Prevalence of sexual dysfunction and its associated factors in women aged 40-65 years with 11 years or more of formal education: a population-based household survey

Sexual function after energy-based treatments of women with urinary incontinence. A systematic review and meta-analysis

INTRODUCTION AND HYPOTHESIS

Urinary incontinence (UI) affects approximately 50% of adult women worldwide and is associated with declining sexual function (SF). Energy-based devices emerged as a minimally invasive alternative treatment. Nevertheless, their effect on sexuality is uncertain. We hypothesize that the UI energy treatment can lead to sexual function improvement.

METHODS

A search was performed in PubMed, Cochrane Library, Web of Science, Embase, and Scopus for randomized clinical trials (RCTs) and nonrandomized studies of intervention, which treated incontinent women using energy, with UI and sexual function (SF) as outcomes. Severe comorbidities, pelvic organ prolapse (POP)> grade 2, and use of medication to treat UI or that affects SF were excluded. Quality assessment and meta-analysis were performed.

RESULTS

From 322 articles, 11 RCTs were included for qualitative analysis. UI symptoms improved in all studies. Regarding SF, RCT with premenopausal women showed improvement in SF in the Er:Yag group (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 and Female Sexual Function Index). A prospective study showed improvement in SF independent of the grade of SUI. RF showed benefits for SF but was not superior to pelvic floor muscle training. One nonrandomized study of intervention with a High-Intensity Focused Electromagnetic Field showed significant improvement of SF in the Golombok Rust Inventory of Sexual Satisfaction total score, a decline in pain and dissatisfaction domains. Meta-analysis with 4 RCTs and 2 nonrandomized studies found no difference between groups (0.26 (95% CI -0.67 to 1.20, and -0.74 (95% CI -3.78 to 2.30) respectively).

CONCLUSIONS

This meta-analysis did not confirm that energy equipment improved the SF of women with UI.

Female sexual dysfunction after bariatric surgery in women with obesity: A systematic review and meta-analysis

BACKGROUND AND OBJECTIVE

Obesity is prevalent and has a negative impact on women's health, including sexual dysfunction. Recent review articles suggest improvement in Female Sexual Function Index (FSFI) and proportion of female sexual dysfunction (FSD) among women with obesity after bariatric surgery.

METHODS

We pooled data from 16 observational studies involving 953 women. The study outcomes were mean FSFI scores and proportion of FSD before and after bariatric surgery. We also sub-analyzed whether age and duration of follow-up affected these outcomes.

RESULTS

The mean age of the subjects was 39.4 ± 4.2 years. Body mass index (BMI) showed significant reduction postoperatively (p < 0.0001). Bariatric surgery led to significant improvement in total FSFI score (p = 0.0005), and all sexual domains except pain. Bariatric surgery reduced the odds of having FSD by 76% compared with those who did not undergo operation (OR 0.24, 95% CI = 0.17, 0.33, p < 0.0001). Our sub-analysis demonstrated a significant reduction in the proportion of FSD for patients <40 years of age. The improvement of total FSFI scores and reduction in proportion of FSD remained significant within the first 12 months after surgery. Univariate meta-regression showed that BMI was not a significant covariate for improvement of FSFI scores (β = 0.395, p = 0.1, 95% CI = 0.884, 0.095).

CONCLUSIONS

Bariatric surgery is shown to improve sexual function scores and prevalence of FSD. This is especially significant among women <40 years of age. This benefit remained significant within the first year after surgery. This appears to be an additional benefit for these patients.

Sexual Function and Associated Factors in Postmenopausal Women

OBJECTIVE

 To assess the sexual function and associated factors in postmenopausal women.

METHODS

 This a descriptive, cross-sectional study with 380 women aged 40 to 65 years, users of public health services in 2019. Questionnaires were applied on demographic characteristics, on climacteric symptoms (menopause rating scale) and on sexual function (sexual quotient, female version). Bivariate and multiple analyses by logistic regression were performed, with adjusted odds ratios (OR_ad) and 95% confidence intervals (95%CIs).

RESULTS

 More than half (243/64%) of the participating women were at risk of sexual dysfunction, with lower scores in the domains of sexual desire and interest, comfort, orgasm, and satisfaction. Women with a partner (OR_ad 2.07; 95%CI 1.03-4.17) and those who reported sleep problems (OR_ad 2.72; 95%CI 1.77-4.19), depressed mood (OR_ad 2.03; 95%CI 1.32-3.10), sexual complaints (OR_ad 8.16; 95%CI 5.06-13.15), and vaginal dryness (OR_ad 3.44; 95%CI 2.22-5.32) showed greater chance of sexual dysfunction.

CONCLUSION

 There was a high prevalence of sexual dysfunction, with the influence of conjugality and climacteric symptoms on sexual function.

The Prevalence of Sexual Dysfunction in the Different Menopausal Stages: A Systematic Review and Meta-Analysis

Objectives: Despite the noticeable advances in sexual dysfunction (SD) research in the menopausal period, scientific literature showed different reports on the prevalence of SD in the menopausal stages. The primary objective of this study was to systematically review and meta-analysis the prevalence of SD in the different menopausal stages and then meta-analysis the included studies in domains of SD separately. Methods: In this systematic review and meta-analysis, keywords were retrieved through MeSH strategy and databases such as PubMed/MEDLINE, PsycINFO, Web of Science (ISI), Scopus, ScienceDirect, SID (Scientific Information Database), Magiran, and Google scholar were searched. Manual review of retrieved citations identified additional citations. The quality of the included studies was assessed using The Newcastle-Ottawa Scale. The main outcome measure in this study was the prevalence of SD in three stages of menopause such as pre, peri, and postmenopause. Results: Of 54 included studies 81,227 menopausal aged women from different menopause stages participated and the sample sizes varied from 49 to 31,581 individuals. The articles from 17 countries worldwide were included in this study. The prevalence of SD in premenopausal aged women was ranged between 22.7% and 72.2%, in perimenopausal aged women, was 37.3-78.2% and also in postmenopausal aged women was extremely reported a wide variety of prevalence ranges and was estimated between 8.7% and 89.01%. The premenopausal women had a lower prevalence of SD compared to other stages of the menopausal period. Conclusion: The results indicated that the prevalence of SD and also domains of SD in different studies were reported much widely. This study can be used as a good resource for obstetricians to understand the high possibility of recurrence of SD and assess the sexual activity of menopausal aged women in the menopause clinic. However, based on the systematic review, more standard and high-quality studies are needed to perform regarding the prevalence of SD in menopausal periods.

