Sexual Dysfunction in the Older Woman

3D quantitative analysis of normal clitoral anatomy in nulliparous women by MRI

INTRODUCTION AND HYPOTHESIS

We present a 3D computational approach for automated clitoral measurements. We hypothesized that computationally derived measurements would be comparable and less variable than reported manual measures.

METHODS

In this retrospective study, MRIs of 22 nulliparous women age 20-49 years with normal vaginal and clitoral anatomy were collected. Manual segmentations were performed to reconstruct 3D models of the whole clitoris (glans, body, crura, and bulbs) and vagina. The length, width, and volume of the clitoral structures and the distance between the vagina and clitoral structures were calculated. Computed clitoral morphometrics (length, width) were compared to median [range] values from a previously published cadaver study (N = 22) using the median test and Moses extreme reaction test. Calculated distances were compared to mean (± SD) reported by a 2D MRI study (N = 20) using independent t-test and Levene's test.

RESULTS

Overall, computed clitoral morphometrics were similar to manual cadaver measurements, where the majority of length and width measures had ~1-2 mm difference and had less variability (smaller range). All calculated distances were significantly smaller and had smaller SDs than manual 2D MRI values, with two-fold differences in the means and SDs. Large variation was observed in clitoral volumetric measures in our cohort.

CONCLUSIONS

The proposed 3D computational method improves the standardization and consistency of clitoral measurements compared to traditional manual approaches. The use of this approach in radiographic studies will give better insight into how clitoral anatomy relates to sexual function and how both are impacted by gynecologic surgery, where outcomes can assist treatment planning.

Sexual Health

Women's sexual health is a frequently ignored area of geriatric medicine. There are clearly defined criteria for sexual dysfunction that are organized by phase of sexual function, including desire, arousal, orgasm, and pain. The menopause transition and comorbid medical conditions (as well as their treatments) can contribute to alterations in sexual function. The partner must be included and involved in the evaluation and management to achieve a better intimate relationship in an established couple. A variety of effective and evidence-based treatments are available to women for sexual concerns in the geriatric population.

The Evolution of the Female Sexual Disorder/Dysfunction Definitions, Nomenclature, and Classifications: A Review of DSM, ICSM, ISSWSH, and ICD

INTRODUCTION

The 2 most well-known classification systems that include sexual medicine diagnoses are the International Classification of Diseases and Statistics (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM). Sexual medicine experts from international societies representing an array of disciplines have revised and redefined female sexual dysfunctions (FSDs) to reflect current scientific evidence and the state of the art.

AIM

To summarize the evidence and interactive and chronological process by which sexual medicine societies' consensus groups developed the current nomenclature, classifications, and definitions for FSDs.

METHODS

We review the contributions and collaborations of the Fourth International Consultation in Sexual Medicine (ICSM), the International Society for the Study of Women's Sexual Health (ISSWSH), and the World Association of Sexual Health in conjunction with the World Health Organization.

MAIN OUTCOME MEASURES

The ICSM and ISSWSH diagnostic systems are contrasted with the DSM classification. We discuss innovations and strengths; relevant evidence regarding epidemiology, etiology, and risk factors; and key differences. We describe how sexual medicine expertise informed FSD codes in the ICD-11 classification.

RESULTS

ICSM and ISSWSH published evidence-based guidelines on the definitions, nomenclature, and diagnostic criteria for FSD that diverge from the DSM psychiatric compendia. These definitions and nomenclature recommend the separation of female sexual desire and arousal disorders, elaborate on subtypes of arousal problems, broaden the scope of sexual pain definitions, and provide a greater understanding of etiologies and risk factors for FSDs.

CONCLUSIONS

These collaborations among sexual medicine experts and their role in the ICD-11 development process provide confidence that the ICD-11 Sexual Dysfunction codes are based on current scientific evidence for diagnosing and coding FSDs in clinical settings worldwide, can serve as endpoints in clinical trials, and will provide specificity for treatment outcomes for FSD therapies. Parish SJ, Cottler-Casanova S, Clayton AH, et al. The Evolution of the Female Sexual Disorder/Dysfunction Definitions, Nomenclature, and Classifications: A Review of DSM, ICSM, ISSWSH, and ICD. Sex Med 2021;9:36-56.

