Impact of clinical and biochemical parameters on quality of life and sexuality in PCOS

Abstract

Hyperandrogenism, irregular menses, infertility and the threat of long term complications associated with obesity cause a major reduction in the quality of life and sexual satisfaction of PCOS women. However, little is known about the individual contribution of clinical and biochemical disturbances to the psychological problems. In 120 untreated PCOS patients (mean age 27 years) complete metabolic (BMI, insulin resistance), hormonal (androgens) and clinical (menstrual irregularity, acne, hirsutism) data were obtained. For psychological variables, health-related quality of life was measured by SF-36, psychological disturbances with the SCL, and sexual satisfaction by visual analogue scales. Correlation analyses, regression models and t-tests for statistical evaluation were computed with the SPSS software. In PCOS patients, BMI and hirsutism scores were most strongly associated with physical quality of life scales and sexual functioning, while acne was not associated with any psychological variable. Specifically, significant correlation was found between BMI and SF-36 scales Physical Function, SCL scale Somatization, sexual attractiveness, and difficulty forming social contacts. Hirsutismus was significantly correlated with SCL scale Somatization, sexual attractiveness, difficulty forming social contacts, and impact of body hair on sexuality. While 35% of the variance in the SF-36 Physical Function scale was accounted for by BMI, no other variables explaining the marked decreases in the psychological scales of the SF-36 were detected. Associations between hormonal and psychological data were weak and inconsistent. No clear effect of androgens on sexual satisfaction was detected. Similarly, menstrual cycle disturbance had no impact on psychological well-being. In conclusion, changes in physical appearance, particularly obesity and excessive body hair, are the most important determinants of psychological problems in PCOS. On the other hand, the role of endocrine and metabolic parameters as well as menstrual cyclicity and infertility appears to be less important.