The use of phosphodiesterase inhibitors in the treatment of female sexual dysfunction: scoping review

Objective

The purpose of this study was to analyze the available evidence regarding the efficacy of iPDE5 in the treatment of female sexual dysfunction (FSD).

Methods

A comprehensive literature search was conducted in March 2023 through the main scientific databases.

Results

A total of 53 articles were identified, out of which, 6 met the predefined inclusion criteria. All of these were randomized controlled trials. Among the included studies, 4 demonstrated the effectiveness of sildenafil in improving sexual response and addressing FSD, while 2 studies failed to establish its efficacy in this context.

Conclusion

Overall, the efficacy of sildenafil in the treatment of FSD remains controversial and inconclusive based on the available evidence. Further research is necessary to clarify the therapeutic potential of iPDE5 in addressing FSD and to better understand the factors that influence treatment outcomes.

Ethnic Minority Representation in Female Sexual Dysfunction Questionnaire Validation: A Scoping Review

BACKGROUND

Female sexual dysfunction (FSD) is a significant cause of distress for an estimated 12-24% of women, and over the past 5 decades several questionnaires have been developed for clinical practice.

AIM

The purpose of this scoping review is to evaluate the ethnic representation of sample populations used in the studies to validate FSD questionnaires.

METHODS

A scoping review was performed using electronic databases, including PubMed and Scopus, to identify FSD questionnaires validated between 1976 and 2021. Weighted averages from the combined ethnicity data were compared to population data from 2019 US census data and 2018 healthcare workforce reports to evaluate epidemiologic diversity. Ethnicity data from each questionnaire were also investigated longitudinally to evaluate trends in representation over the past 50 years.

OUTCOMES

Our outcome of interest was comparison of the weighted averages for ethnicity categories from validation populations to the US female general population, US female health care workforce, and US census data.

RESULTS

48 validation studies were reviewed and showed that the average ethnic representation of the study populations relative to the US general population and US female health care workforce, respectively, was: Caucasian (83.7% vs 62.7% and 68.5%), Black (7.8% vs 13.3% and 8.3%), Hispanic (3.6% vs 16.0% and 9.6%), Native American (0.1% vs 0.8% and 0.3%), Asian (0.6% vs 6.4% and 6.2%), and Other (3.1% vs 0.7% and 1.4%).

CLINICAL IMPLICATIONS

FSD questionnaires are relied upon in research and clinical settings, so lack of diversity in validation populations could lead to under recognition and undertreatment in ethnic minority women.

STRENGTHS & LIMITATIONS

Our results are dependent on the quality of data available from previously published validation studies. We attempted to account for biases in lack of data and size of validation populations by using weighted averages for making comparisons. We chose the US general population and female healthcare workforce for comparison and analyzed validation populations across multiple decades and geographic locations. Many of the validation studies were performed at least 10 years ago and may not reflect the current state of FSD and potential of questionnaire responses of ethnic minority women. This manuscript raises critical awareness regarding the lack of validated instruments for FSD in ethnically diverse women.

CONCLUSION

Study populations used to validate FSD questionnaires demonstrate a trend of ethnic minority underrepresentation relative to the US female general and healthcare workforce populations. Battle CR, Rubin RS, Kingsberg SA, et al. Ethnic Minority Representation in Female Sexual Dysfunction Questionnaire Validation: A Scoping Review. J Sex Med 2022;19:1824-1838.

Prevalence of sexual dysfunctions in women in their early and middle adulthood from the Pokarpackie Voivodeship

Background: Sexual dysfunctions are disorders related to the physiology of sexual responses. Aim of the study: Our study aimed to assess the prevalence of sexual dysfunctions in women in their early and middle adulthood. Material and methods: The early adulthood group consisted of 125 women aged 20–30, and out of these 100 questionnaires qualified for the final analysis. The middle adulthood group consisted of 275 women aged 45–55 in which 200 complete questionnaires were analyzed. The study was conducted in 2016 using a diagnostic survey method and the author's own survey questionnaire, the Mell-Krat Scale for Women and the Female Sexual Function Index (PL-FSFI). Results: Only 38.0% of respondents from the early adulthood group and 25.0% from the middle-adult group interviewed with a gynecologist about their sex life, possible disorders, and problems. Additionally, only 1.0% of women in the middle adulthood group benefited from the advice of a sexologist. According to the interpretation of the Mell-Krat scale, 41.0% of respondents in the early adulthood group and 76.0% of women in the middle adulthood group had a suboptimal score. These results indicate the possibility of sexual response disorders. All women in the early adulthood group and middle adulthood group scored below normal on the PL-FSFI scale indicating that the respondents are at risk for sexual disorders. Conclusions: According to the PL-FSFI scale, all women in the study may be at risk of sexual disorders. According to the Mell-Krat scale, as many as ¾ of women might suffer from sexual response disorders or are at risk of sexual disorders. Taking into account the significance of a sex life, it is necessary to take action to provide women with professional medical and psychological help to improve their intimacy sphere of life.

