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Vasconcelos PA, Paúl C, Nobre PJ. Biopsychosocial determinants of sexual health in older age: the role of health-related, relationship, and psychosexual factors. J Sex Med 2024; 21:420-429. [PMID: 38490973 DOI: 10.1093/jsxmed/qdae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 01/26/2024] [Accepted: 02/02/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Given the unprecedented aging of the population and the increased focus on overall well-being in older age, investigating the determining factors of sexual well-being in older adults becomes essential as it offers insights into promoting healthy aging and overall quality of life. AIM By applying the biopsychosocial model of sexuality in older age, we aimed to identify the role of biomedical and psychosocial factors in predicting sexual well-being in partnered older adults (≥55 years old). METHODS A total of 111 participants (mean [SD], 63.2 [5.96]) completed a self-report questionnaire assessing biopsychosocial dimensions. Bivariate correlational analyses and hierarchical multiple regression were conducted to investigate factors associated with sexual well-being. Health-related factors were entered into the first regression model. The second model included factors pertaining to relationship dimensions. Sexual beliefs were introduced in the third regression model. OUTCOMES Self-rated health, psychological distress, subjective cognitive decline, sexual beliefs, duration of the relationship, relationship satisfaction, and sexual well-being were assessed. RESULTS Findings from the hierarchical regression revealed that duration of relationship [t(104) = -3.07, P < .01], relationship satisfaction [t(104) = 8.49, P < .001], and age-related sexual beliefs [t(104) = -2.75, P < .01] were significant predictors of sexual well-being of partnered older adults [F(6, 104) = 22.77, P < .001, R2 = .57], after controlling for health-related factors. These findings suggest that relationship factors and sexual beliefs play a significant role in predicting sexual well-being of older adults, above and beyond health-related dimensions. CLINICAL IMPLICATIONS Interventional approaches aimed at promoting sexual well-being in older age might benefit from incorporating exercises that demystify age-related sexual beliefs, by normalizing changes that occur with aging and fostering positive attitudes toward sexual expression in older age; particularly for older adults in long-term relationships, relationship satisfaction must also be considered as an important intervention target. STRENGTHS AND LIMITATIONS Further investigation using longitudinal designs is required to examine the causal links between these factors and sexual well-being in older age. CONCLUSION Findings from this study underscore the role of relationship dimensions and age-related sexual beliefs for the sexual well-being of partnered older adults.
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Affiliation(s)
- Priscila A Vasconcelos
- Faculty of Psychology and Educational Sciences, University of Porto. Rua Alfredo Allen, Porto 4200-135, Portugal
| | - Constança Paúl
- Department of Behavioral Sciences, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto 4050-313, Portugal
| | - Pedro J Nobre
- Faculty of Psychology and Educational Sciences, University of Porto. Rua Alfredo Allen, Porto 4200-135, Portugal
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2
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Kürne HG, Akbayrak T. The validity and reliability of the Turkish version of the Postmenopause Sexuality Questionnaire. Int J Gynaecol Obstet 2024; 165:188-193. [PMID: 38084782 DOI: 10.1002/ijgo.15293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 11/13/2023] [Accepted: 11/28/2023] [Indexed: 03/17/2024]
Abstract
OBJECTIVE To translate and to validate the Postmenopause Sexuality Questionnaire (PMSQ) for Turkish women in the climacteric. METHODS The study included 356 menopausal women with a mean age of 60.2 ± 7.6 years. First, the demographic characteristics and obstetric information of the women were recorded. Then, the PMSQ was adapted into Turkish. In order to determine the sexual activity and menopause-specific quality of life, the Female Sexual Function Index (FSFI), The Menopause Specific Quality of Life Questionnaire (MENQOL), and the PMSQ were administered. The reliability and validity of the PMSQ were assessed with internal consistency, test-retest, and criterion validity analyses. RESULTS According to the results of the study, the internal consistency (Cronbach's α = 0.97) and test-retest reliability (r = 0.95) of the PMSQ were found to be high (P < 0.001). Criterion validity was established based on the relationship of PMSQ scores with FSFI (r = 0.76; P < 0.001) and MENQOL (r = -0.47, P < 0.001) scores. CONCLUSION According to this study, it was determined that the Turkish version of the PMSQ can be a valid and reliable scale to evaluate sexual activity in Turkish menopausal women.
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Affiliation(s)
- Hatice Gülşah Kürne
- Division of Physiotherapy and Rehabilitation, Institute of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Türkan Akbayrak
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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3
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Xu C, Pfob A, Mehrara BJ, Yin P, Nelson JA, Pusic AL, Sidey-Gibbons C. Enhanced Surgical Decision-Making Tools in Breast Cancer: Predicting 2-Year Postoperative Physical, Sexual, and Psychosocial Well-Being following Mastectomy and Breast Reconstruction (INSPiRED 004). Ann Surg Oncol 2023; 30:7046-7059. [PMID: 37516723 PMCID: PMC10562277 DOI: 10.1245/s10434-023-13971-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/05/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND We sought to predict clinically meaningful changes in physical, sexual, and psychosocial well-being for women undergoing cancer-related mastectomy and breast reconstruction 2 years after surgery using machine learning (ML) algorithms trained on clinical and patient-reported outcomes data. PATIENTS AND METHODS We used data from women undergoing mastectomy and reconstruction at 11 study sites in North America to develop three distinct ML models. We used data of ten sites to predict clinically meaningful improvement or worsening by comparing pre-surgical scores with 2 year follow-up data measured by validated Breast-Q domains. We employed ten-fold cross-validation to train and test the algorithms, and then externally validated them using the 11th site's data. We considered area-under-the-receiver-operating-characteristics-curve (AUC) as the primary metric to evaluate performance. RESULTS Overall, between 1454 and 1538 patients completed 2 year follow-up with data for physical, sexual, and psychosocial well-being. In the hold-out validation set, our ML algorithms were able to predict clinically significant changes in physical well-being (chest and upper body) (worsened: AUC range 0.69-0.70; improved: AUC range 0.81-0.82), sexual well-being (worsened: AUC range 0.76-0.77; improved: AUC range 0.74-0.76), and psychosocial well-being (worsened: AUC range 0.64-0.66; improved: AUC range 0.66-0.66). Baseline patient-reported outcome (PRO) variables showed the largest influence on model predictions. CONCLUSIONS Machine learning can predict long-term individual PROs of patients undergoing postmastectomy breast reconstruction with acceptable accuracy. This may better help patients and clinicians make informed decisions regarding expected long-term effect of treatment, facilitate patient-centered care, and ultimately improve postoperative health-related quality of life.
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Affiliation(s)
- Cai Xu
- Section of Patient Centered Analytics, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- MD Anderson Center for INSPiRED Cancer Care (Integrated Systems for Patient-Reported Data), The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - André Pfob
- MD Anderson Center for INSPiRED Cancer Care (Integrated Systems for Patient-Reported Data), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Babak J Mehrara
- Department of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peimeng Yin
- Computer Science and Mathematics Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA
| | - Jonas A Nelson
- Department of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea L Pusic
- Department of Surgery, Patient-Reported Outcome Value and Experience (PROVE) Center, Harvard Medical School & Brigham and Women's Hospital, Boston, MA, USA
| | - Chris Sidey-Gibbons
- Section of Patient Centered Analytics, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- MD Anderson Center for INSPiRED Cancer Care (Integrated Systems for Patient-Reported Data), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Goetsch MF, Garg B, Lillemon J, Clark AL. Treating where it hurts-a randomized comparative trial of vestibule estradiol for postmenopausal dyspareunia. Menopause 2023; 30:467-475. [PMID: 36787525 DOI: 10.1097/gme.0000000000002162] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVE To compare efficacies of two strengths of estradiol cream applied to the vulvar vestibule and use of silicone lubricant to reduce intercourse pain scores in postmenopausal women with moderate/severe dyspareunia. METHODS This pilot randomized comparative trial assigned 50 women to nightly applications of estradiol cream, 50 or 100 μg, for 12 weeks. We asked women to have lubricated penetration twice weekly, with intercourse or performing a tampon test. Pain, recorded in dairies, was rated using the 0-10 Numerical Rating Scale. We assessed biopsychosocial outcomes, urinary symptoms, and measured serum estradiol levels and endometrial stripe thicknesses. We performed physical examinations to determine tenderness levels of the vestibule, vagina, pelvic floor muscles, bladder, uterus, and adnexa. Comparisons were made using two-sample t test, Wilcoxon rank-sum test, or χ2 /Fisher's exact test. RESULTS Forty-seven women (94%), with a mean age of 59.7 years, completed the trial. The baseline median intercourse pain score was 8/10 (interquartile range, 6, 8). After 12 weeks, we measured no statistically significant difference between groups in the primary outcome, intercourse pain score, or any secondary outcome measure. For both groups together, the median intercourse pain score diminished by 50% after 4 weeks and 75% after 12 weeks ( P < 0.001). The most tender anatomic area, the vulvar vestibule, improved by 82% to 100% ( P < 0.001) with therapy. We did not measure a statistically significant difference in serum estradiol levels or endometrial stripe thickness between groups. CONCLUSION Estradiol cream applied to the vulvar vestibule, paired with precoital silicone lubricant, is a promising alternative to vaginal therapy for dyspareunia.