Evaluation of the relationship between sexual functions and depressive symptoms among pregnant patients during the second trimester

PURPOSE

Pregnancy is a process during which anatomical, physiological, and emotional changes occur. During this process, the sex lives of couples can be affected. Possible depressive symptoms and female sexual dysfunction can affect the relationship between partners, pregnancy-delivery process, and as a result, the newborn. The objective in the present study was to evaluate the relationship of female sexuality during pregnancy with sociodemographic parameters and depressive symptoms.

METHODS

150 pregnant women during the second trimester of their pregnancy and age-matched 150 healthy volunteers were included in the study. Sociodemographic data were recorded. "Female Sexual Function Index" (FSFI) was used to evaluate sexual functions and "Beck Depression Inventory" (BDI) was used to evaluate depressive symptoms. The data were analysed using SPSS 23 statistical software. The results were interpreted with "Independent Samples t Test", Spearman's Rho correlation coefficient, Mann-Whitney U analysis and Chi-square test, and a p value of < 0.05 was considered statistically significant.

RESULTS

It was detected that FSFI score of the pregnant group was lower compared to that of the non-pregnant group (16.953 ± 8.24; p = 0.000). There was no difference between the groups in terms of BDI scores (p = 0.100). There was no relationship between the FSFI score and the BDI score in the pregnant group (r = - 0.087; p = 0.144).

CONCLUSION

It was found that female sexual dysfunction occurs in pregnant women, depressive symptoms remained unchanged when compared to non-pregnant women and sexual functions remain unaffected.

Mindfulness-based cognitive therapy for sexuality (MBCT-S) improves sexual functioning and intimacy among older women with epilepsy: A multicenter randomized controlled trial

PURPOSE

Women with epilepsy (WWE) frequently experience sexual problems, including sexual dysfunction and sexual distress. Therefore, this study aimed to examine the efficacy of a mindfulness-based cognitive therapy for sexuality (MBCT-S) on sexual function and intimacy among older adult WWE in Iran.

METHODS

A multicenter randomized controlled trial was conducted at 15 neurology clinics in three Iranian cities. WWE together with their partners and healthcare providers were randomly assigned in patient and partner (PP; n = 220), patient, partner, and healthcare provider (PPHP; n = 220), or treatment as usual (TAU; n = 220) group. WWE and their partners in both the PP and PPHP groups received eight weeks of MBCT-S sessions. In the PPHP group, three individual sessions on sexual counseling were added for healthcare providers. Self-assessment scales were used at baseline, one month and six months after completing the intervention. Mixed linear regression models were developed to determine differences among the three groups. Multilevel mediation analyses were conducted to understand the mediating effects of mindfulness, intimacy, patient-physicians relationship and sexual counseling barriers.

RESULTS

Improvements in sexual function, sexual distress, and intimacy were found in both the PP and PPHP groups at one-month and six-month follow-ups. The PPHP group compared with the PP group had greater improvement in intimacy at both follow-ups. Regarding sexual function, the PPHP group performed better than the PP group at the six-month follow-up.

CONCLUSIONS

The MBCT-S appears efficacious in enhancing sexual function and reducing sex-related distress in Iranian older adult WWE. Future studies should examine its efficacy in other populations.

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

OBJECTIVES

This is a cross sectional study conducted in order to determine sexual dysfunction in healthy women and risk factors.

PATIENTS AND METHODS

The population of the study consisted of 282 women. The whole of the population, without sample selection, was included in the study. For data, questionnaire and Female Sexual Function Index-FSFI, whose Turkish validity and reliability study was conducted, were used. Student t and chi-square significant tests and logistic regression analysis were used to carry out statistical analysis.

RESULTS

It was found that 35.8% of 282 women who participated in the study were in the age range of 30-39 years, 54.6% had high school educational level or above, and 59.6% worked. Prevalence was determined as 53.2% FSFI score < 26 according to Female Sexual Function Index FSFI; 23% of the women had complaints about urinary incontinence UI. According to logistic regression results, it is determined that CFB risk is increased in patients with age and urination problem. It was determined that there was no significant correlation between income, number of children, prceived economic status, dyspareunia, having problem with the partner, experiencing premenstrual syndrome, and SD.

