Incidence Of Female Sexual Dysfunction Research Articles

(130) ASSOCIATION BETWEEN CARDIOVASCULAR DISEASE AND RISK OF FEMALE SEXUAL DYSFUNCTION: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Introduction Female sexual dysfunction (FSD) is a considerably underestimated condition. It has been repeatedly reported that patients with cardiovascular diseases (CVD) may suffer from an increased risk of FSD. However, there is still a lack of comprehensive and systematic evaluation of various CVD and FSD. Objective We aimed to elucidate the association between CVD and FSD through a comprehensive literature review and meta-analysis. Methods The PubMed, Scopus, Embase, and Cochrane Library databases were systematically searched from inception to February 28, 2023. We identified all relevant studies reporting the risk of FSD in subjects with or without CVD. The associations between CVD and the risk of FSD were assessed by calculating pooled ORs (cross-sectional studies) and RRs (longitudinal studies) with 95% CIs. We employed random-effects models to account for potential heterogeneity, and the quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). Fifty-four articles with 148 946 individuals were included in our meta-analysis. Results Compared with control subjects, subjects with CVD had a 1.51-fold increased risk of FSD (OR 1.51 95% CI, 1.34-1.69, P < .001, heterogeneity I2 = 91.4%, P < .001). Subgroup analyses indicated that the association between CVD and FSD remained significant in longitudinal studies (RR 1.50 95% CI, 1.21-1.86, P < .001, heterogeneity I2 = 86.7%, P < .001). Particularly, hypertension (OR 1.41 95% CI, 1.23-1.62, P < .001, heterogeneity I2 = 82.7%, P < .001), stroke (OR 1.81 95% CI, 1.54-2.12, P < .001, heterogeneity I2 = 0%, P < .423), and myocardial infarction (OR 2.07 95% CI, 1.60-2.67, P < .001 heterogeneity I2 = 82.4%, P < .001) were significantly associated with FSD. Meta-regression revealed that the primary sources of heterogeneity in FSD are attributable to adjustments for covariates, study design, and study population. Conclusions Our meta-analysis indicated that patients with CVD suffer from a greater risk of developing FSD. Meanwhile, we validated these findings in longitudinal queues. Notably, conditions such as hypertension, stroke, and myocardial infarction demonstrated a significant association with the incidence of FSD. Disclosure No.

Association between cardiovascular disease and risk of female sexual dysfunction: a systematic review and meta-analysis.

Female sexual dysfunction (FSD) is a considerably underestimated condition. It has been repeatedly reported that patients with cardiovascular diseases (CVD) may suffer from an increased risk of FSD. However, there is still a lack of comprehensive and systematic evaluation of various CVD and FSD. We aimed to elucidate the association between CVD and FSD through a comprehensive literature review and meta-analysis. The PubMed, Scopus, Embase, and Cochrane Library databases were systematically searched from inception to 28 February 2023. We identified all relevant studies reporting the risk of FSD in subjects with or without CVD. The associations between CVD and the risk of FSD were assessed by calculating pooled odds ratios (ORs) (cross-sectional studies) and risk ratios (RRs) (longitudinal studies) with 95% CIs. We employed random-effects models to account for potential heterogeneity, and the quality of the included studies was assessed using the Newcastle-Ottawa Scale. Fifty-four articles with 148 946 individuals were included in our meta-analysis. Compared with control subjects, subjects with CVD had a 1.51-fold increased risk of FSD (OR 1.51 95% CI, 1.34-1.69, P < 0.001, heterogeneity I2 = 91.4%, P < 0.001). Subgroup analyses indicated that the association between CVD and FSD remained significant in longitudinal studies (RR 1.50 95% CI, 1.21-1.86, P < 0.001, heterogeneity I2 = 86.7%, P < 0.001). Particularly, hypertension (OR 1.41 95% CI, 1.23-1.62, P < 0.001, heterogeneity I2 = 82.7%, P < 0.001), stroke (OR 1.81 95% CI, 1.54-2.12, P < 0.001, heterogeneity I2 = 0%, P < 0.423), and myocardial infarction (OR 2.07 95% CI, 1.60-2.67, P < 0.001 heterogeneity I2 = 82.4%, P < 0.001) were significantly associated with FSD. Meta-regression revealed that the primary sources of heterogeneity in FSD are attributable to adjustments for covariates, study design, and study population. Our meta-analysis indicated that patients with CVD suffer from a greater risk of developing FSD. Meanwhile, we validated these findings in longitudinal queues. Notably, conditions such as hypertension, stroke, and myocardial infarction demonstrated a significant association with the incidence of FSD.

