Pelvic Floor Dysfunction: Women’s Sexual Concerns Unraveled

IntroductionSexual function of women suffering from pelvic organ prolapse (POP) and/or urinary incontinence (UI) is adversely affected. However, our current understanding of the exact relationship between female sexual dysfunction and POP and/or UI is incomplete. A qualitative study can improve our understanding by describing what women themselves perceive as the real problem.AimTo gain a more in‐depth understanding of the impact of POP and/or UI on the different categories of female sexual dysfunction by way of a qualitative study.MethodsQualitative semistructured interviews were conducted in 37 women scheduled for pelvic floor surgery, and one was excluded from analysis due to incomplete recordings.Main Outcome MeasuresThe impact of POP and/or UI on female sexual function.ResultsOnly 17% of women were completely positive about their sex life. Both POP and UI had a negative effect on body image. Women with POP had a negative image of their vagina, which caused them to be insecure about their partner's sexual experience, while women with UI were embarrassed about their incontinence and pad use, and feared smelling of urine. Worries about the presence of POP during sexual activity, discomfort from POP, and reduced genital sensations were the most important reasons for decreased desire, arousal, and difficulty reaching an orgasm in women with POP. Fear of incontinence during intercourse affected desire, arousal, and orgasm and could be a cause for dyspareunia in women with UI. Desire was divided into two main elements: “drive” and “motivation.” Although “drive,” i.e., spontaneous sexual interest, was not commonly affected by POP and/or UI, a decrease in “motivation” or the willingness to engage in sexual activity was the most common sexual dysfunction mentioned.ConclusionsBody image plays a key role in the sexual functioning of women with POP and/or UI with the biggest impact on women's “motivation.” Roos A‐M, Thakar R, Sultan AH, Burger CW, and Paulus ATG. Pelvic floor dysfunction: Women's sexual concerns unraveled. J Sex Med 2014;11:743–752.     

Can Pelvic Floor Muscle Training Improve Sexual Function in Women with Pelvic Organ Prolapse? A Randomized Controlled Trial

IntroductionPelvic floor muscle training (PFMT) has level 1 evidence of reducing the size and symptoms associated with pelvic organ prolapse (POP). There is scant knowledge, however, regarding whether PFMT has an effect on sexual function.AimThe aim of the trial was to evaluate the effect of PFMT on sexual function in women with POP.MethodsIn this randomized controlled trial, 50 women were randomized to an intervention group (6 months of PFMT and lifestyle advice) and 59 women were randomized to a control group (lifestyle advice only).Main Outcome MeasuresParticipants completed a validated POP‐specific questionnaire to describe frequency and bother of prolapse, bladder, bowel, and sexual symptoms and answered a semi‐structured interview.ResultsNo significant change in number of women being sexually active was reported. There were no significant differences between groups regarding change in satisfaction with frequency of intercourse. Interview data revealed that 19 (39%) of women in the PFMT group experienced improved sexual function vs. two (5%) in the control group (P < 0.01). Specific improvements reported by some of the women were increased control, strength and awareness of the pelvic floor, improved self‐confidence, sensation of a “tighter” vagina, improved libido and orgasms, resolution of pain with intercourse, and heightened sexual gratification for partners. Women who described improved sexual function demonstrated the greatest increases in pelvic floor muscle (PFM) strength (mean 16 ± 10 cmH₂0) and endurance (mean 150 ± 140 cmH₂0s) (P < 0.01).ConclusionPFMT can improve sexual function in some women. Women reporting improvement in sexual function demonstrated the greatest increase in PFM strength and endurance. Brækken IH, Majida M, Ellström Engh M, and Bø K. Can pelvic floor muscle training improve sexual function in women with pelvic organ prolapse? A randomized controlled trial. J Sex Med 2015;12:470–480.     

Is There an Association Between Contraception and Sexual Dysfunction in Women? A Systematic Review and Meta-analysis Based on Female Sexual Function Index

