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Sexual Dysfunction in Middle-Aged Women: A Multicenter Latin American Study Using the Female Sexual Function Index Editorial Comment
Abstract
The purpose of this study was to assess the prevalence of sexual dysfunction (SD) and associated risk factors among middle-aged Latin American women using one validated instrument.
The Female Sexual Function Index (FSFI) was applied to 7,243 healthy women aged 40 to 59 years who were users of 19 healthcare systems from 11 Latin American countries. An itemized questionnaire containing personal and partner sociodemographic data was also filled out.
Mean +/- SD age of surveyed women was 49.0 +/- 5.7 years, with 11.6 years of schooling on average. There were 55.1% of women who were married, 46.8% who were postmenopausal, 14.1% who used hormonal therapy (HT), and 25.6% who were sexually inactive. Among those who were active (n = 5,391), the mean +/- SD total FSFI score was 25.2 +/- 5.9 and 56.8% of them presented SD (FSFI total score <or=26.55), with a prevalence varying from 21.0% to 98.5% depending on the center. Centers were grouped in terciles (according to mean +/- SD prevalence). The tercile with higher SD prevalence (86.4%) compared with that with lower SD prevalence (32.2%) had significantly older women (49.5 +/- 5.3 vs 48.0 +/- 5.6 y) with a higher rate of vaginal dryness (60.4% vs 40.8%) and older partners (53.0 +/- 6.9 vs 50.2 +/- 7.5 y). Similarly, there was a significantly higher rate of married (68.5% vs 63.1%), postmenopausal (49.7% vs 39.3%), and HT-using women (23% vs 9.2%). There were no differences in regard to their health perception, history of oophorectomy, rape, and partner SD rate (27% vs 26.2%). The total FSFI score was significantly lower in the tercile with higher SD prevalence (22.0 +/- 5.0 vs 27.5 +/- 5.4). Logistic regression analysis was used to determine the odds ratios (95% CIs) for the main risk factors associated with SD among those who were sexually active: bad lubrication, 3.86 (3.37-4.43); use of alternative menopausal therapies, 2.13 (1.60-2.84); partner SD, 1.89 (1.63-2.20); older women (>48 y), 1.84 (1.61-2.09); bladder problems, 1.47 (1.28-1.69); HT use, 1.39 (1.15-1.68); negative perception of female health status, 1.31 (1.05-1.64); and being married, 1.22 (1.07-1.40). Protective factors were higher educational level (women), partner faithfulness, and access to private healthcare.
The prevalence of SD in this middle-aged Latin American series was found to be high, varying widely in different populations. A decrease in vaginal lubrication was the most important associated risk factor. Differences in the prevalence of risk factors among the studied groups, several of which are modifiable, could explain the variation of SD prevalence observed in this study.
... In our study, older age remained associated with all domains and the total score of the FSFI in the multivariate analysis, which is consistent with previous reports [17,38]. Blümmel et al. [39], in a multicenter study carried out across 11 Latin American countries, reported that older age (over 48 years) was associated with a higher incidence of sexual dysfunction. As a matter of fact, the mean age in that study was markedly lower than in our sample, and their scores for every domain as well as for the total score of FSFI were higher. ...
... Menopause-related symptoms have been linked to reduced mental and physical quality-of-life scores, with a negative impact on personal and intimate relationships, occupational productivity, and activities of daily living [42,43]. Some studies have looked into the associations between the severity of menopausal symptoms and female sexual function [39,44,45], although as a general rule they do not include individuals over 65 years of age. It has been shown that climacteric symptoms influence female sexual function, significantly increasing the occurrence of sexual dysfunction and affecting the quality of life of middle-aged women [44]. ...
... Previous research has reported significant associations between sexual dysfunction and urogenital symptoms [39], and Chedraui et al. [45] suggested that sexual function was highly influenced by the urogenital function. The findings of the present study support these results, as the urogenital domain of MRS was the one displaying more associations with FSFI in the multivariate analysis. ...
The aim of this study was to examine female sexual functioning and its association with the impact of the symptoms of menopause among Spanish postmenopausal women. A total of 182 postmenopausal women (65.59 ± 7.93 years) participated in this cross-sectional study. The female sexual function index (FSFI) and the menopause rating scale (MRS) were used to analyze sexual function and severity of menopausal symptoms, respectively. Age, education, area of residence, occupation, and depression (Hospital Anxiety and Depression Scale) were considered as possible confounders. The results of a linear multivariate regression analysis showed that the severity of urogenital menopause-related symptoms was associated with lower values in the FSFI total score and the lubrication, satisfaction, arousal, and orgasm domains. These last three subscales were also linked to severe psychological impact, while the MRS total score was only related to the desire domain. Regarding confounders, being younger, working, and residing in a rural area were all linked to better sexual function. All effect sizes were large (adjusted R2 > 0.35). In conclusion, after controlling for possible confounders, postmenopausal women who experience a severe impact of menopausal symptoms endure poorer sexual function, particularly when said symptoms are urogenital or psychological in nature.
... [Insert Table 6 here] Finally, we offered a comparison table between our study sample FSFI total score across the age groups presented in previous FSF studies conducted using the FSFI in Chilean women (Blümel, Binfa, et al., 2004;Blümel et al., 2009; see Supplementary Table 4). ...
... Sexual communication (Frederick et al., 2017) and partner' sexual compatibility (Offman & Matheson, 2005) are both predictors of sexual satisfaction, which was also the case for Chilean women in a relationship who scored signi cantly higher than single women in sexual satisfaction (see Supplementary Table 2). These observations also coincide with previous ndings in Chilean women, where being in a relationship was a protective factor against FSD (Blümel, Binfa, et al., 2004;Blümel et al., 2009). On the other hand, women who practice BDSM-like behaviors had a signi cantly higher satisfaction across all criterion variables than those who do not. ...
Inconsistencies in the Female Sexual Function Index (FSFI) factor structure and current research and clinical guidelines highlight the need for continued exploration of its psychometric evidence. Furthermore, only one study has assessed its measurement invariance (MI), while the only FSFI validation conducted in Chile lacks quality and representativity. Therefore, this study aimed to evaluated the FSFI in a Chilean sample (n = 2595), examining MI across relationship status, age groups, regions of the country, BDSM practices, and paraphilic interests. Confirmatory factor analysis supported a six-factor structure. Criterion-related validity indicated modest-to-moderate effects in satisfaction differences based on relationship status, regions, and BDSM practices. MI was achieved across socio-demographic variables at the factor covariance level. While acknowledging the absence of a clinical group for female sexual dysfunction (FSD) diagnosis, potential pandemic-related impact on scores, online methodology biases, and limited diversity in gender and sexual orientation, our findings supports the FSFI as a valuable research tool for female sexual function and wellbeing. This study significantly expands the applicability of the FSFI and underscores its measurement invariance across sociodemographic factors, as well as its applicability in the Chilean context.
... Sexuality is a complex phenomenon that involves organic and psychoactive processes and is influenced by multiple factors, including biological, social, psychological, historical, and cultural ones [4]. According to the World Health Organization, sexuality influences the physical and mental health of human beings, and for this reason, it constitutes an important aspect of women's lives and is one of the factors to be evaluated when studying the QOL of women with breast cancer [5]. ...
... Surgical management, which includes conservative surgery and mastectomy, with or without reconstruction, can have psychological effects, such as a feeling of loss of femininity and negative body image, in addition to physical effects, such as pain and decreased breast sensitivity [4] [11]. Studies evaluating breast surgery and sexual dysfunction (SD) in these women are quite contradictory in correlating the type of surgery with the worsening or not of sexual function, but there seems to be some advantage for women undergoing conservative surgery and mastectomy with reconstruction [12]- [17]. ...
... These confounding variables were chosen based on our literature review, which included studies showing that these variables were related to sexual function (Blumel et al. 2009;Botros et al. 2006;Chedraui et al. 2011;Jonusiene et al. 2013;Lianjun et al. 2011;Park et al. 2003;Perez-Lopez et al. 2012). We used a p-value <0.1 in the univariate regression model as the criterion for including variables that we were uncertain about or for which we could not find evidence regarding association with the outcome in literature. ...
... This is in agreement with Pérez-López et al.'s study, which determined a negative correlation between total scores of sexual function and scores in the somatic and urogenital domains of the MRS (Perez-Lopez et al. 2012). Furthermore, a multicenter Latin American study conducted among middle-aged women showed that inadequate lubrication and bladder problems (symptoms related to the urogenital domain) were the main factors associated with sexual dysfunction (Blumel et al. 2009). Moreover, atrophic vaginitis has been observed among 45 percent of menopausal women (Nappi and Kokot-Kierepa 2010) and is associated with vaginal dryness, dyspareunia, post-coital bleeding, vaginal irritability, vaginal discharge, and urinary problems(North American Menopause Society 2013). ...
Sexual function could be affected by several factors in postmenopausal women. This cross-sectional study aimed to investigate the relationship between the severity of menopausal symptoms and sexual function. The study was conducted among 405 postmenopausal women aged 40 to 65 years, in Chalus and Noshahr, Iran, from October 2013 to May 2014. The participants were selected using a multi-stage sampling method.
The instruments used for data collection were the Female Sexual Function Index (FSFI), the Menopause Rating Scale (MRS), and a demographics questionnaire. The relationship between the severity of menopausal symptoms and sexual function was examined using Pearson’s correlation coefficient and multiple linear and logistic regressions. The mean unadjusted FSFI and MRS scores were24.11 and 12.45, respectively; and 61.0% of the participants had female sexual dysfunction (FSD) (FSFI≤26.55). A significant negative correlation was observed between the MRS scores (total and all subscales) and the total scores for FSFI (P < 0.001). The results of the logistic regression analysis showed that with every unit increase in the total score of MRS, the likelihood of sexual dysfunction was 9.6% greater. We conclude that menopausal symptoms need to be considered in the design of health initiatives aimed at postmenopausal women’s sexual function.
... 374F. Qualidade de vidaUtilizando a mesma amostra,374,378 Blümel et al.380 avaliaram a qualidade de vida e os fatores que interferem negativamente nessa variável. A prevalência de mulheres com sintomas moderados a graves, comprometendo a qualidade de vida, esteve acima de 50% em todos os países, porém Chile e Uruguai apresentaram as maiores pontuações (80,88% e 67,4%, respectivamente). ...
As mulheres, que representam cerca de metade da população mundial segundo estimativas de janeiro de 2024, podem sofrer com sinais e sintomas da menopausa durante pelo menos um terço de suas vidas, quando apresentam maiores risco e morbimortalidade cardiovasculares. Os efeitos da terapia hormonal da menopausa (THM) na progressão de eventos de aterosclerose e doença cardiovascular (DCV) variam de acordo com a idade em que a THM é iniciada e o tempo desde a menopausa até esse início. Efeitos benéficos nos resultados de DCV e na mortalidade por todas as causas ocorreram quando a THM foi iniciada antes dos 60 anos de idade ou nos 10 anos que se seguiram à menopausa. A decisão sobre o início, a dose, o regime e a duração da THM deve ser tomada individualmente após discussão sobre benefícios e riscos com cada paciente. Para a prevenção primária de condições crônicas na pós-menopausa, não se recomendam o uso combinado de estrogênio e progestagênio em mulheres assintomáticas nem o uso de estrogênio sozinho em mulheres histerectomizadas. Neoplasias hormônio-dependentes contraindicam a THM. Para tratamento da síndrome geniturinária da menopausa, pode-se utilizar terapia estrogênica por via vaginal em pacientes com fatores de risco cardiovascular conhecidos ou DCV estabelecida. Para mulheres com contraindicação à THM ou que a recusam, terapias não hormonais com eficácia comprovada (antidepressivos, gabapentina e fezolinetante) podem melhorar os sintomas vasomotores. Os implantes hormonais manipulados, ou hormônios “bioidênticos” “manipulados”, e a ‘modulação hormonal’ não são recomendados pela falta de evidência científica de sua eficácia e segurança.
... For instance, in the United States, 43% of women reported experiencing sexual dysfunction, compared to 31% of men [15]; in Turkey, the prevalence of FSD was found to be 53.2% [16]; in China, it reached 60% [17]; Brazil exhibited a prevalence ranging from 13.3% to 79.3% among women [18]; and, lastly, in Latin America, a study involving 5,391 individuals found that 56.8% of sexually active women aged 40-59 experienced sexual dysfunction [19]. To promote comprehensive sexual well-being for women is crucial for researchers and healthcare professionals to acknowledge and address the intricate relationship between PWB and sexual health outcomes. ...
(1) Background: Psychological well-being (PWB) and female sexual health are two important areas for women’s quality of life and research, and they are closely related. The aim of this study was to conduct a systematic review of the existing literature to explore the association between PWB and sexual health in women. (2) Methods: This review was carried out following PRISMA. The inclusion criteria were studies with samples of adult women, that evaluated and associated sexual functioning and mental health. Scientific articles were identified on Web of Science, Scopus, EBSCO (PsycInfo, PsycArticles, and Psicodoc), ProQuest, and PubMed. The search was limited to years between 2010 and 2023. (3) Results: 14 selected articles were analyzed, in which population samples and variables related to mental and sexual health were examined. 42.9% of the studies included clinical samples, 71.4% focused on anxiety and depression as main mental health variables, and 50% examined female sexual functioning as a sexual health variable. (4) Conclusions: This review provides more up-to-date information about valuable insights into the possible determinants of female sexual health. The association between PWB and female sexual health has been demonstrated.
... For instance, in the United States, 43% of women reported experiencing sexual dysfunction, compared to 31% of men [15]; in Turkey, the prevalence of FSD was found to be 53.2% [16]; in China, it reached 60% [17]; Brazil exhibited a prevalence ranging from 13.3% to 79.3% among women [18]; and, lastly, in Latin America, a study involving 5391 individuals found that 56.8% of sexually active women aged 40-59 experienced sexual dysfunction [19]. To promote comprehensive sexual well-being for women is crucial for researchers and healthcare professionals to acknowledge and address the intricate relationship between PWB and sexual health outcomes. ...
(1) Background: Psychological well-being (PWB) and female sexual health are two important areas for women’s quality of life and research, and they are closely related. The aim of this study was to conduct a systematic review of the existing literature to explore the association between PWB and sexual health in women. (2) Methods: This review was carried out following the PRISMA checklist. The inclusion criteria were studies with samples of adult women that evaluated and associated sexual functioning and psychological well-being. Scientific articles were identified on Web of Science, Scopus, EBSCO (PsycInfo, PsycArticles, and Psicodoc), ProQuest, and PubMed. The search was limited to years between 2010 and 2023. The methodological quality of the studies was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies (QATOCCS). (3) Results: 14 selected articles were analyzed, in which population samples and variables related to psychological and sexual health were examined. In total, 42.9% of the studies included clinical samples, 71.4% focused on anxiety and depression as the main psychological variables, and 50% examined female sexual functioning as a sexual health variable. (4) Conclusions: This review provides more up-to-date information about valuable insights into the possible determinants of female sexual health. An association between PWB and female sexual health has been demonstrated.
... Menopause is defined as the absence of menstrual periods for twelve consecutive months due to a decline in estrogen levels [20]. Hormone therapy in postmenopausal women has been shown to significantly improve sexual function, including orgasm, pain, and lubrication [21,22]. Additionally, OAB symptom severity decreases with the use of vaginal estrogen in postmenopausal women with atrophy [23, 24 •]. ...
Purpose of Review
In this review, we discuss the available literature regarding the intersection of female sexual function and overactive bladder (OAB). Specifically, this review includes how OAB and its treatments affect female sexual function and quality of life.
Recent Findings
Women suffering from overactive bladder have worse sexual function, and there are multiple prospective studies evaluating sexual function before and after overactive bladder treatment.
Summary
There is a growing body of evidence demonstrating that traditional overactive bladder treatments not only improve OAB but can also improve sexual function.
... 29 A factor that could explain the protective role of sexual activity in survival may be that sexuality reflects the health status of the person. 30 Multiparity appears in our cohort as a protective factor of mortality. A systematic review of eight cohorts showed that the highest mortality was seen in nulliparous and in women with more than four births. ...
Objective:
The aim of this study was to measure the impact of different risk factors in middle-aged women on longevity evaluated after three decades of an initial health screening.
