Genetic and environmental risk factors for sexual distress and its association with female sexual dysfunction

A. Burri, Q. Rahman and T. Spector (2011). Genetic and environmental risk factors for sexual distress and its association with female sexual dysfunction. Psychological Medicine, 41, pp 2435-2445. Copyright © Cambridge University Press 2011. http://dx.doi.org/10.1017/S003329171100049

testosterone and libido in surgically and naturally menopausal women

The assessment and then treatment of a change in libido, or a change in the desire to partake in sexual activity, during the menopausal transition and beyond has been a challenging and elusive area of clinical research. This is partly due to the multidimensional nature of female sexuality, the difficulties of measuring testosterone in women in a reliable and accurate manner, and the complexity of the neurobiology and neurobehavior of female sexual desire. In addition, there is a lack of evidence for diagnostic specificity of low free testosterone levels for the symptom of low libido in women for whom there are no confounding interpersonal or psychological factors; although, in the symptomatic population of surgically or naturally menopausal women, a low level of free testosterone often accompanies a complaint of reduced desire/libido. The randomized clinical trial research on testosterone replacement for naturally and/or surgically menopausal women with sexual dysfunction has been criticized for a high placebo response rate, supraphysiological replacement levels of testosterone, the perception of modest clinical outcome when measuring objective data such as the frequency of sexual intercourse relative to placebo, and the unknown safety of long-term testosterone replacement in the estrogen-replete surgically or naturally menopausal woman. A careful review of current evidence from randomized, controlled trials lends support to the value of the replacement of testosterone in the estrogen-replete menopausal woman for whom libido and desire has declined. The issue of long-term safety remains to be answered. Multifactorial nature of female sexuality The assessment and then treatment of a change in libido, or a change in the desire to partake in sexual activity, during the menopausal transition and beyond has been a challenging and elusive area of clinical research. There is a lack of evidence for the diagnostic specificity of low free testosterone levels for the symptom of low libido in the women for whom there are no confounding interpersonal or psychological factors; although, in the symptomatic population of surgically or naturally menopausal women, a low level of free testosterone often accompanies a complaint of reduced desire/libido [1–6]. Female sexuality is dependent on biological, psychosexual, sociocultural and context-related factors [7–9]. As a consequence, any movement or change in any of these realms may increase or decrease a woman's perception of her drive or motivation to participate in sexual activity. The presence of any chronic medical illness such as diabetes, pulmonary or cardiovascular problems, or depression will in many instances impact a woman's sexuality concurrent with changes related to age [10,11]. The length of the relationship with a partner, as well as aging, has been demonstrated to impact sexual interest and frequency of sexual activity [12,13]. The menopause has been shown to have an incremental effect on a woman's sexuality, separate from the change brought about by aging [14]. The quality of her intimate relationship and the degree to which she feels empowered in it have been demonstrated to affect sexual desire [15]. The culture in which she lives has been shown to affect frequency of sexual intercourse [16]. The degree of stress she is under, as well as her general wellbeing, has also been shown to affect her libido. A recent longitudinal study demonstrated that higher stress lowers wellbeing, resulting in a decrease in sexual arousal, enjoyment, orgasm and desire [17]. In addition, the balance between sexual inhibition and sexual excitement may be unique to each woman and may change according to her circumstances, along with any other change she may have with regard to these opposing forces [18]. Thus, the treatment of any woman distressed by a change in desire at midlife and beyond is driven by many factors. The clinician's task is to elucidate which one or more of these many variables changed in her life, concurrent with her change in sexual desire, and then to determine whether or not these changes are related to her change in sexual desire

Age-related changes relevant to health in women: design, recruitment, and retention strategies for the Longitudinal Assessment of Women (LAW) Study

Objectives: The primary aim was to assess the age-related changes that occur in older women. This paper describes the study rationale and methods, recruitment, and retention strategies. Methods: The Longitudinal Assessment of Women (LAW) Study was a longitudinal, observational, and multidisciplinary evaluation of a population-based cohort of urban-living women, aged between 40 and 80 years at recruitment and randomly invited from a district in Brisbane (a city in Australia) via the electoral roll. Five hundred eleven women were recruited and stratified into four age groups (40-49, 50-59, 60-69, 70-79 years) and were assessed on three or four occasions each year, using interviews and diagnostic instruments (echocardiography, applination tonometry, dual-energy x-ray absorptiometry [DEXA]) Retention strategies included flexibility, accessibility, personalized attention, and feedback. Results: From a sample frame of 1598 names, there were 1082 respondents, of whom 511 (47%) were successfully recruited from those eligible to participate. Recruitment was quickest for the oldest age group, 70-79 years, and slowest for the age group 40-49 years; all age groups achieved their required quota. A scheduling program was developed to minimize the number of visits and maximize the use of allocated time. The largest dropout was seen in year 1 of the study, with very few thereafter. Of the 9 deaths, cancer was the cause in 7. The retention rate after 5 years was 95.5%. Conclusions: The design of the present study, with careful attention to coordination and a personal approach, facilitated the completion of a 5-year study, enabling a collection of a set of wide-ranging data from almost all the women recruited. The information thus collected will form the basis of cross-linking analysis of the risk factors associated with health problems in aging women

