formation of androgens from DHEA. AIMS To confirm in a placebo-controlled, prospective, double-blind and randomized study the benefits of daily intravaginal DHEA for 12 weeks on sexual function using the Female Sexual Function Index (FSFI) questionnaire. METHODS Placebo was administered daily to 157 women while 325 women received 0.50% (6.5 mg) DHEA daily for 12 weeks. All women were postmenopausal meeting the criteria of vulvovaginal atrophy (VVA), namely moderate to severe dyspareunia as their most bothersome symptom of VVA in addition to having ≤5% of vaginal superficial cells and vaginal pH > 5.0. The FSFI questionnaire was filled at baseline (screening and day 1), 6 weeks and 12 weeks. Comparison between DHEA and placebo of the changes from baseline to 12 weeks was made using the analysis of covariance test, with treatment group as the main factor and baseline value as the covariate. MAIN OUTCOME MEASURES The six domains and total score of the FSFI questionnaire were evaluated. RESULTS The FSFI domain desire increased over placebo by 0.24 unit (+49.0%, P = 0.0105), arousal by 0.42 unit (+56.8%, P = 0.0022), lubrication by 0.57 unit (+36.1%, P = 0.0005), orgasm by 0.32 unit (+33.0%, P = 0.047), satisfaction by 0.44 unit (+48.3%, P = 0.0012), and pain at sexual activity by 0.62 unit (+39.2%, P = 0.001). The total FSFI score, on the other hand, has shown a superiority of 2.59 units in the DHEA group over placebo or a 41.3% greater change than placebo (P = 0.0006 over placebo). CONCLUSION The present data show that all the six domains of the FSFI are improved over placebo (from P = 0.047 to 0.0005), thus confirming the previously observed benefits of intravaginal DHEA on female sexual dysfunction by an action exerted exclusively at the level of the vagina, in the absence of biologically significant changes of serum steroids levels.
Collapse
Affiliation(s)
| | | | | | - William Koltun
- Medical Center for Clinical Research, San Diego, CA, USA
| | - Andrée Vachon
- Clinique Médicale St-Louis (recherche) Inc, Quebec City, QC, Canada
| | | | | | - David Portman
- Columbus Center for Women's Health Research, Columbus, OH, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Sathyanarayana Rao TS, Ismail S, Darshan MS, Tandon A. Sexual disorders among elderly: An epidemiological study in south Indian rural population. Indian J Psychiatry 2015; 57:236-41. [PMID: 26600575 PMCID: PMC4623640 DOI: 10.4103/0019-5545.166618] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Realizing a dearth of data on this topic, especially in the Indian context, an epidemiological study was conducted in a south Indian rural population to identify the sexual activity patterns and sexual problems among the population above 60 years of age. OBJECTIVES (1) Assessment of sexual activity patterns among individuals above 60 years. (2) Assessment of the prevalence of sexual disorders among individuals above 60 years. MATERIALS AND METHODS The study sample consisted of 259 participants, which included both males and females above 60 years of age. Subjects who were sexually active and fulfilled the study criteria were administered Arizona Sexual Experience Scale as a screening tool, for the presence of sexual problems. Those who were found to have sexual problems were interviewed further using appropriate questionnaires. RESULTS Only 27.4% of the individuals above 60 years were sexually active, and it progressively dropped as age advanced and none were sexually active after 75 years of age. Among the sexually active males, erectile dysfunction (ED) was prevalent in 43.5%, premature ejaculation in 10.9%, hypoactive sexual desire disorder (HSSD) in 0.77% and anorgasmia in 0.38% of the subjects. Among females, arousal disorder was prevalent in 28%, HSSD in 16%, anorgasmia in 20% and dyspareunia in 8% of the subjects. CONCLUSION The study gives us an insight into the sexual problems of the elderly and brings home the point that sexual problems are very much common among both men and women in the older population. Among elderly males, ED is the most common sexual disorder whereas in elderly females, arousal disorder is the most prevalent female sexual dysfunction, implicating biology plays an important role in men, whereas psychology plays an important role in women sexual functioning.
Collapse
Affiliation(s)
| | - Shajahan Ismail
- Consultant Psychiatrist Argyll House, Sheffield Health and Social Care NHS Trust, # 9 Williamson Road, Sheffield, UK
| | - M. S. Darshan
- Founding Director & Consultant Neuropsychiatrist, Prerana Hospital for Neurocare, Psychiatry and Deaddiction, Mysore, India
| | - Abhinav Tandon
- Director and Consulatant (Neuro) Psychiatrist, Dr. AK Tandon Neuropsychiatric Centre, Allahabad, India
| |
Collapse
|
49
|
Abstract
This volume of the Handbook of Clinical Neurology deals with neurologic disorders of sex and bladder. Sexuality is for the large majority of humans a component of a fulfilled life, even though it is not "vital" in the usual sense of the word. However, dysfunctions of the lower urinary tract (LUT) are vital, as they may lead to chronic infection, dilatation of the upper urinary tract, renal insufficiency, and death. Sexual disorders and LUT are often mentioned in ancient literature, but most contemporary methods of diagnosis and treatment were only introduced in the 20th century. Despite the relatively high prevalence of these disorders, most physicians are ill prepared to discuss them with their patients, let alone to diagnose and treat them. It is the aim of this volume of the Handbook to try to reverse this attitude and convince neurologists that sexual and LUT function need to be addressed in their patients, for reasons of correct diagnosis and possible therapeutic consequences, as well as gaining overall trust from the patient.
Collapse
|
50
|
Shakeri F, Taavoni S, Goushegir A, Haghani H. Effectiveness of red clover in alleviating menopausal symptoms: a 12-week randomized, controlled trial. Climacteric 2015; 18:568-73. [DOI: 10.3109/13697137.2014.999660] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|