Methods:
Women who received an annual check-up between 1990 and 1993 were recruited. Anamnesis and physical examination were recorded. Blood samples for the measurement of glycemia and lipids were taken. Data are reported as of December 2021.
Results:
A total of 1,158 women aged 40 to 60 were studied. At 30.9 years of follow-up, the Kaplan-Meier overall survival was 75.6% (95% confidence interval, 72.6-78.3). The main causes of the 260 deaths observed were the following: cancer (n = 88; 33.8%), cardiovascular disease (n = 55; 21.2%), and infectious disease (n = 41; 15.8%). The following hazard ratios were found with the flexible parametric survival model: personal history of fracture (hazard ratio, 2.55; 95% confidence interval, 1.29-5.02; P = 0.007), type 2 diabetes mellitus (2.14; 1.18-3.88; P = 0.012), personal history of heart disease (1.85; 1.09-3.13; P = 0.022), chronic arterial hypertension (1.65; 1.25-2.17; P < 0.001), postmenopausal status (1.60; 1.13-2.26; P = 0.008), unskilled jobs (1.56; 1.17-2.07; P = 0.002), cigarette smoking (1.51; 1.17-1.94; P = 0.002), age (1.06; 1.03-1.09; P < 0.001), body mass index (1.04; 1.01-1.07; P = 0.004), multiparous (0.72; 0.56-0.93; P = 0.012), and active sexual intercourse (0.68; 0.52-0.87; P = 0.003). Lipid disorders did not reach statistical significance as a risk factor.
Conclusions:
In this cohort, it was observed that most of the classic risk factors for mortality were present. However, a history of fracture appears in middle-aged women as a strong predictor of mortality, surpassing diabetes and arterial hypertension. Multiparity, on the other hand, was a protective factor.
... Similarly, female sexual dysfunction (FSD) is among the most widespread health issues, affecting at least 25% of women worldwide, reaching even a higher prevalence of up to 86.5% in postmenopausal women [17]. Female sexual function changes with age and is susceptible to various sources of disruption, including overall physical and mental health states, partnership quality and sociocultural as well as socioeconomical factors [18]. Furthermore, ovarian sex steroids have a major impact, as their decline due to menopause has been found to be associated with an increased incidence of FSD [19][20][21]. ...
Purpose:
Both iron deficiency (ID) and female sexual dysfunction (FSD) affect more than 25% of the world population. The aim of this study was to identify a connection between these two conditions based on the existing literature and to investigate this interrelation in a small pilot cross-sectional study.
Methods:
A database search for publications referring to ID and FSD was conducted. The resulting common denominators were used to formulate hypotheses regarding the interaction of these diseases. Simultaneously, 45 healthy middle-aged women completed questionnaires about their sexual function and provided a blood sample for the purpose of determining ferritin and haemoglobin levels. The main outcome measures included an analysis of responses to questions on sexuality and partnership and of blood ferritin and haemoglobin levels. The secondary outcomes included an assessment of further influences on libido, such as sex hormones, menopausal status, health, and life satisfaction.
Results:
Altered monoaminergic cerebral metabolism, hyperprolactinaemia and hypothyroidism, impaired socioemotional interaction, increased anxiety, and depression in both, ID and FSD, account for the most comprehensive explanations for the postulated association between the two conditions. Despite a feasible assumption, our empirical findings failed to demonstrate any correlation between ID and FSD. We identified a certain impact of menopausal hormonal status on sexual function.
Conclusion:
ID has no influence on FSD in the given population, although the literature suggests that FSD may at least be partly due to ID. Further research seems justified given the potential advantages for sexual health, considering that ID is an easily treatable disease.
This study aimed to compare the sexual function (SF) and its domains between women with idiopathic premature ovarian insufficiency (POI) and healthy control. A cross-sectional study was conducted on 63 married women with idiopathic POI, referred to the reproductive endocrinology research center (Tehran, Iran), and 784 married women with regular menstrual cycles who visited for routine annual gynecological exams in 2021-2022. The Female Sexual Function Index (FSFI) questionnaire was used to assess the SF of participants. Linear regression and factor analysis were used to analyze the data. Characteristics were similar in both study groups except for body mass index, hip circumference, job status, and number of deliveries. The mean score (standard deviation) of FSFI in women with POI and control were 21.70 (9.0) and 24.30 (5.0), respectively (P < 0.001). All domains’ scores of FSFI were significantly lower in POI women than in the control group (P < 0.05). After adjusting for potential confounders, these findings remained unchanged. Factor analysis demonstrated the arousal and lubrication domains as the most influential factors SF among POI women, while the desire domain played the lowest role. In addition to various health conditions threatening POI women’s future lives, sexual disturbances must be addressed in their routine care.
Objective:
There are limited studies on urogenital symptoms in women who experience menopause before the age of 40 years due to primary ovarian insufficiency (POI) or bilateral oophorectomy (surgical POI). This study aimed to compare the urogenital symptoms, including sexuality, of women with POI to those without the condition.
Methods:
This cross-sectional study conducted was in seven Latin American countries, in which postmenopausal women (with POI and non-POI) were surveyed with a general questionnaire, the Menopause Rating Scale (MRS) and the six-item Female Sexual Function Index (FSFI-6). The association of premature menopause with more urogenital symptoms and lower sexual function was evaluated with logistic regression analysis.
Results:
Women with POI experience more urogenital symptoms (MRS urogenital score: 3.54 ± 3.16 vs. 3.15 ± 2.89, p < 0.05) and have lower sexual function (total FSFI-6 score: 13.71 ± 7.55 vs. 14.77 ± 7.57 p < 0.05) than women who experience menopause at a normal age range. There were no significant differences in symptoms when comparing women based on the type of POI (idiopathic or surgical). After adjusting for covariates, our logistic regression model determined that POI is associated with more urogenital symptoms (odds ratio [OR]: 1.38, 95% confidence interval [CI] 1.06-1.80) and lower sexual function (OR: 1.67, 95% CI 1.25-2.25).
Conclusion:
POI, whether idiopathic or secondary to bilateral oophorectomy, is associated with symptoms that affect vaginal and sexual health.
Menopause may negatively impact Quality of Life (QoL). Our study used a cross-sectional design and research participants were 99 women in natural menopause. In our study, we analyzed the relationship between age at menopause onset, hormone therapy use, duration of couple relationship, menopause duration, psychological morbidity, marital satisfaction, menopause representations, and QoL following the Wilson and Cleary Health-Related QoL conceptual model. The authors found that negative representations, lower marital satisfaction, psychological morbidity, and shorter duration of menopause contributed to lower QoL. Moreover, the authors found that psychological morbidity and menopause representations (identity and control/cure dimensions) had an indirect effect between marital satisfaction and vasomotor, psychosocial, and sexual QoL. Also, we found that age at the onset of menopause showed a moderating effect in the final model. Future studies should replicate these results in a longitudinal design and analyze how the variables that showed a moderating role and indirect effects will function as moderators and mediators, respectively, over time.
Objectives:
To identify the frequencies of clinical suspicion of sarcopenia (CSS) and probable sarcopenia (PS) and their association with ethnic groups.
Methods:
This cross-sectional study categorized 700 women into Afro-descendant and mestizo ethnic groups. Calf circumference, muscle strength, and gait speed were measured. CSS was assessed using a sarcopenia risk scale and the measurement of calf circumference; the muscle strength of the dominant hand was used to establish PS. Unadjusted logistic regressions assessed associations between CSS/PS and ethnicity. Two adjusted logistic regression models included relevant covariates.
Results:
CSS and PS were identified in 10.4% to 20.7% and 7.8% to 14.1% of study participants, respectively. Compared with mestizos, Afro-descendants had a more favorable sarcopenia risk score, greater calf circumference, and greater muscle strength and were associated with a lower risk for CSS (odds ratio [OR]: 0.13, 95% confidence interval [CI]: 0.06-0.28 and OR: 0.12, 95% CI: 0.07-0.21) and PS (OR: 0.12, 95% CI: 0.05-0.30 and OR: 0.11, 95% CI: 0.06-0.21).
Conclusion:
Compared with mestizos, CSS and PS were less frequent among Afro-descendants, who had 87% to 88% lower probability of CSS and 88% to 89% lower probability of PS.
Background
Sexual dysfunction is a common disorder among women, especially during menopause. Metabolic syndrome is a multifactorial disease that, according to previous studies, there is a relationship between the metabolic syndrome and sexual dysfunction among women. The aim of this systematic review and meta-analysis is to obtain the prevalence of Female Sexual Dysfunction (FSD) among women with metabolic syndrome, and to analyze available related evidence.Methods
In this systematic review and meta-analysis, the keywords of MeSH, female sexual dysfunction, FSD, metabolic syndrome were searched in PubMed, Web of Science, Scopus, Science Direct and Google Scholar. The searches were conducted without a lower time limit and until May 2022.ResultsThe prevalence of FSD among women with metabolic syndrome was found to be 39.3% (95% CI: 28.3–51.5). In the subgroup analysis and in the review of 4 studies, the prevalence of sexual dysfunction in postmenopausal women with metabolic syndrome was 49.8% (95% CI: 26.1–73.6). Analyzing the results of the meta-regression test in examining the effect of the three factors of sample size, year of the study, age, and BMI of the patients on the heterogeneity of the meta-analysis, showed that with the increase of the sample size, the prevalence of sexual dysfunction among women with metabolic syndrome decreases (p < 0.05). Moreover, the prevalence of sexual dysfunction among women with metabolic syndrome increases (p < 0.05) with the increase in the years of conducting studies and the mean of age of women with metabolic syndrome. Also, with increasing mean of BMI of female patients with metabolic syndrome, the prevalence of sexual dysfunction in these women also increases (p < 0.05).Conclusion
Female sexual dysfunction is a global health problem that can affect women’s life to a great extent. Metabolic syndrome, which is a set of factors such as obesity, high blood pressure, and diabetes, affects sexual dysfunction in women. From this study, it can be concluded that there is a close relationship between metabolic syndrome and female sexual dysfunction.
Introduction: Polycystic ovarian syndrome is one of the most common causes of infertility in women of reproductive age. It is a combination of chronic anovulation, obesity, and hyperandrogenism that may affect sexual function in women of reproductive age.
Objectives: The study aimed to assess the sexual dysfunction, its frequency, and predisposing factors in infertile polycystic ovary syndrome (PCOS) patients.
Methods: This descriptive cross-sectional study was conducted among 240 infertile women with a definite diagnosis of PCOS. The study duration was 1 year, from August 2019 to August 2020. Data was collected chronologically by interview, physical examination, and laboratory investigations using a structured questionnaire. The presence of hirsutism was assessed using the modified Ferriman–Gallwey (mFG) scoring system. Sexual function was assessed in the domains of desire, arousal, lubrication, orgasm, satisfaction, and pain using the female sexual function index (FSFI). Patients were also assessed for mental health by the depression, anxiety, and stress scale-21 (DASS-21).
Results: Sexual dysfunction was present in 65.4% of patients with the domains of orgasm and arousal were particularly affected (92.9% and 90.0%, respectively). In this study, age and BMI had a significant negative correlation ([Formula: see text] = − 0.55 and [Formula: see text] = − 0.42, respectively) with sexual function. Increasing age and BMI resulted in a significant reduction in sexual function ( [Formula: see text] 0.001 each), including all domains. Patients with symptoms of depression and anxiety were significantly more likely to suffer from sexual dysfunction than those without these symptoms ([Formula: see text] = 0.041 and [Formula: see text] = 0.001, respectively). Hirsutism, serum testosterone (total) level, and stress were found to have no significant effect on sexual function.
Conclusions: Infertile patients with PCOS markedly suffer from sexual dysfunction. Improvement of sexual dysfunction not only improves sexuality and quality of life, but also may improve fertility outcomes in infertile PCOS patients.
Aim: Polycystic ovary syndrome (PCOS) is seen in 5-10% of women, it affects many systems as a result of hyperandrogenism. In addition to its endocrinological and metabolic results, it has been reported that women with PCOS have a decrease in their self-esteem levels due to body image disorders. Sexual dysfunction such as sexual desire, orgasm, arousal and sexual satisfaction occurs in patients with PCOS due to both physical changes and emotional differences. Our aim in this study is to analyze the self-esteem levels and self-esteem levels of women diagnosed with PCOS and to evaluate the factors affecting them. Material and Method: Women between the ages of 18-55 who were diagnosed with PCOS were prospectively included in the study. Demographic characteristics, such as age, marital status, and employment status, were recorded. The patients’ self-esteem levels were analyzed with the Rosenberg self-esteem scale (RBSS). The sexual dysfunction scale (SDS) was used to evaluate the sexual dysfunctions of the women participating in the study. The p
Aim: The cultural differences and taboos of the society affect women’s sexual life and sexual relationship qualities and their belief in sexual myths. In addition, women’s demographic characteristics and living conditions are also effective on sexual myths. Our aim in this study is to analyze the frequency of believing in sexual myths in married women and to examine the factors affecting sexual life and sexual relationship qualities. Material and Method: Married women between the ages of 18-55 in the tertiary gynecology and obstetrics clinic were included in the study, prospectively. Demographic characteristics of women such as age, marital status, marriage and employment status, monthly income, family structure and number of children, sexual life and sexual relationship qualities and sexual myths were compared. The Golombok-Rust Inventory of Sexual Satisfaction (GRISS) Scale, which is used to evaluate the quality of sexual intercourse and sexual dysfunctions, and The Sexual Myth Scale to determine the status of having sexual myths were used. Results: Overall 171 married women were included in the study. The median age was 35 years (IQR 29-43) and 60.8% (n=104) were university graduates and 20.5% (n=35) were graduate/doctoral graduates. The rate of believing in sexual myths among married women was 21.4%. As the age of the women increased, the frequency of sexual intercourse decreased (p
Sexual health in general and issues of old age sexuality in particular are neglected by laymen and healthcare professionals alike. Contrary to popular beliefs, elderly individuals continue to have sexual desire and sexual activities, and they believe that healthy sexual expression is an important aspect of healthy aging. Sexual problems are more frequently found in the elderly. This chapter describes the various causes of sexual dysfunction, assessment, and management of sexual problems in the elderly.
Background:
Cancer is one of the most common diseases and it has many physical and psychological consequences. Women with cancer are more likely to suffer from sexual dysfunction (SD) than healthy women.
Objective:
To estimate the overall prevalence of SD in women with cancer.
Materials and methods:
The international databases Google Scholar, Embase, PubMed, Web of Science, and Scopus were searched for related articles without any time limitation. The keywords "Neoplasia", "Tumor", "Cancer", "Malignancy", "Female Sexual Function Index", "FSFI", and "female sexual dysfunction" along with their combinations were used in the search. Inconsistencies in the data were examined using the I2 test. The data were analyzed using the meta-analysis method and the random-effects model in the Stata software.
Results:
The analysis of 24 articles with a sample size of 5483 women showed that the prevalence of SD in women with cancer was 66% (95% CI: 59-74%). The highest and lowest prevalence were in Africa and Europe, respectively (75%; 95% CI: 66-83% vs. 43%; 95% CI: 26-60%, respectively). There was no relationship between the prevalence of SD and the mean age of the women, sample size, yr of publication, or quality of articles.
Conclusion:
SD is highly prevalent in women with cancer. African and American women with cancer have a higher average SD prevalence than Asian and European ones.
Introduction: In India, socio-economic status, lifestyle, environment, facilities, utilization of resources, education, etc. are the major indicators for the classification in rural and urban population. Material and Methods: This study conducted among 210 rural and urban women in the age group of 40-60 years. Data were collected by using predesigned and pretested schedule and the Greene Climacteric Scale (GCS) was used. Results: The mean age of the participants was 49.20 ± 5.37 years. There were significant differences on the age of menarche, marriage, first pregnancy, first child delivery between the rural and urban women (P<0.05). Significant differences found about the knowledge regarding menopausal symptoms, age of attaining menopause, hormonal therapy, and discussion of menopausal symptoms among them. The most common symptom was loss of interest in sex reported by 72.4% of rural women and in urban muscle and joint pains (73.3%) reported by maximum participants. The menopausal symptoms like pressure or tightness in head and loss of interest in sex found significantly higher between the rural and urban women (P<0.05). Conclusion: Efforts are needed to educate and make the women aware of menopausal symptoms mainly in rural and counselling of all women is needed.
