Sexual satisfaction among middle-aged couples: correlation with frequency of intercourse and health status

The central hypothesis of this investigation is that the greater the sexual satisfaction that a couple reports from their sexual relationship, the better will be their adjustment to the changes that occur during middle age, as reflected in their reported health status and health behaviour. Forty-seven married couples, of North African Jewish origin, were investigated, the women being in the age range 48-53 yr. The findings regarding reported frequency of sexual intercourse and sexual satisfaction of women and men separately showed that a great majority of both men (87%) and women (74%) reported a decrease in sexual activity over the 5 yr preceding the study. Most of the men (56%) said the change was due to the aging process, whereas the women's responses were more varied and included aging, worries and decrease in sexual interest or desire. Eighty percent of the men reported satisfaction in their sexual relationship with their wives, but only 43% of the women stated that they were satisfied. A significant correlation was found, for women only, between the degree of satisfaction and the change in frequency of intercourse. Among the women there was also a positive correlation between general life satisfaction and sexual satisfaction. The hypothesis in regard to mutual (couple) sexual satisfaction was not confirmed in the men. It was validated in the women in regard to only two of the four criteria used - their perception of their health status and of their well-being. The women perceived the sexual satisfaction of their husbands much more accurately than the husbands perceived that of their wives.     

Role of testosterone in the treatment of hypoactive sexual desire disorder

Hypoactive sexual desire disorder (HSDD) is a common clinical problem that may have a very negative impact on a woman's quality of life. Diagnosis and treatment is challenging, as one must keep in mind the complex web of factors influencing sexual functioning alone or in concert. Data suggest that androgens are significant independent factors affecting sexual desire, sexual activity and satisfaction, as well as other components of women's health such as mood and energy. For decades, physicians used various androgen preparations to improve sexual function in women, based on the results of smaller clinical trials and personal clinical observations when taking care of patients. Today, there is substantial body of evidence from randomized placebo-controlled trials that low-dose testosterone treatment is efficacious in women with HSDD who have an established cause of androgen deficiency such as surgical menopause. Recent data support the hypotheses that androgens may also be beneficial in naturally menopausal women or in premenopausal women with low circulating testosterone levels and a decrease in satisfying sexual activity. No single testosterone level has been found to be predictive for low female sexual function, even though women suffering from HSDD commonly have low testosterone levels. The most frequently reported side effects of testosterone treatment are mild hirsutism or acne. Long-term safety is not yet established. Several clinical trials are in progress to further investigate potential benefits and risks of androgen treatment in women with sexual dysfunction.     

Endogenous estrogen levels affect sexual function in elderly post-menopausal women

OBJECTIVE: The objective of this study was to determine if there is an association between endogenous serum concentration of estradiol (E2) and changes in sexual function in post-menopausal women over 3 years. METHODS: Sexually active women (N = 345, mean = 65 years) who participated in the multiple outcomes of raloxifene evaluation trial (MORE) had endogenous E2 levels measured at baseline. All women completed the sexual history questionnaire at baseline and 3 years later. We assessed sexual function (desire, activity, feelings/experiences and sexual problems) among these women by endogenous E2 level (<20 pmol/l or > or =20 pmol/l). RESULTS: At baseline, women with E2 levels <20 pmol/l had significantly greater discomfort and inability to relax compared with women with E2 > or =20 pmol/l (P < 0.05 for all). After 3 years, women with E2 > or =20 pmol/l had significantly less decline in sexual enjoyment (P < 0.02), satisfaction (P < 0.02), sexual comfort (P < 0.05) and sexual feelings summary score (P = 0.001), when compared with women who had E2 levels <20 pmol/l. CONCLUSIONS: Endogenous E2 levels are important predictors of change in sexual function in elderly women who are sexually active. However, this result needs to be proven in a study with a bigger sample size of sexually active women, who present with changes in sexual function over several years. Also, future investigations are needed to assess the effects of other endogenous hormones on sexual function in elderly women.     

