Disfunciones sexuales en las mujeres con endometriosis: estudio de prevalencia / Sexual dysfunctions in women with endometriosis: prevalence study

Antecedentes: En las mujeres con endometriosis, son frecuentes las disfunciones sexuales, particularmente el dolor/dispareunia. Objetivo: Evaluar y caracterizar la prevalencia de disfunciones sexuales en las mujeres con endometriosis en Armenia (Quindío), Colombia. Método: Estudio de corte transversal, en 137 mujeres mayores de 18 años con diagnóstico de endometriosis confirmada histológicamente, atendidas en tres clínicas de alta complejidad entre 2017 y 2022. Se utilizó como instrumento el Índice de Función Sexual Femenina (IFSF). Resultados: La edad promedio de las participantes fue de 34,68 ± 7,32 años. La prevalencia de disfunciones sexuales fue del 75,91%, caracterizando en primer lugar el dolor/dispareunia (75,91%), seguido de disminución del deseo sexual (56,93%) y en tercer lugar problemas de lubricación (54,01%). El promedio en la puntuación del IFSF fue de 20,82 ± 7,22 y la proporción de mujeres con puntuación ≥ 26,55 fue del 24,08%. La mediana en el número de disfunciones sexuales fue 3 (rango: 1 y 6). Conclusiones: En las mujeres con endometriosis se evidencia una alta prevalencia de disfunciones sexuales, equivalente a tres cuartas partes de las afectadas. Al momento de atender una mujer con este padecimiento se requiere evaluar sus efectos en la función sexual para poder implementar intervenciones terapéuticas oportunas.

Background: Sexual dysfunctions, particularly pain/dyspareunia, are common in women with endometriosis. Objective: To evaluate and characterize the prevalence of sexual dysfunctions in women with endometriosis in Armenia (Quindío), Colombia. Method: Cross-sectional study in 137 sexually active women older than 18 years with a diagnosis of histologically confirmed endometriosis, attended in three highly complex clinics between 2017 and 2022. The Female Sexual Function Index (FSFI) was used as an instrument. Results: The average age of the participants was 34.68 ± 7.32 years. The prevalence of sexual dysfunctions reported 75.91%, characterizing pain/dyspareunia in the first place (75.91%), followed by decreased sexual desire (56.93%) and thirdly problems of lubrication (54.01%). The average score of the FSFI was 20.82 ± 7.22; the proportion of women with a score ≥ 26.55 was 24.08%. The median in the number of sexual dysfunctions reached 3 (range: 1 and 6). Conclusions: In women with endometriosis there is evidence of a high prevalence of sexual dysfunctions, equivalent to three-quarters of the affected women. When caring for a woman with this condition, it is necessary to evaluate its effects on sexual function in order to implement timely and effective therapeutic interventions.

Punto G: enfoque anatómico y seguridad del paciente / G-spot: anatomical approach and patient safety

Se investiga la región uretro-vaginal (pared posterior de la uretra ­ pared anterior de la vagina), en el área que corresponde a la descripción del "punto G", con el fin de colaborar a la discusión respecto de si existe una estructura morfológica que lo identifique. Se destaca una mayor y ocasional distribución venosa en esta zona, que puede explicar el fenómeno fisiológico descrito por Gräfenberg. Para los ginecólogos, urólogos y sexólogos, el conocimiento de la anatomía funcional de esa región tiene importancia para tratar las disfunciones orgásmicas además de la incontinencia urinaria. Esta situación controvertida influye en el marco actual de la seguridad del paciente

The urethro-vaginal region (posterior wall of the urethra ­ anterior wall of the vagina) is investigated, in the area that corresponds to the description of the "G-spot", in order to contribute to the discussion regarding whether there is a morphological structure that identifies it. A greater and occasional venous distribution in this area stands out, which may explain the physiological phenomenon described by Gräfenberg. For gynecologists, urologists and sexologists, knowledge of the functional anatomy of that region is important to treat orgasmic dysfunctions in addition to urinary incontinence. This controversial situation influences the current framework of patient safety

Prevalencia y caracterización de las disfunciones sexuales en mujeres en transición a la menopausia / Prevalence and characterization of sexual dysfunctions in women in transition to menopause

Objetivo: Caracterizar las disfunciones sexuales y estimar la prevalencia en un grupo de mujeres en transición a la menopausia, así como evaluar la frecuencia de la sintomatología climatérica. Método: Estudio de corte transversal, entre 2017 y 2020, que incluyó 411 mujeres en transición a la menopausia, residentes en el Quindío, con pareja estable y actividad sexual en las últimas 6 semanas. Se utilizó como instrumento el FSFI-6 (6-Item Female Sexual Function Index). Resultados: La edad promedio fue de 46,53 ± 2,87 años. La prevalencia de disfunciones sexuales fue del 38,92%, caracterizadas por dificultades con el deseo sexual (38,92%), seguido de dolor/dispareunia (35,52%). El promedio general en la puntuación del FSFI-6, en la totalidad de la población participante, fue de 22,29 ± 0,84 puntos; en la población afectada (< 19 puntos) fue de 15,78 ± 3,94. En los dominios, la puntuación más baja estuvo en el deseo (3,14 ± 0,56). La mediana de disfunciones sexuales por mujer fue de tres (23,84%). Conclusiones: más de un tercio de las mujeres del Quindío en transición a la menopausia presentan disfunciones sexuales; el trastorno más común fue el bajo deseo. Se deben hacer esfuerzos para aumentar la conciencia en los asuntos de salud sexual.

