Body imaging and sexual behavior in lean women with polycystic ovary syndrome

Sexual Function in Women with Polycystic Ovary Syndrome Living in Stable Heterosexual Relationships: A Cross-Sectional Study

Background/Objective: The prevalence and character of female sexual dysfunction (FSD) in polycystic ovary syndrome (PCOS) have not been precisely determined. The aim of this study was to assess FSD using the Changes in Sexual Functioning Questionnaire (CSFQ-14) in women with PCOS and their partners compared to a control group, as well as correlations between five subscales, the total score of the CSFQ, and seven questions of the Visual Analogue Scale (VAS). Methods: The study sample (N = 160) comprised two groups: (1) women with PCOS and their partners (n = 91) and (2) women without PCOS and their partners (control group; n = 69). Results: The total scores of the CSFQ did not reveal FSD in either group of women. Regarding all subscales and the total score, the analysis showed a statistically significant difference between women and their partners (in all cases: p < 0.001). The discrepancy in arousal between women and men in the PCOS group was large (the mean difference was -2.32; t = -11.29, p < 0.001, Cohen's d = -1.26). The importance (VAS1), the level (VAS7) of sexual satisfaction, and the intensity of sexual thoughts (VAS2) correlated with almost all domains of the CSFQ. Conclusions: In conclusion, normal sexual function in PCOS does not mean proper sexual functioning in a sexual relationship.

Body image concerns in women with polycystic ovary syndrome: a systematic review and meta-analysis

OBJECTIVE

To assess differences in body image concerns among women with and without polycystic ovary syndrome (PCOS).

DESIGN

This is a systematic review and meta-analysis.

METHODS

Electronic databases (MEDLINE, EMBASE, APA PsychInfo, PUBMED, Web-of-Science Core Collection, and Cochrane Controlled Register of Trials [CENTRAL]) were searched from inception through July 2022. Outcome measures included validated questionnaires reporting on body image concerns. Methodological quality was assessed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system, and included studies were assessed for risk of bias. Meta-analyses were performed using the inverse variance method based on random or fixed effects models (Review Manager, Version 5).

RESULTS

A total of 918 women with PCOS and 865 women without PCOS from 9 studies were included. Meta-analysis of 3 studies using Multidimensional Body-Self Relations Questionnaire Appearance Scale (MBSRQ-AS) showed those with PCOS reported higher dissatisfaction with appearance evaluation and appearance orientation compared to those without PCOS (mean difference [MD] = -0.78, I2 = 0%, P < .00001, and MD = 0.22, I2 = 54%, P = .004, respectively). Meta-analysis of 2 studies showed higher dissatisfaction with overweight preoccupation, lower body area satisfaction, and body weight classification on MBSRQ-AS subscales in those with PCOS compared to those without PCOS (all P < .001). Meta-analysis of 2 studies using the Body Esteem Scale for Adolescents and Adults (BESAA) showed significantly lower scores for the weight subscale in those with PCOS compared to those without PCOS (P = .03).

CONCLUSIONS

Those with PCOS experience more significant body image concerns, emphasising the importance of awareness in the clinical care of PCOS. Considering the limited evidence, further studies are warranted to identify drivers and mitigating factors.

Female sexual function in different phenotypes of polycystic ovarian syndrome: a comparative cross-sectional study

Polycystic ovary syndrome (PCOS) coexisting mood disorders along with a combination of aesthetic manifestations may have a detrimental effect on women's sexual function. Hence, different phenotypes of PCOS have different clinical and biochemical signs and symptoms. The aim of this study was to compare women's sexual function (SF) in different phenotypes of PCOS. This cross-sectional study was conducted on 364 women who met the Rotterdam diagnostic criteria to compare different PCOS phenotypes (A = 95, B = 79, C = 95, and D = 95) and 100 non PCOS women in control group. All participants were invited to fill out the female sexual function index (FSFI). Significant differences were observed between the different phenotypes and control group in terms of the total score, sexual desire, arousal, lubrication, and satisfaction (P < 0.001); however, no significant differences were found between different phenotypes in terms of pain (P > 0.05) and orgasm (P > 0.05) but difference was significant between different phenotypes and control group. In addition, phenotype B had the lowest mean score of total FSFI (P < 0.05). The results indicated that women's SF is significantly different in different PCOS phenotypes. It is concluded that in order to solve the SF problems of women with PCOS, different treatment and care measures should be considered according to the relevant phenotype.