Gender differences in sexual activity among mid-aged adults in Massachusetts

Objectives: The purpose of this study was to determine if self-reported measures of sexual activity differ between aging men and women. Methods: Responses to 12 questions concerning various aspects of sexual activity were compared between 349 women and 589 men aged 51–61, who were participants in two larger community surveys in Massachusetts conducted in 1987 and 1988. Comparisons were made by least squares means adjusted for age, socio-demographic and health-related variables. Analyses were stratified by the presence or absence of one or more current sexual partners. Results: Regardless of partner status, overall satisfaction with sex life did not differ between men and women. For those with partners, the mean frequency of intercourse was somewhat higher for women than men, while mean frequency of sexual desire and fantasies was significantly higher for men. Similar results were seen for those without partners, although frequency was lower and did not differ by gender. Conclusions: We found no gender difference in sexual satisfaction and little difference in frequency in mid-aged adults, but sexual desire and fantasies were more common for men.     

Effects of aromatase inhibition on sexual function and well-being in postmenopausal women treated with testosterone: a randomized, placebo-controlled trial

OBJECTIVE: The extent to which aromatization of testosterone (T) to estradiol is required for the observed effects of testosterone therapy on sexual function and well-being are not known. Therefore, the authors investigated the effects of aromatase enzyme inhibition on sexual function, well-being, and mood in estrogen- and T-replete postmenopausal women in a double-blind, randomized, placebo-controlled study. DESIGN: Postmenopausal women using transdermal estrogen therapy for at least 8 weeks and reporting low sexual satisfaction (score <42 for the Sabbatsberg Sexual Self-rating Scale [SSS]) with a total T value of less than 1.2 nmol/L were treated with 400 muL of a 0.5% T gel (total dose 2 mg) and were randomly assigned to receive treatment with either 2.5 mg/day of letrozole or an identical placebo tablet. Women were assessed at baseline (week -2) and at 0, 4, 8, and 16 weeks. Sexual function was assessed with the SSS, well-being was assessed with the Psychological General Well-being Index, and mood was assessed with the Beck Depression Inventory at 0 and 16 weeks. Eighty-one women were screened, 76 were randomly assigned to a treatment group, and 30 in each group completed the study. Because this was a mechanistic study, only the 60 women who completed the study per protocol were included in the final analysis. RESULTS: Total T and calculated free T increased from baseline in both groups, with no difference between groups. At 16 weeks, estradiol, sex hormone-binding globulin, fasting lipids, lipoprotein(a), and C-reactive protein did not differ from baseline or between groups. Significant increases in total Sabbatsberg Sexual Self-rating Scale scores, total Psychological General Well-being Index scores, and a reduction in Beck Depression Inventory scores from baseline to 16 weeks was seen for both treatment groups, with no effect of treatment allocation. No adverse treatment effects were reported. CONCLUSIONS: Increases in total and free T in the physiologic range in postmenopausal women were associated with improved sexual satisfaction, well-being, and mood. In this study, aromatase inhibition did not influence any of these outcomes. Short-term transdermal T therapy did not modify fasting lipids, lipoprotein(a), or C-reactive protein.     

Hypoactive sexual desire disorder in postmenopausal women: US results from the Women's International Study of Health and Sexuality (WISHeS)

OBJECTIVE: To determine the prevalence of hypoactive sexual desire disorder (HSDD) among US women by reproductive status and age and to explore the correlates of sexually related distress. DESIGN: The Women's International Study on Health and Sexuality questionnaire was mailed to a national sample of US women in 2000. The survey included validated questionnaires: the Short Form-36, which measures overall health status; the Profile of Female Sexual Function, which assesses sexual desire; and the Personal Distress Scale, which measures distress caused by low desire. Four groups of women were studied: surgically postmenopausal, aged 20 to 49 years and 50 to 70 years; premenopausal, aged 20 to 49 years; and naturally postmenopausal, aged 50 to 70 years. Clinically derived cutoff Profile of Female Sexual Function and Personal Distress Scale scores were used to classify women with HSDD and determine its prevalence. The relations between sexual desire and frequency of sexual activity or relationship satisfaction were assessed. Overall health status of HSDD women and women with normal desire were compared. RESULTS: The prevalence of HSDD ranged from 9% in naturally postmenopausal women to 26% in younger surgically postmenopausal women. The prevalence of HSDD was significantly greater among surgically postmenopausal women, aged 20 to 49 years, than premenopausal women of similar age, whereas there were no significant differences in the prevalence between surgically postmenopausal women, aged 50 to 70 years, and naturally postmenopausal women. For many women, HSDD was associated with emotional and psychological distress as well as significantly lower sexual and partner satisfaction. HSDD was also associated with significant decrements in general health status, including aspects of mental and physical health. CONCLUSIONS: HSDD is prevalent among women at all reproductive stages, with younger surgically postmenopausal women at greater risk, and is associated with a less active sex life and decreased sexual and relationship satisfaction.     