This study aims to assess the validity and reliability of the Turkish version of the FSFI-6 questionnaire,an abbreviated version of FSFI-19,a common tool for evaluating female sexual function. The study included 120 female patients aged between 18–65 years who presented to the urology clinic between December 2019 and March 2020. The Turkish version of FSFI-6 was translated from the English version for validation. The abridged FSFI-6 questionnaire consists of questions 2, 4, 7, 11, 16, and 17 of the FSFI-19 form. We recorded the demographic data of the patients. All subjects filled out the FSFI-19 and FSFI-6 questionnaires. The patients were asked to fill out the questionnaires again after two weeks. The mean age of the subjects was 46.58 ± 9.89 years (28–63). The results of the reliability analysis indicated that the intraclass correlation coefficient of the total FSFI-6 score was 0.92 (weighted kappa coefficients of individual items, 0.868–0.975) and the Cronbach’s alpha was 0.862. The validity analysis indicated that the mean total FSFI-6 score was strongly correlated with the mean FSFI-19 score (p < 0.001, r = 0.997). In the test-retest analysis,the kappa coefficient was calculated as 0.891. The FSFI-19 and FSFI-6 scores of the patients with (n = 52) and without climacturia (n = 68) were compared, and it was observed that the scores of the patients with climacturia were significantly lower than those without climacturia (p < 0.001). The abbreviated FSFI-6 questionnaire is a valuable tool for screening women with FSD. It can be used more extensively due to being short and easy to apply. Our results approve the Turkish version of the questionnaire as a valid and reliable tool for evaluating FSD.
Background
Dementia is a major public health problem. Estrogen is a regulator of the central nervous system and its deficit could be involved in cognitive decline in older women.
Objective
This study aimed to evaluate the association of bilateral oophorectomy, menopause hormone therapy (MHT) and other factors on mild cognitive impairment (MCI).
Method
The case–control study included 941 otherwise healthy postmenopausal women aged 60 years and over from six Latin American countries. Personal and family data were recorded and MCI was assessed using the Montreal Cognitive Assessment test (MoCA).
Results
Average age, years of education and body mass index were 66.1 ± 5.8 years, 12.4 ± 5.0 years and 26.0 ± 4.3 kg/m², respectively. A total of 30.2% had undergone bilateral oophorectomy and 40.3% had used MHT. A total of 232 women (24.7%) had MCI. The prevalence of MCI was higher in women with intact ovaries and non-MHT users as compared to MHT users (29.3% vs. 11.7% [odds ratio (OR) 0.32; 95% confidence interval (CI) 0.20–0.51]). Among oophorectomized women, MCI prevalence was higher among non-MHT users as compared to MHT users (45.2% vs. 12.8% [OR 0.18; 95% CI 0.10–0.32]). Logistic regression analysis determined that the variables associated with MCI were age >65 years (OR 1.69; 95% CI 1.20–2.38), parity (having >2 children; OR 1.69; 95% CI 1.21–2.37), bilateral oophorectomy (OR 1.56; 95% CI 1.09–2.24), hypertension (OR 1.41; 95% CI 1.01–1.96), being sexually active (OR 0.56; 95% CI 0.40–0.79), education >12 years (OR 0.46; 95% CI 0.32–0.65) and MHT use (OR 0.31; 95% CI 0.21–0.46).
Conclusion
Age, parity, bilateral oophorectomy and hypertension are independent factors associated with MCI; contrary to this, higher educational level, maintaining sexual activity and using MHT are protective factors.
Objectives: Despite the noticeable advances in sexual dysfunction (SD) research in the menopausal period, scientific literature showed different reports on the prevalence of SD in the menopausal stages. The primary objective of this study was to systematically review and meta-analysis the prevalence of SD in the different menopausal stages and then meta-analysis the included studies in domains of SD separately. Methods: In this systematic review and meta-analysis, keywords were retrieved through MeSH strategy and databases such as PubMed/MEDLINE, PsycINFO, Web of Science (ISI), Scopus, ScienceDirect, SID (Scientific Information Database), Magiran, and Google scholar were searched. Manual review of retrieved citations identified additional citations. The quality of the included studies was assessed using The Newcastle-Ottawa Scale. The main outcome measure in this study was the prevalence of SD in three stages of menopause such as pre, peri, and postmenopause.
Results: Of 54 included studies 81,227 menopausal aged women from different menopause stages participated and the sample sizes varied from 49 to 31,581 individuals. The articles from 17 countries worldwide were included in this study. The prevalence of SD in premenopausal aged women was ranged between 22.7% and 72.2%, in perimenopausal aged women, was 37.3–78.2% and also in postmenopausal aged women was extremely reported a wide variety of prevalence ranges and was estimated between 8.7% and 89.01%. The premenopausal women had a lower prevalence of SD compared to other stages of the menopausal period. Conclusion: The results indicated that the prevalence of SD and also domains of SD in different studies were reported much widely. This study can be used as a good resource for obstetricians to understand the high possibility of recurrence of SD and assess the sexual activity of menopausal aged women in the menopause clinic. However, based on the systematic review, more standard and high-quality studies are needed to perform regarding the prevalence of SD in menopausal periods.
Aim
Various individual, relational, and sociocultural variables have been identified as determinants of sexual responding, but these have rarely been investigated in non-Western cultures that are characterized by sexual conservatism. We aimed to explore the role of socioeconomic status and religion, sexual double standards, erotophobia-erotophilia, sexual dysfunctional beliefs, and relationship satisfaction to explain sexual function and satisfaction in Ecuador.
Method
599 participants (431 women and 159 men) completed an online survey.
Main Outcomes Measures
The Female sexual function was predicted by sexual satisfaction, relationship satisfaction, sexual dysfunctional beliefs, and sexual double standards, while the male sexual function was predicted solely by sexual satisfaction. Additionally, female sexual satisfaction was predicted by sexual function, relationship satisfaction, and sexual dysfunctional beliefs, while male sexual satisfaction was predicted by sexual function and relationship satisfaction.
Results
Female Sexual Function Index, International Index of Erectile Function, Brief Sexual Opinion Survey, Sexual Double Standards Scale, Sexual Dysfunctional Beliefs Questionnaire, New Sexual Satisfaction Scale, and Couple Satisfaction Index.
Conclusion
This study provided novel information on the determinants of sexual function and satisfaction within a culture in which conservative religious beliefs still prevail. Results should be interpreted with caution given the unequal distribution of men and women, social desirability and volunteer biases, and the specific COVID-19 pandemic context during which the survey took place. Markers of sexual conservatism were inversely related to sexual function and satisfaction, mainly in women, and may, therefore, be important targets of treatment. Female sexuality seemed more context-dependent than male sexuality, although enhancing the general climate of the relationship may benefit feeling sexually satisfied in both men and women. DA Hidalgo, M Dewitte. Individual, Relational, and Sociocultural Determinants of Sexual Function and Sexual Satisfaction in Ecuador. Sex Med 2021;XX:XXX–XXX.
Background:
The purpose of this study is to evaluate the impact of menopause on sexual function in women and their spouses.
Methods:
This is a cross-sectional study that was conducted from January 2018 to May 2019 in Rasht (North of Iran). The participants included 215 menopausal women and their spouses. Data were collected using the demographic questionnaire, the Female Sexual Function Index (FSFI) questionnaire, and the International Index of Erectile Function (IIEF) questionnaire.
Results:
On the basis of the FSFI and IIEF scores, 36.28% (78/215) women reported female sexual dysfunction (FSD) and 17.2% (37/215) men reported erectile dysfunction (ED) with 8.37% (N = 18) being mild, 5.58% (N = 12) mild to moderate, and 3.25% (N = 7) moderate ED. After adjusting differences in the female age distribution, the total score and scores of the IIEF subscales were also not significantly lower in the spouses of women with FSD than women without FSD.
Conclusion:
Although, significant correlations between male erectile function and menopausal female sexual function have not identified; but, low scores of the subscales of FSFI in female participants mostly impaired sexual satisfaction and overall satisfaction in their spouses.
Introduction:
The world's population is aging and this trend continues. Older adults are living healthier and longer than in the last decades and their sexual function should also be considered along with their general health. This study aimed to examine the correlation between general health and sexual function in elderly women.
Materials and methods:
In this cross-sectional correlation study, 1245 women over 60 years old were selected in Ardabil health-care centers by a convenient sampling method. Demographic data of all participants were noted and general health and sexual function were evaluated by the Goldberg General Health Questionnaire and Female Sexual Function Index (FSFI) Questionnaire.
Results:
The participants' mean ± standard deviation age was 75.1 ± 7.2 years, most of the women (40.08%) were illiterate, and the majority of them were living with their married (44.81%) or single children (27.14%). The general health score for 380 older women (30.52%) was under 22 (healthy). About 60% of the women had engaged in sexual activity during the past 4 weeks, and the total mean score of FSFI was 17.36 ± 1.44. In addition, 84.33% of the women had sexual dysfunction (FSFI < 26.55). The age (P < 0.05), educational level (P < 0.001), living with children (P < 0.01), and general health status (P < 0.01) were found to be significantly related to sexual function. The total scores for FSFI and the scores for all domains except for satisfaction were in positive correlation with the score for the total and all domains of general health (P < 0.001).
Conclusion:
Sexual function in elderly women is affected by several factors, such as general health. Therefore, to promote successful aging in women, sexual function and general health require more attention when implementing women's health initiatives.
The Female Sexual Function Index is one of the most common instruments used to evaluate the female sexual function. The present study aimed to analyze the test-retest reliability, internal consistency, and discriminant validity of the index in clinical samples and to determine a specific and sensitive cutoff point for the Spanish version of the Female Sexual Function Index. For that purpose, a sample consisting of 117 Colombian women was recruited to evaluate test-retest reliability, and a second sample, consisting of 185 women, was divided into diagnosis and no-diagnosis groups based on DSM-5 criteria. Results showed adequate test-retest reliability after four weeks, and satisfactory evidence of internal consistency was obtained for subscale and overall scores. The inventory was found to have an adequate criterion validity, and it confirmed the differences between diagnosis and no-diagnosis groups. The instrument's cutoff point was determined to be 26 points, with a specificity of 73.9%, a sensitivity of 87.7%, and an area under the curve of 85.9 (CI = 80.0-91.7). These results confirm that the Spanish version of the FSFI is an adequate tool for evaluating female sexual dysfunction based on DSM-5 criteria.
The aim was to evaluate sexual function of healthy women in Croatia and the possible impact of depression, anxiety, and sociodemographic factors. A total of 204 healthy women filled in a basic sociodemographic questionnaire, the Patient Health Questionnaire-9, Anxiety Disorder-7, and Female Sexual Function Index (FSFI). Almost half of study subjects (47.1%) reported at least some degree of sexual dysfunction defined as an FSFI score lower than 26.55. Study results suggest sexual dysfunction of women in Croatia as a still unrecognized problem. More room in research and in the public must be given to this issue.
Background: Depressive symptoms may affect female mid-life sexuality, whereas sexual problems tend to aggravate depression. Despite this, data assessing this association drawn from mid-aged Paraguayan women are scarce.
Objective: This study aimed to assess the association between depressed mood and the risk of sexual dysfunction during female mid-life.
Methods: Sexually active urban-living women from Asunción, Paraguay (n = 193, aged 40–60 years) were surveyed with the 6-item Female Sexual Function Index (FSFI-6), the 10-item Center for Epidemiological Studies Depression Scale (CESD-10), and a general questionnaire containing personal and partner information. Depressed mood was defined as a total CESD-10 score of 10 or more, and an increased risk for sexual dysfunction as an FSFI-6 total score of 19 or less. The association of depressed mood and an increased risk of sexual dysfunction was evaluated with multivariable Poisson regression.
Results: The mean age (±standard deviation) of surveyed woman was 48.3 ± 6.0 years and 61.1% (n = 118) were perimenopausal and postmenopausal. A total of 21.8% (n = 42) had depressed mood and 28.5% (n = 55) had an increased risk of sexual dysfunction. The final adjusted regression model determined that women with depressed mood were twice as likely to have an increased risk of sexual dysfunction, compared to women with normal mood (adjusted prevalence ratio = 2.14, 95% confidence interval 1.26–3.60). On the other hand, depressed mood was associated with a mean total FSFI-6 score that was 20% lower than that observed among women with normal mood (adjusted incidence rate ratio = 0.80, 95% confidence interval 0.68–0.93).
Conclusion: In this mid-aged Paraguayan female sample there was a significant association between depressed mood and an increased risk of sexual dysfunction.
Objectives:
This is a cross sectional study conducted in order to determine sexual dysfunction in healthy women and risk factors.
Patients and methods:
The population of the study consisted of 282 women. The whole of the population, without sample selection, was included in the study. For data, questionnaire and Female Sexual Function Index-FSFI, whose Turkish validity and reliability study was conducted, were used. Student t and chi-square significant tests and logistic regression analysis were used to carry out statistical analysis.
Results:
It was found that 35.8% of 282 women who participated in the study were in the age range of 30-39 years, 54.6% had high school educational level or above, and 59.6% worked. Prevalence was determined as 53.2% FSFI score < 26 according to Female Sexual Function Index FSFI; 23% of the women had complaints about urinary incontinence UI. According to logistic regression results, it is determined that CFB risk is increased in patients with age and urination problem. It was determined that there was no significant correlation between income, number of children, prceived economic status, dyspareunia, having problem with the partner, experiencing premenstrual syndrome, and SD.
Conclusion:
In this study, approximately half of healthy women had SD and development of SD was affected based on some descriptive characteristics. As sexual life was considered as a factor increasing life quality, it was thought that it is fairly important to discuss the questioning of problems related to sexual life for systematic evaluation of patients, as well.
The purpose of this study was to investigate the status of occupational burnout and its influence on the psychological health of factory workers and miners, in order to provide theoretical basis and reference for alleviating occupational burnout and promoting psychological health. The cross-sectional study investigated 6130 factory workers and miners with online questionnaire; the Chinese Maslach Burnout Inventory (CMBI) and Symptom Check List-90 (SCL-90) were used. In total, 6120 valid questionnaires were collected; effectiveness was 99.8%. The percentage of the factory workers and miners suffering from occupational burnout was 85.98% and psychological health problems was 38.27%. A statistically significant difference was observed in relation to the prevalence of occupational burnout among factory workers and miners of different sex, education level, labor contracts, work schedule, monthly incomes, weight, hypertension, age, working years, working hours per day, working hours per week, coal dust, silica dust, asbestos dust, benzene, lead, and noise. The detection rate of psychological health was higher for males than females. The detection rate of psychological health was higher for working days per week less than 5 days than more than 5 days. The detection rate of psychological health with high school education, senior professional title, night shift, divorced, monthly income less than 3000 yuan, weight more than 75 kg, age more than 45 years, and working years between 25 and 30 years was higher than that of the other groups. The results showed that sex, education level, professional title, work schedule, monthly income, hypertension, age, working years, asbestos dust, benzene, and occupational burnout affected psychological health among factory workers and miners. Factory workers and miners had high levels of occupational burnout, and occupational burnout was a risk factor that can lead to psychological health.
Background:
Sexual function plays an essential role in the bio-psychosocial wellbeing and quality of life of women and disturbances in sexual functioning often result in significant distress. Female sexual dysfunction (FSD) and subfertility are common problems affecting approximately 43 and 20% of women respectively. However, despite the high prevalence of both conditions, little has been studied on the effects of subfertility on sexual functioning especially in sub-Saharan Africa. We set out to compare the prevalence of female sexual dysfunction in patients on assessment for sub-fertility and those either seeking or already on fertility control services at a private tertiary teaching hospital in Kenya.
Methods:
This was an analytical cross sectional study. Eligible women of reproductive age (18-49 years), attending the gynaecological clinics with complaints of subfertility and those seeking fertility control services were requested to fill a general demographic tool containing personal data and the Female Sexual Function Index (FSFI) questionnaire after informed consent. Prevalence of sexual dysfunction was calculated as a percentage of patients not achieving an overall FSFI score of 26.55. Univariate and multivariate analysis were done to compare clinical variables to delineate the potential association.
