Abstract
Purpose. No data are currently available on female sexual dysfunction (FSD) in primary adrenal insufficiency (PAI) and the possible impact of replacement therapy. The aim of this study was to evaluate the prevalence of FSD and sexual distress (SD), and to evaluate the possible impact of replacement therapy on sexuality in women with PAI. Methods. Female Sexual Function Index-6 (FSFI-6) and Sexual Distress Scale (SDS) questionnaires were administered to 22 women with PAI and 23 healthy women matched for age as controls. Results. The prevalence of sexual symptoms measured by FSFI-6 (total score < 19) was significantly higher in women with PAI (15/22; 68.2%) compared to the controls (2/23; 8.7%; p = 0.001). Regarding the questionnaire items, significantly different scores were found for desire (p < 0.001), arousal (p = 0.0006), lubrication (p = 0.046) and overall sexual satisfaction (p < 0.0001) in women with PAI compared to the controls. The rate of FSD (FSFI < 19 with SDS >15) was 60% in patients with PAI. A significant inverse correlation was found between FSFI-6 total scores and SD (r = −0.65; p = 0.0011), while a significant direct correlation was found between FSFI-6 total scores and serum cortisol levels (r = 0.55; p = 0.035). Conclusions. A higher prevalence of FSD was found in women affected by PAI compared to healthy women. Desire seems to be the most impaired aspect of sexual function. Moreover, sexual dysfunction in this population seems to be related to sexual distress and cortisol levels.
Highlights
Published: 24 June 2021Primary adrenal insufficiency (PAI) is characterized by the destruction of the cortical portion of the adrenal gland with a depletion of the hormonal function, leading to a progressive deficiency in glucoactive, mineraloactive and androgen hormones
The experimental group was composed of 2 patients with isolated primary adrenal insufficiency (PAI), 20 patients affected by type 2 autoimmune polyendocrine syndrome (APS2) including PAI and chronic thyroiditis with TSH falling within the normal range
The prevalence of sexual symptoms was 44.2%, whereas sexually related personal distress was observed in only 22.8% of respondents. These results indicate that female sexual dysfunction (FSD) may be overestimated when sexual distress (SD) is not considered [19]
Summary
Published: 24 June 2021Primary adrenal insufficiency (PAI) is characterized by the destruction of the cortical portion of the adrenal gland with a depletion of the hormonal function, leading to a progressive deficiency in glucoactive, mineraloactive and androgen hormones. The treatment of PAI includes a replacement therapy with glucocorticoids (cortisone acetate, hydrocortisone) and mineralocorticoids (fludrocortisone) [2]. The lack of a therapeutic target marker often leads to the mentioned drugs being overdosed with a consequent loss of circadian rhythm. Both the hormonal deficit and the replacement therapy itself deeply impact the quality of life (QoL) of these patients [3]. Pharmacological research has developed a modified-release hydrocortisone formulation in order to mimic the circadian rhythm of cortisol as closely as possible. Some studies report an improvement in QoL and metabolic parameters in patients treated with modified-release hydrocortisone [4,5,6]. The studies investigating QoL do not refer to the function and quality of sexual life
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