(115) Prevalence of Clitoral Adhesions in Patients who have Undergone Breast Cancer Care

Abstract Introduction The incidence of female sexual dysfunction (FSD) in patients who have undergone breast cancer care is approximately 66-83% 1,2. Clitoral phimosis is a congenital or acquired condition in which the clitoral hood cannot be fully retracted and can be associated with sexual pain and impaired orgasmic capability. A paper by Aerts et al. in 2018 demonstrated a prevalence of clitoral adhesions/phimosis in patients presenting to their sexual medicine practice to be 22%3. Our sexual health clinic has observed that a large majority of patients who are diagnosed with FSD after treatment for breast cancer also have clitoral phimosis. This may remain underdiagnosed and undertreated since examination of the clitoris and clitoral hood is still not considered a routine portion of the gynecologic examination. Objective There is an increased prevalence of clitoral adhesions in patients who underwent breast cancer care. Methods This was a retrospective observational study. Data was collected from our IRB approved Sexual Health Clinic registry from August 2021 to November 2022. All female patients presenting to our clinic over the age of 18 with a diagnosis of breast cancer who underwent a pelvic exam were included. Patients who did not undergo treatment with an estrogen modulator for their breast cancer were excluded. Results A total of 25 patients presented to the clinic during this time period with a diagnosis of breast cancer. 24 patients underwent a pelvic exam. 23 patients previously underwent treatment with an estrogen modulator. Of these 23 patients, 15 patients (65%) had findings of clitoral adhesions, whereas 8 patients (35%) did not have evidence of clitoral adhesions. Table 1 presents severity of adhesions and associated diagnoses in patients with findings of clitoral adhesions. Conclusions This study serves as preliminary data from our clinic that would indicate that those with a diagnosis of breast cancer that were treated with an estrogen modulator have a higher incidence of clitoral adhesions than the general population. It is therefore our recommendation that all women who have a diagnosis of breast cancer should have a comprehensive vulvar exam including an inspection of the clitoral glans and prepuce. If the prepuce cannot be easily retracted, a diagnosis of clitoral adhesions should be considered. A pilot grant application has been submitted to further investigate prevalence, associated symptoms, severity and treatment efficacy over a longer period. Disclosure No

(531) Effect of COVID- 19 on Sexual Function and Activities Among Women of Reproductive Age

Abstract Introduction The novel SARS corona virus (SARS COV 2) causing the Corona Virus Disease (COVID--19) was first reported in Wuhan, China in 2019 and became a global pandemic in 2020 with severe health and economic consequences forcing nations to declare nationwide lockdown to limit the ragging pandemic. Different patterns of signs and symptoms as well as complications were reported to have followed COVID-19. Objective The objectives of the study were to describe the prevalence of female sexual dysfunction and pattern of dysfunction and to determine the effect of COVID--19 infection pandemic and lockdown on sexual function and activities among women reproductive age. Methods This was a cross sectional study of women in the reproductive age-group evaluating the sexual health function before, during and after the COVID--19 infection pandemic and lockdown. This was assessed using a structured questionnaire and a modified Female Sexual Function Index (FSFI). A pre-tested interviewer administered questionnaire was administered to 203 women participants and the information collected included socio-demographic and gynaecologic characteristics, COVID--19 experiences, sexual history and function before, during and after the COVID--19 pandemic lockdown. Results Most of the respondents were aged between 20 and 50 years (95%), married (77.7%) and were sexually active at the time of the study (92.6%) and 16.3% of the respondents had COVID-19 infection at least once. Only 43.6% of the sexually active respondents currently have normal overall female sexual function score with the mean FSFI score of 24.5. 71.4% had at least mild hyposexual desire, 54.2% with arousal disorder, 32.1% disorders of lubrication, 43.3% have orgasm related dysfunction, 37.8% have sexual satisfaction related dysfunction and 41.1% have disorders of sexual pain. COVID-19 lockdown may have had effect on sexual activities as 11.3% of respondents were not sexually active before the lockdown, 13.3% during the lockdown whereas only 7.4% after the lockdown suggesting abstinence as a result of the lockdown. Among the sexually active respondents during COVID-19 lockdown mean FSFI score of 23.76 and only 36.9% had normal overall FSFI score. Conclusions Female sexual dysfunction is still prevalent with the most common form being disorders of desire and arousal. COVID-19 lockdown resulted in abstinence from sexual intercourse in some women and sexual function also noted to be reduced among the sexually active women with higher incidence of female sexual dysfunction during the lockdown. Disclosure No