BackgroundA growing body of research investigates the sexual functioning status in women with contraceptives use; however, the evidence is still inconclusive.AimTo examine whether contraceptives use is associated with a higher risk of female sexual dysfunction (FSD).MethodsThe electronic databases MEDLINE, Embase, Cochrane Library databases, and PsychINFO were systematically screened for eligible studies before December 2019. We only included those studies assessing women's sexual functioning by the Female Sexual Function Index (FSFI). This study was registered on the PROSPERO (ID: CRD42020167723, http://www.crd.york.ac.uk/PROSPERO).OutcomesThe strength of the association between contraceptives use and risk of FSD was presented by calculating the standard mean dierences (SMDs) and the relative risk (RR) with a 95% confidence interval (CI). The pooled results were calculated using a random-effects model.ResultsA total of 12 studies (7 cross-sectional studies, 3 cohorts, and 1 case-control study) involving 9,427 participants were included. The mean age in the contraceptive users ranged from 22.5 ± 2.4 years to 38.2 ± 4.6 years, while the mean age in the nonusers was 22.5 ± 2.4 years to 36.0 ± 1.0 years. Pooled results showed that no significant difference in the total FSFI scores was observed between contraceptives use and noncontraception (SMD = −1.03, 95% CI: −2.08 to 0.01, P = .053; heterogeneity: I² = 98.2%, P < .001). In line with this finding, the pooled RR also yielded no association between contraception use and the risk of FSD (RR = 1.29, 95% CI: 0.72–2.28, P = .392; heterogeneity: I² = 76.0%, P = .0015). However, the subscale sexual desire showed a significant reduction in women who received contraceptives than those did not use contraception (SMD = −1.17, 95% CI: −2.09 to −0.24, P = .014; heterogeneity: I² = 97.7%, P < .001), while no significant differences were found in sexual arousal, lubrication, orgasm, satisfaction, and pain domain.Clinical ImplicationsThough evidence from this meta-analysis did not support an association between contraceptives use and the risk of FSD, the sexual desire could be significantly impaired by contraceptives use.Strengths & LimitationsThis is the first meta-analysis quantifying the relationship between contraceptives use and the risks of FSD. However, substantial heterogeneities were presented across the included studies.ConclusionNo direct association between contraceptives use and the risk of FSD was found. Nevertheless, declining sexual desire was significantly associated with contraceptives use. Additional double-blind, randomized, placebo-controlled trials are still warranted.Huang M, Li G, Liu J, et al. Is There an Association Between Contraception and Sexual Dysfunction in Women? A Systematic Review and Meta-analysis Based on Female Sexual Function Index. J Sex Med 2020;17:1942–1955.     

Impact of Androgens on Sexual Function in Women With Rectal Cancer – A Prospective Cohort Study

BackgroundWomen treated for rectal cancer are at risk of sexual dysfunction and impaired ovarian androgen production.AimTo investigate a possible association between serum levels of endogenous androgens and sexual function in women with rectal cancer.MethodsWomen diagnosed with stage I–III rectal cancer were consecutively included and prospectively followed with the Female Sexual Function Index (FSFI) questionnaire from baseline to 2 years postoperatively and blood samples for hormone analyses, baseline to 1 year. Androgens were measured with liquid chromatography−mass spectrometry and electrochemiluminescence. The associations between the 4 measured androgens (testosterone, free testosterone, androstenedione, and dehydroepiandrosterone sulphate) and sexual function were assessed with generalized least squares random effects regression analysis in sexually active women.OutcomesThe primary outcome measure was the mean change observed in the FSFI total score when the serum androgen levels changed with one unit. Secondary outcomes were the corresponding mean changes in the FSFI domain scores: sexual desire, arousal, lubrication, orgasm, satisfaction, and pain/discomfort.ResultsIn the 99 participants, the median FSFI total score decreased from 21.9 (range 2.0 – 36.0) to 16.4 (3.5 – 34.5) and 11.5 (2.0 to 34.8) at 1 and 2-years follow-up. After adjustment for age, partner, psychological well-being, preoperative (chemo)radiotherapy, and surgery, total testosterone and androstenedione were significantly associated with FSFI total score (β-coefficients 3.45 (95% CI 0.92 – 5.97) and 1.39 (0.46 – 2.33) respectively). Testosterone was significantly associated with the FSFI-domains lubrication and orgasm, free testosterone with lubrication, androstenedione with all domains except desire and satisfaction, and dehydroepiandrosterone sulphate with none of the domains.Strengths and LimitationsThis is the first study investigating whether androgen levels are of importance for the impaired sexual function seen in women following rectal cancer treatment. The prospective design allows for repeated measures and the use of the FSFI for comparisons across studies. No laboratory data were collected at the 2-year follow-up, and the missing data could have further clarified the studied associations.Conclusion and Clinical ImplicationTestosterone and androstenedione were associated with sexual function in female rectal cancer patients. The results are of interest for future intervention studies and contribute to the understanding of sexual problems, which is an essential component of the rehabilitation process in pelvic cancer survivors.Svanström Röjvall A, Buchli C, Flöter Rådestad A, et al. Impact of Androgens on Sexual Function in Women With Rectal Cancer – A Prospective Cohort Study. J Sex Med 2021;18:1374–1382.     

