Sexual dysfunction and quality of life in postmenopausal type 2 diabetes mellitus: clinical and laboratory factors

Female sexual dysfunction (FSD) has an impact on the lives of many women, and it is inadequately investigated by medical professionals in women living with HIV (WLWH). In the present study, the aim was to investigate the prevalence and risk factors of sexual dysfunction (SD) in a cohort of WLWH using the Female Sexual Function Index (FSFI) questionnaire. This monocentric cross-sectional study was conducted at the ASST Spedali Civili of Brescia, Italy, between April 2023 and August 2023. To assess SD, the FSFI questionnaire was administered in accordance with current European AIDS Clinical Society guidelines to all consecutive cisgender adult WLWH who presented to our unit of Infectious Diseases. We used FSFI < 26.55 to identify participants at risk of SD. Participants were divided into two groups based on the pathological cut-off of FSFI score. Comparison of demographic characteristics, menopausal status, and comorbidities among the two different groups of WLWH. The questionnaire was offered to 371 women and 179 (48.2%) completed it. Of the 192 (51,8%) excluded, there were 129 women who declined to participate and 63 who were unable to do so due to a language barrier. Two-thirds (117/179) of individuals declared sexual intercourse in the previous month and were considered. Among those who completed the questionnaire, 36% scored below the FSFI total cut-off, indicating increased risk of SD. The most frequently impaired domains were desire (56.4%) and lubrication (52.1%). The correlation between age and total FSFI score was significant (P= .008), as well as menopausal women obtained lower FSFI scores (P= .0004). Age and menopausal status are substantial factors influencing sexual functionality. This study is limited by its reliance on self-reported data and a sample size that may be insufficient for detecting subtle effects. However, it leverages the well-validated FSFI tool and benefits from trusted questionnaire administration by HIV healthcare providers. Sexual dysfunction in menopausal WLWH has a high prevalence (36%). Interestingly, around 67% of women declined to investigate and deal with sexual issues.

Arriving at the diagnosis of female sexual dysfunction

AB0679 HEALTH ASSESSMENT IN FEMALE PATIENTS WITH SPONDYLOARTHRITIS: FOCUS ON REPRODUCTIVE SPHERE

Female sexual dysfunction (FSD) has been suggested to be correlated with the burden of cardiovascular risk factors. We aimed to evaluate the possible association between functional indices of vascular function and FSD scores in apparently healthy postmenopausal women. 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. These included FSFI and low sexual function scores as well as measures of PWV and FMD. 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. 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. 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. Longitudinal studies and interventions to improve FSD should further assess the clinical relevance of these findings.

Introduction: Approximately 25% of women in the United States experience a symptomatic pelvic floor disorder such as urinary incontinence, pelvic organ prolapse, anal incontinence, and sexual dysfunction. Aspects associated with breast cancer treatment such a chemotherapy, oophorectomy/ovarian suppression, and endocrine therapy may predispose women to pelvic floor disorders. The prevalence of pelvic floor disorders among breast cancer survivors has been cited at 18%, but unpublished cross-sectional data suggests the prevalence may be much higher. In this study, 8.5% - 11.5% of participants experienced prolapse symptoms, 56.2% experienced anal incontinence symptoms, and 43.3% - 51.2% experience urinary incontinence symptoms. While pelvic floor dysfunction is associated with lower quality of life, it is unknown if breast cancer survivors with pelvic floor disorders experience decreased quality of life. The primary aim of this study was to assess if breast cancer survivors with pelvic floor disorders experience lower quality of life. Methods: Women 18 years or older who were previously treated for breast cancer and who were enrolled in a cancer research registry were invited to complete the Pelvic Floor Distress Inventory 20 (PFDI-20), the Female Sexual Function Index (FSFI), and the Short Form 12. Demographic and clinical data were abstracted from the research registry. A participant was considered eligible for the study if she had enrolled in the cancer registry and completed all core questions (i.e. demographics, cancer diagnosis, cancer treatment, endocrine therapy, medical/surgical history, and risk factors). As per standard PFDI-20 reporting, presence of a symptom was defined as answering a 1, 2, 3, or 4 to a question, while presence of a bothersome symptom was defined as answering a 2, 3, or 4. A score of 26 or less on the FSFI was considered indicative of sexual dysfunction. Results: A total of 634 women were considered eligible for enrollment in the study. 445 were able to be contacted, and 410 women agreed to participate in the study. Of those, 303 returned the PFDI-20 questionnaire and FSFI questionnaire, and 264 returned the SF-12 for response rates of 74% and 64%, respectively. Overall, higher scores on the PFDI-20 was associated with lower scores on both the physical and mental components of the SF-12 (Rho = -0.298, p = &amp;lt;.0001; Rho = -0.202, p = .0009, respectively). When the PFDI-20 was broken into subscores, higher POPDI scores (prolapse) was associated with lower physical component scores but not lower mental component scores. Higher CRADI scores (anal incontinence) and UDI-6 scores (urinary incontinence) were associated with lower physical and mental scores. Neither overall FSFI scores or subset domain scores were associated with lower physical or mental component scores of the SF-12. In linear regression analysis, PFDI summary score remained statistically significantly related to both mental and physical component subscores after controlling for age, race, stage of breast cancer, time since diagnosis, and use of adjuvant endocrine therapy. FSFI scores were related to age and endocrine therapy use, but were not related to SF-12 scores. Conclusion: Among a subset of breast cancer survivors, pelvic disorders including pelvic organ prolapse, urinary incontinence, and anal incontinence exist, and these disorders are associated with decreased mental wellbeing. All pelvic floor disorders except pelvic organ prolapse were associated with decreased physical wellbeing. None of the domains of female sexual dysfunction were associated with decreased physical or mental wellbeing among breast cancer survivors. A subset of breast cancer survivors experiences bothersome pelvic floor disorders and thus screening for these disorders can increase referrals to appropriate treatment and complement survivorship care to enhance overall quality of life. Citation Format: Jon F Pennycuff, Felice Yang, Tania Lobo, Caroline Jackman, Colleen McGuire, Ami Chitalia, Kristi Graves. Pelvic floor disorders and quality of life among breast cancer survivors [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS9-26.