Body image and sexual function in women with polycystic ovary syndrome: a case-control study

OBJECTIVES:

METHODS:

RESULTS:

CONCLUSION:

Features of dynamics of identity in women with polycystic ovarian syndrome and their socio-demographic determinants

With a significant prevalence of polycystic ovary syndrome (PCOS), the question of its impact on the identity of women, the specifics of such identity, as well as its dynamics remain debatable.The aim. To study the features of identity dynamics in women with PCOS and the socio-demographic factors that determine these features.Research methods. A retrospective cohort study was conducted using the SEI-test methods and the Russian language versions of the Life Line, Twenty Statements Test methods on a sample of 110 women of reproductive age (58 women with PCOS, 52 women without PCOS; two surveys during the year).Results. Had been shown that women diagnosed with PCOS show fewer signs of an identity crisis than women without such diagnosis, but their identity is more variable. Such women are less likely to characterize themselves with the help of concepts related to gender and family spheres in favor of personality traits. An analysis of the influence of socio-demographic factors showed that their identity determines a greater number of external factors than in women without PCOS. The ego-identity of such women depends on marital status and place of residence.Conclusion. The identity of women diagnosed with PCOS is more variable, but shows fewer signs of a crisis. It seems necessary to take into account the presence or absence of children when planning further research. The results obtained can be used in the consultation of women with PCOS.

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 Function in Chinese Women with Polycystic Ovary Syndrome and Correlation with Clinical and Biochemical Characteristics

To investigate sexual function in Chinese women with polycystic ovary syndrome (PCOS) and to explore the correlation with clinical and biochemical characteristics. A cross-sectional study was designed in 1000 PCOS women, aged 18–45 years, via the Chinese version of Female Sexual Function Index (FSFI) evaluating sexual function, with additional questions possibly related to sexual life. Clinical and biochemical characteristics likely to affect sexual function were determined, including anthropometric indicators, serum levels of hormones, luteinizing hormone to follicle-stimulating hormone ratio (LH/FSH ratio), prolactin (PRL), total testosterone (TT), free androgen index (FAI), sex-hormone-binding globulin (SHBG), glucose, and lipid metabolism indicators. Nine hundred ten PCOS women participated in the study, 685 patients were included after screening, and 211 were suitable to detect correlations of clinical and biochemical characteristics with sex function parameters. The mean total FSFI score was 24.19 ± 2.8; 79.56% of the women were at risk of female sexual dysfunction (FSD). Women doing regular aerobic exercise and use of contraception had higher FSFI scores, while those with a desire to conceive and clinical signs of hyperandrogenism had lower FSFI scores. There were negative associations of FSFI scores with age and body fat distribution. No significant associations between FSFI scores and hormonal factors (surprisingly including SHBG) were found, except for total testosterone and satisfaction (OR = 0.976, p = 0.002). HOMA-IR was significantly related to reduced desire score (OR = 0.914, p = 0.004) and lubrication score (OR = 0.964, p = 0.044). PCOS was associated with a high risk of FSD (defined according to FSFI) in about 80% of the women in our study, and clinical characteristics play a more important role.

