This article was downloaded by: [Dicle University] On: 11 November 2014, At: 05:54 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Journal of Sex & Marital Therapy Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/usmt20
Effect of Metabolic Syndrome on Sexual Function in Pre- and Postmenopausal Women a
b
c
a
Alper Otunctemur , Murat Dursun , Emin Ozbek , Suleyman Sahin , a
a
d
a
Huseyin Besiroglu , Ismail Koklu , Emre Can Polat , Mustafa Erkoc , a
Eyyup Danis & Muammer Bozkurt
a
a
Okmeydani Training and Research Hospital, Department of Urology, Istanbul, Turkey b
Bahcelievler State Hospital, Department of Urology, Istanbul, Turkey c
Atatürk Training and Research Hospital, Department of Urology, Katip Celebi University, Izmir, Turkey d
Istanbul Medipol University, Faculty of Medicine, Department of Urology, Istanbul, Turkey Accepted author version posted online: 13 May 2014.Published online: 13 Jun 2014.
To cite this article: Alper Otunctemur, Murat Dursun, Emin Ozbek, Suleyman Sahin, Huseyin Besiroglu, Ismail Koklu, Emre Can Polat, Mustafa Erkoc, Eyyup Danis & Muammer Bozkurt (2014): Effect of Metabolic Syndrome on Sexual Function in Pre- and Postmenopausal Women, Journal of Sex & Marital Therapy, DOI: 10.1080/0092623X.2014.918068 To link to this article: http://dx.doi.org/10.1080/0092623X.2014.918068
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content.
Downloaded by [Dicle University] at 05:54 11 November 2014
This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
JOURNAL OF SEX & MARITAL THERAPY, 0(0), 1–10, 2014 C Taylor & Francis Group, LLC Copyright ISSN: 0092-623X print / 1521-0715 online DOI: 10.1080/0092623X.2014.918068
Effect of Metabolic Syndrome on Sexual Function in Pre- and Postmenopausal Women Alper Otunctemur Okmeydani Training and Research Hospital, Department of Urology, Istanbul, Turkey
Downloaded by [Dicle University] at 05:54 11 November 2014
Murat Dursun Bahcelievler State Hospital, Department of Urology, Istanbul, Turkey
Emin Ozbek Atat¨urk Training and Research Hospital, Department of Urology, Katip Celebi University, Izmir, Turkey
Suleyman Sahin, Huseyin Besiroglu, and Ismail Koklu Okmeydani Training and Research Hospital, Department of Urology, Istanbul, Turkey
Emre Can Polat Istanbul Medipol University, Faculty of Medicine, Department of Urology, Istanbul, Turkey
Mustafa Erkoc, Eyyup Danis, and Muammer Bozkurt Okmeydani Training and Research Hospital, Department of Urology, Istanbul, Turkey
Female sexual dysfunction is a prevalent and multidimensional disorder related to many biological, psychological, and social determinants. The authors assessed the effect of one of the many factors affect sexual function—metabolic syndrome—on female sexual function. They equally divided 400 women participants among 4 groups: (a) premenopausal with metabolic syndrome, (b) premenopausal without metabolic syndrome, (c) postmenopausal with metabolic syndrome, and (d) postmenopausal without metabolic syndrome. The authors used the Female Sexual Function Index to assess women’s sexual function. Female sexual dysfunction was found more often in both preand postmenopausal women with metabolic syndrome (p = .001).Overall Female Sexual Function Index score and satisfaction, pain, and desire domain scores independently of the menopause status showed statistically significant differences across women with metabolic syndrome in comparison with participants with no metabolic syndrome (p < .05). The authors also evaluated the associations among 5 components of metabolic syndrome and Female Sexual Function Index scores. Address correspondence to Murat Dursun, Bahcelievler State Hospital, Department of Urology, 34180, Kocasinan Merkez, Bahcelievler, Istanbul, Turkey. E-mail: mrt [email protected] Color versions of one or more of the figures in this article can be found online at www.tandfonline.com/usmt.
2
OTUNCTEMUR ET AL.
