sexual dysfunction

Predictors for sexual dysfunction in the first year postpartum: A systematic review and meta-analysis

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Abstract

Background

Pregnancy and childbirth increase the risk for pelvic floor dysfunction, including sexual dysfunction. So far, the mechanisms and the extent to which certain risk factors play a role remain unclear.

Objectives

In this systematic review of the literature we aimed to determine risk factors for sexual dysfunction in the first year after childbirth.

Search Strategy

We searched MEDLINE, Embase and CENTRAL using the search strategy: sexual dysfunction AND obstetric events.

Selection Criteria

We included original, comparative studies, reported in English, that used validated questionnaires and the ICS/IUGA terminology for sexual dysfunction, dyspareunia and vaginal dryness.

Data Collection and Analysis

We assessed the quality and the risk of bias of the included studies with the Newcastle–Ottawa scale. We extracted the reported data and we performed random-effects meta-analysis to obtain the summary odds ratios (ORs) with 95% confidence intervals (95% CIs). Heterogeneity across studies was assessed using the I2 statistic.

Main Results

Anal sphincter injury was associated with increased odds for both sexual dysfunction (OR 3.00, 95%CI 1.28–7.03) and dyspareunia (OR 1.92, 95% CI 1.47–2.52). Episiotomy was associated with dyspareunia (OR 1.64, 95% CI 1.25–2.14), but not with sexual dysfunction (OR 1.90, 95% CI 0.94–3.84). Compared with spontaneous birth, caesarean section reduced the odds for dyspareunia (OR 0.68, 95% CI 0.54–0.86) but not for sexual dysfunction (OR 1.14, 95% CI 0.89–1.46). Instrumental vaginal birth increased the odds for sexual dysfunction (OR 1.70, 95% CI 1.05–2.76), yet no difference was found for dyspareunia (OR 1.82, 95% CI 0.88–3.75). One study of low quality reported on vaginal dryness and found no association with obstetric events.

Conclusions

Perineal trauma, rather than mode of birth, increases the odds for sexual dysfunction in the first year after childbirth.

Tweetable Abstract

Perineal trauma, rather than mode of birth, correlates with sexual dysfunction and dyspareunia postpartum. #dyspareunia #OASI #episiotomy

Increased Risk of Sexual Dysfunction With Inflammatory Bowel Disease

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Men and women with inflammatory bowel disease (IBD) have a significantly increased risk of sexual dysfunction, according to a new meta-analysis.

“As people get older, the prevalence of sexual dysfunction increases due to disturbance of hormones,” said Dr. Zhigang Zhao from The First Affiliated Hospital of Guangzhou Medical University, in Guangzhou, China.

“Inversely, however, our study, which combined the relative risk from 8 relevant studies, indicated both male and female inflammatory bowel diseases patients with a younger age exhibited significantly increased odds of sexual dysfunction when compared to the healthy subjects, but such association was not found in a relatively older age in both sexes,” he told Reuters Health by email.

Previous studies have reported sexual dysfunction rates ranging from 44% to 53.9% in patients with IBD, with higher rates in women (66%) than in men (40%), but controversy remains regarding the association between IBD and sexual dysfunction.

To investigate, Dr. Zhao’s team conducted a meta-analysis of eight studies including more than 351,000 men and 1,309 women ranging in mean age from 33.6 years to 52.4 years.

Among men, 11.7% of those with IBD had sexual dysfunction, compared with 9.7% of those without IBD, a difference of 40 more men per 1,000, the researchers report in Inflammatory Bowel Diseases, online November 23.

Similarly, 44.9% of women with IBD had sexual dysfunction, compared with 24.0% of women without IBD, a difference of 182 more women per 1,000.

IBD was associated with a 41% increased risk of sexual dysfunction in men and a 76% increased risk in women.

IBD was associated with significantly greater odds of sexual dysfunction among men younger than 50 years and women younger than 40 years, but there was no association between IBD and sexual dysfunction for men 50 and older or women 40 and older.

“The etiologies of sexual dysfunction in inflammatory bowel diseases patients may be multifactorial, including but not limited to the nature of disease (activity, severity, and duration), pelvic floor disorders, psychosocial factors, body image perceptions and changes, medications usage, hypogonadism, and surgical interventions,” Dr. Zhao said.

“Accordingly, those patients with inflammatory bowel diseases who complained about sexual dysfunction may benefit from controlling the disease itself, treating pelvic floor disorders and psychosocial conditions, envisaging reality of the disease and being more confident, treating hypogonadism, and selecting the proper surgery,” he said.

Dr. Zhao added, “Additional high-quality stringent cohort studies with large sample size are still warranted to elucidate the relationship between inflammatory bowel diseases and the risk of sexual dysfunction in both sexes.”

Dr. Sonia Friedman from Harvard Medical School and Brigham and Women’s Hospital, in Boston, who wrote an accompanying editorial, told Reuters Health by email, “Sexual dysfunction in IBD patients is quite common, but few physicians ask their patients about it. Most patients feel comfortable with and would like to discuss this with their physicians (regardless of patient gender or physician gender).”

