1
|
Rezaei N, Behboodi Moghadam Z, Tahmasebi A, Taheri S, Namazi M. Women`s sexual function during the postpartum period: A systematic review on measurement tools. Medicine (Baltimore) 2024; 103:e38975. [PMID: 39058853 PMCID: PMC11272350 DOI: 10.1097/md.0000000000038975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Sexual health is a critical component of overall well-being, yet discussions around sexual function, especially in the context of postpartum recovery, are often taboo or sidelined. The aim was to review measurement tools assessing women's sexual function/health during the postpartum period. METHODS We did a systematic search according to preferred reporting items for systematic reviews and meta-analyses 2020 guidelines in different databases, including PubMed, Web of Science, Scopus, Embase, ProQuest and Open Access Thesis and Dissertations, and Google scholar search engine until June 2023. Also, the reference list of the related reviews has been screened. Eligible studies included observational studies or clinical trials that evaluated women`s sexual function during the postpartum period using existing tools. Data extraction covered study characteristics, measurement tools, and their validity and reliability. RESULTS From 3064 retrieved records, after removing duplicates and excluding ineligible studies, and reviewing the reference list of the related reviews, 41 studies were included in this review. Tools measuring sexual function were developed from 1996 to 2017. Sexual activity questionnaire, female sexual function index (FSFI), sexual function questionnaire, short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire, sexual health outcomes in women questionnaire, shorter version of FSFI, and sexual function questionnaire's medical impact scale and Carol scale. CONCLUSION Sexual activity questionnaire, FSFI, sexual function questionnaire, short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire, sexual health outcomes in women questionnaire, shorter version of FSFI, sexual function questionnaire's medical impact scale, and Carol scale are valid and reliable measuring tools to assess sexual function or sexual health during postpartum period, which can be used in primary studies according to the study aim and objectives.
Collapse
Affiliation(s)
- Nazanin Rezaei
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
- Department of Midwifery, Ilam University of Medical Sciences, Ilam, Iran
| | - Zahra Behboodi Moghadam
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Atbin Tahmasebi
- School of Medicine, Student Research Committee, Ilam University of Medical Sciences, Ilam, Iran
| | - Safoura Taheri
- Department of Midwifery, Ilam University of Medical Sciences, Ilam, Iran
| | - Masoumeh Namazi
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
2
|
Pavarini N, Valadares ALR, Varella GM, Brito LGO, Juliato CRT, Costa-Paiva L. Sexual function after energy-based treatments of women with urinary incontinence. A systematic review and meta-analysis. Int Urogynecol J 2023; 34:1139-1152. [PMID: 36680596 DOI: 10.1007/s00192-022-05419-8] [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: 09/27/2022] [Accepted: 11/17/2022] [Indexed: 01/22/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Urinary incontinence (UI) affects approximately 50% of adult women worldwide and is associated with declining sexual function (SF). Energy-based devices emerged as a minimally invasive alternative treatment. Nevertheless, their effect on sexuality is uncertain. We hypothesize that the UI energy treatment can lead to sexual function improvement. METHODS A search was performed in PubMed, Cochrane Library, Web of Science, Embase, and Scopus for randomized clinical trials (RCTs) and nonrandomized studies of intervention, which treated incontinent women using energy, with UI and sexual function (SF) as outcomes. Severe comorbidities, pelvic organ prolapse (POP)> grade 2, and use of medication to treat UI or that affects SF were excluded. Quality assessment and meta-analysis were performed. RESULTS From 322 articles, 11 RCTs were included for qualitative analysis. UI symptoms improved in all studies. Regarding SF, RCT with premenopausal women showed improvement in SF in the Er:Yag group (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 and Female Sexual Function Index). A prospective study showed improvement in SF independent of the grade of SUI. RF showed benefits for SF but was not superior to pelvic floor muscle training. One nonrandomized study of intervention with a High-Intensity Focused Electromagnetic Field showed significant improvement of SF in the Golombok Rust Inventory of Sexual Satisfaction total score, a decline in pain and dissatisfaction domains. Meta-analysis with 4 RCTs and 2 nonrandomized studies found no difference between groups (0.26 (95% CI -0.67 to 1.20, and -0.74 (95% CI -3.78 to 2.30) respectively). CONCLUSIONS This meta-analysis did not confirm that energy equipment improved the SF of women with UI.