Downloaded by [Dicle University] at 05:54 11 November 2014
Higher fasting glucose levels were significantly associated with the Female Sexual Function Index score (p < .05). This study shows that sexual dysfunction is more prevalent in pre- and postmenopausal women with the metabolic syndrome.
Female sexual dysfunction is a prevalent and multidimensional disorder related to many biological, psychological, and social determinants. The definition of female sexual dysfunction includes persistent or recurrent disorders of sexual interest or desire, disorders of subjective and genital arousal, orgasmic disorders, pain, and difficulty with attempted or incomplete intercourse (Lue et al., 2004). It has long been debated whether the term female sexual dysfunction should be classified as a dysfunction similar to erectile dysfunction or whether it should be considered a pathological condition at all. Also, the prevalence of female sexual dysfunction has been estimated to be as high as 50% (Read, King, & Watson, 1997). Female sexual dysfunction is a public health problem, but few epidemiological data exist regarding its extent and magnitude for psychogenic and organic causes of decreased sexual desire, arousal, orgasm, and pain causing personal distress. Previous studies have discovered that numerous factors—including age, obesity, menopausal status, educational level, financial income, interactions with a partner, psychological factors, hormonal dysfunction, and particularly thyroid disease and the physical health status of the women—could affect their chances of having female sexual dysfunction (Addis et al., 2006, Chedraui, Perez-Lopez, San Miguel, & Avila, 2009; Pasquali et al., 2013). Among the multitude of factors influencing sexual integrity in women, different aspects of lifestyle are considered to play a significant role in the genesis of female sexual dysfunction (Imbimbo et al., 2003; Salonia et al., 2004). Data are limited on the prevalence of female sexual dysfunction in obesity, diabetes mellitus, and metabolic syndrome, which represent important causes of erectile dysfunction in men (Chedrauı et al., 2010; Martelli et al., 2012; Ponholzer et al., 2008). Longitudinal populationbased studies clearly demonstrate that comorbidities such as obesity, hypertension, dyslipidemia, and type 2 diabetes mellitus are major risk factors for atherosclerosis and endothelial dysfunction (Muller & Mulhall, 2006). These abnormalities are very often combined in individuals with metabolic syndrome, also known as syndrome X or insulin resistance syndrome. Metabolic syndrome and its components and female sexual dysfunction seem to be related. Esposito and colleagues (2005) reported on an independent impact of the metabolic syndrome for the genesis of female sexual dysfunction in premenopausal women. They assessed 120 premenopausal women with metabolic syndrome and compared these data with a control group of 80 premenopausal women without metabolic syndrome. In the postmenopausal period, prevalence of metabolic syndrome or any of its components increases—in relation to time since menopause—sedentary and bad habits (Cho et al., 2008; Hidalgo et al., 2006; Janssen, Powell, Crawford, Lasley, & Sutton-Tyrrell, 2008). Also, Martelli and colleagues (2012) evaluated the prevalence of sexual dysfunction among postmenopausal women with and without metabolic syndrome in a study. Therefore, in the present study, we prospectively collected data from pre- to postmenopausal women with or without metabolic syndrome. To evaluate the effect of metabolic syndrome on female sexual function, we used a validated questionnaire called the Female Sexual Function Index (FSFI).