Is There a Relationship Between Overactive Bladder and Sexual Dysfunction in Women With Multiple Sclerosis?

BackgroundLower urinary tract Symptoms (LUTS) and Sexual dysfunction (SD) are common in women with MS and affect quality of life.AimThe aim of this study was to determine the relationship between sexual dysfunction (SD) and overactive bladder in women with Multiple Sclerosis (MS).MethodsFrom January 2019 to January 2021, we evaluated 89 female MS patients admitted for LUTS in a Neuro-Urology Department. SD was investigated using the Female Sexual Function Index (FSFI). All subjects completed the Urinary Symptom Profile scale (USP) and Hospital Anxiety and Depression Scale (HAD A/HAD D). Neurological impairment was assessed using the Expanded Disability Status Scale (EDSS). All patients underwent neurological examination and urodynamic studies. Univariate analysis and Multivariate logistic regression analysis were performed to identify predictors of SD in women with MS (FSFI <26.55).OutcomesPrimary outcome was to determine the association between sexual dysfunction in women with MS and LUTS (overactive bladder, stress incontinence or voiding dysfunction).ResultsSexual dysfunction (FSFI<26,55) affected 74% of women with MS, even with low physical disabilities (EDSS<5). Univariate analysis showed that overactive bladder was more frequent in SD group, but no statistical difference was found (P < .12). No relationship was found between sexual dysfunction and stress incontinence (P = ,47), voiding dysfunction (P= 0.79) or urinary retention (P= .96). Multivariate logistic regression analysis identified overactive bladder to be an independent predictor of sexual dysfunction [aOR 0.03 (CI 0,0.98)]. Sexual dysfunction was not associated with detrusor overactivity on urodynamic studies or with impairment mobility but was strongly associated with the presence of depression (P < .01).Clinical implicationsSexual disorders in women with MS should be assessed as much as urinary disorder.Strengths and limitationsthis study included the largest cohort of women with MS. But the sample was obtained in an outpatient setting with low neurological impairment.ConclusionIn our study, SD was frequent affecting young women with no anticholinergic treatment and low physical impairment. Overactive bladder seemed to be independent predictor of sexual dysfunction. Conversely, SD was not associated with detrusor overactivity, neurological impairment, or duration of disease but was strongly associated with depression.Breton FL, Chesnel C, Lagnau P, et al. Is There a Relationship Between Overactive Bladder and Sexual Dysfunction in Women With Multiple Sclerosis?. J Sex Med 2022;19:729–737.     

Is the Sexual Satisfaction of Postmenopausal Women Enhanced by Physical Exercise and Pelvic Floor Muscle Training?

IntroductionPhysical exercise including pelvic floor muscle (PFM) training seems to improve the sexual function of women with urinary incontinence. This effect in postmenopausal women who are continent has not yet been determined.AimThe aim of this study was to assess the effect of a 3‐month physical exercise protocol (PEP) on the sexual function and mood of postmenopausal women.MethodsThirty‐two sedentary, continent, sexually active women who had undergone menopause no more than 5 years earlier and who had follicle stimulating hormone levels of at least 40 mIU/mL were enrolled into this longitudinal study. All women had the ability to contract their PFMs, as assessed by vaginal bimanual palpation. Muscle strength was graded according to the Oxford Modified Grading Scale (OMGS). A PEP was performed under the guidance of a physiotherapist (M.M.F.) twice weekly for 3 months and at home three times per week. All women completed the Sexual Quotient‐Female Version (SQ‐F) and the Hospital Anxiety and Depression Scale (HADS) before and after the PEP.Main Outcome MeasuresSQ‐F to assess sexual function, HASDS to assess mood, and OMGS to grade pelvic floor muscle strength.ResultsThirty‐two women (24 married women, eight women in consensual unions) completed the PEP. Following the PEP, there was a significant increase in OMGS score (2.59 ± 1.24 vs. 3.40 ± 1.32, P < 0.0001) and a significant decrease in the number of women suffering from anxiety (P < 0.01), but there was no effect on sexual function.ConclusionImplementation of our PEP seemed to reduce anxiety and improve pelvic floor muscular strength in sedentary and continent postmenopausal women. However, our PEP did not improve sexual function. Uncontrolled variables, such as participation in a long‐term relationship and menopause status, may have affected our results. We suggest that a randomized controlled trial be performed to confirm our results. Lara LAS, Montenegro ML, Franco MM, Abreu DCC, Rosa e Silva ACJS, Ferreira CHJ. Is the sexual satisfaction of postmenopausal women enhanced by physical exercise and pelvic floor muscle training? J Sex Med 2012;9:218–223.     