Female sexuality and vaginal health across the menopausal age

OBJECTIVE

The primary aim was to evaluate changes in female sexuality across the menopausal period, and the secondary objective was to test the associations of female sexuality domains with vaginal atrophy and its symptoms.

METHODS

A cross-sectional multicenter study was performed involving 518 women, 40 to 55 years of age, consulting outpatient gynecological services at 30 centers across Italy. Vaginal atrophy was identified by the contemporaneous presence of a pH >5, subjective vaginal dryness, and an objective sign. The relationships between vaginal atrophy and its main symptoms (vaginal dryness and dyspareunia), and Female Sexual Function Index (FSFI) score and its domains (desire, arousal, orgasm, dyspareunia, lubrication, and sexual satisfaction) were analyzed.

RESULTS

The prevalence of sexual dysfunction, as defined by a FSFI score <26.55, was 70.6%, increasing from 55% in the years 40 to 45, to 82.8% (P < 0.01) in the years 52 to 55 of age. Mean FSFI score decreased from 40 to 45, to 46 to 48 years of age (23.13 ± 9.76 vs 19.49 ± 9.88; P < 0.05), and from 48 to 51, to 52 to 55 years of age (21.3 ± 8.06 to 17.59 ± 9.11; P < 0.01). Independent determinants of FSFI were age, vaginal atrophy, and the presence of vaginal dryness and dyspareunia (R2 0.208; P = 0.011). FSFI score was independently correlated (R2 0.116) with weight (CR -0.067; 95% confidence interval [CI] -0.126, -0.006; P < 0.032), menopausal status (CR -2.406; 95% CI -4.180, -0.63; P < 0.008), and vaginal dryness (CR -5.647; 95% CI -7.677, -3.618; P < 0.0001). Vaginal dryness was the only variable correlated independently with each FSFI domain, including desire (also correlated with menopausal status), arousal (with age and menopausal status), lubrication (with age), orgasm (with age), satisfaction (with vaginal atrophy and being an ex-smoker), and dyspareunia (with age and spontaneously referred dyspareunia).

CONCLUSIONS

In the perimenopausal years, FSFI score decreases and sexual dysfunction increases by about 30%. Vaginal dryness is the symptom of vaginal atrophy most closely related to all domains of female sexuality.

Sexual Dysfunction in Women with Depression: A Hospital-Based Cross-sectional Comparative Study

BACKGROUND

There is a need to explore the sexual functioning of women with depression as one part of sexuality is that it helps in developing an intimate emotional and physical relationship with another person, and this relationship may serve as a buffer against life stresses. Our aim was to study the prevalence and types of sexual dysfunction in depressed women patients and to compare them with non-depressed women.

MATERIALS AND METHODS

A total of 270 participants who attended a teaching hospital were selected for the study - 135 cases and 135 controls. Sociodemographic and clinical details were collected. Mini International Neuropsychiatry Interview (M.I.N.I), Hamilton Depression Rating Scale (HAM-D), Arizona Sexual Experiences (ASEX) scale, and Female Sexual Functioning Index (FSFI) scale were used. Sexual dysfunction was assessed in both groups.

RESULTS

Among the cases, 47.40% had mild depression, 44.44% had moderate depression, and 8.15% were severely depressed. On the ASEX, 46.66% of the cases had sexual dysfunction, while it was only 8.89% among the controls. The difference in sexual dysfunction among cases and controls was statistically significant. Using the FSFI, 40% of the cases had female sexual dysfunction (FSD), and it was only 11.1% in controls.

CONCLUSION

Sexual dysfunction was more common in females with clinical depression than in those without depression. Numerous factors can operate in the causation of FSD. This study underlines the importance of screening females with depression for FSD, for its early diagnosis and management.

Medication Use and Sexual Function: A Population-Based Study in Middle Aged Women

INTRODUCTION

Medications used to treat chronic diseases have contributed to increasing longevity and improving quality of life. These medications are considered an indispensable resource in the management of most treatable diseases. However, they can affect sexual function through their effects on the central or the peripheral nervous system or due to hormonal effects.

AIM

To evaluate the association between the use of medication for chronic diseases and sexual dysfunction in Brazilian women 45-60 years of age.

METHODS

A secondary analysis of household survey data from a previous cross-sectional, population-based study conducted with a sample of 749 women of a population of 257,434 female urban residents in the age bracket of interest. Sexual function was evaluated using the Short Personal Experiences Questionnaire (SPEQ). Associations between the use of medication and sexual function were evaluated, as were correlations with other variables.

MAIN OUTCOME MEASURE

We found associations of the individual SPEQ domains with the use of some medications.