Results:
The prevalence of female sexual dysfunction was 31.2% in the subfertile group and 22.6% in fertility control group. The difference was not statistically significant (p = 0.187). The mean domain and overall female sexual function scores were lower in the subfertile group than the fertility control group though this was not statistically significant. The most prevalent sexual domain dysfunctions in both the subfertility and fertility control groups were desire and arousal while the least in both groups was satisfaction dysfunction. Subfertility type was not associated with sexual dysfunction. Higher education attainment was protective of female sexual dysfunction in the subfertile group while use of hormonal contraception was associated with greater sexual impairment in the fertility control group. On logistic regression analysis, higher maternal age and alcohol use appeared to be protective against sexual dysfunction.
Conclusion:
The present study demonstrated no association between the fertility status and the prevalence female sexual dysfunction. Subfertility type was not associated with sexual dysfunction. Education level and hormonal contraception use were associated with female sexual dysfunction in the subfertile and fertility control groups respectively while alcohol use and higher maternal age appeared to be protective against sexual dysfunction.
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.
Introduction:
Hormone-related changes in menopause may negatively affect sexual function.
Aim:
The primary aim of this study was to evaluate sexual functioning in Polish women with the Female Sexual Function Index (FSFI). The secondary aim was to evaluate the major factors affecting sexual functions in middle-aged Polish women.
Methods:
The Menopause Rating Scale was used to assess the menopausal symptoms. The Polish translation of the FSFI was used to assess sexual function.
Outcomes:
69.73% of respondents had sexual dysfunction according to FSFI (FSFI score ≤ 26.55).
Results:
80.61% of women experienced menopausal symptoms during the 4-week period of study. Psychological and urogenital symptoms were the most frequently reported among all the women enrolled in the study (78.23% and 77.21%). Sexual problems were observed in women who did not use hormone therapy (β = 0.09, t = -1.97, P = .048) and showed no somatic symptoms (β = 0.03, t = 2.95, P = .002).
Clinical implications:
It is important for health care providers to ask women about this problem and understand the factors that may influence sexual problems in menopause.
Strengths & limitations:
A validated survey tool was used. The limitation was selection of participants in the clinical setting and sample population size.
Conclusion:
Sexual problems were much more common in women who did not use hormone therapy and showed no somatic symptoms. Dąbrowska-Galas M, Dąbrowska J, Michalski B. Prevalence and Associated Risk Factors of Sexual Problems Among Polish Middle-Aged Women. Sex Med 2019;7:472-479.
Objective To validate the six-item female sexual function index (FSFI-6) in middle-aged Brazilian women.
Methods Cross-sectional observational study, involving 737 (premenopausal n = 117, perimenopausal n = 249, postmenopausal n = 371) Brazilian sexually active women, aged between 40 and 55 years, not using hormonal contraceptive methods. The Brazilian FSFI-6 was developed from the translation and cultural adaptation of the Portuguese FSFI-6 version. The participants completed a general questionnaire, the FSFI-6, and the menopause rating scale (MRS). The validation was performed by AMOS 16.0 software (SPSS, Inc., Chicago, IL, USA) for a confirmatory factor analysis (CFA). The chi-square of degrees of freedom (χ2/df), the comparative fit index (CFI), the Tucker-Lewis index (TLI) and the root-mean-square error of approximation (RMSEA) were used as indices of goodness of fit. Cronbach α coefficient was used for internal consistency.
Results The process of cultural adaptation has not altered the Brazilian FSFI-6, as compared with the original content. The CFA for the FSFI-6 score showed an acceptable fit (χ2/df = 3.434, CFI = 0.990, TLI = 0.980, RMSEA = 0.058, 90% confidence interval (90%CI) = 0.033–0.083, p ≤ 0.001) and a good reliability was established in FSFI-6 and MRS (Cronbach α = 0.840 and = 0.854, respectively). In addition, 53.5% of the sample had low sexual function.
Conclusion The FSFI-6 was translated and adapted to the Brazilian culture and is a consistent and reliable tool for female sexual dysfunction screening in Brazilian middle-aged women.
Background:
Sexual health is the most important aspect of person's well being, self-esteem and quality of life. Sexual pleasure leads to enhanced conjugal relationships and an overall healthy psychological state. There is paucity of data on sexual health of postmenopausal women.
Aims and objectives:
To assess the prevalence and determinants of sexual health in postmenopausal women of North India.
Materials and methods:
The study was conducted over a period of 18 months, from January 2016 to June 2017. Standard FSFI-6 questionnaire and various socio-demographic factors were used to analyse the sexual health of 110 menopausal women.
Results:
80.9% postmenopausal women reported sexual dysfunction (SD). We found more sexual dysfunction in postmenopausal women with increasing age and increasing duration of menopause. Satisfied past sexual experience, joint family structure, low socioeconomic and education status were found to be important determinants of sexual health of postmenopausal females. Parity, substance use and past medical and gynaecological history of participants and various partner's factors like medical disorders, substance use and sexual disorders showed no association with sexual health in postmenopausal females.
Conclusion:
Sexuality varies with cultural and social differences across the globe. The prevalence of female sexual dysfunction in our study is much higher because Indian women are suppressed, self conscious, inhibited and hesistant to talk about their sexual problems with health care professionals. Also revalidation of the FSFI tool for Indian population is required. Further studies are needed to evaluate the sexual health in postmenopausal women.
The purpose of this review study is to evaluate sexual function and its effective factors in menopause. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The key words of “menopause,” “postmenopause,” “postmenopausal,” “premenopause,” “pre-menopausal period,” “sexual function,” “sexual health,” “sexuality,” “sexual and gender disorders,” “sexual development,” “sexual dysfunction,” “sexual disorders,” “sexual behavior and “sexual activity” were used in combination with the Boolean operators OR and AND. After reviewing the selected articles, 27 papers were selected based on the criteria for entering the study and the goals set. The results of the reviewed articles showed that, in the physical domain, the factors affecting sexual function can be mentioned, age, hormonal changes, medical problems and reproductive history. Sexual disorders in menopause can be affected by some of the individual and social characteristics and psychological problems. Considering the fact that many psychological and social injuries occur in this period following sexual disorders; therefore, policies and programs for improving the quality of life of women in menopause should be aimed at eliminating sexual dysfunction, correcting attitudes and negative emotions and help to women for more comfortable in menopause.
Purpose
To assess the impact of serum androgen levels and androgen receptor CAG polymorphism on sexual function in 45 healthy midlife women living in a heterosexual relationship.
Methods
Cross-sectional study [Cantonal Ethics Committee Bern (Ref.-Nr. KEK-BE: 087/13)]. Main outcome measures: Association between androgen serum levels, androgen receptor CAG polymorphism and sexual function was assessed by the FSFI-d questionnaire.
Results
In our cohort of healthy, midlife, well-educated, middle-class, mostly postmenopausal women living in a heterosexual satisfying partnership, sexual function was perceived to remain stable or to decline during menopausal transition with sexual desire scoring lowest (FSFI-d 3.3 ± 0.9). Androgen serum levels did not correlate with sexual function. Mean CAG repeat number was 21.6 ± 1.9. There was a highly inverse though non-significant correlation between female sexual function and AR CAG repeat polymorphism with specifically higher numbers of CAG repeats being significantly positively correlated to more frequent or more severe pain during or after sexual intercourse.
Conclusion
The AR polymorphism is a non-negligible factor in female sexual function. Future studies on female sexual (dys)function should incorporate its assessment.
For 15 years, the Collaborative Group for Research of the Climacteric in Latin America (REDLINC) has been conducting research on several topics including age of menopause, metabolic syndrome, quality of life and climacteric symptoms, sexual dysfunction, poor quality of sleep and insomnia, and use of menopausal hormone therapy (MHT) in the general population and among gynecologists. Examples of data to have emerged for this region include the age of menopause (49 years), a high prevalence of metabolic syndrome (42.9%), and a new waist circumference cut-off value for the Latin American population (88 cm). Sexual dysfunction, poor quality of life, and sleep disorders have a prevalence of over 50%, with obesity and sedentary lifestyles affected importantly. MHT use is still low (12.5%), lack of prescription the most important reason for not using it, and gynecologists use MHT for themselves but do not recommend it often to their patients. The prevalence of alternative therapy use, recommended by physicians, is high.
Aim:
To investigate the prevalence and predictors of sexual frequency, sexual desire in midlife partnered Chinese women.
Methods:
Sexual frequency, sexual desire over the past 3 months, menopausal symptoms and other socioeconomic information were assessed for women aged 40-65 years in the Shanghai Sixth People's Hospital.
Results:
Among 3485 eligible partnered participants, the prevalence of low sexual frequency (less than once per week) and low sexual desire (less than 5 scores) were 72.74% (95% confidence interval (CI) = 71.16%-74.23%) and 71.79% (95% CI = 70.30-73.17%), respectively. Multivariable logistic regression analysis revealed that age (odds ratio (OR) = 1.20, 95% CI = 1.17-1.23), more educated (>15 years) (compared with<10 years, OR = 0.62, 95% CI = 0.48-0.82), perimenopause, postmenopause (compared with premenopause, OR = 1.48, 95% CI = 1.02-2.15, OR = 2.76, 95% CI = 1.80-4.23), sleep disorder (OR = 1.24, 95% CI = 1.02-1.50), unemployment (OR = 2.05, 95% CI = 1.45-2.92) were independently associated with low sexual frequency, while multiple linear regression revealed that age β = -0.126, 95% CI = -0.139--0.114), unemployment (β = -0.792, 95% CI = -0.954 to -0.629),chronic diseases (compared with no disease, single disease (β = -0.200, 95% CI = -0.020 to -0.077, multiple diseases (β = -0.792, 95% CI = -0.859 to -0.372), body mass index (β = -0.615, 95% CI = -0.859 to -0.372), postmenopause (β = -0.915, 95% CI = -1.143 to -0.759) were independent indicators for low sexual desire after adjusting for confounders.
Conclusion:
Low sexual frequency and low sexual desire were quite prevalent in midlife Chinese partnered women. Some factors, such as sleep disorder, obesity are modifiable or can be prevented or treated with safe and effective therapies.
Objective: This study aimed to evaluate the impact of different risk factors on long-term mortality in middle-aged women.
Methods: Women who received preventive health care control between 1990 and 1993 were recruited. Anamnesis and physical examination were recorded. Blood samples for the measurement of glycemia and lipids were taken. Data are reported as of December 2017.
Results: We studied 1197 women aged between 40 and 60 years. We observed 183 deaths (survival 84.0%; 95% confidence interval [CI], 81.7–86.1, Kaplan–Meier survival analysis). The main causes of death were cancer (39.9%; 95% CI, 32.7–47.1), cardiovascular disease (22.9%; 95% CI, 16.8–29.1), infectious disease (13.7%; 95% CI, 8.6–18.7), other causes (7.1%, 95% CI, 3.4–10.9), and unspecified cause (6.6%; 95% CI, 2.9–10.2). The final Cox regression model showed the following hazard ratios for mortality: diabetes mellitus 2.51 (95% CI, 1.40–4.51), history of fracture 2.47 (95% CI, 1.15–5.30), history of heart illness 2.06 (95% CI, 1.15–3.72), arterial hypertension 1.51 (95% CI, 1.08–2.11), age 1.07 (95% CI, 1.04–1.10), body mass index 1.06 (95% CI, 1.02–1.09), and sexual intercourse 0.94 (95% CI, 0.89–0.98). Lipid disorders did not reach statistical significance as a risk factor.
Conclusion: Diabetes, a history of fractures, and cardiovascular risk factors, except lipids, are markers of long-term mortality in middle-aged women. Physicians should pay special attention to these risk factors.
Sexual well-being frequently declines following the menopause transition and can be associated with significant personal and relationship distress. This distress is the hallmark of female sexual dysfunction (FSD). FSD is highly prevalent in postmenopausal women. The prevalence of sexual problems increases with age, but conversely this is associated with decreasing distress with advancing age. This pattern has been seen across multiple international populations with varied cultural norms. While the etiology of FSD is multifactorial, the physiological changes of sex hormone insufficiency and postmenopausal symptoms, such as dyspareunia, are primary factors contributing to FSD at midlife. The International Menopause Society is working to increase awareness of FSD and to provide a framework for practitioners to address sexual medicine concerns. This White Paper aims to review the process of care for female sexual well-being following menopause, from initially approaching the discussion of FSD, to identifying clinical signs and symptoms, and ultimately determining the best available biopsychosocial therapies. As with most processes of care, the first step is often the most difficult. Health-care practitioners need to broach the topic of sexuality in the clinical setting. Lack of information on, comfort with, and biases about the topic of sexuality after menopause are significant hurdles that the International Menopause Society addresses in this document. Each member of the Writing Group remains committed to continued advocacy for the validity of FSD as a diagnosis, the need for therapies for women to be both available and included in health insurance coverage, and continued therapeutic research to provide evidence-based solutions.
Background
Female sexual dysfunction affects 41% of reproductive-age women worldwide, making it a highly prevalent medical issue. Predictors of female sexual dysfunction are multifaceted and vary from country to country. A synthesis of potential risk factors and protective factors may aid healthcare practitioners in identifying populations at risk, in addition to revealing modifiable factors to prevent sexual dysfunction among reproductive-age women.
Methods
Observational studies which assessed the prevalence and predictors of female sexual dysfunction in reproductive-age women were systematically sought in relevant databases (2000–2014). Significant predictors were extracted from each included publication. A qualitative analysis of predictors was performed with a focus on types of sexual regimes and level of human development.
Results
One hundred thirty-five studies from 41 countries were included in the systematic review. The types of predictors varied according to the location of the study, the type of sexual regime and the level of gender inequality in that country/region. Consistently significant risk factors of female sexual dysfunction were: poor physical health, poor mental health, stress, abortion, genitourinary problems, female genital mutilation, relationship dissatisfaction, sexual abuse, and being religious. Consistently significant protective factors included: older age at marriage, exercising, daily affection, intimate communication, having a positive body image, and sex education. Some factors however had an unclear effect: age, education, employment, parity, being in a relationship, frequency of sexual intercourse, race, alcohol consumption, smoking and masturbation.
Conclusions
The sexual and reproductive lives of women are highly impacted by female sexual dysfunction, and a number of biological, psychological and social factors play a role in the prevalence of sexual dysfunction. Healthcare professionals who work with women should be aware of the many risk factors for reproductive-age women. Future prevention strategies should aim to address modifiable factors, e.g. physical activity and access to sex education; international efforts in empowering women should continue.
Objective: To investigate awareness in Latin America, knowledge of postmenopausal vaginal atrophy was evaluated in a sample of women from this region.
Methods: A total of 2509 postmenopausal women aged 55–65 years, resident in Argentina, Brazil, Chile, Colombia and Mexico, completed a structured online questionnaire.
Results: Over half the surveyed population (57%) reported experiencing symptoms of vaginal atrophy. Only 6% of the overall cohort attributed symptoms of vaginal atrophy directly to the condition, and 71% did not consider the condition to be chronic, resulting in many women not accessing effective therapy. Half the women (49%) affected by vaginal atrophy had used lubricating gels and creams; 36% had used some form of local hormone treatment. To understand symptoms and/or treatment options for vaginal discomfort, the majority of survey participants (92%) were willing to seek advice from health-care professionals; most (61%) felt/would feel comfortable talking to their doctor about this.
Conclusion: Many women in Latin America lack knowledge of postmenopausal vaginal atrophy, not appreciating the chronic nature of the condition, and may benefit from dialog initiated by health-care professionals to facilitate greater understanding and increased awareness of the availability of effective treatment.
Introduction
To determine the prevalence of sexual dysfunction in pre and postmenopausal women.
Material and methods
A cross-sectional, descriptive, comparative study was done in climacteric women from 40 to 59 years of age. Female sexual function was evaluated with the female sexual function index (FSFI) on the day of consultation. The comparison between pre and postmenopausal women and between those with or without sexual dysfunction was done with Mann Whitney U test, χ², and Spearman’s correlation analysis was done.
