Obesity and female sexual dysfunctions: A systematic review of prevalence with meta-analysis.

Obesity represents a major global health challenge. Female sexual dysfunctions have a negative impact on quality of life and overall health balance. A higher rate of female sexual dysfunctions in obese women has been suggested. This systematic review summarized the literature on female sexual dysfunction prevalence in obese women. The review was registered (Open Science Framework OSF.IO/7CG95) and a literature search without language restrictions was conducted in PubMed, Embase and Web of Science, from January 1990 to December 2021. Cross-sectional and intervention studies were included, the latter if they provided female sexual dysfunction rate data in obese women prior to the intervention. For inclusion, studies should have used the female sexual function index or its simplified version. Study quality was assessed to evaluate if female sexual function index was properly applied using six items. Rates of female sexual dysfunctions examining for differences between obese vs class III obese and high vs low quality subgroups were summarized. Random effects meta-analysis was performed, calculating 95% confidence intervals (CI) and examining heterogeneity with I2 statistic. Publication bias was evaluated with funnel plot. There were 15 relevant studies (1720 women participants in total with 153 obese and 1567 class III obese women). Of these, 8 (53.3%) studies complied with >4 quality items. Overall prevalence of female sexual dysfunctions was 62% (95% CI 55-68%; I2 85.5%). Among obese women the prevalence was 69% (95% CI 55-80%; I2 73.8%) vs 59% (95% CI 52-66%; I2 87.5%) among those class III obese (subgroup difference p=0.15). Among high quality studies the prevalence was 54% (95% CI 50-60%; I2 46.8%) vs 72% (95% CI 61-81%; I2 88.0%) among low quality studies (subgroup difference p=0.002). There was no funnel asymmetry. We interpreted that the rate of sexual dysfunctions is high in obese and class III obese women. Obesity should be regarded as a risk factor for female sexual dysfunctions.

[Design and validation of the second edition of the Women's Sexual Function Questionnaire, FSM-2]. / Diseño y validación de la segunda edición del Cuestionario de Función Sexual de la Mujer, FSM-2.

OBJECTIVE: To design and validate the second edition of the Female Sexual Function questionnaire (FSF-2). MATERIAL AND METHODS: A cross-sectional and multicentre study was conducted on 187 women (18-70 years) who completed a test (preliminary questionnaire FSF-2), and then answered a structured anamnesis on female sexual function. Four weeks later they completed a retest, which was equal to the test but with an additional question about possible influence of recent events in their sex life. RESULTS: The mean age of the women was 43.51 years. Internal consistency of the questionnaire: Cronbach's α of the 0.919 test, of structured anamnesis 0.921, of the 0.920 retest. Test-retest reliability: mean test scores 30.53 ± 8.605, retest 30.05 ± 8.770, without significant differences. Correlation between total test and retest scores (intraclass correlation coefficient) 0.960, significant (P<.01); between total test scores and structured anamnesis 0.977, significant (P<.01). Concordance between test questions and structured anamnesis (kappa index), minimum 0.706, maximum 0.915; between test and retest questions, minimum 0.630, maximum 0.802. Content validity by expert consensus. Criteria validity: specificity of the questionnaire exceeding 90% for all items/domains, sensitivity greater than 80%, except for items 5, 6, 9 (70-80%). Validity of the construct through factor analysis, grouping of items into 2 components (they explain 66.586% of variance). CONCLUSIONS: The FSF-2 questionnaire is reliable and valid. It evaluates the sexual response of women, describing important aspects of their sexual activity as a couple: anticipatory anxiety, initiative, confidence to communicate, preferences and events that may influence. It can detect sexual dysfunction in the couple.

[Design and validation of a Male Sexual Function Questionnaire]. / Diseño y validación del Cuestionario de Función Sexual del Hombre, FSH.

OBJECTIVE: The objective of this work was to design and validate a questionnaire on Male Sexual Function (MSF) in the Spanish language, following the criteria contemplated in the Diagnostic and Statistical Manual of Mental Disorders, DSM-5, for the diagnosis of sexual dysfunctions. MATERIAL AND METHODS: A cross-sectional and multicentre study was conducted on 163 men (18-70 years) who self-completed a test (MSF questionnaire). They then answered questions on the Structured History of Male Sexual Function (AMSF). Four weeks later they completed a re-test, which was the same, but including a supplementary question about the possible influence of recent events. RESULTS: Internal consistency: Cronbach's α test 0.840, AMSF 0.835, retest 0.855. Test-retest reliability: mean test scores 33.13±6.566, retest 33.11±6.791; Student t 0.122, not significant (P=.903); correlation total test-retest scores (intraclass correlation coefficient) 0.979, significant correlation (P<.01); total correlations test-AMSF scores (intraclass correlation coefficient) 0.966, significant correlation (P<.01). Concordance: between questions of the AMSF test (Kappa index) minimum 0.749, maximum 0.934; between test-retest questions: 0.724, 0.844. Content validity using expert consensus. Criteria validity: specificity>90% for all items / domains, sensitivity>80% except item 4 (76%). Content validity: using factor analysis, grouping of items into 4 components (explain 75% variance); high correlation between "sexual desire" and "confidence in erection". CONCLUSIONS: The MSF questionnaire is reliable, stable and valid, with high specificity and sensitivity. It evaluates the sexual response of the male, describing aspects of interest: anticipatory anxiety, initiative, confidence to communicate preferences, events that may influence. Can detect sexual dysfunction in the couple.

[Pharmacological treatment of the premature ejaculation]. / Tratamiento farmacológico de la eyaculación precoz.

Biomedical approach to premature ejaculation (PE) has permited a better phisiopatologycal knowledge and so the use of pharmacological agents for the treatment of this sexual dysfuncion. Most of the studies to evaluate the eficacy of these drugs were not carried at all the parameters which actually define PE: intravaginal ejaculatory latencie time (IELT) tested with watch, ejaculation control self perception cuantification (questionaries) and cuantification of generated consequences in patient and partner, if it existes. For this reason, it is difficult to analyse the scientific evidence and we use medicines with no approved indication for PE ("off label"). This text is a review of pharmacologycal agents with no approved indication (PDE type 5 inhibitors, α-blockers, tramadol, SSRI, clomipramine), and pharmacologycal agents developed to be used in the treatment of PE and having got indication in this sexual dysfunction or "on label" drugs (topic anesthesics, dapoxetine).

[The medical history taking in sexual health: skills and attitudes]. / La anamnesis en la historia clínica en salud sexual: habilidades y actitudes.

A sexual satisfactory life favourably affects quality of life, there being evidence that shows there are multiple organic processes of which sexual dysfunction is often a precocious sign of underlying organic disease (cardiovascular, endocrinological or neurological). Difficulties exist in recording the sexual anamnesis on the part of the professional, the patient, or by the health system. Nevertheless, given its importance, it is necessary for the doctor to adopt an attitude of active search, especially among the population of risk. To do this, it is necessary that the situation is propitious (sense of the opportunity), preserving the confidentiality of the meeting, and it will be carried out naturally and with empathy, adopting a listening attitude, taking into account the non-verbal language, without issuing valued judgments, and resorting to assertivity to overcome the resistances. This article proposes guidelines to perform an anamnesis adequately.