Physician diagnosed arthritis, reported arthritis and radiological non-axial osteoarthritis

SummaryObjectiveTo determine the question that best predicts radiographic evidence of non-axial osteoarthritis (OA).DesignThe Melbourne Women's Mid-life Health Project (MWMHP), commenced in 1991, is a population-based prospective study of 438 Australian-born. Two hundred and fifty-seven (57%) women remained in longitudinal assessment in 2002 and 224 (87%) women agreed to undergo X-rays of their hands and knees between 2002 and 2003.MethodsAnnually participants were asked about aches and stiff joints and arthritis or rheumatism. In the eleventh year of follow-up X-rays were scored for evidence of OA using a validated scale, by two investigators who were blinded to questionnaire results. Information on hormone therapy use, physical activity, mood, smoking, body mass index (BMI) and age were obtained by both self-administered and face-to-face questionnaires.ResultsPatient reported physician diagnosed arthritis was the best predictor of radiological OA (ROA). The question had a specificity of 64%, a positive predictive value of 57% and a negative predictive value of 71%. Even the most reliable question about arthritis still had a relatively low specificity for radiologically diagnosed OA. Reporting symptoms were significantly more common in participants who were depressed, those who had a higher negative affect and those with a higher BMI.ConclusionIn large epidemiological studies where questionnaire assessment of OA is required, the greatest accuracy is achieved by asking about physician diagnosed arthritis. Concurrent application of a validated scale for mood is important

Recognising female sexual dysfunction as an essential aspect of effective diabetes care

The following literature review will focus on sexual dysfunction in women living with diabetes, drawing on international studies in this specialist field. The key aim of this paper is generate a greater understanding and recognition of the issues facing these women and to determine a more proactive approach to identification, consultation and potential treatment options. The main findings highlight the unique role practitioners have with women with diabetes and how to facilitate partnership working. Nurses have the most frequent contact with people living with diabetes in any healthcare system. Nurses’ knowledge about sexuality in relation to diabetes should improve patient education, recognition and could signal undiagnosed or increased risk of sexual dysfunction to enable treatment so care can be optimised accordingl

The value of follicle-stimulating hormone concentration and clinical findings as markers of the late menopausal transition

CONTEXT: The Stages of Reproductive Aging Workshop proposed bleeding and hormonal criteria for the menopausal transition, but operational definitions of hormone parameters were not specified. OBJECTIVE: This paper investigates the longitudinal relationship of annual serum FSH levels with four proposed bleeding criteria for the late menopausal transition in two cohort studies. The goal is to provide empirically based guidance regarding application of hormonal criteria that may be optimal for widespread application in clinical and research settings for assessing menopausal stage. DESIGN/SETTING: Prospective menstrual calendar and annual serum FSH data were collected from two population-based cohort studies: the Melbourne Women\u27s Midlife Health Project and the Study of Women\u27s Health Across the Nation. PARTICIPANTS: Participants in the study were 193 Melbourne Women\u27s Midlife Health Project and 2223 Study of Women\u27s Health Across the Nation women aged 42-57 yr at baseline who contributed 10 or more menstrual cycles and at least one annual serum FSH value. MAIN OUTCOME MEASURE(S): Association between bleeding criteria for the late menopausal transition and FSH was a main outcome measure. Associations of bleeding criteria, FSH, and hot flashes with the final menstrual period were also measured. RESULTS: A single FSH measure is an independent marker of the late menopausal transition, but FSH concentrations are less predictive of menopausal stage than any of four proposed bleeding criteria. Criterion FSH values for the late transition are similar across both studies. Experience of hot flashes adds no information in the presence of hormonal and bleeding criteria. CONCLUSIONS: An annual serum FSH concentration of 40 IU/liter could be incorporated, in conjunction with bleeding markers, into the Stages of Reproductive Aging Workshop paradigm for markers of the late menopausal transition

The questionnaire for urinary incontinence diagnosis (QUID): Validity and responsiveness to change in women undergoing non-surgical therapies for treatment of stress predominant urinary incontinence