RESULTS

Mean age of participants was 52.5 ± 4.4 years. Mean age at menopause was 46.5 ± 5.8 years. The overall prevalence of medication use was 68.8%, with the drugs predominantly consisting of those used for cardiovascular diseases. In the Poisson regression analysis, sexual dysfunction, as based on the overall SPEQ score, was associated with sexual inactivity (prevalence ratio [PR] = 4.05; 95% CI 3.16-5.20; P < .001), a sedentary lifestyle (PR = 1.49; 95% CI 1.06-2.09; P = .021), and untreated anxiety (PR = 1.44; 95% CI 1.08-1.92; P = .014). Analysis of the individual SPEQ domains revealed that women who scored low in the desire domain were more likely to use antihypertensive agents (P = .019), whereas a lower score for the arousal domain was associated with the use of antidepressants, with treatment for osteoarticular diseases and with polypharmacy (P = .003). Women with lower scores in the satisfaction domain were more likely to use antidepressants, drugs for osteoarticular diseases, diabetes medication, and polypharmacy (P = .019). A lower score in the orgasm domain was associated with the use of antidepressants, the treatment of osteoarticular diseases, and diabetes (P < .001). Hormone therapy proved protective against loss of libido (P = .036).

CLINICAL IMPLICATIONS

Some medications can interfere with sexual function negatively and, clinicians have to be aware of it to choose the treatment with fewer collateral effects.

STRENGTH & LIMITATIONS

The strength of our study is the large, population-based sample of middle-aged women evaluated for sexual dysfunction with the SPEQ. However, it was a self-reported cross sectional study.

CONCLUSION

This study found no association between the use of medication for chronic diseases and the overall SPEQ score, whereas untreated anxiety was 1 of the main factors associated with female sexual dysfunction. On the other hand, medical treatments were found to contribute to lower scores in the different sexual function domains. Common drug culprits included antihypertensives, antidepressants, treatment for osteoarticular disease, diabetes medications, and polypharmacy. Hormone therapy protected against loss of libido. Gueldini de Moraes AV, Ribeiro Valadares AL, Lui Filho JF, et al. Medication Use and Sexual Function: A Population-Based Study in Middle Aged Women. J Sex Med 2019;16:1371-1380.

The association between depression and sexual satisfaction among Malay elderly in Malaysia

BACKGROUND

Malaysia is experiencing population ageing and expects to be an aged nation by 2030. Depression is one of the common disorder among elderly worldwide and the prevalence of depression in Malaysia is expected to increase as a result of population ageing. The association of depression and sexual satisfaction was unclear, particularly among the elderly. Therefore, this study aimed to examine the association between depression and sexual satisfaction among the Malay elderly population.

METHODS

One hundred and nine married community-dwelling elderly (Mean age = 63.23 years old) participated in this cross-sectional study. Hierarchical logistics regression was used to examine the association of depression on sexual satisfaction while controlling for potential confounders.

RESULTS

Prevalence of depression and sexual dissatisfaction were 26.6% and 20.2%, respectively. Depression was significantly associated with sexual satisfaction (P = 0.002; OR = 0.19, 95% CI = 0.06, 0.66). Depressed participants were 81% less likely to experience sexual satisfaction compared to those without depression.

LIMITATIONS

Cross-sectional study design assessing the association between depression and sexual satisfaction.

CONCLUSIONS

Findings from this study suggest that attention should be given to the prevention and treatment of depression among the elderly as a mechanism to improve sexual health.

Sexual Function and Factors Affecting Menopause: A Systematic Review

The purpose of this review study is to evaluate sexual function and its effective factors in menopause. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The key words of “menopause,” “postmenopause,” “postmenopausal,” “premenopause,” “pre-menopausal period,” “sexual function,” “sexual health,” “sexuality,” “sexual and gender disorders,” “sexual development,” “sexual dysfunction,” “sexual disorders,” “sexual behavior and “sexual activity” were used in combination with the Boolean operators OR and AND. After reviewing the selected articles, 27 papers were selected based on the criteria for entering the study and the goals set. The results of the reviewed articles showed that, in the physical domain, the factors affecting sexual function can be mentioned, age, hormonal changes, medical problems and reproductive history. Sexual disorders in menopause can be affected by some of the individual and social characteristics and psychological problems. Considering the fact that many psychological and social injuries occur in this period following sexual disorders; therefore, policies and programs for improving the quality of life of women in menopause should be aimed at eliminating sexual dysfunction, correcting attitudes and negative emotions and help to women for more comfortable in menopause.

Evaluation of the occurrence of sexual dysfunction and general quality of life in female patients with psoriasis

BACKGROUND

Psoriasis has a significant impact on quality of life (QoL). Sexual life can also be affected, with sexual dysfunction being reported by 25-70% of patients.

OBJECTIVES

To determine the occurrence of sexual dysfunction and evaluate QoL in women with psoriasis.

METHODS

This case-control study included women aged 18-69 years. The validated Brazilian Portuguese versions of the Female Sexual Function Index (FSFI) and of the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) were administered to all participants to assess sexual function and QoL, respectively. Patients with psoriasis underwent clinical evaluation for the presence of comorbidities, especially psoriatic arthritis and other rheumatic manifestations. Location of lesions and the extent of skin involvement were also assessed.

RESULTS

The sample consisted of 150 women, 75 with diagnosis of psoriasis and 75 healthy controls. Prevalence of sexual dysfunction was high in women with psoriasis (58.6% of the sample). Prevalence was statistically higher in women with psoriasis than in controls (P = 0.014). The SF-36 domain scores were also lower in women with psoriasis, with role limitations due to physical health, limitations due to emotional problems, and mental health being the most affected domains.

STUDY LIMITATIONS

Sample size was calculated to evaluate the association between the occurrence of sexual dysfunction and psoriasis, but it did not include the determination of the possible causes of this dysfunction.

CONCLUSIONS

QoL and sexual function were altered in women with psoriasis and should be taken into consideration when assessing disease severity.

