目的:多囊卵巢综合征(PCOS)患者的性类固醇水平与性功能有什么关系?
结论:与没有PCOS的患者相比,患有PCOS的女性报告了更多的性功能障碍和更多的性困扰,但只有少数和弱的雄激素水平和性功能之间的关联被观察到。
背景:文献显示,PCOS患者报告性功能和性满足水平较低,性交困扰较多。促成因素似乎是肥胖,脱发,多毛症,痤疮,不孕症,焦虑,抑郁症,自卑.在患有PCOS的女性中,临床和/或生化高雄激素血症是常见的;它与性功能的关系是,然而,不确定。
方法:这项观察性前瞻性病例对照研究,研究对象为135名女性(68名PCOS,67对照)从2017年3月至2020年3月进行。
方法:有和没有PCOS的异性恋女性,18-40岁,在稳定的关系中,没有任何合并症,使用液相色谱-串联质谱法进行了广泛的医学和内分泌筛查,并进行了有效的性功能问卷。
结果:患有PCOS的女性报告性功能显着降低(女性性功能指数(FSFI)P<0.001,部分η2=0.104),性困扰水平较高(女性性困扰量表修订P<0.001,部分η2=0.090),他们更经常符合性功能障碍的定义(41.2%对11.9%,P<0.001,PhiV=0.331)和临床性困扰(51.5%vs19.4%,P<0.001,PhiV=0.335)。校正混杂因素的回归分析显示,雄激素水平与性功能之间的关联很少且较弱。每个模型最多解释15%的性功能。在显著的第×组激素相互作用之后,对两组分别进行的分析显示,PCOS组无显著相关性.对照组仅显示睾酮与FSFI疼痛之间的弱负相关(β=-6.022,P=0.044,AdjR2=0.050),FAI和FSFI性高潮之间(β=-3.360,P=0.023,AdjR2=0.049)以及雄烯二酮与临床性困扰之间(β=-7.293,P=0.036,exp(β)=0.001)。
结论:关于性功能的研究重点可能会产生选择偏倚。可能有更严重的性障碍的妇女选择或不选择参加。PCOS女性和对照组在关系持续时间和激素避孕药使用方面的差异可能会扭曲性功能结果。
结论:PCOS患者性功能受损。然而,内分泌干扰似乎对性功能的直接影响最小。解决性行为和提供性心理咨询在PCOS女性的临床护理中很重要。
背景:这项研究由参与中心的部门资助:生殖内分泌学和不孕症,妇产科,伊拉斯谟大学医学中心,鹿特丹,荷兰;心身OBGYN和性学系,莱顿大学医学中心,莱顿,荷兰;性学和心身OBGYN系,阿姆斯特丹大学医学中心,阿姆斯特丹大学,阿姆斯特丹,荷兰。J.S.E.L.从以下公司获得了不受限制的研究资助(按字母顺序排列):安什实验室,套圈,默克·塞罗诺和罗氏诊断。他还从安什实验室获得了顾问费,套圈,TitusHealthcare和Roche诊断。其他作者没有利益冲突。
背景:CCMO寄存器,注册号:NL55484.078.16,2016年3月10日。https://www.toetsingonline.nl/to/ccmo_search。nsf/Searchform?OpenForm。
What is the relationship of sex steroid levels with sexual function in women with and without polycystic ovary syndrome (PCOS)?
Women with PCOS reported more sexual dysfunction and more sexual distress compared to those without PCOS, but only few and weak associations between androgen levels and sexual function were observed.
The literature shows that women with PCOS report lower levels of sexual function and sexual satisfactionand more sexual distress. Contributing factors seem to be obesity, alopecia, hirsutism, acne, infertility, anxiety, depression, and low self-esteem. In women with PCOS clinical and/or biochemical hyperandrogenism is common; its relationship with sexualfunction is, however, inconclusive.
This observational prospective
case control study with 135 women (68 PCOS, 67 control) was conductedfrom March 2017 until March 2020.
Heterosexual women with and without PCOS, aged 18-40 years, in a steady relationshipand without any comorbidities, underwent an extensive medical and endocrine screening using liquid chromatography-tandem mass spectrometry and validated sexual function questionnaires.
Women with PCOS reported significantly lower sexual function (Female Sexual Function Index (FSFI) P < 0.001, partial η2 = 0.104), higher levels of sexual distress (Female Sexual Distress Scale-Revised P < 0.001, partial η2 = 0.090), and they more often complied with the definition of sexual dysfunction (41.2% vs 11.9%, P < 0.001, Phi V = 0.331) and clinical sexual distress (51.5% vs 19.4%, P < 0.001, Phi V = 0.335). Regression analysis adjusted for confounders showed only few and weak associations between androgen levels and sexual function, with each model explaining a maximum of 15% sexual function. Following significant Group × Hormone interactions, analyses for both groups separately showed no significant associations in the PCOS group. The control group showed only weak negative associations between testosterone and FSFI pain (β = -6.022, P = 0.044, Adj R2 = 0.050), between FAI and FSFI orgasm (β = -3.360, P = 0.023, Adj R2 = 0.049) and between androstenedione and clinical sexual distress (β = -7.293, P = 0.036, exp(β) = 0.001).
The focus of the study on sexual functioning potentially creates selection bias. Possibly women with more severe sexual disturbances did or did not choose to participate. Differences between women with PCOS and controls in relationship duration and hormonal contraceptive use might have skewed the sexual function outcomes.
Sexual function is impaired in women with PCOS. However, endocrine perturbations seem to have minimal direct impact on sexual function. Addressing sexuality and offering psychosexual counseling is important in the clinical care for women with PCOS.
This study was funded by the departments of the participating centers: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Psychosomatic OBGYN and Sexology, Leiden University Medical Center, Leiden, the Netherlands; and Department of Sexology and Psychosomatic OBGYN, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands. J.S.E.L. received unrestricted research grants from the following companies (in alphabetical order): Ansh Labs, Ferring, Merck Serono and Roche Diagnostics. He also received consultancy fees from Ansh Labs, Ferring, Titus Healthcare and Roche Diagnostics. The other authors have no conflicts of interest.
CCMO register, registration number: NL55484.078.16, 10 March 2016. https://www.toetsingonline.nl/to/ccmo_search.nsf/Searchform?OpenForm.