Department of Experimental Medicine, Medical Physiopathology, Food Science and Endocrinology Section, Viale Policlinico 155,Rome, Italy.
J Sex Med. 2013 Apr;10(4):1024-33. doi: 10.1111/jsm.12069. Epub 2013 Jan 24.
Weight loss in sexually active women improves their quality of life. At present, no studies have investigated whether weight loss may affect female sexual function in severe obese women.
The aim of this study was to investigate the effects of different programs of weight loss on female sexual dysfunction complaints and on endothelial function in premenopausal obese females.
Forty-four out of overall 80 obese fertile women (age 18-49 years; mean 36 years) were enrolled because of sexual complaints at Female Sexual Function Index-6 (FSFI-6 score ≤19). Patients were then allocated to different treatments of 8 weeks duration each: an intensive residential program with hypocaloric diet plus controlled physical exercise along with lifestyle modifications at a specialized clinic (Group A, N = 23) and a non-intensive outpatient clinic program consisting of hypocaloric diet and physical exercise at home (Group B, N = 21). Afterward, overall patients were allocated to an extended 8-week follow-up period consisting of outpatient clinic controlled diet plus physical exercise at home.
Primary end points were modifications of FSFI-6 scores and endothelial function as measured by reactive hyperemia (RHI) with EndoPat-2000. Secondary end points were modifications in body composition as measured by dual-energy X-ray absorptiometry (DEXA).
After 16 weeks, FSFI-6 score and the frequency of sexual activity were significantly higher in Group A compared with Group B (P < 0.01), and significant improvements in arousal, lubrication, and satisfaction sub-domain scores were also found (P < 0.01). Group A showed improvements in RHI (P < 0.01) and marked improvement in homeostasis model assessment of insulin resistance (P < 0.001), anthropometric parameters as weight (P < 0.01), body mass index (P < 0.01), fat mass (P < 0.0001), and percentage of fat mass (P < 0.005) compared with Group B. A relationship between peak insulin (P < 0.0001) and RHI (P < 0.001) vs. FSFI-6 scores was found, respectively.
A multidisciplinary approach to female obesity appears to be superior to conventional outpatient clinic to produce weight loss and to improve several aspects of sexual dysfunction in obese women. Such changes might be related to persistent improvements in endothelial function and in insulin resistance.
性活跃女性的体重减轻可以提高她们的生活质量。目前，还没有研究调查体重减轻是否会影响严重肥胖女性的女性性功能。
本研究旨在调查不同减肥方案对绝经前肥胖女性性功能障碍投诉和内皮功能的影响。
共有 80 名肥胖且有生育能力的女性（年龄 18-49 岁；平均 36 岁）因女性性功能指数-6（FSFI-6 评分≤19）出现性问题而被纳入研究。然后，将患者分为不同的 8 周治疗组：在专门诊所进行低热量饮食加控制的体力活动，同时进行生活方式改变的强化住院计划（A 组，N=23）和在家进行低热量饮食和体力活动的非强化门诊诊所计划（B 组，N=21）。之后，所有患者被分配到一个为期 8 周的延长随访期，包括门诊控制饮食和在家进行体力活动。
主要终点是通过 EndoPat-2000 测量的反应性充血（RHI）来衡量 FSFI-6 评分和内皮功能的变化。次要终点是通过双能 X 射线吸收法（DEXA）测量的身体成分的变化。
16 周后，A 组的 FSFI-6 评分和性活动频率明显高于 B 组（P<0.01），并且在唤起、润滑和满意度亚域评分方面也发现了显著改善（P<0.01）。A 组的 RHI 也有所改善（P<0.01），胰岛素抵抗稳态模型评估（HOMA-IR）明显改善（P<0.001），体重（P<0.01）、体重指数（P<0.01）、体脂量（P<0.0001）和体脂百分比（P<0.005）等人体测量参数也明显改善，与 B 组相比。还发现了峰值胰岛素（P<0.0001）与 RHI（P<0.001）与 FSFI-6 评分之间的关系。
多学科方法治疗女性肥胖症似乎优于传统门诊治疗，能有效减轻体重，并改善肥胖女性性功能障碍的多个方面。这些变化可能与内皮功能和胰岛素抵抗的持续改善有关。