<h3>Introduction/Background</h3> Gynecologic cancers greatly affect a woman's sexuality, sexual functioning, intimate relationships, and sense of self. Twenty-three to seventy percent of cervical cancer survivors report problems with their sexual functioning. However, little is known about how sexual dysfunction affect their quality of life since many of them report psychosexual healthcare needs, but only one-third seek professional help. Evaluating their female sexual function will help identify the presence of sexual dysfunction among cervical cancer survivors, provide appropriate intervention and improve their quality of life. <h3>Methodology</h3> The study used a prospective, cross-sectional survey design that employed a self-administered questionnaire using the Female Sexual Function Index (FSFI) to identify the presence of sexual dysfunction among cervical cancer patients in a tertiary medical center from June to December 2019. Descriptive statistics were reported to describe the distribution of patients in terms of the different numerical variables, whereas frequency and simple percentage were used to determine the distribution of respondents in terms of the different categorical variables. <h3>Results</h3> Forty-two cervical cancer patients were assessed. The mean age of the studied population was 44.85. More than half was married (59.52%), and majority was from Cebu City (66.78%). Approximately 43% (42.86%) finished college and were mostly catholics (69.05%). The mean age of diagnosis was 42.85, with an average gravidity and parity of 1. Most of the patients interviewed were diagnosed with stage 3B cervical cancer (42.86%). The mean overall Female Sexual Function Index (FSFI) score of the studied population was 6.59, which indicated that all of the patients studied had female sexual dysfunction. <h3>Conclusion</h3> All the cervical cancer patients included in this study had female sexual dysfunction as evidenced by the low FSFI scores in each of the 6 dimensions and low overall FSFI score. <h3>Disclosures</h3> None.

Prevalence of Sexual Dysfunction among Postmenopausal Women with and without Metabolic Syndrome

Objectives: Female sexual dysfunction (FSD) is a very common sexual health problem worldwide. The prevalence of FSD in Chinese women is, however, unknown. This is the first study to investigate a large number of young women throughout China via the internet, to determine the prevalence and types of FSD and to identify the risk factors for FSD. Methods: The primary endpoint was the Female Sexual Function Index (FSFI) score, with additional questions on contraception, sexual activity, relationship stability, pregnancy and other factors which may influence sexual function. The online questionnaire was completed by women from 31 of the 34 Chinese provinces. Results: A total of 1618 completed questionnaires were received, and 1010 were included in the analyses after screening (62.4%). The mean age of the respondents was 25.1 ± 4.5 years. The mean total FSFI score was 24.99 ± 4.60. According to FSFI definitions (cut-off score 26.55), 60.2% of women were at risk of FSD. Based on domain scores, 52 were considered at high risk of dysfunction for pain (5.1%), 35 for orgasm (3.5%), 33 for desire (3.3%), 20 for arousal (2.0%), 6 for satisfaction (0.6%) and 2 for lubrication (0.2%). Conclusions: The prevalence of FSFI scores indicating risk of sexual dysfunction was about 60% in Chinese women. An unstable relationship, pressure to become pregnant, non-use of contraception, negative self-evaluation of appearance and increasing age were significantly associated with FSD in young Chinese women.