Collapse
Affiliation(s)
- Nádia Pavarini
- School of Medical Science, University of Campinas (UNICAMP), Campinas, Brazil
| | - Ana L R Valadares
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-881, Brazil.
| | - Glaucia M Varella
- School of Medical Science, University of Campinas (UNICAMP), Campinas, Brazil
| | - Luiz G O Brito
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-881, Brazil
| | - Cássia R T Juliato
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-881, Brazil
| | - Lúcia Costa-Paiva
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-881, Brazil
| |
Collapse
|
3
|
Armeni A, Armeni E, Augoulea A, Stergiotis S, Kaparos G, Alexandrou A, Eleftheriadis M, Georgopoulos N, Vlahos N, Lambrinoudaki I. Climacteric symptoms, age, and sense of coherence are associated with sexual function scores in women after menopause. J Sex Med 2023; 20:313-323. [PMID: 36763958 DOI: 10.1093/jsxmed/qdac031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/26/2022] [Accepted: 10/19/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Postmenopausal sexual function presupposes the integration of hormonal, neural, and vascular interactions and is subject to optimal crosstalk among psychological, interpersonal, cultural, and environmental factors. Sense of coherence (SOC) reflects a person's ability to cope with stressors and may influence the occurrence of menopausal symptoms and sexual dysfunction. AIM To investigate the association of severity of climacteric symptoms, cardiometabolic risk factors, and SOC with sexual function in postmenopausal women. METHODS Overall 281 sexually active postmenopausal women without significant psychopathology or cardiovascular disease attending the Menopause Unit of Aretaieion Hospital were evaluated by the Female Sexual Function Index (FSFI), Greene Climacteric Scale, Beck Depression Scale, and Sense of Coherence Scale. Hormonal and biochemical parameters and cardiometabolic risk factors were evaluated. FSFI scores <26.5 were considered pathologic. OUTCOMES Total and subdomain scores of sexual response were determined. RESULTS Pathologic FSFI scores were found in 79.7% of the sample. Linear models of multivariable regression analysis showed that FSFI scores were associated with (1) Beck scores (b = -0.200; 95% CI, -0.472 to -0.073, P = .001), vasomotor symptom severity (b = -0.324; 95% CI, -0.985 to 0.051; P < .001), and age and (2) SOC (b = 0.150, 95% CI, 0.036-0.331; P = .008), vasomotor symptom severity (b = -0.361; 95% CI, -0.743 to 0.245; P < .001), and age. Both models were adjusted for menopausal age, diabetes mellitus, hypertension, type of menopause, and menopausal hormone therapy intake. SOC was associated with Beck depression scores (β = -0.487, P < .001; Greene Climacteric Scale total scores, β = -0.199, P < .001). FSFI score <26.5 vs >26.5 was associated with SOC (odds ratio, 0.982; 95% CI, 0.563 to 1.947; P = .006) and moderate to severe vasomotor symptom severity (odds ratio, 2.476; 95% CI, 1.478 to 3.120; P = .009) independent of age, diabetes mellitus, hypertension, menopausal hormone therapy intake, type of menopause, or Beck depression classification. CLINICAL IMPLICATIONS The results indicate the importance of psychometric assessment of postmenopausal women when presenting with scores of low sexual function. The severity of vasomotor symptoms should also be addressed in any case. STRENGTHS AND LIMITATIONS This is the first study investigating the relationship between SOC and sexuality in menopause in a carefully selected homogenous population. Limitations included the cross-sectional design and the fact that sexual distress was not assessed. CONCLUSIONS Pathologic FSFI scores were highly prevalent in this sample of postmenopausal women. FSFI is associated positively with age and severity of vasomotor symptoms and negatively with SOC.