The relationship between menopausal symptoms and sexual function

Sexual function could be affected by several factors in postmenopausal women. This cross-sectional study aimed to investigate the relationship between the severity of menopausal symptoms and sexual function. The study was conducted among 405 postmenopausal women aged 40-65 years, in Chalous and Noshahr, Iran, from October 2013 to May 2014. The participants were selected using a multistage sampling method. The instruments used for data collection were the Female Sexual Function Index (FSFI), the Menopause Rating Scale (MRS), and a demographics questionnaire. The relationship between the severity of menopausal symptoms and sexual function was examined using Pearson's correlation coefficient and multiple linear and logistic regressions. The mean unadjusted FSFI and MRS scores were 24.11 and 12.45, respectively; and 61.0 percent of the participants had female sexual dysfunction (FSD) (FSFI ≤26.55). A significant negative correlation was observed between the MRS scores (total and all subscales) and the total scores for FSFI (p < 0.001). The results of the logistic regression analysis showed that with every unit increase in the total score of MRS, the likelihood of sexual dysfunction was 9.6 percent greater. We conclude that menopausal symptoms need to be considered in the design of health initiatives aimed at postmenopausal women's sexual function.

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

Background

Female sexual dysfunction affects 41% of reproductive-age women worldwide, making it a highly prevalent medical issue. Predictors of female sexual dysfunction are multifaceted and vary from country to country. A synthesis of potential risk factors and protective factors may aid healthcare practitioners in identifying populations at risk, in addition to revealing modifiable factors to prevent sexual dysfunction among reproductive-age women.

Methods

Observational studies which assessed the prevalence and predictors of female sexual dysfunction in reproductive-age women were systematically sought in relevant databases (2000–2014). Significant predictors were extracted from each included publication. A qualitative analysis of predictors was performed with a focus on types of sexual regimes and level of human development.

Results

One hundred thirty-five studies from 41 countries were included in the systematic review. The types of predictors varied according to the location of the study, the type of sexual regime and the level of gender inequality in that country/region. Consistently significant risk factors of female sexual dysfunction were: poor physical health, poor mental health, stress, abortion, genitourinary problems, female genital mutilation, relationship dissatisfaction, sexual abuse, and being religious. Consistently significant protective factors included: older age at marriage, exercising, daily affection, intimate communication, having a positive body image, and sex education. Some factors however had an unclear effect: age, education, employment, parity, being in a relationship, frequency of sexual intercourse, race, alcohol consumption, smoking and masturbation.

Conclusions

The sexual and reproductive lives of women are highly impacted by female sexual dysfunction, and a number of biological, psychological and social factors play a role in the prevalence of sexual dysfunction. Healthcare professionals who work with women should be aware of the many risk factors for reproductive-age women. Future prevention strategies should aim to address modifiable factors, e.g. physical activity and access to sex education; international efforts in empowering women should continue.

Electronic supplementary material

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

Cultural factors and sexual dysfunction in clinical practice

Attitudes to sex and the perceived role of sexual activity are very strongly influenced by cultural values. Culturally determined gender roles influence relationships between different-sex partners, and cultural values affect attitudes towards sexual variation. Cultures define what is deviant and from where help is sought. Through differing patterns of child-rearing, cultures also affect individuals' cognitive development, world views and explanatory models of emotional distress. It is critical that clinicians are aware of the role of culture in defining sexual dysfunction and how cultural factors can be used in initiating treatment as well as in therapeutic engagement and alliance. Although epidemiological data on prevalence of sexual dysfunction across cultures are scanty, it is likely that prevalences vary, as will pathways into care and patterns of help-seeking. In this article we discuss the potential impact of culture on sexual dysfunction, and issues that clinicians, whether in specialist or in general services, need to be aware of in assessing and treating patients who present with sexual dysfunction.

Effects of Oral vs Transdermal Estrogen Therapy on Sexual Function in Early Postmenopause: Ancillary Study of the Kronos Early Estrogen Prevention Study (KEEPS)

IMPORTANCE

Sexual dysfunction, an important determinant of women's health and quality of life, is commonly associated with declining estrogen levels around the menopausal transition.

OBJECTIVE

To determine the effects of oral or transdermal estrogen therapy vs placebo on sexual function in postmenopausal women.

DESIGN, SETTING, AND PARTICIPANTS

Ancillary study of the Kronos Early Estrogen Prevention Study (KEEPS), a 4-year prospective, randomized, double-blinded, placebo-controlled trial of menopausal hormone therapy in healthy, recently menopausal women. Of 727 KEEPS enrollees, 670 agreed to participate in this multicenter ancillary study. Women were 42 to 58 years old, within 36 months from last menstrual period. Data were collected from July 2005 through June 2008 and analyzed from July 2010 through June 2017.

INTERVENTIONS

Women were randomized to either 0.45 mg/d oral conjugated equine estrogens (o-CEE), 50 µg/d transdermal 17β-estradiol (t-E2), or placebo. Participants also received 200 mg oral micronized progesterone (if randomized to o-CEE or t-E2) or placebo (if randomized to placebo estrogens) for 12 days each month.

MAIN OUTCOMES AND MEASURES

Aspects of sexual function and experience (desire, arousal, lubrication, orgasm, satisfaction, and pain) were assessed using the Female Sexual Function Inventory (FSFI; range, 0-36 points; higher scores indicate better sexual function). Low sexual function (LSF) was defined as an FSFI overall score of less than 26.55. Distress related to low FSFI score (required for the diagnosis of sexual dysfunction) was not evaluated.