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Affiliation(s)
- Martha F Goetsch
- From the Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR
| | - Bharti Garg
- From the Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR
| | | | - Amanda L Clark
- Division of Urogynecology, Department of Obstetrics and Gynecology, Oregon Health and Science University, and Kaiser Permanente Center for Health Research, Portland, OR
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Mercier J, Dumoulin C, Carrier-Noreau G. Pelvic floor muscle rehabilitation for genitourinary syndrome of menopause: why, how and when? Climacteric 2023:1-7. [PMID: 37019140 DOI: 10.1080/13697137.2023.2194527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Genitourinary syndrome of menopause (GSM) is caused by chronic deprivation of estrogen and other sex steroids during the postmenopausal period, which leads to changes in the vulvovaginal tissues. These changes cause bothersome symptoms, such as vaginal dryness, pruritus, dyspareunia, increased daytime urinary frequency, urgency and urinary incontinence, which have considerable negative effects on women's quality of life and sexual function. Recent studies have investigated a novel treatment approach for GSM. Pelvic floor muscle (PFM) rehabilitation, a low-cost conservative management with no side-effects, has been studied alone or in combination with other treatment modalities to reduce the signs and symptoms of GSM. The aim of this article is to discuss why PFM rehabilitation could be useful for women with GSM, how it may help improve signs and symptoms of GSM and when this treatment should be recommended.
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Affiliation(s)
- J Mercier
- Institut Universitaire de Gériatrie de Montréal Research Center, University of Montreal, Montreal, QC, Canada
| | - C Dumoulin
- Institut Universitaire de Gériatrie de Montréal Research Center, University of Montreal, Montreal, QC, Canada
- School of Rehabilitation, Faculty of Medicine, Institut Universitaire de Gériatrie de Montréal Research Center, Université de Montréal, Montreal, QC, Canada
| | - G Carrier-Noreau
- Institut Universitaire de Gériatrie de Montréal Research Center, University of Montreal, Montreal, QC, Canada
- School of Rehabilitation, Faculty of Medicine, Institut Universitaire de Gériatrie de Montréal Research Center, Université de Montréal, Montreal, QC, Canada
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Choijamts B, Byambasuren M, Ariunbold OE, Sodnomdorj E, Davaatseren M, Gochoo M, Tumurbaatar E, Jadamba T. Impact of perimenopausal symptomatology on quality of life in Mongolian women. J OBSTET GYNAECOL 2022; 42:3134-3141. [PMID: 36052870 DOI: 10.1080/01443615.2022.2106829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This cross-sectional study focussed on perimenopausal Mongolian women and aimed to determine the quality of life (QOL) and risk factors in this population. We collected data on 392 women using a predesigned questionnaire and classified the participants according to menopausal status. We used The Menopause Rating Scale (MRS) and the World Health Organisation Quality of Life (WHOQOL)-BREF. Blood pressure (p = .003) and body mass index (p = .02) were significantly high, whereas sexual activity was significantly decreased in postmenopausal women (p = .001). In perimenopausal women, somatovegetative (p = .003) and psychological (p = .025) symptoms were significantly severe, and menopausal symptom severity was significantly higher (p = .017). Menopausal symptoms (p = .02) and monthly sexual activity (p = .005) significantly influenced overall QOL. Sexuality had a significantly negative effect on psychological health (p = .03). Age, occupation, menopausal stage and somatovegetative symptoms have significant effects on health-related QOL (p< .05). Our findings showed that menopausal symptoms and sexual activity significantly affect QOL in middle-aged Mongolian women.Impact StatementWhat is already known on this subject? Women experience physiological changes at the onset of menopause. However, as their oestrogen levels decline, many women also experience physical, psychological and somatovegetative symptoms. Postmenopausal health has been the main issue affecting middle-aged women, until recently. Here, we showed that menopausal transition is a turning point for middle-aged women and suggest that more attention should be paid to the health of perimenopausal women in Mongolia.What do the results of this study add? The study results showed that perimenopausal women had a higher prevalence of health-related problems than postmenopausal women, including weight gain, cardiovascular symptoms and vasomotor symptoms. The prevalence of genitourinary health problems increased with age.What are the implications of these findings for clinical practice and/or further research? General practitioners and gynaecologists in Mongolia should acquire a better understanding of the physiological changes that occur during menopause and pay greater attention to genitourinary issues as they affect general, health-related quality of life.
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Affiliation(s)
- Batsuren Choijamts
- Graduate School, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.,School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.,Mongolian Menopause and Andropause Society, Ulaanbaatar, Mongolia
| | - Myagmardagva Byambasuren
- Mongolian Menopause and Andropause Society, Ulaanbaatar, Mongolia.,School of Public Health, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Oyun-Erdene Ariunbold
- Graduate School, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.,Gynecology Department, MD Health Care Centre, Ulaanbaatar, Mongolia
| | - Enkhee Sodnomdorj
- School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.,Mongolian Menopause and Andropause Society, Ulaanbaatar, Mongolia
| | | | - Mendsaikhan Gochoo
- School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Enkhnaran Tumurbaatar
- Graduate School, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.,Brain, Mind Research Institute, Mongolian Academy of Sciences, Ulaanbaatar, Mongolia
| | - Tsolmon Jadamba
- Brain, Mind Research Institute, Mongolian Academy of Sciences, Ulaanbaatar, Mongolia
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McHugh J, Alexander M, Kudesia R, Krant J, Comander A, Tollefson M, Geyer C. Living Your Best Life: Lifestyle Medicine for All Women. Am J Lifestyle Med 2022; 16:577-588. [PMID: 36072687 PMCID: PMC9442465 DOI: 10.1177/15598276221087677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In an era of ever-increasing healthcare expenditures, yet simultaneously worsening outcomes, many of our patients choose between traditional medical care or often unproven alternative therapies. While the recognition of lifestyle change in addressing cardiovascular and metabolic disease grows, there is less understanding of the impact of lifestyle change on issues facing women every day. Millions of women around the globe struggle with infertility, cancer, sexual dysfunction, and dermatologic needs. Yet, research on the benefits of lifestyle change on these conditions is scarce, and gaps exist both in our understanding of evidence-based approaches to address these issues, as well as adequate provider education when evidence exists. The Women’s Health Member Interest Group convened medical experts in these areas that affect women’s lives to provide insights and meaningful education applicable not only for our patients, but also in our own lives.