Results
One hundred and ten women were studied, 55 were premenopausal (group 1) and 55 postmenopausal (group 2). The median of age in group 1 was 46 (40-58) years and in group 2 it was 53 (45-60) years. Premenopausal women had higher education level than postmenopausal women (p < 0.023). From those sexually active, 62.1% had sexual dysfunction. No statistically significant difference was found in education level, religion and marital status between women with or without sexual dysfunction. No difference in sexual dysfunction was found between premenopausal (62.1%) and postmenopausal (62.5%) women, but greater sexual dysfunction was found starting from 50 years age. Age negatively correlated with FSFI score (ρ = –0.324, p < 0.001).
Conclusion
In postmenopausal women, those older had a greater impairment in sexual function.
Aims:
This study explored the impact of menopause on sexual health and marital relationships, the associated factors and the support needed among middle-aged and older women.
Background:
Although women experiencing menopause are more vulnerable to sexual health and marital problems, few studies have addressed this topic.
Design:
A mixed-methods design was used, comprising primarily quantitative methods with a qualitative component to evaluate the impact of menopause on sexual health.
Methods:
Eligible women from community-based women center in Hong Kong were recruited for a survey. The Female Sexual Function Index (FSFI) was used to evaluate sexual function and risk factors for developing sexual dysfunction. Purposively selected women were invited to participate in in-depth individual interviews to explore the impact of menopause on sexual health, the barriers encountered and the desired support.
Findings:
In total, 540 respondents completed the survey with response rate of 59.7% where 30 respondents participated the in-depth individual interview. The prevalence of sexual dysfunction in the overall respondents and post-menopause were 85.1% and 91.2%, respectively. Depression was found as a strong factor associated with sexual dysfunction. The qualitative data showed that menopause had a considerable negative impact on women's sexual lives. Vaginal dryness and low sexual desire were most commonly reported. Knowledge, financial support and family understanding were important to helping women manage menopause.
Conclusion:
This study provides further knowledge for healthcare providers and policy makers to develop appropriate strategies and deliver suitable services to improve the quality of sexual health of menopausal women. This article is protected by copyright. All rights reserved.
Background
Paying attention to sexual dysfunction and its coping strategies is essential owing to its impact on mental health in postmenopausal women and their families. This study aimed to determine the relationship between women coping strategies toward the process of menopause and sexual dysfunction in menopausal women.
Materials and Methods
This is a cross-sectional study in which 233 married menopausal women were sampled in the first 5 years after cessation of menstrual cycle using health records in the health centers in Isfahan in 2015. The method of data collection was a demographic characteristics form, sexual function questionnaire of Rosen et al., along with a researcher-made coping strategies questionnaire. The validity and reliability of these instruments were assessed, and the resulting data were analyzed utilizing inferential statistical tests (t-test and Chi-square test) and SPSS 16 software.
Results
According to the results of this study, the relative frequency of sexual dysfunction in menopausal women is 67.42%. The mean score of the avoidance strategy in people with overall sexual dysfunction was significantly higher than the group without disorder (P < 0.001). The mean of coping strategies of social support seeking (P < 0.001), problem-solving (P = 0.016), and target replacement strategy (P = 0.004) were significantly lower than that in the group without disorder.
Conclusions
In line with the findings of this study, problem-oriented strategies such as social support, problem solving, and target replacement are the best strategies for decreasing sexual dysfunction or increasing sexual satisfaction. These results emphasize the reinforcement of health personnel skills in teaching approach of these strategies to this group of women.
The Sexual Self-Consciousness Scale (SSCS), developed by van Lankveld, Geijen, and Sykora in 2008, measures self-consciousness in sexual situations distinguishing dimensions of Sexual Embarrassment and Sexual Self-Focus. To date, there is no Spanish translation or validation of this scale for use with Spanish speakers. Therefore, the goal of this study was to adapt and validate the SSCS in a sample of 288 Ecuadorian women (18–55 years old). A confirmatory factor analysis (CFA) of the data showed a good model fit when a three-factor structure was considered: (i) Sexual Embarrassment (items 1, 2, 3, 4, and 5); (ii) Sexual Partner-Focus (items 6, 7, 9, and 12); (iii) Sexual Self-Focus (items 8, 10, and 11). This version includes a distinction between sexual self-focus and sexual partner-focus (worries about the impression made on the partner). Reliability was good, and validity supported this distinction. Greater body-image dissatisfaction was positively associated with all SSCS factors, and each factor was differently associated with sexual desire (dyadic, general, and solitary) and with each phase of sexual functioning (desire, excitation, lubrication, orgasm, and satisfaction). Overall, Sexual Embarrassment had the greatest impact on sexual functioning impairment. Implications for clinical interventions are discussed.
Objective: To apply a chilean version of the MRS scale to evaluate quality of life in climacteric women. Methods: Application of chilean version of the MRS scale in 45-64 year-old women registered at Metropolitan Health Service (MHS) of Chile. Group 1, women attending programmed health preventive controls (n=844); and Group 2, women who require attention by gynecologist (n=360). Results: The suitable behavior of the used instrument was confirmed because the analysis of internal reliability showed Crombach's alpha >0.8; external reliability showed correlation in re-test of both group with Pearson's coefficient p
The loss of sexuality observed in the climacteric period is difficult to evaluate. An important advance has been the development of the Female Sexual Function Index (FSFI), a test based on the norms of the International Consensus Development Conference on Sexual Female Dysfunctions. Aim: To study the effects of hormone replacement therapy (HRT) on sexuality, applying the FSFI. Material and methods: The FSFI was applied to 300 healthy women between 45-64 years, sexually active, beneficiaries of the Southern Metropolitan Health Service. Results: The mean age of the sample studied was 51±5 years, 27% were HRT users, 21% had had an hysterectomy and 98% had a stable couple. The total score of the FSFI decreased from 27.3±5.8 in women between 45 and 49 years of age to 19.3±7.0 in women between 60 and 64 years (p
Defining and measuring Female Sexual Dysfunction (FSD) is a complex and challenging task. Several factors have confounded the theory and measurement of FSD including: the use of an inappropriate male paradigm; difficulty in capturing the complexity of women's sexual response; an evolving but presently untested nosology; and the relative independence between subjective and objective aspects of women's sexual response. Each of these factors have contributed to the difficulty in developing meaningful and valid endpoints for clinical trials.The Food and Drug Administration's (FDA) 2000 draft guidance document for female sexual dysfunction clinical trials recommended the use of daily diary measures as primary and self-administered questionnaires (SAQs) as secondary endpoints. Event logs or diary measures may be adequate for assessing aspects of male sexual performance (e.g., erectile function), or in other therapeutic areas with discrete and readily observable endpoints (e.g., incontinence). However, psychometric theory suggests that for female sexual dysfunction clinical trials, SAQ instruments may provide more sensitive and reliable measures of outcome. We offer an alternative set of recommendations in the hope that the FDA will reconsider its position and to serve as potential guidelines for non-industry sponsored research on female sexuality as well. First, we propose that SAQs be elevated from their current status as secondary endpoints to be considered as potential primary endpoints in clinical trials of FSD. Second, we recommend that depending on the trial design and intervention under study, either an SAQ or diary measure (typically one or the other, and not both), might serve as a primary endpoint in a clinical trial. Third, SAQs and diaries should be employed, analyzed and interpreted in their particular areas of strength. Diaries are most useful for enumerating events and/or counting frequencies. SAQs are superior at gathering subjective data related to women's sexual function. Fourth, we believe there is a theoretical basis for considering SAQs to be superior measurement tools compared to diaries in assessing sexual dysfunction in women. At present, however there is insufficient objective data to fully support this opinion. Conversely, we do not anticipate either theoretical or objective evidence to support the alternative hypothesis (that diaries are superior to SAQs). If this proves to be correct in the future, diary measures may no longer be considered as primary endpoints for FSD clinical trials. Finally, we recommend that the FDA and/or other regulatory agencies reconsider the emphasis given to the number of successful or satisfactory sexual events over time as primary endpoints because they do not definitively demonstrate whether there has or has not been any improvement in the FSD endpoint under study (e.g., sexual desire). Successful and satisfactory encounters represent an amalgam of subjective assessments that are too far removed from the essential FSD component.
Aim. To apply and validate in Chilean population "The Female Sexual Function Index" (International Consensus Development Conference on Sexual Female Dysfunctions). Design and methods. 383 sexually active healthy women between 20-59 years, beneficiaries of the Center of Health "Carol Urzúa". Instrument: questionnaire of 19 questions, contained in six domains: desire, arousal, lubrication, orgasm, satisfaction and pain. Statistical analysis: We used ANOVA, Kruskall-Wallis, squared Chi, logistical regression and Cronbach's alpha correlation coefficient. Results. Mean age: 35.3±10.9 years, married (50.4%) or cohabit (17.0%), with middle education (48.2%). The internal consistency of the test was good (>0.70). The sexuality achieves its maximum expression between 35-40 years (score: 29.1±4.9) and declines afterwards (21.0±6.0), especially desire and arousal. After 44 years old the risk of sexual disfunction increases (OR:3.6, IC: 2.1-6.3, p
Context While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men. Objective To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders. Design Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults. Participants A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey. Main Outcome Measures Risk of experiencing sexual dysfunction as well as negative concomitant outcomes. Results Sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Differences among men are not as marked but generally consistent with women. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall wellbeing. Conclusions The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.
Introduction
The sexual response depends on the adequate function of all systems related to the genital and extra-genital organs. Physiological conditions such as menopause can interfere with sexual expression because of central and peripheral changes. Genital effects of estrogen include vaginal trophism, lubrication, and local pleasure sensation in the sexual arousal phase. Hypoestrogenism causes changes in the four layers of the vaginal wall that may result in dyspareunia and a loss in the quality of the genital arousal response.
Aim
The purpose of this review is to highlight the changes in the vaginal wall caused by hypoestrogenism, its possible relationship with dyspareunia, and its repercussions for genital arousal. Treatments for hypoestrogenism are also discussed.
Methods
We evaluated the data available in PubMed (1982–2008) and surveyed the reference list for relevant studies. Two reviewers analyzed the data independently. A study was considered to be of high quality if it had all three of the following characteristics: (i) prospective design; (ii) valid data; and (iii) adequate sample size. Reviews and experimental animal studies were also considered.
Main Outcome Measures
Normal genital morphology, hypoestrogenism and hormone replacement therapy were the focus of the studies reviewed in this paper.
Results
Atrophy of the vaginal wall may be associated with dyspareunia and genital sexual arousal disorder, but psychological and sociocultural aspects must also be considered. Regardless, however, local estrogen therapy is useful in improving vaginal wall trophism and, thus, in improving the sexual response.
Conclusions
There are many possible alterations in the structure of the vaginal wall that are related to estrogen deficiency that may require medical intervention beyond the usual strategies used to attain adequate sexual function. Physicians should attempt to treat these alterations, and more research is needed to elucidate the physiopathology of dyspareunia and genital sexual arousal physiology. Lara LAS, Useche B, Ferriani RA, Reis RM, Sá MFS, Freitas MMS, Rosa e Silva JC, and Rosa e Silva ACJS. The effects of hypoestrogenism on the vaginal wall: Interference with the normal sexual response.
Introduction:
Sexual functioning is a common and multidimensional problem, associated with multiple biological, medical, psychological, sociocultural, political, economic, and interpersonal factors.
Aim:
The study was planned to determine the prevalence and risk factors for low sexual function in women in an outpatient clinic of a university hospital in Istanbul.
Methods:
Totally, 1,009 women over 20 years of age or their healthy female companions were interviewed in the outpatient clinics of the Department of Internal Medicine in a university hospital in Istanbul.
Main outcome measures:
Female Sexual Function Index (FSFI) was used to evaluate sexual function.
Results:
The mean age of women was 38.62 +/- 12.82 and 22.2% of women were postmenopausal. The mean FSFI score was found to be 24.25 +/- 9.50 out of a maximum total score of 36. Based on the total FSFI score, 43.4% of the women had scores less then 26. The mean domain scores were: desire 3.14 +/- 1.47, arousal 3.60 +/- 1.85, lubrication 4.53 +/- 2.01, orgasm 4.02 +/- 1.97, satisfaction 4.27 +/- 1.64, and pain 4.69 +/- 1.96 out of a maximum domain score of six. The rate of low sexual function by the age groups were 22% for those 20-29 years, 39.7% for those 30-39 years, 50.2% for those 40-49 years, 71.3% for those 50-59 years, 82.9% for those 60-64 years, and 87.8% for those 65 and over. Lower educational level, menopause, depression, presence of sexual dysfunction in their partner, and contraceptive use were found to be significantly associated with low sexual function in women.
Conclusions:
The prevalence of low sexual function in women was found to significantly increase with age. The most significantly affected domains were desire and arousal followed by orgasmic problems, satisfaction, and pain, respectively.
Aim:
To analyze behaviors, mental perception, satisfaction, and expectations relating to sexuality in France.
Methods:
A total of 1,002 subjects (483 men and 519 women) aged 35 years and over in a representative sample of the French population were surveyed by phone using a dedicated questionnaire in November 2003.
Main outcome measures:
Sexual behaviors and mental perception, satisfaction and expectations concerning sexual life.
Results:
Of the population, 80.2% reported having a sexual partner. The mean number of times subjects had sex per week was 1.8 (2.0 in men, 1.6 in women). The decision preceded the act by a few seconds or minutes in 82.7% of subjects. Thinking about sex was "frequent" in 47.1% of subjects, especially for men (60.8%). Regardless of gender, sexuality was more synonymous with pleasure (44.0%) and love (42.1%) than with procreation, children, or motherhood (7.8%). During sexual intercourse, simultaneous orgasms and feelings of closeness were important for the majority of subjects, 35.8% (41.6% of men) and 22.8%, respectively; foreplay, enjoyment, and vaginal penetration were the most important accomplishments for 13.1%. Regardless of gender, 83.0% of subjects expressed relative or full satisfaction with their sex life. However, only 38.7% of subjects (31.6% of men and 45.2% of women) did not wish to change anything, while 17.2% would like to have more time for it. Of the subjects, 63.0% reported a decrease in sexual desire during periods of work-related stress, especially in women (72.3%). The main sexual complaints reported by men were diminution of sexual desire (24.9%), early ejaculation (23.7%), and erectile problems (14.4%). In women, they were diminution of sexual desire (45.7%), orgasm disorders (15.5%), and dyspareunia (15.5%).
Conclusions:
This survey showed that the attitude of subjects, especially men, toward sexuality is changing through years and highlighted the extent of sexual problems in the general population.
Introduction:
The literature shows a discrepancy in the association between child sexual abuse (CSA) and adult sexual function. One of the proposed explanations for this discrepancy is the different ways in which CSA is assessed. While some studies explicitly ask potential participants whether they are sexual abuse survivors, others ask whether participants experienced specific unwanted sexual behaviors.
Aim:
This study investigated the differences between women who self-identified as CSA survivors, women who experienced similar unwanted sexual experiences but did not identify as CSA survivors (NSA), and women with no history of sexual abuse (control). CSA was defined as unwanted touching or penetration of the genitals before the age of 16.
Methods:
A sample of 699 college students anonymously completed a battery of questionnaires on sexuality and sexual abuse history.
Main outcome measures:
Sexual function was measured with the Female Sexual Function Index (FSFI), and sexual satisfaction was measured with the Sexual Satisfaction Scale-Women. History of CSA was measured with a modified version of Carlin and Ward's childhood abuse items.
Results:
Differences emerged between women who experienced sexual abuse before age 16 and women who never experienced sexual abuse (control) on the personal distress subscale of the Sexual Satisfaction Scale. The CSA group (N = 89) reported greater sexual distress compared to the NSA (N = 98) group, and the NSA group reported more distress than the control group (N = 512). No significant group differences were observed in the FSFI. Characteristics of the abuse that predicted whether women identified as CSA survivors included vaginal penetration, fear at the time of the abuse, familial relationship with the perpetrator, and chronic frequency of the abuse. These abuse characteristics were associated with sexual satisfaction but not with sexual function.
Conclusions:
Differences in levels of sexual satisfaction between women with and without a history of CSA were associated with the type of CSA definition adopted. It remains unexplained why the CSA group showed more personal distress about their sexuality but not more sexual dysfunction.
Introduction:
Accurate estimates of prevalence/incidence are important in understanding the true burden of male and female sexual dysfunction and in identifying risk factors for prevention efforts.
Aim:
To provide recommendations/guidelines concerning state-of-the-art knowledge for the epidemiology/risk factors of sexual dysfunctions in men and women.
