Original Research—Women’s Sexual HealthSexual Complaints, Pelvic Floor Symptoms, and Sexual Distress in Women over Forty
Introduction
The Diagnostic and Statistical Manual of Mental Disorders (DSM) IV-TR classifies female sexual disorder (FSD) into four broad categories: sexual desire disorders, female sexual arousal disorder, female orgasmic disorder, and sexual pain disorders 1, 2. Some studies estimate that 40–50% of women report at least one sexual complaint related to these aspects of sexual function [3]. However, not all sexual complaints lead to dissatisfaction or sexual distress.
Because the DSM-IV-TR defines female sexual disorder (FSD) as “disturbances in sexual desire and in the psycho-physiological changes that characterize the sexual response cycle and cause marked distress and interpersonal difficulty,”[1] both sexual function and sexually related personal distress should be considered when assessing FSD. However, until recently, most research on female sexual function has focused on sexual complaints but has not considered the quality-of-life impact of these complaints in relation to sexual distress [4].
The Female Sexual Distress Scale (FSDS) [5] is a potentially useful adjunct to other validated sexual function questionnaires because it allows an assessment of distress related to sexual function. Using the FSDS, one recent study of U.S. adult women found that 44% of women reported sexual complaints but only 12% reported “distress” with sexual function [6]. These data are helpful in creating a frame of reference regarding the impact of sexual complaints on quality of life. However, there has been little investigation of the sexual complaints that women find most bothersome or distressing. For example, low libido is the most common sexual complaint, but many women with low libido do not report personal distress related to this symptom [3]. Additionally, prior research suggests that women with pelvic floor symptoms, such as pelvic organ prolapse and incontinence, may be more likely to report sexual symptoms 7, 8. However, little is known about whether pelvic floor complaints, such as incontinence of urine during sexual activity, are sexually distressing [9].
Section snippets
Aims
Our study aims to investigate the association between reported sexual complaints and perceived level of sexual distress in women. In a population of adult women seeking ambulatory gynecologic care, we assessed sexual complaints, sexual interference from pelvic floor symptoms, and distress related to sexual function. Our goal was to investigate which sexual symptoms and problems were most likely to be associated with distress in this setting. We hypothesize that certain sexual complaints,
Study Setting
This is a planned secondary analysis of a cross-sectional study of women with prior sexual experience seeking benign gynecologic or urogynecologic care at five outpatient sites in metropolitan Baltimore, MD [8]. The primary study was designed to investigate whether pelvic floor symptoms, such as urinary incontinence and pelvic organ prolapse, are associated with female sexual complaints. The study was funded by the National Institute of Health and approved by an Institutional Review Board.
Participants
Women
Statistical Analysis
Statistical analysis was performed using STATA version 9.2 (StataCorp LP, College Station, TX, USA). First, we used Pearson chi-square or one-way analysis of variance tests to compare general characteristics and measures of sexual complaints among women with and without sexual distress.
We then performed multivariate logistic regression to identify measures of sexual complaints associated with sexual distress. In fitting the model, we considered independent variables found to be statistically
Results
During enrollment of study participants, between January 1, 2006 and April 1, 2007, a total of 420 women were approached for participation, and 344 (82%) enrolled. Of the enrolled participants, 305 (89%) completed the questionnaire. Within this cohort of 305 women, 80 (27%) were seeking treatment of pelvic floor conditions, 69 (23%) came for treatment of other gynecologic complaints, and the remaining 152 (50%) were seeking annual gynecologic care [8]. Our analysis is limited to the 96%
Discussion
Female sexual dysfunction appears to be prevalent [3] and can have adverse effects on a woman's quality of life [4]. The diagnosis of FSD should not be applied unless the patient expresses both sexual complaints and sexual distress related to those symptoms [1]. In this population, personal distress related to sexual function was reported by 26% of women. This result suggests that a substantial proportion of women seeking gynecologic care have clinically significant sexual complaints. This
Conclusion
In conclusion, our results suggest that distress related to sexual function is relatively common among women seeking gynecologic care. In addition, our results suggest that dyspareunia and decreased sexual arousal are the complaints most strongly associated with sexual distress in this setting. Further research is needed to understand the interrelationships between multiple coexistent symptoms and the underlying factors leading to the development of multiple sexual complaints. Improved
Category 1
- (a)
Conception and Design
Leise R. Knoepp; Victoria L. Handa; Geoffrey W. Cundiff
- (b)
Acquisition of Data
Leise R. Knoepp; Victoria L. Handa; Geoffrey W. Cundiff
- (c)
Analysis and Interpretation of Data
Leise R. Knoepp; Victoria L. Handa; Geoffrey W. Cundiff
Category 2
- (a)
Drafting the Article
Leise R. Knoepp; Victoria L. Handa; Geoffrey W. Cundiff; Leonard R. Derogatis; Stuart H. Shippey; Chi Chiung Grace Chen
- (b)
Revising It for Intellectual Content
Leise R. Knoepp; Victoria L. Handa; Geoffrey W. Cundiff; Leonard R. Derogatis;
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2015, Journal of Sexual MedicineCitation Excerpt :The high prevalence was found among 497 women aged 18–82 years attending for annual examination in the United States [3]. POP and urinary incontinence may be linked to sexual dysfunction, such as sexual avoidance, orgasm deficiency, poor body image, and reduced sexual desire and arousal [4,5]. The sensation of obstruction within the vagina and vaginal laxity are two main reasons given for reduced sexual satisfaction in women with POP [6].