Predictors of Sex-Induced Crisis, Sexual Function and Marital Satisfaction in Women With Sickle Cell Disease

Sex-induced and orgasm-induced crisis, sexual dysfunction, and marital satisfaction among women with sickle cell disease (SCD) is under-reported. This study assessedsexualfunction in women with SCD and comparedsexualfunction in women with SCD to women without SCD. This was a descriptive and comparative cross-sectional survey that involved 435 women with SCD and 406 women without SCD (as controls). This study demonstrates the predictors of sex-induced crisis, sexual function and marital satisfaction in women with sickle cell disease. The prevalence of dyspareunia and marital dissatisfaction was higher in women with SCD than those without SCD. In addition, SCD was significantly associated with multiple sexual dysfunctions, with reported symptoms of sexual desire disorder (HSDD), female sexual arousal disorder (FSAD), and female sexual orgasm disorder (FSOD). Genotype, age, age at puberty, dyspareunia, and duration of infertility were the observed independent predictors of sexual dysfunction in women with SCD. Also, most (54.02%) of the SCD subjects experienced sex-induced and orgasm-induced crises. Although water intake before and after sex was reported to be beneficial in preventing sex-induced and orgasm-induced crisis in women with SCD, it was not a predictor of sexual dysfunction. SCD patients are at risk of sex-induced and orgasm-induced crisis as well as sexual dysfunction. No study has ever reported the incidence of sex-and orgasm-induced crisis and sexual dysfunction in women with SCD. Also, we used a reasonably large sample size and utilized widely acceptable validated and reproducible tools like ENRICH Marital Satisfaction (EMS) and Female Sexual Function Index (FSFI) to assess the marital satisfaction and sexual function of the studied participants. This allows for the generalization of our findings. The limitations of the present study include recall bias and the inability to document real-time occurrences of sex-and orgasm-induced crisis and the incidence of female sexual dysfunction. Furthermore, though the risk factors of sexual dysfunction as perceived by women with SCD were elicited, biological risk factors and the possible associated mechanisms were not determined in this study. Our study shows that sex-induced and orgasm-induced crisis and sexual dysfunction are significant morbidities in women with SCD, and fluid/water intake before and after sexual activity may be beneficial. Adesoye OB, Akhigbe RE. Predictors of Sex-Induced Crisis, Sexual Function and Marital Satisfaction in Women With Sickle Cell Disease. J Sex Med 2022;19:1625-1633.

Prevalence of sexual dysfunction in women with cervical cancer: a systematic review and meta-analysis

ABSTRACT Cervical cancer (CC) is a common malignant gynaecological tumour. However, as survival rates have improved, increasing attention has focused on the quality of the survivors’ sex lives. We conducted a meta-analysis to investigate the prevalence and severity of female sexual dysfunction (FSD) in women with CC. We searched the PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, and Wang Fang databases, and extracted data from all studies published up to December 2020 that evaluated sexual dysfunction in patients with CC with the female sexual function index (FSFI). Studies were screened according to specific inclusion and exclusion criteria, and the qualities of the included studies were evaluated. Sixteen studies with a total of 2009 women with CC, including 1306 women with FSD, were included in the meta-analysis. Among patients with CC, the incidence of FSD was 80% (95% confidence interval (95%CI) 0.74–0.87) and the average FSFI score was 20.25 (95%CI 18.96–21.53). These results revealed a high prevalence of FSD and poor sexual function among women with CC, suggesting a need to assess sexual function regularly in these women with CC to improve early recognition of FSD and thereby allow appropriate interventions to enhance the sex life of affected patients.

