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Sexual function through decades : Association with androgens and cardiometabolic features
Between 30 and 32% of women suffered from decreased sexual desire, and that this number varied little across age, expressed in decades. Since testosterone insufficiency is one of the several causes of decreased libido, the relationship of androgen blood test values in aging women without sexual dysfunction must be better defined (J Am Med Assoc 1999; 281: 537-544). It is generally accepted that a decrease in the adrenal androgen precursor, DHEAS, takes place in women, as well as in men, as they age. However, the decrease in testosterone with age is not well documented (International Journal of Impotence Research 2004 16, 112–120). Most longitudinal studies demonstrated a continuous decline in total testosterone, DHEAS and androstenedione levels with age, with no or very little variation occurring in relation to the menopausal status (Acta Obstet Gynecol Scand 1999;78:642–647; Clin Endocrinol Metab 2005;90:3847–3853; Maturitas 2008;61:67–77).
Burger studied found that the mean SHBG levels decreased by 43% from 4 y before to 2 y after the final menstrual period (FMP). He found the greatest change to be the 2 y before the FMP, with the median age pre-FMP being 51 y and the median age post-FMP being 54 y (J Clin Endocrinol Metab 2000; 85: 2832–2838). Rannevik also showed a clearcut fall in SHBG concentration related to the menopause (Maturitas 1995; 21: 103–113). Bancroft showed no significant change in SHBG levels in comparing pre-, peri-, and postmenopausal women (Clin Endocrinol (Oxf) 1996; 45: 577–587). The association between sex hormone levels, cardiometabolic abnormalities and the development of actual cardiovascular events in women has not been clearly established yet. Results from the few available long-term follow-up studies in the general female population report either no independent relationship between endogenous sex hormone levels and CVD events or only suggest a potential role for testosterone (J Clin Endocrinol Metab 2010;95:740–747; Atherosclerosis 2011;216:414–419).
The aim of our study was to determine the change in sexual function among Turkish women through decades and to define the association between sexual dysfunction and androgens and cardiometabolic features.
200 postmenopausal women between the ages of 50-70 years and 200 premenopausal women between the ages of 30-49 years who applied to Menopause and Gynecology Clinics at Marmara University affiliated Pendik Education and Research Hospital, Istanbul were included in this prospective survey. Groups were constructed according to decades (i.e. 30-39, 40-49, 50-59, 60-70). Sexual function was assessed between the groups, using the Female Sexual Function Index (FSFI). The index is composed of 19 questions grouped into six domains: desire, arousal, lubrication, orgasm, satisfaction and dyspareunia. It is used to evaluate female sexual function in the previous 4 weeks. Each question can provide a score varying from 0 to 5. Scores obtained for questions in each domain are summed up and multiplied by a constant factor to provide individual domain scores. The total FSFI score is the sum of scores obtained for each domain. Lower total FSFI scores are indicative of lower sexual function. A FSFI total score of 26.55 or less is suggestive of sexual dysfunction (lower sexual function). Cardiometabolic features and androgen levels were also compared between the groups.
Sexual function determined at each decade by using FSFI were 27.18, 23.11, 18.40, and 11.35, respectively. Lubrication, orgasm and pain domains seem to be constant through the age of 30s and 40s. On the contrary, desire, arousal and satisfaction domains tend to be lesser in the 40s than in theage of 30s. As time passes after the 30s , the total FSFI score decreases till the late 60s. All domains decrease in the first 10 years after menopause and even more in the age of 60s. Serum total testosterone, androstenedione, DHEAS levels decreased through the decades. Multivariate analysis showed no association between sexual dysfunction and androgen levels in premenopausal women. Serum DHEAS level was associated with sexual dysfunction only among postmenopausal women. Multivariate analysis showed no association between sexual dysfunction and cardiometabolic features neither in pre nor post-menopausal women.
1.FSFI total score was significantly lower among postmenopausal than premenopausal women.
2.All of the domains of FSFI were significantly lower postmenopausal than premenopausal women.
3.Sexual dysfunction was 64.6% in postmenopausal women , whereas; 42.1% in premenopausal women.
4.As age, systolic blood pressure, diastolic blood pressure increased in postmenopausal women , so did the FSFI total score
5.As time since menopause increased, FSFI total score decreased.
6.Lubrication, orgasm and pain domains seem to be constant through the age of 30s and 40s.
7.Desire, arousal and satisfaction domains tend to be lesser in the 40s than in the age of 30s.
8.All FSFI domains decreased in the first 10 years after menopause and even more in the age of 60s
9.Serum total testosterone, androstenedione, DHEAS levels decreased through the decades.
10.There was no association between sexual dysfunction and androgen levels in premenopausal women.
11.Serum DHEAS level was associated with sexual dysfunction only among postmenopausal women.
12.There was no association between sexual dysfunction and cardiometabolic features neither in premenopausal nor postmenopausal women.