Objective: To characterize sexual dysfunctions and estimate the prevalence in a group of women in transition to menopause, as well as to evaluate the frequency of climacteric symptoms. Method: Cross-sectional study, between 2017 and 2020, included 411 women in transition to menopause, residents of Quindío, with a stable partner and sexual activity in the last 6 weeks. The FSFI-6 (6-Item Female Sexual Function Index) was used as an instrument. Results: The mean age was 46.53 ± 2.87 years. The prevalence of sexual dysfunctions was 38.92%, characterized by difficulties with sexual desire (38.92%), followed by pain/dyspareunia (35.52%). The general average, in the FSFI-6 score, in the entire participating population, was 22.29 ± 0.84 points; while in the affected population (< 19 points), it was 15.78 ± 3.94. In the domains, the lowest score was in desire (3.14 ± 0.56). The median number of sexual dysfunctions per woman was three (present in 23.84%). Conclusions: This study showed that more than one third of the women in Quindío, in transition to menopause, had sexual dysfunctions; the most common type of disorder was low desire. Efforts should be made to increase awareness about sexual health issues.

A sexualidade de indivíduos transgêneros: recomendações para profissionais de saúde / The sexuality of individuals transgender: recommendations for healthcare professionals

Indivíduos transgêneros (ou trans) apresentam diferença entre a sua identidade de gênero e o sexo que lhe foi atribuído ao nascimento, o que provoca sofrimento grave, nomeado como disforia de gênero, estado que apresenta melhora após a transição para o gênero autor-reconhecido. Pessoas transgêneras apresentam os piores marcadores de saúde mental entre os LGBTQIA+. O objetivo deste texto é levantar aspectos psicossociais e sexuais de indivíduos transgêneros e trazer algumas recomendações para profissionais de saúde. Os tratamentos disponibilizados para essa população são os de afirmação de gênero (supressão da puberdade, tratamento hormonal cruzado, cirurgia reconstrutiva torácica e cirurgias genitais afirmativas de gênero). Muitas vezes, as alterações corporais conseguem diminuir os sintomas de disforia, melhorando a qualidade de vida. Porém, para muitos deles, apenas a mudança do papel social de gênero é suficiente. As disfunções sexuais mais frequentes experimentadas por mulheres e homens trans são dificuldades para iniciar e buscar contato sexual (mulheres, 26%, homens, 32%) e para atingir o orgasmo (29% e 15%). A atenção à saúde transgênera deve conter cuidados inter e multidisciplinares holísticos, envolvendo endocrinologia, cirurgia, voz e comunicação, atenção primária, saúde reprodutiva, saúde sexual e mental para acompanhar intervenções de afirmação de gênero, bem como prevenção, cuidado e gerenciamento de doenças crônicas. Indivíduos transgêneros enfrentam, além de todas as questões que afligem a sociedade contemporânea, a invisibilidade reforçada principalmente pela falta de conhecimento e pelos preconceitos. Faz-se necessário um atendimento que seja acolhedor, educativo, não preconceituoso e que respeite a individualidade daqueles que carregam em suas histórias sofrimento e violência.

Associação da educação sexual, cinesioterapia e terapia manual no tratamento de mulheres anorgásmicas: um estudo de caso / Association of sex education, kinesiotherapy and manual therapy in the treatment of anorgasmic women: a case study

O orgasmo é o ápice da excitação sexual e, quando comumente não experienciado, denomina-se anorgasmia, segunda queixa sexual mais frequente entre mulheres. A fisioterapia é um recurso que visa beneficiar a qualidade de vida das mulheres anorgásmicas por meio da prevenção, reparação de função e tratamento de quadros álgicos. O estudo teve como objetivo avaliar os efeitos da associação das técnicas de cinesioterapia aplicada à musculatura do assoalho pélvico, massagem perineal e conscientização acerca da sexualidade das participantes. Os métodos utilizados foram educação sexual, massagem perineal e cinesioterapia associada ao uso da sonda uroginecológica New PelviFit Trainer, como biofeedback visual, para promover conscientização e estimar os efeitos sobre a condição da musculatura do assoalho pélvico de mulheres com relato de anorgasmia. O resultado obtido com o protocolo da associação das técnicas terapêuticas em mulheres com disfunção orgásmica apresentou melhora da função sexual feminina, aumento da força e do estado de relaxamento da musculatura do assoalho pélvico, avaliados pelo questionário Índice de Função Sexual Feminina, quantificados por meio da escala de Oxford modificada e da escala de avaliação de flexibilidade vaginal, respectivamente. Como conclusão, a aplicação das técnicas fisioterapêuticas aliadas ao tratamento humanizado, com enfoque na conscientização das mulheres, autopercepção corporal e manutenção da função sexual, promoveu melhora da disfunção sexual orgásmica. Apesar de necessário maior embasamento científico relativo ao tema, a presente abordagem para o tratamento em questão apresentou-se promissora e pertinente à base de dados. (AU)

Orgasm is the peak of sexual excitement, when not commonly experienced, it is called anorgasmia, second most frequent sexual complaint among women. Physiotherapy is a resource that aims to improve the quality of life of anorgasmics women through prevention, function repair and pain management. The purpose of the study was to evaluate the effects of kinesiotherapy techniques applied on the pelvic floor muscles, associated with perineal massage and the participants' sexual awareness. The methods used were sexual education, perineal massage, kinesiotherapy associated with the use of the New PelviFit Trainer urogynecological probe, as a visual feedback, to promove awearness and estimate its effects on the pelvic floor muscles condition in women reporting anorgasmia. The result obtained with the protocol of association of therapeutic techniques in women with orgasmic dysfunction showed improvement in the female sexual function, assessed by the Female Sexual Function Index questionnaire, increased strength and pelvic floor muscles relaxation, quantified using the Modified Oxford scale and the vaginal flexibility assessment scale, respectively. As a conclusion, the application of physiotherapeutic techniques combined with humanized treatment, with a focus on awareness of women, body self-perception and maintenance of sexual function, promoted improvement of orgasmic sexual dysfunction. Despite the need for a greater scientific basis on the subject, the present approach to the treatment in question was promising and relevant to the database. (AU)

Adherencias del capuchón del clítoris al glande: una condición poco estudiada y poco examinada / Clitoral hood adhesions to the glans penis: an understudied and under-examined condition

