McCoy Female Sexuality Questionnaire Research Articles

The use of a pill containing ethinylestradiol-norgestimate improves female sexuality despite the decrease in circulating androgens: a pilot study

Purpose To evaluate the initial impact of a combined oral contraceptive (COC) containing norgestimate (NGM) on female sexuality and on circulating androgen levels in users. Materials and methods Six months modification in the McCoy Female Sexuality Questionnaire (MFSQ) and testosterone (T) and dehydroepiandrosterone sulphate (DHEAS) serum levels in women starting a monophasic pill containing ethinyl-estradiol (EE) 35 µg and NGM 0.250 mg. Results The study was completed by 36 subjects. There was a significant increase in MFSQ during treatment (p < 0.0001) (and its domains with the exclusion of vaginal lubrication domain) with concomitant decreases in T (−4.45%, p < 0.0001) and DHEAS (−19.41%, p < 0.0001) serum levels. Conclusions Contraception with EE/NGM was associated with a short term non-deteriorating effect on sexuality despite the evident decrease in androgen levels. Female sexuality during COC use is a complex topic and is not only linked with changes in serum androgen levels.

(273) Influences of Oral Dehydroepiandrosterone (DHEA) Administration on Hormonal Profile, Menopausal Clinical Symptoms and Sexual Function in Early Postmenopausal Symptomatic Women

Abstract Introduction Dehydroepiandrosterone (DHEA) and its sulfate (DHEAs) are steroid hormones secreted by the adrenal glands. The aging process is associated with decreased levels of DHEA and DHEAs, which are the initial causes of many age-related changes. Objective We aimed to evaluate the effects of oral administration of DHEA (50mg/day) on hormonal profile, menopausal clinical symptoms and sexual function in early postmenopausal symptomatic Caucasian women at baseline and after 2, 4 and 6 months of treatment. Methods For our prospective clinical trial, 42 symptomatic early postmenopausal women (50–55±3.5 years) were selected. Participants were divided into two groups. The study group (n-22) received oral DHEA 50mg/day for 6 months and the control group (n-20) received placebo. Serum levels of DHEA, DHEAs, androstenedione (A4), allopregnanolone (3α,5α- THP), progesterone (P4), 17OH progesterone (17OHP), cortisol, testosterone (T), dihydrotestosterone (DHT), estrone (E1), estradiol (E2), SHBG, LH, FSH and β-Endorphin were determined at baseline and after 2, 4 and 6 months of treatment. The results of the Menopause Rating Scale (MRS) and the McCoy Female Sexuality Questionnaire (MFSQ) were evaluated before and after the treatment. Results During the treatment period in the study group, a progressive increase in serum levels of DHEA, DHEAs, A4, T, DHT, E2, E1, 3α,5α-THP and β-Endorphin were observed. P4 and 17OHP levels showed only a slight increase. By the 4th month of treatment and final data, a decrease in cortisol levels was observed. LH and FSH levels gradually decreased. SHBG levels remained constant. After 6 months of treatment, assessing the results of the MRS in the DHEA group showed a progressive improvement of menopausal symptoms. The results of the McCoy questionnaire were also improved in the study group. Conclusions DHEA administration had a significant effect on certain endocrine parameters in early postmenopausal symptomatic Caucasian women, was associated with improvements of menopausal physical symptoms, sexual function and psycho-emotional parameters. Our findings support the hypothesis that administration of DHEA in symptomatic postmenopausal women restores both androgenic and estrogenic milieu and reduces most of the clinical symptoms caused by the changes of these environments during postmenopausal period. On this basis we can assume, that DHEA may be considered as a potentially effective medication for MHT. However, conducting further, more specific clinical trials are needed. Disclosure No.

Factors affecting female sexual well-being: a 5-year follow-up of a randomised clinical trial on post-abortion contraception

IntroductionSexual well-being is associated with general well-being. Several factors, such as overweight, infertility, anxiety and sex hormones, also play a role, but the effects of hormonal contraception remain a point...