CONCLUSION

In this study, approximately half of healthy women had SD and development of SD was affected based on some descriptive characteristics. As sexual life was considered as a factor increasing life quality, it was thought that it is fairly important to discuss the questioning of problems related to sexual life for systematic evaluation of patients, as well.

Sexual dysfunction among Nigerian women with epilepsy

OBJECTIVES

Sexual dysfunction (SD) has been shown to be more prevalent among females with epilepsy (FWE) when compared with controls. Identified risk factors for SD among FWE include depression, antiepileptic drug (AED) type, epileptic lateralization, and temporal lobe involvement. Despite a huge population of FWE in sub-Saharan Africa and by extension Nigeria, there are limited studies on the effect of AEDs and epilepsy on sexual function among FWE in the region. We therefore studied predictors and patterns of SD among Nigerian FWE.

METHOD

This was a descriptive study carried out at the University College Hospital, Oyo State - a tertiary hospital in South-Western Nigeria. The Zung Self-rating Depression Scale was used to assess mood. Sexual dysfunction was measured using the Arizona Sexual Experience Scale (ASEX) questionnaire.

RESULTS

The frequency of clinically significant SD among FWE (35, 50.0%) was similar to that of controls (27, 38.6%; p = 0.173). However, the mean ASEX score was higher in FWE than in controls (p = 0.009). Using domains defined by the Diagnostic and Statistical Manual of Mental Disorders - 5th Edition (DSM-V), we observed that FWE had higher scores in all domains. Sexual dysfunction was also more prevalent among FWE with lesional epilepsy when compared with those with nonlesional epilepsy. Standardized beta coefficients from multiple regressions conducted suggest that age of FWE, the presence of motor weakness, and systolic blood pressure contributed to SD.

SIGNIFICANCE

Females with epilepsy had higher ASEX scores in all domains, with older FWE and those with lesional epilepsy more likely to have SD. Healthcare providers should pay attention to SD among FWE for improved quality of life.

An examination of the sexual functions of patients who underwent a gynecologic cancer operation and received brachytherapy

Objective:

This study was planned as a descriptive study for the purpose of examining the sexual functions of patients' who underwent a gynecological operation and received brachytherapy.

Methods:

The study was conducted with 118 women who attended the Radiation Oncology Unit at Ege University Medical Faculty Hospital in Izmir Province for Gynecological Oncology follow-up, who participated voluntarily and were assigned using the random sampling method. The participants were married, sexually active, had a diagnosis of gynecologic cancer, underwent an operation and received brachytherapy for four months after the operation. The Individual Identification Form and Female Sexual Function Index (FSFI) were used as the data collection tools.

Results:

The average age of women who participated in study was 50.90±7.98 and 41.5% of them had completed primary school. About 60% of the participants had cervical cancer and 69.5% had a total abdominal hysterectomy with bilateral salpingo-oopherectomy. The FSFI average score was determined to be 15.77±8.71. It was found that 97.5% of the participants received fewer than 30 points from the scale and these participants thus experienced sexual dysfunction.

Conclusions:

According to the findings obtained from the study, almost all thewomen that had an operation as a result of adiagnosis of gynecologic cancer and received brachytherapy experienced sexual dysfunction.

Using the Theory of Planned Behavior incorporated with perceived barriers to explore sexual counseling services delivered by healthcare professionals in individuals suffering from epilepsy

People with epilepsy (PWE) are highly likely to suffer from sexual dysfunction, and dealing with this issue is a challenge for healthcare providers. Unfortunately, there is no theory-driven study that has investigated the counseling practice of healthcare providers for sexual problems in PWE. Therefore, we decided to apply the well-established Theory of Planned Behavior (TPB) to examine factors associated with healthcare providers' sexual counseling in PWE. Apart from TPB, perceived barriers toward providing counseling could be a possible factor that needs to be investigated as well. Therefore, two models explaining sexual counseling practice were proposed. Model 1 included only TPB and Model 2 included TPB incorporated with perceived barriers. Five hundred fifty-nine Iranian healthcare professionals responsible for PWE were recruited across several neurology clinics and asked to complete TPB-specific questionnaires. The same healthcare professionals were asked to complete an additional questionnaire on their attitudes toward sexual counseling 18months later. Structural equation modeling suggested Model 2 to be more useful in explaining sexual counseling practice compared with Model 1. Moreover, attitude and perceived behavioral control showed stronger associations with behavioral intention, whereas subjective norm showed weaker associations. The associations were similar across different healthcare professionals (i.e., medical doctors vs. nurses). In conclusion, TPB incorporated with perceived barriers might be a useful theory for different types of healthcare providers to improve and enhance sexual counseling practice.

