Department of Psychology, Catholic University of Milan, Milan, Italy.
Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Hum Reprod. 2019 Jun 4;34(6):1065-1073. doi: 10.1093/humrep/dez046.
Is infertility-related distress a risk factor for impaired female sexual function in women undergoing assisted reproduction?
Infertility-related distress, and especially social, sexual, and relationship concerns, is associated with female sexual dysfunction.
Women with infertility are more likely to present sexual dysfunction relative to those without infertility. Moreover, assisted reproduction is associated with increased risk for female sexual problems. To date, this higher proportion of sexual impairment in infertile women has been simplistically linked to the stress associated with the condition and investigated risk factors included mainly demographic and clinical variables. Quantitative studies aimed at identifying risk factors for sexual dysfunction that also included the evaluation of infertility-related distress are conversely lacking.
STUDY DESIGN, SIZE, DURATION: This observational study was conducted at the Infertility Unit of the Fondazione Ca' Granda, Ospedale Maggiore Policlinico of Milan between 2017 and 2018.
PARTICIPANTS/MATERIALS, SETTING, METHODS: We included 269 consecutive patients with infertility aged 24-45 (37.8 ± 4.0 years). Sexual function outcomes were sexual dysfunction (assessed with the Female Sexual Function Index), sexual distress (evaluated with the Female Sexual Distress Scale-Revised), dyspareunia, and number of intercourses in the month preceding ovarian stimulation. Infertility-related distress was measured with the Fertility Problem Inventory (FPI). The effects of potential confounders such as demographic variables (women's and partners' age and level of education) and infertility-related factors (type and cause of infertility, number of previous IVF cycles, and duration of infertility) were also examined.
Women with higher infertility-related distress were more likely to report sexual dysfunction (odds ratio = 1.02 per point of score; 95% CI, 1.01-1.03; P = 0.001). Three FPI domains (i.e. social, relational, and sexual concerns) were correlated with almost all sexual function outcomes (Ps < 0.05).
LIMITATIONS, REASONS FOR CAUTION: Women who were not sexually active were not included, thus reasons for sexual inactivity should be further explored in future studies. Data regarding men (e.g. sexual function and infertility-related distress) were lacking, thus cross-partner effects were not examined. Recall bias (also due to the fact that questionnaires were administered on the day of oocytes retrieval) and social desirability bias may have also affected women's responses to the questionnaires.
Social, relational, and sexual concerns should be assessed and addressed in psychological counselling with the infertile couple.
STUDY FUNDING/COMPETING INTEREST(S): None.
Not applicable.
不孕相关的困扰是否是接受辅助生殖的女性性功能障碍的风险因素？
不孕相关的困扰，尤其是社会、性和关系方面的困扰，与女性性功能障碍有关。
与没有不孕的女性相比，患有不孕的女性更有可能出现性功能障碍。此外，辅助生殖与女性性问题的风险增加有关。迄今为止，这种不孕女性性功能损害比例较高的情况被简单地归因于与疾病相关的压力，并调查了包括主要人口统计学和临床变量在内的风险因素。相反，缺乏旨在确定性功能障碍风险因素的定量研究，这些因素还包括对不孕相关困扰的评估。
研究设计、规模、持续时间：这项观察性研究于 2017 年至 2018 年在米兰的 Fondazione Ca' Granda，Ospedale Maggiore Policlinico 的不孕科进行。
参与者/材料、地点、方法：我们纳入了 269 名年龄在 24-45 岁（37.8±4.0 岁）之间的连续不孕患者。性功能结果包括性功能障碍（用女性性功能指数评估）、性困扰（用修订后的女性性困扰量表评估）、性交疼痛和卵巢刺激前一个月的性交次数。不孕相关困扰用生育问题量表（FPI）来衡量。还检查了潜在混杂因素的影响，如人口统计学变量（女性和伴侣的年龄和教育水平）和不孕相关因素（不孕的类型和原因、之前的 IVF 周期数量和不孕持续时间）。
不孕相关困扰程度较高的女性更有可能报告性功能障碍（每增加 1 分，比值比为 1.02；95%置信区间，1.01-1.03；P=0.001）。FPI 的三个领域（即社会、关系和性关注）与几乎所有的性功能结果相关（P<0.05）。
局限性、谨慎的原因：未包括无性生活的女性，因此未来的研究应进一步探讨无性生活的原因。缺乏有关男性的资料（例如，性功能和不孕相关的困扰），因此没有检查夫妻间的相互影响。回忆偏倚（也由于问卷是在取卵当天进行的）和社会期望偏差也可能影响女性对问卷的反应。
应在不孕夫妇的心理辅导中评估和处理社会、关系和性方面的问题。
研究资金/利益冲突：无。
不适用。