Prevalence and Associated Factors of Female Sexual Dysfunction Among Sexually Active Students of the University of Buea

INTRODUCTION

Female sexual dysfunction (FSD) is a common public health issue. Most studies, especially in the sub-Saharan region are typically carried out in the older married female population, but the post-secondary education period is crucial for the development of the sexuality of young women. Poor awareness and management of FSD may lead to adverse physical and psychosocial complications later on in the lives of these women.

AIM

To determine the prevalence of the risk of having FSD and the factors associated with having FSD among sexually active students of the University of Buea.

METHODS

This was a cross-sectional study carried out in the University of Buea involving 405 sexually active students; 16 years of age and above. Quantitative data on sociodemographic, biological, interpersonal and psychosocial characteristics were collected. A validated Japanese modified version of the Female Sexual Function Index (FSFI-J) was used to assess the risk of having female sexual dysfunction. Data analysis involved descriptive statistics, binary and multivariate logistic analyses.

MAIN OUTCOME MEASURES

Prevalence of risk of having FSD and its associated factors among students of the University of Buea.

RESULTS

A total of 171 (42.0%) out of 405 students showed a risk of having at least one form of FSD. The commonest forms of dysfunction were problems of sexual pain (46.9%), orgasm (42.0%), desire (29.1%) and arousal (21.2%). Participants who were unmarried but in a relationship (P = .002) were less likely to experience FSD. Lower levels of education (first year [P = .005], second year [P = .001]), having a history of sexual assault (P = 0.012) and poor health (P = .012) were all independently associated with a higher risk of having FSD.

CONCLUSION

The prevalence of students at risk of having FSD was high with 4 out of every 10 students showing a risk of having at least one form. Lower levels of education, having a history of sexual assault and poor health were independent risk factors of FSD. Being unmarried but in a relationship was the sole protective factor against FSD. Halle-Ekane GE, Timti LF, Tanue EA, Ekukole CM, Yenshu EV. Prevalence and Associated Factors of Female Sexual Dysfunction Among Sexually Active Students of the University of Buea. Sex Med 2021;9:100402.

Should I Seek Help for Sexual Difficulties? Middle-Aged Lebanese Women's Views

This qualitative study explored the way middle-aged Lebanese women address their sexual difficulties. Data analysis revealed three overarching themes and subthemes. From these we developed a help-seeking behavior framework for sexual difficulties. The framework focuses on: the perception of the problem, the beliefs about help-seeking and the sources of help. This framework can be used to facilitate access to personalized sexuality-related care based on a better understanding of the complex interplay of personal, socio-cultural and service-related factors that influence help-seeking behavior for sexual problems.

Decreased Sexual Desire among Middle-Aged and Old Women in China and Factors Influencing It: A Questionnaire-Based Study

Objective

This survey was designed and conducted with an aim to present data on sexual desire and activity in Chinese women.

Methods

Between October 2013 and December 2013, we surveyed 3000 women (aged 40–65 years) at Beijing No. 2 Hospital and the Yuetan Community Health Service Center using a questionnaire. The primary outcomes included determination of sexual desire in the past 4 weeks, reasons for stopping sexual activity, and postmenopausal syndrome. The secondary outcome was determination of factors for low sexual desire.

Results

A total of 2400 women (mean age 54.33 ± 6.25 years; mean menopausal age 50.11 ± 3.31 years) returned the questionnaire, with 58% of women reporting lowered sexual desire and 39.3% reporting stoppage of sexual activity. Compared with the postmenopausal group, the incidence of anxiety, depressive, somatic, and vasomotor symptoms was higher in the perimenopausal group. Muscle and joint pain (45.8%) and vaginal pruritus (21.5%) were the most commonly reported menopausal and vulvovaginal symptoms, respectively. The odds of decrease in sexual desire were significantly higher with older age, menopause, presence of gynecological disease, menopausal depression symptoms, menopausal vasomotor symptoms, and vulvovaginal atrophy; only cesarean delivery (odds ratio = 0.887, P=0.018) was associated with lesser reduction in sexual desire compared with the aforementioned factors.

Conclusion

This survey showed that a high proportion of Chinese middle-aged and old women have lowered sexual desire and activity. Lack of sexual desire is associated with multiple factors and affects the quality of life of women.

Middle-aged Lebanese women's interpretation of sexual difficulties: a qualitative inquiry

BACKGROUND

The study explores women's perception and experience of sexual difficulties. The need to address the subject was triggered by the scarcity of research that reflects on women's subjective views on sexual difficulties. This is particularly crucial for middle-aged women who frequently experience hormonal and psychosocial changes that may affect their sexual life.

METHODS

Using in-depth individual and focus groups interviews, 52 Lebanese women aged 40-55 years discussed their thoughts, feelings and behaviours concerning sexual difficulties. Women were recruited purposefully from clinical and non-clinical settings to get maximum sampling variation that provided rich information and deep understanding of the subject. Recordings were transcribed verbatim and analysed about the framework analysis. Many strategies were adopted to ensure rigour.