Female sexual function mediates the effects of medication adherence on quality of life in people with epilepsy

PURPOSE

The purpose of this study was to understand the mediating effects of female sexual functioning in the association between medication adherence and quality of life (QoL) in Iranian women with epilepsy (WWE).

METHODS

Women's sexual functioning was measured using Female Sexual Function Index; QoL using Quality of Life in Epilepsy; epilepsy severity using Liverpool Seizure Severity Scale; subjective medication adherence using Medication Adherence Report Scale; and objective medication adherence using serum level for antiepileptic drugs in 567 WWE. Medication adherence was measured at baseline, while women's sexual functioning, QoL, and epilepsy severity were measured at the 6-month follow-up. Structural equation modeling and regression models were conducted to examine the mediating role of women's sexual functioning.

RESULTS

The mediating effects of sexual functioning in the relationship between medication adherence (including subjective and objective measures) and QoL were supported in the total score of Female Sexual Function Index (coefficient=0.415, SE=0.117, p<0.001 for subjective medication adherence; coefficient=1.980, SE=0.446, p<0.001 for objective medication adherence). Seizure severity was significantly associated with QoL but only when objective medication adherence was measured (coefficient=-0.094, SE=0.036, p=0.009).

CONCLUSION

Our results extended the importance of medication adherence from symptom reduction to the beneficial effects of women's sexual functioning and QoL. Health care providers should be aware of these additional benefits of medication adherence and use these arguments to encourage female patients to take their medication, which can eventually increase their sexual satisfaction and overall QoL.

Topical Alprostadil Treatment of Female Sexual Arousal Disorder

Objective:

TO review the pharmacology, pharmacokinetics, efficacy, and safety of topical alprostadil in the treatment of female sexual arousal disorder (FSAD).

Data Sources:

A literature search was conducted using MEDLINE (1966–May 2006), EMBASE, and International Pharmaceutical Abstracts with the search terms alprostadil, female, and sexual dysfunction/drug therapy.

Study Selection and Data Extraction:

All published and unpublished clinical trials and abstracts involving the efficacy and safety of topical alprostadil use in women were reviewed. Data on file with the manufacturer were also included.

Data Synthesis:

Topical alprostadil is a vasodilatory agent under development for the treatment of FSAD. In-clinic application of alprostadil increases genital vasocongestion, vaginal erythema, transudates, and some patient-assessed indices of sexual arousal; however, these effects have not been consistently superior to placebo. Three of 4 trials investigating at-home use of topical alprostadil have demonstrated improvements in achievement of satisfactory levels of sexual arousal and successful sexual encounters in patients with FSAD. Adverse events appear to be mild and localized and consist of burning and itching at the application site.

Conclusions:

Two formulations of topical alprostadil are in Phase II clinical trials for the treatment of FSAD. Initial results of clinical trials have demonstrated some beneficial effects on arousal success rates and other subjective measures of sexual arousal; however, these results have been inconsistent and not reproducible in all trials. The results of ongoing clinical studies are needed to further define the role of topical alprostadil in the treatment of FSAD.

Abnormal sexuality in Parkinson's disease: fact or fancy?

PURPOSE

Patients with Parkinson's disease (PD) variably report sexual dysfunctions. We assessed sexuality in PD by comparing sexual function between a large group of patients with idiopathic PD and a group of subjects without PD.

METHODS

We recruited 121 patients with mild-to-moderate PD (aged 40-80years) from four Italian Movement Disorder Clinics and 123 non-Parkinsonian controls (NPC) (aged 40-80years). Sexual function was assessed with four scales: the Brief Index of Sexual Functioning (BISF-M for men; BISF-W for women), the International Index of Erectile Function (IIEF), and the Female Sexual Function Index (FSFI). Both groups also underwent assessment with the Beck Depression Inventory (BDI) and the Mini Mental State Examination (MMSE), and patients were assessed with the Parkinson's Disease Questionnaire-8 (PDQ-8).

