Quality of life among women with sexual dysfunction undergoing hemodialysis: a cross-sectional observational study

Effect of Cold Dialysis Solution on the Sexual Dysfunction of Patients with Chronic Renal Failure Undergoing Hemodialysis: A Randomized Clinical Trial

Background: The present study aimed to evaluate the effect of cold dialysis solution on the sexual dysfunction of patients with chronic renal failure undergoing hemodialysis. Methods: This randomized clinical trial was conducted with a before and after parallel design among 60 hemodialysis patients diagnosed with sexual dysfunction. The selected subjects were randomly allocated to the two groups of experimental and control (30 per each). Patients in the experimental and control groups underwent hemodialysis for one month using 35.5°C and 37°C dialysis solutions, respectively. Following the procedure, male and female sexual function was assessed in the study groups. Data were collected using the International Index of Erectile Functions, the female sexual function index (FSFI), and a demographic questionnaire. Data analysis was performed using Chi-square, Fisher's exact test, Mann-Whitney U test, t-test, paired t-test, and Wilcoxon test at 95% confidence interval. Results: No significant difference was observed between the experimental and control groups regarding male sexual function before and after the intervention (P > 0.05). However, the Mann-Whitney U test indicated a significant difference in the female subjects’ arousal in the experimental group before (3.68 ± 0.38) and after the intervention (3.98 ± 0.46; z = 2.216; P = 0.027). Conclusions: Cold dialysis solution could only increase the sexual arousal of the women in the experimental group, and no changes were observed in other sexual function domains of the male and female patients. Given the short duration of our intervention, it is recommended that further longitudinal studies be performed on larger cohorts of patients in different geographical regions.

Sexual Dysfunction and Associated Anxiety and Depression in Female Hemodialysis Patients: A Cross-Sectional Study at Karachi Institute of Kidney Diseases

Objectives

Hemodialysis patients have to combat certain negative effects such as sexual dysfunction, depression, and anxiety. This study aimed to measure the sexual function and identify the relationship between sexual dysfunction, depression, and anxiety in females undergoing hemodialysis.

Methods

The descriptive, cross-sectional study was conducted at a dialysis unit in November 2019. Forty-eight females were enrolled in the study. Participants were interviewed for sociodemographic, clinical, and biochemical parameters. Sexual function was assessed through the Female Sexual Function Index (FSFI) while depression and anxiety scores were calculated using the hospital anxiety and depression scale (HADS).

Results

In this study, the mean age of patients was 44.60 ± 10.27 years. Median sexual function scores were low across all domains. A maximum possible score of 3.4 was calculated for the satisfaction domain while the minimum score calculated was 0 for arousal, lubrication, and orgasm. 14.6% and 45.8% were suffering from borderline abnormal and abnormal depression, respectively. However, 33.3% and 31.3% had borderline abnormal and abnormal anxiety, respectively. Pearson’s correlation showed a significant negative correlation between age and desire domain (r = -0.343; p < 0.05) and demonstrated that arousal, lubrication, orgasm, satisfaction, and pain domains were associated with borderline abnormal depression. None of the sexual domains were correlated with anxiety.

Conclusions

Sexual dysfunction, depression, and anxiety are highly prevalent in hemodialysis patients. In this study, borderline abnormal depression was independently linked to sexual dysfunction excluding sexual desire. Therefore, healthcare teams should keep up with the progress of their patients and evaluate for psychosexual health so that they can be timely managed.

Partner status moderates the relationships between sexual problems and self-efficacy for managing sexual problems and psychosocial quality-of-life for postmenopausal breast cancer survivors taking adjuvant endocrine therapy

OBJECTIVE

Past studies indicate that >90% of breast cancer survivors taking adjuvant endocrine therapy (AET) experience menopausal symptoms including sexual problems (eg, vaginal dryness, dyspareunia); however, research examining the impact of these problems on quality-of-life is limited. This cross-sectional study examined (1) the impact of sexual problems and self-efficacy for coping with sexual problems (sexual self-efficacy) on quality-of-life (ie, psychosocial quality-of-life and sexual satisfaction), and (2) partner status as a moderator of these relationships.