SHBG as a Marker of NAFLD and Metabolic Impairments in Women Referred for Oligomenorrhea and/or Hirsutism and in Women With Sexual Dysfunction

PCOS is one of the most common endocrine disorders and NAFLD is one of its most dangerous metabolic consequences. The diagnosis of NAFLD is not a practical task and the condition is at risk of being overlooked. The use of simpler but still reliable surrogate markers is necessary to identify women with a high likelihood of NAFLD. The aim of this study was to evaluate the clinical correlates of NAFLD Liver Fat Score (NAFLD-LFS) in women with oligomenorrhea and/or hirsutism. Furthermore, the study aimed to evaluate whether, among the hormonal parameters evaluated in such women, possible hallmarks of NAFLD may be identified. To this purpose, 66 women who attended our Outpatient Clinic for oligomenorrhea and/or hyperandrogenism were included in the study. In order to validate the results obtained in the first cohort, a second independent sample of 233 women evaluated for female sexual dysfunction (FSD) was analyzed. In cohort 1, NAFLD-LFS positively correlated with metabolic and inflammatory parameters. Among the hormone parameters, NAFLD-LFS showed no significant relationships with androgens but a significant negative correlation with SHBG (p<0.0001) that therefore appeared as a candidate hallmark for pathologic NAFLD-LFS. The ROC analysis showed a significant accuracy (81.1%, C.I.69.1-93.0, p <0.0001) for SHBG in identifying women with a pathological NAFLD-LFS. In particular, a SHBG 33.4 nmol/l was recognized as the best threshold, with a sensitivity of 73.3% and a specificity of 70.7%. In order to validate this SHBG as a marker of metabolic impairment possible related with the presence of NAFLD, we tested this threshold in cohort 2. FSD women with SHBG <33.4 nmol/l had worse metabolic parameters than women with SHBG ≥33.4 nmol/l and a significantly higher NAFLD-LFS even after adjusting for confounders (B=4.18 [2.05; 6.31], p=0.001). In conclusion, this study provides a new evidence in the diagnostic process of NAFLD, showing that the measurement of SHBG, which is routinely assessed in the workup of women referred for possible PCOS, could identify women at higher metabolic risk, thus detecting those who may deserve further targeted diagnostic assessment.

Sexual dysfunction in polycystic ovary syndrome: a systematic review and meta-analysis

PURPOSE

Polycystic ovarian syndrome (PCOS) is a common disorder characterized by clinical or biochemical hyperandrogenism and ovulary dysfunction. Female sexual dysfunction (FSD) adversely affects quality of life and interpersonal relationships. We aimed to compare the prevalence of FSD in women with and without PCOS.

METHODS

We pooled data from 28 observational studies involving 6256 women. Apart from the total prevalence of FSD, subgroup analyses based on different PCOS diagnostic criteria and obesity status (body mass index [BMI] ≥ 25 kg/m²) were performed. The differences in total and subscale scores of the Female Sexual Function Index (FSFI) among women with and without PCOS were also compared.

RESULTS

Women with PCOS were younger (mean ± SD 28.56 ± 3.0 vs 31.5 ± 3.2 years, p < 0.001) with higher BMI (28.5 ± 4.2 vs 27.0 ± 6.1 kg/m², p < 0.001), Ferriman-Gallwey score (10.0 ± 3.2 vs 4.0 ± 2.1, p < 0.001), and serum total testosterone level (2.34 ± 0.58 nmol/L vs 1.57 ± 0.60 nmol/L, p < 0.001) compared with women without PCOS. The prevalence of FSD among women with and without PCOS was 35% and 29.6%, respectively. There was no significant difference in total FSFI score (24.59 ± 3.97 vs 26.04 ± 3.05, p = 0.237) between the two groups. Women with PCOS, however, had significantly lower scores in the pain (p < 0.001) and satisfaction subscales (p = 0.010) compared with women without PCOS. Women with PCOS had 1.32 higher odds (95% CI 1.07, 1.61) of having FSD than women without PCOS.

CONCLUSION

Women with PCOS have a higher risk of FSD than those without PCOS. Although total FSFI scores were not significantly different, women with PCOS tended to report dyspareunia and lack of sexual satisfaction.

