Continuum of Symptoms in Polycystic Ovary Syndrome (PCOS): Links with Sexual Behavior and Unrestricted Sociosexuality

Regulatory emotional self-efficacy and self-compassion mediate anxiety, depression, body image distress and subjective well-being in women with polycystic ovary syndrome: A cross-sectional study

AIMS

This study aims to investigate the mediating role of regulatory emotional self-efficacy and self-compassion in the relationship among anxiety, depression, body image distress and subjective well-being among women with polycystic ovary syndrome.

DESIGN

A cross-sectional study.

METHODS

The study recruited 510 women with polycystic ovary syndrome from a tertiary hospital affiliated with a university in Hunan Province, China. The study employed several tools to collect data, including the Generalized Anxiety Scale, the Patient Health Questionnaire-9, the Body Image States Scale, the Self-Compassion Scale, the Regulatory Emotional Self-Efficacy Scale and the Index of Well-being questionnaire. Data analysis was carried out using descriptive analysis, spearman correlation analysis, ordinary least squares regression and bootstrapping.

RESULTS

The study's findings indicate that regulatory emotional self-efficacy and self-compassion both act as mediators in the connection between anxiety, depression, body image distress and subjective well-being among women with polycystic ovary syndrome.

CONCLUSION

The study emphasizes the significance of regulatory emotional self-efficacy and self-compassion in promoting well-being among women with polycystic ovary syndrome. It also implies that interventions targeted at enhancing these factors could potentially enhance the subjective well-being of women affected by PCOS.

IMPACT

Our study's primary contribution is to underscore the crucial mediating roles of regulatory emotional self-efficacy and self-compassion in the relationship among anxiety, depression, body image distress and subjective well-being. Our study indicates that clinical practitioners should prioritize improving the regulatory emotional self-efficacy and self-compassion of women with polycystic ovary syndrome, reducing their anxiety, depression and body image distress and improving their subjective well-being.

REPORTING METHOD

This study was reported according to the Standards for Reporting Qualitative Research (SRQR).

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution outside of participation in the actual study for purposes of data collection.

Psychometric properties of the Iranian version of the polycystic ovary syndrome quality of life questionnaire for married and unmarried women with PCOS: PCOSQoL-47 and PCOSQoL-42

INTRODUCTION

The incidence of PCOS is notably elevated in Iran, making it crucial to examine the quality of life among these individuals. This study aimed to thoroughly evaluate the psychometric properties of the Iranian adaptations of the PCOSQoL-47 and PCOSQoL-42 questionnaires. The application of these tools is significant as they could enhance further research in in communities with similar social norms concerning marriage and sexuality.

METHODS

This study employed a cross-sectional design. Following the linguistic validation of the Iranian adaptation of the PCOSQoL-47 and PCOSQoL-42, a panel of experts reviewed the items through an evaluation of the content validity index (CVI) and content validity ratio (CVR). Subsequently, a semi-structured interview was carried out to evaluate face validity. Consequently, discriminant validity was assessed using the known groups comparison. Convergent validity was evaluated by assessing the correlation between similar content on the PCOSQoL-47 and PCOSQoL-42, SF-12 and body image questionnaire. Responsiveness was assessed by comparing two scales scoring in baseline and eight-week follow-up data of prescription contraceptive Daine-35. In addition, reliability analyses including internal consistency and test-retest analysis were carried out.

RESULTS

The CVR in this study for the total scale was 0.98 for two scales, indicating a satisfactory result. The CVI for the scale was found to be 0.98 and 0.99 for PCOSQoL-42 and PCOSQoL-47, respectively suggesting that it had a good content validity. Known groups comparison revealed that the two scales effectively distinguished between sub-groups of women with varying symptoms specific to PCOS, thereby supporting their discriminant validity. Additionally, convergent validity was evaluated and, as anticipated, a strong positive correlation was observed between corresponding subscales of the two instruments. The paired t-test showed significant changes in PCOSQoL-47 and PCOSQoL-42 scores (p < 0.001) indicating as a responsive outcome measure to detect significant changes over time before and after treatment. Additional analyses indicated satisfactory results of PCOSQoL-42 for internal consistency (Cronbach's alpha ranging from 0.72 to 0.78) and intraclass correlation coefficients (ranging 0.67 to 0.92; P < 0.05). regarding PCOSQoL-47, Cronbach's alpha ranging from 0.80 to 0.82 and intraclass correlation coefficients (ranging 0.61 to 0.73; P < 0.05).