Is One Question Enough to Detect Female Sexual Dysfunctions? A Diagnostic Accuracy Study in 6,194 Women

IntroductionLiterature shows that recognition of sexual dysfunctions in women is insufficient and existing instruments to aid detection are mostly too extensive to be used in routine practice.AimTo develop a brief and accurate screening instrument to detect female sexual dysfunctions in routine care.MethodsThe initial item pool for the index test consisted of 15 items. In a 4-year period, a total of 12,957 persons filled out the test on a specifically designed web-site. Six thousand one hundred ninety-four complete data sets could be used for statistical analysis. The validated German version of the Female Sexual Function Index (FSFI-d) served as reference standard to estimate the accuracy of the screening test. In order to test several possible ways of combining items a multi-step procedure employing univariate analyses, multiple logistic regression, and classification and regression tree analysis was applied to a learning sample and cross-validated in a test sample.Main Outcome MeasuresDiagnostic performance (sensitivity, specificity, positive and negative predictive value, accuracy, diagnostic odds ratio as well as adjusted odds ratio) of the items and resulting models to discriminate women with sexual dysfunction from those without were calculated.ResultsOne dichotomous question for overall satisfaction proved to show high accuracy as a stand-alone instrument and played also a central role in multivariate models. It may be recommended as a one-question screening test (76.4% sensitivity and 76.5% specificity in the test sample). A hierarchical two-question test yielded higher sensitivity (93.5%) and lower specificity (60.1%). A slightly more extensive version consists of five questions (83.1% sensitivity and 81.2% specificity).ConclusionsDespite some methodological limitations of our study all developed tests showed acceptable to good diagnostic performance, all are very short and could therefore be easily implemented into routine care. Further tests of psychometric properties in other settings are needed. Kriston L, Günzler C, Rohde A, and Berner MM. Is one question enough to detect female sexual dysfunctions? A diagnostic accuracy study in 6,194 women.     

Why Is Impaired Sexual Function Distressing to Men? Consequences of Impaired Male Sexual Function and Their Associations With Sexual Well-Being

Introduction

According to theoretical models of sexual dysfunction, the complex association between male sexual function and subjective sexual well-being (ie, sexual satisfaction and distress) may be partially mediated by specific “consequences” of impaired function, but little research has assessed the frequency of specific consequences or their association with well-being.

Is Mode of Delivery Associated With Sexual Response? A Pilot Study of Genital and Subjective Sexual Arousal in Primiparous Women With Vaginal or Cesarean Section Births

IntroductionAlthough postpartum sexual concerns are common, limited data exist on postpartum sexual response. Furthermore, the physiological process of vaginal birth may negatively impact genital response compared with unlabored cesarean section (C-section), but this hypothesis has yet to be tested.AimTo (i) compare genital and subjective sexual response and sexual concordance by mode of delivery with inclusion of a control group, (ii) compare groups on self-reported sexual function over the past month, (iii) examine the relationship between laboratory measurement of sexual response and self-reported sexual function, and (iv) investigate association between obstetrical factors and breastfeeding and between sexual response and self-reported sexual function.Methods3 groups of cisgender women were recruited from the community: primiparous women who delivered via vaginal birth within the past 2 years (VB group; n = 16), primiparous women who delivered via unlabored C-section within the past 2 years (CS group, n = 15), and age-matched nulliparous women (NP group, n = 18). Laser Doppler imaging was used to assess genital response while participants watched a neutral and erotic film.Main Outcome MeasuresThe main outcome measures were change in flux units from neural to erotic video as a measure of genital response, subjective sexual arousal rated continuously throughout films, perceived genital response rated after films, and Female Sexual Function Index (FSFI).ResultsWomen in the VB group had significantly lower change in flux units than women in the CS (P = .005, d = 1.39) and NP (P < .001, d = 1.80) groups. Groups did not differ on their subjective indices of sexual response or in sexual concordance. Women in both postpartum groups reported lower FSFI scores than women in the NP group. No relationship was determined between FSFI scores and sexual response in the laboratory. Results suggested that genital trauma and breastfeeding may negatively impact FSFI scores, but they were not related to genital response or subjective sexual arousal as measured in the laboratory.Clinical ImplicationsResults underscore the importance of balancing objective and subjective indices of sexual response and function, especially considering the biopsychosocial nature of postpartum sexuality.Strengths & LimitationsThe present study is the first to apply modern sexual psychophysiological methodology to the study of postpartum sexuality. Cross-sectional methodology limits the ability to make causal inferences, and the strict inclusion criteria limits generalizability.ConclusionPhysiological changes as a result of labor and delivery may have a detrimental impact on genital response; however, these physiological differences may not impact women's subjective experience of postpartum sexuality.Cappell J, Bouchard KN, Chamberlain SM, et al. Is Mode of Delivery Associated With Sexual Response? A Pilot Study of Genital and Subjective Sexual Arousal in Primiparous Women With Vaginal or Cesarean Section Births. J Sex Med 2020; 17:257–272.     

