Sexual Function in Women With Polycystic Ovary Syndrome: Design of an Observational Prospective Multicenter Case Control Study.

Hester Pastoor,Joop S.E Laven,Stephanie Both,Reinier Timman,Ellen T.M Laan

doi:10.1016/j.esxm.2020.07.002

Abstract

IntroductionThe prevalence of polycystic ovary syndrome (PCOS) is 10–15% in women of reproductive age. Its characteristics are (i) clinical or biochemical hyperandrogenism, (ii) oligomenorrhea or amenorrhea, and (iii) polycystic ovaries on ultrasound. PCOS is associated with lower quality of life, depression, anxiety, diabetes, and cardiovascular disease. Treatment commonly entails oral contraceptive use to lower endogenous androgen levels. Androgen levels and comorbidities may affect sexual function. Previous studies have addressed a limited range of possible contributing factors. We will assess sexual function as well as genital and self-reported sexual arousal in a laboratory setting in women with PCOS compared to an age-matched healthy control group. Modulation by biopsychosocial factors mentioned will be studied.MethodsThis is a multicenter prospective case control study. The study population includes healthy women with and without PCOS, aged 18–40 years, in a stable heterosexual relationship for at least 6 months. Power is calculated at 67 participants in each group. Anticipating a drop out of 10%, 150 participants will be recruited.Main outcome measuresThe main outcomes measured are sexual function using the Female Sexual Function Index, Sexual Desire Inventory, and Female Sexual Distress Scale-Revised; genital sexual arousal measured as vaginal pulse amplitude; and self-reported sexual arousal in response to erotic stimuli in a laboratory setting. The mediators that will be investigated include testosterone, free androgen levels, oral contraceptive use, sensitivity to androgens (using CAG repeat length), body mass index, body image, mental health, and self-esteem.ConclusionStrengths of this study are the inclusion of a broad range of biopsychosocial outcome measures including DNA analysis, a healthy control group, and standardized assessment of genital and self-reported sexual arousal in a laboratory setting. With the design of this study we aim to provide an insight into which biopsychosocial factors associated with PCOS are related to sexual function, and how sexual function may be affected by treatment. These new insights may help to improve clinical management of PCOS while improving the quality of life.Pastoor H, Both S, Timman R, et al. Sexual Function in Women With Polycystic Ovary Syndrome: Design of an Observational Prospective Multicenter Case Control Study. Sex Med 2020;8:718–729.

Highlights

The prevalence of polycystic ovary syndrome (PCOS) is 10e15% in women of reproductive age
A pilot study concerning the effect of circulating androgen levels found no significant differences in clitoral vascularization in non-aroused women with PCOS in comparison with control women,[98] but nothing is known about the genital response to sexual stimulation
The primary aim of this study is to assess differences between women with PCOS and control women in the following sexual outcome measures: Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), Sexual Desire Inventory (SDI), and genital and subjective sexual responsiveness to sexual stimuli measured with vaginal pulse amplitude (VPA)

Summary

Introduction

The prevalence of polycystic ovary syndrome (PCOS) is 10e15% in women of reproductive age. Its characteristics are (i) either clinical (hirsutism) or biochemical hyperandrogenism (elevated androgen serum levels), (ii) oligomenorrhea or amenorrhea, and (iii) polycystic ovaries on ultrasound.[2] Following the Rotterdam criteria, PCOS is diagnosed when 2 out of 3 characteristics are present.[2] Treatment of PCOS is complex and varies depending on symptoms and whether there is a desire to have children. In the latter group, the first-line treatment in women who are overweight or obese is lifestyle modification followed by ovulation induction. Lifestyle changes contribute to optimizing success rates in establishing a pregnancy and reducing complication rates by normalizing insulin resistance and androgen levels.3e6 In women who do not want to become pregnant, treatment usually consists of oral contraceptive pill (OCP) use and lifestyle changes if indicated.[7]

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