Sexual function, menopause and hormone replacement therapy (HRT)

Objective: To assess the prevalence of female sexual dysfunction in premenopausal and postmenopausal women with and without hormone replacement therapy (HRT). To determine the relationship between menopause and sexual activity, and the impact of HRT on sexual function. Methods: A cross-sectional analysis of 231 Colombian-born women, aged 40–62 years. Sexual function was measured by self-questionnaire. The analysis was performed by using the χ²-test and multivariate regression analysis. The sexual function was divided in five domains: desire, arousal, lubrication, orgasm and pain; in addition, questioning about sexual satisfaction was included in the research. Results: In the study 38.1% of women showed sexual dysfunction in the desire, and 25% in the arousal, these two being the most affected domains. Even though menopause marginally decreases all stages of sexual function, this association was statistically significant only for the lubrication and pain domains. HRT improves sexual function in the orgasm, lubrication and pain domains in a statistically significant manner. The level of sexual satisfaction was better on postmenopausal women with HRT than ones without HRT. Age negatively influences almost all sexual function domains in a significant manner. Conclusions: Menopause affects in a negative manner some domains of female sexual function. HRT improves some factors of the sexual function during menopause but it not improves desire and arousal which were the most affected domains. There is a negative association between age and female sexual response in middle-aged women.     

Efficacy and safety of a testosterone patch for the treatment of hypoactive sexual desire disorder in surgically menopausal women: a randomized, placebo-controlled trial

OBJECTIVE: Evaluation of the use of testosterone therapy for hypoactive sexual desire disorder (HSDD) after oophorectomy has mostly involved women treated with oral estrogen preparations. We investigated the efficacy and safety of a testosterone patch in surgically menopausal women receiving concurrent transdermal estrogen. DESIGN: Women with HSDD after oophorectomy, for whom this was a concern, who were using transdermal estrogen, were recruited to a 24-week, randomized, double-blind, placebo-controlled trial in Europe and Australia. Patients were randomly allocated to placebo (n = 40) or testosterone 300 microg/day (n = 37) treatment. Primary endpoints were changes in sexual desire measured by the sexual desire domain of the Profile of Female Sexual Function and the frequency of satisfying sexual activity at 24 weeks. RESULTS: Sixty-one women (79%) completed the trial. All subjects who received at least one application of study medication were included in analysis. The testosterone-treated group experienced a significantly greater change from baseline in the domain sexual desire score compared with placebo (change from baseline, 16.43 versus 5.98; P = 0.02). The domain scores for arousal, orgasm, decreased sexual concerns, responsiveness, and self-image as well as decreased distress were also significantly greater with testosterone therapy than placebo. The frequency of satisfactory sexual events increased but was not statistically different between treatment groups (P = 0.06) Adverse events occurred with similar frequency in both groups, and no serious risks of therapy were observed CONCLUSIONS: In this study, transdermal testosterone therapy via a skin patch improved sexual desire and other sexual function domains. It was well tolerated in these oophorectomized women with HSDD receiving concomitant transdermal estrogen.     