RESULTS

Women's narratives led to four themes: women's inability to communicate sexual desires and concerns; male sexual difficulties; marital conflicts; and sexual difficulties as context-bound. Women's sexual difficulties are driven by double standards and inhibiting sexual socialisation. Once married, many women had very challenging sexual experiences. They were obliged to silently bear their husbands' poor sexual performance to protect their masculinity and thus their social image and identity. Women's narratives also showed that marital conflicts, daily life problems as well as physical and psychological burdens further challenged their sexual wellbeing and contributed to their sexual difficulties.

CONCLUSION

The study makes a unique contribution to voicing women's views and concerns as sexuality is insufficiently researched and reported in Lebanon. It emphasises the multidimensional nature of female sexual difficulties, particularly the gender-based norms that inhibit their sexual selves and profoundly affect their sexual wellbeing and capacity to claim their sexual likes and dislikes. Findings have implications on research and practice to help women prevent and overcome their sexual difficulties.

The Role of Sexual Desire, Sexual Satisfaction, and Relationship Satisfaction in the Sexual Function of Arab Couples Living in Saudi Arabia

INTRODUCTION

This study is one of the first to examine the association between relationship and sexual variables as approached from a dyadic perspective in Saudi Arabian couples. Theoretical models assign an important role to relationship factors in women's sexuality.

AIM

We examined the role of sexual and relationship satisfaction relative to sexual desire in explaining sexual function in a sample of clinical versus nonclinical couples.

METHODS

This is a cross-sectional, observational study in a sample of 50 heterosexual couples with sexual problems and 50 control couples without problems (N = 100 couples; 200 men and women).

MAIN OUTCOME MEASURE

All participants completed an Arabic version of measures of relationship satisfaction, sexual satisfaction, sexual desire, sexual distress, and sexual function.

RESULTS

Results showed that in the clinical group, sexual function of women was predicted by their own and their partner's level of sexual satisfaction, and their own level of solitary and dyadic sexual desire. Men's sexual function was predicted by their own sexual satisfaction and their partner's relationship satisfaction. In the control group, the sexual function of women was predicted only by their level of sexual satisfaction. In men, sexual function was predicted by their own sexual satisfaction and their level of dyadic sexual desire.

CONCLUSION

These results suggest that sexual desire rather than relationship satisfaction plays an important role in women's sexual dysfunction. Being the most consistent determinant of male and female sexual functioning, sexual satisfaction is an important target of intervention in Arabian couples. A Attaky, J Schepers, G Kok, et al. The Role of Sexual Desire, Sexual Satisfaction, and Relationship Satisfaction in the Sexual Function of Arab Couples Living in Saudi Arabia. Sex Med 2021;9:100303.

Sexual dysfunction and health condition in Chinese doctor: prevalence and risk factors

To our knowledge, little attention has been paid to the sexual function of health workers. The aim of the present study was to assess the frequency of sexual dysfunction among Chinese doctors. In addition, the risk factors for sexual dysfunction were analyzed. This was a questionnaire-based multicenter cross-sectional survey performed in five large academic medical centers in China. A total of 539 male doctors, 547 female doctors were evaluated. We analyzed doctors' demographic characteristics, quality of life, sexual function and attitudes towards sexual problems. Chinese doctors are at high risk of sexual dysfunction and poor health. The prevalence of sexual dysfunction appears to increase with age, and is associated with various social and demographic factors including monthly income, physical exercise, working hours, night shift and health-related quality. The quality of life and sexual health of doctors deserves special attention as a significant public health concern. Alleviating work pressure, increasing income, improving quality of life and therapeutic sexual problems should be considered comprehensively.

Cervix human papilloma virus positivity: Does it cause sexual dysfunction?

Objective:

To investigate whether testing positive for human papilloma virus (HPV) in cervical screening has an impact on female sexual functioning.

Materials and Methods:

This study was designed as a single-center, prospective, descriptive-cross-sectional study and 300 women who received HPV testing in our hospital [HPV-positive (n=187) or HPV-negative (n=113)]. The Arizona Sexual Experiences (ASEX) scale and Female Sexual Functioning index (FSFI) were administered to study participants during face-to-face interviews.

Results:

No significant differences were found between women who were HPV-positive and HPV-negative in sexual functions as assessed using the ASEX and FSFI scales (p=0.343 and p=0.604, respectively). In addition, the analyses addressing whether sexual functioning was affected by a positive test result, at diagnosis or during the follow-up (before 2 weeks, 2 weeks-1 month, 1-3 months, 3-6 months, 6 months-1 year and over 1 year) revealed no significant differences between HPV-positive and HPV-negative women in sexual functioning (p>0.05). Sexual dysfunction was less common in married women than in the ASEX scale (p=0.03), and this difference was not detected when the FSFI scale was applied. The incidence of dysfunction was more frequent in working women than in retirees (p=0.006, p=0.01).

Conclusion:

Educational attainment, socioeconomic status, age, employment status, and marital status were found to have statistically significant effects on sexual functioning. Sexual functioning was affected by neither HPV test results (positive/negative) nor time from diagnosis.

Analysis of low sexual desire in Chinese women: a national population-based epidemiological survey in mainland China

Background Low sexual desire is the most prevalent female sexual health problem; however, national epidemiologic data on female sexual desire in China are absent. Understanding factors related to low sexual desire are essential in preparing educational and consultative programs and policies to improve women's sexual health.

