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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.
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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
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Malaijerdi R, Amini L, Haghani H, Sadeghi Avval Shahr H. Investigating the relationship between menopausal women's health anxiety and sexual performance and attitude towards menopause. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:199. [PMID: 37546008 PMCID: PMC10402768 DOI: 10.4103/jehp.jehp_925_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/24/2022] [Indexed: 08/08/2023]
Abstract
BACKGROUND Menopause is a natural event in the life of women. Women's concerns during menopause and the role of health anxiety in the attitude and sexual performance of women during this period affect the quality of life. Therefore, the present study was conducted with the aim of determining the relationship between health anxiety and sexual performance and attitude towards menopause in postmenopausal women. MATERIALS AND METHODS The present study was a cross-sectional study of communication type that was conducted on 200 postmenopausal women with records in Sabzevar Comprehensive Health Centers in 2021-2022. In order to collect information, standard questionnaires of health anxiety, attitude towards menopause, and sexual performance were used. The collected data were analyzed by SPSS version 16 software and descriptive and analytical statistical tests (Spearman). A significance level of less than 0.05 was considered. RESULT The results of data analysis showed that health anxiety has a significant relationship with the dimensions of desire (p = 0.045 and r = -0.142) and sexual pain (p < 0.001 and r = 0.274). Also, there was a significant relationship between the attitude towards menopause with sexual performance (p < 0.001 and r = 0.244) and health anxiety with the attitude towards menopause (p < 0.001 and r = 0.27). CONCLUSION The results of this study showed that there is an inverse relationship between health anxiety and sexual desire and a significant direct relationship with sexual pain. Also, the attitude towards menopause has a significant direct relationship with sexual behavior and health anxiety. Therefore, it is suggested to pay attention to the mental health of postmenopausal women along with the physical aspect and to pay attention to educational programs to improve the care and health programs of these women.
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Affiliation(s)
- Raziyeh Malaijerdi
- MSc Student of Midwifery, Midwifery Department, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Amini
- PhD, Midwifery Department, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Haghani
- PhD, Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Homa Sadeghi Avval Shahr
- PhD, Midwifery Department, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
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Dilixiati D, Kadier K, Laihaiti D, Lu JD, Rezhake R, Azhati B, Rexiati M. The relationship between sleep disorders, quality, and duration and sexual dysfunction: a systematic review and meta-analysis. J Sex Med 2023:7143630. [PMID: 37186140 DOI: 10.1093/jsxmed/qdad054] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/24/2023] [Accepted: 03/24/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND The associations between sexual dysfunction (SD) and sleep disorders, sleep quality, and sleep duration remain unclear. AIM To assess the relationship between sleep and SD through a literature review and meta-analysis. METHODS The PubMed, Scopus, Embase, Ovid MEDLINE, and Cochrane Library databases were systematically searched from inception to November 10, 2022. OUTCOMES Pooled relative risks and 95% CIs were used to examine the association of sleep disorders with SD in longitudinal studies. Pooled odds ratios (ORs) and 95% CIs were used to examine the associations between SD and sleep disorders, sleep quality, and sleep duration in cross-sectional studies. RESULTS Forty-three articles, including 11 longitudinal studies and 32 cross-sectional studies, were included in the quantitative analysis. The pooled relative risk of SD in patients with sleep disorders was 1.97 in longitudinal studies (95% CI, 1.46-2.67, P < .001; heterogeneity: I2 = 95.0%, P < .001), while the pooled OR of SD in patients with sleep disorders was 2.05 in cross-sectional studies (95% CI, 1.76-2.39, P < .001; heterogeneity: I2 = 91.4%, P < .001). When compared with controls, subjects with poor sleep quality had a 1.49-fold increased risk of SD (OR, 1.49; 95% CI, 1.31-1.71, P < .001; heterogeneity: I2 = 73.4%, P < .001). In addition, short sleep duration was associated with the risk of SD (OR, 1.14; 95% CI, 1.06-1.22, P < .001; heterogeneity: I2 = 0.0%, P = .849). CLINICAL IMPLICATIONS The risk of SD is significantly increased in patients with sleep disorders and poor sleep quality, indicating that clinicians should monitor sleep among patients with SD. STRENGTHS AND LIMITATIONS This study is the most comprehensive meta-analysis of the association between sleep and SD to date. However, different sleep disorders may have varying associations with sleep duration and sleep quality; thus, we could not identify the independent effects across the studies. CONCLUSION Our systematic review and meta-analysis results suggest that sleep disorders, especially obstructive sleep apnea, increase the risk of SD in men and women. Poor sleep quality is significantly associated with SD. Short sleep duration is associated with an increased risk of SD.