A cross sectional study on female sexual function following pelvic radiotherapy.

e24051 Background: Pelvic radiotherapy (PRT) is an integral part of treatment in many pelvic cancers. PRT is associated with multiple organic changes in the genital area that have the potential to negatively impact female sexuality and quality of life. Fear of cancer transmission and stigma associated can result in lack of sexual activity and many women get abandoned by their partners. Often this topic is neglected and limited studies are available assessing female sexual function (FSF) especially from Indian subcontinent. This study was an attempt to assess the FSF in patients who had received PRT as part of their curative treatment for pelvic malignancy. Methods: This was an observational cross-sectional study conducted in January 2022. Study included female patients who received RT for pelvic malignancy. Patients with a minimum of 6 months follow up after RT with clinical complete response, sexually active before start of treatment &amp; living with their partners at time of study were included. Demographic profile was collected from treatment records. Socioeconomic status calculated using updated B J Prasad’s scale. Female Sexual Function Index (FSFI) questionnaire was used with score ≤ 26 indicating female sexual dysfunction (FSD). Questionnaire was filled by patients under supervision of a trained staff. 6 domains of sexual function i.e. desire, arousal, lubrication, orgasm satisfaction &amp; pain were studied. Patients reporting zero score in any of the domain indicating no sexual activity in the last 4 weeks were also included. Results: 38 eligible patients with age range from 34-69 years, mean age 51 years, 37% patients were &gt; 60 years. All were house wives, 40% illiterate, 50% high school &amp; below, 10% were above high school. 70% were from rural area. 13% belonged to upper class, 35% upper middle &amp; middle class, 52% to lower middle and lower class. Commonest diagnosis was carcinoma cervix (86%) followed by endometrium (10%) &amp; anorectum (4%). All patients with carcinoma cervix received radical chemoRT. Patients with Ca Endometrium were postoperative. 92% of all patients received pelvic EBRT &amp; 3% only vault brachytherapy. The mean duration from completion of RT was 17 months (range 6 – 41 months). FSD was found in 89%. Age wise mean scores in six domains of FSFI &amp; overall score is illustrated in the table. 0 score in at least one of the domain was reported by 65% patients. Conclusions: Study showed a very high incidence of FSD among pelvic cancer survivors after RT. Since there are limited data in this domain from Indian patients, this can become baseline data for further studies. Our data is limited by lack of comparison of FSD from age adjusted healthy females of this region.[Table: see text]

Impact of infertility duration on female sexual health

BackgroundInfertility, an important source of stress, could affect sexual life. Extensive studies suggest that the incidence of sexual dysfunction is highly prevalent in infertile women. As the duration of infertility increases, the level of stress is also likely to increase even further, and this could aggravate psychological pain and cause sexual dysfunction. However, the effect of infertility duration on sexual health is unclear.MethodsWe conducted a case-control study in which 715 patients participated between September 1,2020 and December 25, 2020. We included patients diagnosed with infertility (aged between 20 to 45), who were divided into four groups according to their infertility durations: ≤ 2 years (Group I, n = 262), > 2 years but ≤ 5 years (Group II, n = 282), > 5 years but ≤ 8 years (Group III, n = 97), and > 8 years (Group IV, n = 74). A questionnaire survey on female sexual functions and psychological depression was administered to participants, and their female sexual functions and depression status were measured using the Female Sexual Function Index (FSFI) and Patient Health Questionnaire (PHQ-9), respectively.ResultsAs the number of years of infertility increased, the PHQ-9 score as well as the incidence of psychological depression increased significantly (p < 0.05), but the total score of FSFI and those of its six domains/sub-scales were not significantly different among the four groups. An analysis of the relevant factors affecting sexual functions, using the multivariable logistic regression model, revealed that when the infertility duration was greater than 8 years, there was a significant increase in the incidence of sexual dysfunction [adjusted odds ratios (AOR) = 5.158, 95% confidence interval (CI): 1.935–13.746, P = 0.001], arousal disorder (AOR = 2.955, 95% CI: 1.194–7.314, P = 0.019), coital pain (AOR = 3.811, 95% CI: 1.045–13.897, P = 0.043), and lubrication disorder (AOR = 5.077, 95% CI: 1.340–19.244, P = 0.017).ConclusionsAn increasing infertility duration is a risk factor for the occurrence of sexual dysfunction. Hence, as the infertility duration increases, the incidence of female sexual dysfunction and psychological distress could also increase, especially when the infertility duration is more than 8 years.