RESULTS

No differences in total score were found between PD and NPC for any sexual function scale (BISF-M, BISF-W, IIEF, FSFI: p>0.05). However, the Orgasm/Pleasure Domain (BISF, D5) was significantly lower in male patients than in controls.

CONCLUSION

Our findings fail to confirm previous findings that PD is associated with a significant sexual impairment. NPC and patients with PD have comparable sexual function in both sexes. Thus, rather than dismissing sexual dysfunction as a normal parkinsonian symptom, physicians should refer patients to sexual medicine specialists who can investigate and discuss problems fully, diagnose possible comorbidities, and suggest appropriate treatments.

Efficacy of psychosocial interventions in men and women with sexual dysfunctions--a systematic review of controlled clinical trials: part 2--the efficacy of psychosocial interventions for female sexual dysfunction

INTRODUCTION

As yet, a summary of the research evidence concerning the efficacy of psychological treatment in female sexual dysfunction is lacking. Previous reviews were often nonsystematic or explored one specific sexual dysfunction.

AIM

Our systematic review provides an overview of the efficacy of psychosocial interventions in all female sexual dysfunction.

MAIN OUTCOME MEASURES

Main outcome measures included for example psychometrically validated scales, diary notes, interviews, and vulvar algesiometer. The efficacy of psychosocial interventions was measured for example by the frequency of and satisfaction with sexual activity and sexual functioning. Safety and acceptance were evaluated on the basis of adverse events and dropout rates.

METHODS

The systematic literature search included electronic database search, handsearch, contact with experts, and an ancestry approach. Studies were included if the woman was given a formal diagnosis of a sexual dysfunction (International Statistical Classification of Diseases and Related Health Problems-ICD10/-9; Diagnostic and Statistical Manual of Mental Disorders-IV/-III-R) and when the intervention was psychosocial or psychotherapeutic. The control group included either another treatment or a waiting-list control group. The report of relevant outcomes was necessary for inclusion as well as the design of the study (randomized, controlled trials [RCTs] and controlled clinical trials). The assessment of methodological quality comprised aspects of randomization, blinding, incomplete outcome data, selective reporting, and allegiance.

RESULTS

We identified 15 RCTs that investigated efficacy in female sexual dysfunction and two further studies that examined male and female sexual dysfunction together. Most trials explored sexual pain disorders. About half of all studies in women used either a concept derived from Masters and Johnson or a cognitive-behavioral treatment program. Both approaches showed significant improvements compared with a control group. Benefit was not always maintained over the (variable) follow-up period.

CONCLUSIONS

Traditional sexual therapeutic concepts proved to be efficacious in the treatment of female sexual dysfunction. A shortcoming was the rather low methodological quality of included studies.

The female factor: predicting compliance with a post-prostatectomy erectile preservation program

INTRODUCTION

Early post-radical prostatectomy (RP) erectile preservation (EP) therapy may be critical to preserve erections after surgery.

AIM

To assess if pre-RP female sexual function predicts of partner compliance with an EP protocol.

MAIN OUTCOME MEASURES

Compliance, defined as use of localized penile EP therapy (intracavernosal injections [ICIs], vacuum erection device [VED], or alprostadil) at 3 and 6 months after RP.

METHODS

Records of patients enrolled in our EP program from April 2007 to June 2008 were reviewed. Before surgery, patients completed the Sexual Health Inventory for Men (SHIM) and their female partners completed the Female Sexual Function Index (FSFI) questionnaire. Prior to surgery, patients were advised to take sildenafil 25 mg every nightly and use a 250-µg alprostadil suppository three times/week. At 1 month, additional daily use of a VED was encouraged. All patients unable to achieve erections sufficient for penetration were encouraged to initiate ICI of Trimix (phentolamine, papaverine, and PGE1) twice weekly after 3 months following surgery. Data were analyzed using binary logistic regression analysis holding all input variables constant.

RESULTS

Twenty-nine patients had preoperative SHIM>7 and pre-RP partner FSFI data available. After a 4-week follow-up, compliance with alprostadil suppository declined and both ICI and VED usage increased. At 6 months, six (25.0%) patients had return of natural erectile function and 22 (91.7%) were achieving assisted erections. Higher preoperative partner FSFI scores were associated with greater compliance to the localized penile therapy component of our EP protocol (risk ratio 3.8, P=0.05).