INTRODUCCIÓN: El clítoris es una de las estructuras vulvares menos examinadas, pese a su relevancia en la vida sexual y sus importantes relaciones anatómicas. Las adherencias del capuchón del clítoris han sido descritas y clasificadas según la exposición del glande, siendo relacionadas con trastornos del deseo sexual. La inervación del clítoris depende de raíces de S3-S4, siendo posible que síntomas frecuentes del piso pélvico tengan relación con esta condición. Realizamos un análisis retrospectivo de pacientes de policlínico de piso pélvico entre noviembre de 2021 y abril de 2022. Se incluyeron 100 pacientes con adherencias al ingreso. RESULTADOS: Promedio de edad 45,8 ± 15,5 años. Las adherencias fueron el 19% leves, el 62% moderadas y el 18% graves. Los principales síntomas eran mal vaciado vesical (38%), dolor (28%), disfunción sexual (39%) y síntomas irritativos vesicales (43%); solo una paciente fue asintomática. El área visible promedio del clítoris era de 20,7 ± 13,7 mm2. CONCLUSIONES: Las adherencias del capuchón del clítoris son un hallazgo común, muchas veces no diagnosticadas, por lo que su evaluación debe ser parte de la exploración física. Pueden asociarse a sintomatología de piso pélvico.

INTRODUCTION: The clitoris is one of the least examined vulvar structures despite its relevance in sexual life and important anatomical relationships. Clitoral hood adhesions have been described in the literature, classified based on glans exposure, and related to sexual desire disorders. The innervation of the clitoris depends on the roots of S3-S4, and frequent pelvic floor symptoms may be associated with this condition. We retrospectively analyzed the clinical record of patients admitted to a pelvic floor clinic between November 2021 and April 2022. One hundred patients with adhesions at the time of admission were registered. RESULTS: Average 45.8 ± 15.5 years. Clitoral hood adhesions were mild (19%), moderated (62%), or severe (18%). The main symptoms were voiding dysfunction symptoms (38%), pain (28%), sexual dysfunction (39%), and irritative bladder symptoms (43%); only one patient was asymptomatic. The visible area of the clitoris was 20.7 ± 13.7 mm2. CONCLUSIONS: Adhesions of the clitoral hood are often undiagnosed, and its analysis should be part of the physical exam. Clitoral hood adhesions could be associated with pelvic floor symptoms.

Transsphenoidal surgery for prolactinomas in male patients: a retrospective study / 亚洲男科学杂志(英文版)

Male patients with prolactinomas usually present with typical hyperprolactinemia symptoms, including sexual dysfunction and infertility. However, clinical factors related to sexual dysfunction and surgical outcomes in these patients remain unclear. This study aimed to investigate the outcomes of male patients with prolactinomas after transsphenoidal surgery and the risk factors affecting sexual dysfunction. This study was conducted on 58 male patients who underwent transsphenoidal surgery for prolactinomas between May 2014 and December 2020 at the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. We evaluated the sexual function of patients before and after surgery through International Index of Erectile Function-5 scores, libido, and frequency of morning erection. Of the 58 patients, 48 (82.8%) patients had sexual intercourse preoperatively. Among those 48 patients, 41 (85.4%) patients presented with erectile dysfunction. The preoperative International Index of Erectile Function-5 scores in patients with macroprolactinomas were significantly higher than those in patients with giant prolactinomas (17.63 ± 0.91 vs 13.28 ± 1.43; P = 0.01). Postoperatively, the incidence of erectile dysfunction was 47.9%, which was significantly lower than that preoperatively (85.4%; P = 0.01). Twenty-eight (68.3%) patients demonstrated an improvement in erectile dysfunction. Tumor size and invasiveness were significantly correlated with the improvement of erectile dysfunction. Preoperative testosterone <2.3 ng ml-1 was an independent predictor of improvement in erectile dysfunction. In conclusion, our results indicated that tumor size and invasiveness were important factors affecting the improvement of sexual dysfunction in male patients with prolactinoma. The preoperative testosterone level was an independent predictor related to the improvement of erectile dysfunction.

Avaliação da função sexual e da atividade física em mulheres após tratamento do câncer de colo de útero: estudo transversal / Assessment of sexual function and physical activity in women after cervical cancer treatment: a cross-sectional study

Introdução: O tratamento do câncer do colo do útero (CCU) promove menopausa precoce em mulheres diagnosticadas durante o menacme. A consequente interrupção abrupta da produção dos hormônios ovarianos impacta na sexualidade e outras áreas da vida da mulher, inclusive sua atividade física. É possível que a atividade física influencie a atividade sexual nessas mulheres. Objetivo: Avaliar o nível de atividade física e a função sexual nas mulheres após o tratamento oncológico e verificar se a atividade física está associada a melhor função sexual. Método: Este estudo transversal incluiu mulheres tratadas para câncer do colo do útero em um hospital de referência em oncologia no Brasil, com idade entre 18 e 50 anos, submetidas a ooforectomia bilateral e/ou radioterapia pélvica há, no máximo 11 anos. O desfecho primário foi o estado da função sexual e do nível de atividade física e a correlação entre eles e o tratamento oncológico. As mulheres responderam os questionários Female Sexual Function Index (FSFI) e o International Physical Activity Questionnaire (IPAQ) por entrevista remota entre agosto de 2021 a julho de 2022. Resultados: 50 mulheres foram entrevistadas. A média de idade foi 50 anos (DP = ±5). Todas as mulheres que tinham atividade sexual apresentaram algum nível de disfunção sexual. A maior parte das mulheres era fisicamente ativa (60%). Não houve correlação do perfil de atividade física, nem da função sexual com o tratamento oncológico realizado. Não houve associação entre atividade física e maior qualidade na função sexual. Conclusão: Todas as mulheres que relataram relação sexual tinham disfunção sexual e a maioria delas era ativa fisicamente.