METHODS

A national epidemiological survey on female sexual function was conducted from February 2014 to January 2016 in mainland China. Women were randomly selected using multistage, stratified, cluster sampling. The sexual functioning was assessed by using the Chinese version of the 19-item Female Sexual Function Index (FSFI) questionnaire.

RESULTS

The questionnaire on sexual dysfunction was completed by 25446 women who were aged 20-70 years. The prevalence of low sexual desire was 21.6% (domain score ≤4.28), and the declines in sexual desire started as early as 25-29 years. Sexual arousal was most closely related to sexual desire (Pearson's correlation = 0.760). Higher educational attainment was associated with a decreased risk of low sexual desire. Diabetes, non-gynaecological cancer, pelvic inflammatory disease and pelvic pain had negative effects on sexual desire (OR = 1.44, 99% CI = 1.11-1.87; OR = 1.92, 99% CI = 1.18-3.13; OR = 1.32, 99% CI = 1.07-1.63; OR = 1.77, 99% CI = 1.13-2.76 respectively).

CONCLUSIONS

The prevalence of low sexual desire in females in China was modest. Low sexual desire is correlated with sexual arousal disorder. Biopsychosocial factors have overlapping effects on sexual desire.

A Survey on the Experience of Singaporean Trainees in Obstetrics/Gynecology and Family Medicine of Sexual Problems and Views on Training in Sexual Medicine

Introduction

Asian patients may have more difficulty seeking help for their sexual problems because of a largely conservative culture. Residents from both obstetrics and gynecology (OBGYN) and family medicine (FM) departments are ideally placed to address sexual problems.

Aim

This survey explored the experience of residents from OBGYN and FM in managing sexual problems and their views on training in sexual medicine (SM).

Method

An anonymized questionnaire collecting data on trainee characteristics, exposure to male and female sexual problems, and training in SM was sent to all FM and OBGYN residents in Singapore. These residents had completed their medical registration with the Singapore Medical Council and were at various stages of specialty training in both FM and OBGYN residency programs in Singapore.

Main Outcome Measure

Trainees’ exposure to male and female sexual problems and their views on training in Sexual Medicine.

Results

The overall response from the survey was 63.5% (122/192)—54% (70/129) and 69% (52/75) of FM and OBGYN residents responded, respectively. 63% were female, with 22% being senior residents, and 55% attended Singaporean medical schools. About one quarter (30/122) of the respondents encountered patients with sexual problems at least monthly. Most would refer these patients directly to specialists, psychologists, and sex therapists. More than 80% of residents were not confident in managing sexual problems in either sex (89% for male problems; 83% for female problems). Among the recognized categories, only 30% felt confident to manage erectile dysfunction, 26% for vaginismus, while less than 10% felt confident to manage libido, arousal, or orgasm disorders. 95% of the residents agreed that SM should be part of both training curricula, with 70% and 25% suggesting at junior and senior residency, respectively. 93% of them were interested to obtain further knowledge and skills in SM through their core training curriculum and from seminars.

Conclusions

This survey reported a significant number of residents in OBGYN and FM departments are regularly exposed to patients with sexual problems but lack the skills to manage them. OBGYN residents were more familiar with managing female sexual problems while FM residents tend to have more experience in male sexual problems. Almost universally, the residents in FM and OBGYN were very keen to acquire skills in SM, and the results support the incorporation of appropriate knowledge and skills into both national residency program curricula.

Huang Z, Choong DS, Ganesan AP, et al. A Survey on the Experience of Singaporean Trainees in Obstetrics/Gynecology and Family Medicine of Sexual Problems and Views on Training in Sexual Medicine. J Sex Med 2019;8:107–113.

Prevalence and risk factors of sexual dysfunction in healthy women in Turkey

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.

Sexuality-Related Factors and Quality of Life Among Reproductive-Aged Married Female Migrant Workers: A Cross-Sectional Study in Southern China

Introduction

Sexuality is a critical part of overall well-being. However, until now, studies on women’s health related to the effect of sexuality on physical and psychosocial outcomes have been seriously ignored, especially the health-related quality of life (QOL) of reproductive-aged married female migrant workers.

Aim

To analyze the associations between sexuality-related factors and QOL and explore the independent contributions of sexuality-related factors to QOL in this population group in southern China.

Methods

In this cross-sectional survey, 609 Chinese married female migrant workers aged 19–49 years were studied. Clustered multiple linear regressions were used to analyze the associations between sexuality-related variables and QOL.

Outcomes

QOL was measured using the Short Form (SF-36) Healthy Survey. Details of the participants (sociodemographic, health-related and sexuality-related factors) were obtained.

Results

Approximately 10.0% of respondents always felt a lack of sexual interest and lubrication difficulties, and 37.5% of respondents seldom or never experienced sexual satisfaction. Multiple regression analyses revealed that women who never felt lubrication difficulties obtained higher role physical, bodily pain, general health, and physical component summary scores in physical domains and higher vitality (VT), mental health (MH), and mental component summary (MCS) scores in mental domains compared with those who always felt lubrication difficulties. Compared with those who always experienced sexual satisfaction, women who never experienced sexual satisfaction had relatively lower role physical, bodily pain, and general health scores in physical domains, and women who never or seldom experienced sexual satisfaction had lower VT, MH, and MCS scores in mental domains. The independent contributions of sexuality-related factors in mental domains (VT, MH, and MCS) accounted for 50.0%, 52.4%, and 39.5%, respectively; more than that of all sociodemographic and health-related variables in the VT and MH domains.