“Ask IBD patients about sexual function; if yes, figure out cause and treat or refer for treatment,” she said. “Evaluate for depression, IBD activity, hypogonadism, pelvic floor dysfunction in women, and medications – specifically steroids, anti-depressants, and narcotics. For men, check testosterone and have them see a urologist.”

Sexual dysfunction linked to metabolic syndrome in postmenopausal women

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Decreased sexual activity, desire and satisfaction are associated with metabolic syndrome in older women, according to study findings published in The American Journal of Medicine.

“In these healthy community-dwelling older women, the prevalence of low sexual desire was significantly higher in women who met the diagnostic criteria for metabolic syndrome,” Susan Trompeter, MD, clinical professor in the department of medicine at the University of California, San Diego School of Medicine and the VA San Diego Healthcare System, said in a press release. “In addition, we observed a higher prevalence of dysfunction by [Female Sexual Function Index] criteria in desire, arousal, orgasm and satisfaction, comparing sexually active women with metabolic syndrome to those without.”

Susan Trompeter

Susan Trompeter

Trompeter, Elizabeth Barrett-Connor, MD, of the division of epidemiology, department of family medicine and public health, University of California, San Diego, and colleagues evaluated data from the Rancho Bernardo study on 376 postmenopausal women (mean baseline age, 73 years) who completed a clinic visit between 1999 and 2002 and returned the Female Sexual Function Index (FSFI) mailed in 2002.

The questionnaire evaluated female sexual function through 19-items. Metabolic syndrome was defined as meeting at least three of the five following criteria: impaired glucose tolerance; waist circumference greater than 88 cm; triglycerides 150 mg/dL or greater; HDL cholesterol less than 50 mg/dL; and systolic blood pressure of at least 130 mm Hg or diastolic BP of at least 85 mm Hg, or a diagnosis of hypertension or current antihypertensive medication use.

Elizabeth Barrett-Connor

Elizabeth Barrett-Connor

Overall, 42% of participants met the criteria for metabolic syndrome: 23% met three of five criteria, 14% met four criteria and 5% met five criteria.

About 39% of participants reported sexual activity within the past 4 weeks, and sexual activity was linked to older age and living with a spouse or partner. Twenty-three percent of participants reported sexual desire, and 78% reported sexual satisfaction. A decrease in sexual activity and sexual desire was linked to older age and number of years since menopause.

More participants who were sexually inactive (48.3%) met the criteria for metabolic syndrome compared with 31.1% of sexually active participants (P = .001). Compared with about one-quarter of participants reporting sexual desire, nearly half (45.6%) of participants reporting no sexual desire met the criteria for metabolic syndrome (P = .008).

Compared with participants without metabolic syndrome, participants with metabolic syndrome had lower sexual desire (P = .0401) and lower arousal (P = .0086) scores, individually and combined (P = .0047). Reported orgasm frequency was lower (P = .0427), and the prevalence of orgasm dysfunction (P = .0134) was higher among participants with metabolic syndrome.

“Overlapping pathways affecting sexual function in women are complex and still poorly understood; however, both physiological and psychological variables contribute to sexual activity and function,” Trompeter said in the release. “Prevention of chronic disease and optimization of health may preserve sexual activity and satisfaction.” – by Amber Cox

Rheumatoid arthritis patients suffer sexual dysfunction

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Over one-third of patients with rheumatoid arthritis are sexually dysfunctional and suffer from low libido, painful intercourse, orgasmic dysfunction, and overall sexual dissatisfaction, according to research presented during the European League Against Rheumatism (EULAR) annual congress held recently in London, England.

“Sexuality is an important dimension of personality and human body, therefore any involvement in this area should be considered as important,” the researchers said. “Sexual disturbances in rheumatoid arthritis patients are poorly described in literature.”

The researchers interviewed a sample of 1.290 patients from a specialized rheumatoid arthritis clinic of whom 1,048 (80.74 percent) were women and 250 (19.26 percent) were men. Average disease activity was low and average age was 55.1 years. The researchers did not control the study with non-rheumatoid arthritis patients. [EULAR 2016, abstract OP0308-HPR]

Forty percent of women reported no sexual activity. Of the sexually active women (59.8 percent), 60.1 percent reported satisfactory sexual activity while 16.1 percent reported no satisfactory sexual activity, 7.8 percent reported lack or loss of sexual desire, 13.7 percent reported dyspareunia, and 2.2 percent reported orgasmic dysfunction.

Thirty-one percent of men reported no sexual activity. Of the sexually active men (69.2 percent), 49.1 percent reported satisfactory sexual activity while 12.1 percent reported premature ejaculation, 13.2 percent reported no satisfactory sexual activity, 5.8 percent reported a lack or loss of sexual desire, 16.1 percent reported orgasmic dysfunction, and 3.4 percent reported dyspareunia.

“There was statistical significance between patients reporting no sexual activity and higher disease activity,” the researchers said.

Though there were no statistically significant precipitating factors associated with sexual disorders and disease activity, and in a majority of patients there were no precipitating factors at all, non-significant precipitating factors included infidelity, insecurity in sexual role, and biological or physical causes, all of which were more common among women.