Methods:
An International Consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respective sexual medicine topic represent the opinion of experts from five continents developed in a process over a 2-year period. Concerning the Epidemiology/Risk Factors Committee, there were seven experts from four countries.
Main outcome measure:
Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation and debate.
Results:
Standard definitions of male and female sexual dysfunctions are needed. The incidence rate for erectile dysfunction is 25-30 cases per thousand person years and increases with age. There are no parallel data for women's sexual dysfunctions. The prevalence of sexual dysfunction increases as men and women age; about 40-45% of adult women and 20-30% of adult men have at least one manifest sexual dysfunction. Common risk factor categories associated with sexual dysfunction exist for men and women including: individual general health status, diabetes mellitus, cardiovascular disease, other genitourinary disease, psychiatric/psychological disorders, other chronic diseases, and socio-demographic conditions. Endothelial dysfunction is a condition present in many cases of erectile dysfunction and there are common etiological pathways for other vascular disease states. Increasing physical activity lowers incidence of ED in males who initiate follow-up in their middle ages.
Conclusions:
There is a need for more epidemiologic research in male and female sexual dysfunction.
To describe opinions and attitudes concerning sexuality of the Brazilian urban population.
A population survey was carried out in 2005 on a representative sample of 5,040 interviewees. An analysis of the attitudes regarding sexual initiation and sexual education of teenagers, considering gender, age, schooling, income, marital status, color, geographic region and opinion on fidelity, homosexuality, and masturbation. The results were contrasted with a similar survey carried out in 1998, when possible.
Most interviewees selected the "sex is evidence of love" option when describing the meaning of sex. As in 1998, the majority was in favor of sexual initiation after marriage (63.9% for women vs. 52.4% for men initiation); results differed among religions. School teenage education on the use of condoms was supported by 97% of the interviewees across all social groups. The proportion of Brazilians who agreed with having access to condoms in health services (95%) and at school (83.6%) was high. Fidelity remained an almost unanimous value and there was an increase, in 2005, in the proportion of those in favor of sexual initiation after marriage, and in the rate of acceptance of masturbation and homosexuality compared to the 1998 survey. The younger generations tend to be more tolerant and egalitarian.
As observed in other countries, this study confirms the difficulty in establishing a single dimension that guides sexual life ("liberal" vs "conservative"). The study suggests that the normativity concerning sexual activity should be understood in the light of the local culture and social organization of sexuality, considered by the STD/Aids programs. Opinions in favor of free access to preservatives at school clash with the slower results obtained in fighting the stigma and discriminating against homosexual minorities. The design of laical policies on sexuality allow for the dialog across different perspectives.
This article empirically studies how much aging modifies human sexual activity and sexual desire, and what the most important determinants in this change are. The analyses are based on 2 representative national sex surveys conducted in Finland in the 1990s. As a result of female widowhood, aging men had a higher incidence of sexual intercourse compared with aging women; and in relationships, women were more likely than men to report lack of sexual desire. In regression analysis, age was a predictor of sexual activity but not of sexual desire, when controlling for the impact of other factors. Relationship duration did not play an important role in sexual activity or sexual desire when controlling for a number of other variables. Sexual desire, valuing sexuality, and a healthy partner were important to female sexual activity; and high sexual self-esteem, good health, and active sexual history were important to male sexual activity. To keep up their sexual desire, both men and women needed good health, good sexual functioning, positive sexual self-esteem, and a sexually skilful partner.
To evaluate sexual function among postmenopausal diabetic women.
A total of 72 postmenopausal women, 36 diabetic, with a stable partner were included in this study. Sexual functioning was assessed using the Female Sexual Functioning Index (FSFI) and depression using the Beck Depression Inventory scale.
There was no difference between diabetic and control women regarding age, years of schooling, number of children, age at menarche, age at first sexual experience, years postmenopausal or body mass index. Diabetics had a worse score for depression (11.5 +/- 5.6 vs. 8.9 +/- 4.7, p < 0.03), a lower frequency of sexual intercourse per month (2.7 +/- 2.8 vs. 4.4 +/- 2.9, p < 0.01) and a more deteriorated marital relationship (scale of 0-20: 13.4 +/- 2.9 vs. 15.1 +/- 1.9, p < 0.009). Diabetics demonstrated worse scores globally (19.3 +/- 8.1 vs. 26.8 +/- 4.5, p < 0.0001) and in all domains of the FSFI: desire (2.6 +/- 1.4 vs. 3.8 +/- 1.1, p < 0.0001), arousal (3.5 +/- 1.9 vs. 4.7 +/- 0.8, p < 0.002), lubrication (3.2 +/- 1.9 vs. 4.5 +/- 1.3, p < 0.003), orgasm (3.2 +/- 1.8 vs. 4.5 +/- 1.1, p < 0.002), satisfaction (3.8 +/- 1.3 vs. 4.8 +/- 0.9, p < 0.0005) and pain (3.1 +/- 1.7 vs. 4.6 +/- 1.3, p < 0.0001) (values all mean +/- standard deviation). Considering sexual dysfunction as a score higher than 26.55, the prevalence of sexual dysfunction among diabetics was 75.0% vs. 30.6% in the control group (p < 0.001). After adjusting for depression, years of schooling, hysterectomy, marital relationship and age, diabetes mellitus remained an important risk factor for sexual dysfunction (odds ratio 6.2, 95% confidence interval 2.0-19.6, p < 0.02).
Diabetes mellitus affects all areas of female sexuality and this condition is independent of depression.
To study sexual functioning and attitudes towards sexuality in postmenopausal women.
A cross-sectional study was conducted among 219 healthy postmenopausal women with a uterus, aged 45-55 years, and not taking hormone therapy, who attended the gynecological and menopause clinic, Songklanagarind Hospital. The Female Sexual Function Index (FSFI) questionnaire was used as the instrument.
The median age at enrollment and menopause age of women were 52 and 49, respectively. All the women had engaged in sexual intercourse. Sixty nine percent reported being sexually active once or twice in the previous four weeks, 27.9% three to four times and 3.1% more than four times. The mean total FSFI score was 20.4 while the proportion of women with female sexual dysfunction based on FSFI overall scores of 26.5 or less was 82.2%. Almost all the women displayed a positive attitude towards sexuality. Ninety six percent reported having sex in menopause as a natural normal part of life, 95% regarded having sex to make their partner happy whereas 77% regarded sex as a way to make themselves happy.
Sexual dysfunction in postmenopausal women was rather high. However, they were still satisfied with their sexual relationship and had a positive attitude towards sexuality.
From a representative sample of 2460 Danish citizens, ages 18 to 88, anonymous answers were obtained to a 317-item quality-of-life (QL) questionnaire, which included five questions on sexuality. Among the respondents in the sample, 1.2% reported they were bisexual and 0.9% homosexual. Although sexual problems were found in all age groups, lack of a suitable sex partner and inability to achieve orgasm were more common among the young and erectile dysfunction more common among the old. Most frequent problems among the women were reduced sexual desire (11.2%) and the lack of a suitable sex partner (4.9%), and among the men, the lack of a suitable sex partner (7.3%) and erectile dysfunction (5.4%). The QL of persons with sexual problems was from 1.2 to 19.1% lower than the population mean (as expressed in terms of this mean). The intermediate sized covariation between sexual problems and the QL suggests that such problems can be symptoms of a reduced QL rather than medical problems to be tackled through medical intervention or sex therapy proper. Implications for a quality-of-life-sensitive clinical practice are discussed.
While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men.
To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders.
Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults.
A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey.
Risk of experiencing sexual dysfunction as well as negative concomitant outcomes.
Sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Differences among men are not as marked but generally consistent with women. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall well-being.
The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.
Female sexual dysfunction is highly prevalent but not well defined or understood. We evaluated and revised existing definitions and classifications of female sexual dysfunction.
An interdisciplinary consensus conference panel consisting of 19 experts in female sexual dysfunction selected from 5 countries was convened by the Sexual Function Health Council of the American Foundation for Urologic Disease. A modified Delphi method was used to develop consensus definitions and classifications, and build on the existing framework of the International Classification of Diseases-10 and DSM-IV: Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, which were limited to consideration of psychiatric disorders.
Classifications were expanded to include psychogenic and organic causes of desire, arousal, orgasm and sexual pain disorders. An essential element of the new diagnostic system is the "personal distress" criterion. In particular, new definitions of sexual arousal and hypoactive sexual desire disorders were developed, and a new category of noncoital sexual pain disorder was added. In addition, a new subtyping system for clinical diagnosis was devised. Guidelines for clinical end points and outcomes were proposed, and important research goals and priorities were identified.
We recommend use of the new female sexual dysfunction diagnostic and classification system based on physiological as well as psychological pathophysiologies, and a personal distress criterion for most diagnostic categories.
This article presents the development of a brief, self-report measure of female sexual function. Initial face validity testing of questionnaire items, identified by an expert panel, was followed by a study aimed at further refining the questionnaire. It was administered to 131 normal controls and 128 age-matched subjects with female sexual arousal disorder (FSAD) at five research centers. Based on clinical interpretations of a principal components analysis, a 6-domain structure was identified, which included desire, subjective arousal, lubrication, orgasm, satisfaction, and pain. Overall test-retest reliability coefficients were high for each of the individual domains (r = 0.79 to 0.86) and a high degree of internal consistency was observed (Cronbach's alpha values of 0.82 and higher) Good construct validity was demonstrated by highly significant mean difference scores between the FSAD and control groups for each of the domains (p < or = 0.001). Additionally, divergent validity with a scale of marital satisfaction was observed. These results support the reliability and psychometric (as well as clinical) validity of the Female Sexual Function Index (FSFI) in the assessment of key dimensions of female sexual function in clinical and nonclinical samples. Our findings also suggest important gender differences in the patterning of female sexual function in comparison with similar questionnaire studies in males.
Background
Symptom scales for aging women have clinically been used for years and the interest in measuring health-related quality of life (HRQoL) has increased in recent years. The Menopause Rating Scale (MRS) is a formally validated scale according to the requirements for quality of life instruments. The aim of this paper is to review the current state of the instrument particularly concerning versions of the scale in different languages.
MRS versions available
The translations were performed following international methodological recommendations for the linguistic & cultural adaptation of HRQoL instruments. The first translation was done from the German original scale into English (UK & USA). The English version was used as the source language for the translations into French, Spanish, Swedish, Mexican/Argentine, Brazilian, Turkish, and Indonesian languages (attached as additional PDF files).
Conclusion
The MRS scale is obviously a valuable tool for assessing health related quality of life of women in the menopausal transition and is used worldwide. The currently available 9 language versions have been translated following international standards for the linguistic and cultural translation of quality of life scales. Assistance is offered to help interested parties in the translation process.
The objectives of this study are to compare the two definitions of female sexual dysfunction, namely dysfunction per se (A category) and personal distress caused by dysfunction (B category), and to gauge their associations with some sociodemographic aspects and level of sexual well-being. The subjects were a nationally representative sample of sexually active Swedish women (n: 1056) aged 18-65 y, who participated in a combined structured interview/questionnaire investigation. The functions analysed were: self-reported sexual desire, interest, lubrication, orgasm, genital pain and vaginism, which were subclassified for the A and B categories into no, mild (sporadically occurring) and manifest dysfunction. Sexual well-being was reported along a six-grade scale ranging from very satisfied to very dissatisfied. The sociodemographic items registered were: education, occupation, financial situation, social group, immigrant status, location of domicile and church-going. Aggregated mild and manifest dysfunction per se of sexual interest, orgasm and vaginal lubrication were reported by about 60-90%. More than one-third had dyspareunia, but few reported vaginism. Mild dysfunctions were clearly more common than manifest dysfunctions. Not fully 45% of those with manifest low interest and orgasm perceived these dysfunctions as manifestly distressing, while in 60-70% lubricational insufficiency of dyspareunia led to manifest distress. Age and the included sociodemographic variables had marginal or no influence on sexual functions. A four-factor sexual function pattern was identified, closely linking A and B categories in a pairwise manner. Three factors, labelled sexual desire, orgasm and genital function were powerful classifiers (discriminant analysis) of level of sexual well-being. Hence, it is a matter of taste whether to use the A or the B category. Together, they can explain the gross level of satisfaction with sexual life to an adequate extent.
The Global Study of Sexual Attitudes and Behaviors (GSSAB) is an international survey of various aspects of sex and relationships among adults aged 40-80 y. An analysis of GSSAB data was performed to estimate the prevalence and correlates of sexual problems in 13,882 women and 13,618 men from 29 countries. The overall response rate was modest; however, the estimates of prevalence of sexual problems are comparable with published values. Several factors consistently elevated the likelihood of sexual problems. Age was an important correlate of lubrication difficulties among women and of several sexual problems, including a lack of interest in sex, the inability to reach orgasm, and erectile difficulties among men. We conclude that sexual difficulties are relatively common among mature adults throughout the world. Sexual problems tend to be more associated with physical health and aging among men than women.
The Female Sexual Function Index (FSFI) is a brief multidimensional scale for assessing sexual function in women. The scale has received initial psychometric evaluation, including studies of reliability, convergent validity, and discriminant validity (Meston, 2003; Rosen et al., 2000). The present study was designed to crossvalidate the FSFI in several samples of women with mixed sexual dysfunctions (N = 568) and to develop diagnostic cut-off scores for potential classification of women's sexual dysfunction. Some of these samples were drawn from our previous validation studies (N = 414), and some were added for purposes of the present study (N = 154). The combined data set consisted of multiple samples of women with sexual dysfunction diagnoses (N = 307), including female sexual arousal disorder (FSAD), hypoactive sexual desire disorder (HSDD), female sexual orgasm disorder (FSOD), dyspareunia/vaginismus (pain), and multiple sexual dysfunctions, in addition to a large sample of nondysfunctional controls (n = 261). We conducted analyses on the individual and combined samples, including replicating the original factor structure using principal components analysis with varimax rotation. We assessed Cronbach's alpha (internal reliability) and interdomain correlations and tested discriminant validity by means of a MANOVA (multivariate analysis of variance; dysfunction diagnosis x FSFI domain), with Bonferroni-corrected post hoc comparisons. We developed diagnostic cut off scores by means of standard receiver operating characteristics-curves and the CART (Classification and Regression Trees) procedure. Principal components analysis replicated the original five-factor structure, including desire/arousal, lubrication, orgasm, pain, and satisfaction. We found the internal reliability for the total FSFI and six domain scores to be good to excellent, with Cronbach alpha's >0.9 for the combined sample and above 0.8 for the sexually dysfunctional and nondysfunctional samples, independently. Discriminant validity testing confirmed the ability of both total and domain scores to differentiate between functional and nondysfunctional women. On the basis of sensitivity and specificity analyses and the CART procedure, we found an FSFI total score of 26.55 to be the optimal cut score for differentiating women with and without sexual dysfunction. On the basis of this cut-off we found 70.7% of women with sexual dysfunction and 88.1% of the sexually functional women in the cross-validation sample to be correctly classified. Addition of the lubrication score in the model resulted in slightly improved specificity (from .707 to .772) at a slight cost of sensitivity (from .881 to .854) for identifying women without sexual dysfunction. We discuss the results in terms of potential strengths and weaknesses of the FSFI, as well in terms of further clinical and research implications.