METHODS

Postmenopausal breast cancer survivors taking AET completed measures of sexual problems (Menopause-Specific Quality-of-Life [MENQOL] sexual subscale], sexual self-efficacy, psychosocial quality-of-life (MENQOL psychosocial subscale), and sexual satisfaction (Functional Assessment of Cancer Therapy-General item).

RESULTS

Bivariate analyses showed that women reporting greater sexual problems and lower sexual self-efficacy had poorer quality-of-life and less sexual satisfaction (all P-values < 0.05). Partner status moderated the relationship between sexual problems and psychosocial quality-of-life (P = 0.02); at high levels of sexual problems, unpartnered women experienced poorer psychosocial quality-of-life than partnered women. Partner status also moderated the relationship between self-efficacy and psychosocial quality-of-life (P = 0.01). Self-efficacy was unrelated to psychosocial quality-of-life for partnered women; for unpartnered women, low self-efficacy was associated with poorer quality-of-life. Partner status did not moderate the relationships between sexual problems or self-efficacy with sexual satisfaction.

CONCLUSIONS

Greater sexual problems and lower sexual self-efficacy were associated with poorer psychosocial quality-of-life and sexual satisfaction among postmenopausal breast cancer survivors taking AET. Interventions to address sexual problems and sexual self-efficacy, particularly among unpartnered women, may be beneficial for improving the well-being of postmenopausal breast cancer survivors on AET.

Prevalence of female sexual dysfunction in Brazil: A systematic review

The aim of this systematic review is to investigate the prevalence of female sexual dysfunction in the Brazilian population. This is a systematic review conducted in July 2016 in which four databases were searched: MEDLINE/Pubmed, Scopus, LILACS, and Cinahl. Two investigators extracted the primary data, which were fully analyzed, and applied the inclusion/exclusion criteria. The search found 113 results, and 20 of them compounded the scope of this study. Only four of the studies showed good methodology quality. The main diagnostics criteria used were validated questionnaires specific for sexual function assessment. Regarding the variation of prevalence values, female sexual dysfunction ranged from 13.3% to 79.3% of the studied population, while this value for changes in sexual desire ranged from 11% to 75%, arousal from 8% to 68.2%, lubrication from 29.1% to 41.4%, orgasm from 18% to 55.4%, and satisfaction from 3.3% to 42%; sexual activity frequency ranged from 55.8% to 78.5%, dyspareunia from 1.2% to 56.1%, and pleasure modifications was not addressed. Beside the divergences among studies, there is still a high prevalence of female sexual dysfunction in Brazil.

Discussing Sexual Dysfunction with Chronic Kidney Disease Patients: Practice Patterns in the Office of the Nephrologist

INTRODUCTION

Sexual dysfunction (SD) is a common problem in patients suffering from chronic kidney disease (CKD). Sexual health remains a difficult subject to detect and discuss. Although many studies have been performed on the incidence of SD, little is known about practice patterns when it concerns quality of life (QoL)-related questions such as SD in the nephrologists' practice.

AIM

The aim of this study was to determine to which extent nephrologists, important renal care providers, discuss SD with their patients and their possible barriers toward discussing this subject.

METHODS

A 50-item questionnaire was sent to all Dutch nephrologists (n = 312).

MAIN OUTCOME MEASURES

The survey results.

RESULTS

The response rate of the survey was 34.5%. Almost all responders (96.4%) stated to address SD in less than half of their new patients. The most important barrier not to discuss SD was patients not expressing their concern regarding SD spontaneously (70.8%). Other important barriers were: "the lack of a suitable moment to discuss" (61.9%) and "insufficient time" (46.9%). Eighty-five percent of the nephrologists stated that insufficient attention was paid to SD and treatment options during their training. Sixty-five percent of the respondents stated to be in need of extending their knowledge on the discussing of SD.

CONCLUSIONS

Dutch nephrologists do not discuss problems with sexual function routinely. The lack of knowledge, suitable education, and insufficient time are factors causing undervaluation of SD in CKD patients. Implementation of competent sexual education and raising awareness among nephrologists on the importance of paying attention to SD could improve care and QoL for patients with CKD. More research should be performed among patients and other renal care providers to develop an adequate method to enhance our current system.

Evaluation of sexual dysfunction in women with type 2 diabetes

BACKGROUND

Sexual dysfunction is a common complication of diabetes that adversely affects their quality of life. Its prevalence is known to be higher in diabetic men with and it is estimated to affect 20-85% of patients but the problem is probably less common in diabetic women. This study investigated the prevalence of sexual dysfunction and its risk factors among women with diabetes.