RESULTS

The 670 participants had a mean (SD) age of 52.7 (2.6) years. The t-E2 treatment was associated with a significant yet moderate improvement in the FSFI overall score across all time points compared with placebo (average efficacy, 2.6; 95% CI, 1.11-4.10; adjusted P = .002). With o-CEE treatment, there was no significant difference in FSFI overall score compared with placebo (mean efficacy, 1.4; 95% CI, -0.1 to 2.8; adjusted P = .13). There was no difference in FSFI overall score between the t-E2 and o-CEE groups on average across 48 months (adjusted P = .22). In the individual domains of sexual function, t-E2 treatment was associated with a significant increase in mean lubrication (0.61; 95% CI, 0.25-0.97; P = .001) and decreased pain (0.67; 95% CI, 0.25-1.09; P = .002) compared with placebo. Overall, the proportion of women with LSF was significantly lower after t-E2 treatment compared with placebo (67%; 95% CI, 55%-77% vs 76%; 95% CI, 67%-83%; P = .04). For o-CEE there was no significant reduction in the odds of LSF.

CONCLUSIONS AND RELEVANCE

Treatment with t-E2 modestly improved sexual function in early postmenopausal women, but whether it relieved symptoms of distress is not known.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00154180.

Is the age at menopause a cause of sexual dysfunction? A Brazilian population-based study

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.

Repercussões da Menopausa para a Sexualidade de Idosas: Revisão Integrativa da Literatura

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.

Prevalence of female sexual dysfunction in Brazil: A systematic review

The aim of this systematic review is to investigate the prevalence of female sexual dysfunction in the Brazilian population. This is a systematic review conducted in July 2016 in which four databases were searched: MEDLINE/Pubmed, Scopus, LILACS, and Cinahl. Two investigators extracted the primary data, which were fully analyzed, and applied the inclusion/exclusion criteria. The search found 113 results, and 20 of them compounded the scope of this study. Only four of the studies showed good methodology quality. The main diagnostics criteria used were validated questionnaires specific for sexual function assessment. Regarding the variation of prevalence values, female sexual dysfunction ranged from 13.3% to 79.3% of the studied population, while this value for changes in sexual desire ranged from 11% to 75%, arousal from 8% to 68.2%, lubrication from 29.1% to 41.4%, orgasm from 18% to 55.4%, and satisfaction from 3.3% to 42%; sexual activity frequency ranged from 55.8% to 78.5%, dyspareunia from 1.2% to 56.1%, and pleasure modifications was not addressed. Beside the divergences among studies, there is still a high prevalence of female sexual dysfunction in Brazil.

Female Sexual Function During the Menopausal Transition in a Group of Iranian Women

OBJECTIVE

To determine the prevalence of sexual problems in Iranian women and association of sexual dysfunction with menopausal symptoms.

MATERIALS AND METHODS

In this cross-sectional study, 151 married women with the age of 40-60 yearsold who were referred for treatmentto Department of Gynecology in Vali-e-Asr Hospital (Tehran, Iran) from April to July 2012, were recruited. They were evaluated concerning their sexual function in the domains of desire, arousal, lubrication, orgasm, satisfaction and pain with the female sexual function index (FSFI) questionnaire.Menopause rating scale (MRS) was developed for the diagnosis and quantification of climacteric symptoms.

RESULTS

Total frequency of sexual dysfunction was 53% with the domains of lubrication, arusal and desire being commonly affected 62%, 70% and 98.5% of cases respectively. There is a relationship between severity of somatic and urogenital symptoms with sexual dysfunction (p = 0.03, p = 0.00 respectively).

CONCLUSION

A considerable percentage of women experienced sexual dysfunctions in this period. Somatic and urogenital symptoms during the menopausal period could be a factor to maintain or intensity of sexual dysfunctions.

Attitudes About Sexual Activity Among Postmenopausal Women in Different Ethnic Groups: A Cross-sectional Study in Jahrom, Iran

BACKGROUND

Sexual function is affected by personal and interpersonal factors, familial and social traditions, culture, religion, menopause, and aging. So, ethnicity is a determining factor in sexual function. The present study aimed to investigate the prevalence of sexual dysfunction and attitudes towards sexuality in postmenopausal women among three different ethnic groups in Iran.

METHODS

This cross-sectional study was conducted on 746 postmenopausal women between 50 and 89 years who referred to Honoree clinic, Jahrom in 2013. Among the study participants, 42.4% were Arab, 33.5% were Persian, and 24.1% were Lor. Data were collected about women's socio-demographic characteristics, attitudes regarding sexuality and sexual function. The descriptive statistics were used for demographic variables. Moreover, ANOVA, post hoc (LSD) was used. Besides, p<0.05 was considered statistically significant.

RESULTS

The participants' mean age was 60.10±6.89 years and the total mean score of Female Sexual Function Index (FSFI) was 19.31±8.5. In addition, 81.5% of the women had sexual dysfunction (FSFI <26.55) and only 147 women (18.5%) had normal sexual function (FSFI >26.55). Sexual dysfunction was 75.3% in Arabs, 83.2% in Persians, and 86.1% in Lors. Besides, the most prevalent sexual dysfunction was dyspareunia in Arabs and arousal disorder in Persians and Lors.

CONCLUSION

The results of this study showed that sexual dysfunction is considerable among postmenopausal women. The most prevalent sexual dysfunction was dyspareunia in Arabs and arousal disorder in Persians and Lors.

Examining the sexual function and related attitudes among aged women: A cross- sectional study

BACKGROUND

Sexual function and its subsequent satisfaction are among the most important aspects of women's life. However, this instinct could be influenced by some factors such as diseases, drug using, aging, and hormonal and physiologic changes associated with menopause, and sexual behavior.

OBJECTIVE

The aim of this study was to describe the prevalence rates of sexual dysfunction, and related attitudes among aged women in Jahrom, Iran.