Background: Cervical cancer (CC) treatment promotes early menopause in women diagnosed during menacme. The consequent abrupt interruption of the production of ovarian hormones impacts on sexuality and other areas of a woman's life, including her physical activity. It is possible that physical activity influences sexual activity in these women. Aim: To evaluate the level of physical activity and sexual function in women after cancer treatment and to verify whether physical activity is associated with better sexual function. Method: This cross-sectional study included women aged between 18 and 50 years treated for cervical cancer at a reference hospital in oncology in Brazil, who had undergone bilateral oophorectomy and/or pelvic radiotherapy for a maximum of 11 years. The primary outcome was sexual function status and physical activity level and understanding between them and cancer treatment. The women answered the Female Sexual Function Index (FSFI) and the International Physical Activity Questionnaire (IPAQ) by remote interview between August 2021 and July 2022. Results: 50 women were interviewed. The mean age was 50 years (SD = ±5). All women who had sexual activity had some level of sexual dysfunction. Most women were physically active (60%). There was no change in the physical activity profile or sexual function with the oncological treatment performed. There was no association between physical activity and better quality of sexual function. Conclusion: All women who reported sexual intercourse had sexual dysfunction and most of them were physically active.

Sexual dysfunction in the climacteric period and associated factors / Disfunção sexual no climatério e fatores associados

Abstract Objectives: to evaluate associated factors with sexual dysfunction among middle-aged women. Methods: cross-sectional and analytical study was carried out with climacteric women attended at a Family Health Strategy Unit in the city of Montes Claros, MG. Brazil. The eligible women answered a question form containing sociodemographic, behavioral, anthropometric, gynecological factors and sexuality. The Body Mass Index and waist circumference were used to assess nutritional status and metabolic risk. To evaluate quality of life and sexual performance the Menopause Rating Scale and the Sexual Quotient - Female Version were used, respectively. Bivariate analysis and hierarchical multiple regression were used to identify associated factors with sexual dysfunction in the climacteric period. Results: among 195 women, 29.6% had sexual dysfunction. The prevalence of unsatisfactory sexual performance was higher among women who reported moderate to severe climacteric symptoms (OR=2.47) and lower schooling level was also associated (OR=1.95). However, age at menarche below 12 years (OR=0.43) and non-white (OR=0.36) seem to have a protective effect for good sexual performance. Conclusion: the prevalence of sexual dysfunction was high and the level of schooling and climacteric symptomatology were associated factors with this outcome.

Resumo Objetivos: avaliar os fatores associados à disfunção sexual entre as mulheres de meia-idade. Métodos: estudo de corte transversal e analítico realizado com mulheres climatéricas atendidas em uma Unidade de Estratégia de Saúde da Família no município de Montes Claros-MG, Brasil. As mulheres elegíveis responderam a um formulário contendo questões sociodemográficas, comportamentais, antropométricas, fatores ginecológicos e sexualidade. Utilizou-se o Índice e Massa Corporal e a circunferência da cintura para avaliar o estado nutricional e risco metabólico. Para avaliar a qualidade de vida e o desempenho sexual foram utilizados a Menopause Rating Scale e o Quociente Sexual -Versão Feminina, respectivamente. Empregou-se análise bivariada e regressão múltipla hierarquizada para identificar fatores associados à disfunção sexual no climatério. Resultados: dentre 195 mulheres, 29,6% apresentaram disfunção sexual. A prevalência de desempenho sexual insatisfatório foi maior entre as mulheres que declararam sintomas climatéricos moderados a graves (OR = 2,47) e o menor grau de escolaridade (OR = 1,95). No entanto, a idade da menarca abaixo de 12 anos (OR = 0,43) e a cor de pele não branca (OR = 0,36) parecem ter efeito protetor para o bom desempenho sexual. Conclusão: a prevalência de disfunção sexual foi elevada e o nível de escolaridade e a sintomatologia climatérica foram fatores associados a esse resultado.

Hormone therapy in the treatment of breast cancer and main outcomes in sexuality

Hormone-dependent breast cancer has growth factors that respond positively to the hormones estrogen and progesterone. Thus, adjuvant endocrine therapy causes decreased or undetectable serum levels of these hormones. However, this treatment can have side effects that compromise the sexual health of patients, such as dyspareunia, vaginal dryness and decreased libido. In this scenario, the objective of this work was to document the main outcomes in sexuality in women after treatment for hormonepositive breast cancer. Thus, this is an integrative literature review, in which the following databases were used: U.S. National Library of Medicine (PubMed), Virtual Health Library (BVS), SCOPUS and Scientific Electronic Library Online (SCIELO), using the descriptors: "sexuality", "antineoplastic agents, hormonal" and "breast neoplasms", joined by the Boolean operator "AND". Full articles published in the last 5 years (2017-2022) were included; written in Portuguese or English. Articles dealing with non-hormone-dependent or metastatic breast cancer, or with patients younger than 18 years, or articles that did not answer the research question were excluded. In total, 26 articles were identified, of which 7 comprised the final sample of this review. A total of 3,850 women participated in the included studies. The main sexual dysfunctions found were: dyspareunia, hot flashes, decreased libido, vaginal dryness, breast tenderness, self-image concerns and hair loss. The symptom vaginal dryness was the most prevalent, mentioned in 71.4% of the articles included. In view of the adverse effects listed in this review, there is a need to carry out more studies on this topic, since the diagnosis of this comorbidity brings clinical, psychological, emotional, sociocultural and economic outcomes for the patient. Thus, a multidisciplinary team must assertively address these complaints to improve the overall quality of life of these women (AU)

Barreras y facilitadores de los médicos de atención primaria para abordar las consultas vinculadas a la sexualidad de pacientes durante el climaterio / Barriers and facilitators of primary care physicians to address consultations related to the sexuality of patients during the climacteric