The role of PCOS in mental health and sexual function in women with obesity and a history of infertility

STUDY QUESTIONDo mental health and sexual function differ between women with or without polycystic ovary syndrome (PCOS) with comparable BMI and fertility characteristics?SUMMARY ANSWERWomen with PCOS have a poorer mental quality of life than women without PCOS, but there were no differences in symptoms of depression, anxiety, physical quality of life or sexual function.WHAT IS KNOWN ALREADYVarious studies suggest that women with PCOS have poorer mental health, such as higher symptoms of anxiety and depression with a lower quality of life, and have an impaired sexual function compared to women without PCOS. However, in most studies, BMI and infertility status differ between women with and without PCOS, which may hamper comparability.STUDY DESIGN, SIZE, DURATIONThis study is a cross-sectional analysis of a 5-year follow-up of a randomized controlled trial (RCT) among women with obesity and a history of infertility.PARTICIPANTS/MATERIALS, SETTING, METHODSParticipants in this follow-up study of an RCT were women with obesity and infertility randomized to a lifestyle intervention followed by infertility treatment or prompt infertility treatment (control), stratified by ovulatory status and trial centre. In total, 173 (30.0%) women of the 577 women randomized in the initial trial participated in this follow-up study, with a mean follow-up of 5.5 years (range 3.7–7.0 years); of these women 73 had been diagnosed with PCOS and 100 did not have PCOS. Participants completed questionnaires on symptoms of anxiety and depression (Hospital Anxiety and Depression scale (HADS)), quality of life (36-item Short Form Health Survey (SF-36)) and sexual function (McCoy Female Sexuality Questionnaire (MFSQ)). We also compared quality of life subscale scores in women with and without PCOS and compared them to an age-matched Dutch reference population with average BMI. Effect sizes were calculated to assess the differences.MAIN RESULTS AND THE ROLE OF CHANCESymptoms of anxiety and depression, physical quality of life and sexual function did not differ significantly between obese women with and without PCOS. However, women with PCOS had a worse mental quality of life summary component score (−3.60 [95% CI −6.72 to −0.56]), mainly due to a lower score on the subscale ‘role limitations due to emotional problems’ (−12.41 [95% CI −22.78 to −2.28]), compared to women without PCOS. However, compared to an age-matched Dutch reference population, the obese infertile women with and without PCOS both scored lower on almost all physical and mental quality of life subscales.LIMITATIONS, REASONS FOR CAUTIONThese are secondary analyses of the follow-up study of the RCT. No power analysis was performed for the outcomes included in this analysis and, as our study had a relatively small sample size, the null findings could be based on insufficient power to detect small differences between the groups. Our study population had a high mean BMI (average total group 34.5 [SD ± 5.1]); therefore, our results may only be generalizable to women with obesity.WIDER IMPLICATIONS OF THE FINDINGSOur results indicate that PCOS status is associated with impaired mental quality of life. Anxiety and depression, physical quality of life and sexual function in obese infertile women with PCOS seem more related to the obesity than the PCOS status.STUDY FUNDING/COMPETING INTEREST(S)The initial study and follow-up were supported by grants from: ZonMw (50-50110-96-518), the Dutch Heart Foundation (2013T085) and the European Commission (633595). The Department of Obstetrics and Gynaecology of the UMCG received an unrestricted educational grant from Ferring pharmaceuticals BV, The Netherlands, outside the submitted work. A.H. reports consultancy for Ferring pharmaceuticals. B.W.J.M. is supported by an NHMRC Practitioner Fellowship (GNT1082548). B.W.J.M. reports consultancy for ObsEva, Merck Merck KGaA, iGenomix and Guerbet. All other authors declare no competing interests.TRIAL REGISTRATION NUMBERThe initial trial was registered on 16 November 2008 in the Dutch trial register; clinical trial registry number NTR1530.

Effects of Menopause on Sexual Function in Indian Women: A McCoy's Questionnaire-Based Assessment.

Background:Menopause is associated with physical, physiological, psychological changes and may lead to sexual dysfunction (SD) effecting woman's health and well-being. Scientific research in the area of female sexuality in India is scant. Therefore, this study aimed to investigate female sexual function at perimenopause and menopause and determine the association between sociodemographic and physiological factors with sexual function.Materials and Methods:This was a cross-sectional hospital-based study carried out in perimenopausal and menopausal women. Study participant's details were collected by gynecologists and clinical research professionals following the participant's informed consent. The case report and McCoy female sexuality questionnaire were used. The association between sociodemographic status and sexual function was determined. Data were summarized using descriptive statistics for portraying profile of the participants and t-test for comparison.Results:A total of 129 women in the menopausal (SD − 3.26) and 112 in the premenopausal group (SD − 6.01) were enrolled. The sociodemographic parameters did not significantly affect the sexual function scores in both groups. In terms of vaginal atrophy, a significant increase in urgency was noted in the postmenopause group. The general domain of sexual function was significantly lower in menopausal than and perimenopausal with a P < 0.001. Looking at individual domains of sexual function, for sexual interest, satisfaction, vaginal lubrication, and orgasm, the mean value of perimenopausal participants was significantly higher when compared to menopausal women; for a primary partner domain, no significant differences between the two groups were noted.Conclusion:Overall, the sociodemographic profile did not impact sexual function in this study. Compared with menopausal women, perimenopausal women showed better, more complete sexual function based on McCoy's score except partner-related domain that is constant from perimenopause to menopause in a monogamous relationship.