Defining and measuring Female Sexual Dysfunction (FSD) is a complex and challenging task. Several factors have confounded the theory and measurement of FSD including: the use of an inappropriate male paradigm; difficulty in capturing the complexity of women's sexual response; an evolving but presently untested nosology; and the relative independence between subjective and objective aspects of women's sexual response. Each of these factors have contributed to the difficulty in developing meaningful and valid endpoints for clinical trials. The Food and Drug Administration's (FDA) 2000 draft guidance document for female sexual dysfunction clinical trials recommended the use of daily diary measures as primary and self-administered questionnaires (SAQs) as secondary endpoints. Event logs or diary measures may be adequate for assessing aspects of male sexual performance (e.g., erectile function), or in other therapeutic areas with discrete and readily observable endpoints (e.g., incontinence). However, psychometric theory suggests that for female sexual dysfunction clinical trials, SAQ instruments may provide more sensitive and reliable measures of outcome. We offer an alternative set of recommendations in the hope that the FDA will reconsider its position and to serve as potential guidelines for non-industry sponsored research on female sexuality as well. First, we propose that SAQs be elevated from their current status as secondary endpoints to be considered as potential primary endpoints in clinical trials of FSD. Second, we recommend that depending on the trial design and intervention under study, either an SAQ or diary measure (typically one or the other, and not both), might serve as a primary endpoint in a clinical trial. Third, SAQs and diaries should be employed, analyzed and interpreted in their particular areas of strength. Diaries are most useful for enumerating events and/or counting frequencies. SAQs are superior at gathering subjective data related to women's sexual function. Fourth, we believe there is a theoretical basis for considering SAQs to be superior measurement tools compared to diaries in assessing sexual dysfunction in women. At present, however there is insufficient objective data to fully support this opinion. Conversely, we do not anticipate either theoretical or objective evidence to support the alternative hypothesis (that diaries are superior to SAQs). If this proves to be correct in the future, diary measures may no longer be considered as primary endpoints for FSD clinical trials. Finally, we recommend that the FDA and/or other regulatory agencies reconsider the emphasis given to the number of successful or satisfactory sexual events over time as primary endpoints because they do not definitively demonstrate whether there has or has not been any improvement in the FSD endpoint under study (e.g., sexual desire). Successful and satisfactory encounters represent an amalgam of subjective assessments that are too far removed from the essential FSD component.
To explore the prevalence and risk factors of female sexual dysfunction (FSD) in Iran. A total of 2626 women aged 20-60 years old were interviewed by 41 female general practitioners and answered a self-administered questionnaire on several aspects of FSD including desire, arousal, pain and orgasmic disorders (OD). Criteria of sexual dysfunction followed classification by DSM-IV. The sexual function was evaluated by the Female Sexual Function Index (FSFI). The subjects were randomly identified from 28 counties of Iran. Data on medical history, toxic habits and current use of medication were also obtained. Of the women interviewed, 31.5% (759) reported FSD. The prevalence increased with age, from 26% in women aged 20-39 years to 39% in those >50 years (tested for trend P<0.001). Thirty-seven percent reported OD, 35% desire disorders (DD) and 30% arousal disorders (AD), all of which increased significantly with age. Pain disorders were reported by 26.7%, occurring most frequently in women aged 20-29 years. The educational level (P=0.01) and marriage age (<18 years) (P=0.04) were inversely correlated with the risk of DD, OD and AD. No significant differences were detected in smoking history (P=0.18), the presence of previous pelvic surgery (P=0.08) and contraception methods used (P=0.42). A history of psychological problems (P=0.04), married status (P=0.03), low physical activity (P=0.012), chronic disease (P<0.01), multiparity (P<0.05) menopause status (P<or=0.01) and spousal erectile dysfunction (P=0.01) were significantly associated with FSD. This study provides a quantitative estimate of the prevalence and the main risk factors for FSD in Iranian women.
We assessed the prevalence of and risk factors for FSD using the Turkish version of the FSFI in Turkish women.
The study consisted of 518 women 18 to 55 years old living in Ankara, who completed the FSFI for the evaluation of FSD. The women were divided into 3 groups according to age, that is 18 to 30 (273), 31 to 45 (192) and 46 to 55 years (53). Demographic characteristics and risk factors were assessed in all women. Findings were compared between women with and without FSD.
According to the FSFI score 48.3% of women reported FSD (FSFI score less than 25). The prevalence of FSD was 41% at ages 18 to 30 years, 53.1% at ages 31 to 45 years and 67.9% at ages 46 to 55 years. FSD was detected as a desire problem in 48.3% of women, an arousal problem in 35.9%, a lubrication problem in 40.9%, an orgasm problem in 42.7%, a satisfaction problem in 45.0% and a pain problem in 42.9%. Risk factors for FSD were age, smoking (OR 2.4, 95% CI 6.8 to 18.1), menopause (OR 1.7, 95% CI 2.7 to 10.2), diet (OR 1.2, 95% CI 1.9 to 5.5) and marital status (OR 0.8, 95% CI 1.5 to 3.2) (each p <0.001).
Overall 48.3% of women in our study had FSD according to the FSFI. Apart from age, the most important risk factors for FSD were smoking, diet based life-style changes, menopause status and marital status.
We investigated the prevalence and comorbidity of sexual dysfunction in a clinical Portuguese sample. A total of 96 participants (47 females and 49 males with a diagnosis of sexual dysfunction (DSM-IV; American Psychological Association, 1994) assigned by a group of trained sex therapists) answered the Female Sexual Function Index (FSFI; Rosen et al., 2000) and the International Index of Erectile Function (IIEF; Rosen et al., 1997). Results indicated erectile dysfunction (70%) and female hypoactive sexual desire disorders (40.4%) as the most prevalent complaints, with premature ejaculation (22.4%), vaginismus (25.5%), and female orgasmic disorder (21.3%) also showing relevant prevalences. Comorbidity studies indicated higher levels of overlapping among female sexual difficulties with strong associations between desire, subjective arousal, and orgasmic disorders, as well as between dyspareunia and vaginismus.
To assess the age at menopause (AM) in Latin America urban areas.
A total of 17,150 healthy women, aged 40 to 59 years, accompanying patients to healthcare centers in 47 cities of 15 Latin American countries, were surveyed regarding their age, educational level, healthcare coverage, history of gynecological surgery, smoking habit, presence of menses, and the use of contraception or hormone therapy at menopause. The AM was calculated using logit analysis.
The mean age of the entire sample was 49.4 +/- 5.5 years. Mean educational level was 9.9 +/- 4.5 years, and the use of hormone therapy and oral contraception was 22.1% and 7.9%, respectively. The median AM of women in all centers was 48.6 years, ranging from 43.8 years in Asuncion (Paraguay) to 53 years in Cartagena de Indias (Colombia). Logistic regression analysis determined that women aged 49 living in cities at 2,000 meters or more above sea level (OR = 2.0, 95% CI: 1.4-2.9, P < 0.001) and those with lower educational level (OR = 1.9, 95% CI: 1.3-2.8, P < 0.001) or living in countries with low gross national product (OR = 2.1, 95% CI: 1.5-2.9, P < 0.001) were more prone to an earlier onset of menopause.
The AM varies widely in Latin America. Lower income and related poverty conditions influence the onset of menopause.
To study the sexual activity and the prevalence of sexual dysfunctions and related help seeking behaviour, among people in Europe aged 40-80 years. A telephone survey was carried out in 2001-2002 in Sweden, the UK, Belgium, Germany, Austria, France, Spain and Italy, of 4,977 men and 5,023 women, using a structured, standardized questionnaire Eighty-three percent of men and 66% of women had sexual intercourse during the year preceding the interview. The sexual dysfunctions most frequently reported were early ejaculation (11%) and erectile dysfunction (8%) in men; and a lack of sexual interest (18%), an inability to reach orgasm (13%) and lubrication difficulties (11%) in women. Of the 23% of men and 32% of women who reported sexual dysfunction, 26% had consulted a physician, with considerable between-country differences. Sexual activity is widespread among adult middle-aged and elderly people, but many experience sexual dysfunctions and few seek medical care.
How do physical affection, sexual activity, mood, and stress influence one another in the daily lives of mid-aged women? Fifty-eight women (M age, 47.6 yrs) recorded physical affection, several different sexual behaviors, stressful events, and mood ratings every morning for 36 weeks. Using multilevel modeling, we determined that physical affection or sexual behavior with a partner on one day significantly predicted lower negative mood and stress and higher positive mood on the following day. The relation did not hold for orgasm without a partner. Additionally, positive mood on one day predicted more physical affection and sexual activity with a partner, but fewer solo orgasms the following day. Negative mood was mostly unrelated to next-day sexual activity or physical affection. Sexual orientation, living with a partner, and duration of relationship moderated some of these effects. Results support a bidirectional causal model in which dyadic sexual interaction and physical affection improve mood and reduce stress, with improved mood and reduced stress in turn increasing the likelihood of future sex and physical affection.
Sexual difficulties in women appear to be widespread in society; the relationship between female sexual function and obesity is unclear. This study aimed to investigate the relationship between body weight, the distribution of body fat and sexual function in women. Fifty-two, otherwise healthy women with abnormal values of female sexual function index (FSFI) score (< or =23) were compared with 66 control women (FSFI >23), matched for age and menopausal status. All women were free from diseases known to affect sexual function. FSFI strongly correlated with body mass index (BMI) (r=-0.72, P=0.0001), but not with waist-to-hip ratio (r=-0.09, P=0.48), in women with sexual dysfunction. Of the six sexual function parameters, desire and pain did not correlate with BMI, while arousal (r=-0.75), lubrication (r=-0.66), orgasm (r=-0.56) and satisfaction (r=-0.56, all P<0.001) did. FSFI score was significantly lower in overweight women as compared with normal weight women, while cholesterol and triglyceride levels were higher. On multivariate analysis, both age and BMI explained about 68% of FSFI variance, with a primacy of BMI over age (ratio 4:1). In conclusion, obesity affects several aspects of sexuality in otherwise healthy women with sexual dysfunction.
Background:
Vaginal atrophy is a frequent complaint of postmenopausal women; symptoms include vaginal dryness, itching, discomfort and painful intercourse. Systemic treatment for these symptoms in the form of oral hormone replacement therapy is not always necessary. An alternative choice is oestrogenic preparations administered vaginally (in the form of creams, pessaries, tablets and the estradiol releasing ring).
Objectives:
The objective of this review is to compare the effectiveness, safety and acceptability of oestrogenic preparations for women who suffer from vaginal atrophy.
Search strategy:
We searched the Cochrane Menstrual Disorders and Subfertility Group register of trials (searched January 2003), The Cochrane Library (Issue 2, 2003), MEDLINE (1966-January 2003), EMBASE (1980-January 2003), Current Contents (1993-January 2003), Biological Abstracts (1969-2002), Social Sciences Index (1980-January 2003), PsycINFO (1972-February 2003), CINAHL (1982-January 2003) and reference list of articles. We also contacted manufacturers and researchers in the field.
Selection criteria:
The inclusion criteria were randomised comparisons of oestrogenic preparations administered intravaginally in postmenopausal women for the treatment of symptoms resulting from vaginal atrophy or vaginitis.
Data collection and analysis:
Twenty nine trials were identified, of these 13 were excluded. Trials were assessed for quality and two reviewers extracted data independently. Ratios for dichotomous and means for continuous outcomes were estimated. Outcomes analysed were included under the headings of efficacy, safety and acceptability.
Main results:
Sixteen trials with 2129 women were included in this review. The overall quality of the studies was good, although not all trials measured the same outcomes. All trials measured efficacy with various outcome measures. When comparing efficacy of oestrogenic preparations (in the form of creams, pessaries, tablets and the estradiol releasing vaginal ring) with each other in relieving the symptoms of vaginal atrophy, results indicated significant differences favouring the cream, ring, and tablets when compared to placebo and non-hormonal gel. Fourteen trials compared safety. Four looked at hyperplasia, four looked at endometrial overstimulation and six looked at adverse effects. One trial showed significant adverse effects of cream (conjugated equine oestrogen) when compared to tablets (estradiol) which included uterine bleeding, breast pain and perineal pain (1 RCT; OR 0.18, 95% CI 0.07 to 0.50). Two trials showed significant endometrial overstimulation as evaluated by progestagen challenge test in the cream (conjugated equine oestrogen) group when compared to the ring (OR 0.29, 95% CI 0.11 to 0.78). Although not statistically significant there was a 2% incidence of simple hyperplasia in the ring group when compared to cream (conjugated equine oestrogen) and 4% incidence of hyperplasia (one simple, one complex) in the cream group (conjugated equine oestrogen) when compared to the tablet (estradiol). Nine studies compared acceptability to the participants by comparing comfort of product, ease of use, overall product rating, delivery system and satisfaction. Results showed a significant preference for the estradiol releasing vaginal ring.
Reviewer's conclusions:
Creams, pessaries, tablets and the estradiol vaginal ring appeared to be equally effective for the symptoms of vaginal atrophy. One trial found significant side effects noted following cream (conjugated equine oestrogen) administration when compared to tablets causing uterine bleeding, breast pain and perineal pain. Another trial found significant endometrial overstimulation following cream (conjugated equine oestrogen) when compared to the ring. As a treatment choice women appeared to favour the estradiol releasing vaginal ring for ease of use, comfort of product and overall satisfaction.
b>Introduction. Many recent studies have investigated the prevalence of female sexual difficulty/dysfunction.
Aim. Investigate female sexual difficulty/dysfunction using data from prevalence studies.
Methods. We reviewed published prevalence studies excluding those that had not included each category of sexual difficulty (desire, arousal, orgasm, and pain), were based on convenience sampling, or had a response rate <50% or a sample size <100.
Main Outcome Measures. For each study we used the prevalence of any sexual difficulty as the denominator and calculated the proportion of women reporting each type of difficulty. For each category of sexual difficulty we used the prevalence of that difficulty lasting 1 month or more as the denominator and calculated the proportion of difficulties lasting several months or more and 6 months or more.
Results. Only 11 of 1,248 studies identified met our inclusion criteria. These studies used different measures of sexual dysfunction, so generating a simple summary prevalence was not possible. However, we observed consistent patterns in the published data. Among women with any sexual difficulty, on average, 64% (range 16–75%) experienced desire difficulty, 35% (range 16– 48%) experienced orgasm difficulty, 31% (range 12–64%) experienced arousal difficulty, and 26% (range 7–58%) experienced sexual pain. Of the sexual difficulties that occurred for 1 month or more in the previous year, 62–89% persisted for at least several months and 25–28% persisted for 6 months or more. Two studies investigated distress. Only a proportion of women with sexual difficulty were distressed by it (21–67%).
Conclusions. Desire difficulty is the most common sexual difficulty experienced by women. While the majority of difficulties last for less than 6 months, up to a third persist for 6 months or more. Sexual difficulties do not always cause distress. Consequently, prevalence estimates will vary depending on the time frame specified by researchers and whether distress is included in these estimates.<br /
Introduction. Sexual functioning is a common and multidimensional problem, associated with multiple biological, medical, psychological, sociocultural, political, economic, and interpersonal factors. Aim. The study was planned to determine the prevalence and risk factors for low sexual function in women in an outpatient clinic of a university hospital in Istanbul. Methods. Totally, 1,009 women over 20 years of age or their healthy female companions were interviewed in the outpatient clinics of the Department of Internal Medicine in a university hospital in Istanbul. Main Outcome Measures. Female Sexual Function Index (FSFI) was used to evaluate sexual function. Results. The mean age of women was 38.62 ± 12.82 and 22.2% of women were postmenopausal. The mean FSFI score was found to be 24.25 ± 9.50 out of a maximum total score of 36. Based on the total FSFI score, 43.4% of the women had scores less then 26. The mean domain scores were: desire 3.14 ± 1.47, arousal 3.60 ± 1.85, lubrication 4.53 ± 2.01, orgasm 4.02 ± 1.97, satisfaction 4.27 ± 1.64, and pain 4.69 ± 1.96 out of a maximum domain score of six. The rate of low sexual function by the age groups were 22% for those 20-29 years, 39.7% for those 30-39 years, 50.2% for those 40-49 years, 71.3% for those 50-59 years, 82.9% for those 60-64 years, and 87.8% for those 65 and over. Lower educational level, menopause, depression, presence of sexual dysfunction in their partner, and contraceptive use were found to be significantly associated with low sexual function in women. Conclusions. The prevalence of low sexual function in women was found to significantly increase with age. The most significantly affected domains were desire and arousal followed by orgasmic problems, satisfaction, and pain, respectively.
Several studies indicate that quality of life (QoL) is impaired in middle aged women. Assessment of QoL using a single validated tool in Latin American climacteric women has not been reported to date at large scale.
The Menopause Rating Scale (MRS) was used to assess QoL among middle aged Latin American women and determine factors associated with severe menopausal symptoms (QoL impairment).
In this cross-sectional study, 8373 healthy women aged 40-59 years, accompanying patients to healthcare centres in 18 cities of 12 Latin American countries, were asked to fill out the MRS and a questionnaire containing socio-demographic, female and partner data.