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Affiliation(s)
- John McHugh
- USC Keck School of Medicine, Corona del Mar, CA, USA
- Boston University School of Medicine, Las Vegas, NV, USA
- CCRM Fertility Houston & Houston Methodist Hospital, Houston, TX, USA
- SUNY Downstate Medical Center, New York, NY, USA
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Megan Alexander
- USC Keck School of Medicine, Corona del Mar, CA, USA
- Boston University School of Medicine, Las Vegas, NV, USA
- CCRM Fertility Houston & Houston Methodist Hospital, Houston, TX, USA
- SUNY Downstate Medical Center, New York, NY, USA
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Rashmi Kudesia
- USC Keck School of Medicine, Corona del Mar, CA, USA
- Boston University School of Medicine, Las Vegas, NV, USA
- CCRM Fertility Houston & Houston Methodist Hospital, Houston, TX, USA
- SUNY Downstate Medical Center, New York, NY, USA
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Jessica Krant
- USC Keck School of Medicine, Corona del Mar, CA, USA
- Boston University School of Medicine, Las Vegas, NV, USA
- CCRM Fertility Houston & Houston Methodist Hospital, Houston, TX, USA
- SUNY Downstate Medical Center, New York, NY, USA
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Amy Comander
- USC Keck School of Medicine, Corona del Mar, CA, USA
- Boston University School of Medicine, Las Vegas, NV, USA
- CCRM Fertility Houston & Houston Methodist Hospital, Houston, TX, USA
- SUNY Downstate Medical Center, New York, NY, USA
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Michelle Tollefson
- USC Keck School of Medicine, Corona del Mar, CA, USA
- Boston University School of Medicine, Las Vegas, NV, USA
- CCRM Fertility Houston & Houston Methodist Hospital, Houston, TX, USA
- SUNY Downstate Medical Center, New York, NY, USA
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Cynthia Geyer
- USC Keck School of Medicine, Corona del Mar, CA, USA
- Boston University School of Medicine, Las Vegas, NV, USA
- CCRM Fertility Houston & Houston Methodist Hospital, Houston, TX, USA
- SUNY Downstate Medical Center, New York, NY, USA
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
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Gabes M, Kann G, von Sommoggy J, Stute P, Apfelbacher CJ. 'As long as I have a restroom somewhere […], I am fine': a qualitative study on the perspectives of peri- and postmenopausal women on the impact of the urinary component of the genitourinary syndrome of menopause (GSM). BMC WOMENS HEALTH 2021; 21:391. [PMID: 34743728 PMCID: PMC8573922 DOI: 10.1186/s12905-021-01523-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/05/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Our aim was to gain insight into the experiences of women suffering from the urinary component of the Genitourinary Syndrome of Menopause (GSM) and to understand the impact of urinary complaints as part of GSM on the lives of affected women. DESIGN Qualitative study. SETTING Online, primary care. PARTICIPANTS AND METHODS Postmenopausal women aged from 46 to 85 years reporting vaginal and urinary complaints were recruited to participate in either online or face-to-face focus groups to share their experiences with urinary complaints as part of GSM. Transcripts of sessions were analysed using qualitative content analysis. RESULTS One online focus group, one face-to-face focus group and one online-interview were conducted, involving 11 women. Five a priori assumed main themes related to the impact of urogenital symptoms were identified: daily life, emotional well-being, sexual functioning, self-concept and body image, and interpersonal relations and communication. Additionally, two further themes associated with GMS as a clinical condition were inductively found: unmet healthcare needs, including expectations of affected women regarding menopausal symptoms and a lack of adequate health education, and aspects on the personal dealing with the complaints, including personal coping strategies and medical treatment. CONCLUSIONS This study showed that urinary complaints as part of GSM have, similar to vaginal complaints, negative impacts on the daily life, the emotional well-being, the sexual functioning, the self-concept and body impact as well as interpersonal relations and communication of affected women. We further identified several unmet healthcare needs that should trigger improvements in healthcare.
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Affiliation(s)
- Michaela Gabes
- Institute of Social Medicine and Health Systems Research, Otto-Von-Guericke-University Magdeburg, Dr.-Gessler-Str. 17, 93051, Regensburg, Magdeburg, Germany. .,Medical Sociology, Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.
| | - Gesina Kann
- Medical Sociology, Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Julia von Sommoggy
- Medical Sociology, Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Petra Stute
- Department of Obstetrics and Gynaecology, Inselspital Bern, Bern, Switzerland
| | - Christian J Apfelbacher
- Institute of Social Medicine and Health Systems Research, Otto-Von-Guericke-University Magdeburg, Dr.-Gessler-Str. 17, 93051, Regensburg, Magdeburg, Germany
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9
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Logan S, Thu WPP, Ho K, Cauley JA, Kramer MS, Yong EL. Sexual inactivity and sexual dysfunction in midlife Singaporean women: A prospective cross-sectional study of prevalence and risk factors. Maturitas 2021; 152:1-9. [PMID: 34674802 DOI: 10.1016/j.maturitas.2021.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/30/2021] [Accepted: 07/03/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To examine factors relating to both sexual inactivity and sexual dysfunction in midlife Singaporean women. STUDY DESIGN Sociodemographic, medical/lifestyle factors, physical activity, BMI, handgrip strength (HGS) and physical performance data collected from healthy Chinese, Indian, and Malay women, aged 45-69 years, attending gynaecology clinics. MAIN OUTCOME MEASURES Sexual inactivity and sexual dysfunction (defined as total score ≤ 26.55) assessed using the Female Sexual Function Index (FSFI). RESULTS 1048 women completed the FSFI. Mean (±SD) age was 56.2 (±6.2). Sexual inactivity was reported by 43.2% and was positively associated with older age [55-64 years (aOR 2.0, 95% CI 1.3-3.0) and ≥65 years (aOR 2.5, 95% CI 1.2-5.1)], younger menarche (aOR 1.8, 95% CI 1.3-2.5), lowest education (aOR 2.1, 95% CI 1.2-3.6), lowest income (aOR 1.8, 95% CI 1.1-2.8), unmarried (aOR 4.0, 95% CI 2.6-6.4), nulliparity (aOR 1.9, 95% CI 1.1-3.4), and BMI <18.5 kg/m2 (aOR 2.7, 95% CI 1.3-5.6). Among the sexually active, sexual dysfunction was identified in 70.3%. Sexual dysfunction was positively associated with menopause ≥10 years (aOR 2.4, 95% CI 1.1-5.0), nulliparity (aOR 3.0, 95% CI 1.1-9.8), moderate/severe vaginal dryness (aOR 13.8, 95% CI 4.8-38.7) and HGS <18 kg (aOR 1.9, 95% CI 1.1-3.2) and negatively associated with use of menopausal hormone therapy (aOR 0.3, 95% CI 0.1-0.6). CONCLUSION This, the largest Singaporean sexual function study, is the first to include physical performance in a healthy population. Most were sexually active but reported dysfunction. Novel associations included underweight BMI with sexual inactivity and weaker HGS and Malay ethnicity with greater and less sexual dysfunction, respectively.
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Affiliation(s)
- Susan Logan
- Department of Obstetrics and Gynaecology, National University Hospital, National University of Singapore, 119228, Singapore; NUS Yong Loo Lin School of Medicine, National University of Singapore, 19228, Singapore.
| | - Win Pa Pa Thu
- Department of Obstetrics and Gynaecology, National University Hospital, National University of Singapore, 119228, Singapore
| | - Kylie Ho
- NUS Yong Loo Lin School of Medicine, National University of Singapore, 19228, Singapore
| | - Jane A Cauley
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, Pittsburgh, United States
| | - Michael S Kramer
- Department of Obstetrics and Gynaecology, National University Hospital, National University of Singapore, 119228, Singapore; Departments of Epidemiology, Biostatistics & Occupational Health and of Pediatrics, McGill University Faculty of Medicine, Montreal, Quebec H3G 1Y6, Canada
| | - Eu-Leong Yong
- Department of Obstetrics and Gynaecology, National University Hospital, National University of Singapore, 119228, Singapore; NUS Yong Loo Lin School of Medicine, National University of Singapore, 19228, Singapore.
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10
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The Gynogram: A Multicentric Validation of a New Psychometric Tool to Assess Coital Pain Associated With VVA and Its Impact on Sexual Quality of Life in Menopausal Women. J Sex Med 2021; 18:955-965. [PMID: 33896758 DOI: 10.1016/j.jsxm.2021.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/17/2021] [Accepted: 02/22/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Vulvo-Vaginal Atrophy (VVA) affects about fifty percent of postmenopausal women, contributing more vulnerable sexual and psycho-relational equilibrium. To date, no psychometric instruments have been designed to assess the impact of coital pain associated with VVA on sexual quality of life. AIM To validate a new psychometric tool, the Gynogram, able to investigate coital pain and to quantify its impact on sexual well-being in menopause. METHODS 214 sexually active postmenopausal women were enrolled in the study during clinical consultations in gynecological outpatient clinics in Italy. After gynecological examination and evaluation of the presence of VVA, the study sample was divided in a clinical group (103 women with certified diagnosis of VVA) and in a control group (111 women without certified diagnosis of VVA) according to the Vaginal Health Index (VHI) cut-off. Factor, Reliability and Receiving Operating Characteristics (ROC) analysis were performed in order to validate our newly created Gynogram. OUTCOMES A structured questionnaire, named Gynogram, to assess coital pain and its impact, and the Female Sexual Function Index (FSFI). RESULTS The factor analysis performed on the original form (80 items) reduced the Gynogram to 24 items. Reliability analysis conducted with Cronbach's Alpha coefficients showed high values in all the components (ranging from .813 to .972), both in the long and in the short form. The sensitivity analysis demonstrated that the Gynogram, with a cut-off ≤93, is able to recognize a clinically significant coital pain. With respect to the FSFI, statistically significant differences were found for all the domains. In addition, statistically significant differences were found for all the twelve factors of the Gynogram, showing that VVA profoundly affects the sexual quality of life of women in post-menopause. CLINICAL TRANSLATION The utility of this tool consists in the possibility to improve prognosis, compliance/adherence and treatment outcomes. STRENGTHS AND LIMITATIONS The Gynogram is able to evaluate and to quantify the impact of coital pain associated with VVA. Moreover, it can also recognize the areas of biopsychosocial functioning being more affected by this clinical condition. The main limit of the study is the impossibility to evaluate both mental health and partner's general and sexual health. CONCLUSIONS The Gynogram is a new and validated psychometric tool able to detect the impact of symptomatic VVA on sexual quality of life among post-menopausal women, with a specific focus on the different areas of sexual functioning. Nappi RE, Graziottin A, Mollaioli A, et al. The Gynogram: A Multicentric Validation of a New Psychometric Tool to Assess Coital Pain Associated With VVA and Its Impact on Sexual Quality of Life in Menopausal Women. J Sex Med 2021;18:955-965.