A lifestyle intervention improves sexual function of women with obesity and infertility: A 5 year follow-up of a RCT.

BackgroundObesity and infertility are associated with poorer sexual function. We have previously shown that a lifestyle intervention in women with obesity and infertility reduced weight and improved cardiometabolic health and quality of life, which may positively affect sexual function. We now report on sexual function 5 years after randomization.Methods and findingsIn total 577 women, between 18–39 years of age, with infertility and a BMI ≥29 kg/m2 were randomized to a six-month lifestyle intervention targeting physical activity, diet and behavior modification or prompt infertility care as usual. Intercourse frequency and sexual function were assessed with the McCoy Female Sexuality Questionnaire (MFSQ), 5.4±0.8 years after randomization. 550 women could be approached for the follow-up study, of whom 84 women in the intervention and 93 in the control group completed the MFSQ. Results were adjusted for duration of infertility, polycystic ovary syndrome and whether women were attempting to conceive. The intervention group more often reported having had intercourse in the past 4 weeks compared to the control group (aOR: 2.3 95% CI 0.96 to 5.72). Among women reporting intercourse in the past 4 weeks, the intervention group (n = 75) had intercourse more frequently (6.6±5.8 vs. 4.9±4.0 times; 95% CI 0.10 to 3.40) and had higher scores for vaginal lubrication (16.5±3.0 vs. 15.4±3.5; 95% CI 0.15 to 2.32) and total ‘sexual function’ score (96.5±14.2 vs. 91.4±12.8; 95% CI 0.84 to 9.35) compared to the control group (n = 72). Sexual interest, satisfaction, orgasm and sex partner scores did not differ statistically between the groups. The intervention effect on sexual function was for 21% mediated by the change in moderate to vigorous physical activity.ConclusionA six-month lifestyle intervention in women with obesity and infertility led to more frequent intercourse, better vaginal lubrication and overall sexual function 5 years after the intervention. (Trial Registration: NTR1530).

Sexual well-being after first trimester termination of pregnancy: Secondary analysis of a randomized contraceptive trial.

Although termination of pregnancy is one of the most common procedures conducted worldwide, little is known about sexual well-being after termination of pregnancy. The objective of this study was to assess sexual well-being after termination of pregnancy, and factors affecting it during a 1-year follow up. In total, 748 women requesting first trimester termination of pregnancy and participating in a randomized controlled trial on early provision of intrauterine contraception were provided with questionnaires regarding their sexual life, anxiety, quality of life and contraceptive method used at the time of termination of pregnancy, 3 and 12months after termination of pregnancy. Sexual well-being was measured by the 9-item McCoy Female Sexuality Questionnaire. Anxiety and quality of life were assessed by the State-Trait Anxiety Inventory (STAI) Scale and EuroQoL questionnaire (EQoL). The McCoy index remained unchanged during the follow up. At all three time-points measured, higher (ie, better) McCoy scores were associated with a lower STAI index (mean difference -2.26 [95% CI -3.23 to -1.29], P<0.001; -3.76 [95% CI -4.79 to -2.74], P<0.001; -4.50 [95% CI -5.88 to -3.12], P<0.001) and being in a relationship (1.16 [95% CI 0.08-2.25], P=0.023; 1.67 [95% CI 0.43-2.89], P<0.001; 2.81 [95% CI 1.28-4.34], P<0.001), and correlated positively with a higher EQoL index (r=0.20, r=0.20, r=.27, P<0.001) and higher frequency of intercourse (r=0.50, r=0.46, r=0.42, P<0.001). Women using intrauterine contraception had higher McCoy index measurements at 3months compared with others. There were no significant differences between users of hormonal vs non-hormonal contraceptive methods. Sexual well-being does not change significantly after termination of pregnancy. Instead, it is strongly and positively associated with quality of life, relationship status and frequency of intercourse. Anxiety is negatively associated with sexual well-being.