BackgroundMenopause-related endocrinological shifts are linked to sexual dysfunction, and women with endometriosis exhibit lower Female Sexual Function Index (FSFI) scores, indicating impaired sexual well-being.AimTo assess the impact of menopause on sexual function in women with endometriosis.MethodsAn anonymous online survey was conducted among 1586 French women diagnosed with endometriosis. The FSFI questionnaire was used to evaluate sexual function, and menopause was defined as ≥12 months of amenorrhea. Multivariable logistic regression was performed to assess the relationship between FSFI scores and menopause status, adjusting for tobacco use, education, number of symptoms, and history of surgery. Logworth analyses were used to determine the strongest components of FSFI associated with menopause.OutcomesThe primary outcome was the FSFI total score and its six domains (desire, arousal, vaginal lubrication, orgasm, satisfaction, and dyspareunia) in menopausal and non-menopausal women with endometriosis.ResultsMenopausal women had significantly lower FSFI scores (15.3 vs. 16.9, P = 0.021). After adjustment, FSFI remained significantly lower (P = 0.026) in menopausal women but did not reach the established FSFI cutoff for sexual dysfunction (P = 0.451). Stratified analysis by age showed a steep decline in FSFI between 46 and 50 years, partial improvement at 51-55 years, and further decline after 55 years, particularly in arousal, orgasm, dyspareunia, and satisfaction. Arousal (logworth = 4.53, P < 0.001) was the most affected domain, followed by satisfaction (logworth = 1.81, P = 0.015).Clinical ImplicationsArousal appears to be the key determinant of sexual function decline in menopausal women with endometriosis, highlighting the need for targeted interventions such as hormone therapy, pain management, and sexual counseling.Strengths & LimitationsThe study benefits from a large sample size and validated FSFI assessment but is limited by selection bias from online recruitment, self-reported diagnosis of endometriosis, and lack of hormonal status confirmation. The cross-sectional design prevents causal inferences.ConclusionMenopause is associated with a decline in FSFI scores among women with endometriosis, with arousal being the most affected domain, underscoring the need for further research on personalized management strategies for sexual dysfunction in this population.

Considering the prevalence of Human Papillomavirus (HPV) infection and the lack of HPV vaccination program in Iran among young women and the importance of quality of life and sexual performance in women, we decided to conduct a study to examine the relationship between HPV infection and sexual dysfunction and quality of life in Iranian women. In this cohort study, 250 married women who infected with HPV were recruited via convinence sampling from colposcopy clinic of Arash women hospital (Tehran, Iran) from April 2020 to May 2022.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 (the total FSFI score is calculated by the sum of the nineteen items). Sexual quality of life-female (SQOL-F) items (Likert-type scale with a cut-off of 65 points) were organized into four sub-scales: psychosexual feelings, sexual and relationship satisfaction, self-worthlessness, and sexual repression. All patients filled out the female sexual function index (FSFI) and sexual quality of life (SQOL) questionnaires. Variables were analysed via correlation coefficient and linear regression tests. Mean age and mean marriage duration were 38.5±4.5 and 12.2±7.2, respectively. There was a weak correlation between FSFI and SQOL (r=0.15, p=0.001).Time of marriage and genital warts were the predictors on the FSFI and SQOL. The findings suggest that HPV infection can impair sexual function and quality of life. This research contributes valuable insights, especially considering the prevalence of HPV.