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Affiliation(s)
- Diliyaer Dilixiati
- Department of Urology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
- Xinjiang Clinical Medical Research Center of Urogenital Diseases, Urumqi 830054, China
| | - Kaisaierjiang Kadier
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Duolikun Laihaiti
- Department of Joint Surgery, Changji Branch of First Affiliated Hospital of Xinjiang Medical University, Changji 831199, China
| | - Jian-De Lu
- Department of Urology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
- Xinjiang Clinical Medical Research Center of Urogenital Diseases, Urumqi 830054, China
| | - Remila Rezhake
- Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi 830017, China
| | - Baihetiya Azhati
- Department of Urology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
- Xinjiang Clinical Medical Research Center of Urogenital Diseases, Urumqi 830054, China
| | - Mulati Rexiati
- Department of Urology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
- Xinjiang Clinical Medical Research Center of Urogenital Diseases, Urumqi 830054, China
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The Relationship Between Sleep and Sexual Function in Women. CURRENT SEXUAL HEALTH REPORTS 2022. [DOI: 10.1007/s11930-022-00347-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Ballot O, Ivers H, Ji X, Morin CM. Sleep Disturbances During the Menopausal Transition: The Role of Sleep Reactivity and Arousal Predisposition. Behav Sleep Med 2022; 20:500-512. [PMID: 34176385 DOI: 10.1080/15402002.2021.1937171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Sleep disturbances are common during the menopausal transition and several factors can contribute to this increased incidence. This study examined the association between sleep reactivity, arousal predisposition, sleep disturbances, and menopause. METHODS Data for this study were derived from a longitudinal, population-based study on the natural history of insomnia. A total of 873 women (40-60 years) were divided into two groups according to their menopausal status at baseline: reproductive (n = 408) and postmenopausal (n = 465). Participants were evaluated annually throughout the five-year follow-up period. Four questionnaires were used to examine sleep quality, insomnia severity, sleep reactivity, and arousal predisposition. The data were analyzed using two approaches: cross-sectional with a multivariate analysis and binary regression, and longitudinal with a linear mixed models using menopausal groups (3) x time (5) design. RESULTS Cross-sectional analyses showed that postmenopausal women reported significantly more severe insomnia and poorer sleep quality than reproductive women. Sleep reactivity and arousal predisposition were significant predictors of sleep disturbances. Longitudinal analyses revealed increased sleep disturbances in the two years before and after the menopausal transition. Sleep reactivity and arousal predisposition did not moderate the temporal relationship between menopausal transition and sleep disturbances. CONCLUSION More sleep disturbances were reported during the menopausal transition, but those difficulties were not explained by sleep reactivity and arousal predisposition. These results suggest the involvement of other psychophysiological factors in the development of sleep disturbances during the menopause.
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Affiliation(s)
- O Ballot
- École de Psychologie, Université Laval, Québec, QC, Canada
| | - H Ivers
- École de Psychologie, Université Laval, Québec, QC, Canada
| | - X Ji
- École de Psychologie, Université Laval, Québec, QC, Canada
| | - C M Morin
- École de Psychologie, Université Laval, Québec, QC, Canada
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McHugh J, Alexander M, Kudesia R, Krant J, Comander A, Tollefson M, Geyer C. Living Your Best Life: Lifestyle Medicine for All Women. Am J Lifestyle Med 2022; 16:577-588. [PMID: 36072687 PMCID: PMC9442465 DOI: 10.1177/15598276221087677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In an era of ever-increasing healthcare expenditures, yet simultaneously worsening outcomes, many of our patients choose between traditional medical care or often unproven alternative therapies. While the recognition of lifestyle change in addressing cardiovascular and metabolic disease grows, there is less understanding of the impact of lifestyle change on issues facing women every day. Millions of women around the globe struggle with infertility, cancer, sexual dysfunction, and dermatologic needs. Yet, research on the benefits of lifestyle change on these conditions is scarce, and gaps exist both in our understanding of evidence-based approaches to address these issues, as well as adequate provider education when evidence exists. The Women’s Health Member Interest Group convened medical experts in these areas that affect women’s lives to provide insights and meaningful education applicable not only for our patients, but also in our own lives.