Sexual function and combined oral contraceptives - a randomised, placebo-controlled trial.

ObjectiveThe effect of combined oral contraceptives (COCs) on female sexuality has long been a matter of discussion, but placebo-controlled studies are lacking. Thus, the aim of the present study was to investigate if an oestradiol-containing COC influences sexual function.DesignInvestigator-initiated, randomised, double-blinded, placebo-controlled clinical trial where 202 healthy women were randomised to a combined oral contraceptive (1.5 mg oestradiol and 2.5 mg nomegestrol acetate) or placebo for three treatment cycles.MethodsSexual function at baseline and during the last week of the final treatment cycle was evaluated by the McCoy Female Sexuality Questionnaire. Serum and hair testosterone levels were assessed at the same time points.ResultsCompared to placebo, COC use was associated with a small decrease in sexual interest (COC median change score: −2.0; interquartile range (IQR): −5.0 to 0.5 vs placebo: −1.0; IQR: −3.0 to 2.0, P = 0.019), which remained following adjustment for change in self-rated depressive symptoms (B = −0.80 ± 0.30, Wald = 7.08, P = 0.008). However, the proportion of women who reported a clinically relevant deterioration in sexual interest did not differ between COC or placebo users (COC 18 (22.2%) vs placebo 16 (17.8%), P = 0.47). Change in other measured aspects of sexual function as well as total score of sexual function did not differ between the two treatments.ConclusionsThis study suggests that use of oestradiol-based COCs is associated with reduced sexual interest. However, the changes are minute, and probably not of clinical relevance.

Risk factors of overactive bladder syndrome and its relation to sexual function in menopausal women.

Overactive bladder syndrome is a common and annoying complication worldwide that could negatively affect the quality of life of afflicted individuals. We aimed to determine the prevalence and risk factors of overactive bladder syndrome and its relation to sexual function in healthy menopausal women. This cross-sectional study was done on 340 women aged 45-60 years in Tabriz, northwest Iran, during 2015-2016. Data were collected using a demographic data questionnaire, the Overactive Bladder Syndrome Score, and the McCoy Female Sexuality Questionnaire. Fifty-six (16.5%), 63 (18.5%), and 10 (2.9%) of the participating women had mild, moderate, and severe overactive bladder syndrome, respectively. Predictors of overactive bladder included: night sweats, central prolapse, episiotomy, varicose disease, illiteracy or education at the primary level, systolic blood pressure >140 mmHg and lack of physical activity. We found a significant difference between the women with and without overactive bladder with respect to the total score and sub-domain scores related to sex partner (p = 0.029) and sexual interest (p = 0.049). The prevalence of overactive bladder was quite high in this study. Since sexual dysfunction is not an easy topic to talk about and can affect women's quality of life, physicians should consider talking about these issues besides urinary issues to all middle-aged women.

Weight gain, body image and sexual function in young patients treated with contraceptive vaginal ring. A prospective pilot study

Introduction: Oral contraceptives could induce mood changes. As far as our knowledge, there are no studies in literature that have examined the role of vaginal contraception in self-perceived body image.Aim: To evaluate the effects of intravaginal contraception on weight gain and perceived body image in relation with the Beck’s Depression Inventory questionnaire (BDI) and the McCoy Female Sexuality Questionnaire (MFSQ).Methods: Twenty-one adult (18–35 years old) eumenorrheic (menstrual cycle of 25–35 days), lean (body mass index – BMI – of 19–25 kg/m2) women who were referred for hormonal contraception were administered the Stunkard Figure Rating Scale (FRS), BDI and MFSQ. Subjects were studied in basal condition and after 6 months of therapy with vaginal contraception (NuvaRing®; Organon-Schering-Plough Italia, Milan, Italy).Main outcome measures: BMI, FRS, MFSQ and BDI.Results: After 6 months of therapy with NuvaRing®, both body weight (60.0 ± 8.3; p = 0.050) and BMI (22.1 ± 3.1; p = 0.028) slightly, but statistically, increased. FRS and BDI showed no differences after the vaginal contraception. Hormonal contraception was associated with a significant decrease in the two-factor Italian MFSQ score.Conclusions: Vaginal ring seems a good alternative to other hormonal contraceptive not significantly altering the female sexuality and not influencing the FRS and BDI.