Introducción. Pese a la alta prevalencia de disfunciones sexuales femeninas durante el climaterio y a que existen intervenciones para mejorarlas, este problema no suele ser consultado por las pacientes ni explorado por los profesionales de la salud. Si bien suponemos que existen condicionamientos culturales que actuarían como barreras para su abordaje, no conocíamos las percepciones, incomodidades y experiencias de los profesionales que atienden en el ámbito de la atención primaria a pacientes que transitan su climaterio. Objetivos. Comprender desde la perspectiva de los médicos de atención primaria los factores que contribuyen a la invisibilidad de la problemática de las disfunciones sexuales femeninas durante el climaterio en mujeres de clase media atendidas en el Área Metropolitana de Buenos Aires. Diseño. Estudio exploratorio transversal con enfoque cualitativo realizado en el Hospital Italiano de Buenos Aires durante2020 y 2021. Resultados. A partir del análisis de diez entrevistas semiestructuradas a médicos de atención primaria (de familia, clínicos y ginecólogos) identificamos seis ejes temáticos: 1) un modelo institucional en el que el tiempo limitado para la consulta y forma de pago capitada incentivaría a que las las disfunciones sexuales femeninas permanezcan invisibilizadas; 2) la longitudinalidad de la relación médico-paciente contribuiría como un facilitador del abordaje de problemáticas vinculadas con la esfera sexual; 3) la discordancia de género entre los profesionales y las pacientes operaría como un obstáculo para abordar aspectos de la sexualidad durante el climaterio; 4) la biografía y la formación de los profesionales de la salud influiría sobre sus habilidades para abordar la problemática de la sexualidad de sus pacientes; 5) el examen ginecológico y/o la detección de síntomas de depresión contribuyen a abrir la puerta para indagar sobre la disfunción sexual femenina; y 6) el prejuicio de que el fin de la etapa reproductiva implicaría el fin de la actividad sexual. Conclusiones. Si bien no existen recomendaciones formales para la pesquisa sistemática de disfunciones sexuales femeninas, su elevada prevalencia, su fácil diagnóstico y la existencia de herramientas terapéuticas para aliviarlas, ameritan que estén más disponibles entre nuestras hipótesis diagnósticas. (AU)

Background. Despite the high prevalence of female sexual dysfunctions during the climacteric and the existence of interventions to improve them, this problem is not usually consulted by patients or explored by health professionals. Although weassume that there are cultural conditioning factors that would act as barriers to its approach, we were unaware of the perceptions, discomforts, and experiences of the professionals who care for patients who are going through their climactericin the field of primary care. Objectives. To understand, from the perspective of primary care physicians, the factors that contribute to the invisibility of the female sexual dysfunctions problem during the climacteric in middle-class women treated in the Buenos Aires Metropolitan Area. Design. Cross-sectional exploratory study with a qualitative approach carried out at Hospital Italiano de Buenos Aires during 2020 and 2021. Results. From the analysis of ten semi-structured interviews with primary care physicians (family, clinicians and gynecologists) we identified six thematic axes: 1) an institutional model in which the limited time for consultation and capitated form of payment would encourage female sexual dysfunctions to remain invisible; 2) the longitudinality of the doctor-patient relationship would contribute as a facilitator in addressing problems related to the sexual sphere; 3) the gender discrepancy between professionals and patients would operate as an obstacle to address aspects of sexuality during the climacteric; 4) the biography and training of health professionals would influence their abilities to address the problems of their patients'sexuality; 5) gynecological examination and/or the detection of symptoms of depression contribute to opening the door toinquire about FSD; 6) the prejudice that the end of the reproductive stage would imply the end of sexual activity. Conclusions. Although there are no formal recommendations for the systematic screening of female sexual dysfunctions, its high prevalence, its easy diagnosis and the existence of therapeutic tools to alleviate them, deserve that they be more available among our diagnostic hypotheses. (AU)

Efficacy of Hormonal and Nonhormonal Approaches to Vaginal Atrophy and Sexual Dysfunctions in Postmenopausal Women: A Systematic Review / Eficácia das abordagens hormonais e não hormonais para atrofia vaginal e disfunções sexuais em mulheres na pós-menopausa: Uma revisão sistemática

Abstract Objective To evaluate the efficacy of the hormonal and nonhormonal approaches to symptoms of sexual dysfunction and vaginal atrophy in postmenopausal women. Data Sources We conducted a search on the PubMed, Embase, Scopus, Web of Science, SciELO, the Cochrane Central Register of Controlled Trials (CENTRAL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, as well as on clinical trial databases. We analyzed studies published between 1996 and May 30, 2020. No language restrictions were applied. Selection of Studies We selected randomized clinical trials that evaluated the treatment of sexual dysfunction in postmenopausal women. Data Collection Three authors (ACAS, APFC, and JL) reviewed each article based on its title and abstract. Relevant data were subsequently taken from the full-text article. Any discrepancies during the review were resolved by consensus between all the listed authors. Data Synthesis A total of 55 studies were included in the systematic review. The approaches tested to treat sexual dysfunction were as follows: lubricants and moisturizers (18 studies); phytoestrogens (14 studies); dehydroepiandrosterone (DHEA; 8 studies); ospemifene (5 studies); vaginal testosterone (4 studies); pelvic floor muscle exercises (2 studies); oxytocin (2 studies); vaginal CO2 laser (2 studies); lidocaine (1 study); and vitamin E vaginal suppository (1 study). Conclusion We identified literature that lacks coherence in terms of the proposed treatments and selected outcome measures. Despite the great diversity in treatment modalities and outcome measures, the present systematic review can shed light on potential targets for the treatment, which is deemed necessary for sexual dysfunction, assuming that most randomized trials were evaluated with a low risk of bias according to the Cochrane Collaboration risk of bias tool. The present review is registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42018100488).