A comparison of physical anxiety levels in adolescent and young women with polycystic ovary syndrome and in other healthy adolescent and young women in a university hospital, Turkey

Purpose

This study was conducted to investigate the Social Physique Anxiety (SPA) level in adolescent and young women with polycystic ovarian syndrome (PCOS).

Design/methodology/approach

This is a descriptive study. It was conducted in Turkey. The study was conducted from January 1, 2017 to December 31, 2017. It was completed with a total of 150 young women – 75 of them had PCOS and 75 of them were healthy. Study data were collected using demographic information form and Social Physique Anxiety Scale (SPAS).

Findings

The study was found that the adolescent and young women with PCOS had higher subscales and total scores for total SPAS at a statistically significant level than healthy adolescent and young women (p < 0.05).

Practice implication

The findings of this study may be used for planning and implementing interventions in health-care practice such as screening and early treatment of SPA of women with PCOS.

Originality/value

It was found that PCOS in adolescent and young women increased the SPA level. In line with these results, health professionals must be particularly aware of the potential psychosocial and health needs of adolescent and young women with PCOS.

Disparate Relationship of Sexual Satisfaction, Self-Esteem, Anxiety, and Depression with Endocrine Profiles of Women With or Without PCOS

Women with polycystic ovary syndrome (PCOS) are at increased risk of psychological distress including anxiety and depressive symptoms. However, less is known about sexual satisfaction and self-esteem as well as the relationship of these aspects of psychological function with clinical and hormonal profiles associated with PCOS. This cross-sectional study compared women with PCOS (N = 96) and healthy controls (N = 47). This study assessed sexual function (primary outcome), self-esteem, anxiety, and depression as well as evaluation of clinical, endocrine, and metabolic parameters. Overall, sexual satisfaction scores were comparable among women with and without PCOS. However, psychosexual function of women with PCOS exhibited distinguishing characteristics. The unconscious aspect of sexuality: frequency of erotic dreams, significantly correlated with free testosterone (ρ = 0.24, P = 0.03) and DHEAS (ρ = 0.31, P = 0.004) only in the PCOS group. In contrast, in women with PCOS, the frequency of masturbation did not correlate with endocrine profiles, but correlated with trait anxiety (ρ = 0.21, P = 0.049) and depression (ρ = 0.21, P = 0.05). Only one aspect of self-esteem (body appearance) was reduced in the PCOS group (P = 0.02) and was related to BMI and androgen. Women with PCOS had greater state anxiety (P = 0.02) and depression (P < 0.001); these scores correlated with BMI. However, anxiety and depression correlated with testosterone only in women without PCOS. The above findings indicate that PCOS is associated with a broad range of alterations of psychological function including psychosexual aspects; these alterations are in complex relationship with BMI and androgen levels.

Sexual function and functioning of women in reproductive age

Abstract Introduction: Sexual function (SF) is an important issue in women’s health from the beginning of sexual life. SF can be modified by several factors, and the presence of sexual dysfunction may negatively affect the quality of life of these women. Objective: This study aimed to investigate the sexual function, its associated factors and the association with the functioning in women in reproductive age. Method: A cross-sectional observational study with 172 women that attended 6 Family Health Facilities in the northeast region of Brazil. The evaluation tool consisted of (i) sociodemographic, obstetrical and gynecological issues, and questions about habits and health conditions, (ii) female sexual quotient (FSQ), and (iii) World Health Organization Assessment Schedule 2.0 (WHODAS 2.0). Prevalence of sexual dysfunction was calculated, and bivariate analysis was used to estimate the association of independent variables with the outcome of sexual dysfunction. Results: The prevalence of sexual dysfunction was 37.2%, and 39.5% of the sample considered their sexual health as fair to good. In total, 26.2% of women never think of sex spontaneously, they do not remember or imagine themselves during sexual intercourse, and 38.4% think about it sometimes. No association was found between the investigated variables and sexual dysfunction; however, the latter showed an association on interpersonal relationships of women (p = 0.016). Conclusions: There is a considerable prevalence of sexual dysfunction between women in reproductive age. Thus, results emphasize the relevance of investigations about female sexual function among women in reproductive age that are not in the pregnancy and postpartum period.