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Affiliation(s)
- John McHugh
- USC Keck School of Medicine, Corona del Mar, CA, USA
- Boston University School of Medicine, Las Vegas, NV, USA
- CCRM Fertility Houston & Houston Methodist Hospital, Houston, TX, USA
- SUNY Downstate Medical Center, New York, NY, USA
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Megan Alexander
- USC Keck School of Medicine, Corona del Mar, CA, USA
- Boston University School of Medicine, Las Vegas, NV, USA
- CCRM Fertility Houston & Houston Methodist Hospital, Houston, TX, USA
- SUNY Downstate Medical Center, New York, NY, USA
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Rashmi Kudesia
- USC Keck School of Medicine, Corona del Mar, CA, USA
- Boston University School of Medicine, Las Vegas, NV, USA
- CCRM Fertility Houston & Houston Methodist Hospital, Houston, TX, USA
- SUNY Downstate Medical Center, New York, NY, USA
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Jessica Krant
- USC Keck School of Medicine, Corona del Mar, CA, USA
- Boston University School of Medicine, Las Vegas, NV, USA
- CCRM Fertility Houston & Houston Methodist Hospital, Houston, TX, USA
- SUNY Downstate Medical Center, New York, NY, USA
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Amy Comander
- USC Keck School of Medicine, Corona del Mar, CA, USA
- Boston University School of Medicine, Las Vegas, NV, USA
- CCRM Fertility Houston & Houston Methodist Hospital, Houston, TX, USA
- SUNY Downstate Medical Center, New York, NY, USA
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Michelle Tollefson
- USC Keck School of Medicine, Corona del Mar, CA, USA
- Boston University School of Medicine, Las Vegas, NV, USA
- CCRM Fertility Houston & Houston Methodist Hospital, Houston, TX, USA
- SUNY Downstate Medical Center, New York, NY, USA
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Cynthia Geyer
- USC Keck School of Medicine, Corona del Mar, CA, USA
- Boston University School of Medicine, Las Vegas, NV, USA
- CCRM Fertility Houston & Houston Methodist Hospital, Houston, TX, USA
- SUNY Downstate Medical Center, New York, NY, USA
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
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Creff G, Jegoux F, Bendiane MK, Babin E, Licaj I. Social and sexual health of thyroid cancer survivors 2 and 5 years after diagnosis: the VICAN survey. Support Care Cancer 2021; 30:2777-2785. [PMID: 34837541 DOI: 10.1007/s00520-021-06715-7] [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: 03/06/2021] [Accepted: 11/19/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Thyroid cancer (TC) incidence is increasing. With its good prognosis and the young population concerned, the number of survivors is rising. However, their quality of life appears worse than expected. This study aims to assess the social and sexual health (SSH) of TC survivors and associated factors after a 2- and 5-year follow-up. METHODS This study belongs to the National VICAN Survey implemented in France among TC patients diagnosed between January and June 2010. Data were collected via phone interviews, medical surveys, and from medico-administrative register in 2012 and 2015. We used multivariable logistic regressions to qualify TC impact on SSH. RESULTS Across 146 patients, 121 were women, 50.7% were less than 42 years old, 77.5% were diagnosed at an early-stage, and 97.6% underwent thyroidectomy. At 2 years, 60.0% experienced social life discomfort because of cancer, 40.6% reported a decreased sexual desire, 37.4% fewer intercourse, 31.9% felt dissatisfied with this frequency, 30% reported difficulties achieving orgasm, and 15.2% considered that cancer had a negative influence for procreation. No significant difference was observed at 5 years. SSH was never discussed with medical professionals for 96.7% patients, as it was not proposed as a topic of concern (79.1%). In multivariable analysis, depression, embarrassment regarding their physical appearance since treatment, and reduced gestures of affection remained associated with decreased sexual desire. CONCLUSION This study highlights that TC is associated with an alteration of SSH which remains even at 5 years post-diagnosis. SSH should be discussed during diagnosis and considered during follow-up.
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Affiliation(s)
- Gwenaelle Creff
- Department of Otolaryngology Head and Neck Surgery, Rennes University Hospital, 35000, Rennes, France.
