Management of Hypertension with Female Sexual Dysfunction

Cognitive behavior therapy for female sexual dysfunction: a systematic review and meta-analysis

INTRODUCTION

Sexual dysfunction has a negative influence on both human physical and psychological health across various ages and frequently results in the deterioration of quality of life for individuals and/or partners.

OBJECTIVE

The objective of the study was to assess the effectiveness of cognitive behavioral therapy (CBT) for female sexual dysfunction (FSD).

METHODS

We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, and Web of Science databases from inception to January 6, 2023 (updated on April 15, 2024). The risk of bias in all included randomized controlled trials (RCTs) was assessed using the Cochrane risk of bias tool (revised version 2.0), and meta-analysis was conducted using R (version 4.2.0). We used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to evaluate the certainty of the evidence.

RESULTS

Ten RCTs involving 837 patients were included, and three RCTs were judged at high risk of bias due to missing outcome data and baseline imbalances. In the post-intervention follow-up, CBT participants showed a greater increase in FSFI scores than those receiving routine care (MD: 7.63, 95% CI: 5.25 to 10.02, GRADE: low), and greater improvement than waitlist participants (MD: 3.13, 95% CI: 0.90 to 5.35, GRADE: moderate). In the short-term follow-up (4 to 24 weeks after completion of intervention), CBT participants had a greater increase in FSFI scores than routine care (MD: 11.13, 95% CI: 0.27 to 22.00, GRADE: low) and waitlist participants (MD: 3.80, 95% CI: 1.46 to 6.14, GRADE: very low).

CONCLUSION

CBT can improve the clinical symptoms of patients with FSD. However, large-scale RCTs are needed in the future.

Prevalence and Risk Factors Associated With Sexual Dysfunction in Malagasy Women With and Without Type 2 Diabetes Mellitus: A Cross-Sectional Study in a University Hospital Center, Antananarivo Madagascar

Background and Aims

Female sexual dysfunction (FSD) remains a very little studied subject in Madagascar, despite the resulting alteration of quality of life. Our study aims to determine the prevalence and risk factors for sexual dysfunction in Malagasy women with and without type 2 diabetes (T2DM).

Methods

This was a descriptive and analytical cross-sectional study, carried out in the Endocrinology department of the Joseph Raseta Befelatanana University Hospital Center over a period of 18 months. FSD was assessed using the Female Sexual Function Index questionnaire in women with and without T2DM.

Results

We retained 122 patients with T2DM and 127 without T2DM. The prevalence of FSD was 47.5% in diabetics and 44.1% in non-diabetics. In patients with T2DM, factors associated with FSD were age [50-59 years] (OR = 2.03 [1.03-4.51]), nephropathy (OR = 2.18 [1.09-3.98]), ischemic stroke (p = 0.0483), ischemic heart disease (p = 0.005), carotid atherosclerosis (OR = 2.64 [1.09-7.85]), obesity (OR = 3.64 [1.22-12.3]), calcium channel blocker use (OR = 4.71 [1.35-21.0]), history of genitourinary infections (OR = 2.06 [1.07-4.28]). In patients without T2DM, they were age [50 - 59 years] (OR = 4.86 [2.16-11.3]), age of first sexual intercourse < 18 years (OR = 2.06 [1.04-4.57]), irregular menstrual cycle (OR = 2.02 [1.00-6.37]), number of gestations ≥ 4 (OR = 1.99 [1.00-5.41]), abortion (OR = 3.15 [1.21-29.1]) and number of children ≥ 4 (OR = 2.17 [1.01-4.81]).

Conclusion

FSD was more common in diabetics than non-diabetics. Its early management and associated risk factors are necessary to improve the quality of life of patients.

Associations between arterial health and sexual function in women aged 60-64 years

INTRODUCTION

Female sexual dysfunction is very common, but its determinants remain under-investigated. Vasculogenic impairments are suggested to be related to female sexual dysfunction, but previous literature regarding the association is scarce. This study aims to study the association between arterial health and female sexual function in women in their 60s.

MATERIAL AND METHODS

The sample for this cross-sectional study comprised 117 women (aged 60-64 years) who participated in the Finnish Retirement and Aging study. Arterial health was measured according to the participants' pulse wave velocity, ankle-brachial index, blood pressure, and pulse pressure. Sexual function was measured using the Female Sexual Function Index, which resulted in a total score and six sub-scores. Associations were examined using multivariable regression analyses, which were adjusted for age, relationship happiness, systemic menopausal hormone therapy and/or local estrogen, smoking, alcohol risk use, body mass index, and depressive symptoms.

RESULTS

Higher diastolic blood pressure was associated with a higher total Female Sexual Function Index score (β = 0.24, 95% confidence interval [CI] 0.07-0.41) and with higher desire (β = 0.02, 95% CI 0.01-0.04), arousal (β = 0.04, 95% CI 0.01-0.08), lubrication (β = 0.04, 95% CI 0.002-0.08), satisfaction (β = 0.03, 95% CI 0.003-0.05), and pain (β = 0.06, 95% CI 0.02-0.10) sub-scores. Also, higher ankle-brachial index was associated with higher satisfaction sub-score (β = 2.10, 95% CI 0.44-3.73) and lower pulse pressure was associated with higher orgasm sub-score (β = 0.03, 95% CI 0.0002-0.06). Other associations between ankle-brachial index and Female Sexual Function Index scores were statistically insignificant, but considering the magnitude the findings may imply clinical significance. Systolic blood pressure and pulse wave velocity were not associated with sexual function.