The Use of Botulinum Toxin in the Pelvic Floor for Women with Chronic Pelvic Pain–A New Answer to Old Problems?

Chronic pelvic pain occurs in about 15% of women and has a variety of causes requiring accurate diagnosis and appropriate treatment if pain reduction is to be effected. Superficial conditions such as provoked vestibulodynia and deeper pelvic issues such as pelvic floor myalgia were traditionally difficult to diagnose and adequately treat. For provoked vestibulodynia, there are limited data, in the form of case reports and small series, to indicate that botulinum toxin (BoNT) injections may provide short-term (3–6 months) benefit. Retreatment is reported to be successful and side effects are few. Class-I studies are essential to adequately assess this form of treatment. For pelvic floor myalgia, 1 class-I study and 3 class-II to -III studies indicate efficacy of BoNT. In the only double-blind, randomized, controlled study, significant reduction in pelvic floor pressures with significant pain reduction for some types of pelvic pain are reported compared with baseline. No differences in pain occurred compared with the control group who had physical therapy as an intervention. Physical therapy should be used as a noninvasive first-line treatment, with BoNT injections reserved for those who are refractory to treatment. Pelvic floor disorders should be considered as a cause for chronic pelvic pain in women and an attempt made to diagnose and treat such problems as a routine practice. The use of BoNT as a therapeutic option for pelvic floor muscle spasm and pain is still in its infancy. Initial reports suggest that there may be a significant role for women with chronic pain that is refractory to currently available medical and surgical treatments, however, there are very few high-quality studies and research is essential before this novel treatment can be accepted into widespread use for pelvic pain attributable to the pelvic floor.     

The Metabolic Syndrome and Sexual Function in Climacteric Women: A Cross‐Sectional Study

IntroductionStudies have associated the metabolic syndrome with poor sexual function; the results, however, are controversial.AimsTo evaluate the relationship between the metabolic syndrome and sexual function and to identify the factors associated with poor sexual function.MethodsA secondary analysis of a cross‐sectional cohort study including 256 women of 40–60 years of age receiving care at the outpatient department of a university teaching hospital.Main Outcome MeasuresA specific questionnaire was applied to collect sociodemographic and behavioral data, and the Short Personal Experience Questionnaire was used to evaluate sexual function, with a score ≤7 being indicative of poor sexual function. Anthropometric measurements, blood pressure, fasting glucose, high‐density lipoprotein, total cholesterol, triglycerides, follicle‐stimulating hormone and thyroid stimulating hormone levels were determined.ResultsThe prevalence of the metabolic syndrome, as defined by the International Diabetes Federation, was 62.1%, and the prevalence of poor sexual function was 31.4%. The only factor related to female sexual function that was associated with the metabolic syndrome was sexual dysfunction in the woman‘s partner. The factors associated with poor sexual function in the bivariate analysis were age >50 years (P = 0.003), not having a partner (P < 0.001), being postmenopausal (P = 0.046), the presence of hot flashes (P = 0.02), poor self‐perception of health (P = 0.04), partner's age ≥50 years, and time with partner ≥21 years. Reported active (P = 0.02) and passive (P = 0.01) oral sex was associated with an absence of sexual dysfunction. In the multiple regression analysis, the only factor associated with poor sexual function was being 50 years of age or more.ConclusionsThe prevalence of the metabolic syndrome was high and was not associated with poor sexual function in this sample of menopausal women. The only factor associated with poor sexual function was being over 50 years of age. Politano CA, Valadares ALR, Pinto‐Neto A, and Costa‐Paiva L. The metabolic syndrome and sexual function in climacteric women: A cross‐sectional study. J Sex Med 2015;12:455–462.     