CONCLUSIONS

Preoperative female sexual function correlated with greater partner compliance with the localized component of our EP protocol. Consideration of a female partner's preoperative sexual function in predicting patient erectile function recovery after RP is warranted. Future studies are necessary to determine the clinical significance of this factor.

Sexual activities, sexual and life satisfaction, and successful aging in women

INTRODUCTION

Sexuality for women at all ages is a vital aspect of life satisfaction and is based upon continuing growth, development, and adaptation. The successful aging model includes physical, mental/emotional, and social well-being. There is no known published literature on the topic of sexual activities of older women and its implications on life and sexual satisfaction.

AIM

To investigate the sexual activities of older women in Israel, their levels of sexual satisfaction and life satisfaction, and to examine the relationship between the level of sexual activities, sexual satisfaction, and life satisfaction.

MAIN OUTCOME MEASURE

Components of the Derogatis Sexual Functioning Inventory, and the Life Satisfaction Index.

METHODS

A descriptive, correlational study guided by the theory of "successful aging" by Havighurst (1961) was conducted using a convenience sample of 127 women who attended a menopause clinic for routine and follow up care.

RESULTS

The research findings described older women as being involved in varied, though limited, sexual activities. There was no significant relationship discovered between the number of sexual activities and age. The level of sexual satisfaction of the studied sample was found to be above the mean score. Most of the women reported good sexual/intimate communication with their partners. Women were not satisfied with the limited variety in their sex life. Women reported a high level of life satisfaction. Ultimately, a positive significant correlation was discovered between sexual satisfaction and level of current sexual activity, and between sexual satisfaction and life satisfaction.

CONCLUSIONS

Older women are interested in continuing their sexual activities. It is a component of life satisfaction. The desire for sexual variety suggested an important area for patient education. Couple communication was deemed a priority. Health providers should include sexual health issues in their discussions with clients of all ages.

Dyspareunia in Puerto Rican middle-aged women

OBJECTIVE

Dyspareunia is a common sexual dysfunction. There is a lack of studies that address female sexual dysfunction in Puerto Rico. The present cross-sectional study characterized dyspareunia in a sample of Puerto Rican women aged 40 to 59 years and evaluated the relationship between reported dyspareunia with demographic, lifestyle, and health factors.

METHODS

Nine hundred twenty Puerto Rican women participated in health fairs conducted in 22 municipalities between May 2000 and November 2001 where they filled out a questionnaire. Contingency table and chi statistics were used to evaluate the bivariate associations of dyspareunia with demographic, lifestyle, and health factors. Crude and multivariate logistic regression models were used to estimate the magnitude of the association between dyspareunia and demographic, lifestyle, and health factors.

RESULTS

The overall prevalence of dyspareunia in this population was 18%. Dyspareunia was somewhat lower among women aged 40 to 49 years (17%) than among those aged 50 to 59 years (21%), not reaching statistical significance. Dyspareunia was associated with educational attainment, employment status, menopause status, current hormone therapy use, genitourinary symptoms, and loss of libido (P < 0.05). Current cigarette smoking, body mass index, physical activity, alcohol use, parity, and ever use of oral contraceptives were not associated with dyspareunia in bivariate analysis (P > 0.05). In the multivariate analysis, incontinence (prevalence odds ratio [POR], 1.67; 95% CI, 1.02-2.73), vaginal dryness (POR, 3.97; 95% CI, 2.49-6.31), vaginal itching (POR, 2.44; 95% CI, 1.55-3.83), loss of libido (POR, 3.08; 95% CI, 1.92-4.94), and partnership (POR, 2.22; 95% CI, 1.29-3.82) remained associated with dyspareunia.

CONCLUSIONS

Our results agree with previous studies regarding the potential association between health and lifestyle factors and dyspareunia. Additional studies of female sexual dysfunction in Puerto Rican women are highly warranted.

Factors associated with sexual dysfunction in Jordanian women and their sexual attitudes

BACKGROUND

Female sexual dysfunction (FSD) is defined as disorders of libido, arousal, and orgasm, as well as sexual pain, that leads to personal distress or interpersonal difficulties. Social aspects of FSD have been understudied. The aim of this study was to explore the social aspects of FSD and sexual attitudes of Jordanian women.

