Andrology Unit, Department of Life, Health and Environment Sciences, University of L'Aquila, Piazzale Tommasi 1, 67110, L'Aquila, Italy.
Spinal Unit, San Raffaele Institute of Sulmona, Sulmona, Italy.
J Endocrinol Invest. 2020 Jul;43(7):1001-1007. doi: 10.1007/s40618-020-01185-w. Epub 2020 Jan 25.
Spinal cord injury (SCI) affects sexual health of both male and female, but little attention has been given to sexuality of SCI women. Similar to penile erection, vaginal lubrication represents a neurovascular event and then both denervation and vascular damage might contribute to its impairment. Nevertheless, the relative weight of lesion location/degree and vascular risk factors in determining hypolubrication in women with SCI has not yet been investigated. The aim of this study was to recognize among putative determinants of poor sexual arousal in women with SCI, neurogenic and vascular/metabolic independent predictors of vaginal hypolubrication.
Twenty-eight consecutive female patients admitted to a rehabilitation program because of chronic SCI (≥ 1 year) underwent clinical and biochemical evaluations, including assessment of vaginal lubrication by the Female Sexual Function Index (FSFI). As, in people with SCI, waist circumference overestimates visceral fat mass due to abdominal muscle paralysis, metabolic syndrome (MetS) was defined according to specific criteria proposed for SCI population: BMI ≥ 22 kg/m and two or more of the following: triglycerides ≥ 150 mg/dL (or actual treatment), HDL < 50 mg/dL, hypertension (or actual treatment), fasting glucose ≥ 100 mg/dL or diabetes mellitus type 2.
A FSFI lubrication sub-score < 3.6, suggestive for impaired vaginal lubrication, was exhibited by 53.7% of the study population. When compared to the group with normal lubrication, a significantly higher proportion of these women had paraplegia (93.3% vs 38.5%, p = 0.003) and met the SCI-specific criteria for MetS (73.4% vs 7.6%, p = 0.0006), whereas, no significant differences were found between the two groups in the proportion of women exhibiting the single components of MetS. At the multiple logistic regression analysis, only the presence of MetS exhibited a significant independent association with impaired vaginal lubrication (OR = 3.1, 95% CI 1.2, 5.8, p = 0.01).
In women with SCI, a clustering of modifiable vascular/metabolic risk factors, constituting the MetS, could contribute to sexual dysfunctions by affecting the vaginal lubrication, independently of the level of the spinal cord lesion.
脊髓损伤（SCI）会影响男性和女性的性健康，但很少有人关注 SCI 女性的性行为。类似于阴茎勃起，阴道润滑是一种神经血管事件，因此去神经和血管损伤都可能导致其受损。然而，在确定 SCI 女性阴道润滑不足的病变部位/程度和血管危险因素的相对权重方面，尚未进行研究。本研究的目的是在 SCI 女性的不良性唤起的潜在决定因素中，识别神经源性和血管/代谢独立预测阴道润滑不足的因素。
28 名连续的因慢性 SCI（≥1 年）而接受康复计划治疗的女性患者接受了临床和生化评估，包括使用女性性功能指数（FSFI）评估阴道润滑情况。由于 SCI 患者的腰围会因腹肌瘫痪而高估内脏脂肪量，因此代谢综合征（MetS）根据针对 SCI 人群的特定标准定义：BMI≥22kg/m2 且有以下两项或以上情况：甘油三酯≥150mg/dL（或实际治疗）、HDL＜50mg/dL、高血压（或实际治疗）、空腹血糖≥100mg/dL 或 2 型糖尿病。
研究人群中 53.7%的 FSFI 润滑子评分＜3.6，提示存在阴道润滑不足。与润滑正常的组相比，这些女性中截瘫的比例明显更高（93.3% vs 38.5%，p=0.003），且符合 SCI 特异性 MetS 标准的比例更高（73.4% vs 7.6%，p=0.0006），而两组间具有 MetS 单一成分的女性比例无显著差异。在多因素逻辑回归分析中，只有 MetS 的存在与阴道润滑不足有显著的独立关联（OR=3.1，95%CI 1.2，5.8，p=0.01）。
在 SCI 女性中，构成 MetS 的可改变的血管/代谢危险因素的聚集可能通过影响阴道润滑来导致性功能障碍，而与脊髓损伤的程度无关。
