Does surgical menopause affect sexual performance differently from natural menopause?

Surveillance of Indonesian female sexual function after hysterectomy

BACKGROUND

Sexual function is one component of quality of life that could be fulfilled by humans. Hysterectomy, which is an operative procedure in women, may cause disturbance in sexual function.

AIM

This study aims to determine the surveillance of sexual function after hysterectomy.

METHODS

This is a cross-sectional study involving 92 gynecological tumor patients who had undergone a hysterectomy by open laparotomy procedure for at least 3 months. Evaluation of sexual dysfunction using the female sexual function index (FSFI-6) questionnaire, which assesses sexual function in the form of sexual disorder, sexual dysfunction, desire disorders, stimulation, orgasm disorders, and pain. The study was conducted in September-November 2018 in Dr. Cipto Mangunkusumo Hospital, Jakarta. The patients were divided into total and radical hysterectomy groups and whether castration was performed.

RESULTS

The total group had 71 total hysterectomy and 21 radical hysterectomy patients. Sexual dysfunction (radical hysterectomy 47.6%, n = 10/21; total hysterectomy 28.2%, n = 20/71; castration 33.8%, n = 24/71; and without castration 28.6%, n = 6/21); orgasmic disorders (total hysterectomy 28.2%, n = 20/71; radical hysterectomy 47.6%, n = 10/21; castration 33.8%, n = 24/71; without castration 28.6%, n = 6/21); and pain disorder (radical hysterectomy 28.6%, n = 6/21; compared with 9.9%, n = 7/71 total hysterectomy).

CONCLUSION

No significant differences were found between sexual function after radical hysterectomy and total hysterectomy, as well as between the castration groups. Based on these findings, sexual function is an important reference for health professionals to be considered in conducting counseling before and after surgery.

Long-Term Follow Up of Sexual Function and Steroid Levels in Women after Perimenopausal Hysterectomy with or without Concomitant Oophorectomy

Hysterectomy, most often performed because of bleeding disorders or uterine leiomyoma, is one of the most common major surgical procedures in women and is usually performed during the perimenopausal period on ages 45-55 years. Hysterectomy may be combined with bilateral salpingo-oophorectomy, as a risk-reducing procedure to minimize the risk of ovarian cancer. An open question is whether concomitant oophorectomy, with cessation of ovarian androgen secretion, has any long-term effects on sexual function. In the present prospective cohort study of women undergoing benign hysterectomy, the long-term (10-12 years) effects on sexual function and changes in sex hormone levels were investigated in women having undergone perimenopausal hysterectomy, with or without concomitant bilateral salpingo-oophorectomy. Originally, 491 women (mean age around 50 years) were operated with (patient preference) either only hysterectomy (HYST) or hysterectomy plus bilateral salpingo-oophorectomy (HYST + BSO), and 441 women (90%; HYST; n = 271 and HYST + BSO; n = 170) completed a one-year survey. In the present study, 185 women (42%) of the cohort with one-year follow up participated in the long-term follow up after 10-12 years. Follow-up was with the 10-item McCoy Female Sex Questionnaire and blood analysis of levels of testosterone, estradiol and sexual-hormone-binding globulin. The results showed that specific aspects of sexual function were lower after HYST + BSO compared to HYST 10-12 years after surgery. These lowered items were frequency of sexual fantasies, enjoyment of sexual activity, sexual arousal, and orgasmic frequency. No long-term differences in sex hormone levels were found between the two groups. In conclusion, some items related to sexual function were lower after HYST + BSO in a long-term perspective study, although the levels of testosterone were unaltered. This finding may have implications for clinical recommendations concerning prophylactic salpingo-oophorectomy or for hysterectomy during the perimenopausal age.

Effects of Surgical and Natural Menopause on Body Image, Self-Esteem, and Dyadic Adjustment: A Descriptive and Comparative Study

This study aimed to assess body image, self-esteem, and dyadic adjustment in surgically menopausal, naturally menopausal, and perimenopausal women. This descriptive and comparative study was conducted in the clinics and polyclinic of a university hospital with a total of 274 women: 91 in the surgical menopause, 91 in the natural menopause, and 92 in the perimenopause groups. An Individual Introduction Form, the Body Cathexis Scale (BCS), Rosenberg Self-Esteem Scale (RSES), and Dyadic Adjustment Scale (DAS) were used for data collection. The women in the surgical menopause group had significantly higher mean scores for RSES and BCS and lower mean scores for DAS than the women in the natural menopause and perimenopause groups, with the higher BCS and RSES scores indicating lower self-esteem and body satisfaction. A weak negative correlation was found among dyadic adjustment, self-esteem, and body image of women in the surgical menopause group. Results showed that body image, self-esteem, and dyadic adjustment in menopausal women were impaired. This impairment was greater in the surgical menopause group than in the natural menopause group. Additionally, the presence of comorbid chronic diseases, less education, and being overweight negatively affected dyadic adjustment in women. Clinicians' awareness of the importance of the psychological aspects of menopause and the difference in the effects of menopause transition on mental well-being (body image, self-esteem, and marital harmony) according to the occurrence of menopause will enable them to help patients cope more easily with this process.