MATERIALS AND METHODS

This descriptive-analytic study was performed during May 2012 to Feb 2013 at Diabetes clinic of Shahid Beheshti Hospital of Qom and The Female Sexual Function Index (FSFI) was used for evaluation of sexual dysfunction.

CONCLUSION

In this study, 59 (53.6%) women had sexual dysfunction. The mean age of patients with sexual dysfunction and healthy people was 48.22 ± 6.61 and 48.14 ± 5.37 years respectively and it was not statistically different in both groups (P = 0.94). Also, there was no significant difference between two groups in average duration of diabetes, fasting blood sugar (FBS), glycosylated hemoglobin (HbA1c) level, insulin resistance, abdominal circumference and body mass index BMI. Although the history of hypertension, coronary artery disease and exercise levels were not significantly associated with sexual dysfunction, but there was a significant association between albuminuria and sexual dysfunction (P = 0.001). Retinopathy and sexual dysfunction had statistically significant relationship (P = 0.007) while no association was found between diabetic neuropathy and sexual dysfunction (P = 0.79).

RESULTS

Sexual dysfunction is a common complication in diabetic patients which accompanies with some complications of diabetes and should be considered especially in patients with nephropathy or retinopathy.

Impact of iron supplementation on sexual dysfunction of women with iron deficiency anemia in short term: a preliminary study

INTRODUCTION

Iron deficiency anemia (IDA) is a common micronutrient deficiency worldwide. It is an important health problem especially in women of reproductive age. IDA may cause anxiety, which is the major factor for female sexual dysfunction (FSD).

AIM

The aim of the present study was to determine the impact of IDA on FSD in women of reproductive age.

METHODS

In total, 207 women were enrolled. Women with IDA who were admitted in an outpatient clinic of family medicine were asked to complete Beck Anxiety Inventory (BAI), Female Sexual Function Index (FSFI), and Quality of Life (QoL) questionnaires. Questionnaires were completed before and after IDA treatments. Blood samples were obtained for measurements of hemoglobin, hematocrit, levels of serum iron, and iron-binding capacity.

MAIN OUTCOME MEASURES

Outcomes of blood samples were used for diagnosing of IDA. BAI, FSFI, and QoL scores were evaluated. Paired samples t-tests and Pearson correlation analyses were used to assess relationship between findings of IDA treatments and other parameters.

RESULTS

The mean age was 33.6 ± 8.4 years. There were statistical significant differences between pre- and posttreatment in terms of hemoglobin, hematocrit, serum iron, and serum iron-binding capacity. BAI scores were decreased and FSFI scores, which were statistically significant, increased after IDA treatments (P < 0.001). However, QoL scores were developed without statistical significance.

CONCLUSION

There is a risk for anxiety as well as FSD in IDA women of reproductive age. Treatment of IDA can significantly improve sexual functions and QoL in these women population in short term.

Women and ESRD: modalities, survival, unique considerations

Women currently constitute 44.3% of prevalent patients on hemodialysis and 47% of those on peritoneal dialysis. Women on dialysis do not experience the survival benefit seen in those not on dialysis. This loss of a survival advantage is partially related to a lower cardiovascular survival benefit along with a higher noncardiovascular mortality rate compared with their male counterparts. Of particular concern is the markedly higher mortality rates seen in women less than 45 years of age on dialysis. There are several female hormonal abnormalities in the female dialysis patient that can result in menstrual irregularities, anovulation, infertility, sexual dysfunction, early menopause, accelerated bone loss, and potentially increased risk of cardiovascular complications. Although fertility is impaired in dialysis, conception occurs in 1% to 7% of women of childbearing years on dialysis. Hence, all women with a potential for pregnancy should be counseled regarding the risks of pregnancy and contraceptive options. There are specific gynecologic considerations unique to peritoneal dialysis, including hemoperitoneum, decreased fertility, and uterine prolapse. Sexual dysfunction is commonly seen in the female dialysis population and is associated with depression and a lower quality of life; however, despite the high prevalence, it is generally not assessed nor is it treated. Depression is also common in the female dialysis population. Like sexual dysfunction, depression is underdiagnosed and undertreated in this population.