Is Female Sexual Function Related to the Male Partners' Erectile Function?

IntroductionThere are limited data concerning the relationship between the sexual functioning of each partner in a heterosexual couple.AimThis cross‐sectional study was to investigate the association between female sexual function and the male partners' erectile function.MethodsTwo self‐administered questionnaires were used, one distributed to 2,159 female employees of two hospitals in Southern Taiwan and the other to their male partners, if available, to assess sexual function in each partner of the couple.Outcome MeasureFemale sexual function and male erectile function were assessed by the Female Sexual Function Index (FSFI) and by the International Index of Erectile Function (IIEF), respectively.ResultsAmong the 1,580 female and 779 male respondents, 632 sexually active couples were eligible for the analysis with mean ages of 36.9 years (range 21–67) and 39.5 years (range 18–80) for the women and men, respectively. After adjustment for female age group, nearly all the FSFI and IIEF domain scores correlated significantly to a slight to moderate degree. On the basis of the FSFI and IIEF scores, 42.9% (255/594) of the women reported sexual difficulty, and 15.0% (96/632) of the men reported mild to moderate erectile dysfunction (ED). After adjustment for female age group, the female partners of men with ED had significantly lower total and domain scores of the FSFI than those of men without ED, with effect sizes of η_p² = 0.02–0.08. After further adjustment for other risk factors, ED of the male partner was still a significant risk factor for female sexual difficulty as well as for sexual difficulty in the aspects of arousal, orgasm, sexual satisfaction, and sexual pain (odds ratio = 2.5–3.3).ConclusionsSignificant correlations between female sexual functioning and male erectile function were identified. Jiann B‐P, Su C‐C, and Tsai J‐Y. Is female sexual function related to the male partners' erectile function? J Sex Med 2013;10:420-429.     

Is There an Association Between Schizophrenia and Sexual Dysfunction in Both Sexes? A Systematic Review and Meta-Analysis

BackgroundMounting clinical studies have reported patients with schizophrenia are at high risk of developing sexual dysfunction (SD), but a directly calculated prevalence of SD is currently lacking.AimTo further quantify the association between schizophrenia and SD.MethodsMEDLINE (PubMed), Embase (OVID), the Cochrane Library databases, and the PsycINFO were systematically searched for eligible studies reporting the sexual functioning in patients with schizophrenia. This meta-analysis has been registered on PROSPERO (ID: CRD42019121720, http://www.crd.york.ac.uk/PROSPERO).OutcomesThe relationship between schizophrenia and SD was detected by calculating the relative risk (RR) with a 95% confidence interval (CI). The GRADE-profiler was employed to rank the quality of the evidence.Results10 observational studies (3 case-control studies and 7 cross-sectional studies) were finally included, enrolling a total of 3,570 participants (mean age 28.6–46.2 years), of whom 1,161 had schizophrenia and the remainders were the healthy control subjects. Synthetic results indicated that schizophrenia was significantly associated with an increased risk of SD regardless of gender (3 studies reporting both sexes: RR = 2.24, 95%CI: 1.66–3.03, P < .001, heterogeneity: I² = 0.0%, P = .431; 7 studies reporting men: RR = 2.63, 95%CI: 1.68–4.13, P < .001, heterogeneity: I² = 82.7%, P < .001; 5 studies reporting women: RR = 2.07, 95%CI: 1.46–2.94, P < .001; heterogeneity: I² = 79.7%, P = .001). In accordance with the GRADE-profiler, the quality of the evidence of primary outcomes was LOW, MODERATE, and LOW in studies including both sexes, men, and women, respectively.Clinical ImplicationsOur findings confirmed the potential link between schizophrenia and SD. Clinicians should routinely assess the sexual functioning for those patients with schizophrenia and further recommend the preferred antipsychotics for them.Strengths & LimitationsThis is the first meta-analysis investigating the association between schizophrenia and the risks of SD in both sexes. Nonetheless, substantial heterogeneities were identified across the selected studies.ConclusionRobust data from this meta-analysis showed increased rates of SD in patients with schizophrenia compared with the general populations. Therefore, more specific psychological and pharmaceutical interventions are needed to help patients with schizophrenia gain a better sexual life.Zhao S, Wang X, Qiang X, et al. Is There an Association Between Schizophrenia and Sexual Dysfunction in Both Sexes? A Systematic Review and Meta-Analysis. J Sex Med 2020;17:1476–1488.     