Sexual dysfunction in patients with myasthenia gravis

BackgroundMyasthenia gravis (MG) is an autoimmune disease that causes fatigueable muscle weakness. Sexual dysfunction (SD) is a common condition, but the association between SD and MG remains poorly understood. MethodsAn observational study was conducted to explore SD incidence and risk factors in MG patients. The study enrolled 158 MG patients and 161 age- and sex-matched healthy individuals. SD was investigated using the Female Sexual Function Inventory (FSFI), the abridged International Index of Erectile Function-5 (IIEF-5), and the Chinese Index of Premature Ejaculation-5 (CIPE-5). The mental health was evaluated using Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA). ResultsA total of 52 male patients and 106 female patients were finally included. The average age of these patients was 41.82 ± 10.44 years. The incidence of female SD was significantly higher in MG patients (48.11%) than in healthy people (22.64%) (P < 0.001). The incidence of SD in male MG patients was also higher. Age and depression were significantly correlated with decreased libido, wakefulness, lubrication, orgasm, and satisfaction scores, indicating that these are risk factors for SD. Age (OR:1.13, CI%:1.06–1.21, P < 0.001) and HAMD scores (OR:1.53, CI%:1.0–2.13, P = 0.011) are independent risk factors for SD of MG patients. ConclusionSD is a common problem in MG, and its severity does not change with the severity of the disease. Age and depression are risk factors for sexual dysfunction.

Prevalence of Hypoactive Sexual Desire Disorder Among Sexually Active Postmenopausal Women With Metabolic Syndrome at a Public Hospital Clinic in Brazil: A Cross-sectional Study.

AimsTo evaluate the prevalence of hypoactive sexual desire disorder (HSDD) among postmenopausal women diagnosed with metabolic syndrome (MS) and to compare it to that of a control group without MS.MethodsThis is a cross-sectional study carried out in 2 public tertiary hospitals in the state of São Paulo, Brazil, with a sample of 291 postmenopausal women aged between 40 and 65 years. Sexual function was evaluated using the Female Sexual Function Index (FSFI) questionnaire and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, diagnostic criteria and was related to the diagnosis of MS, which was determined according to the guidelines defined by the Adult Treatment Panel.Main outcome measuresAnalysis of sexual function with emphasis on sexual desire (HSDD), the incidence of MS, and the components of MS.ResultsThe prevalence of HSDD was significantly higher among women diagnosed with MS than among women without MS (P = .01). Women diagnosed with high blood pressure (P < .01) and increased triglycerides (P = .03) also had a higher prevalence of HSDD than did women without these conditions. The FSFI domain scores for desire, arousal, lubrication, orgasm, and satisfaction and the total FSFI score were significantly lower for postmenopausal women with MS, whereas the pain domain score was not significantly different between the groups (P = .913). The incidence of female sexual dysfunction was significantly higher among women with MS, regardless of the diagnostic criteria used (P < .05).ConclusionPostmenopausal women diagnosed with MS have higher rates of HSDD than do women without MS.Clinical Trial Registration: ID NCT02430987.Dutra da Silva GM, Rolim Rosa Lima SM, Reis BF, et al. Prevalence of Hypoactive Sexual Desire Disorder Among Sexually Active Postmenopausal Women With Metabolic Syndrome at a Public Hospital Clinic in Brazil: A Cross-sectional Study. J Sex Med 2020;8:545–553.