Sexual function in the postpartum period: effects of maternal depression and interpersonal psychotherapy treatment

Women's sexual functioning in the postpartum period is understudied given its potential impact on women's mental health and their relationships with their partners. The sexual functioning of women with postpartum depression (PPD) in particular is not well characterized. The goals of this study were to examine factors associated with the sexual functioning of postpartum women and to compare the long-term sexual functioning of depressed postpartum women treated with interpersonal psychotherapy with a group of postpartum women who had never been depressed. Depressed (120) and never depressed (56) postpartum women were enrolled. Self-report questionnaires and clinician-rated measures were completed at initial entry to study, immediately post-treatment, and at 6, 12, and 18 months post-treatment. Analyses revealed significant differences in sexual interest between depressed and never depressed postpartum women (t (171) = 11.82, p < 0.001). Although sexual interest improved significantly following treatment for depression (t (104) = −3.18, p < 0.01), those women who fully recovered continued to experience less interest (F (2, 140) = 32.24, p < 0.0001) and less sexual satisfaction through 2 years postpartum than never depressed women. These findings suggest that differences in sexual functioning exist between depressed and never depressed postpartum women, even after depressed women are treated and have recovered from their depression. Clinicians should inquire about changes in sexual functioning when treating women with PPD.     

地黄叶总苷胶囊治疗糖尿病女性性功能障碍的临床研究

目的 评价地黄叶总苷胶囊治疗糖尿病女性性功能障碍的有效性及安全性。方法 选取2011年5月~2014年12月在我院治疗的糖尿病患者中存在女性性功能障碍者54例,随机分成观察组和对照组,各27例。观察组给予地黄叶总苷胶囊联合西地那非片治疗,对照组给予西地那非片治疗,比较两组患者中医证候积分、治疗前后体内性激素水平变化、女性性功能量表（FSFI）六大维度变化、不良反应发生率等。结果 治疗后治疗组总有效率90.30%,高于对照组的70.37%,统计学意义显著（P＜0.01）;两组较治疗前在中医证候积分改善方面均不同程度得到了改善,但是观察组较对照组改善更明显（P＜0.05）;对照组在性唤起、性欲方面有改善,在阴道湿润度、性交痛、性交满意度方面落后观察组,差异有统计学意义（P＜0.05）;观察组治疗后的雌二醇（E2）、睾酮（T）、孕酮（P）水平较治疗前升高（P＜0.05）,对照组治疗前后无明显变化（P＞0.05）;治疗组不良反应发生率为0,低于对照组的7.41%,差异具有统计学意义（P＜0.05）。结论 地黄叶总苷胶囊可有效改善糖尿病女性性功能障碍患者的幸福指数,在阴道湿润度和性交痛方面的效果优于单纯西药,能够降低西地那非片副作用,值得临床推广。     

Controlled prospective longitudinal study of women with cancer: I. Sexual functioning outcomes

The incidence and etiology of sexual difficulties for women with survivable cancer were studied. Women with early stage gynecologic cancer (n = 47) were assessed after their diagnosis but prior to treatment and then reassessed at 4, 8, and 12 months posttreatment. Sexual and medical outcomes were compared with data from members of two matched comparison groups who were also assessed longitudinally: women diagnosed and treated for benign gynecologic disease (n = 18) and gynecologically healthy women (n = 57). Global sexual behavior disruption did not occur, but the frequency of intercourse declined for women treated for disease, whether malignant or benign. In relation to the sexual response cycle, diminution of sexual excitement is pronounced for women with disease; however, this difficulty is more severe and distressing for women with cancer, possibly due to significant coital and postcoital pain, premature menopause, treatment side effects, or a combination. Changes in desire, orgasm, and resolution phases of the sexual response cycle may also occur, but they are of lesser magnitude or duration or both. Approximately 30% of the women treated for cancer were diagnosed with a sexual dysfunction. The nature, early timing, and maintenance of sexual functioning morbidity suggest the instrumental role that cancer and cancer treatments play in these deficits (particularly arousal problems) and suggest that preventive therapies are necessary.     

