Institute of Biomedicine, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, PO Box 09-01-4671, Guayaquil, Ecuador.
Menopause. 2009 Nov-Dec;16(6):1139-48. doi: 10.1097/gme.0b013e3181a4e317.
The purpose of this study was to assess the prevalence of sexual dysfunction (SD) and associated risk factors among middle-aged Latin American women using one validated instrument.
The Female Sexual Function Index (FSFI) was applied to 7,243 healthy women aged 40 to 59 years who were users of 19 healthcare systems from 11 Latin American countries. An itemized questionnaire containing personal and partner sociodemographic data was also filled out.
Mean +/- SD age of surveyed women was 49.0 +/- 5.7 years, with 11.6 years of schooling on average. There were 55.1% of women who were married, 46.8% who were postmenopausal, 14.1% who used hormonal therapy (HT), and 25.6% who were sexually inactive. Among those who were active (n = 5,391), the mean +/- SD total FSFI score was 25.2 +/- 5.9 and 56.8% of them presented SD (FSFI total score <or=26.55), with a prevalence varying from 21.0% to 98.5% depending on the center. Centers were grouped in terciles (according to mean +/- SD prevalence). The tercile with higher SD prevalence (86.4%) compared with that with lower SD prevalence (32.2%) had significantly older women (49.5 +/- 5.3 vs 48.0 +/- 5.6 y) with a higher rate of vaginal dryness (60.4% vs 40.8%) and older partners (53.0 +/- 6.9 vs 50.2 +/- 7.5 y). Similarly, there was a significantly higher rate of married (68.5% vs 63.1%), postmenopausal (49.7% vs 39.3%), and HT-using women (23% vs 9.2%). There were no differences in regard to their health perception, history of oophorectomy, rape, and partner SD rate (27% vs 26.2%). The total FSFI score was significantly lower in the tercile with higher SD prevalence (22.0 +/- 5.0 vs 27.5 +/- 5.4). Logistic regression analysis was used to determine the odds ratios (95% CIs) for the main risk factors associated with SD among those who were sexually active: bad lubrication, 3.86 (3.37-4.43); use of alternative menopausal therapies, 2.13 (1.60-2.84); partner SD, 1.89 (1.63-2.20); older women (>48 y), 1.84 (1.61-2.09); bladder problems, 1.47 (1.28-1.69); HT use, 1.39 (1.15-1.68); negative perception of female health status, 1.31 (1.05-1.64); and being married, 1.22 (1.07-1.40). Protective factors were higher educational level (women), partner faithfulness, and access to private healthcare.
The prevalence of SD in this middle-aged Latin American series was found to be high, varying widely in different populations. A decrease in vaginal lubrication was the most important associated risk factor. Differences in the prevalence of risk factors among the studied groups, several of which are modifiable, could explain the variation of SD prevalence observed in this study.
本研究旨在使用一种经过验证的工具评估中年拉丁美洲女性性功能障碍（SD）的流行情况及其相关危险因素。
应用女性性功能指数（FSFI）对来自 11 个拉丁美洲国家的 19 个医疗保健系统的 7243 名 40 至 59 岁健康女性进行评估。还填写了一份包含个人和伴侣社会人口统计学数据的分项问卷。
调查女性的平均年龄为 49.0 ± 5.7 岁，平均接受了 11.6 年的教育。55.1%的女性已婚，46.8%处于绝经期，14.1%使用激素治疗（HT），25.6%性生活不活跃。在活跃的女性中（n=5391），平均总分 FSFI 为 25.2 ± 5.9，56.8%的女性存在 SD（FSFI 总分≤26.55），患病率从 21.0%到 98.5%不等，具体取决于中心。中心按均值±SD 患病率分为三组。SD 患病率较高的三分位数（86.4%）与 SD 患病率较低的三分位数（32.2%）相比，女性年龄明显较大（49.5 ± 5.3 岁比 48.0 ± 5.6 岁），阴道干燥率较高（60.4%比 40.8%），伴侣年龄较大（53.0 ± 6.9 岁比 50.2 ± 7.5 岁）。同样，已婚（68.5%比 63.1%）、绝经后（49.7%比 39.3%）和使用 HT 的女性（23%比 9.2%）的比例也较高。在健康认知、卵巢切除术史、强奸和伴侣 SD 率方面没有差异（27%比 26.2%）。SD 患病率较高的三分位数（22.0 ± 5.0）的总 FSFI 评分明显较低（27.5 ± 5.4）。使用逻辑回归分析确定与性活跃女性 SD 相关的主要危险因素的优势比（95%置信区间）：润滑不良，3.86（3.37-4.43）；使用替代绝经治疗，2.13（1.60-2.84）；伴侣 SD，1.89（1.63-2.20）；女性年龄较大（>48 岁），1.84（1.61-2.09）；膀胱问题，1.47（1.28-1.69）；HT 使用，1.39（1.15-1.68）；对女性健康状况的负面认知，1.31（1.05-1.64）；已婚，1.22（1.07-1.40）。保护因素包括女性的较高教育水平、伴侣的忠诚和获得私人医疗保健。
本研究中，中年拉丁美洲女性 SD 的患病率较高，不同人群的患病率差异很大。阴道润滑度下降是最重要的相关危险因素。研究组之间危险因素的患病率存在差异，其中一些是可以改变的，这可以解释本研究中观察到的 SD 患病率的变化。