Resumo Objetivo Avaliar a eficácia das abordagens hormonais e não hormonais para os sintomas de disfunção sexual e atrofia vaginal em mulheres na pós-menopausa. Fontes de Dados Pesquisamos as bases de dados PubMed, Embase, Scopus, Web of Science, SciELO, Cochrane Central Register of Controlled Trials (CENTRAL), e Cumulative Index to Nursing and Allied Health Literature (CINAHL), assim como bancos de dados de ensaios clínicos. Foram analisados estudos publicados entre 1996 e 30 de maio de 2020. Nenhuma restrição de idioma foi aplicada. Seleção dos Estudos Foram selecionados ensaios clínicos randomizados que avaliavam o tratamento das disfunções sexuais em mulheres na pós-menopausa. Coleta de Dados Três autores (ACAS, APFC e JL), revisaram cada artigo com base em seu título e resumo. Os dados relevantes foram posteriormente retirados do texto completo do artigo. Quaisquer discrepâncias durante a revisão foram resolvidas por consenso entre todos os autores listados. Síntese dos Dados Ao todo, 55 estudos foram incluídos na revisão sistemática. As abordagens testadas para tratar a disfunção sexual foram: lubrificantes e hidratantes (18 estudos); fitoestrogênios (14 estudos); deidroepiandrosterona (DHEA; 8 estudos); ospemifeno (5 estudos); testosterona vaginal (4 estudos); exercícios para os músculos do assoalho pélvico (2 estudos); oxitocina (2 estudos);laser de CO2 vaginal (2 estudos); lidocaína (1 estudo), e vitamina E vaginal (1 estudo). Conclusão Identificou-se falta de coerência na literatura quanto aos tratamentos propostos e medidas de resultados selecionadas. Apesar da grande diversidade de modalidades de tratamento e medidas de resultados, esta revisão sistemática pode lançar luz sobre alvos potenciais para o tratamento, que é considerado necessário para a disfunção sexual, assumindo que a maioria dos estudos randomizados foi avaliada com baixo risco de viés de acordo com a ferramenta de avaliação de risco de viés de Cochrane Collaboration. Esta revisão tem cadastro no International Prospective Register of Systematic Reviews (PROSPERO; CRD42018100488).

Disfunción sexual en mujeres con esclerosis sistémica / Sexual dysfunction in women with systemic sclerosis

Introducción: la disfunción sexual (DS) es común entre las mujeres con enfermedades crónicas, incluyendo esclerosis sistémica (ES). Se ha asociado con características como la duración de la enfermedad, dolor, disminución de la actividad funcional, entre otras. Desde nuestro conocimiento, aún no contamos con datos locales. Objetivos: evaluar la frecuencia de DS en mujeres con ES; describir las características sociodemográficas, clínicas y psicológicas asociadas con la DS en mujeres con ES. Materiales y métodos: estudio observacional, analítico y de corte transversal. Se incluyeron mujeres de entre 20 y 59 años con diagnóstico de ES, según los criterios de clasificación del European League Against Rheumatism/American College of Rheumatology (ACR/EULAR 2013). Se excluyeron pacientes con enfermedades crónicas no controladas, otras patologías reumatológicas autoinmunes, e inactividad sexual o patología genitourinaria no relacionadas a ES en las últimas 4 semanas. La DS se evaluó con la versión en español del cuestionario índice de función sexual femenina (Female sexual function index, FSFI). Resultados: se incluyeron 56 pacientes. El 78,57% presentó DS y 19,64% era sexualmente inactiva debido a la enfermedad. Escala visual análoga (EVA) de fatiga (coeficiente β: -0,08, IC 95%: -0,14 a -0,02; p<0,01), edad (coeficiente β: -0,23, IC 95%: -0,40 a -0,05; p=0,01) y fibromialgia (coeficiente β: -11,90, IC 95%: -17,98 a -5,82; p<0,01) mostraron una asociación significativa e independiente con DS en el análisis multivariado. Conclusiones: la DS es frecuente entre las mujeres con ES, y las pacientes más jóvenes, sin fibromialgia y con menor fatiga presentaron una mejor funcionalidad sexual.

Introduction: sexual impairment (SI) is common among women with chronic diseases, including systemic sclerosis (SSc). It has been associated with characteristics such as the duration of the disease, pain, decreased functional activity, among others. To the best of our knowledge, we still do not have local data. Objectives: to evaluate the frequency of SI in women with SSc. To describe the sociodemographic characteristics, disease itself and psychological items associated with SI in women with SSc. Materials and methods: observational, analytical, cross-sectional study. We included women between 20 and 59 years diagnosed with SSc according to 2013 classification criteria ACR/EULAR. We excluded patients with uncontrolled chronic diseases or other autoimmune rheumatologic diseases and patients who, in the last 4 weeks, had dyspareunia or were sexually inactive due to causes not attributable to their disease. SI was assessed using the Spanish version of female sexual function index questionnaire (FSFI). Results: 56 patients were included. 78.57% presented SI and 19.64% of them were sexually inactive patients due to the disease. Fatigue VAS (β coefficient: -0.08, CI 95%: -0.14 to -0.02; p<0.01), age (β coefficient: -0.23, CI 95%: -0.40 to -0.05; p=0.01) and fibromyalgia (β coefficient: -11.90, CI 95%: -17.98 to -5.82; p<0.01) showed significant and independent association with SI in the multivariate analysis. Conclusions: SI is frequent among women with SSc, and younger patients, without fibromyalgia and with less fatigue have better sexual function.

Disfunción sexual en mujeres con esclerosis sistémica / Sexual dysfunction in women with systemic sclerosis

Introducción: la disfunción sexual (DS) es común entre las mujeres con enfermedades crónicas, incluyendo esclerosis sistémica (ES). Se ha asociado con características como la duración de la enfermedad, dolor, disminución de la actividad funcional, entre otras. Desde nuestro conocimiento, aún no contamos con datos locales. Objetivos: evaluar la frecuencia de DS en mujeres con ES; describir las características sociodemográficas, clínicas y psicológicas asociadas con la DS en mujeres con ES. Materiales y métodos: estudio observacional, analítico y de corte transversal. Se incluyeron mujeres de entre 20 y 59 años con diagnóstico de ES, según los criterios de clasificación del European League Against Rheumatism/American College of Rheumatology (ACR/EULAR 2013). Se excluyeron pacientes con enfermedades crónicas no controladas, otras patologías reumatológicas autoinmunes, e inactividad sexual o patología genitourinaria no relacionadas a ES en las últimas 4 semanas. La DS se evaluó con la versión en español del cuestionario índice de función sexual femenina (Female sexual function index, FSFI). Resultados: se incluyeron 56 pacientes. El 78,57% presentó DS y 19,64% era sexualmente inactiva debido a la enfermedad. Escala visual análoga (EVA) de fatiga (coeficiente ß: -0,08, IC 95%: -0,14 a -0,02; p<0,01), edad (coeficiente ß: -0,23, IC 95%: -0,40 a -0,05; p=0,01) y fibromialgia (coeficiente ß: -11,90, IC 95%: -17,98 a -5,82; p<0,01) mostraron una asociación significativa e independiente con DS en el análisis multivariado. Conclusiones: la DS es frecuente entre las mujeres con ES, y las pacientes más jóvenes, sin fibromialgia y con menor fatiga presentaron una mejor funcionalidad sexual.