Libido and orgasm in middle-aged woman

OBJECTIVES: Determine which social, demographic and sexual function variables that most influence libido or desire and orgasm domains in the premenopausal and postmenopausal women. METHODS: A cross-sectional analysis of 231 Colombian-born women, aged 40-62 years. The sexual function was measured by self-questionnaire. The analysis was performed by using the chi2-test and multivariate regression analysis. The sexual function was divided in five domains: desire, arousal, lubrication, orgasm, pain; additionally satisfaction was included. RESULTS: The women with a higher level of education and with a good perception of their satisfaction with their partners, reported better performance in the desire. Age and the non existence of sexual partner influenced in a negative way on the desire. In sexual active women the orgasm was negatively influenced by low satisfaction scores, lack of emotional closeness with their partners and low educational level. High scores in lubrication and desire were associated with a good performance in the orgasm. The hormone therapy (HT) was associated with better scores in orgasm. CONCLUSIONS: Age, level of education, the presence or lack of sexual partner, degree of satisfaction with emotional closeness with the partner and adequate lubrication, influence the desire and orgasm domains in a significant way. By identifying these associations we can then perform some inexpensive interventions. Improving lubrication for menopausal women. Including men in educational activities to sensitize them toward women's feelings. Organizing educational campaigns for middle-aged women to demystify that sexuality is only for young people.     

Long-term effect of treatment of female incontinence in general practice.

BACKGROUND: Urinary incontinence in women can be treated successfully by the general practitioner. However, little is known about the long-term effects of conservative treatment. AIM: To evaluate the long-term effect of treatment of female incontinence by the general practitioner (pelvic floor exercises, and bladder training) in female urinary incontinence. METHOD: A total of 88 women, aged between 20 and 65, who had participated in a controlled trial between 1987 and 1990, were contacted to participate in a five-year follow-up study. Stress incontinence and urge incontinence were treated by means of pelvic floor exercises and bladder training respectively, while a mixed incontinence was treated by bladder training followed by pelvic floor exercises. The outcome measures were a constructed scale for the severity of the incontinence, a seven-day bladder chart, and a questionnaire concerning patients' opinions. All patients were evaluated by an independent researcher. RESULTS: Compared with the one-year follow-up, the number of continent women remained the same, but a significantly greater number of patients worsened. Forty per cent of the women stayed in the same category of severity, while 45% moved into the contiguous categories. The weekly frequency of wet episodes increased significantly, with a mean increase of 2.65 episodes. Women with mixed incontinence were especially prone to relapse in the long-term. Compliance with the exercises had a positive influence on the outcomes, with 67% of the women expressing satisfaction with the results. CONCLUSIONS: Despite a decline in the effect of conservative treatment in the long-term, the majority of the women are satisfied with their treatment. Patient compliance is the key to long-term success.     

Testosterone enhances estradiol''s effects on postmenopausal bone density and sexuality

To investigate the role of androgens in increasing bone density and improving low libido in postmenopausal women, we have studied the long-term effects of estradiol and testosterone implants on bone mineral density and sexuality in a prospective, 2 year, single-blind randomised trial. Thirty-four postmenopausal volunteers were randomised to treatment with either estradiol implants 50 mg alone (E) or estradiol 50 mg plus testosterone 50 mg (E&T), administered 3-monthly for 2 years. Cyclical oral progestins were taken by those women with an intact uterus. Thirty-two women completed the study. BMD (DEXA) of total body, lumbar vertebrae (L1–L4) and hip area increased significantly in both treatment groups. BMD increased more rapidly in the testosterone treated group at all sites. A substantially greater increase in BMD occurred in the E&T group for total body (P < 0.008), vertebral L1–L4 (P < 0.001) and trochanteric (P < 0.005) measurements. All sexual parameters (Sabbatsberg sexual self-rating scale) improved significantly in both groups. Addition of testosterone resulted in a significantly greater improvement compared to E for sexual activity (P < 0.03), satisfaction (P < 0.03), pleasure (P<0.01), orgasm (P < 0.035) and relevancy (P < 0.05). Total cholesterol and LDL-cholesterol fell in both groups as did total body fat. Total body fat-free mass (DEXA, anthropometry, impedance) increased in the E&T group only. We concluded that in postmenopausal women, treatment with combined estradiol and testosterone implants was more effective in increasing bone mineral density in the hip and lumbar spine than estradiol implants alone. Significantly greater improvement in sexuality was observed with combined therapy, verifying the therapeutic value of testosterone implants for diminished libido in postmenopausal women. The favourable estrogenic effects on lipids were preserved in women treated with T, in association with beneficial changes in body composition.     