CONCLUSIONS

This study suggested a plausible association between higher diastolic blood pressure and female sexual function, but considering clinical significance our findings suggest an association between higher ankle-brachial index and good sexual function in women in their 60s.

Sexual dysfunction and commonly used drugs in neurology

Sexual dysfunction is common in men and women with neurological diseases. Medications used in neurology can cause sexual dysfunction independently of the disease process and this may adversely affect patients' quality of life. This review focuses on medications commonly prescribed to neurological patients that may contribute to altered sexual function, and discusses how they may differ in men and women.

Association between cardiovascular disease and risk of female sexual dysfunction: a systematic review and meta-analysis

AIMS

Female sexual dysfunction (FSD) is a considerably underestimated condition. It has been repeatedly reported that patients with cardiovascular diseases (CVD) may suffer from an increased risk of FSD. However, there is still a lack of comprehensive and systematic evaluation of various CVD and FSD. We aimed to elucidate the association between CVD and FSD through a comprehensive literature review and meta-analysis.

METHODS AND RESULTS

The PubMed, Scopus, Embase, and Cochrane Library databases were systematically searched from inception to 28 February 2023. We identified all relevant studies reporting the risk of FSD in subjects with or without CVD. The associations between CVD and the risk of FSD were assessed by calculating pooled odds ratios (ORs) (cross-sectional studies) and risk ratios (RRs) (longitudinal studies) with 95% CIs. We employed random-effects models to account for potential heterogeneity, and the quality of the included studies was assessed using the Newcastle-Ottawa Scale. Fifty-four articles with 148 946 individuals were included in our meta-analysis. Compared with control subjects, subjects with CVD had a 1.51-fold increased risk of FSD (OR 1.51 95% CI, 1.34-1.69, P < 0.001, heterogeneity I2 = 91.4%, P < 0.001). Subgroup analyses indicated that the association between CVD and FSD remained significant in longitudinal studies (RR 1.50 95% CI, 1.21-1.86, P < 0.001, heterogeneity I2 = 86.7%, P < 0.001). Particularly, hypertension (OR 1.41 95% CI, 1.23-1.62, P < 0.001, heterogeneity I2 = 82.7%, P < 0.001), stroke (OR 1.81 95% CI, 1.54-2.12, P < 0.001, heterogeneity I2 = 0%, P < 0.423), and myocardial infarction (OR 2.07 95% CI, 1.60-2.67, P < 0.001 heterogeneity I2 = 82.4%, P < 0.001) were significantly associated with FSD. Meta-regression revealed that the primary sources of heterogeneity in FSD are attributable to adjustments for covariates, study design, and study population.

CONCLUSION

Our meta-analysis indicated that patients with CVD suffer from a greater risk of developing FSD. Meanwhile, we validated these findings in longitudinal queues. Notably, conditions such as hypertension, stroke, and myocardial infarction demonstrated a significant association with the incidence of FSD.

Sexual function scores are associated with arterial stiffness in postmenopausal women

BACKGROUND

Female sexual dysfunction (FSD) has been suggested to be correlated with the burden of cardiovascular risk factors.

AIM

We aimed to evaluate the possible association between functional indices of vascular function and FSD scores in apparently healthy postmenopausal women.

METHODS

This cross-sectional study included 116 postmenopausal women who underwent assessment of endothelial function with measurement of flow-mediated dilation (FMD) of the branchial artery and arterial stiffness estimation with measurement of the carotid-femoral pulse wave velocity (PWV). We used the Greene Climacteric Scale to evaluate vasomotor symptomatology, the Female Sexual Function Index (FSFI) to evaluate FSD and the Beck Depression Inventory to evaluate mood disorder. Low sexual function was defined as an FSFI score <26.55.

OUTCOMES

These included FSFI and low sexual function scores as well as measures of PWV and FMD.

RESULTS

Sexual function scores were associated with measures of blood pressure (normal vs low sexual function; systolic blood pressure: 120.2 ± 15.0 mm Hg vs 113.4 ± 14.6 mm Hg; analysis of covariance P = .026; diastolic blood pressure: 75.9 ± 10.5 mm Hg vs 70.3 ± 9.9 mm Hg; analysis of covariance P = .012; both adjusted for age, body mass index, current smoking, and PWV). Systolic blood pressure, but not diastolic blood pressure, was associated with FSFI (B = 0.249, P = .041) and PWV (B = 0.392, P < .001). PWV measures were associated with FSFI (B = -0.291, P = .047) and pulse pressure (B = 0.355, P = .017). FMD measures were also associated with FSFI (B = 0.427, P = .033). All models were adjusted for age, body mass index, current smoking, insulin resistance, vasomotor symptomatology, and Beck Depression Inventory.

CLINICAL IMPLICATIONS

Our findings demonstrate that lower scores of sexual function are associated with deteriorated vascular function mainly manifested as arterial stiffening, further contributing to systolic blood pressure changes.

STRENGTHS AND LIMITATIONS

The strength of this study is the carefully selected healthy sample of postmenopausal women, with simultaneous assessment of climacteric symptomatology and mood disorders. The limitations include the small sample size, the cross-sectional design, and the recruitment of consecutive outpatients of a university menopause clinic.

CONCLUSION

Longitudinal studies and interventions to improve FSD should further assess the clinical relevance of these findings.