CONCLUSION

The PCOSQoL-47 and PCOSQoL-42 have undergone thorough testing in Iran and may be utilized as outcome measures in forthcoming studies within this demographic.

Total and bioavailable 25-hydroxyvitamin D is not associated with improved sexual dysfunction following vitamin D supplementation in women with polycystic ovarian syndrome: a pilot study

BACKGROUND

Vitamin D (Vit D) deficiency has been linked to symptoms of polycystic ovary syndrome (PCOS), yet little is known about Vit D supplementation as a treatment for sexual dysfunction (SDy) in women with PCOS.

AIM

To explore the implications of serum total 25-hydroxyvitamin D (25[OH]D) and bioavailable 25[OH]D (bio-25[OH]D) status and replacement on women with PCOS and SDy.

METHODS

Reproductive-age women with PCOS who were not desiring fertility were eligible provided that they also had SDy, as assessed by the Female Sexual Function Index (FSFI), and were without severe depression, as evaluated by the Beck Depression Inventory II (BDI-II). Participants were given the recommended dietary allowance of Vit D (600 IU daily) plus hormonal contraception (HC; cyclic ethinyl estradiol/drospirenone) or no HC for 6 months. Comparisons between groups were analyzed by chi-square test and t-test, and Pearson's correlation coefficient analyzed correlations between FSFI with demographics, BDI-II, androgen levels, and total and bio-25[OH]D.

OUTCOMES

The outcomes included SDy (FSFI <26.55), total and serum bio-25[OH]D levels, and total and free testosterone.

RESULTS

A total of 42 women without severe depression completed the FSFI, with 28 (66.7%) having SDy. All FSFI domains, including arousal, lubrication, orgasm, and pain, were significantly lower as compared with women without SDy, with no associations with respect to demographics, total and free testosterone, or total and bio-25[OH]D. Vit D replacement was initiated with HC (n = 18) or no HC (n = 10), and for those completing the study, FSFI improved (score >26.55) in 61% (11/18) regardless of the treatment group. A time-treatment effect showed a significant change for the domain of orgasm, suggesting that HC had more of an impact than Vit D replacement. Improvement in sexual function as a dichotomous variable was not associated with age, body mass index, other demographics, total and free testosterone, total and bio-25[OH]D, or HC use.

CLINICAL IMPLICATIONS

Due to the prevalence of SDy in women with PCOS, efficacious treatment options are necessary.

STRENGTHS AND LIMITATIONS

This study is the first to analyze the effect of Vit D supplementation on SDy in women with PCOS. Limitations included the small number of participants who completed the study, thus limiting meaningful conclusions and generalizability.

CONCLUSION

Vit D status was not associated with SDy and BDI-II. While HC may have played a role, standard Vit D supplementation could not account for the noted improvement in FSFI in women with PCOS.

Androgen receptors and sociosexual behaviors in mammals: The limits of generalization

Circulating testosterone is easily aromatized to estradiol and reduced to dihydrotestosterone in target tissues and elsewhere in the body. Thus, the actions of testosterone can be mediated either by the estrogen receptors, the androgen receptor or by simultaneous action at both receptors. To determine the role of androgens acting at the androgen receptor, we need to eliminate actions at the estrogen receptors. Alternatively, actions at the androgen receptor itself can be eliminated. In the present review, I will analyze the specific role of androgen receptors in male and female sexual behavior as well as in aggression. Some comments about androgen receptors and social recognition are also made. It will be shown that there are important differences between species, even between strains within a species, concerning the actions of the androgen receptor on the behaviors mentioned. This fact makes generalizations from one species to another or from one strain to another very risky. The existence of important species differences is often ignored, leading to many misunderstandings and much confusion.