MATERIALS AND METHODS

This cross-sectional study was conducted on 746 postmenopausal women aged between 50 and 89 years old who had referred to obstetric and gynecologic clinic in Jahrom, from April to October 2014. Female Sexual Function Index questionnaire was used order to assess the sexual function. The cases were classified into three categories according to the attitude scores: negative (17-32), medium (33-38), and positive (39-48). One-way ANOVA test was used to determine the relationship between FSFI and attitude scores.

RESULTS

The participants' mean±SD age was 60.10±6.89 years and the total mean score of FSFI was 19.31±8.5. In addition, 81.5% of the women had sexual dysfunction (FSFI< 26.55) and only 147 women (18.5%) had normal sexual function (FSFI> 26.55). Almost 62.1% the women displayed a negative attitude towards sexuality and only 18.8% women had positive attitude. Feeling of dyspareunia (p= 0.02), lubrication (p< 0.0001), orgasm (p= 0.002) and satisfaction (p= 0.002) were significantly different between three categories of attitudes regarding sexuality, respectively.

CONCLUSION

Our data showed that sexual disorders were highly prevalent among postmenopausal women. The most affected problems were arousal, dyspareunia, and lubrication. More than half of the women had negative attitude towards sexual function consequently this could affect their sexual function. So, it seems screening of sexual dysfunction for finding the causes in women should be the main sexual health program. Also, it would be important to emphasis the role of physicians and experts on education and counseling in this subject.

The metabolic syndrome and sexual function in climacteric women: a cross-sectional study

INTRODUCTION

Studies have associated the metabolic syndrome with poor sexual function; the results, however, are controversial.

AIMS

To evaluate the relationship between the metabolic syndrome and sexual function and to identify the factors associated with poor sexual function.

METHODS

A secondary analysis of a cross-sectional cohort study including 256 women of 40-60 years of age receiving care at the outpatient department of a university teaching hospital.

MAIN OUTCOME MEASURES

A specific questionnaire was applied to collect sociodemographic and behavioral data, and the Short Personal Experience Questionnaire was used to evaluate sexual function, with a score ≤ 7 being indicative of poor sexual function. Anthropometric measurements, blood pressure, fasting glucose, high-density lipoprotein, total cholesterol, triglycerides, follicle-stimulating hormone and thyroid stimulating hormone levels were determined.

RESULTS

The prevalence of the metabolic syndrome, as defined by the International Diabetes Federation, was 62.1%, and the prevalence of poor sexual function was 31.4%. The only factor related to female sexual function that was associated with the metabolic syndrome was sexual dysfunction in the woman's partner. The factors associated with poor sexual function in the bivariate analysis were age >50 years (P=0.003), not having a partner (P<0.001), being postmenopausal (P=0.046), the presence of hot flashes (P=0.02), poor self-perception of health (P=0.04), partner's age ≥ 50 years, and time with partner ≥ 21 years. Reported active (P=0.02) and passive (P=0.01) oral sex was associated with an absence of sexual dysfunction. In the multiple regression analysis, the only factor associated with poor sexual function was being 50 years of age or more.

CONCLUSIONS

The prevalence of the metabolic syndrome was high and was not associated with poor sexual function in this sample of menopausal women. The only factor associated with poor sexual function was being over 50 years of age.

Psychosocial pathways to sexual dysfunction among female inmates

Although health surveys on sexual issues during incarceration have shown that women report having engaged in sexual activities while in prison, studies on sexual functioning in female inmates have been largely dismissed. This study aimed to assess sexual functioning among incarcerated women and determine the psychometric and sociodemographic features that are possibly related to the risk of sexual dysfunction. This was a cross-sectional study conducted inside a penitentiary for women in São Paulo, Brazil. From June 2006 to June 2010, 315 inmates convicted of robbery or homicide were recruited. High risk of female sexual dysfunction (HRFSD) was measured using the Female Sexual Function Index and participants were also evaluated for alcohol and drug misuse, impulsiveness, depressive symptoms, and psychosocial features. Descriptive statistics and multivariate logistic regression were utilized to analyze the data. Among the participants, 253 (80.32 %) met the criteria for HRFSD. Older age, total time of imprisonment, and depressive symptoms were related to a higher risk, while the status of being married, being Black, having sexual relations with other inmates, and receiving conjugal visits were associated with a lower risk. As only 110 (34.92 %) inmates admitted to having sexual relationships inside prison, we evaluated this sub-sample separately. For this sub-sample, 61 (55.45 %) women met the criteria for HRFSD and the main factors associated with this risk were total time of imprisonment and depressive symptoms. Incarcerated women are uniquely vulnerable because they often have histories of deprivation and violence stemming from multiple sources and experience considerable psychological symptoms as a consequence of imprisonment. With the affected population rarely receiving psychosocial management for sexual dysfunction, service delivery efforts should be intensified to target this high-risk population.

Epidemiology of the symptoms of menopause - an intercontinental review

Introduction

The age of menopause is a time of many changes in the psychophysical-social functioning of women, with reduced ovarian hormonal activity and estrogen levels. The most common, troublesome symptoms of menopause age include depressive disorders, sleep disorders, sexual dysfunction, discomfort associated with muscle pain, joint aches, osteoporosis and characteristic hot flashes.

Aim of the study

Aim of the study is to determine and compare the rate of menopausal symptoms among women living in continents of both Americas, Africa, Australia and Eurasia.

Material and methods

The results of this work were obtained in 2014 on the basis of the data from a review of the 64 most important studies using the PubMed database. Research published in the period 2000-2014, from Africa, both Americas, Australia and Eurasia, were taken into account.

Results

The prevalence of menopausal symptoms in African women is disconcertingly high. Women from South America complain about occurrence of depressive, sexual dysfunctions and discomfort associated with muscle pain and joint aches. Symptoms most reported by women in the United States are pains associated with muscles and joints. Women in Australia suffer mainly due to vasomotor symptoms and sexual dysfunction, while in the group of women surveyed in Asia there is observed an alarming increase in the proportion of women reporting depressive disorders. In Europe there was a much greater incidence of sleep disorders and depressive disorders.