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Frost R, Donovan C. A qualitative exploration of the distress experienced by long-term heterosexual couples when women have low sexual desire. SEXUAL AND RELATIONSHIP THERAPY 2021. [DOI: 10.1080/14681994.2018.1549360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Rebecca Frost
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Caroline Donovan
- School of Applied Psychology, Griffith University, Brisbane, Australia
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Female Sexual Function and Its Association with the Severity of Menopause-Related Symptoms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197235. [PMID: 33022931 PMCID: PMC7579461 DOI: 10.3390/ijerph17197235] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 09/25/2020] [Accepted: 10/01/2020] [Indexed: 12/27/2022]
Abstract
The aim of this study was to examine female sexual functioning and its association with the impact of the symptoms of menopause among Spanish postmenopausal women. A total of 182 postmenopausal women (65.59 ± 7.93 years) participated in this cross-sectional study. The female sexual function index (FSFI) and the menopause rating scale (MRS) were used to analyze sexual function and severity of menopausal symptoms, respectively. Age, education, area of residence, occupation, and depression (Hospital Anxiety and Depression Scale) were considered as possible confounders. The results of a linear multivariate regression analysis showed that the severity of urogenital menopause-related symptoms was associated with lower values in the FSFI total score and the lubrication, satisfaction, arousal, and orgasm domains. These last three subscales were also linked to severe psychological impact, while the MRS total score was only related to the desire domain. Regarding confounders, being younger, working, and residing in a rural area were all linked to better sexual function. All effect sizes were large (adjusted R2 > 0.35). In conclusion, after controlling for possible confounders, postmenopausal women who experience a severe impact of menopausal symptoms endure poorer sexual function, particularly when said symptoms are urogenital or psychological in nature.
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Optimizing Women's Sexual Function and Sexual Experience After Radical Cystectomy. Urology 2020; 151:138-144. [PMID: 32841656 DOI: 10.1016/j.urology.2020.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/27/2020] [Accepted: 08/10/2020] [Indexed: 12/29/2022]
Abstract
Survivorship in bladder cancer has improved in terms of lower morbidity, mortality, and improved oncological outcomes. However, there is a dearth of research on women's quality of life, specifically, on the effect of radical cystectomy on women's sexual function and sexual experience. This narrative literature review focuses on the current state of knowledge about women's sexual function after cystectomy, identifies patient and provider-related factors that have contributed to the lack of research and sexual health support in clinical practice, and proposes a model for sexual rehabilitation as well as future areas for research.
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Faubion SS, Fairbanks F, Kuhle CL, Sood R, Kling JM, Vencill JA, Mara KC, Kapoor E. Association Between Body Mass Index and Female Sexual Dysfunction: A Cross-sectional Study from the Data Registry on Experiences of Aging, Menopause, and Sexuality. J Sex Med 2020; 17:1971-1980. [PMID: 32771351 DOI: 10.1016/j.jsxm.2020.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/24/2020] [Accepted: 07/02/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Obesity and female sexual dysfunction (FSD) are prevalent conditions, and both are associated with significant adverse effects on health and well-being. AIM To investigate the association between body mass index and FSD, as well as potential moderators. METHODS This cross-sectional study was performed by analyzing medical records of 6,688 women seeking consultation for menopause-related or sexual health-related concerns at women's health clinics at Mayo Clinic Rochester, MN, and Scottsdale, AZ, between May 1, 2015, and September 15, 2019. OUTCOMES Female sexual function was assessed by the Female Sexual Function Index, and sexual distress was assessed by the Female Sexual Distress Scale-Revised. RESULTS Being overweight or obese was associated with a lack of sexual activity. Among sexually active women, those who were overweight or obese had lower Female Sexual Function Index total scores and sexual function domain scores (indicating worse sexual function), including sexual arousal, lubrication, satisfaction, orgasm, and pain, and higher levels of sexual distress than those with normal weight. However, on multivariable analysis, these associations were found to be mediated by other factors, including age, level of education, reproductive stage, medication use, and mood disturbances, which are known to impact body weight and sexual function in women. CLINICAL IMPLICATIONS Overweight and obesity were associated with sexual inactivity and greater odds of having FSD, which should prompt proactive assessment of sexual function. STRENGTHS AND LIMITATIONS The strengths of this study include the large cohort size and assessment of sexual problems in addition to sexual distress, a key component of the definition of sexual dysfunction. This study also took into account multiple potential moderating factors. Limitations include the cross-sectional design, which precludes determination of causality as well as lack of diversity in the cohort, potentially limiting generalizability of results. In addition, sexual function was not assessed in women reporting no recent sexual activity, which may confound results. CONCLUSION Overweight/obesity and FSD are highly prevalent conditions, which appear to be indirectly associated. These results highlight the need to identify and address FSD in all overweight and obese women, with particular attention to potential contributing factors. Faubion SS, Fairbanks F, Kuhle CL, et al. Association Between Body Mass Index and Female Sexual Dysfunction: A Cross-sectional Study from the Data Registry on Experiences of Aging, Menopause, and Sexuality. J Sex Med 2020;17:1971-1980.
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Affiliation(s)
- Stephanie S Faubion
- Center for Women's Health, Mayo Clinic, Rochester, MN, USA; Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, USA.
| | - Flavia Fairbanks
- Department of Obstetrics and Gynecology and PROSEX, University of Sāo Paulo School of Medicine, Sao Paulo, Brazil
| | - Carol L Kuhle
- Center for Women's Health, Mayo Clinic, Rochester, MN, USA; Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Richa Sood
- Center for Women's Health, Mayo Clinic, Rochester, MN, USA; Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Juliana M Kling
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Jennifer A Vencill
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA; Department of Psychology and Psychiatry, Mayo Clinic, Rochester, MN, USA
| | - Kristin C Mara
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Ekta Kapoor
- Center for Women's Health, Mayo Clinic, Rochester, MN, USA; Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA; Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
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Hyde EK, Martin DE, Rieger KL. Factors shaping the provision of sexual health education for adults with acute coronary syndrome: A scoping review. PATIENT EDUCATION AND COUNSELING 2020; 103:877-887. [PMID: 31767244 DOI: 10.1016/j.pec.2019.11.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 11/08/2019] [Accepted: 11/15/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Each year, 63,000 Canadians are diagnosed with acute coronary syndrome (ACS) and 73 % survive. Sexual health education for ACS survivors is recommended but is not routinely provided. A scoping review was performed to inform health care providers about factors shaping sexual health education for ACS survivors. METHODS Three databases were searched, 208 studies were screened, and 24 were included in this scoping review. Significant points from the selected studies were charted and synthesized. RESULTS This review confirmed absent to limited provision of sexual health education to individuals with ACS. Key factors influencing lack of provision of sexual health were categorized according to macro, meso, and micro levels. At the macro level, societal and cultural factors were noted. The meso level included healthcare environment and limited healthcare provider knowledge. At the micro level, healthcare professional-healthcare consumer relationships and role clarity were noted. CONCLUSION A sex positive approach may facilitate provision of sexual health education. PRACTICE IMPLICATIONS This scoping review points to the need to use a sex positive lens to identify and remove barriers to facilitate the provision of sexual health education. Providing this education may result in reduced fear, depression, and anxiety in ACS survivors.
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Affiliation(s)
- Emily K Hyde
- College of Nursing, Rady Faculty of Health Sciences, Helen Glass Centre for Nursing, 89 Curry Place, University of Manitoba, Winnipeg, MB R3T 2N2 Canada.
| | - Donna E Martin
- College of Nursing, Rady Faculty of Health Sciences, Helen Glass Centre for Nursing, 89 Curry Place, University of Manitoba, Winnipeg, MB R3T 2N2 Canada.
| | - Kendra L Rieger
- College of Nursing, Rady Faculty of Health Sciences, Helen Glass Centre for Nursing, 89 Curry Place, University of Manitoba, Winnipeg, MB R3T 2N2 Canada.