EFFECT OF METABOLIC SYNDROME
3
Downloaded by [Dicle University] at 05:54 11 November 2014
METHOD We performed a prospective cross-sectional study of participants who visited our urology clinic, the Okmeydani Training and Research Hospital, from February 2011 to January 2013. The women were admitted to our clinic because of different complaints such as flank pain, lumbago, groin pain, and renal cyst; all women were ambulatory. We evaluated all women for metabolic syndrome and menopausal period. Exclusion criteria were pelvic trauma/surgery, urinary incontinence, lower urinary tract symptoms, cardiovascular disease, psychiatric problems, use of drugs, and alcohol abuse. Also, we excluded women who had had endocrinological/gynecological diseases and who had taken psychotropics. We also excluded sexually inactive women, as stated in the questionnaire (“no activity in the last 4 weeks”). We divided the remaining eligible women (N = 400) into four equal groups of 100 each: premenopausal with metabolic syndrome, premenopausal without metabolic syndrome, postmenopausal with metabolic syndrome, and postmenopausal without metabolic syndrome. Postmenopausal status was defined as the cessation of menses for at least 1 year, and perimenopausal status as skipped menstruation with perimenopausal symptoms. Premenopausal women who have regular menses were assessed. Assays for serum total and high-density lipoprotein cholesterol, triglyceride, and glucose levels were performed in the hospital’s chemistry laboratory. Metabolic syndrome was defined according to the guidelines set forth by several organizations: the Joint Interim Statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; the National Heart, Lung, and Blood Institute; the American Heart Association; the World Heart Federation; the International Atherosclerosis Society; and the International Association for the Study of Obesity (Alberti et al., 2009). We took the presence of any three of the following five risk factors as sufficient for diagnosing metabolic syndrome: (a) elevated waist circumference >88 cm; (b) elevated triglyceride (>150 mg/dL) or drug treatment for elevated triglyceride; (c) reduced high-density lipoprotein cholesterol (130 and/or diastolic >85 mm Hg) or antihypertensive drug treatment in a patient with a history of hypertension; and (e) elevated fasting glucose (>100 mg/dL) or drug treatment for elevated glucose. We used the FSFI to assess sexual function. Participating women completed the FSFI form (translated into Turkish). The FSFI is divided into six main domains: desire, arousal, lubrication, orgasm, satisfaction, and pain, with each item scored with a 5- or 6-point Likert-type scale. The maximum score for each domain is 6, and total FSFI scores ranged from 2 to 36, with higher scores indicating better sexual function (Rosen et al., 2000). A cutoff total score of ≤26.55 on the FSFI is the current standard for diagnosing sexual dysfunction in women across a wide range of ages (18–74 years) and lifestyles (Kim, Kim, Kim, Cho, & Jeon, 2011; Wigel, Meston, & Rosen, 2005). We used the same cutoff value for FSFI to diagnose female sexual dysfunction in this study. Furthermore, to estimate the presence or sexual difficulty in each domain, a score of 40% or less of the maximum value of the desire subscale (≤2.4) and a score of less than 60% of the maximum value of the other five domain subscales (
Journal of Sex & Marital Therapy Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/usmt20
Effect of Metabolic Syndrome on Sexual Function in Pre- and Postmenopausal Women a
b
c
a
Alper Otunctemur , Murat Dursun , Emin Ozbek , Suleyman Sahin , a
a
d
a
Huseyin Besiroglu , Ismail Koklu , Emre Can Polat , Mustafa Erkoc , a
Eyyup Danis & Muammer Bozkurt
a
a
Okmeydani Training and Research Hospital, Department of Urology, Istanbul, Turkey b
Bahcelievler State Hospital, Department of Urology, Istanbul, Turkey c
Atatürk Training and Research Hospital, Department of Urology, Katip Celebi University, Izmir, Turkey d
Istanbul Medipol University, Faculty of Medicine, Department of Urology, Istanbul, Turkey Accepted author version posted online: 13 May 2014.Published online: 13 Jun 2014.
To cite this article: Alper Otunctemur, Murat Dursun, Emin Ozbek, Suleyman Sahin, Huseyin Besiroglu, Ismail Koklu, Emre Can Polat, Mustafa Erkoc, Eyyup Danis & Muammer Bozkurt (2014): Effect of Metabolic Syndrome on Sexual Function in Pre- and Postmenopausal Women, Journal of Sex & Marital Therapy, DOI: 10.1080/0092623X.2014.918068 To link to this article: http://dx.doi.org/10.1080/0092623X.2014.918068
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content.