Differentiating Components of Sexual Well-Being in Women: Are Sexual Satisfaction and Sexual Distress Independent Constructs?

IntroductionSexual satisfaction and sexual distress are common outcome measures in studies of sexual health and well-being. However, confusion remains as to if and how the two constructs are related. While many researchers have conceptualized satisfaction and distress as polar opposites, with a lack of satisfaction indicating high distress and vice versa, there is a growing movement to view satisfaction and distress as relatively independent factors and measure them accordingly.AimThe study aimed to assess the level of independence between sexual satisfaction and distress in female clinical and nonclinical samples.MethodsNinety-nine women (mean age = 25.3) undergoing treatment (traditional sex therapy and/or gingko biloba) for sexual arousal disorder with or without coexistent hypoactive sexual desire disorder and/or orgasmic disorder completed surveys assessing sexual satisfaction, sexual distress, sexual functioning, and relational functioning at pretreatment, mid-treatment, posttreatment, and follow-up. Two hundred twenty sexually healthy women (mean age = 20.25) completed similar surveys at 1-month intervals.Main Outcome MeasuresSexually dysfunctional women completed the Sexual Satisfaction Scale for Women (SSS-W), the Female Sexual Function Index (FSFI), and the Dyadic Adjustment Scale. Sexually healthy women completed the SSS-W, the FSFI, the Relationship Assessment Scale, and the Dimensions of Relationship Quality Scale.ResultsSexual satisfaction and distress were generally closely and inversely related; however, distress was more closely related to sexual functioning variables than was satisfaction in the clinical sample, and satisfaction was more closely related to relational variables than was distress in the nonclinical sample. Additionally, satisfaction and distress showed partially independent patterns of change over time, and scales of distress showed a larger change in response to treatment than did scales of satisfaction.ConclusionAlthough sexual satisfaction and distress may be closely related, these findings suggest that they are, at least, partially independent constructs. Implications for research on sexual well-being and treatment outcome studies are discussed. Stephenson KR, and Meston CM. Differentiating components of sexual well-being in women: Are sexual satisfaction and sexual distress independent constructs?     

Is the Relationship Between Cigarette Smoking and Male Erectile Dysfunction Independent of Cardiovascular Disease? Findings from a Population-Based Cross-Sectional Study

IntroductionCigarette smoking has been implicated in the pathophysiology of cardiovascular disease (CVD) and as a risk factor for erectile dysfunction (ED). However, various aspects of the associations between cigarette smoking, ED, and CVD need further elucidation.AimWe explored the relationship between cigarette smoking, ED, and CVD using data from a population-based cross-sectional study of 1,580 participants.MethodsPostal questionnaires were sent to randomly selected age-stratified male population samples obtained from the Western Australia Electoral Roll.Main Outcome MeasuresIn addition to items covering sociodemographic and self-reported clinical information and smoking habits, the 5-item International Index of Erectile Function was used to assess erectile function.ResultsCompared with never smokers, the odds of ED, adjusted for age, square of age, and CVD, were significantly higher among current smokers (odds ratio [OR] = 1.40; 95% confidence interval [CI] 1.02, 1.92) and ever smokers (OR = 1.57; 95% CI 1.02, 2.42). Similarly, the adjusted odds of severe ED were significantly higher among former smokers. Albeit not statistically significant, the age-adjusted odds of ED among current smokers increased with the number of cigarettes smoked. Among former smokers, the age-adjusted odds of ED were significantly higher 6–10 years following cessation of smoking than ≤5 or >10 years. Compared with never smokers without CVD, the age-adjusted odds of ED among former smokers and ever smokers without CVD were about 1.6. Regardless of smoking, these odds were significantly higher among participants with CVD.ConclusionsCompared with never smokers, former smokers and ever smokers have significantly higher odds of ED. The relationship between smoking and ED is independent of that between smoking and CVD, and not because of confounding by CVD. Patterns of ED in former smokers suggest that there may be a latent interval between active smoking and symptomatic ED, involving a process initially triggered by smoking. Chew K-K, Bremner A, Stuckey B, Earle C, and Jamrozik K. Is the relationship between cigarette smoking and male erectile dysfunction independent of cardiovascular disease? Findings from a population-based cross-sectional study.     

Does Metabolic Syndrome Impair Sexual Function in Middle‐ to Old‐Aged Women?