Sexual Dysfunction in Patients with Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis.

Sexual dysfunction is an under-recognized problem in men and women with obstructive sleep apnea (OSA). Epidemiologic findings were inconclusive regarding the risk for sexual dysfunction associated with OSA. The aim of this study was to examine the association between OSA and sexual dysfunction. The PubMed, Cochrane Library, and Embase databases were searched for observational studies on the OSA and the risk of sexual dysfunction. The methodologic quality of the case-control and cohort studies was assessed with Newcastle-Ottawa Scale (NOS). The cross-sectional study quality methodology checklist was used for cross-sectional study. Data were pooled for the random-effects model. Sensitivity analyses were conducted to assess potential bias. The association between OSA and sexual dysfunction was summarized using relative risk (RR) with a 95% confidence interval (CI). This meta-analysis included 1,275 participants from nine studies. Five studies reported the incidence of erectile dysfunction (ED); the remaining four studies reported the incidence of female sexual dysfunction (FSD). Pooled results demonstrated that OSA was associated with increased risk of ED (pooled RR = 1.82, 95% CI: 1.12-2.97) as well as FSD (pooled RR = 2.00, 95% CI: 1.29-3.08). Estimates of the total effects were generally consistent in the sensitivity analysis. No evidence of publication bias was observed. Evidence from the observational studies suggested that OSA individuals might have an increased incidence of sexual dysfunction despite significant heterogeneity. More researches are warranted to clarify the relationship between OSA and the increased risk of sexual dysfunction.

Seksualność kobiet z zespołem metabolicznym

Introduction. Metabolic syndrome (MetS) is a risk factor for cardiovascular disease, and may be diagnosed in one in four adults worldwide. Since sexual dysfunction may occur in as many as 19–63% females, the following issues were addressed in the presented study: 1) Is there a relationship between metabolic syndrome and sexual disorders in female patients with MetS? 2) What is the potential impact of diet on occurrence of female sexual dysfunction? Material and methods. The study involved 99 regularly menstruating women, of which 71 patients were diagnosed with metabolic syndrome (those were assigned to study group), and 28 patients did not have metabolic abnormalities (control group). All subjects underwent physical examination, including basic anthropometric measurements, and biochemical blood tests were performed. Dietary intake was analyzed quantitatively and qualitatively using a three-day dietary recall. Participants were also asked to fill in questionnaires concerning their sexual life, and overall quality of life. Results. There were no age differences between the groups. Number of meals per day was lower, and total caloric value was higher in MetS group. Women with metabolic syndrome were less sexually active, and found themselves less sexually attractive as compared to control group. In the MetS group, Mell-Krat SFM score was lower than in control group (44.6 ± 12.5 vs. 56.2 ± 5.7, p < 0.001), which indicated a higher incidence of female sexual dysfunction. Similar results were found using FSFI Scale (23.4 ± 10.4 vs. 28.3 ± 7.8, p = 0.005). Evaluation with SF-36 quality of life questionnaire showed no differences between the groups. Conclusions. 1. The number of meals per day is lower, but the total dietary caloric value is higher in women with metabolic syndrome than in control group not having MetS. 2. Women with metabolic syndrome are less sexually active, and have less satisfactory sexual relations than healthy females. 3. There is no difference in quality of life between women with and without metabolic syndrome. 4. Dietary habits have no impact on overall quality of life, quality of sexual life or occurrence of sexual disorders.