Conclusions

Sexuality-related factors (lubrication difficulties and sexual satisfaction) were significant independent determinants of QOL among reproductive-aged Chinese married female migrant workers, especially in mental domains.

Li BB, Liu N, Li B, et al. Sexuality-Related Factors and Quality of Life Among Reproductive-Aged Married Female Migrant Workers: A Cross-Sectional Study in Southern China. Sex Med 2019;7:384–395.

Sexualıty and marıtal adjustment ın women wıth hypertensıon ın Turkey: how culture affects sex

This study examined the relationship between sexual dysfunction and marital adjustment in women with hypertension and the effect of the cultures on the sexual problems of women. Mixed method was used in this study. The study was conducted as quantitative (in descriptive type) to examine sexual dysfunction and marital adjustment in women with hypertension and as qualitative to examine the effect of culture on the views of individuals on sexual problems. The study included 102 women who met inclusion criteria (who were on medication and had active sexual life for 1 year). Patient information form, Arizona Sexual Experience Scale (Female), and Marital Adjustment Test (MAT) were used to collect the data. The mean age of the subjects was found to be 55.10 ± 9.13, the mean duration of hypertension diagnosis was 8.66 ± 6.43, and the mean time to start was 7.87 ± 6.30. The mean duration of marriage for the women with hypertension was 34.08 ± 12.507. There was a negative correlation between sexual orientation, orgasm and sexual satisfaction from the subscales of ASEX and the overall scale (p < 0.05). Accordingly, as the adaptation in marriage diminished, sexual problems increased in women. As a result of the study, it was determined that HT had a negative effect on sexual functioning problems and marital adjustment, but women accepted this situation because of their culture, "women do not have the right to sexuality" and naturally accept the absence of sexuality after a certain age.

Pelvic floor disorders associated with higher-level sexual dysfunction in the Kersa district, Ethiopia

Objective:

To assess the prevalence of female sexual dysfunction and its association with pelvic floor disorder (PFD) in a large scale, community-based study.

Materials and Methods:

A total of 2389 women who were married and still in union at the time of the study were drawn from 3432 women who had ever been married who participated in a PFD study. Study participants were selected through a multistage sampling procedure based on Kersa Health and Demographic Surveillance System database. The Female Sexual Function Index questionnaire was employed to collect data. The index score <26.55 was used as a cut-off point for sexual dysfunction. The content of the tool was validated and internal reliability was checked using Cronbach’s alpha. Poisson regression model with robust variance estimation was used to investigate the relationship between PFDs and sexual dysfunction.

Results:

From the total 2389 participants, 1127 [47.0%; 95% confidence interval (CI): 45.0-49.0] had sexual dysfunction. Sexual desire disorder was the most prevalent disorder (72.0%; 95% CI: 70.0-74.0). After controlling for confounding factors, the prevalence of female sexual dysfunction was found as 56% (adjusted prevalence ratio, 1.56; 95% CI: 1.44-1.69) higher with women with PFD as compared with women without PFD.

Conclusion:

In the rural community of Kersa, about half of the women have sexual dysfunction and it is significantly associated with PFD. This would call for an urgent intervention against PFD to maximize the women’s sexual and reproductive health.

Sexual function of undergraduate women: a comparative study between Brazil and Italy

OBJECTIVE

to evaluate the sexual function of Italian and Brazilian nursing students using the Female Sexual Function Index (FSFI), to estimate the prevalence of sexual dysfunctions and related factors.

METHOD

this is a cross-sectional study involving 84 Brazilian and 128 Italian undergraduate. For the evaluation of sexual function, the Female Sexual Function Index (FSFI) questionnaire was used.

RESULTS

Italian women presented significantly higher sexual dysfunction index (n=78/60.9%) than the Brazilian women (n=32/38.1%) (p=0.00). Only the "desire" and "excitation" domains showed no difference between groups. Younger, single and without a steady relationship women had a higher rate of sexual dysfunction (p<0.05).

CONCLUSION

the high rate of sexual dysfunction in a young public suggests the need for more research to increase knowledge about the influence of psychosocial and related factors on female sexual function, directing care towards the promotion of sexual and reproductive health.

Predictors of female sexual dysfunction: a systematic review and qualitative analysis through gender inequality paradigms

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.

Electronic supplementary material

The online version of this article (10.1186/s12905-018-0602-4) contains supplementary material, which is available to authorized users.

Do Sleeping Disorders Impair Sexual Function in Married Iranian Women of Reproductive Age? Results from a Cross-Sectional Study

Purpose

This study aimed to evaluate the relationship between sleep quality and sexual function among Iranian women.

