背景:多囊卵巢综合征(PCOS)是一种常见且令人痛苦的内分泌疾病,与生活质量降低有关,不孕不育,糖尿病,心血管疾病,抑郁症,焦虑,和饮食失调。PCOS的特点,它的合并症,它的治疗可能会影响性功能。然而,关于PCOS女性性功能的研究有限且相互矛盾。
目的:目的是对已发表的关于PCOS女性性功能的文献进行系统回顾,并评估研究质量和结局的确定性,通报2023年PCOS评估和管理国际准则。
方法:搜索了8个电子数据库,直到2023年6月1日。包括在PCOS人群中使用经过验证的性问卷或视觉模拟量表(VAS)报告性功能的研究。使用随机效应模型进行meta分析,比较PCOS和非PCOS组,以Hedges/g作为标准化平均差异。研究质量和结果的确定性通过偏倚风险评估和建议分级来评估,评估,根据Cochrane的开发和评估(等级)方法。目视检查漏斗图的出版偏倚。
结果:包括32篇文章,其中28人使用经过验证的问卷,4人使用VAS。随机效应模型中的汇总女性性功能指数(FSFI)得分显示,PCOS女性大多数子域的性功能较差,包括唤醒(对冲的g[Hg][95%CI]=-0.35[-0.53,-0.17],I2=82%,P<0.001),润滑(Hg[95%CI]=-0.54[-0.79,-0.30],I2=90%,P<0.001),性高潮(Hg[95%CI]=-0.37[-0.56,-0.19],I2=83%,P<0.001),和疼痛(Hg[95%CI]=-0.36[-0.59,-0.13]I2=90%,P<0.001),以及总性功能(Hg[95%CI]=-0.75[-1.37,-0.12],I2=98%,P=0.02)和性满意度(Hg[95%CI]=-0.31[-0.45,-0.18],I2=68%,P<0.001)。基于生育状况和体重指数(BMI)的敏感性和亚组分析并未改变结果的方向或意义。VAS研究的荟萃分析表明,过多的体毛对性行为的负面影响,性吸引力较低,与对照组相比,PCOS女性的性满意度较低,在令人满意的性生活的重要性方面没有差异。没有研究评估性困扰。等级评估显示所有结果的确定性较低。
结论:PCOS患者的性心理功能似乎受损,但是缺乏相关的痛苦分数的证据,这需要满足性心理功能障碍的标准。卫生保健专业人员应讨论性功能和痛苦,并意识到PCOS对性功能的多因素影响。未来的研究需要评估心理性功能和痛苦,以帮助理解PCOS中心理性功能障碍的程度。最后,未来的研究应包括更多样化的人群(例如非异性恋人群和更多种族人群),还应评估性功能障碍治疗的疗效(例如生活方式和药物干预).
BACKGROUND: Polycystic ovary syndrome (PCOS) is a common and distressing endocrine disorder associated with lower quality of life, subfertility, diabetes, cardiovascular disease, depression, anxiety, and eating disorders. PCOS characteristics, its comorbidities, and its treatment can potentially influence sexual function. However, studies on sexual function in women with PCOS are limited and contradictory.
OBJECTIVE: The aim was to perform a systematic
review of the published literature on sexual function in women with PCOS and assess the quality of the research and certainty of outcomes, to inform the 2023 International Guidelines for the Assessment and Management of PCOS.
METHODS: Eight electronic databases were searched until 1 June 2023. Studies reporting on sexual function using validated sexuality questionnaires or visual analogue scales (VAS) in PCOS populations were included. Random-effects models were used for meta-analysis comparing PCOS and non-PCOS groups with Hedges\' g as the standardized mean difference. Study quality and certainty of outcomes were assessed by risk of bias assessments and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) method according to Cochrane. Funnel plots were visually inspected for publication bias.
RESULTS: There were 32 articles included, of which 28 used validated questionnaires and four used VAS. Pooled Female Sexual Function Index (FSFI) scores in random-effects models showed worse sexual function across most subdomains in women with PCOS, including arousal (Hedges\'s g [Hg] [95% CI] = -0.35 [-0.53, -0.17], I2 = 82%, P < 0.001), lubrication (Hg [95% CI] = -0.54 [-0.79, -0.30], I2 = 90%, P < 0.001), orgasm (Hg [95% CI] = -0.37 [-0.56, -0.19], I2 = 83%, P < 0.001), and pain (Hg [95% CI] = -0.36 [-0.59, -0.13] I2 = 90%, P < 0.001), as well as total sexual function (Hg [95% CI] = -0.75 [-1.37, -0.12], I2 = 98%, P = 0.02) and sexual satisfaction (Hg [95% CI] = -0.31 [-0.45, -0.18], I2 = 68%, P < 0.001). Sensitivity and subgroup analyses based on fertility status and body mass index (BMI) did not alter the direction or significance of the results. Meta-analysis on the VAS studies demonstrated the negative impact of excess body hair on sexuality, lower sexual attractiveness, and lower sexual satisfaction in women with PCOS compared to controls, with no differences in the perceived importance of a satisfying sex life. No studies assessed sexual distress. GRADE assessments showed low certainty across all outcomes.
CONCLUSIONS: Psychosexual function appears to be impaired in those with PCOS, but there is a lack of evidence on the related distress scores, which are required to meet the criteria for psychosexual dysfunction. Health care professionals should discuss sexual function and distress and be aware of the multifactorial influences on sexual function in PCOS. Future research needs to assess both psychosexual function and distress to aid in understanding the degree of psychosexual dysfunction in PCOS. Finally, more diverse populations (e.g. non-heterosexual and more ethnically diverse groups) should be included in future studies and the efficacy of treatments for sexual dysfunction should also be assessed (e.g. lifestyle and pharmacological interventions).