SUBJECTS AND METHODS

Six hundred thirteen married females were studied between October 2006 and August 2007 at the National Center for Diabetes, Endocrinology and Genetics (NCDEG), Amman, Jordan. Females were interviewed using a special questionnaire that was suitable to our culture and added to the Arabic translation of the Female Sexual Function Index (FSFI) Questionnaire.

RESULTS

Older age was associated with a decreased total FSD index and its domain scores. Women with obesity were more likely to have impaired arousability and impaired capability of reaching orgasm. About 58.5% of women reported that they prepared themselves if they had sexual desire and 68.2% reported wearing special attire for this purpose. Only 37.2% of women could ask their husband for a special excitement.

CONCLUSIONS

FSD is prevalent in Jordan. Its social aspects are understudied and need more research in the future.

Testosterone for low libido in postmenopausal women?

Use of testosterone in older woman with hypoactive sexual-desire disorder (HSDD) is controversial. One concern about existing testosterone therapies for HSDD is the common recommendation to concomitantly administer estradiol because of the known risks of such therapy in postmenopausal women. This large, year-long, double-blind, placebo-controlled trial of testosterone therapy in postmenopausal women examined the hypothesis that testosterone alone would be efficacious in improving HSDD. The results of this trial confirm the improvement in sexual function for postmenopausal women seen in earlier studies using testosterone in combination with estradiol, implying that estradiol administration may not be essential for the beneficial effects of testosterone. However, this study raised some concerns regarding testosterone therapy on the risk of breast and endometrial cancer, highlighting the need for further long-term trials to better assess the long-term safety of this approach for the treatment of HSDD in women.

Genital injuries in postmenopausal women after sexual assault

Physiological and anatomical changes that occur as a result of menopause alter sexual response and sexual function. These changes can result in genital injuries from both consensual sexual intercourse and sexual assault. The purpose of this article is to review the literature examining what is known about postmenopausal women and genital injuries. Only seven research studies were found that examine genital injuries in postmenopausal women after sexual assault. Of the comparative studies, a majority determined that postmenopausal women are more likely to sustain genital injuries after sexual assault than younger women. No literature was found that specifically investigates genital injuries incurred as a result of consensual sexual intercourse versus sexual assault in the postmenopausal population.

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

OBJECTIVE

To evaluate the prevalence of sexual dysfunction and its associated factors in middle-aged women with 11 years or more of formal education.

METHODS

A cross-sectional, population-based study was carried out using an anonymous, self-response questionnaire. A total of 315 Brazilian-born women, 40-65 years of age with 11 years or more of schooling, participated in the study. The instrument used in the evaluation was based on the Short Personal Experiences Questionnaire. Sexual dysfunction was calculated from the mean score of sexual responsiveness (pleasure in sexual activities, excitation and orgasm), frequency of sexual activities and libido. Sociodemographic and clinical factors were evaluated. Poisson multiple regression analysis was carried out and the prevalence ratios with respective 95% confidence intervals (95%CI) were calculated.

RESULTS

The prevalence of sexual dysfunction was 35.9% among our study population. Multiple regression analysis showed that sexual dysfunction was positively associated with older age (prevalence ratios=1.04; 95%CI:1.01-1.07) and with the presence of hot flashes (prevalence ratios=1.37; 95%CI:1.04-1.80). Having a sexual partner (PR=0.47; 95%CI:0.34-0.65) and feeling well or excellent (prevalence ratios= 0.68; 95%CI: 0.52-0.88) were factors associated with lower sexual dysfunction scores.

CONCLUSIONS

Sexual dysfunction was present in more than one-third of women that were 40-65 years of age with 11 years or more of formal education. Within that age group, older age and hot flashes were associated with higher sexual dysfunction scores, whereas feeling well and having a sexual partner were associated with better sexuality.