Methods

This study was conducted on 277 married women of reproductive age. The inclusion criteria were as follows: married women aged 18–45 years, with at least basic literacy, and women married monogamously for at least one year. The following tools were used for gathering data: a demographic questionnaire; Pittsburgh Sleep Quality Index (PSQI); Insomnia Severity Index (ISI); Epworth Sleepiness Scale (ESS); and Female Sexual Function Index (FSFI). Pearson correlation coefficients, independent t-tests, chi-square tests, and linear regression analyses were used to analyze the data.

Results

There was a significant inverse relation between poor sleep quality (r = −0.13, P = 0.02), daytime sleepiness (r = −0.39, P < 0.001), insomnia (r = −0.35, P < 0.001), and sexual function. Sexual desire was significantly related to sleep quality and insomnia (P < 0.001). Sexual arousal (r = −0.18, r = −0.29, P < 0.001), lubrication (r = −0.21, r = −0.3, −0.12, P < 0.001), orgasms (r = 0.17, r = −0.15, P < 0.001), and sexual satisfaction (r = −0.02, −r = 0.3, r = −0.15, P < 0.001) were significantly related to all types of sleep disorders (poor sleep quality, insomnia, and sleepiness). Pain during intercourse was significantly associated with poor sleep quality and insomnia. With each unit decrease in sleep quality, sexual function decreased by 0.49 (P < 0.001), and with each unit increase in the delay of sleep onset, sexual function decreased by 1.58 (P = 0.04).

Conclusion

Results of this study showed that there was a significant relationship between sleep quality and sexual function in Iranian women of reproductive age. The quality of sleep among reproductive-aged women merits the attention of health care providers and policy makers.

Sexual activity and function assessment in middle-aged Chinese women using the female sexual function index

OBJECTIVE

To assess sexual activity, sexual function, and their correlation with vaginal maturation status among middle-aged Chinese women.

METHODS

A cross-sectional study with comparisons across age groups was carried out. In all, 120 women aged 45 to 60 years were recruited into three groups: 45 to 50 (youngest group), 51 to 55 (intermediate group), and 56 to 60 years old (eldest group). Sexual function was assessed through the Female Sexual Function Index (FSFI); vaginal maturation status was determined through the Vaginal Maturation Index (VMI) and pH value. Sexual activity was recorded with self-administered questionnaires.

RESULTS

Low sexual frequency was present in a higher proportion of women, but sexual distress was identified within a lower proportion of women in the eldest group. The total FSFI score was significantly lower in the eldest group than in the youngest and intermediate groups (P < 0.01 and 0.05, respectively); however, the domain score of sexual desire, arousal, and satisfaction was lower in the eldest group than in the youngest group (P < 0.01, 0.05, and 0.05) only. The domain score for lubrication was lower in the eldest group than in both the youngest and intermediate groups (P < 0.01 and 0.05), and the pain score was lower in both the intermediate and eldest groups than in the youngest group (P < 0.01 and 0.05). A lower VMI (P < 0.001) and a higher pH value (P < 0.01) were observed in the eldest group, compared with the youngest group. Moreover, VMI was positively correlated with the total FSFI score, the domain score for sexual desire, and lubrication (r = 0.26, 0.25, 0.34; P < 0.05, 0.05, 0.01), but the opposite associations were demonstrated for pH value (r = -0.47, -0.37, -0.38; P < 0.01, respectively), especially with vaginal pain (r = -0.44, P < 0.01).

CONCLUSIONS

Among middle-aged Chinese women, sexual desire is lower in 56 to 60-year-old women, compared with those aged 45 to 55 years, whereas vaginal dryness and dyspareunia become more prevalent with age. Importantly, sexual function is associated with vaginal maturation status in women at midlife.

Sexual functioning and quality of life of Hong Kong Chinese women with infertility problem

Infertility is estimated to affect 10-15% of couples in industrialized countries and many of them are under tremendous stress. Stress can lead to poor quality of life and sexual dysfunction in general, but little is known about their prevalence in infertile women. We, therefore, conducted this cross-sectional survey in two primary care subfertility clinics between August 2012 and April 2013. A total of 159 women completed two validated Chinese questionnaires: Female Sexual Function Index and core Fertility Quality of Life. The overall Female Sexual Function Index score (mean ± SD) of the whole group was 24.99 ± 4.22. Using the urban Chinese cut-off, the prevalence of female sexual dysfunction, low desire, arousal disorder, lubrication disorder, orgasmic disorder and sexual pain were 32.5%, 15.7%, 19.3%, 22.3%, 33.1% and 15.1%. The core Fertility Quality of Life score of the whole group was 59.76 ± 13.59 and the subgroup of infertile women with sexual dysfunction (n = 50) had significantly lower mean core Fertility Quality of Life score than those without sexual dysfunction (n = 109) (55.03 versus 61.88) (p = 0.005). Among the subscales, the relational score had the strongest correlation with sexual dysfunction. Infertile women with sexual dysfunction had significantly worse quality of life especially in the relational aspect.

