Department of Obstetrics/Gynecology.
Division of Reproductive Endocrinology and Infertility.
Menopause. 2018 Nov;25(11):1238-1243. doi: 10.1097/GME.0000000000001225.
To identify risk factors for decreased libido among women in the late reproductive years.
Prospective cohort. Women aged 35 to 47 years identified through random digit dialing were prospectively followed for 4 years with serial hormone assays and standardized questionnaires. Mean hormone values, hormone trends over 4 years, and fluctuation in hormone levels were compared among women with and without a decrease in libido at the last assessment period. Total testosterone, dihydroepiandrosterone sulfate, estradiol, follicle-stimulating hormone, luteinizing hormone, body mass index, psychosocial, and socioeconomic variables were evaluated using multivariable logistic regression.
Of 326 women, 87 (27%) reported a decreased libido, whereas 239 (73%) did not. Participant-specific means for all hormone levels over the study period were similar among both groups. However, total testosterone fluctuation over the study was significantly different between groups. Women whose testosterone levels fluctuated from 3.8 to 21.5 ng/dL around a mean value of 9 ng/dL were four times more likely to report decreased libido compared with women with little fluctuation in testosterone [odds ratio (OR) 4.0; 95% CI, 1.6-10.0]. Depression (OR 3.4; 95%CI, 1.9-6.1), vaginal dryness (OR 3.5; 95%CI, 1.8-6.6), and children living at home (OR 1.4; 95%CI, 1.1-1.7) were also independently associated with decreased libido.
Decreased libido in the late reproductive years is associated with a pronounced fluctuation in total testosterone over time. Other independent risk factors for decreased libido include vaginal dryness, depression, and living with children. Sexual dysfunction is a complex disorder, related to physiological and psychosocial factors, requiring further investigation.
确定生育后期女性性欲降低的风险因素。
前瞻性队列研究。通过随机数字拨号确定年龄在 35 至 47 岁的女性，对其进行为期 4 年的前瞻性随访，连续进行激素检测和标准化问卷调查。在最后一次评估期，比较性欲下降的女性和未下降的女性的平均激素值、4 年内的激素趋势以及激素水平的波动情况。采用多变量逻辑回归评估总睾酮、硫酸脱氢表雄酮、雌二醇、卵泡刺激素、黄体生成素、体重指数、心理社会和社会经济变量。
在 326 名女性中，87 名（27%）报告性欲下降，239 名（73%）未报告。在整个研究期间，两组的所有激素水平的个体特定平均值相似。然而，研究期间总睾酮的波动在两组之间存在显著差异。与睾酮波动较小的女性相比，睾酮水平在 9ng/dL 左右的均值上下波动 3.8-21.5ng/dL 的女性报告性欲下降的可能性高出四倍[比值比（OR）4.0；95%可信区间，1.6-10.0]。抑郁（OR 3.4；95%可信区间，1.9-6.1）、阴道干燥（OR 3.5；95%可信区间，1.8-6.6）和与孩子同住（OR 1.4；95%可信区间，1.1-1.7）也与性欲下降独立相关。
生育后期性欲下降与总睾酮随时间的显著波动有关。性欲下降的其他独立风险因素包括阴道干燥、抑郁和与孩子同住。性机能障碍是一种复杂的疾病，与生理和心理社会因素有关，需要进一步研究。