Effects of Hormonal Profile, Weight, and Body Image on Sexual Function in Women with Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a hyperandrogenic endocrinological disorder associated with chronic oligo-anovulation and polycystic ovarian morphology. Compared to women without PCOS, women with PCOS have a risk of sexual dysfunction that is more than 30% higher. Although alterations in sex hormones and psychosocial wellbeing have been proposed, the precise mechanisms of FSD in PCOS remain unclear. The aim of our study was to analyze how the hormonal, clinical and psychometric parameters of PCOS patients are involved in the development of sexual dysfunction. The study group consisted of 54 women, aged between 21 and 32 years, diagnosed with PCOS. We collected the following parameters: age, body mass index (BMI), the Ferriman-Gallwey score (FG), maximum duration of oligomenorrhea, abdominal circumference (AC), free testosterone value (FT), luteinizing hormone/follicle stimulating hormone (LH/FSH) ratio value, serum cortisol value and ovarian ultrasound appearance. At the time of the examination, patients were asked to fill in the Female Sexual Function Index (FSFI) and the Body Exposure during Sexual Activities Questionnaire (BESAQ). Statistically significant differences were observed between normal weight and overweight women regarding BESAQ (p-value = 0.02) and FSFI total (p-value <0.001). Elevated BMI, AC or BESAQ scores correlated with a lower FSFI score. The most involved domains of the scale were orgasm, arousal, and desire. Elevated BESAQ scores increase the risk of female sexual dysfunction (FSD) by 4.24 times. FT, BESAQ score, BMI, and LH/FSH ratio were found to independently predict FSD. The cutoff point for the BESAQ score in detecting FSD was found to be 1.97. Weight, body image and anxiety related to sexual activities seem to be significant components in the development of sexual dysfunction in PCOS patients, beyond the effect due to hyperandrogenism. FT value has a U-shape effect in sexual dysfunction, because both in the case of deficit and in the case of excess, sexual function is impaired. BESAQ is a strong predictor for sexual dysfunction in women with PCOS, along with FT value, LH/FSH ratio and BMI.

Diagnosis values of three-dimensional power Doppler ultrasonography in polycystic ovary syndrome and its relationship with serum sex hormone levels

BACKGROUND

The diagnosis of polycystic ovary syndrome (PCOS) is of great significance for early detection, timely standardized treatment and prevention of long-term complications. This study aimed to observe and measure the intraovarian blood flow distribution and blood flow indexes in patients with PCOS by three-dimensional power Doppler ultrasonography, and to evaluate its diagnostic value for PCOS and its correlation with serum sex hormone levels.

EXPERIMENTAL DESIGN

Patients who were diagnosed with PCOS and met the inclusion and exclusion criteria were recruited as the PCOS group, and 85 age-matched healthy women were arranged in healthy control (HC) group. Participants underwent three-dimensional power Doppler ultrasound. Serum sex hormone was analyzed by chemiluminescence. The diagnostic value was analyzed by relative operating characteristic (ROC) analysis. Spearman correlation coefficient analysis was applied to determine the correlation of vascularization index with serum sex hormone levels.

RESULTS

The vascularization index (VI), flow index (FI), and vascularization flow index (VFI) values in PCOS patients were all statistically higher than those of HC. The combined index (0.445 * VI + 0.1 * FI + 1.057 * VFI) has a higher diagnostic value of PCOS compared with the three indexes alone.

CONCLUSION

Three-dimensional power Doppler ultrasound could observe and quantitatively evaluate the distribution of blood flow in the ovary, which has a high diagnostic value and might provide a reference in clinical use.

Ferreira C, Dantas PB, Browne RAV, de Queiros V, Soares GM, Gonçalves AK, Cabral BG, Maranhão TMO, Dantas PMS. Effects of high-intensity interval training in combination with detraining on mental health in women with polycystic ovary syndrome: A randomized controlled trial

This study aimed to investigate the effects of high-intensity interval training (HIIT) and detraining on the quality of life and mental health of 23 women with polycystic ovary syndrome (PCOS). Participants were randomly assigned to the HIIT group (n = 12) [26.0 ± 3.92] and the control group (n = 11) [26.6 ± 4.68]. HIIT sessions comprised 40-60 min, 3 days a week for 12 weeks, followed by detraining for 30 days. We assessed the quality of life using the Short Form Health Survey (SF-36) and mental health by the Depression, Anxiety, and Stress Scale (DASS-21), and we compared group changes on these variables at three time points: 1) at baseline, 2) after 12 weeks of HIIT (or no training), and 3) after 30 days of detraining (or no training). The participants were classified as overweight and had a high percentage of body fat (41.5%) and irregular menstrual cycles (amenorrhea) (66.7%). Throughout training, participants in the HIIT group reported improvements in domains of the quality of life: functional capacity (M = 80.4 ± 3.4 vs. M = 87.0 ± 3.1), physical role functioning (M = 72.5 ± 9.4 vs. M = 81.8 ± 9.7), and general health perception (M = 48.6 ± 4.6 vs. M = 69.0 ± 5.8). Regarding anxiety symptoms (M = 6.4 ± 1.6 vs. M = 3.7 ± 0.7) and depression symptoms (M = 6.7 ± 1.6 vs. M = 3.8 ± 0.9), those reduced significantly after HIIT. After a 30-day detraining period, there was an increase in the significant change in the quality of life; however, domains of mental health showed instability. In summary, the HIIT program promoted improvements in the quality of life and mental health in women with PCOS. The 30 days of detraining changed the benefits in the quality of life and stability in the changes in mental health domains.

