Second Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, Aretaieion Hospital, GR-11528 Athens, Greece.
Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Patras Medical School, University Hospital, GR-26504 Patras, Greece.
J Sex Med. 2023 Feb 27;20(3):313-323. doi: 10.1093/jsxmed/qdac031.
Postmenopausal sexual function presupposes the integration of hormonal, neural, and vascular interactions and is subject to optimal crosstalk among psychological, interpersonal, cultural, and environmental factors. Sense of coherence (SOC) reflects a person's ability to cope with stressors and may influence the occurrence of menopausal symptoms and sexual dysfunction.
To investigate the association of severity of climacteric symptoms, cardiometabolic risk factors, and SOC with sexual function in postmenopausal women.
Overall 281 sexually active postmenopausal women without significant psychopathology or cardiovascular disease attending the Menopause Unit of Aretaieion Hospital were evaluated by the Female Sexual Function Index (FSFI), Greene Climacteric Scale, Beck Depression Scale, and Sense of Coherence Scale. Hormonal and biochemical parameters and cardiometabolic risk factors were evaluated. FSFI scores <26.5 were considered pathologic.
Total and subdomain scores of sexual response were determined.
Pathologic FSFI scores were found in 79.7% of the sample. Linear models of multivariable regression analysis showed that FSFI scores were associated with (1) Beck scores (b = -0.200; 95% CI, -0.472 to -0.073, P = .001), vasomotor symptom severity (b = -0.324; 95% CI, -0.985 to 0.051; P < .001), and age and (2) SOC (b = 0.150, 95% CI, 0.036-0.331; P = .008), vasomotor symptom severity (b = -0.361; 95% CI, -0.743 to 0.245; P < .001), and age. Both models were adjusted for menopausal age, diabetes mellitus, hypertension, type of menopause, and menopausal hormone therapy intake. SOC was associated with Beck depression scores (β = -0.487, P < .001; Greene Climacteric Scale total scores, β = -0.199, P < .001). FSFI score <26.5 vs >26.5 was associated with SOC (odds ratio, 0.982; 95% CI, 0.563 to 1.947; P = .006) and moderate to severe vasomotor symptom severity (odds ratio, 2.476; 95% CI, 1.478 to 3.120; P = .009) independent of age, diabetes mellitus, hypertension, menopausal hormone therapy intake, type of menopause, or Beck depression classification.
The results indicate the importance of psychometric assessment of postmenopausal women when presenting with scores of low sexual function. The severity of vasomotor symptoms should also be addressed in any case.
This is the first study investigating the relationship between SOC and sexuality in menopause in a carefully selected homogenous population. Limitations included the cross-sectional design and the fact that sexual distress was not assessed.
Pathologic FSFI scores were highly prevalent in this sample of postmenopausal women. FSFI is associated positively with age and severity of vasomotor symptoms and negatively with SOC.
绝经后性功能需要整合荷尔蒙、神经和血管的相互作用，并受到心理、人际、文化和环境因素之间最佳相互作用的影响。心理一致感（SOC）反映了一个人应对压力的能力，可能会影响绝经症状和性功能障碍的发生。
研究绝经后妇女的更年期症状严重程度、心血管代谢危险因素和 SOC 与性功能的关系。
共有 281 名无明显精神病理学或心血管疾病的有性生活的绝经后妇女参加了 Aretaieion 医院的更年期门诊，通过女性性功能指数（FSFI）、格林绝经量表、贝克抑郁量表和心理一致感量表进行评估。评估了激素和生化参数以及心血管代谢危险因素。FSFI 评分<26.5 被认为是病理性的。
发现 79.7%的样本存在病理性 FSFI 评分。多元回归分析的线性模型显示，FSFI 评分与（1）贝克评分（b=-0.200；95%置信区间，-0.472 至-0.073，P=0.001）、血管舒缩症状严重程度（b=-0.324；95%置信区间，-0.985 至 0.051；P<0.001）和年龄以及（2）SOC（b=0.150，95%置信区间，0.036-0.331；P=0.008）、血管舒缩症状严重程度（b=-0.361；95%置信区间，-0.743 至 0.245；P<0.001）和年龄相关。两个模型均调整了绝经年龄、糖尿病、高血压、绝经类型和绝经激素治疗的摄入。SOC 与贝克抑郁评分（β=-0.487，P<0.001；格林绝经量表总分，β=-0.199，P<0.001）相关。FSFI 评分<26.5 与>26.5 与 SOC（比值比，0.982；95%置信区间，0.563 至 1.947；P=0.006）和中度至重度血管舒缩症状严重程度（比值比，2.476；95%置信区间，1.478 至 3.120；P=0.009）相关，独立于年龄、糖尿病、高血压、绝经激素治疗的摄入、绝经类型或贝克抑郁分类。
研究结果表明，当出现性功能低下的评分时，对绝经后妇女进行心理评估非常重要。在任何情况下都应解决血管舒缩症状的严重程度。
这是第一项在精心挑选的同质人群中研究 SOC 与绝经后性功能之间关系的研究。局限性包括横断面设计以及未评估性功能障碍的事实。
在该绝经后妇女样本中，病理性 FSFI 评分非常普遍。FSFI 与年龄和血管舒缩症状的严重程度呈正相关，与 SOC 呈负相关。