Mean age of the entire sample was 49.1+/-5.7 years (median 49), a 62.5% had 12 or less years of schooling, 48.8% were postmenopausal and 14.7% were on hormonal therapy (HT). Mean total MRS score (n=8373) was 11.3+/-8.5 (median 10); for the somatic subscale, 4.1+/-3.4; the psychological subscale, 4.6+/-3.8 and the urogenital subscale, 2.5+/-2.7. The prevalence of women presenting moderate to severe total MRS scorings was high (>50%) in all countries, Chile and Uruguay being the ones with the highest percentages (80.8% and 67.4%, respectively). Logistic regression determined that impaired QoL (severe total MRS score > or =17) was associated with the use of alternatives therapies for menopause (OR: 1.47, 95% CI [1.22-1.76], p=0.0001), the use of psychiatric drugs (OR: 1.57, 95% CI [1.29-1.90], p=0.0001), attending a psychiatrist (OR: 1.66, 95% CI [1.41-1.96], p=0.0001), being postmenopausal (OR: 1.48, 95% CI [1.29-1.69, p=0.0001]), having 49 years or more (OR: 1.24, 95% CI [1.08-1.42], p=0.001), living at high altitude (OR: 1.43, 95% CI [1.25-1.62, p=0.0001]) and having a partner with erectile dysfunction (OR: 1.69, 95% CI [1.47-1.94, p=0.0001]) or premature ejaculation (OR: 1.34, 95% CI [1.16-1.55, p=0.0001]). Lower risk for impaired QoL was related to living in a country with a lower income (OR: 0.77, 95% CI [0.68-0.88], p=0.0002), using HT (OR: 0.65, 95% CI [0.56-0.76], p=0.0001) and engaging in healthy habits (OR: 0.59, 95% CI [0.50-0.69], p=0.0001).
To the best of our knowledge this is the first and largest study assessing QoL in a Latin American climacteric series with a high prevalence of impairment related to individual female and male characteristics and the demography of the studied population.
A select group of investigators attended a structured workshop, the Stages of Reproductive Aging Workshop (STRAW), at Park City, Utah, USA, in July 2001, which addressed the need in women for a staging system as well as the confusing nomenclature for the reproductive years.
Few trials have studied the prevalence of sexual dysfunction (SD) and related risk factors in postmenopausal women using the DSM-IV criteria.
To evaluate the prevalence of SD in menopausal women and the impact of risk factors.
Five hundred thirty four healthy women, 40 to 64 years of age were interviewed using the Laumann test (DSM-IV).
Mean age was 52.4 +/- 5.7 years. Eighty three percent were peri or postmenopausal, 23% used hormonal substitution therapy and 79.2% were sexually active. Among sexually active women, the prevalence of SD increased along with age, from 22.2% at the 40-44 years old range to 66.0% in the 60-64 years old group. Hormone users and healthy women had a low risk for SD (Odds ratio (OR): 0.1 IC: 0.0-0.1 and OR: 0.6 IC: 0.3-0.9, respectively). The risk increased in menopausal women (OR: 3.3 IC: 1.6-6.9), those older than 49 years (OR: 3.4 IC: 1.8-6.4), those subjected to hysterectomy (OR: 3.7 IC: 1.3-10.6) or those with an impotent sexual partner (OR: 3.2 IC: 1.2-8.6).
There is a high prevalence of SD among climacteric women. Estrogens, either endogenous or exogenous, have a positive influence on sexuality.
In order to determine the prevalence of sexual dysfunction (SD) and related risk factors in a cohort of middle-aged women the Laumann's test (DSM-IV) was passed to 534 healthy women between 40 and 64 years old (mean: 52.4+/-5.7) attending the Southern Metropolitan Health Service in Santiago de Chile. Of all the women, 82.8% were peri- or postmenopausal, 23% had received hormone replacement therapy (HRT) and 79.2% were sexually active. Among those who were sexually active a total of 51.3% presented SD. The prevalence of SD increased with age (from 22.2% in the 40-44-year age group to 66% in the 60-64-year age group). HRT users and healthy women presented a lower risk of SD (OR: 0.1 CI: 0.0-0.1 and OR: 0.6 CI: 0.3-0.9, respectively). The risk increased after the menopause (OR: 3.3 CI: 1.6-6.9) and with age older than 49 years (OR: 3.4 CI: 1.8-6.4), hysterectomy (OR: 3.7 CI: 1.3-10.6) and when male partners presented erectile dysfunction (OR: 3.2 CI: 1.2-8.6). In conclusion sexual dysfunction affects more than 51% of middle-aged women who are sexually active and increases with age. Ovarian function and HRT significantly influence sexual activity.
It has been suggested that approximately 40% of women between 40 and 64 years of age cease their sexual activity. Our objective was to examine the reasons that sexual activity has stopped and to determine the effect that this behavior has on the marital stability of those middle-aged women.
A total of 534 healthy women between 40 and 64 years of age who were attending the Southern Metropolitan Health Service in Santiago, Chile, were asked to take part in the study.
The main reasons for sexual inactivity in middle-aged women were sexual dysfunction (49.2%), unpleasant personal relationship with a partner (17.9%), and lack of a partner (17.7%). These reasons vary with aging; in women younger than 45 years, the most frequent reason was erectile dysfunction (40.7%); in those between 45 and 59, low sexual desire (40.5%); and, in women older than 60 years, the lack of a partner (32.4%). Sexual inactivity did not affect marital stability because women without sexual relationships (68.2% of the entire sample) were married. Among the divorced women, female sexual dysfunction was responsible for only 11.7% of the separations.
Low sexual desire is the main reason for ceasing sexual activity. Nevertheless, stopping sexual relationships does not seem to be important in marital stability.
The loss of sexuality observed in the climacteric period is difficult to evaluate. An important advance has been the development of the Female Sexual Function Index (FSFI), a test based on the norms of the International Consensus Development Conference on Sexual Female Dysfunctions.
To study the effects of hormone replacement therapy (HRT) on sexuality, applying the FSFI.
The FSFI was applied to 300 healthy women between 45-64 years, sexually active, beneficiaries of the Southern Metropolitan Health Service.
The mean age of the sample studied was 51 +/- 5 years, 27% were HRT users, 21% had had an hysterectomy and 98% had a stable couple. The total score of the FSFI decreased from 27.3 +/- 5.8 in women between 45 and 49 years of age to 19.3 +/- 7.0 in women between 60 and 64 years (p < 0.01). A significantly better sexuality was observed in HRT users, with FSFI scores of 28.1 +/- 5.5 and 24.6 +/- 6.8 in HRT users and non users, respectively (p < 0.01). Women on HRT obtained a higher score in all of the test domains, especially in lubrication, orgasm and sexual satisfaction.
Female sexuality decreases with aging. HRT users have a better sexual function than non users.
To assess the importance of sex and the prevalence of sexual dysfunction among middle-aged and older adults throughout the world. Increasing life expectancy has been accompanied by improvements in the health of the middle-aged and elderly, but little is known about how this has affected their sexual experience.
Data were collected in 29 countries from 27,500 men and women aged 40 to 80 years using a standardized questionnaire (self-completed or by interview). Sexual dysfunction was defined as frequent and persistent problems. They included early ejaculation and erectile difficulties in men, lubrication difficulties and pain during intercourse in women, and a lack of sexual interest, an inability to achieve orgasm, and a feeling of unpleasurable sex in both.
More than 80% of the men and 65% of the women had had sexual intercourse during the past year. Of these subjects, the most common dysfunctions were early ejaculation (14%) and erectile difficulties (10%) among the men and a lack of sexual interest (21%), inability to reach orgasm (16%), and lubrication difficulties (16%) among the women. Overall, 28% of the men and 39% of the women said that they were affected by at least one sexual dysfunction.
The results of our study indicate that sexual desire and activity are widespread among middle-aged and elderly men and women worldwide and persist into old age. The prevalence of sexual dysfunctions was quite high and tended to increase with age, especially in men. Although major between-country differences were noted, this global study revealed some clear and consistent patterns.
The aims of this prospective study were to compare sexual functioning between women with male partners who have erectile dysfunction (ED) and women without partners with ED and also to investigate the effect of the treatment of male ED on female partner's sexual function. The study included 87 women and their male partners. We divided the women into two groups: 38 women with male partners complaining of ED (ED group) and 49 women with male partners who have no ED (control group). Of the men with ED, 30 were treated with penile prosthesis implantation (n = 17) or oral sildenafil citrate (n = 13). We evaluated all the men with the International Index of Erectile Function (IIEF; Rosen, Cappelleri, Smith, Lipsky, & Pena, 1999), physical examination, and color penile Doppler ultrasound. We evaluated female sexual function with the Female Sexual Function Index (FSFI; Rosen et al., 2000) to assess sexual desire, arousal, lubrication, orgasm, satisfaction, and pain. We compared female sexual function scores between the women of the male partners with and without ED and also compared before both groups and after the treatment of male partners in the ED group. Additionally, we compare the scores according to the type of treatment given to the male partners. Sexual arousal (p = 0.009), lubrication (p = 0.001), orgasm (p = 0.006), satisfaction (p = 0.000), pain (p = 0.039), and total score (p = 0.003) were highly significantly lower in the ED group than in the control group, although sexual desire did not differ between the two groups (p = 0.515). We investigated the effect of male ED on female sexual functions and found no statistically significant differences in the presence of organic type impotence, older age, and lower erection scores on the IIEF (p = 0.53, p = 0.15, and p = 0.1, respectively). After the treatment of male ED, we observed significant improvement in sexual arousal (p = 0.001), lubrication (p = 0.002), orgasm (p = 0.000), satisfaction (p = 0.000), and pain (p = 0.002) in the women. These findings suggest that female sexual function is affected by male erection status and may improve after the treatment of male sexual dysfunction.
Data on the sexual activity of middle-aged and older women are scant and vary widely. This analysis estimates the prevalence and predictors of sexual activity and function in a diverse group of women aged 40-69 years.
The Reproductive Risk Factors for Incontinence Study at Kaiser (RRISK) was a population-based study of 2,109 women aged 40-69 years who were randomly selected from long-term Kaiser Permanente members. Women completed self-report questionnaires on sexual activity, comorbidities, and general quality of life. Logistic and linear regression and proportional odds models were used when appropriate to identify correlates of sexual activity, frequency, satisfaction, and dysfunction.
Mean age was 55.9 (+/- 8) years and nearly three fourths of the women were sexually active. Of the sexually active women, 60% had sexual activity at least monthly, approximately two thirds were at least somewhat satisfied, and 33% reported a problem in one or more domains. Monthly or more frequent sexual activity was associated with younger age, higher income, being in a significant relationship, a history of moderate alcohol use, and lower body mass index (BMI) (all P < .05). Satisfaction with sexual activity was associated with African-American race, lower BMI, and higher mental health score (all P < .05). More sexual dysfunction was associated with having a college degree or greater, poor health, being in a significant relationship, and a low mental health score (all P < .05).
Middle-aged and older women engage in satisfying sexual activity, and one third reported problems with sexual function. Demographic factors as well as some issues associated with aging can adversely affect sexual frequency, satisfaction, and function.
II-3.
Whether depressed mood reported in the transition to menopause by women with no history of depression is associated with menopausal status and changes in reproductive hormones is controversial and lacks scientific information.
To identify new onset of depressive symptoms and diagnosed depressive disorders in the menopausal transition and to determine the associations of menopausal status, reproductive hormones, and other risk factors with these cases.
A within-woman, longitudinal (8-year) study to identify risk factors of depressed mood.
A subset of a randomly identified, population-based cohort.
Premenopausal women with no history of depression at cohort enrollment.
The Center for Epidemiological Studies of Depression scale (CES-D) was used to assess depressive symptoms, and the Primary Care Evaluation of Mental Disorders (PRIME-MD) was used to identify clinical diagnoses of depressive disorders.
High CES-D scores (> or=16) were more than 4 times more likely to occur during a woman's menopausal transition compared with when she was premenopausal (odds ratio, 4.29; 95% confidence interval, 2.39-7.72; P<.001). Within-woman change in menopausal status, increased levels of follicle-stimulating hormone and luteinizing hormone, and increased variability of estradiol, follicle-stimulating hormone, and luteinizing hormone around the woman's own mean levels were each significantly associated with high CES-D scores after adjusting for smoking, body mass index, premenstrual syndrome, hot flashes, poor sleep, health status, employment, and marital status. A diagnosis of depressive disorder was 2(1/2) times more likely to occur in the menopausal transition compared with when the woman was premenopausal (odds ratio, 2.50; 95% confidence interval, 1.25-5.02; P=.01); the hormone measures were also significantly associated with this outcome.
Transition to menopause and its changing hormonal milieu are strongly associated with new onset of depressed mood among women with no history of depression.
To determine the prevalence of hypoactive sexual desire disorder (HSDD) among US women by reproductive status and age and to explore the correlates of sexually related distress.
The Women's International Study on Health and Sexuality questionnaire was mailed to a national sample of US women in 2000. The survey included validated questionnaires: the Short Form-36, which measures overall health status; the Profile of Female Sexual Function, which assesses sexual desire; and the Personal Distress Scale, which measures distress caused by low desire. Four groups of women were studied: surgically postmenopausal, aged 20 to 49 years and 50 to 70 years; premenopausal, aged 20 to 49 years; and naturally postmenopausal, aged 50 to 70 years. Clinically derived cutoff Profile of Female Sexual Function and Personal Distress Scale scores were used to classify women with HSDD and determine its prevalence. The relations between sexual desire and frequency of sexual activity or relationship satisfaction were assessed. Overall health status of HSDD women and women with normal desire were compared.
The prevalence of HSDD ranged from 9% in naturally postmenopausal women to 26% in younger surgically postmenopausal women. The prevalence of HSDD was significantly greater among surgically postmenopausal women, aged 20 to 49 years, than premenopausal women of similar age, whereas there were no significant differences in the prevalence between surgically postmenopausal women, aged 50 to 70 years, and naturally postmenopausal women. For many women, HSDD was associated with emotional and psychological distress as well as significantly lower sexual and partner satisfaction. HSDD was also associated with significant decrements in general health status, including aspects of mental and physical health.
HSDD is prevalent among women at all reproductive stages, with younger surgically postmenopausal women at greater risk, and is associated with a less active sex life and decreased sexual and relationship satisfaction.
Reduced sexual quality of life is a frequently reported yet rarely studied consequence of obesity. The objectives of this study were to 1) examine the prevalence of sexual quality-of-life difficulties in obese individuals and 2) investigate the association between sexual quality of life and BMI class, sex, and obesity treatment-seeking status.
Subjects consisted of 1) 500 participants in an intensive residential program for weight loss and lifestyle modification (BMI = 41.3 kg/m2), 2) 372 patients evaluated for gastric bypass surgery (BMI = 47.1 kg/m2), and 3) 286 obese control subjects not seeking weight loss treatment (BMI = 43.6 kg/m2). Participants completed the Impact of Weight on Quality of Life-Lite, a measure of weight-related quality of life. Responses to the four Sexual Life items (assessing enjoyment, desire, performance, and avoidance) were analyzed by BMI, sex, and group.
Higher BMI was associated with greater impairments in sexual quality of life. Obese women reported more impairment in sexual quality of life than obese men for three of four items. Gastric bypass surgery candidates reported more impairment in sexual quality of life than residential patients and controls for most items. In general, residential patients reported levels of impairment greater than or equal to controls.
Obesity is associated with lack of enjoyment of sexual activity, lack of sexual desire, difficulties with sexual performance, and avoidance of sexual encounters. Sexual quality of life is most impaired for women, individuals with Class III obesity, and patients seeking gastric bypass surgery.
Using creams, pessaries or a vaginal ring to apply oestrogen vaginally relieves the symptoms relieves the symptoms of vaginal atrophy, although some creams may cause more adverse effects Vaginal atrophy is a common condition in women after menopause. It causes vaginal dryness and itching, and can make intercourse painful. The female hormone oestrogen is a treatment option for vaginal atrophy, but can cause adverse effects such as bleeding and breast tenderness. Women can take oestrogen through tablets or injections. Alternatively, they can apply the hormone locally using creams, pessaries (tablets placed in the vagina) or a hormone-releasing ring placed in the vagina. The review found that all methods of delivering oestrogen relieved the symptoms. However, some creams may cause more adverse effects and women preferred vaginal rings.