The effect of low glycemic index diet on the reproductive and clinical profile in women with polycystic ovarian syndrome: A systematic review and meta-analysis

Background

Treatment for polycystic ovary syndrome (PCOS) usually initiates with a series of lifestyle modifications such as diet, weight loss, and exercise.

Aims

We, therefore, conducted this meta-analysis to systematically review and evaluate the possible benefits of LGD on a range of anthropometric, clinical, and biochemical parameters in women with PCOS.

Methods

We performed a systematic search through major indexing databases, including Scopus, Pubmed/Medline, ISI web of science, Embase, Cochrane central, and CINAHL (1966-April 30, 2021) using key concepts of PCOS.

Results

Of 935 initial publications, 542 remain after duplicates removal. Then, 141 records were removed at the title and abstract screening level. After excluding 392 literatures, we finally included 8 articles. The final selected studies included 412 overweight and obese individuals with PCOS (207 cases in LGID group and 205 patients in comparators) with a mean age of 21-32 years. Measured emotional health (3 studies, 132 participants, SMD: -1.97; 95%CI:-3.54, -0.40, P = 0.01, I ² = 89%) and body hair (3 studies, 132 participants, SMD: -0.40; 95%CI:-0.46, -0.35, P < 0.0001, I ² = 0%), were found to be significantly lower in women in LGD vs control diet groups. Moreover, infertility (3 studies, 132 participants, SMD: 1.45; 95%CI: 0.30, 2.61, P = 0.01, I ² = 79%) was significantly higher in women in LGD vs control diet groups.

Conclusion

The present meta-analysis has shown that LGD may play a significant role in reducing the risk and improving the clinical and biochemical features of PCOS. So far the evidences for choosing the best dietary modalities for PCOS are not strong to make a definite recommendation.

Impaired Sexual Function in Young Women With PCOS: The Detrimental Effect of Anovulation

BACKGROUND

Even though polycystic ovary syndrome (PCOS) is a common reproductive disorder affecting young women, its impact on their sexual health is not well known.

AIM

To examine the different aspects of female sexuality in young women with PCOS and attempt to associate hormonal changes and ovulatory status with their sexual function.

METHODS

Anthropometric characteristics, hormonal levels and sexual function based on the Female Sexual Function Index (FSFI) questionnaire were assessed in 76 young women with PCOS and 133 matched controls.

OUTCOMES

Sexual function is significantly impaired in young women with PCOS.

RESULTS

Women with PCOS demonstrated lower scores than controls in arousal (5.04 ± 1.19 vs 4.48 ± 1.44, P < .001), lubrication (5.29 ± 1.17 vs 4.69 ± 1.54, P < .001), orgasm (4.78 ± 1.40 vs 4.11 ± 1.61, P = .001), satisfaction (5.22 ± 1.10 vs 4.78 ± 1.31, P = .016), and total score of the FSFI (29.51 ± 5.83 vs 26.76 ± 6.81, P < .001), even after correction for BMI. When corrected for total testosterone, the domains of lubrication, satisfaction, and total score of FSFI remained significantly impaired in women with PCOS (P values .037, .024, & .044 respectively). In multivariate logistic regression analysis, after adjusting for the effect of BMI and hormone levels, dysfunction in orgasm, satisfaction and the total FSFI score were still 3-4 times more common in PCOS (adjusted OR [95% CI]: 3.54, P = .020; 2.96, P = .050; 3.87, P = .027). Even though no statistically significant differences were observed between women with ovulatory PCOS and controls, we detected statistically significant differences in all domains of sexual function apart from pain between controls and PCOS women with anovulation (desire P value .04, arousal P value <.001, lubrication P value <.001, orgasm P value .001, satisfaction P value .001 and FSFI total score P value <.001).