The sexuological impact of hormonal contraceptives based on their route of administration

Evidence on the effects of hormonal contraceptives on female sexuality is conflicting. We enrolled 556 women, divided into six groups: two composed of subjects using a combined hormonal contraceptive (COC) containing 0.020 (“COC20”) and 0.030 (“COC30”) mg of ethynyl estradiol (EE), “natural”, using COC containing 1.5 mg of estradiol (E2), “ring”, using a vaginal ring releasing each day 0.015 mg of EE + 0.120 of etonogestrel, “subcutaneous”, using a progestin only subcutaneous contraceptive implant releasing etonogestrel and “controls”, using no hormonal contraceptive methods. The subjects were required to answer to the McCoy female sexuality questionnaire and were subjected to a blood test for hormonal evaluation. An ultrasound evaluation of the dorsal clitoral artery was also performed. The higher McCoy sexological value were recorded in the subdermal group; significant differences were recorded among the groups in terms of hormone distribution, with the higher levels of androstenedione in subdermal and control groups. The ultrasound evaluation of dorsal clitoral artery shows a significative correlation between pulsatility and resistance indices and orgasm parameters of McCoy questionnaire. The recorded difference in the sexual and hormonal parameters among the studied hormonal contraceptives may guide toward the personalization of contraceptive choice.

Endometriosis and Infertility: Impact on Sexuality

Objective: Endometriosis is a condition that has a great impact on women’s life. One of the most important consequences of the disease is infertility that may exacerbate the psychological, relational and sexual consequences on patients. The aim of the present study was to examine quality of life, anxiety, sexual functioning and relationship satisfaction of women with endometriosis and infertility. Infertility is supposed to be associated with a worse clinical profile. Design and Method: Data were collected on 71 patients (39 women with endometriosis and 32 with endometriosis and infertility) aged between 20 and 50 (M=34.21, SD=8.38), recruited in the Gynecological and Obstetrics department of Policlinico Umberto I, Rome. Participants completed: a socio-demographic questionnaire, the World Health Organization Quality of Life (WHOQOL)-Bref for quality of life, the McCoy Female Sexuality Questionnaire (MFS-Q) for sexual and relationship satisfaction, the Female Sexual Functioning Index (FSFI) for sexual functioning and the Hamilton Anxiety Rating Scale (HAM-A) for anxiety symptoms. Results: Women without infertility obtained worse scores: sexual functioning (F(1,69)=10.97 p&lt;.01), sexual (F(1,69)=17.44 p&lt;.001) and relationship satisfaction (F(1,69)=10.18 p&lt;.001) and quality of life (F(1,69)=13.56 p&lt;.001). Conclusions: Contrary to our hypothesis, endometriosis, with or without fertility impairment, has an impact on patients’ relationship, sexuality and quality of life. Therefore, infertility is not the main factor that explains a negative clinical profile. The present study suggests the importance of psychosexual counseling during medical treatment of the disease, and the need of involving partners in the assessment and in the health care decision making.

Quality of life and sexual satisfaction in women suffering from endometriosis: An Italian preliminary study

Summary Endometriosis is a chronic gynaecological disease that affects women during the reproductive age, and may compromise their quality of life (QoL) and sexual satisfaction. Few data are available on women affected by pelvic endometriosis in the absence of deep infiltrating endometriosis. Aim of the study To evaluate QoL and sexual satisfaction in a group of Italian women affected by pelvic endometriosis identifying specific sociodemographic variables that could impact on the individual perception of the disease. Method A survey was conducted on 150 women with pelvic endometriosis, recruited at the University hospital of Rome. The control group included 150 healthy women matched for age and relational status. A sociodemographic questionnaire, the Italian versions of the WHOQOL-Bref and McCoy Female Sexuality Questionnaire (MFSQ) and the Visual Analogue Scale were administered to participants. Results Our data show that the experimental group obtained a lower score than the control group in the questionnaire total scores and, specifically, in the physical, psychological and social relationships domains (WHOQOL) and in the sexuality domain (MFSQ). A positive and significant correlation was observed between relational status and the MSFQ total score. No significant correlation emerged between pain intensity and sociodemographic variables, total scores and subscales of the MSFQ and WHOQOL-BREF. Discussion and conclusion Our results showed that the disease has a negative impact on many areas of the overall functioning and sexuality quality of life of women. Nevertheless, the existence of mediatory variables emerged, emphasising how the presence of a partner could be considered a protective value in the experience of pain, therefore stressing the need to adopt a bio-psychosocial perspective to study and fully understand the disease.