Sexual dysfunction in Turkish women with dyspareunia and its impact on the quality of life

Purpose of Investigation: The authors aimed to determine the prevalence of female sexual dysfunction (FSD) among Turkish dyspareunic women and to establish the associated factors with FSD. Furthermore, they aimed to investigate if dyspareunia and possible associated sexual complaints were related to impaired quality of life (QoL). Materials and Methods: The study included 154 women admitted to the present gynecology department at a tertiary center in the west region of Turkey, 67 of which suffered from dyspareunia. The remaining 87 sexually healthy women were included in the control group. FSD was assessed with 19-item validated female sexual function index (FSFI). QoL was assessed using short form 36 (SF-36). The chi-squared test and t-test were used for analysing the group differences. Pearson’s correlation test was used to determine the effect of the variables of FSFI on the SF-36. Multivariance analysis and logistic regression was used to determine independent risk factors for FSD and to estimate odds ratio (OR) with 95% confidence interval (CI). Results: The incidence of FSD in dyspareunic group and control group was 86.57% and 36.8%, respectively (p p Conclusion: The present results show that dyspareunia has a major impact on women’s sexual function and QoL. Clinicians have an important role for encouraging women to report their sexual complaints. Identifying dyspareunia and treating FSD may positively affect women’s sexual function and overall QoL.

Prävalenz, Diagnostik und Therapie weiblicher sexueller Funktionsstörungen in der gynäkologischen Praxis – Eine deutschlandweite Repräsentativbefragung

Theoretischer Hintergrund und Fragestellung: Aus internationalen Studien ist bekannt, dass Frauenärzte sich kaum nach sexuellen Problemen ihrer Patientinnen erkundigen. Auch die Betroffenen selbst äußern ihre Beschwerden nur selten vor einem Arzt. Ziel dieser explorativen Studie war deshalb eine repräsentative Erhebung des Umgangs deutscher Gynäkologen mit Frauen, die sexuelle Funktionsstörungen haben. Material und Methodik: An eine repräsentative Stichprobe von 1390 deutschen Gynäkologen wurden standardisierte Fragebögen versandt, von denen 203 (56 % Frauen) zurückgesandte in die Auswertung eingeschlossen werden konnten. Der Bogen enthielt Fragen zum Kenntnisstand, Zuständigkeitsgefühl und Fortbildungsbedarf bez. sexueller Funktionsstörungen bei Frauen (FSD). Die Auswertung erfolgte deskriptiv. Ergebnisse: Die Prävalenz von FSD wurde von den Gynäkologen etwa auf 12 % geschätzt. Eigenes Wissen um sexualtherapeutische Interventionen und Behandlungen wurde eher für gering gehalten, während die Kenntnisse über Sexualanamnese, Motivation zur Therapie und allgemeine Beratung von den meisten Ärzten für gut befunden wurden. Ihre eigene Zuständigkeit bei FSD sahen die Gynäkologen v. a. im Erkennen der sexuellen Funktionsstörung (94,5 %), in der Beratung und Aufklärung (94,6 %) und in der Motivation zur Therapie (92,5 %). Schlussfolgerung: Im Vergleich zu anderen Studien berichten deutsche Gynäkologen über niedrigere subjektive Prävalenzraten sexueller Funktionsstörungen in ihrer Praxis. Eine routinemäßige Anamnese sexueller Beschwerden findet nicht statt. Gynäkologen sehen ihre Zuständigkeit v. a. im Erkennen von FSD und in der Motivation zur Behandlung. Gleichzeitig äußern sie einen großen Fortbildungsbedarf und bemängeln Kooperationen mit Kollegen und Krankenkassen. Eine verbesserte Aus-, Fort- und Weiterbildung erscheint nötig, um den Gynäkologen eine bereits im Studium aufzubauende Basiskompetenz zu vermitteln.