Yoga Effects on Physical Activity and Sexual Satisfaction Among the Iranian Women With Multiple Sclerosis: A Randomized Controlled Trial

Background

Multiple Sclerosis (MS) is a chronic and disabling disease resulting in disabilities in young and middle-aged persons. In this study, researchers explored the effect of yoga techniques on physical activities and sexual function among some Iranian women with MS.

Materials and Methods

In this study, 60 Iranian women with multiple sclerosis (MS) were placed in two equally divided control and case groups through random selection to assess pre-and post-effects of yoga exercises on their physical activities and sexual satisfaction levels. Women in case group were offered a series of yoga training and exercises for 3 months, which consisted of 8 sessions per month for 60 to 90 minutes at each session. Yoga training program included the 3 principles of slow motions (Hatayoga), respiratory exercises (Pranayama) and centralization to control mind via meditation, expansion and stasis (Rajayoga). After 3 months both groups were surveyed using the initial questionnaire to evaluate and compare findings with the base-line data.

Results

Researchers found significant statistical difference in physical activity and sexual satisfaction levels among the women in case group (P=0.001). Women in case group showed improvement in physical ability while women in control group manifested exacerbated symptoms.

Conclusion

Yoga techniques may improve physical activities and sexual satisfaction function of women with MS.     

Changes in sex behaviour after menopause: effects of tibolone

In order to analyse both sexual desire after menopause and its response to treatment with tibolone, a randomized placebo/tibolone trial has been designed with 28 postmenopausal patients. They were asked to answer a questionnaire designed by us to obtain quantitative measurements to describe changes in sexual desire. After selection, the patients were randomly assigned to two groups as follows: 14 in the group treated with 2.5 mg/day of tibolone and 14 in the placebo group treated with 500 mg/day of calcium. The patients were monitored after 3, 6 and 12 months. Before joining this study, they had signed a written consent. It was observed that the sexual desire after menopause underwent a significant fall, with decline in arousability and intercourse. The comparative results show that the patients treated with tibolone experience an improvement after the third month of treatment and this improvement was maintained until the end of treatment. We conclude that the questionnaire proposed here is a useful non-parametric method to diagnose a patient's sexuality status at the baseline assessment and a valuable tool for monitoring various therapies. Furthermore, tibolone proved to be effective in managing reduced sexual desire which appears in postmenopausal patients.     

Breast cancer surgery: comparing surgical groups and determining individual differences in postoperative sexuality and body change stress

Women diagnosed and surgically treated for regional breast cancer (N = 190) were studied to determine the sexual and body change sequelae for women receiving modified radical mastectomy (MRM) with breast reconstruction in comparison with the sequelae for women receiving breast-conserving therapy (BCT) or MRM without breast reconstruction. The sexuality pattern for women receiving reconstructive surgery was one that was significantly different--with lower rates of activity and fewer signs of sexual responsiveness--than that for women in either of the other groups. Significantly higher levels of traumatic stress and situational distress regarding the breast changes were reported by the women receiving an MRM in contrast to the women treated with BCT. Using a model to predict sexual morbidity, regression analyses revealed that individual differences in sexual self-schema were related to both sexual and body change stress outcomes.     