Restoring testosterone levels by adding dehydroepiandrosterone to a drospirenone containing combined oral contraceptive: II. Clinical effects

ObjectivesCombined oral contraceptives (COCs) decrease androgen levels, including testosterone (T), which may be associated with sexual dysfunction and mood complaints in some women. We have shown that ‘co-administration' of dehydroepiandrosterone (DHEA) to a drospirenone (DRSP)-containing COC restored total T levels to baseline and free T levels by 47%. Here we describe the effects on sexual function, mood and quality of life of such an intervention. Study designThis was a randomized, double-blind, placebo-controlled study in 99 healthy COC starters. A COC containing 30mcg ethinylestradiol (EE) and 3mg DRSP was used for three cycles, followed by six cycles of the same COC combined with 50mg/day DHEA or placebo. Subjects completed the Moos Menstrual Distress Questionnaire (MDQ), the McCoy Female Sexuality Questionnaire and the short form of the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q). Safety and tolerability, including effects on skin, were evaluated. ResultsThe addition of DHEA induced small but significant improvements compared to placebo in the MDQ score for autonomic reactions during the menstrual (−2.0 vs. 0.71; p=0.05) and the premenstrual phase (−3.1 vs. 2.9; p=0.01) and for behavior during the intermenstrual phase (−1.4 vs. 3.6; p=0.02). A significant difference was found in the MDQ score for arousal during the premenstrual phase in favor of placebo (−5.0 vs. 1.0; p=0.01). There were no statistically significant differences between groups for the MSFQ and Q-LES-Q scores. DHEA ‘co-administration' resulted in an acceptable safety profile. DHEA negated the beneficial effect of the COC on acne according to the subjects’ self-assessment. Conclusions‘Co-administration' with DHEA did not result in consistent improvements in sexual function, mood and quality of life indicators in women taking EE/DRSP. Retrospectively, the 50 mg dose of DHEA may be too low for this COC. ImplicationsA well-balanced judgment of the clinical consequences of normalizing androgens during COC use may require complete normalization of free T.

Health-related quality of life in women with or without hot flashes

We assessed the impact of hot flashes and various forms of hormone therapy on health-related quality of life and sexual well-being in recently postmenopausal women. We prospectively interviewed 150 healthy women about hot flashes and health-related quality of life (using the Women's Health Questionnaire and the McCoy Female Sexuality Questionnaire), menopause-related symptoms, and general health. The women were classified into those with (n = 72) and without (n = 78) hot flashes and treated for 6 months with transdermal estradiol (1 mg/d), oral estradiol (2 mg/d) with or without medroxyprogesterone acetate (5 mg/d), or placebo. At baseline, hot flashes contributed most strongly to poor sleep (correlation coefficient r = -0.525, P < 0.0001), somatic symptoms such as muscle pains (r = -0.348, P < 0.0001), menstrual cycle-resembling complaints (r = -0.304, P < 0.0001), anxiety and fears (r = -0.283, P < 0.0001), decreased memory and concentration (r = -0.279, P = 0.001), and sexual behavior (r = -0.174, P = 0.035). The different hormone therapy regimens alleviated hot flashes equally effectively and were therefore combined into a single group for further analysis. In women with baseline flashes, hormone therapy use significantly improved the scores for sleep (0.787 [0.243] vs 0.557 [0.249], hormone therapy vs placebo, P = 0.001, at 6 mo), memory and concentration capacity (0.849 [0.228] vs 0.454 [0.301], P < 0.0001, at 6 mo), and anxiety and fears (0.942 [0.133] vs 0.826 [0.193], P = 0.005, at 6 mo). Hormone therapy use showed no significant impact on these variables in women without baseline flashes. Hot flashes contribute differently to various variables affecting health-related quality of life shortly after menopause. Estradiol or an estradiol-medroxyprogesterone acetate combination similarly alleviates hot flashes and improves health-related quality of life in relation to elimination of hot flashes. Hormone therapy use does not confer any detectable quality-of-life benefit over placebo in women without disturbing baseline flashes.