The prevalence of sexual dysfunction and associated risk factors in women with chronic pelvic pain: a cross-sectional study

The aims of the study were to determine the prevalence of sexual dysfunction, its subtypes and associated risk factors in women with chronic pelvic pain (CPP) as compared to a general female population. We evaluated 112 women (mean age 34.73 +/- 8.07; age range 18-50) complaining of CPP with a comprehensive history including female sexual function index (FSFI) and several general assessment questions (GAQs), a complete physical examination and routine laboratory tests. A group of 108 healthy women (mean age 33.28 +/- 7.95; age range 19-52) without CPP were enrolled as cross-sectional controls. According to the general population, the incidence of female sexual dysfunction (FSD) was 67.8% in women with CPP and 32.2% in women without CPP (P < 0.0001). Among 112 CPP patients, 78 (69.6%) of them had FSD and 34 (30.4%) patients did not have FSD in the study (P < 0.0001). In that 78 patients, 42 patients (53.8%) had hypoactive sexual desire disorder, 26 patients (33.3%) had sexual arousal disorder, 17 patients (21.7%) had orgasmic disorder and finally 58 patients (74.3%) had sexual pain disorder. The FSFI scores in both groups were as follows: (patients vs. controls; median value; P value, respectively): desire: 3.31 versus 3.98 (P < 0.0001); arousal: 3.58 versus 4.35 (P < 0.0001); lubrication: 4.20 versus 4.88 (P < 0.0001); orgasm: 3.70 versus 4.48 (P < 0.0001); sexual satisfaction: 3.80 versus 4.64 (P < 0.0001); sexual pain: 2.75 versus 4.98 (P < 0.0001) and total FSFI score: 21.35 versus 27.29 (P < 0.0001). The prevalence of FSD was higher in women with CPP than in a general healthy population not complaining of CPP. Investigation of female sexuality was essential for these patients.

Knowledge of women’s issues and epilepsy (KOWIE-II): a survey of health care professionals

Attendees of the American College of Physicians 2003 annual meeting were invited to complete a computerized version of the Knowledge of Women’s Issues and Epilepsy (KOWIE-II) questionnaire. This 10-item survey includes items specific to issues that affect women with epilepsy (WWE), including hormone sensitive seizures, effects of antiepileptic drugs (AEDs) on oral contraception, bone health, sexual function, pregnancy, and breast-feeding. A total of 202 healthcare providers (HCP) responded to the survey, 92% of which identified themselves as physicians. Few understood the effects of endogenous steroid hormones on seizure threshold (24%) and that epilepsy is associated with an increased incidence of female sexual dysfunction (37%). Most knew that enzyme-inducing AEDs may reduce the efficacy of oral contraceptives (71%) and that certain AEDs are associated with bone disease (77%). The majority were aware that most WWE have healthy children (86%), that women do not need to discontinue AEDs during pregnancy (75%), and that the most appropriate AED during pregnancy is one that best addresses the patient’s seizures. Fewer than half (47%) of participants knew that women taking AEDs could breast-feed safely. This sample of HCPs was not adequately informed about the unique issues affecting WWE. An aggressive educational effort is necessary to close the gaps in knowledge.

Female sexual dysfunction following vaginal surgery: myth or reality?

This article reviews the mechanisms by which vaginal surgery affects female sexual function and related pathophysiology to potential causes. The anatomy, neurovascular supply of the clitoris and introitus, and intrapelvic nerve supply are discussed as they apply to vaginal surgery. Methods to avoid neurovascular damage during pelvic floor surgery have been corroborated by supporting literature. The incidence of female sexual dysfunction after various transvaginal procedures for indications such as stress urinary incontinence and pelvic organ prolapse, anterior/posterior colporrhaphy, perineoplasty, and vaginal vault prolapse has been discussed. Current literature regarding female sexual dysfunction following other procedures such as vaginal hysterectomy, Martius flap interposition, and vesicovaginal and rectovaginal fistula repair also are reviewed.

Psychotherapy for female sexual dysfunction: A review

The increasing recognition of the significant incidence of female sexual dysfunction as well as the increasing acceptance of sex therapy as the preferred option for addressing problems in sexual functioning give rise to questions as to effectiveness of psychotherapy for female sexual dysfunction. This article presents a review of empirical studies of the treatment of female sexual dysfunction that meet minimal methodological criteria. Because of the variety and seriousness of methodological problems in the studies reviewed, guidelines for sample selection and description, research design, assessment and classification, and data analysis are provided. In addition, the 21 studies reviewed are examined for information they give about the treatment of female sexual dysfunction.