Maintenance factors were similarly statistically non-significant and in the minority, but these included biological causes, infidelity, changes in relationship, partner’s sexual dysfunction, and depression and anxiety, again, more common among women than men.

“There are many factors that may influence the prevalence and worsening of sexual disturbances; higher [disease activity score] is correlated with [less] sexual activity,” said lead author Dr. Pedro Santos-Moreno of the Biomab, Center for Rheumatoid Arthritis in Bogota, Colombia, citing prior work that showed improving disease activity does improve patients’ sexual drive, but that drug therapy may not be enough.

Santos-Moreno suggested clinics with a high volume of rheumatoid arthritis patients might benefit from the presence of a psychologist familiar with sexuality issues.

Clinical factors associated with sexual dysfunction among men in methadone maintenance treatment and buprenorphine maintenance treatment: a meta-analysis study

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Methadone maintenance treatment is proven to be effective treatment for opioid dependence. Of the many adverse events reported, sexual dysfunction is one of the most common side effects. However, there may be other clinical factors that are associated with sexual dysfunction among methadone users. We conducted a meta-analysis to examine the clinical factors associated with sexual dysfunction among male patients on methadone and buprenorphine treatments, of which eligible studies were selected using prior defined criteria. A total of 2619 participants from 16 eligible studies, published from inception till December 2012, were identified from the PubMed, OVID and EMBASE databases. The included studies provided prevalence estimates for sexual dysfunction among methadone users with a meta-analytical pooled prevalence of 52% (95%confidence interval (CI), 0.39–0.65). Only four studies compared sexual dysfunction between the two groups, with a significantly higher combined odds ratio in the methadone group (odds ratio=4.01, 95% CI, 1.52–10.55,P=0.0049). Our study shows that eight clinical factors are associated with sexual dysfunction among men receiving opioid substitution treatment, namely age, hormone assays, duration of treatment, methadone dose, medical status, psychiatric illness, other current substance use and familial status, and methadone versus buprenorphine treatment. Despite the methodological limitations, the findings of this meta-analysis study may offer better insights to clinicians in dealing with both sexual dysfunction and its related problems.

Sex Drive and Menopause: 50 Shades of Normal.

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Desire may decline with estrogen levels

Sex and menopause may seem like odd bedfellows. Especially if you’re one of the 15 to 70 percent of menopausal or postmenopausal women with sexual dysfunction, such as low desire or painful intercourse.

Why do studies report such varying percentages?

Perhaps because when it comes to sex, there are 50 shades of “normal,” according to Judith M. Volkar, MD, an OB/GYN for Cleveland Clinic’s Center for Specialized Women’s Health. There are no standards on how often you should have — or desire — sex. Sexual dysfunction simply refers to any issue that causes distress or interpersonal difficulty in the bedroom. So if you’re not desiring or having sex and you’re not distressed by it, then you’re not dysfunctional.

But if you are distressed, you’re not alone. And there are plenty of things you can do to make your sex life satisfying during menopause and beyond.

Improve function — even without hormone help

As women go through menopause, their estrogen levels drop. Lower levels of estrogen cause a decrease in blood flow to the vagina, which can make it less sensitive to touch and less receptive to physical arousal. Less estrogen also can mean less vaginal lubrication. All of that can make intercourse less desirable, more difficult or downright uncomfortable.

Fortunately, several things can help women, says Dr. Volkar:

  • Over-the-counter vaginal lubricants can supplement natural lubrication.
  • Vaginal moisturizers are like lubricants, but they stay in the vagina longer and cling to vaginal walls. Use them a couple of times a week (not at the time of intercourse).
  • Vaginal estrogen can help if lubricants and moisturizers are not enough. As a vaginal cream, dissolvable tablet or long-term insert, estrogen can restore vaginal mucosa to the way it was before menopause.
  • An FDA-approved clitoral therapy device works like a gentle vacuum that can increase blood flow to the clitoris. In addition to increasing vaginal lubrication, it can enhance the ability to achieve orgasm.

While some drugs are being tested, currently there is no Viagra®-type drug to treat low libido in women.

Try increasing your receptivity instead of your sex drive

Hormones aren’t the only factor in a woman’s sex life. Emotions play a big role, too. While men can use sex as a stress reliever, women usually prefer to relieve stress before having sex. Tension, fatigue and relationship issues all can affect a woman’s sexual desire.

But here’s an interesting fact: Women don’t necessarily need to desire sex in order to enjoy it. It’s like going to the gym. You may not feel like working out on a particular day. But once you start on the treadmill, you get into it, enjoy it and feel better afterward.

So, instead of trying to increase your sex drive, try increasing your receptivity — your willingness or ability to enjoy sex once you get into it. You might try:

  • Reading erotic books or articles that make you start thinking about sexual things
  • Watching erotic videos
  • Talking to your partner about things that arouse you
  • Scheduling a romance night — and thinking beforehand about what you’ll do

You’re never too old! Talk to your doctor

If these tips don’t help and you are bothered by your sexual function, see a physician. You are never too old. Even if you haven’t had sex in years, a doctor can guide you in restoring enjoyment.

 menopause-women-sexual-dysfunction-2-190x155Source: clevelandclinic.org