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Lee SR, Cho MK, Cho YJ, Chun S, Hong SH, Hwang KR, Jeon GH, Joo JK, Kim SK, Lee DO, Lee DY, Lee ES, Song JY, Yi KW, Yun BH, Shin JH, Chae HD, Kim T. The 2020 Menopausal Hormone Therapy Guidelines. J Menopausal Med 2020; 26:69-98. [PMID: 32893509 PMCID: PMC7475284 DOI: 10.6118/jmm.20000] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/19/2020] [Accepted: 08/20/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
| | - Sa Ra Lee
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Moon Kyoung Cho
- Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Korea
| | - Yeon Jean Cho
- Department of Obstetrics and Gynecology, Dong-A University Medical Center, Busan, Korea
| | - Sungwook Chun
- Department of Obstetrics and Gynecology, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Seung Hwa Hong
- Department of Obstetrics and Gynecology, Chungbuk National University Hospital, Cheongju, Korea
| | - Kyu Ri Hwang
- Department of Obstetrics & Gynecology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Gyun Ho Jeon
- Department of Obstetrics and Gynecology, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Jong Kil Joo
- Department of Obstetrics and Gynecology, Pusan National University Hospital, Busan, Korea
| | - Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Ock Lee
- Center for Gynecologic Cancer, National Cancer Center, Goyang, Korea
| | - Dong Yun Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Seoul, Korea
| | - Eun Sil Lee
- Department of Obstetrics and Gynecology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jae Yen Song
- Department of Obstetrics and Gynecology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Kyong Wook Yi
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Bo Hyon Yun
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Ho Shin
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Hee Dong Chae
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Tak Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
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Harder H, Starkings RM, Fallowfield LJ, Menon U, Jacobs IJ, Jenkins VA. Sexual functioning in 4,418 postmenopausal women participating in UKCTOCS: a qualitative free-text analysis. Menopause 2019; 26:1100-1009. [PMID: 31290761 PMCID: PMC6791508 DOI: 10.1097/gme.0000000000001377] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/26/2019] [Accepted: 03/26/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Sexual well-being can contribute significantly to the overall quality of women's lives. This qualitative study aimed to examine sexual activity, functioning, and satisfaction in a large sample of postmenopausal women from the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) METHODS:: Thematic analysis was used to evaluate the free-text data of the Fallowfield Sexual Activity Questionnaire (FSAQ) completed by UKCTOCS participants at baseline before annual screening. RESULTS A total of 24,305 women completed the baseline FSAQ and 4,525 (19%) provided free-text data, with 4,418 comments eligible for analysis. Median age was 64 years; 65% had a partner and 22.5% were sexually active. Four interrelated themes were derived: partner availability, physical and sexual health, mental well-being, and interpersonal relationships. Primary reason for absence of sexual activity was lack of a partner, mainly due to widowhood (n = 1,000). Women discussed how partner's medical condition (27%) or sexual dysfunction (13.5%), their own physical health (18%) or menopause-related symptoms (12.5%), and prescribed medication (7%) affected sexual activity. Impact of low libido in self (16%) or partner (7%), relationship problems (10.5%) or logistics (6%), and perceptions of ageing (9%) were also mentioned. Few (3%) referred to positive sexual experiences or had sought medical help for sexual problems (6%). CONCLUSIONS This qualitative analysis explored postmenopausal women's perspective on their sexual functioning. Having an intimate partner and good physical health are key factors for continuation of sexual activity and satisfaction. Further sexual education for healthcare professionals is needed to raise awareness about sexuality and sexual difficulties in later life. : Video Summary: Supplemental Digital Content 1, http://links.lww.com/MENO/A426.
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Affiliation(s)
- Helena Harder
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Rachel M.L. Starkings
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Lesley J. Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Usha Menon
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Ian J. Jacobs
- EGA Institute for Women's Health, University College London, London, United Kingdom
- University of New South Wales, Sydney, Australia
| | - Valerie A. Jenkins
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
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Midlife sexuality in women's words. Menopause 2019; 26:1088-1089. [DOI: 10.1097/gme.0000000000001408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bazi T. The underutilization of obliterative and constrictive surgery in the surgical treatment of pelvic organ prolapse. Int Urogynecol J 2019; 30:1221-1224. [PMID: 31183534 DOI: 10.1007/s00192-019-03994-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 05/20/2019] [Indexed: 11/29/2022]
Abstract
Vaginal length and caliber are necessary for satisfactory vaginal coitus. Surgical treatment of pelvic organ prolapse (POP) can include preservation of vaginal length and caliber, or shortening and narrowing of the vagina (constrictive and obliterative surgery). The latter option is proven to have fewer complications and a lower risk of recurrence of POP. Women undergoing surgical intervention for POP who are not coitally active and choose not to be coitally active for the rest of their lives should be offered constrictive and obliterative surgery.
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Affiliation(s)
- Tony Bazi
- American University of Beirut Medical Center, PO box 11-0236, Riyad El-Solh, Beirut, 11072020, Lebanon.
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Mernone L, Fiacco S, Ehlert U. Psychobiological Factors of Sexual Functioning in Aging Women - Findings From the Women 40+ Healthy Aging Study. Front Psychol 2019; 10:546. [PMID: 30918494 PMCID: PMC6424880 DOI: 10.3389/fpsyg.2019.00546] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 02/25/2019] [Indexed: 11/13/2022] Open
Abstract
Background: A variety of biological and psychosocial factors are associated with women’s sexual health in midlife and older age. Evidence suggests a decline in sexual functioning in the context of aging and the menopausal transition, including changes in sexual desire, arousal, lubrication, orgasm, pain, and/or contentment. However, not all women in midlife and older age experience such a decline, and it remains unclear how the endocrine environment and psychosocial aspects contribute to the maintenance of healthy sexual functioning. Therefore, the aim of this study was to examine psychobiological predictors of sexual functioning in healthy middle-aged and elderly females. Methods: A total of 93 healthy, sexually active women aged 40–73 years completed a battery of validated psychosocial questionnaires, including measures of sexual functioning (Female Sexual Function Index) and of protective psychological traits and interpersonal variables. The steroid hormones estrogen, testosterone, progesterone and dehydroepiandrosterone sulfate were determined in saliva samples, while follicle-stimulating hormone, luteinizing hormone and sex hormone-binding globulin were determined in dried blood spots. The findings were statistically adjusted for multiple testing. Results: Age and postmenopausal status were negatively associated with overall sexual functioning, arousal, and lubrication. Regression analyses revealed that relationship satisfaction, emotional support, self-esteem, optimism, and life satisfaction each significantly predicted overall sexual functioning or specific aspects of sexual functioning, including arousal, contentment, orgasm, and pain (all p < 0.029). For desire and lubrication, no associations were found with the tested psychosocial factors. In terms of steroid hormones, testosterone was positively linked to orgasm (p = 0.012). In this sample, 79.6% reported to have healthy sexual functioning according to the questionnaires’ cutoff. Younger age (OR = 0.911, 95% CI 0.854–0.970, p = 0.004) and a higher level of emotional support (OR = 1.376, 95% CI 1.033–1.833, p = 0.029) were associated with the presence of healthy sexual functioning. Discussion: Although aging and menopause negatively affected aspects of sexual functioning, the accompanying endocrine correlates were not predictive for sexual functioning in this healthy sample of middle-aged and older females. Instead, our findings suggest that sexual functioning is highly dependent on psychosocial aspects related to well-being. Accordingly, personality traits such as optimism, and interpersonal aspects such as emotional support and relationship satisfaction were identified as important predictors of sexual functioning.