| | - Franck Jegoux
- Department of Otolaryngology Head and Neck Surgery, Rennes University Hospital, 35000, Rennes, France
| | | | - Emmanuel Babin
- Head and Neck Department, University Hospital Centre Caen, Caen, France
- Cancer & Cognition Platform, Ligue Contre Le Cancer, Caen, France
| | - Idlir Licaj
- Cancer & Cognition Platform, Ligue Contre Le Cancer, Caen, France
- Clinical Research Department, Centre François Baclesse, Caen, France
- Department of Community Medicine, Faculty of Health Sciences, The UiT Arctic University of Norway, Tromsø, Norway
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Schaedel Z, Holloway D, Bruce D, Rymer J. Management of sleep disorders in the menopausal transition. Post Reprod Health 2021; 27:209-214. [PMID: 34748453 DOI: 10.1177/20533691211039151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The menopausal transition is associated with increasing sleep disorders including sleep apnoea and restless leg syndrome. Insomnia is the most common and is recognised as a core symptom of the menopause. Guidelines to support decision making for women with sleep problems during the menopausal transition are lacking. Sleep problems are associated with negative impacts on healthcare utilisation, quality of life and work productivity. Sleep deprivation is a risk factor for cardiovascular disease, diabetes, obesity and neurobehavioral dysfunction. Declining oestrogen is implicated as a cause of menopausal sleep disruption. Vasomotor symptoms (VMS) and menopausal mood disturbance are also factors in the complex aetiology. VMS commonly precipitate insomnia and, due to their prolonged duration, they often perpetuate the condition. Insomnia in the general population is most effectively treated with cognitive behavioural therapy (CBT) (also effective in the menopausal transition.) The associations of menopausal sleep disturbance with VMS and depression mean that other treatment options must be considered. Existing guidelines outline effectiveness of hormone replacement therapy (HRT), CBT and antidepressants. HRT may indirectly help with sleep disturbance by treating VMS and also via beneficial effect on mood symptoms. The evidence base underpinning menopausal insomnia often references risks associated with HRT that are not in line with current international menopause guidelines. This may influence clinicians managing sleep disorders, leading to hesitation in offering HRT, despite evidence of effectiveness. Viewing sleep symptoms on an axis of menopausal symptoms - towards vasomotor symptoms or towards mood symptoms may help tailor treatment options towards the symptom profile.
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Zwerling B, Keymeulen S, Krychman ML. Sleep and Sex: A Review of the Interrelationship of Sleep and Sexuality Disorders in the Female Population, Through the Lens of Sleeping Beauty Syndrome. Sex Med Rev 2020; 9:221-229. [PMID: 33023862 DOI: 10.1016/j.sxmr.2020.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/10/2020] [Accepted: 08/16/2020] [Indexed: 01/25/2023]
Abstract
INTRODUCTION For many, sleep and sex are crucial for physical, emotional, and mental well-being. Poor sleep quality is linked to a myriad of ailments from coronary artery disease to major depressive disorder. Likewise, a decrease in the frequency of sexual activity is associated with a decrease in self-rated health status. Kleine-Levin syndrome (KLS) is a rare sleep disorder that provides a unique lens to examine the intricate interplay between sleep and sex as it is one of the few sleep disorders defined by concomitant sexual dysfunction. OBJECTIVES This study reviews the literature on links between sleep disorders and sexuality with a focus on women's health followed by a case study of unusual patient with KLS with persistent genital arousal disorder. METHODS Literature searches were conducted for English language publications, including foreign language publications with English abstracts with ninety-five articles reviewed. The literature review is followed by a case report. RESULTS We review the known literature linking sleep and women's sexual health with a focus on insomnia, circadian rhythm sleep disorder, obstructive sleep apnea, restless leg syndrome, sexsomnia, and KLS. We then present a case of KLS-associated persistent genital arousal disorder, which was amenable to treatment with a multimodal approach aimed at symptomatic relief with intravaginal diazepam suppositories, topical clitoral lidocaine, and duloxetine. CONCLUSION This case highlights that hypersexuality and persistent arousal cannot effectively be treated in isolation but rather must be contextualized within a patient's broader medical history and diagnoses. Specifically, sleep quality and potential sleep disorders should be assessed for those presenting with sexual health complaints (and vice versa). Zwerling B, Keymeulen S, Krychman ML. Sleep and Sex: A Review of the Interrelationship of Sleep and Sexuality Disorders in the Female Population, Through the Lens of Sleeping Beauty Syndrome. Sex Med Rev 2021;9:221-229.
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Affiliation(s)
- Blake Zwerling
- Department of Obstetrics & Gynecology, University of California, Irvine, Orange, CA, USA
| | - Sawa Keymeulen
- School of Medicine, University of California, Irvine, Orange, CA, USA
| | - Michael L Krychman
- Department of Obstetrics & Gynecology, University of California, Irvine, Orange, CA, USA.
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Bülbül T, Mucuk S, Dolanbay M, Turhan İ. Do complaints related to menopause affect sexuality and marital adjustment? SEXUAL AND RELATIONSHIP THERAPY 2020. [DOI: 10.1080/14681994.2020.1813886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Tülay Bülbül
- Faculty of Health Sciences, Department of Obstetrics and Gynecology Nursing, Erciyes University, Kayseri, Turkey
| | - Salime Mucuk
- Faculty of Health Sciences, Department of Obstetrics and Gynecology Nursing, Erciyes University, Kayseri, Turkey
| | - Mehmet Dolanbay
- Faculty of Medicine, Department of Obstetrics and Gynecology, Erciyes University, Kayseri, Turkey
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