IntroductionTo date, there are few studies dealing with the impact of metabolic syndrome (MS) on female sexual function, and the association between MS and female sexual dysfunction (FSD) in middle‐ to old‐aged women remains unclear.AimTo evaluate the impact of MS on sexual function in middle‐ to old‐aged women.MethodsFrom May 2009 to January 2010, we performed a cross‐sectional study of sexually active women (≥40 years old) who visited a health‐screening clinic. Comprehensive history taking, anthropometric measurement, laboratory testing, and questionnaire administration were performed for each of the total 773 women enrolled.Main Outcome MeasuresThe Female Sexual Function Index (FSFI) was used to assess the key dimensions of female sexual function.ResultsThe median age of enrolled subjects was 48 (40–65) years, and the rates of MS and FSD were 12.2% (94/773) and 54.7% (423/773), respectively. We found that the demographics of women with and without MS (P < 0.05) differed significantly from one another in terms of age, menopausal status, body mass index, educational status, household income, and urinary incontinence (UI) symptoms, although their frequency of FSD was similar (52.1% vs. 55.1%). After adjusting clinical confounders, we found that only the pain domain score was significantly different between women with MS and without MS, while the total FSFI score and other constituent domain scores showed little difference between the two groups. However, in the multivariate logistic regression model, MS and most of its components were not associated with FSD; only age, menopausal status, smoking, depression, and symptomatic UI proved to be independent risk factors for FSD (P < 0.05).ConclusionsOur study suggests that MS may have little impact on sexual function in middle‐ to old‐aged women. Further studies with population‐based and longitudinal design should be conducted to confirm this finding. Kim YH, Kim SM, Kim JJ, Cho IS, and Jeon MJ. Does metabolic syndrome impair sexual function in middle‐ to old‐aged women?     

Male Sexual Function in New Zealand: A Population-Based Cross-Sectional Survey of the Prevalence of Erectile Dysfunction in Men Aged 40–70 Years

BackgroundSexual function declines with age and erectile dysfunction (ED) is a common condition worldwide; however, prevalence rates vary markedly between populations and reliable data specific to New Zealand (NZ) are lacking.AimTo assess the prevalence of ED in NZ men using a population-based cross-sectional survey.MethodsPostal questionnaires were sent, according to a modified Dillman method, to a randomly selected age-stratified population-based sample of 2,000 men 40 to 70 years old obtained from the electoral roll. Self-reported erectile function was assessed using the five-item International Index of Erectile Function (IIEF-5) and the single-question self-assessment tool.OutcomesThe prevalence of ED is presented as crude, age-adjusted to the distribution of the NZ population, and standardized to the World Health Organization World Standard Population (WSP). Associations between sexual function and age were analyzed using χ² test.ResultsThe response rate was 30% (599) and 28% (562) were complete for analysis. The crude prevalence of ED was 42% (22% mild, 10% mild to moderate, 6% moderate, and 4% severe), the age-adjusted prevalence was 38%, and the WSP-adjusted prevalence was 37%. Among men reporting ED, 16% were medically diagnosed and 22% were treated. ED affected 24% of men in their 40s, 38% in their 50s, and 60% in their 60s (P < .001). Age was associated with a significant increase in diagnosed ED (P = .001), treated ED (P = .006), dissatisfaction with current sexual function (P < .001), associated anxiety or depression (P = .023), and a decrease in sexual activity (P < .001).Clinical TranslationApproximately one in three NZ men 40 to 70 years old might have ED. Although comparable to overseas populations, this prevalence is high.Strengths and LimitationsThis study provides the most reliable, comprehensive, and current information on ED and its risk factors in NZ men. Strengths include the large sample, the use of random selection from a population-based sampling frame, established effective survey methods, and the validated IIEF-5. Limitations include the inability of cross-sectional data to determine causation, non-sampling errors associated with the population-based sampling frame, the low response rate, the inability to assess non-respondents, the possibility of men with ED who were sexually inactive not responding or not completing the IIEF-5, and the inherent inability to rule out recall bias.ConclusionED is a marker of subclinical cardiovascular disease. The high prevalence and low levels of diagnosis and treatment indicate a lost opportunity for timely intervention to delay or prevent the progression toward clinical disease.Quilter M, Hodges L, von Hurst P, et al. Male Sexual Function in New Zealand: A Population-Based Cross-Sectional Survey of the Prevalence of Erectile Dysfunction in Men Aged 40–70 Years. J Sex Med 2017;14:928–936.