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Affiliation(s)
- Laura Mernone
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Zurich, Zurich, Switzerland.,University Research Priority Program Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Serena Fiacco
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Zurich, Zurich, Switzerland.,University Research Priority Program Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Ulrike Ehlert
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Zurich, Zurich, Switzerland.,University Research Priority Program Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
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Kling JM, Sidhu K, Rullo J, Mara KC, Frohmader Hilsaca KS, Kapoor E, Faubion SS. Association Between Alcohol Use and Female Sexual Dysfunction From the Data Registry on Experiences of Aging, Menopause, and Sexuality (DREAMS). Sex Med 2019; 7:162-168. [PMID: 30674443 PMCID: PMC6525105 DOI: 10.1016/j.esxm.2018.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 11/27/2018] [Accepted: 11/29/2018] [Indexed: 11/09/2022] Open
Abstract
Introduction Sexual dysfunction is a common problem in women and the nature of its association with alcohol use remains unclear. Aim To explore the association between alcohol use and female sexual dysfunction (FSD). Methods Associations between self-reported drinking and sexual function were evaluated in 2,253 women presenting for consultation to a women’s health specialty clinic. A short version of the Alcohol Use Disorders Identification Test (AUDIT-C) was used to evaluate alcohol use. Women with an AUDIT-C ≥3 were considered at risk for hazardous drinking. Multivariable regression, controlling for depression, anxiety, and abuse (childhood and recent), was used to assess the association between alcohol consumption and FSD (defined as a Female Sexual Function Index [FSFI] ≤26.55 and Female Sexual Distress Scale [FSDS] ≥11) in sexually active women. Main Outcome Measure The main study outcome measure was the presence of FSD as defined by a score ≤26.55 on the FSFI and ≥11 on the FSDS. Results 57% of the 1,649 sexually active women were classified as having FSD; 80% reported any alcohol use and 38% reported drinking patterns with the potential to be hazardous. The women at risk for hazardous drinking had significantly higher FSFI domain scores indicating better sexual function (P ≤ .001). However, in multivariable analyses, there was no significant difference in the rates of FSD across alcohol use categories in women. Conclusion In women presenting for consultation to a women’s health specialty clinic, an association between alcohol use and FSFI scores was seen, in which greater risk of hazardous drinking was associated with better sexual function scores. However, when sexual distress was included to define sexual dysfunction, those with FSD were not at higher risk of hazardous drinking. Given the complex nature of FSD, additional study is needed to further clarify these relationships. Kling JM, Sidhu K, Rullo J, et al. Association Between Alcohol Use and Female Sexual Dysfunction From the Data Registry on Experiences of Aging, Menopause, and Sexuality (DREAMS). Sex Med 2019;7:162–168.
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Affiliation(s)
- Juliana M Kling
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA.
| | | | - Jordan Rullo
- Women's Health Clinic, Division of General Internal Medicine, Mayo Clinic Rochester, Rochester, MN, USA
| | - Kristin C Mara
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Karla S Frohmader Hilsaca
- Women's Health Clinic, Division of General Internal Medicine, Mayo Clinic Rochester, Rochester, MN, USA
| | - Ekta Kapoor
- Women's Health Clinic, Division of General Internal Medicine, Mayo Clinic Rochester, Rochester, MN, USA; Division of Endocrinology, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Stephanie S Faubion
- Women's Health Clinic, Division of General Internal Medicine, Mayo Clinic Rochester, Rochester, MN, USA
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The Feasibility and Safety of Reproductive Organ Preserving Radical Cystectomy for Elderly Female Patients With Muscle-Invasive Bladder Cancer: A Retrospective Propensity Score-matched Study. Urology 2018; 125:138-145. [PMID: 30445122 DOI: 10.1016/j.urology.2018.09.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/06/2018] [Accepted: 09/18/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the feasibility and safety of reproductive organ preserving radical cystectomy (ROPRC) compared to radical cystectomy (RC) for elderly female patients with muscle-invasive bladder cancer. METHODS We retrospectively studied 135 elderly female patients (aged ≥75 years) who underwent RC followed by cutaneous ureterostomies at our center between January 1, 2007 and December 31, 2017. Eighty-four patients treated with RC, and 51 patients treated with ROPRC, were grouped into 45 pairs. Patient demographics, extensive peri-operative, and oncological data were then recorded and evaluated. RESULTS In the matched group, the incidence of short-term and long-term complications in the ROPRC group were lower than the RC group (18.0% vs 28.0%, P = .035; 12.0% vs 22.0%, P = .030). Furthermore, operative time was shorter, estimated blood loss was lower, and bowel recovery was quicker in the ROPRC group (207.5 minutes vs 267.9 minutes, P < .001; 500 mL vs 600 mL, P = .024; 3.0 days vs 4.0 days, P < .001, respectively) compared to the RC group. The recurrence free survival (P = .658), overall survival (P = .604), and cancer-specific survival (P = .361) were all equivalent when compared between the 2 groups with a median follow-up period of 34.0 and 38.0 months, respectively. The surgical approach (RC vs ROPRC) was an independent risk factor for short-term complications (P = .045), duration of operative time (P < .001), estimated blood loss (P = .004), and bowel recovery (P < .001). CONCLUSION This propensity score-matched cohort study showed that ROPRC was both feasible and safe for elderly female patients with muscle-invasive bladder cancer compared to RC, and also had comparable oncological outcomes after a lengthy follow-up period.
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Thomas HN, Neal-Perry GS, Hess R. Female Sexual Function at Midlife and Beyond. Obstet Gynecol Clin North Am 2018; 45:709-722. [PMID: 30401552 DOI: 10.1016/j.ogc.2018.07.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Sexual function is an important component of quality of life for women. Midlife poses several challenges to optimal sexual function and intimacy for women. In addition to anatomic factors related to estrogen deficiency, such as genitourinary syndrome of menopause, vulvovaginal atrophy, and pelvic organ prolaps, psychosocial factors, including prior sexual trauma, play an important role in sexual function in women. Several treatments have emerged for female sexual dysfunction; long-term studies and head-to-head comparisons are lacking.
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Affiliation(s)
- Holly N Thomas
- Department of Medicine, Center for Women's Health Research and Innovation (CWHRI), University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, USA.
| | - Genevieve S Neal-Perry
- Department of Obstetrics and Gynecology, University of Washington, 4245 Roosevelt Way NE, 4th Floor, Seattle, WA 98105, USA
| | - Rachel Hess
- Department of Population Health Sciences, University of Utah, 295 Chipeta Way 1N492, Salt Lake City, UT 84108, USA; Department of Internal Medicine, University of Utah, 295 Chipeta Way 1N492, Salt Lake City, UT 84108, USA
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Women's Quality of Life in Menopause with a Focus on Hypertension. J Obstet Gynaecol India 2018; 69:279-283. [PMID: 31178645 DOI: 10.1007/s13224-018-1172-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022] Open
Abstract
Background One-third of each woman's life is naturally during her menopause. This study was conducted to determine the factors related to the quality of life in postmenopausal women. Materials and Methods This cross-sectional study was carried out using cluster sampling method on 218 postmenopausal women aged 40-60 years old in Kermanshah in 2014. The data were collected through interview and with the standard questionnaire of Menopausal Quality (MENQOL) of Life and analyzed using SPSS software version 19. Results The mean age of menopause was 50.03 ± 4.48 years. Mean scores of quality of life and four domains, vasomotor, psychosocial, physical and sexual were 3.15±0.970, 3.71 ± 1.81, 3.32±0.959, 2.91 ± 1.06, 3.74 ±1.59, respectively. Conclusion Chronic conditions such as hypertension in postmenopausal women can lead to lower quality of life. Therefore, provision of coherent support programs for controlling chronic diseases requires serious intervention from health care providers.
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Climacteric-related symptoms in menopause transition and beyond: a prospective 19-year follow-up study on previously hysterectomized women. Menopause 2018; 25:890-896. [DOI: 10.1097/gme.0000000000001091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abadi OSRR, Cheraghi MA, Tirgari B, Nayeri ND, Rayyani M. Feeling an Invisible Wall: The Experience of Iranian Women's Marital Relationship After Surgical Menopause: A Qualitative Content Analysis Study. JOURNAL OF SEX & MARITAL THERAPY 2018; 44:627-640. [PMID: 29452055 DOI: 10.1080/0092623x.2018.1440451] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Sexual relationships after surgical menopause matter when talking about sex is taboo and marriage is the only justified way to meet sexual needs. In this qualitative research study, 22 surgical menopausal women shared their experiences of sexual/marital relationship after surgery through in-depth, face-to-face, semi-structured interviews. Qualitative content analysis technique was used for data analysis. An overarching theme entitled "feeling an invisible wall" reflected this experience. It comprised three categories: (1) declined marital intimacy, (2) disarming, and (3) transformation of societal norms into concerns. This study proposed new contextual information about the marital relationship of Iranian women after surgical menopause that was not openly articulated before and which may be applicable for others in such contexts. Women's main concern was the emotional separation because of the sexual consequences of the surgery. Healthcare providers should be aware of women's concerns, which may alter their marital relationship. They must provide individualized care, education, and support for couples to make thoughtful decisions about rebuilding their sexual relationship. Results may also have implications for psychiatrists, sex/marital therapists, and probably clergy who have the authority to openly address this important issue to the public.