CLINICAL IMPLICATIONS

Women with PCOS have compromised sexual function, which is independent of their BMI and highly dependent on their ovulatory status.

STRENGTHS AND LIMITATIONS

This is the first study in women with PCOS that implicates anovulation as a risk factor for sexual impairment in PCOS. Further studies are needed to elucidate the mechanisms implicated and to examine the effect of PCOS therapy on the patients' sexual function.

CONCLUSION

The adverse effect of PCOS status on the female sexual function is independent of BMI and only partially dependent on hormonal changes characterizing the syndrome. Anovulation appears to be the major determinant of sexual impairment among women with PCOS. Mantzou D, Stamou MI, Armeni AK, et al. Impaired Sexual Function in Young Women With PCOS: The Detrimental Effect of Anovulation. J Sex Med 2021;18:1872-1879.

Sexual incentive motivation and male and female copulatory behavior in female rats given androgen from postnatal day 20

Masculinization and feminization of rat sexual behavior has been supposed to occur during a short postnatal period. However, much data have made it evident that these processes may continue until adolescence. In the present study, we evaluated whether androgen treatment of females from postnatal day 20 and onwards could alter sexual motivation and behavior in a male direction. Juveniles were ovariectomized on day 20 and concurrently implanted with Silastic capsules containing either testosterone or dihydrotestosterone. Controls were implanted with an empty capsule. Tests for sexual incentive motivation and male sexual behavior were performed every fifth day when the females were between 50 and 75 days of age. At day 80, a test for female sexual behavior was performed. Females treated with testosterone approached a female sexual incentive far more than a male incentive, showing that sexual motivation had been changed in a male-like direction. Dihydrotestosterone had a similar, albeit smaller, effect. Females implanted with an empty capsule approached both incentives equally. Testosterone produced a high level of mounting behavior, whereas intromission-like behavioral patterns were rare and ejaculation-like behavior was absent. In the test for female sexual behavior, the testosterone-treated animals displayed a relatively high lordosis quotient, far above that displayed in females implanted with dihydrotestosterone or an empty capsule. It is concluded that treatment with an aromatizable androgen during the peripubertal-adolescent period masculinizes sexual motivation and partly sexual behavior. A non-aromatizable androgen weakly masculinize sexual motivation without enhancing male sexual behavior. It appears that simultaneous actions on androgen and estrogen receptors are needed for significant masculinization during the period studied here. Since the testosterone-treated females displayed lordosis, sexual behavior was not defeminized. In sum, these results suggest that sexual differentiation continues well into the peripubertal and adolescent periods.

The mental health of women with polycystic ovary syndrome: a systematic review and meta-analysis

Polycystic ovary syndrome (PCOS) has been proposed to be associated with several mental health problems, including anxiety, depression, diminished sexual satisfaction, and lowered health-related quality of life, etc. A systematic review and meta-analysis of published literature was conducted comparing the mental health of women with and without PCOS. Ten English and Chinese databases were searched up to 12/31/2018. Random-effects models were introduced, and subgroup analysis, sensitivity test, and meta-regression were carried out to determine the source for heterogeneity among studies. Forty-six studies, including 30,989 participants (9265 women with PCOS and 25,638 controls), were qualified for review according to the inclusion criteria. Twenty-eight studies reported depression symptoms, 22 studies were on anxiety, 16 studies showed quality of life (QoL) status, 12 studies were about sexual dysfunction, five on emotional distress, four on binge eating, and four on somatization. Women with PCOS reported significantly higher depression (SMD = 0.64; 95% CI 0.50-0.78), anxiety (SMD = 0.63; 95% CI 0.50-0.77), lower QoL (SMD = - 0.55; 95% CI -0.69 to -0.40), and not significant sexual dysfunction (SMD = - 0.24; 95% CI - 0.49 to 0.01). Studies from different countries, adopting various diagnosis criteria, using diverse instruments, as well as in different years, have reported heterogenetic results. Women with PCOS in China reported a larger effect size of depression and anxiety than patients from other countries. The results of this study have indicated that women with PCOS suffer from depression, anxiety, and experience a lower quality of life, whereas their sexual function is not distinct from that of healthy women. Psychological health care interventions for women with PCOS were addressed.