Clitoral Vascularization and Sexual Behavior in Young Patients Treated with Drospirenone–Ethinyl Estradiol or Contraceptive Vaginal Ring: A Prospective, Randomized, Pilot Study

Oral contraceptives (OC) are effective for birth control and have good cycle control and tolerability. However, the hormonal components could modify mood and libido. The aim of this study is to evaluate the genital vascular effects and sexual behavior of an OC containing 30 μg ethinyl estradiol and 3 mg drospirenone in comparison with a flexible combined contraceptive vaginal ring. Forty women underwent a sonographic assessment of the clitoral anatomy and vascularization and were administered the McCoy Female Sexuality Questionnaire (MFSQ) and the Beck's Depression Inventory questionnaire (BDI). Estradiol, androstenedione, testosterone, and SHBG were assayed. Free Androgen Index (FAI) and Free Estrogen Index (FEI) were calculated. The patients were randomly submitted to OC (group I; n = 21) or vaginal ring (group II; n = 19). Ultrasonographic clitoral volume, pulsatility index (PI) of dorsal clitoral arteries, MFSQ, BDI, and hormonal and biochemical assays were analyzed. After therapy, the testosterone levels were reduced in both groups, whereas estradiol decreased only in group I women. The SHBG increased in all the subjects, and both FAI and FEI decreased. The clitoral volume decreased in all the women. The PI of the dorsal clitoral artery increased only in patients on OC. The hormonal contraception was associated, in both studied groups, with a significant decrease of the two-factor Italian MFSQ score, which was more marked in OC users. In group I subjects, there was a reduction of the number of intercourse/week and a reduction of orgasm frequency during intercourse. The pain during intercourse worsened after OC use. The vaginal ring users reported a vaginal wetness. Six-month treatment with hormonal contraception is associated with a diminished MFSQ score. However, the frequency of sexual intercourse and orgasm was reduced only by the use of OC. The OC use was associated with increased pain during intercourse.

Evaluation of a rural nurse-led clinic for female sexual dysfunction

The objective of this study was to explore changes in the sexual function of women who attended a rural nurse-led female sexual dysfunction clinic. This exploratory study was designed as a one-group pre-test/post-test design from a convenience sample of women attending the clinic. The setting was a women's health centre located in regional Western Australia. One hundred eleven women aged between 18 and 65 years were recruited from clinic attendees. The Australian version of the validated McCoy Female Sexuality Questionnaire was completed before the first appointment (T0), and 1 (T1) and 6 months (T2) after the last appointment. Women attending the clinic reported significant increases in sexual desire, satisfaction and orgasm quality and achievement at 1 and 6 months after their last appointment. There was also a significant increase in satisfaction with their main sexual partner at 6 months. This study confirmed the value of an innovative approach to managing female sexual dysfunction in a rural area with workforce shortages and limited health services. It is recommended that care by a nurse-led multidisciplinary team be used in the management of sexual dysfunction. Further research is needed to see if this model of care would be effective in other settings.

Sexual Functioning in Women with Mild and Severe Symptoms of Charcot-Marie-Tooth Disease

Charcot-Marie-Tooth (CMT) disease is one of the most frequently inherited neurological disorders, and while it is known that individuals suffering from this condition have low quality of life, little is known about their sexual function and satisfaction. To describe the functioning on different domains of sexuality in a relatively large sample of women with CMT, provide comparisons between mildly and severely affected patients and between women with the two different types of CMT (demyelinating vs. axonal), and assess the relationship between sexual function and age of onset. Fifty-seven women (age: 18-60 years) were approached in a CMT rehabilitation clinic by a psychologist and administered the Italian version of the McCoy Female Sexuality Questionnaire (MFSQ). Data from 40 patients who had had sexual intercourse in the previous 4 weeks were analyzed. The main outcome measures are the factors MFSQ-SEX and MFSQ-PARTNER, which describe sexual functioning and sexual satisfaction with a partner, respectively. Almost 30% of women did not engage in sexual intercourse with a partner. Overall sexual problems were more prominent in younger women and tended to be lower as age increased: this pattern was different from what was reported in previous studies in comparable samples of healthy Italian women. Severity of CMT was associated with better sexual functioning in the areas of desire, arousal, orgasm, and satisfaction, with women with more severe symptoms reporting greater functioning. Women with more severe CMT symptoms reported more pain during intercourse. Age of CMT onset and type of CMT (demyelinating vs. axonal) were not associated with differences in sexual functioning. Findings point to the importance of including assessment of sexual dysfunction in young women with mild CMT symptoms and the importance of providing sex therapy or counseling to these patients.