Marital Satisfaction Trends in Hong Kong Between 2002 and 2012

Macrosocial changes may generate influences on marital quality. This study used data from the 2002-2012 Knowledge, Attitude, and Practice surveys conducted by the Family Planning Association of Hong Kong to track the trends of marital satisfaction of both husbands and wives over a 10-year period in Hong Kong, with associated factors. Results indicated that 85% of the husbands and around 80% of the wives reported that they were satisfied with their marital relationships, and no significant changes in general were observed for them between 2002 and 2012 except for some subgroups. Husbands aged 45-49 years, in employment and whose monthly household income between 25,000 HKD and 39,999 HKD, reported marital satisfaction decreased over the past 10 years and wives with primary education or below also reported a decreasing trend during this period. Education and family income had positive influences on the husbands' and wives' marital satisfaction, and husbands were more likely to be sensitive to the unemployment. Less than one-third of couples needed professional counseling on family-related issues, and couple conflicts and work-family conflicts were the urgent needs that should be given priority in delivering services. The implications of this study are discussed in the Chinese context of Hong Kong.

Frequency, severity, and risk factors related to sexual dysfunction in Chinese women with T2D

BACKGROUND

The aim of the present study was to assess the frequency and severity of female sexual dysfunction (FSD) in those with T2D (T2D) compared with non-diabetic controls. In addition, risk factors for FSD were analyzed.

METHODS

Sexual dysfunction, measured using the Female Sexual Function Index (FSFI), was evaluated using a questionnaire in 184 women with T2D and 146 non-diabetic controls at three study sites in China. In the T2D group, FSD was examined by education level, correlations between FSD and other variables were analyzed, and risk factors were studied.

RESULTS

The frequency of FSD in the T2D group was 75.0%, much higher than in the control group (56.2%; P = 0.001). The severity of FSD in the T2D group was 17.84 ± 8.47 (mean ± SD), significantly lower than in the control group (21.14 ± 8.08; P = 0.001). In patients with T2D, being older (P = 0.001), taking oral antidiabetic medications (P = 0.013), and having diabetic neuropathy (P = 0.036) were risk factors for FSD.

CONCLUSIONS

The rate of FSD is high in China and, as seen in the literature, more severe in diabetics than non-diabetics. Being older, taking oral antidiabetic medications, and diabetic neuropathy are risk factors for FSD.

The Association Between Female Sexual Dysfunction and the Husband's Erectile Dysfunction: Evidence from Married Couples in Hong Kong

Little is known about the association between the sexual functioning of each partner in a heterosexual married couple. By using a community-based survey of Hong Kong Chinese couples in 2012, this study attempted to examine the relation between female sexual dysfunction and their husbands' erectile dysfunction. Among the 1,518 female and 1,059 male respondents, 944 sexually active couples were eligible for the analysis, with mean age of 39.3 ± 6.8 years (range = 21-50) for the wives and 43.6 ± 8.6 years (range = 18-80) for the husbands. Of the wives, 27.0% reported at least one form of female sexual dysfunction and 5.0% of the husbands reported erectile dysfunction. After adjusting for the female's age and other risk factors, the total and domain scores of female sexual dysfunction were not associated with her husband's erectile dysfunction except for physical pain during sexual intercourse. Therefore, whether to screen the partner's sexual function depends on the age of the female clients.

Sexual dysfunction among reproductive-aged Chinese married women in Hong Kong: prevalence, risk factors, and associated consequences

INTRODUCTION

Although female sexual dysfunction (FSD) is a serious public health issue endangering women's well-being, systematic research on FSD among reproductive-aged Chinese women in Hong Kong is quite scarce.

AIM

This study aims to estimate the prevalence, risk factors, and associated consequences of FSD among reproductive-aged Chinese married women in Hong Kong.

METHODS

This study was based on a community-based survey across Hong Kong conducted by the Family Planning Association of Hong Kong in 2012 with 1,518 married women aged 21-49 years.

MAIN OUTCOME MEASURE

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition classification was adopted to assess FSD.

RESULTS

It was found that 25.6% of the married women surveyed reported at least one form of sexual dysfunction and that the prevalence of six domains of sexual dysfunction was as follows: 10.6% for lack of interest in sex, 10.5% for not finding sex pleasurable, 9.3% for lubrication difficulties, 8.8% for inability to achieve orgasm, 8.8% for orgasm delay, and 8.4% for physical pain during sex. Multivariate analyses showed that low education and income, average or poor health, lower frequency of sex, abortion history, traditional attitudes toward sex, and marital dissatisfaction are all significant risk factors for different components of FSD. It was also been found that four domains of FSD (the exceptions being orgasm delay and physical pain during sex) have severe consequences for married women's life satisfaction and sexual satisfaction.

CONCLUSION

The prevalence of FSD is lower among reproductive-aged Chinese married women in Hong Kong than among women in the United States and some Asian countries. The risk factors associated with FSD include sociodemographic factors, physical health, sexual experience and attitudes, and relationship factors. FSD has significant consequences for married women's life quality. These findings have great implications for FSD prevention and relevant service delivery.