Recovery time period and quality of life after hysterectomy

Background: Women who had undergone hysterectomy have to overcome problems related to sexual and reproductive health. They often suffer a decline in self-esteem due to sexual dysfunction and the inability to give birth, along with their quality of recovery. This study aims to describe the relationships between recovery time and the components of quality of life after hysterectomy.

D esign and methods: 103 women post-hysterectomy from several community-integrated health center in Surabaya were selected using the total sampling technique.

Results: Findings show that there is relationship between recovery time period and sexual activity (P=0.000). However, no significant relationship exists between recovery time period personal relationships and social support.

Conclusions: It is recommended that nurses should improve their social support for women and families during recovering, to avoid pathological stress and improve quality of life.

Does Type of Menopause Affect the Sex Lives of Women?

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.

Sexual Health in Menopause

Sexual function worsens with advancing menopause status. The most frequently reported symptoms include low sexual desire (40-55%), poor lubrication (25-30%) and dyspareunia (12-45%), one of the complications of genitourinary syndrome of menopause (GSM). Declining levels of sex steroids (estrogens and androgens) play a major role in the impairment of sexual response; however, psychological and relational changes related with aging and an increase in metabolic and cardiovascular comorbidities should also be taken into account. Although first-line therapeutic strategies for menopause-related sexual dysfunction aim at addressing modifiable factors, many hormonal and non-hormonal, local and systemic treatment options are currently available. Treatment should be individualized, taking into account the severity of symptoms, potential adverse effects and personal preferences.

Sexual Function Under Adequate Estrogen Therapy in Women After Oophorectomy Versus Natural Menopause

Background: There is scarce evidence regarding endogenous postmenopausal ovarian testosterone (T) production and estrogen replacement roles in different sexual domains. This study aimed to determine whether lower endogenous T in oophorectomized women that were estradiol (E2)-treated influenced global or specific domains of sexual function. Depressive and cognitive symptoms were evaluated to exclude potential confounders. Materials and Methods: Eighty-one recently postmenopausal women treated with transdermal E2, 36 with bilateral oophorectomy (O), and 45 controls (C) were investigated through hormonal profile, Female Sexual Function Index, Mini Mental, and Beck Depression Inventory. Results: T levels, as expected, were lower in O than in C (p = 0.001); nonetheless, O presented a lower risk of sexual dysfunction (55.6% vs. 85.7%, p = 0.037), due to less pain (p = 0.005), increased lubrication (p = 0.012), and satisfaction (p = 0.042). O, however, required 50% higher E2 gel doses to control vasomotor symptoms (VMS) than did C. In O, all T measurements were positively, although weakly, correlated with desire (r = 0.374-0.381, p = 0.016-0.024). E2 levels were positively correlated with arousal in all women (r = 0.338, p = 0.038) and in O (r = 0.521, p = 0.032). Depression and cognition scores did not differ between the groups. Conclusions: Despite lower T levels, O women receiving E2 therapy had better global sexual function. Earlier onset and longer E2 treatment could have prevented vulvovaginal atrophy in O. Oophorectomized patients may require higher doses of E2 replacement. E2 levels, achieved by appropriate hormone therapy for VMS control, and very low T levels correlated with distinct sexual domains and may act in complementary areas of sexuality in postmenopausal women.

Long-term experience with a novel uterine-sparing transvaginal mesh procedure for uterovaginal prolapse

OBJECTIVES

To evaluate outcomes and quality of life in patients operated transvaginally with an original mesh shape for uterus-sparing prolapse surgery and to demonstrate the safety and efficacy of the technique.

STUDY DESIGN

We prospectively evaluated 66 postmenopausal patients (POP-Q Stage III: 32, IV: 34) operated between May 2008 and December 2013. We used wide weave polypropylene monofilament mesh that functions as a hammock anchored posteriorly to sacrospinous ligaments, its anterior wings exit the pelvis through the obturatory membrane. Follow-up was scheduled at 3-, 12- months and in May 2016. Prolapse-Quality of Life Questionnaire (P-QoL) was administered preoperatively, at 12 months and in May 2016. The chi square and Wilcoxon test were used for statistical analysis.