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Affiliation(s)
| | - Mohammad Ali Cheraghi
- b Critical Care and Management Nursing Department , School of Nursing and Midwifery, Tehran University of Medical Sciences , Tehran , Iran
| | - Batool Tirgari
- a Nursing Research Center , Kerman University of Medical Sciences , Kerman , Iran
| | - Nahid Dehaghan Nayeri
- c Nursing and Midwifery care Research Center , School of Nursing and Midwifery, Tehran University of Medical Sciences , Tehran , Iran
| | - Masoud Rayyani
- a Nursing Research Center , Kerman University of Medical Sciences , Kerman , Iran
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Sexual inactivity in partnered female cancer survivors. Maturitas 2017; 105:89-94. [DOI: 10.1016/j.maturitas.2017.04.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 04/24/2017] [Accepted: 04/25/2017] [Indexed: 12/17/2022]
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Bell S, Reissing ED. Sexual Well-Being in Older Women: The Relevance of Sexual Excitation and Sexual Inhibition. JOURNAL OF SEX RESEARCH 2017; 54:1153-1165. [PMID: 27911092 DOI: 10.1080/00224499.2016.1250147] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The aim of this study was to use the dual control model of sexual response (DCM) to investigate variation in sexual well-being among women 50 years of age and older. Data from 185 women 50 years of age and older (M = 59.46, SD = 6.96) were used to examine the relationships between sexual excitation (SE) and sexual inhibition (SI) and their lower-order factors to indicators of sexual well-being (i.e., sexual functioning, satisfaction, distress, frequency of sexual activity, and breadth of sexual behavior). Possible moderating factors were also explored. Independently, SE and SI were associated with the majority of the indicators of sexual well-being, and the directions of associations were consistent with the tenets of the DCM. SE and SI lower-order factors were significant predictors of sexual function, satisfaction, and frequency of sexual activity. Sexual distress was predicted more strongly by SI factors and breadth of sexual behavior by one SE lower-order factor (arousability). Partner physical and mental health and participant's own mental health were identified as moderating variables of these associations. Findings of this study are discussed considering the contribution of the DCM to understanding the role of diversity in older women's sexual well-being.
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Predictors of female genital organ involvement in radical cystectomy for urothelial carcinoma of the bladder: A single-center retrospective analysis of 112 female patients. Int J Surg 2017; 47:101-106. [PMID: 28964932 DOI: 10.1016/j.ijsu.2017.09.059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 09/16/2017] [Accepted: 09/18/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To evaluate predictors of organ involvement and oncological outcomes after radical cystectomy with anterior exenteration in female patients. METHODS Among 1198 patients who underwent radical cystectomy for the bladder tumor between 1990 and 2015, 178 (14.9%) patients were female. They were divided into two groups according to pelvic involvement in pathology. Their medical records and pathology and image findings were reviewed retrospectively. Non-urothelial cell carcinoma and no genital organ pathology were excluded. Multivariate logistic regression was performed to predict factors associated with female organ involvement. RESULTS Out of 112 eligible female patients with urothelial cell carcinoma, 11 (9.8%) had female genital organ involvement. Female genital organ involvement occurred primarily in the uterus (63.6%) mostly. The 5-year overall survival rates were 67.3% in the non-involvement group and 18.9% in the involvement group. On multivariate analysis Tumor location of trigone or bladder neck at transurethral resection of bladder tumor (TUR-B) (odds ratio [OR] 19.84, 95% confidence interval [CI] 2.89-230.68, p = 0.0056), maximum tumor size at computed tomography (CT) (OR 2.17, 95% CI 1.29-4.34, p = 0.0095), and hydronephrosis at CT (OR 17.61, 95% CI 2.28-296.26, p = 0.0158) were associated with female organ involvement. CONCLUSIONS Tumor location of trigone or bladder neck at TUR-B, maximum tumor size at CT or hydronephrosis at CT were significant factors to predict female genital organ involvement. Preoperative recognition of female genital organ involvement could increase the decision to perform genital organ-sparing surgeries.
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Abstract
OBJECTIVES The aim of the study was to evaluate the association between age at menopause and sexual dysfunction and the components of sexual function in postmenopausal women. METHODS In this cross-sectional population-based study, data of 540 women aged 45 to 60 years regarding the age they were when they achieved menopause and its association with sexual dysfunction (evaluated using the Short Personal Experiences Questionnaire) were obtained through interviews. We assessed the data for associations between age at menopause and sexual dysfunction and demographic, behavioral, and clinical characteristics. RESULTS Age at menopause was not associated with sexual dysfunction. Arousal (dysfunction) was the only component of sexual function that was associated with premature ovarian insufficiency (POI) and early menopause (P = 0.01). It was reported by 64.2% of women with POI (women <40 y), compared with sexual dysfunction rates of 50% and 45.6% of women aged 40 to 45 and >45 years, respectively (P = 0.04). In women with POI or early menopause, Poisson regression analysis showed that having a partner with sexual problems (prevalence ratio [PR] = 6.6; 95% CI: 3.3-13,2; P < 0.001) and dyspareunia (PR = 3.9; 95% CI: 1.8-8.2; P = 0.0005) were factors associated with arousal dysfunction. Satisfaction with the partner as a lover (PR = 0.4; 95% CI: 0.2-0.7; P = 0.002) was protective against arousal dysfunction. CONCLUSIONS Arousal dysfunction was associated with early ovarian failure and POI. The major factors affecting this association were having a partner with sexual problems, dyspareunia, and no satisfaction with the partner as a lover. These findings highlight the importance of evaluating partner problems and improving lubrication in these groups of women.
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Crema IL, Tilio RD, Campos MTDA. Repercussões da Menopausa para a Sexualidade de Idosas: Revisão Integrativa da Literatura. PSICOLOGIA: CIÊNCIA E PROFISSÃO 2017. [DOI: 10.1590/1982-3703003422016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo A menopausa representa transformações hormonais significativas que podem ser acompanhadas de mudanças sociais e emocionais. Além disso, a população idosa feminina tem apresentado maiores comprometimentos em relação à sexualidade do que os homens. Este estudo teve por objetivo apresentar uma revisão integrativa da literatura científica nacional e internacional sobre as possíveis repercussões da menopausa para a sexualidade de idosas. As buscas foram realizadas nas bases Lilacs, SciELO, PePSIC e PsycINFO com análise da produção científica nacional e internacional relativa ao período de janeiro de 2006 a março de 2016. Foram analisadas 36 produções na íntegra cujo perfil predominante é de estudos quantitativos, descritivos e transversais, desenvolvidos com mulheres de diferentes faixas etárias na pós-menopausa, incluindo idosas. Todavia, estudos com amostras compostas exclusivamente por idosas são minoria. Entre os resultados houve predominância de pesquisas voltadas para a avaliação e quantificação das possíveis patologias e sintomas biológicos que afetam a sexualidade (redução da libido, de lubrificação e de orgasmos, por exemplo). A maioria das pesquisas aponta para a importância da análise conjunta de aspectos biológicos, psicológicos, sociais, culturais e individuais para a compreensão das suas distintas influências na sexualidade das idosas. Destaca-se a necessidade de realização de pesquisas com abordagem mista e voltadas apenas para mulheres idosas a fim de ampliar a compreensão acerca das suas perspectivas sobre as repercussões da menopausa para a sexualidade pretendendo respaldar práticas clínicas e políticas sociais destinadas a essa população.
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Factors associated with sexual quality of life among midlife women in Serbia. Qual Life Res 2017; 26:2793-2804. [PMID: 28580495 DOI: 10.1007/s11136-017-1608-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To assess factors associated with better sexual quality of life (QOL) in midlife period among women who are and are not sexually active. METHODS Participants were 500 women aged 40-65 years from Belgrade, Serbia. Data were collected through general questionnaire (regarding socio-demographic characteristics, lifestyle habits, general medical, and gynecological history) in which one item investigated having partnered sexual activity (heterosexual intercourses). The sexual domain of the Utian Quality of Life Scale was used to assess the sexual QOL. The sexual QOL consisted of reflections on the satisfaction with frequency of sexual interactions, as well as sexual and romantic life in general. Higher scores indicated better sexual QOL. RESULTS Most women were sexually active in midlife (81.6%). The mean sexual QOL score for the overall sample was 9.99 (range 3-15). The level of sexual QOL did not differ between sexually active and non-active women. Factors associated with better sexual QOL in sexually active menopausal women were being married or coupled, being physically active, having more children, having hot flushes, and not having tachycardia. Factors associated with better sexual QOL in sexually inactive menopausal women were drinking alcohol, being physically active, not having insomnia or skin rash. CONCLUSIONS Sexual QOL among Serbian urban midlife women was good and did not differ between women who were sexually active and those who were not. Further studies are needed to determine in what manner women who are not sexually active in midlife achieve high level of satisfaction with their sexual QOL.