Downloaded by [Dicle University] at 05:54 11 November 2014
This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
JOURNAL OF SEX & MARITAL THERAPY, 0(0), 1–10, 2014 C Taylor & Francis Group, LLC Copyright ISSN: 0092-623X print / 1521-0715 online DOI: 10.1080/0092623X.2014.918068
Effect of Metabolic Syndrome on Sexual Function in Pre- and Postmenopausal Women Alper Otunctemur Okmeydani Training and Research Hospital, Department of Urology, Istanbul, Turkey
Downloaded by [Dicle University] at 05:54 11 November 2014
Murat Dursun Bahcelievler State Hospital, Department of Urology, Istanbul, Turkey
Emin Ozbek Atat¨urk Training and Research Hospital, Department of Urology, Katip Celebi University, Izmir, Turkey
Suleyman Sahin, Huseyin Besiroglu, and Ismail Koklu Okmeydani Training and Research Hospital, Department of Urology, Istanbul, Turkey
Emre Can Polat Istanbul Medipol University, Faculty of Medicine, Department of Urology, Istanbul, Turkey
Mustafa Erkoc, Eyyup Danis, and Muammer Bozkurt Okmeydani Training and Research Hospital, Department of Urology, Istanbul, Turkey
Female sexual dysfunction is a prevalent and multidimensional disorder related to many biological, psychological, and social determinants. The authors assessed the effect of one of the many factors affect sexual function—metabolic syndrome—on female sexual function. They equally divided 400 women participants among 4 groups: (a) premenopausal with metabolic syndrome, (b) premenopausal without metabolic syndrome, (c) postmenopausal with metabolic syndrome, and (d) postmenopausal without metabolic syndrome. The authors used the Female Sexual Function Index to assess women’s sexual function. Female sexual dysfunction was found more often in both preand postmenopausal women with metabolic syndrome (p = .001).Overall Female Sexual Function Index score and satisfaction, pain, and desire domain scores independently of the menopause status showed statistically significant differences across women with metabolic syndrome in comparison with participants with no metabolic syndrome (p < .05). The authors also evaluated the associations among 5 components of metabolic syndrome and Female Sexual Function Index scores. Address correspondence to Murat Dursun, Bahcelievler State Hospital, Department of Urology, 34180, Kocasinan Merkez, Bahcelievler, Istanbul, Turkey. E-mail: mrt [email protected] Color versions of one or more of the figures in this article can be found online at www.tandfonline.com/usmt.
2
OTUNCTEMUR ET AL.
Downloaded by [Dicle University] at 05:54 11 November 2014
Higher fasting glucose levels were significantly associated with the Female Sexual Function Index score (p < .05). This study shows that sexual dysfunction is more prevalent in pre- and postmenopausal women with the metabolic syndrome.
Female sexual dysfunction is a prevalent and multidimensional disorder related to many biological, psychological, and social determinants. The definition of female sexual dysfunction includes persistent or recurrent disorders of sexual interest or desire, disorders of subjective and genital arousal, orgasmic disorders, pain, and difficulty with attempted or incomplete intercourse (Lue et al., 2004). It has long been debated whether the term female sexual dysfunction should be classified as a dysfunction similar to erectile dysfunction or whether it should be considered a pathological condition at all. Also, the prevalence of female sexual dysfunction has been estimated to be as high as 50% (Read, King, & Watson, 1997). Female sexual dysfunction is a public health problem, but few epidemiological data exist regarding its extent and magnitude for psychogenic and organic causes of decreased sexual desire, arousal, orgasm, and pain causing personal distress. Previous studies have discovered that numerous factors—including age, obesity, menopausal status, educational level, financial income, interactions with a partner, psychological factors, hormonal dysfunction, and particularly thyroid disease and the physical health status of the women—could affect their chances of having female sexual dysfunction (Addis et al., 2006, Chedraui, Perez-Lopez, San Miguel, & Avila, 2009; Pasquali et al., 2013). Among the multitude of factors influencing sexual integrity in women, different aspects of lifestyle are considered to play a significant role in the genesis of female sexual dysfunction (Imbimbo et al., 2003; Salonia et al., 2004). Data are limited on the prevalence of female sexual dysfunction in obesity, diabetes mellitus, and metabolic syndrome, which represent important causes of erectile dysfunction in men (Chedrauı et al., 2010; Martelli et al., 2012; Ponholzer et al., 2008). Longitudinal populationbased studies clearly demonstrate that comorbidities such as obesity, hypertension, dyslipidemia, and type 2 diabetes mellitus are major risk factors for atherosclerosis and endothelial dysfunction (Muller & Mulhall, 2006). These abnormalities are very often combined in individuals with metabolic syndrome, also known as syndrome X or insulin resistance syndrome. Metabolic syndrome and its components and female sexual dysfunction seem to be related. Esposito and colleagues (2005) reported on an independent impact of the metabolic syndrome for the genesis of female sexual dysfunction in premenopausal women. They assessed 120 premenopausal women with metabolic syndrome and compared these data with a control group of 80 premenopausal women without metabolic syndrome. In the postmenopausal period, prevalence of metabolic syndrome or any of its components increases—in relation to time since menopause—sedentary and bad habits (Cho et al., 2008; Hidalgo et al., 2006; Janssen, Powell, Crawford, Lasley, & Sutton-Tyrrell, 2008). Also, Martelli and colleagues (2012) evaluated the prevalence of sexual dysfunction among postmenopausal women with and without metabolic syndrome in a study. Therefore, in the present study, we prospectively collected data from pre- to postmenopausal women with or without metabolic syndrome. To evaluate the effect of metabolic syndrome on female sexual function, we used a validated questionnaire called the Female Sexual Function Index (FSFI).