Clitoral Changes, Sexuality, and Body Image During the Menstrual Cycle: A Pilot Study

A relationship between sexual function and all body image variables has been reported. However, there are no studies analyzing the relationship between menstrual cycle, body image, and sexuality. To evaluate clitoral changes, sexual behavior, and perceived body image during the menstrual cycle. Twenty-four women underwent ultrasonographic (US) clitoral measurements, color Doppler evaluation of the clitoral artery, and hormonal testing. In addition, they were administered the McCoy Female Sexuality Questionnaire (MFSQ), the Stunkard Figure Rating Scale (FRS), and the Beck's Depression Inventory questionnaire (BDI). The main outcome measures were clitoral volume, clitoral artery pulsatility index (PI), the MFSQ, the FRS, and the BDI. The subjects had a mean age of 29.3 ± 4.5 years and a mean body mass index (kg/m(2) = BMI) of 21.2 ± 2.0. US and color Doppler assessments showed significant increase in clitoral body volume (P = 0.039) and a decrease in the PI (P = 0.027) of the clitoral artery during the periovulatory phase of the menstrual cycle. These changes were significantly and positively correlated with estradiol levels (P = 0.009 and P = 0.017, respectively). The two-factor Italian MFSQ for sexuality and partnership was similar in all the phases of the cycle. The number of intercourses/week slightly increased in the periovulatory phase. The mean BDI was normal in all women and did not change during the cycle. The FRS showed no difference in all examined parameters during the three phases of the menstrual cycle. In young, lean, eumenorrheic Italian women, there is no significant change, during the menstrual cycle, in sexual function, body image perception, and symptoms of depression, as assessed by the two-factor Italian MFSQ for sexuality and partnership, the FRS, and the total BDI score. However, our results suggest that estrogens, influencing clitoral anatomic and vascular changes, may favor genital arousability.

Body Mass Index, Stunkard Figure Rating Scale, and Sexuality in Young Italian Women: A Pilot Study

Increased body mass index is associated with a higher prevalence of metabolic diseases, depression, and sexual dysfunction. In obese patients, the perception of an altered body image may influence health and psychologically related behaviors. Furthermore, there is a significant positive relationship between sexual function, sexual satisfaction, and all body image variables. To evaluate the relationship between body weight, perceived body image, and sexual behavior. Ninety women underwent ultrasonographic clitoral volume measurement and color Doppler evaluation of the clitoral and ophthalmic arteries. The subjects filled the McCoy Female Sexuality Questionnaire (MFSQ), the Stunkard Figure Rating Scale (FRS), and the Beck's Depression Inventory (BDI) questionnaire. Clitoral volume, clitoral and ophthalmic artery pulsatility index (PI), MFSQ, FRS, and BDI. The women were distributed into three groups: lean (N = 47); overweight (N = 22); and obese (N = 21). The ophthalmic artery showed lower PI in lean (1.72 ± 0.39) than in overweight (1.99 ± 0.30) and obese women (2.08 ± 0.19). The obese subjects presented the worst clitoral vascularization. The MFSQ for sexuality was higher in lean (45.8 ± 11.8) than in overweight (36.4 ± 15.0) and obese (36.1 ± 10.8) women. The frequency of intercourse per week was higher in lean (2.2 ± 1.4) than in overweight (1.3 ± 0.7) and obese (1.2 ± 0.4) women. The percentage of anorgasmic women was higher in obese (23%) than in lean subjects (6%). The FRS evidenced that the lean subjects represented themselves with a mean value (3.5 ± 1.0) lower than overweight (4.8 ± 0.7) and obese women (5.9 ± 0.6). The silhouette that represented their own ideal was significantly higher in obese (4.0 ± 0.4) than in overweight (3.3 ± 0.5) and lean (2.9 ± 0.7) subjects. The mean BDI was significantly higher in obese (15.8 ± 5.4) than in lean (8.4 ± 6.8) women. Lifestyle modifications such as weight loss may be mandatory in obese subjects because obesity might impair the quality of sexual life by inducing genital and general vascular stiffness and body image distortion.