Psychiatric Disorders, Self-Esteem, and Quality of Life in Adolescents with Polycystic Ovary Syndrome

STUDY OBJECTIVE

To assess psychiatric disorders in adolescents with polycystic ovary syndrome (PCOS) and evaluate health-related quality of life and self-esteem in this group.

DESIGN

Cross-sectional design. The survey was composed of validated measures and a semistructured interview.

SETTING

University School of Medicine, Turkey.

PARTICIPANTS

Female adolescents aged 13-18 years.

INTERVENTIONS AND MAIN OUTCOME MEASURES

Assessment of psychiatric disorders through a semistructured interview (Schedule for Affective Disorders and Schizophrenia for School Age Children) conducted by a child and adolescent psychiatrist. Health-related quality of life was measured using the Pediatric Quality of Life Inventory (PedsQL) and self-esteem was measured using the Rosenberg Self-Esteem Scale (RSES).

RESULTS

A total of 28 adolescent with PCOS and 31 age- and sex-matched healthy peers were recruited. The psychiatric diagnosis rate was higher in the PCOS group than in the control group (P < .5). In the patient group, 6 of 28 patients (21%) were diagnosed with depressive disorder and the most common single diagnosis was major depressive disorder. There were no significant differences in the PCOS and control groups in terms of RSES and PedsQL scores. There was no significant relationship between RSES scores and body image related to hirsutism, acne, and body mass index. Also, there was no significant relationship between PedsQL scores and hirsutism, acne, and body mass index.

CONCLUSION

Adolescents with PCOS frequently experience psychiatric disorders. Physicians should be aware that adolescents with PCOS are at a high risk for major depression and anxiety disorders.

Continuous versus intermittent aerobic exercise in the improvement of quality of life for women with polycystic ovary syndrome: A randomized controlled trial

Polycystic ovary syndrome predisposes alterations which contribute to the reduction of quality of life. This randomized controlled clinical trial study was to evaluate the effect of two protocols of aerobic exercise on quality of life in women with polycystic ovary syndrome. Women were allocated to three groups: continuous aerobic training (n = 28), intermittent aerobic training (n = 29), and control group (no training; n = 30). Testosterone levels, body composition indices, and quality of life were assessed at baseline and after 16 weeks of intervention. Both protocols were effective to improve testosterone levels, anthropometric indices, and quality of life in polycystic ovary syndrome women. Thus, these protocols should be included in the clinical environment to improve clinical parameters psychological, biological and social health to this population.

Body-image distress is increased in women with polycystic ovary syndrome and mediates depression and anxiety

OBJECTIVE

To evaluate differences in body-image distress (BID) scores between women with polycystic ovary syndrome (PCOS) and controls and whether BID mediates anxiety and depression.

DESIGN

Cross-sectional study.

SETTING

Academic institution.

PATIENT(S)

Reproductive-aged women with PCOS (n = 189) and controls (n = 225).

INTERVENTION

Administering the Multidimensional Body-Self Relations-Appearance Subscale (MBSRQ-AS), Stunkard Figure Rating Scale (FRS), Hospital Anxiety and Depression Scale (HADS), and PCOS quality of life survey (MPCOS-Q).

MAIN OUTCOME MEASURE(S)

BID, depression, and anxiety scores and mediation of depression and anxiety scores by BID.

RESULT(S)

Women with PCOS had worse BID scores on all five MBSRQ-AS subscales adjusted for age, body mass index, race, pregnancy history, income, and employment, and larger differences on the FRS compared with the control women. In multivariable regression models, the prevalence of depressive (28% vs. 19.2%) and anxiety (76.5% vs. 56.5%) symptoms were also statistically significantly higher in women with PCOS compared with the controls. Most MBSRQ-AS subscale scores statistically significantly correlated with depression, anxiety, and quality of life scores. The association between PCOS/control status and higher anxiety and depression scores was completely mediated by the appearance evaluation and body areas satisfaction subscales and partially mediated by overweight preoccupation, appearance orientation, and self-classified weight.