Introduction: Sexual issues in postmenopausal women have garnered limited interest despite their high prevalence. Menopause is a natural part of ageing in women and has been reported to have a negative impact on the quality of life. In the present study, we examined the association between sexual functions and quality of life parameters in postmenopausal women. Materials and Method: In total, 67 postmenopausal women who sequentially presented to climacteric clinics were enrolled in this study. All participants were administered a structured sociodemographic data form, a 7-item relationship assessment scale, female sexual function index and the 36-item short-form health survey -SF-36-. Results: Mean age, mean age at the beginning of menopause and mean menopause duration were 52.6±6.14, 46.46±5.58 and 6.23±4.94 years, respectively. 36-item short-form health survey -SF-36-social function score was positively correlated with sexual desire, arousal, degree of lubrication, ability to achieve orgasm, intercourse satisfaction, female sexual function index pain domain score, and total female sexual function index score. Moreover, 36-item shortform health survey -SF-36-physical function score was positively correlated with arousal, pain and total female sexual function index score. 36-item short-form health survey -SF-36-physical role difficulties score was positively correlated with the ability to achieve orgasm and female sexual function index pain scores. female sexual function index score correlated with SF-36 social function, physical function and physical role difficulties subscale scores. 36-item shortform health survey -SF-36-social function score predicted arousal, ability to achieve orgasm, intercourse satisfaction, pain and total female sexual function index scores after controlling for age and menopause duration. Conclusion: In the evaluation of sexual functioning in postmenopausal women, problems related to relationship with partner and quality of life, especially physical functions, should be take into account carefully. Keywords: Post-menopause; Life quality; Sexual dysfunction, physiological; Sexual dysfunction, psychological

The study's main objective was to describe the prevalence and severity of female sexual dysfunction (FSD) amongst a group of Ghanaian women in the outpatient setting of the predominantly rural Volta region of Ghana. Additionally we determine the predictors of FSD severity and care seeking behaviors of women with the condition. This was a cross sectional study conducted in the outpatient setting of the Ho Teaching Hospital in the rural-savannah, agro-ecological zone of Volta Region, Ghana. FSD was assessed using the Female Sexual Function Index (FSFI) questionnaire. FSD was defined with a cutoff of ≤23 so as not to under-estimate the prevalence in this conservative setting. FSFI score >23 was designated "no FSD". We further categorized women with FSD as having mild (FSFI Total score 18-23), moderate (FSFI Total score <18 to >10) or severe (FSFI Total score ≤10) FSD. Due to sample size restrictions, we combined the moderate and severe FSD groups in our analyses and defined "moderate/severe FSD" as an FSFI Total score < 18. Participants with FSD were further asked to indicate whether or not they sought help for their conditions, the reasons they sought help, and the types of help they sought. We used p<0.05 to determine statistical significance for all analyses and logistic regression models were used to determine crude and age-adjusted effect estimates. FSD Prevalence: Out of 407 women approached, 300 (83.8%) agreed and consented to participate in the study. The prevalence of FSD was 48.3% (n = 145). Compared to those without FSD, over a third of the FSD women resided in rural settings (37.90% vs 20.60%; p = 0.001) and tended to be multiparous, with a significantly greater proportion having at least three children (31.70% vs 18.10%; p = 0.033). FSD Severity: Over a quarter of the sample (27.6%, n = 40) met the cut-off for moderate to severe FSD. In age-adjusted models, lubrication disorder was associated with 45 times the odds of moderate/severe FSD (age-adj. OR: 45.38, 95% CI: 8.37, 246.00; p<0.001), pain with 17times the odds (age-adj. OR: 17.18, 95% CI: 4.50, 65.50; p<0.001) and satisfaction almost 5times the odds (age-adj. OR: 4.69, 95% CI: 1.09, 20.2; p = 0.04). Compared to those with 1-3 children, nulliparous women had 3.5 times higher odds of moderate/severe sexual dysfunction as well (age-adj. OR:3.51, 95% CI:1.37,8.98; p = 0.009). FSD-related Health Seeking Behaviors: Statistically significant predictors of FSD-related care seeking included having FSD of pain disorder (age-adj. OR: 5.91, 95% CI:1.29, 27.15; p = 0.02), having ≥4 children (age-adj. OR: 6.29, 95%CI: 1.53, 25.76; p = 0.01). Of those who sought help, seven in 10 sought formal help from a healthcare provider, with General Practitioners preferred over Gynecologist. About one in 3 (31.3%) who did not seek help indicated that they did not know their sexual dysfunction was a medical condition, over a quarter (28.9%) "thought it was normal" to have FSD, and interestingly, 14.1% did not think a medical provider would be able to provide them with assistance. Sexual dysfunctions are prevalent yet taboo subjects in many countries, including Ghana. Awareness raising and efforts to feminize the physician workforce are necessary to meet the healthcare needs of vulnerable members of Ghanaian society.

Sexual Dysfunction in Women Treated for Type 1 Diabetes and the Impact of Coexisting Thyroid Disease.