Conclusions

Women around the world suffer from ailments characteristic for the menopausal period regardless of ethnic origin, skin color or socio-demographic factors.

Comparison of sexual dysfunction between diabetic and non-diabetic women

CONTEXT

Sexual dysfunction (SD) among diabetic women is an important disorder. It has many negative effects on general health.

AIMS

This study aimed to compare SD status between diabetic and non-diabetic women.

SETTINGS AND DESIGN

This study was conducted on 200 women, half of them diabetic and the others as non-diabetic in Tohid Hospital (Sanandaj, Iran).

MATERIALS AND METHODS

The non-diabetic group was matched for age (±5 years) and education. Data were collected using an interview-based questionnaire containing demographic characteristics and female sexual function index (FSFI).

STATISTICAL ANALYSIS USED

Univariate and multivariate analyses were performed to assess and interpret the results.

RESULTS

Analyses of the data showed that low educational levels, longer duration of diabetes and poor controlled diabetes were associated with the lower FSFI scores. In both groups the prevalence of SDs for all FSFI domains was high. Furthermore, multivariate analysis showed that these three variables were associated with lower FSFI scores.

CONCLUSIONS

Study confirms that Kurdish Iranian diabetic women are at an increased risk of SD. Low educational level, longer duration of diabetes, and poor controlled diabetes were associated with a lower FSFI score.

Factors associated with sexual function in Iranian women with type 2 diabetes mellitus: partner relationship as the most important predictor

Background:

No comprehensive study has been conducted on risk factors of sexual dysfunction in women with diabetes mellitus.

Objectives:

The aim of this study was to consider all possible influencing variables including hormonal, physical and, psychological status, socioeconomic status, and dietary intake to get more accurate and reliable results.

Patients and Methods:

Sexual function was assessed by Iranian validated female sexual function index (FSFI).The variables of the study were demographic and diabetes-related factors, stress-depression, physical activity, blood pressure, anthropometric measurements, lipid profile, cortisol, sex and thyroid hormones, 25-hydroxy vitamin D, and dietary intake.

Results:

Among all investigated variables, partner relationship showed a strong positive association with FSFI (β = 1.93 ± 0.41, P < 0.0001). In addition, not considering partner relationship, FSFI showed a significant negative association with age (β = -0.19 ± 0.20, P = 0.04), stress-depression score (β = -0.08 ± 0.04, P = 0.04), DD (β = -0.03 ± 0.01, P = 0.04), and systolic blood pressure (β = -0.14 ± 0.06, P = 0.03). Significant associations between FSFI and serum sex hormones and other biochemical were found in neither postmenopausal nor non-menopausal women. The means of SFSI in postmenopausal women were greater than non-menopausal (P = 0.02).

Conclusions:

It seems that in our population, female sexual function was much more than just a hormonal or physical problem and psychological factors, especially partner relationship and stress-depression, are the most determinants. In addition, age, duration of challenging with disease, and the lack of controlling systolic blood pressure were common factors that decreased sexual function.

Prevalence and risk factors of female sexual dysfunction among healthcare personnel in Malaysia

OBJECTIVE

To determine the prevalence and risk factors of female sexual dysfunction (FSD) among healthcare personnel in selected healthcare facilities in Malaysia.

METHODS

This was a cross-sectional study carried out at three large healthcare facilities that were selected by convenience sampling. Within each facility, stratified random sampling was used to select suitable candidates to participate in the study (n=201). Validated questionnaires were used to assess depression, anxiety, sexual function in women and erectile dysfunction (ED) in their partners.

RESULTS

The prevalence of FSD was 5.5%. Women with sexual dysfunction were more likely to be married longer (OR=4.08; 95% CI; 1.15-4.50), had lower frequency of sexual intercourse (OR=5.00; 95% C; 1.05-23.76) and had a spouse with ED (OR=24.35; 95% CI; 4.55-130.37). Multivariate analysis showed that ED was the strongest predictor for FSD (AOR=27.30; 95% CI; 4.706-159.08).

CONCLUSION

One in eighteen female healthcare personnel suffered from FSD and presence of ED in the partner strongly impacted her sexual function, negatively. The findings highlight the importance of including the male partner in clinical assessment of FSD.

Survey of the prevalence of sexual dysfunctions in Kurdish women

This study evaluates the prevalence of female sexual dysfunctions among Kurdish women. Participants in the study were 196 women between 15 and 55 years of age who attended the gynecological clinic of Be'sat Hospital in Sanandaj Province, Iran. The authors collected relevant data using the Female Sexual Function Index. The mean score was 22.71 (SD = 5). Using a cutoff score of 26.55, the authors found that 151 women (77%) had some sexual dysfunction. Scores declined as patients' age increased; further, an older age at marriage was associated with a higher score. This study, the first about sexual dysfunctions in Kurdish society, shows that sexual dysfunctions are prevalent among women of this ethnicity. Clinicians should complete further studies to assess the factors contributing to this phenomenon.

Patterns of help-seeking in women when problems arise in their sexual life: a discussion paper

AIMS AND OBJECTIVES

To explore patterns of help-seeking in women who have sexual dysfunction and the implications for nursing practice.

BACKGROUND

Female sexual dysfunction is a common problem that is under-reported and untreated. Barriers to help-seeking reported in existing literature relate to the perception among many women that sexual dysfunction is: part of the normal ageing process; not bothersome or does not exist; an issue that health professionals are reluctant to address; a taboo subject. However, little is known about patterns of help-seeking in women with sexual problems. This leaves a potential gap in nursing knowledge regarding appropriate, supportive strategies.