CONCLUSION(S)

Women with PCOS have increased BID and depressive and anxiety symptoms. In our study different aspects of BID either fully or partially mediated the association between PCOS/control status and depression and anxiety scores, suggesting that therapeutic interventions targeted at improving body image may decrease depressive and anxiety symptoms.

Is polycystic ovary syndrome associated with risk of female sexual dysfunction? A systematic review and meta-analysis

The aim of this study was to evaluate whether polycystic ovary syndrome (PCOS) is a risk factor for female sexual dysfunction (FSD) by conducting a systematic review and meta-analysis. The databases PubMed, EMBASE and the Cochrane Library were searched for relevant studies. The association between PCOS and risk of FSD was assessed by relative risk or standard mean differences with 95% confidence interval. The protocol for this meta-analysis is available from PROSPERO (CRD42018102247). Overall, 2626 participants (mean age 25-36 years) were included from 10 studies (five cross-sectional and five case-control studies), 1163 of whom were women with PCOS. The pooled results from eight included studies providing the number of cases revealed no significant association between PCOS and increased risk of FSD (RR = 1.09, 95% CI 0.9 to 1.32; heterogeneity: I² = 11.0%). The combined overall standard mean difference from five studies reporting Female Sexual Function Index (FSFI) scores showed that patients with PCOS had similar values in total FSFI scores compared with healthy controls (standard mean difference = -0.03, 95% CI -0.12 to 0.05; heterogeneity: I² = 0.0%). Sensitivity analyses yielded similar results. This meta-analysis suggests no direct association between PCOS and risk of FSD. Well-controlled trials with large sample sizes, however, are needed to validate this evidence.

Clustering of PCOS-like traits in naturally hyperandrogenic female rhesus monkeys

Study question

Do naturally occurring, hyperandrogenic (≥1 SD of population mean testosterone, T) female rhesus monkeys exhibit traits typical of women with polycystic ovary syndrome (PCOS)?

Summary answer

Hyperandrogenic female monkeys exhibited significantly increased serum levels of androstenedione (A4), 17-hydroxyprogesterone (17-OHP), estradiol (E2), LH, antimullerian hormone (AMH), cortisol, 11-deoxycortisol and corticosterone, as well as increased uterine endometrial thickness and evidence of reduced fertility, all traits associated with PCOS.

What is known already

Progress in treating women with PCOS is limited by incomplete knowledge of its pathogenesis and the absence of naturally occurring PCOS in animal models. A female macaque monkey, however, with naturally occurring hyperandrogenism, anovulation and polyfollicular ovaries, accompanied by insulin resistance, increased adiposity and endometrial hyperplasia, suggests naturally occurring origins for PCOS in nonhuman primates.

Study design, size, duration

As part of a larger study, circulating serum concentrations of selected pituitary, ovarian and adrenal hormones, together with fasted insulin and glucose levels, were determined in a single, morning blood sample obtained from 120 apparently healthy, ovary-intact, adult female rhesus monkeys (Macaca mulatta) while not pregnant or nursing. The monkeys were then sedated for somatometric and ultrasonographic measurements.

Participants/materials, setting, methods

Female monkeys were of prime reproductive age (7.2 ± 0.1 years, mean ± SEM) and represented a typical spectrum of adult body weight (7.4 ± 0.2 kg; maximum 12.5, minimum 4.6 kg). Females were defined as having normal (n = 99) or high T levels (n = 21; ≥1 SD above the overall mean, 0.31 ng/ml). Electronic health records provided menstrual and fecundity histories. Steroid hormones were determined by tandem LC-MS-MS; AMH was measured by enzymeimmunoassay; LH, FSH and insulin were determined by radioimmunoassay; and glucose was read by glucose meter. Most analyses were limited to 80 females (60 normal T, 20 high T) in the follicular phase of a menstrual cycle or anovulatory period (serum progesterone <1 ng/ml).