ObjectivesThe study’s main objective was to describe the prevalence and severity of female sexual dysfunction (FSD) amongst a group of Ghanaian women in the outpatient setting of the predominantly rural Volta region of Ghana. Additionally we determine the predictors of FSD severity and care seeking behaviors of women with the condition.Study design and settingThis was a cross sectional study conducted in the outpatient setting of the Ho Teaching Hospital in the rural-savannah, agro-ecological zone of Volta Region, Ghana.Methods and proceduresFSD was assessed using the Female Sexual Function Index (FSFI) questionnaire. FSD was defined with a cutoff of ≤23 so as not to under-estimate the prevalence in this conservative setting. FSFI score >23 was designated “no FSD”. We further categorized women with FSD as having mild (FSFI Total score 18–23), moderate (FSFI Total score <18 to >10) or severe (FSFI Total score ≤10) FSD. Due to sample size restrictions, we combined the moderate and severe FSD groups in our analyses and defined “moderate/severe FSD” as an FSFI Total score < 18. Participants with FSD were further asked to indicate whether or not they sought help for their conditions, the reasons they sought help, and the types of help they sought. We used p<0.05 to determine statistical significance for all analyses and logistic regression models were used to determine crude and age-adjusted effect estimates.ResultsFSD Prevalence: Out of 407 women approached, 300 (83.8%) agreed and consented to participate in the study. The prevalence of FSD was 48.3% (n = 145). Compared to those without FSD, over a third of the FSD women resided in rural settings (37.90% vs 20.60%; p = 0.001) and tended to be multiparous, with a significantly greater proportion having at least three children (31.70% vs 18.10%; p = 0.033).FSD Severity: Over a quarter of the sample (27.6%, n = 40) met the cut-off for moderate to severe FSD. In age-adjusted models, lubrication disorder was associated with 45 times the odds of moderate/severe FSD (age-adj. OR: 45.38, 95% CI: 8.37, 246.00; p<0.001), pain with 17times the odds (age-adj. OR: 17.18, 95% CI: 4.50, 65.50; p<0.001) and satisfaction almost 5times the odds (age-adj. OR: 4.69, 95% CI: 1.09, 20.2; p = 0.04). Compared to those with 1–3 children, nulliparous women had 3.5 times higher odds of moderate/severe sexual dysfunction as well (age-adj. OR:3.51, 95% CI:1.37,8.98; p = 0.009).FSD-related Health Seeking Behaviors: Statistically significant predictors of FSD-related care seeking included having FSD of pain disorder (age-adj. OR: 5.91, 95% CI:1.29, 27.15; p = 0.02), having ≥4 children (age-adj. OR: 6.29, 95%CI: 1.53, 25.76; p = 0.01). Of those who sought help, seven in 10 sought formal help from a healthcare provider, with General Practitioners preferred over Gynecologist. About one in 3 (31.3%) who did not seek help indicated that they did not know their sexual dysfunction was a medical condition, over a quarter (28.9%) “thought it was normal” to have FSD, and interestingly, 14.1% did not think a medical provider would be able to provide them with assistance.ConclusionsSexual dysfunctions are prevalent yet taboo subjects in many countries, including Ghana. Awareness raising and efforts to feminize the physician workforce are necessary to meet the healthcare needs of vulnerable members of Ghanaian society.

Objective This study aimed to investigate the association between depression and female sexual function among postmenopausal women. Study design The study group was composed of 232 sexually active postmenopausal women. Serum testosterone, androstenedione, dehydroepiandrosterone sulfate, fasting glucose, insulin, sex hormone-binding globulin, total cholesterol, high-density lipoprotein, low-density lipoprotein and triglyceride levels were analyzed. Quantification of pelvic organ prolapse was performed for each patient. The Female Sexual Function Index (FSFI) questionnaire and the Beck Depression Inventory (BDI) were distributed and compared between postmenopausal and premenopausal women. Results The mean BDI score was 17.5 ± 9.8. Sexual dysfunction determined by the mean FSFI score was 64.2%. In total, 70.5% of the postmenopausal women with sexual dysfunction had moderate to severe depression. There was a low negative correlation between age and duration after menopause and mean FSFI scores (r = –0.334 and r = –386, respectively). There was a negligible positive correlation between age and duration after menopause and mean BDI scores (r = 0.281 and r = 0.276, respectively). The satisfaction domain of the FSFI was significantly decreased with postmenopausal depression. Conclusion Postmenopausal women with sexual dysfunction had higher depression scores. Age and time after menopause were weakly associated with both FSFI and BDI scores in postmenopausal women.