Introduction: sexual impairment (SI) is common among women with chronic diseases, including systemic sclerosis (SSc). It has been associated with characteristics such as the duration of the disease, pain, decreased functional activity, among others. To the best of our knowledge, we still do not have local data. Objectives: to evaluate the frequency of SI in women with SSc. To describe the sociodemographic characteristics, disease itself and psychological items associated with SI in women with SSc. Materials and methods: observational, analytical, cross-sectional study. We included women between 20 and 59 years diagnosed with SSc according to 2013 classification criteria ACR/EULAR. We excluded patients with uncontrolled chronic diseases or other autoimmune rheumatologic diseases and patients who, in the last 4 weeks, had dyspareunia or were sexually inactive due to causes not attributable to their disease. SI was assessed using the Spanish version of female sexual function index questionnaire (FSFI). Results: 56 patients were included. 78.57% presented SI and 19.64% of them were sexually inactive patients due to the disease. Fatigue VAS (ß coefficient: -0.08, CI 95%: -0.14 to -0.02; p<0.01), age (ß coefficient: -0.23, CI 95%: -0.40 to -0.05; p=0.01) and fibromyalgia (ß coefficient: -11.90, CI 95%: -17.98 to -5.82; p<0.01) showed significant and independent association with SI in the multivariate analysis. Conclusions: SI is frequent among women with SSc, and younger patients, without fibromyalgia and with less fatigue have better sexual function.

Sexual Experiences of Infertile Women: A Qualitative Study

It is suggested that stress related to infertility causes marriage conflicts and decreases in the frequency of sexual intercourse. Aim: This study aimed to explore the experiences of the sexuality of infertile women. Patients and Methods: A phenomenological design was used in this study. We conducted face-to-face, semistructured, in-depth interviews with 11 infertile women. The interviews were audio-recorded, and a thematic approach was used to assess the data. Results: The average age of the women was 33.05 ± 3.40 years, and their age of first sexual intercourse was 23.0 ± 2.8 years and all of them are legally married. The durations of experiencing the problem of infertility were as follows; 3-5 years in 33%, 6-10 years in 27%, and 11 years and above in 38%. According to interpretative phenomenological analysis, two main themes emerge. Two main themes were determined: Perception of Sexuality and Sexual Problems. The results show that infertile women have a higher risk for sexual dysfunction than fertile women. Conclusion: These findings suggest that the diagnosis of infertility is an important factor in assessing the differences in the sexual satisfaction of women. In infertility counseling, health professionals must explain the gender differences. Also, infertile couples must encourage to share each other's feelings and this may help couples to cope with the communication problems they may experience.

Sexual desire in Brazilian women: an integrative review of scientific literature / Desejo sexual em mulheres brasileiras: uma revisão integrativa da literatura científica

Women's sexual desire is a recurring subject in gynecology and psychotherapy offices where a relevant and frequent complaint is the lack of sexual desire. This study aimed to carry out an integrative review of the scientific literature published between 2008 and 2018, on the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Scientific Eletronic Library Online, Literatura Latino-Americana e do Caribe em Ciências da Saúde platforms on the subject of sexual desire in Brazilian women. Three groups of descriptors were taken into consideration for the searches; the first included "sexual desire" the second, "woman" and the third, "Brazil". Among the 35 articles selected, data regarding the type of research carried out; the cut-out criterion selected for sample and perspective that were used to comprehend desire were collected. The conclusion is that most articles maintain a biological perspective for understanding desire and point out a gap to be filled by psychology on this matter.

O desejo sexual nas mulheres é tema recorrente nos consultórios de ginecologia e psicoterapia; e a sua falta, uma queixa frequente e relevante. Tendo em vista essa constatação, este trabalho propõe-se a fazer uma revisão integrativa da literatura científica produzida entre 2008 e 2018, nas plataformas Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Scientific Eletronic Library Online, Literatura Latino-Americana e do Caribe em Ciências da Saúde, sobre o tema do desejo sexual em mulheres brasileiras. Foram utilizados três grupos de descritores para as buscas, o primeiro relacionado é relacionado a "desejo sexual"; o segundo, a "mulher", "feminino" e "gênero"; e o terceiro, a "Brasil". Entre os 35 artigos selecionados, foram levantados dados quanto ao tipo de pesquisa realizada, à escolha do critério para recorte da amostra e à perspectiva utilizada para a compreensão do desejo. Conclui-se que a maior parte dos artigos mantém uma perspectiva biológica para compreensão do desejo, e que há uma lacuna a ser ocupada pela psicologia no que concerne a esse assunto.