Life after infertility treatment: a long-term investigation of marital and sexual function

After leaving in-vitro fertilization (IVF) treatment, both successful and unsuccessful women are generally lost to follow-up. In order to assess overall life satisfaction as well as marital and sexual adjustment after the completion of infertility treatment, three groups of women were studied: group 1 (n = 41), successful IVF women; group 2 (n = 16), unsuccessful IVF women who adopted; and group 3 (n = 18), unsuccessful IVF women who remained childless. All women who had completed a minimum of three IVF cycles between the years 1982 and 1993 were invited to participate in a 'life after infertility' follow-up study. Those who agreed were mailed a lengthy questionnaire which included questions about their reproductive history and infertility treatment, the impact of infertility on their marital and sexual relationship and their final thoughts about treatment. Four standardized questionnaires were also administered. Results revealed that women who became biological mothers through IVF were significantly more satisfied with their lives than women who were unsuccessful in IVF and remained childless (F = 8.62, P < 0.001). Childless women reported that infertility had exerted a significantly greater negative impact on their marriages than that reported by the other two groups. There were no significant differences, however, between the three groups on the standardized measures of marital and sexual satisfaction.      

城市女性性生活质量的相关因素

目的：探讨城市女性性生活质量的相关因素。方法：采用女性性生活质量问卷，对1529名城市已婚女性进行调查。以问卷的6个因子（性满意度、性交流、性焦虑、性反应、性态度、性体像）得分的10百分位数作为分界点，因子分≤10百分位数的为低分组，〉10百分位数的为对照组，进行单因素和多因素Logistic逐步回归分析。结果：性生活质量问卷总均分为106．9&#177;17．2，性满意度因子均分为24．1&#177;4．9，性交流因子均分为17．7&#177;5．1，性焦虑因子均分为26．0&#177;3．9，性反应因子均分为16．2&#177;3．9，性态度因子均分为13．0&#177;3．0，性体像因子均分为10．0&#177;1．9。多因素Logistic逐步回归分析显示，高年龄组（OR=1．25～16．72，P〈0．01）的女性，出现性满意度低、性交流少、性反应能力低、不接纳手淫的风险性高；汉族（OR=0．53，P〈0．05）、教育程度高（OR=0．40，P〈0．01）的女性，出现性焦虑的风险小；每月收入高的女性（OR=0．35～0．64，P〈0．01），其性生活质量低的风险小；有子女的女性易于出现对形象的不自信（OR=1．63—2．91，P〈0．01），但性满意度低的风险小（OR=0．46，P〈0．05）；绝经状态的女性（OR=1．54—2．32，P〈0．05或0．01）出现性满意度低、性焦虑多、性反应能力低、对自我形象不自信的风险性增大；夫妻关系不和睦（OR=3．25～8．87，P〈0．01）是性满意度、性交流，性焦虑的不利因素；丈夫有性功能障碍（OR=3．50～11．40，P〈0．01）是女性性满意度、性反应的不利因素；丈夫有躯体疾病（OR=2．17～3．13，P〈0．05或0．01）的女性易于表现为性满意度低、性焦虑多。结论：社会心理因素对女性性生活质量的各方面都会产生影响。     

The treatment of postmenopausal vaginal atrophy with Ovestin vaginal cream or suppositories: clinical, endocrinological and safety aspects

Seventy-four postmenopausal women presenting with vaginal atrophy were treated with either Ovestin® vaginal cream (Group A, 23 women: 1 mg/day E₃; Group B, 30 women: 0.5 mg/day E₃) or vaginal suppositories (Group C, 21 women: 0.5 mg/day E₃), applied daily for 3 wk (A and B) or 2 wk (C) before retiring. Ten women from A and 10 from B applied a maintenance dose (1 application twice weekly) during wk 4–16. Effects on vaginal cytology, cervical mucus and clinical and colposcopic findings were studied. Endometrial biopsies were done in 16 patients (A) before and after 3 wk of treatment, and, in 8 of the cases, at 16 wk. A routine laboratory screening program was performed before and after 16 wk of treatment in 10 patients (A). Plasma samples for hormone level determinations were obtained in 32 patients.

Clinical and colposcopic findings showed a beneficial effect of treatments, confirmed by vaginal smears, and persisting during maintenance therapy. Effect on cervical mucus was slight to moderate. No side effects occurred and tolerance was very good. Endometrium remained atrophic under treatment. Screening program revealed no abnormalities. Treatments induced a sharp rise in plasma E₃, followed by a gradual decline. Gonadotropins were slightly suppressed. E₁, E₂, PRL and SHBG capacity remained unchanged.