Abstract
PurposeWe compared the sexual function in women with classic forms of congenital adrenal hyperplasia (CAH) and polycystic ovary syndrome (PCOS) to find if the cause of androgen excess determines sexual functioning.MethodsHundred and four women (21 with CAH, 63 with PCOS and 20 healthy controls) aged 18–40 years were included into the study. All participants completed a questionnaire regarding their sociodemographic background and underwent anthropometric and basic biochemical measurements. Plasma levels of total testosterone, androstenedione, and 17-hydroxyprogesterone were measured with immunoassay. To assess the sexual functions, the Female Sexual Function Index (FSFI) questionnaire was applied.ResultsApart from the higher physical activity in PCOS patients (P = 0.017), we found no significant sociodemographic differences between the studied groups. In clinical assessment, women with CAH had a lower incidence of acne (P = 0.006). Their plasma levels of 17OHP (P = 0.005) and insulin resistance index (P = 0.0248) were higher, while total testosterone (P = 0.0495) and glucose (P = 0.0061) was lower compared to the PCOS group. Significantly more women with CAH were homosexual (P = 0.003) and bisexual (P = 0.006). CAH group showed a lower total FSFI score (P = 0.0043) and lower scores in three domains: lubrication (P = 0.0131), sexual satisfaction (P = 0.0006), and dyspareunia (P < 0.0001). Higher physical activity was associated in all women with higher total FSFI score (P = 0.009) and scores in the domain of desire (P = 0.034) and sexual satisfaction (P = 0.01), while in CAH women apart from the total score (P = 0.03) and sexual satisfaction (P = 0.002) also in the domains of orgasm (P = 0.005), and pain (P = 0.03).ConclusionsCAH women present more often homosexual and bisexual orientation, while their sexual functions are impaired compared to PCOS patients.
Highlights
Androgen excess is one of the most common endocrine disorders affecting approximately 7% of reproductive-age women [1, 2]
Congenital adrenal hyperplasia (CAH), a term applied to a group of autosomally inherited recessive disorders caused by mutations in a single enzyme involved in cortisol synthesis, is much less common
The main finding is that despite the common clinical picture, sexual functions in women with CAH are impaired compared to polycystic ovary syndrome (PCOS) women
Summary
Androgen excess is one of the most common endocrine disorders affecting approximately 7% of reproductive-age women [1, 2]. Girls and adult women with CAH manifest increased gender atypical behavior (which correlates with the severity of CYP21A2 genotype), most of them develop their gender identity as women [6] Their sexual orientation is usually heterosexual, but in this group, homosexual and bisexual orientation were observed more frequently than in the general population [7]. Women with this syndrome report worse marital functioning, less satisfaction with their sex life, and rate themselves negatively as sexual partners [12] Both CAH and PCOS show a similar clinical picture like hyperandrogenism, metabolic syndrome, and menstrual abnormalities, and both can be associated with sexual dysfunction compared to women without AED. In our study, we decided to compare sexual functions in patients suffering from those two diseases which have a different origin, in reference to healthy women without hyperandrogenism, to establish if pathogenesis of AED has an influence on sexual life in women
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