Prevalencia de disfunción sexual en gestantes en control prenatal en una institución hospitalaria en Rionegro, Colombia, 2020-2021 / Prevalence of sexual dysfunction among pregnant women attending prenatal care at a hospital in Rionegro, Colombia, 2020-2021

RESUMEN Objetivo: Describir la prevalencia de la disfunción sexual en un grupo de mujeres gestantes y hacer una exploración de posibles factores asociados a la disfunción sexual en estas mujeres. Materiales y métodos: Estudio descriptivo y trasversal en mujeres gestantes cuyas edades son de 15 años o más, con actividad sexual en la gestación, que asistieron al control prenatal en el Hospital San Juan de Dios de Rionegro entre los meses de enero y marzo del 2021. Se excluyeron pacientes con limitaciones o discapacidad cognitiva, o clasificadas con trastorno mental según la Organización Mundial de la Salud (OMS), gestantes con patologías crónicas, placentarias, ovulares, hemorrágicas e infecciosas, y las pacientes cuya gestación fue resultado de violencia sexual. Se aplicó el cuestionario Índice de Función Sexual Femenina (FSFI), se midieron variables sociodemográficas y de salud sexual y reproductiva. Los resultados se expresan en frecuencias absolutas y relativas para las variables cualitativas y medianas, y rangos intercuartílicos para las variables cuantitativas. Resultados: La mediana de edad fue de 27,5 años (RIC: 21,3-31,0); de edad gestacional 28,5 semanas (RIC: 21,3-34,8). Tras la aplicación del FSFI, 37 mujeres (37,7%) tuvieron disfunción sexual (puntaje < 26,5). La mediana del puntaje de las participantes sin disfunción sexual fue de 29,4 (RIC 26,8-32), mientras que por el lado de las que tienen disfunción sexual fue de 22,3 (RIC 20-24). La media del puntaje para cada dominio fue: deseo: 3,6 (RIC: 3,0-4,2); excitación: 4,5 (RIC: 3,6-5,1); lubricación: 4,8 (RIC: 3,9-5,4); orgasmo: 4,4 (RIC: 3,6-5,2); dolor: 4,4 (RIC: 3,6-6,0); y satisfacción: 5,4 (RIC: 4,8-6,0). Fueron factores protectores no tener hijos ni cesáreas previas. La ausencia de compañero y menor edad estuvieron asociados a disfunción sexual. Conclusión: La disfunción sexual se presenta en por lo menos un tercio de las gestantes, especialmente en el tercer trimestre. En la práctica clínica diaria se hace necesario abordar la disfunción sexual, ya que se puede contribuir desde el abordaje de la educación a un problema que puede afectar las relaciones de pareja y la calidad de vida. Es fundamental generar nuevas investigaciones que incluyan la evaluación de la efectividad y seguridad de estrategias educativas en este grupo poblacional con disfunción sexual.

ABSTRACT Objective: To describe the prevalence of sexual dysfunction in a group of pregnant women, and to explore potential factors associated with this condition in this population. Material and methods: Descriptive cross-sectional study in pregnant women 15 years of age and older, sexually active during gestation, receiving prenatal care at the San Juan de Dios Hospital in Rionegro between January and March, 2021. The exclusion criteria were patients with disabilities or cognitive impairment, or classified as having a mental disorder according to the World Health Organization (WHO); pregnant women with chronic, placental, ovulation, hemorrhagic or infectious conditions; and patients whose pregnancy was the result of sexual assault. The Female Sexual Function Index (FSFI) questionnaire was applied, and sociodemographic and sexual and reproductive health variables were measured. Results are expressed as absolute and relative frequencies for qualitative variables, and as medians and interquartile ranges for quantitative variables. Results: The mean age in years was 27.5 (IQR: 21.331.0) and the mean gestational age was 28.5 weeks (IQR: 21.3-34.8). After administering the FSFI, it was found that 37 women (37.7%) had sexual dysfunction (score < 26.5). The median scores for the participants without sexual dysfunction and those with sexual dysfunction were 29.4 (IQR 26.8-32) and 22.3 (IQR 20-24), respectively. The mean scores for each domain were: desire 3.6 (IQR: 3.0-4.2); arousal 4.5 (IQR: 3.65.1); lubrication 4.8 (IQR: 3.9-5.4); orgasm 4.4 (IQR: 3.6-5.2); pain 4.4 (IQR: 3.6-6.0); and satisfaction 5.4 (IQR: 4.8-6.0). The total score (p<0.05) was better in older women and those with one or more children. Conclusion: Sexual dysfunction occurs at least in one-third of pregnant women, especially during the third trimester. Sexual dysfunction should be considered in daily clinical practice, given that approaching the topic from an education perspective can help reduce a problem that affects the couple and quality of life. It is critical to undertake additional research that includes assessment of the effectiveness and safety of educational strategies in this population with sexual dysfunction.

Recomendações terapêuticas para tratar o efeito negativo do câncer na saúde sexual de homens e mulheres / Therapeutic recommendations to address the negative effect of cancer on the sexual health of men and women

Estamos testemunhando um aumento previsível de sobreviventes ao câncer em decorrência da sofisticação crescente dos tratamentos, porém esses pacientes enfrentam sintomas de longo prazo, com efeitos psicológicos, sendo a disfunção sexual o mais prevalente e duradouro e com tendência a piorar quando não tratada. O objetivo desse artigo é discutir o comprometimento da saúde sexual como um dos efeitos colaterais mais dramáticos dos tratamentos de câncer e propor algumas recomendações terapêuticas. O modelo atual de resposta sexual é biopsicossocial, considerando que pacientes fragilizados pelo diagnóstico e pelos tratamentos para o câncer apresentarão alterações em dimensões psicológicas, sociais, culturais e relacionais. A saúde sexual feminina fica comprometida com sintomas físicos e psicológicos e dificuldades relacionais. Sobreviventes de câncer da próstata apresentam capacidade erétil insuficiente para a penetração. A terapêutica tradicional busca melhorar a função erétil, mas há evidências de que essas intervenções são insuficientes por não abordar as sequelas psicológicas. A perda da intimidade sexual pode comprometer o relacionamento do casal, a satisfação com o relacionamento, a saúde física e mental e a qualidade de vida. Há evidências de eficácia de programas psicoeducacionais, com orientações ao casal antes e durante o tratamento, mindfulness e tratamento em grupo. Mesmo com evidências da necessidade de abordar a saúde sexual dos sobreviventes dos tratamentos de câncer, os profissionais de saúde justificam a não abordagem com a falta de capacitação e a de tempo. Apresentamos um modelo breve de treinamento dos profissionais de saúde para a abordagem da saúde sexual, com resultados promissores.