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The prevalence of sexual activity, and sexual dysfunction and behaviours in postmenopausal woman in Poland. MENOPAUSE REVIEW 2016; 15:156-164. [PMID: 27980527 PMCID: PMC5137479 DOI: 10.5114/pm.2016.63495] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 10/10/2016] [Indexed: 01/28/2023]
Abstract
Introduction Despite the aging of the population, there is limited data available about sexual life and behaviours among of postmenopausal and late postmenopausal women. Aim of the study was to assess the prevalence of sexual dysfunction, behaviours, and preferences in the Polish population in 2015. Material and methods This observational survey study involved 538 women, of whom 220 were over 50 years old. The main focus was on the differences and changes between older age groups, mainly 50-59 years and over 60 years. Results For 80.9% of the women above 50 years old, sex played at least a moderately important role in life. Sex was definitely important and very important for 40.45% of them. Most women over 50 years old (65.5%) were sexually active. Regardless of age, the respondents were more likely to have sexual intercourse several times a month. Less than half of the women over 50 years old (42.7%) realised their sexual fantasies. Women in the group of 50-59 years old statistically less often than younger women declared that the frequency of intercourse they had was too small. There was a statistical tendency showing that women up to 49 years old declared more sexual problems than older women. Women over 50 years old reported fewer problems in comparison to younger women, e.g. less often they claimed that sex is not pleasurable (p = 0.064). Conclusions The prevalence of sexual activity declines with age, yet a substantial number of woman engage in vaginal intercourse, oral sex, and masturbation even past the seventh decade of life.
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Abstract
PURPOSE OF REVIEW Sexuality is an essential part of a healthy life. It can contribute significantly to the physical, psychological and social wellbeing of menopausal women, therefore, to their quality of life. This study is an overview of the most recent findings in the literature retrieved from searches of computerized databases. We extracted all notable information concerning definition, epidemiology, symptoms, diagnostic evaluation and management. RECENT FINDINGS The experience of sexuality in menopause is fundamentally shaped by the biological and psychological changes that occur on a substrate of modifications linked to the ageing process. Moreover, several additional factors, including effects of illness, medications and psychosocial stressors can contribute to sexual dysfunction. Patients should be educated about the causes of sexual dysfunction and available treatment. SUMMARY In recent years, the field of research in sexual dysfunctions has made great progress in many areas of investigation, from epidemiology to pathophysiology providing a better understanding of causes and promoting better care. However, the multifactorial nature of human sexuality still makes our ability to comprehensively treat sexual dysfunction quite difficult. An integrated approach is needed to recognize different aspects involved and to identify the proper intervention strategies for early prevention and promotion of a healthy sexuality in menopause.
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Szoeke C, Coulson M, Campbell S, Dennerstein L. Cohort profile: Women's Healthy Ageing Project (WHAP) - a longitudinal prospective study of Australian women since 1990. Womens Midlife Health 2016; 2:5. [PMID: 30766701 PMCID: PMC6300017 DOI: 10.1186/s40695-016-0018-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 09/13/2016] [Indexed: 01/24/2023] Open
Abstract
Background The cohort was commenced to examine women’s health from midlife (45–55 years) before the menopausal transition and into ageing. Methods Randomised selection and assessment of 2,001 women living in the Melbourne metropolitan area was conducted by the Roy Morgan Centre in 1990/91. Of the 779 women who met the entry criteria for the longitudinal follow-up (aged 45–55 years, menstruating, having a uterus and at least one ovary and not taking hormone therapy) 438 agreed to be seen annually across the menopausal transition from 1992 to 1999. Longitudinal prospective follow-up since 2000 has continued intermittently (2002/03, 2004/05, 2012/13, 2014/15). Data collection has included fasting biomarkers in each year since 1992, clinical assessment, lifestyle and quality of life data, physical measures and validated questionnaire data. Participants have consented to data linkage and, to date, mammogram and BioGrid data have been accessed. Biobank storage including serum, deoxyribonucleic acid (DNA) storage and PAXgene tubes are maintained. Discussion The WHAP has contributed to over 200 published research findings, several books, and book chapters in a variety of areas, including: health and wellbeing; mental and cognitive health; bone health; lifestyle, vascular risk and prevention; women’s health and hormonal transition; and cross-cultural research. With all participants now aged over 70 years, the cohort is ideally placed to answer key questions of healthy ageing in women. With more than 25 years of longitudinal prospective follow-up this Australian dataset is unique in its duration, breadth and detail of measures including clinical review and specialized disease-specific testing and biomarkers. Ongoing follow-up into older ages for this long-running cohort will enable the association between mid to late-life factors and healthy ageing to be determined. This is particularly valuable for the examination of chronic diseases which have a 20–30 year prodrome and to provide knowledge on multiple morbidities. The dataset has a unique opportunity to improve our understanding of temporal relationships and the interactions between risk factors and comorbidities. Electronic supplementary material The online version of this article (doi:10.1186/s40695-016-0018-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cassandra Szoeke
- 1Department of Medicine-Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria 3050 Australia
| | - Melissa Coulson
- 1Department of Medicine-Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria 3050 Australia
| | | | - Lorraine Dennerstein
- 1Department of Medicine-Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria 3050 Australia
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Associations between body mass index and sexual functioning in midlife women: the Study of Women's Health Across the Nation. Menopause 2016; 22:1175-81. [PMID: 25803669 DOI: 10.1097/gme.0000000000000452] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE This study aims to examine baseline and longitudinal associations between body mass index (BMI) and sexual functioning in midlife women. METHODS Midlife women (N = 2,528) from the Study of Women's Health Across the Nation reported on sexual functioning and underwent measurements of BMI annually beginning in 1995-1997, with follow-up spanning 13.8 years. Associations between baseline levels and longitudinal changes in BMI and sexual desire, arousal, intercourse frequency, and ability to climax were assessed with generalized linear mixed-effects models. Models were adjusted for demographic variables, depressive symptoms, hormone therapy use, alcohol intake, menopause status, smoking status, and health status. RESULTS Mean BMI increased from 27.7 to 29.1 kg/m2, whereas all sexual functioning variables declined across time (P values ≤ 0.001). Higher baseline BMI was associated with less frequent intercourse (P = 0.003; 95% CI, -0.059 to -0.012). Although overall change in BMI was not associated with changes in sexual functioning, years of greater-than-expected BMI increases relative to women's overall BMI change trajectory were characterized by less frequent intercourse (P < 0.001; 95% CI, -0.106 to -0.029) and reduced sexual desire (P = 0.020; 95% CI, -0.078 to -0.007). CONCLUSIONS Although women's overall BMI change across 13.8 years of follow-up was not associated with overall changes in sexual functioning, sexual desire and intercourse frequency diminished with years of greater-than-expected weight gain. Results suggest that adiposity and sexual functioning change concurrently from year to year. Further research should explore the impact of weight management interventions as a strategy for preserving sexual functioning in midlife women.
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Baber RJ, Panay N, Fenton A. 2016 IMS Recommendations on women’s midlife health and menopause hormone therapy. Climacteric 2016; 19:109-50. [DOI: 10.3109/13697137.2015.1129166] [Citation(s) in RCA: 520] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
Sexuality is an important component in the lives of menopausal women. Despite the importance of sexual function in menopausal women, sexual dysfunction increases with age. Age-related decline in sexual function may significantly reduce quality of life, making recognition of sexual dysfunction by physicians important for getting menopausal women effective care. Sexual dysfunction can result from multiple etiologies including psychosocial factors, medication side effects, vulvovaginal atrophy, chronic illness, or hypoactive sexual desire disorder. Discovering the etiology and identifying modifiable factors of the sexual function will help define appropriate treatment.
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Affiliation(s)
- Kimberley Thornton
- Department of Obstetrics and Gynecology, Montefiore Medical Center, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Mazer Building Room 322, Bronx, NY 10461, USA
| | - Judi Chervenak
- Department of Obstetrics and Gynecology, Montefiore Medical Center, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Mazer Building Room 322, Bronx, NY 10461, USA
| | - Genevieve Neal-Perry
- Department of Obstetrics and Gynecology, University of Washington, 1959 Northeast Pacific Street, Box 356460, Seattle, WA 98195-6460, USA.
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Burri A, Hilpert P, Spector T. Longitudinal Evaluation of Sexual Function in a Cohort of Pre- and Postmenopausal Women. J Sex Med 2015; 12:1427-35. [DOI: 10.1111/jsm.12893] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Frost RN, Donovan CL. Low sexual desire in women: amongst the confusion, could distress hold the key? SEXUAL AND RELATIONSHIP THERAPY 2015. [DOI: 10.1080/14681994.2015.1020292] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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