An Update of the International Society of Sexual Medicine's Guidelines for the Diagnosis and Treatment of Premature Ejaculation (PE)

INTRODUCTION

In 2009, the International Society for Sexual Medicine (ISSM) convened a select panel of experts to develop an evidence-based set of guidelines for patients suffering from lifelong premature ejaculation (PE). That document reviewed definitions, etiology, impact on the patient and partner, assessment, and pharmacological, psychological, and combined treatments. It concluded by recognizing the continually evolving nature of clinical research and recommended a subsequent guideline review and revision every fourth year. Consistent with that recommendation, the ISSM organized a second multidisciplinary panel of experts in April 2013, which met for 2 days in Bangalore, India. This manuscript updates the previous guidelines and reports on the recommendations of the panel of experts.

AIM

The aim of this study was to develop clearly worded, practical, evidenced-based recommendations for the diagnosis and treatment of PE for family practice clinicians as well as sexual medicine experts.

METHOD

A comprehensive literature review was performed.

RESULTS

This article contains the report of the second ISSM PE Guidelines Committee. It offers a new unified definition of PE and updates the previous treatment recommendations. Brief assessment procedures are delineated, and validated diagnostic and treatment questionnaires are reviewed. Finally, the best practices treatment recommendations are presented to guide clinicians, both familiar and unfamiliar with PE, in facilitating treatment of their patients.

CONCLUSION

Development of guidelines is an evolutionary process that continually reviews data and incorporates the best new research. We expect that ongoing research will lead to a more complete understanding of the pathophysiology as well as new efficacious and safe treatments for this sexual dysfunction. We again recommend that these guidelines be reevaluated and updated by the ISSM in 4 years. Althof SE, McMahon CG, Waldinger MD, Serefoglu EC, Shindel AW, Adaikan PG, Becher E, Dean J, Giuliano F, Hellstrom WJG, Giraldi A, Glina S, Incrocci L, Jannini E, McCabe M, Parish S, Rowland D, Segraves RT, Sharlip I, and Torres LO. An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation (PE). Sex Med 2014;2:60-90.

An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation (PE)

INTRODUCTION

In 2009, the International Society for Sexual Medicine (ISSM) convened a select panel of experts to develop an evidence-based set of guidelines for patients suffering from lifelong premature ejaculation (PE). That document reviewed definitions, etiology, impact on the patient and partner, assessment, and pharmacological, psychological, and combined treatments. It concluded by recognizing the continually evolving nature of clinical research and recommended a subsequent guideline review and revision every fourth year. Consistent with that recommendation, the ISSM organized a second multidisciplinary panel of experts in April 2013, which met for 2 days in Bangalore, India. This manuscript updates the previous guidelines and reports on the recommendations of the panel of experts.

AIM

The aim of this study was to develop clearly worded, practical, evidenced-based recommendations for the diagnosis and treatment of PE for family practice clinicians as well as sexual medicine experts.

METHOD

A comprehensive literature review was performed.

RESULTS

This article contains the report of the second ISSM PE Guidelines Committee. It offers a new unified definition of PE and updates the previous treatment recommendations. Brief assessment procedures are delineated, and validated diagnostic and treatment questionnaires are reviewed. Finally, the best practices treatment recommendations are presented to guide clinicians, both familiar and unfamiliar with PE, in facilitating treatment of their patients.

CONCLUSION

Development of guidelines is an evolutionary process that continually reviews data and incorporates the best new research. We expect that ongoing research will lead to a more complete understanding of the pathophysiology as well as new efficacious and safe treatments for this sexual dysfunction. We again recommend that these guidelines be reevaluated and updated by the ISSM in 4 years.

Sexual behavior and symptoms among reproductive age Chinese women in Hong Kong

INTRODUCTION

As sexual medicine evolves, much advancement has been achieved in understanding male sexuality and treating male sexual dysfunction. Less is known about female sexual pattern, the prevalence of sexual problems, and their correlation with confounding factors.

AIM

To enhance our understanding of female sexuality and the risk factors that contributed to sexual problems in reproductive age women.

METHOD

A cross-sectional survey was conducted in family planning and prepregnancy checkup clinics from December 2007 to December 2009, with 2,146 sexually active Chinese women aged 21 to 40 years completed the entire questionnaire.

MAIN OUTCOME MEASURES

Prevalence of sexual symptoms, coital frequency, and other sexual behavior-related activities were measured.

RESULTS

Overall, 59.0% of respondents had at least one sexual problem. In this sample, 31.8% of respondents reported no desire; 31.7% had arousal problems; 40% had anorgasmia, and 33.8% experienced coital pain for at least 3 months within the past 1 year. Chi-square test showed significant correlation among the four types of sexual problems(P < 0.001). Univariate regression model showed that all sexual symptoms were significantly correlated with unidirectional coitus initiation, low coital frequency, and low foreplay enjoyment. Loglinear model revealed that desire, arousal, and orgasmic problems were correlated with low foreplay enjoyment. Arousal problem was correlated with high acceptance toward pornography and history of medical disease. Coital pain was correlated with secondary education and planning to have more children. Both unidirectional coitus initiation and low coital frequency were major contributors to all four sexual symptoms.

CONCLUSIONS

Sexual problem is a prevalent health issue among reproductive age women. A number of risk factors are identified, which provide useful direction to the design of counseling and education materials that might help to enhance sexual performance in women.