Female sexual dysfunction: classification, pathophysiology, and management

Female sexual dysfunction is a prevalent problem in the general community; however, it has not been studied as extensively as male sexual dysfunction. Female sexual dysfunction is a common complication after most pelvic surgeries. With the introduction of screening programs, most pelvic malignancies are detected at earlier stages and in younger patients. Sexual dysfunction is a major quality-of-life issue in these young women. Hysterectomy (simple or radical) is the most common type of pelvic surgery in women and is one of the most important causes of female sexual dysfunction. Additionally, female sexual dysfunction is an important issue after urologic (radical cystectomy) and colorectal surgeries (simple and radical proctocolectomy). Sexual dysfunction is a common problem among postmenopausal women. Modifications in the surgical technique (nerve sparing) are rapidly evolving in the field of urology and colorectal surgery, which will be soon followed by modifications in the field of gynecologic surgery. In this article we summarize the pathophysiology and classification of female sexual dysfunction, with special emphasis on the relationship between female sexual dysfunction and pelvic surgeries.

Female sexual dysfunction in Lower Egypt

OBJECTIVE

The aim of this study was to assess the prevalence and associated factors of female sexual dysfunction (FSD) in Lower Egypt.

DESIGN

A cross-sectional clinic-/hospital-based survey.

SETTING

Five district medical centres in Dakahlia Governorate: Shirbin, Bilquas, Samblawen, Dekrinis and Mansoura City.

POPULATION

One thousand married women aged between 16 and 49 years.

METHODS

Data were collected by personal interview in a questionnaire format in addition to physical examination (when allowed).

MAIN OUTCOME MEASURES

FSD and associated risk factors.

RESULTS

The response rate was 93.6%. 68.9% of women had one or more sexual problems; however, 23% of the women with sexual problems were not distressed by these issues. 31.5% of women suffered from dyspareunia. 49.6% of the women had decreased sexual desire, 36% had difficult arousal and 16.9% had anorgasmia (primary and secondary). Marital disharmony, 'hate' and unfavourable socio-economic circumstances were the most common aggravating factors (28.1%) for sexual dysfunction among the participants, followed by pregnancy-related events (15.7%). Most women (84.5%) received no help for their sexual problems. 90.3% of the women were circumcised. Only 7.1% (46 of 645) of women with sexual problems had received treatment, with no real improvement reported in 58.7% (27 of the 46 women).

CONCLUSIONS

FSD is a highly prevalent problem within the scope of this study. Low reporting rates and very low treatment rates were identified in the sample from Lower Egypt.

Genetic influences on variation in female orgasmic function: a twin study

Orgasmic dysfunction in females is commonly reported in the general population with little consensus on its aetiology. We performed a classical twin study to explore whether there were observable genetic influences on female orgasmic dysfunction. Adult females from the TwinsUK register were sent a confidential survey including questions on sexual problems. Complete responses to the questions on orgasmic dysfunction were obtained from 4037 women consisting of 683 monozygotic and 714 dizygotic pairs of female twins aged between 19 and 83 years. One in three women (32%) reported never or infrequently achieving orgasm during intercourse, with a corresponding figure of 21% during masturbation. A significant genetic influence was seen with an estimated heritability for difficulty reaching orgasm during intercourse of 34% (95% confidence interval 27-40%) and 45% (95% confidence interval 38-52%) for orgasm during masturbation. These results show that the wide variation in orgasmic dysfunction in females has a genetic basis and cannot be attributed solely to cultural influences. These results should stimulate further research into the biological and perhaps evolutionary processes governing female sexual function.

Effects of genital prolapse surgery on sexuality

OBJECTIVE

A prospective study was performed to evaluate the effects of genital prolapse surgery on sexuality. Additionally we investigated which variables are risk factors for persistence or development of sexual problems after surgery.

METHODS

All 82 patients participating in a randomized trial comparing vaginal and abdominal surgical correction of descensus uteri, were asked to complete the Questionnaire for screening Sexual Dysfunctions (QSD) before and at six months and one year after surgery.

RESULTS

Sixty-two patients completed the questionnaire. General satisfaction about sexuality was significantly improved after surgery. Of 41 patients who were sexually active both before surgery and at one year after surgery, 28 (68.3%) patients reported sexual problems before surgery. In 13 (46.4%) of these patients, all sexual problems disappeared. Of the 13 patients without sexual problems before surgery, two patients reported de novo sexual problems. The relative risk on disappearance of sexual problems in patients with large cystocele was 1.5 (95% confidence interval 1.1-2.1) times higher than the risk in patients without large cystocele.

CONCLUSION

Satisfaction about sexuality increases and the prevalence of sexual problems decreases in patients undergoing surgical correction of descensus uteri.