DESIGN

Discursive inquiry framed theoretically by Vogel's model.

METHODS

A literature review was undertaken by searching relevant databases. A combination of keywords was used to identify peer-review papers relating to women's help-seeking behaviour for sexual dysfunction. Vogel's model was used as a framework to extract relevant information from the papers and structure the discussion.

RESULTS

Vogel's model comprises four steps: encoding and interpreting, generating options, decision-making and evaluation of behaviour. Using this stepwise approach helped elucidate the complex mechanisms associated with help-seeking in a structured manner. The key issues associated with help-seeking intention are concerned with women's personal awareness of and interaction with the environment.

CONCLUSIONS

Vogel's model offers a new approach to understanding the dynamics that underpin women's decisions to seek professional help when sexual concerns arise and also provides a useful framework for nurses to consider women's specific sexual concerns.

RELEVANCE TO CLINICAL PRACTICE

Implications for nursing practice are focused on public awareness, women's empowerment and the provision of effective sexual health care. Because sexual dysfunction is a global phenomenon, it is likely that the discussion in this paper will be relevant to an international, nursing readership.

Sexual dysfunction, depression, and anxiety in young women according to relationship status: an online survey

BACKGROUND: Sexual dysfunction is a common, still poorly understood problem among women. Being or not in a relationship seems to be a risk factor for sexual dysfunction. OBJECTIVES: To evaluate the presence of sexual problems, anxiety, and depression in young women and to correlate findings with current relationship status (single, in a committed relationship, or married). METHODS: Data were collected trough an online survey from a total of 155 women aged between 20 and 29 years. Sociodemographic data were collected, and both the Hospital Anxiety and Depression scale and the Female Sexual Function Index were applied. Data were statistically analyzed using the chi-square and Kruskal-Wallis tests, and groups were compared in 2 x 2 matrices using the Mann-Whitney test. RESULTS: Single women showed a significantly higher prevalence of problems in the lubrication (45.3%), orgasm (53.1%), satisfaction (67.2%), and pain (50%) domains and also in total Female Sexual Function Index scores (60.9%) in comparison with the other groups. Additionally, significantly higher depression scores were found among single women (5.89±3.3) in comparison to those in a committed relationship (4.05±2.83). Anxiety scores were similar in all groups. CONCLUSION: Our findings suggest that single women have a poorer sexual function and are more likely to have mood disorders in comparison to their peers involved in stable relationships.

A Comparative study on sexual dysfunctions before and after menopause

BACKGROUND

Sexual instinct which is the cause of numerous changes in an individual's life could be influenced by different factors such as menopause and ageing. This study was designed to compare sexual dysfunction before and after menopause.

MATERIALS AND METHODS

This was a cross-sectional study. Participants were 174 menopausal women who referred to medical health centers of Isfahan, Iran. Data were collected through self constructed sexual dysfunctions questionnaire in relation to their sexual activities before and after menopause. The reliability and validity of this questionnaire was determined by content validity and Cronbach's alpha coefficient.

FINDINGS

Findings showed that the relative frequency of sexual dysfunctions was 38% in the productive period and 72.4% in the menopause period. There was a significant association between sexual dysfunctions before and after the menopause period (p < 0.001). Sexual dysfunctions in these women in the productive and menopause period were 49.2% and 62.6% in desire disorder, 34.3% and 34.9% in dyspareunia, 26.8% and 75.3% in arousal disorder, 23.5% and 56.3% in orgasmic disorder and 16.4% and 15.6% in vaginismus, respectively.

CONCLUSIONS

A considerable percentage of women experienced sexual dysfunctions in productive and menopause periods, and menopause could be a factor to maintain or intensify sexual dysfunctions.

The prevalence of the components of low sexual function and associated factors in middle-aged women

INTRODUCTION

Female sexual function depends on biological, psychological, and sociocultural contexts.

AIM

The objective of the present study was to evaluate the prevalence of low levels of functioning in each of the sexual function domains (desire, arousal, and orgasm) and the factors associated with these phenomena, as well as to assess the frequency of sexual activity in this same sample population.

METHODS

A cross-sectional, population-based study was conducted using an anonymous self-response questionnaire completed by 378 Brazilian-born women of 40-65 years of age with 11 years or more of formal education. The evaluation instrument was based on the Short Personal Experiences Questionnaire.

RESULTS

The prevalence of low sexual desire was 60.6%; low arousal, 37%; and low orgasmic function, 31.1%. Multiple regression analysis showed that having a sexual partner (prevalence ratio [PR] = 0.69, confidence interval [CI] = 0.53-0.90) and nervousness (PR = 1.33, CI = 1.01-1.75) were factors associated with low sexual desire. Aging (PR = 1.04, CI = 1.02-1.06), having a sexual partner (PR = 0.57, CI = 0.41-0.81), feeling well/excellent (PR = 0.59, CI = 0.41-0.85), and having hot flashes (PR = 1.47, CI = 1.01 = 2.15) were factors found to be associated with low sexual arousal. Having a sexual partner (PR = 0.55, CI = 0.42-0.71), feeling well/excellent (PR = 0.68, CI = 0.49-0.94), and having hot flashes (PR = 2.08, CI = 1.43 = 3.04) were factors found to be associated with low sexual orgasmic function. Having a sexual partner (PR = 0.47, CI = 0.38-0.58), feeling well/excellent (PR = 0.78, CI = 0.69-0.89), and having hot flashes (PR = 1.15, CI = 1.05-1.26) were factors found to be associated with a frequency of sexual activity of once a week or less.

CONCLUSIONS

In this sample of middle-aged women, low sexual desire was the most prevalent sexual problem. These results highlight the importance of identifying and treating factors associated with each individual component of low female sexual function.