EFFECT OF METABOLIC SYNDROME
3
Downloaded by [Dicle University] at 05:54 11 November 2014
METHOD We performed a prospective cross-sectional study of participants who visited our urology clinic, the Okmeydani Training and Research Hospital, from February 2011 to January 2013. The women were admitted to our clinic because of different complaints such as flank pain, lumbago, groin pain, and renal cyst; all women were ambulatory. We evaluated all women for metabolic syndrome and menopausal period. Exclusion criteria were pelvic trauma/surgery, urinary incontinence, lower urinary tract symptoms, cardiovascular disease, psychiatric problems, use of drugs, and alcohol abuse. Also, we excluded women who had had endocrinological/gynecological diseases and who had taken psychotropics. We also excluded sexually inactive women, as stated in the questionnaire (“no activity in the last 4 weeks”). We divided the remaining eligible women (N = 400) into four equal groups of 100 each: premenopausal with metabolic syndrome, premenopausal without metabolic syndrome, postmenopausal with metabolic syndrome, and postmenopausal without metabolic syndrome. Postmenopausal status was defined as the cessation of menses for at least 1 year, and perimenopausal status as skipped menstruation with perimenopausal symptoms. Premenopausal women who have regular menses were assessed. Assays for serum total and high-density lipoprotein cholesterol, triglyceride, and glucose levels were performed in the hospital’s chemistry laboratory. Metabolic syndrome was defined according to the guidelines set forth by several organizations: the Joint Interim Statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; the National Heart, Lung, and Blood Institute; the American Heart Association; the World Heart Federation; the International Atherosclerosis Society; and the International Association for the Study of Obesity (Alberti et al., 2009). We took the presence of any three of the following five risk factors as sufficient for diagnosing metabolic syndrome: (a) elevated waist circumference >88 cm; (b) elevated triglyceride (>150 mg/dL) or drug treatment for elevated triglyceride; (c) reduced high-density lipoprotein cholesterol (130 and/or diastolic >85 mm Hg) or antihypertensive drug treatment in a patient with a history of hypertension; and (e) elevated fasting glucose (>100 mg/dL) or drug treatment for elevated glucose. We used the FSFI to assess sexual function. Participating women completed the FSFI form (translated into Turkish). The FSFI is divided into six main domains: desire, arousal, lubrication, orgasm, satisfaction, and pain, with each item scored with a 5- or 6-point Likert-type scale. The maximum score for each domain is 6, and total FSFI scores ranged from 2 to 36, with higher scores indicating better sexual function (Rosen et al., 2000). A cutoff total score of ≤26.55 on the FSFI is the current standard for diagnosing sexual dysfunction in women across a wide range of ages (18–74 years) and lifestyles (Kim, Kim, Kim, Cho, & Jeon, 2011; Wigel, Meston, & Rosen, 2005). We used the same cutoff value for FSFI to diagnose female sexual dysfunction in this study. Furthermore, to estimate the presence or sexual difficulty in each domain, a score of 40% or less of the maximum value of the desire subscale (≤2.4) and a score of less than 60% of the maximum value of the other five domain subscales (