Aims The Questionnaire for Urinary Incontinence Diagnosis (QUID), a 6-item urinary incontinence (UI) symptom questionnaire, was developed and validated to distinguish stress and urge UI. This study's objective was to evaluate QUID validity and responsiveness when used as a clinical trial outcome measure. Methods Participants enrolled in a multi-center trial of non-surgical therapy (continence pessary, pelvic floor muscle training or combined) for stress-predominant UI and completed baseline and 3-month diaries, the Urinary Distress Inventory (UDI) and QUID. Data from all treatment groups were pooled. QUID internal consistency (Cronbach's Α) and convergent/discriminant validity (Pearson correlations) were evaluated. Responsiveness to change was assessed with 3-month score outcomes and distribution-based measurements. Results Four hundred forty-four women (mean age 50) were enrolled with stress (N = 200) and mixed (N = 244) UI; 344 had 3-month data. Baseline QUID Stress and Urge scores (both scaled 0–15, larger values indicating worse UI) were 8.4 ± 3.2 and 4.5 ± 3.3, respectively. Internal consistency of QUID Total, Stress, and Urge scores was 0.75, 0.64 and 0.87, respectively. QUID Stress scores correlated moderately with UDI-Stress scores (r = 0.68, P  < 0.0001) and diary stress UI episodes (r = 0.41, P  < 0.0001). QUID Urge scores correlated moderately with UDI-Irritative scores (r = 0.68, P  < 0.0001) and diary urge UI episodes (r = 0.45, P  < 0.0001). Three-month QUID Stress and Urge scores improved (4.1 ± 3.4 and 2.2 ± 2.7, both P  < 0.0001). QUID Stress score effect size (1.3) and standardized response mean (1.2) suggested a large change after therapy. Conclusion The QUID has acceptable psychometric characteristics and may be used as a UI outcome measure in clinical trials. Neurourol. Urodynam. 29:727–734, 2010. © 2010 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/77446/1/20818_ftp.pd

A hot-deck multiple imputation procedure for gaps in longitudinal data on recurrent events

We consider the analysis of longitudinal data sets that include times of recurrent events, where interest lies in variables that are functions of the number of events and the time intervals between events for each individual, and where some cases have gaps when the information was not recorded. Discarding cases with gaps results in a loss of the recorded information in those cases. Other strategies such as simply splicing together the intervals before and after the gap potentially lead to bias. A relatively simple imputation approach is developed that bases the number and times of events within the gap on matches to completely recordedhistories. Multiple imputation is used to propagate imputation uncertainty. The procedure is developed here for menstrual calendar data, where the recurrent events are menstrual bleeds recorded longitudinally over time. The recording is somewhat onerous, leading to gaps in the calendar data. The procedure is applied to two important data sets for assessing the menopausal transition, the Melbourne Women's Midlife Health Project and the TREMIN data. A simulation study is presented to assess the statistical properties of the proposed procedure. Some possible extensions of the approach are also considered. Copyright © 2007 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/57519/1/2939_ftp.pd

Dietary patterns and β-amyloid deposition in aging Australian women

Introduction: Evidence indicates that associations between diet and Alzheimer's disease may occur through biomarker pathways such as amyloid-β (Aβ); however, few studies have investigated dietary/Aβ relationships, and no study has investigated this relationship in women.Methods: Dietary patterns were extrapolated for 115 participants from the Women's Health Aging Project. Aβ deposition was measured via in vivo F-18 florbetaben positron emission tomography scanning.Results: Participants were, on average, aged 70 years (±2.63 SD), had 13 years of education (±3.57 SD), a BMI of 28 kg/m2 (±5.46 SD), and a daily energy intake of 5161 kJ (±1679.03 SD). Four dietary patterns were identified: high fat, Mediterranean, junk food, and low fat. Adherence to the junk food diet was a significant predictor of Aβ deposition (β = .10, P = .03).Discussion: This study highlights the potential of diet to influence neurodegenerative disease and as a potential modifiable lifestyle risk factor for Alzheimer's disease

Nuclear medicine procedures and the evaluation of male sexual organs: a short review

Sexuality consists of three aspects that are interrelated and inseparable, biological, physiological and social. The biological aspect considers the individual's capability to give and to receive pleasure. In consequence, it covers the functionality of the sexual organs and the physiology of human sexual response cycle. Diagnostic imaging modalities, such as single photon emission computed tomography (SPECT) and positron emission tomography (PET) have been used to evaluate clinical disorders of the male reproductive system. PET and SPECT procedures basically involve the administration of a radiopharmaceutical that has a higher uptake in a specific tumor or tissue. The aim of this brief review is to present some radiopharmaceuticals that have been used in the clinical evaluation of the male sexual organs (testes, prostate, seminal vesicles, penis) related with male sexuality. This information could be useful in better understanding the male sexual response cycle, as well as the sexual disorders, when considering the male sexual organs and the pelvic floor. Moreover, the findings obtained with PET and SPECT imaging could help to evaluate the efficacy of clinical results of therapeutic procedures. In conclusion, the knowledge from these images could aid in better understanding the physiology of the different organs related with sexuality. Furthermore, they could be important tools to evaluate the physiological integrity of the involved organs, to improve clinical strategies and to accompany the patients under treatment