Collapse
Affiliation(s)
- Anastasia Armeni
- Second Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, Aretaieion Hospital, GR-11528 Athens, Greece.,Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Patras Medical School, University Hospital, GR-26504 Patras, Greece
| | - Eleni Armeni
- Second Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, Aretaieion Hospital, GR-11528 Athens, Greece
| | - Areti Augoulea
- Second Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, Aretaieion Hospital, GR-11528 Athens, Greece
| | - Stefanos Stergiotis
- Second Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, Aretaieion Hospital, GR-11528 Athens, Greece
| | - George Kaparos
- Biochemical Laboratory, National and Kapodistrian University of Athens, Aretaieion Hospital, GR-11528 Athens, Greece
| | - Andreas Alexandrou
- Second Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, Aretaieion Hospital, GR-11528 Athens, Greece
| | - Makarios Eleftheriadis
- Second Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, Aretaieion Hospital, GR-11528 Athens, Greece
| | - Neoklis Georgopoulos
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Patras Medical School, University Hospital, GR-26504 Patras, Greece
| | - Nicolaos Vlahos
- Second Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, Aretaieion Hospital, GR-11528 Athens, Greece
| | - Irene Lambrinoudaki
- Second Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, Aretaieion Hospital, GR-11528 Athens, Greece
| |
Collapse
|
4
|
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
|
5
|
|
6
|
Politano CA, Valadares ALR, Pinto-Neto A, Costa-Paiva L. The metabolic syndrome and sexual function in climacteric women: a cross-sectional study. J Sex Med 2014; 12:455-62. [PMID: 25441664 DOI: 10.1111/jsm.12749] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Studies have associated the metabolic syndrome with poor sexual function; the results, however, are controversial. AIMS To evaluate the relationship between the metabolic syndrome and sexual function and to identify the factors associated with poor sexual function. METHODS A secondary analysis of a cross-sectional cohort study including 256 women of 40-60 years of age receiving care at the outpatient department of a university teaching hospital. MAIN OUTCOME MEASURES A specific questionnaire was applied to collect sociodemographic and behavioral data, and the Short Personal Experience Questionnaire was used to evaluate sexual function, with a score ≤ 7 being indicative of poor sexual function. Anthropometric measurements, blood pressure, fasting glucose, high-density lipoprotein, total cholesterol, triglycerides, follicle-stimulating hormone and thyroid stimulating hormone levels were determined. RESULTS The prevalence of the metabolic syndrome, as defined by the International Diabetes Federation, was 62.1%, and the prevalence of poor sexual function was 31.4%. The only factor related to female sexual function that was associated with the metabolic syndrome was sexual dysfunction in the woman's partner. The factors associated with poor sexual function in the bivariate analysis were age >50 years (P=0.003), not having a partner (P<0.001), being postmenopausal (P=0.046), the presence of hot flashes (P=0.02), poor self-perception of health (P=0.04), partner's age ≥ 50 years, and time with partner ≥ 21 years. Reported active (P=0.02) and passive (P=0.01) oral sex was associated with an absence of sexual dysfunction. In the multiple regression analysis, the only factor associated with poor sexual function was being 50 years of age or more. CONCLUSIONS The prevalence of the metabolic syndrome was high and was not associated with poor sexual function in this sample of menopausal women. The only factor associated with poor sexual function was being over 50 years of age.
Collapse
Affiliation(s)
- Carlos A Politano
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | | | | | | |
Collapse
|
7
|
Ringa V, Diter K, Laborde C, Bajos N. Women's Sexuality: From Aging to Social Representations. J Sex Med 2013; 10:2399-408. [DOI: 10.1111/jsm.12267] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|