RESULTS

Mean follow-up was 5.6 (SD: 1.6, Range: 1.1-8.1) years. The overall success rate (POP-Q ≤ 2) was 92.5% at 12 months and 84.4% at May 2016, these data remained stable over time (p > 0.05). Early complications occurred in 2 (3%) patients, late in 5 (7.8%) of which mesh extrusion in 4 (6.3%). Data from P-QoL showed significant improvement between preoperative and postoperative data (P < 0.01 for all domains) and they remained stable with time (p > 0.05). De-novo dyspareunia was 17.6% at 12 months and 10.3% at May 2016.

CONCLUSIONS

The low rate and grade of complications demonstrates the safety of the procedure, which offers stable anatomical correction with significant improvement in QoL.

Women's sexual dysfunction associated with psychiatric disorders and their treatment

Impairment of mental health is the most important risk factor for female sexual dysfunction. Women living with psychiatric illness, despite their frequent sexual difficulties, consider sexuality to be an important aspect of their quality of life. Antidepressant and antipsychotic medication, the neurobiology and symptoms of the illness, past trauma, difficulties in establishing relationships and stigmatization can all contribute to sexual dysfunction. Low sexual desire is strongly linked to depression. Lack of subjective arousal and pleasure are linked to trait anxiety: the sensations of physical sexual arousal may lead to fear rather than to pleasure. The most common type of sexual pain is 10 times more common in women with previous diagnoses of anxiety disorder. Clinicians often do not routinely inquire about their patients' sexual concerns, particularly in the context of psychotic illness but careful assessment, diagnosis and explanation of their situation is necessary and in keeping with patients' wishes. Evidence-based pharmacological and non-pharmacological interventions are available but poorly researched in the context of psychotic illness.

Repercussões da Menopausa para a Sexualidade de Idosas: Revisão Integrativa da Literatura

Resumo A menopausa representa transformações hormonais significativas que podem ser acompanhadas de mudanças sociais e emocionais. Além disso, a população idosa feminina tem apresentado maiores comprometimentos em relação à sexualidade do que os homens. Este estudo teve por objetivo apresentar uma revisão integrativa da literatura científica nacional e internacional sobre as possíveis repercussões da menopausa para a sexualidade de idosas. As buscas foram realizadas nas bases Lilacs, SciELO, PePSIC e PsycINFO com análise da produção científica nacional e internacional relativa ao período de janeiro de 2006 a março de 2016. Foram analisadas 36 produções na íntegra cujo perfil predominante é de estudos quantitativos, descritivos e transversais, desenvolvidos com mulheres de diferentes faixas etárias na pós-menopausa, incluindo idosas. Todavia, estudos com amostras compostas exclusivamente por idosas são minoria. Entre os resultados houve predominância de pesquisas voltadas para a avaliação e quantificação das possíveis patologias e sintomas biológicos que afetam a sexualidade (redução da libido, de lubrificação e de orgasmos, por exemplo). A maioria das pesquisas aponta para a importância da análise conjunta de aspectos biológicos, psicológicos, sociais, culturais e individuais para a compreensão das suas distintas influências na sexualidade das idosas. Destaca-se a necessidade de realização de pesquisas com abordagem mista e voltadas apenas para mulheres idosas a fim de ampliar a compreensão acerca das suas perspectivas sobre as repercussões da menopausa para a sexualidade pretendendo respaldar práticas clínicas e políticas sociais destinadas a essa população.

Sexual health in Spanish postmenopausal women presenting at outpatient clinics

OBJECTIVE

One of the most common complaints among postmenopausal women is a change in sexual drive. The aim of this study was to assess the current state of sexual health in Spanish postmenopausal women who present at outpatient gynecology clinics.

METHOD

In this multicenter, observational, cross-sectional, questionnaire-based study, a survey was conducted that included 3026 Spanish postmenopausal women in a routine clinical setting in outpatient gynecology clinics at public and private institutions throughout Spain. We used the Women's Sexual Function questionnaire, which has been validated in Spain.

RESULTS

In the multivariate analysis, we found that the best indicators of sexual health in postmenopausal women were a higher education (p < 0.001), working or previously worked (p < 0.001), a stable partner (p < 0.001), living in an urban area (p < 0.01), healthy habits and received information about menopause (p < 0.001).

CONCLUSION

These results indicate that it is important to provide health education and information about menopause and the complaints associated with this period in a woman's life.