Main results and the role of chance

Of 80 monkeys, 15% (n = 12) exhibited classifiable PCOS-like phenotypes. High T females demonstrated elevations in serum levels of LH (P < 0.036), AMH (P < 0.021), A4 (P < 0.0001), 17-OHP (P < 0.008), E2 (P < 0.023), glucocorticoids (P < 0.02-0.0001), the serum T/E2 ratio (P < 0.03) and uterine endometrial thickness (P < 0.014) compared to normal T females. Within the high T group alone, anogenital distance, a biomarker for fetal T exposure, positively correlated (P < 0.015) with serum A4 levels, while clitoral volume, a biomarker for prior T exposure, positively correlated (P < 0.002) with postnatal age. Only high T females demonstrated positive correlations between serum LH, and both T and A4. Five of six (83%) high T females with serum T ≥2 SD above T mean (0.41 ng/ml) did not produce live offspring.

Large scale data

N/A.

Limitations, reasons for caution

This is an initial study of a single laboratory population in a single nonhuman primate species. While two biomarkers suggest lifelong hyperandrogenism, phenotypic expression during gestation, prepuberty, adolescence, mid-to-late reproductive years and postmenopause has yet to be determined.

Wider implications of the findings

Characterizing adult female monkeys with naturally occurring hyperandrogenism has identified individuals with high LH and AMH combined with infertility, suggesting developmental linkage among traits with endemic origins beyond humans. PCOS may thus be an ancient phenotype, as previously proposed, with a definable pathogenic mechanism(s).

Study funding/competing interest(s)

Funded by competitive supplement to P51 OD011106 (PI: Mallick), by P50 HD028934 (PI: Marshall) and by P50 HD044405 (PI: Dunaif). The authors have no potential conflicts of interest.

Impact of Physical Resistance Training on the Sexual Function of Women with Polycystic Ovary Syndrome

INTRODUCTION

There is a need for specific measures to address overall care in women with polycystic ovary syndrome (PCOS). Physical resistance training (PRT) has been shown to improve certain body parameters. However, the effect of PRT on the sexual function of PCOS women has not been evaluated.

AIM

The study aimed to assess sexual function and emotional status of PCOS women after 16 weeks of PRT.

METHODS

This case-control study involved 43 women with PCOS and 51 control ovulatory women, aged 18-37 years. All women were subjected to a supervised PRT protocol for 16 weeks and evaluated at the end of the program. Sexual function was assessed at baseline and after PRT protocol.

MAIN OUTCOME MEASURES

The main outcome measure used was the Female Sexual Function Index (FSFI).

RESULTS

Of the 43 women with PCOS, 30 (69.70%) had a basal total FSFI score ≤ 26.55 and 24 of them (58.54%) had a score ≤ 26.55 after PRT (P = 0.08). Of the 51 control women, 32 (62.7%) and 27 (52.9%) had FSFI scores < 26.55 at baseline and after PRT, respectively (P = 0.06). Control women experienced a significant improvement in pain domain score after PRT (P < 0.03). PCOS women experienced significant increases in total score and in the desire, excitement and lubrication domains after PRT (P < 0.01 each). After PRT, there was a significant difference between the PCOS and control groups in the sexual desire domain (4.09 ± 1.29 vs. 3.75 ± 1.42, P = 0.04). Significantly fewer women in the PCOS group were at risk of depression (P < 0.01) and anxiety (P < 0.02) after than before PRT, whereas the differences in the control group were not significant. Mean depression and anxiety scores were reduced significantly in both the PCOS (P < 0.01 each) and control (P < 0.01) groups.

CONCLUSIONS

PRT significantly enhanced total score and the desire, excitement, and lubrication domains of the FSFI in PCOS women. PRT reduced pain, and total depression and anxiety scores in both groups.