Systematic review of sexual function in older women.

OBJECTIVE: As life expectancy increases and women are remaining healthy in to older age, sexual function in later life is an increasingly important and relevant topic for both women and clinicians. As a foundation to a wider project examining sexual function in later life, we undertook a systematic review and meta-analysis to investigate sexual frequency and sexual function in women over the age of 60. METHODS: A literature search of the AMED (Allied and Complementary Medicine), EMBASE and MEDLINE databases was performed, using search terms including 'sexual function', 'elderly', 'female', 'woman', 'sexuality'. Quality assessment of studies was performed using the Newcastle-Ottawa scale. RESULTS: There were 10 eligible cross-sectional studies, 4 of which reported sufficient data for meta-analysis. There was a wide range of study sizes from 59 to 27, 500 participants. Each study utilised a different tool for assessing sexual function. The largest study reported that up to 73% of women remain sexually active in later life [1]. Other studies documented decreasing sexual desire with age and an association between enjoyment of sex in the past with good sexual function in the present. Meta-analysis was performed with 4 studies comparing women over the age of 60 with women under 60. This demonstrated a significant decrease in the proportion of women who were sexually active over the age of 60 (SMD 9.73, [4.69, 14.78], p = 0.0002). There were non-significant trends towards poorer sexual function (p = 0.06) and decreased interest in sex (p = 0.19) in older age. CONCLUSION: Female sexual activity declines significantly with age and there is a non-significant association with poorer sexual function and decreasing sexual desire. Multiple biopsychosocial factors can impact on sexual function however, information relating to specific areas of sexual dysfunction with aging is sparse. This systematic review will inform a large-scale primary research project examining sexual function and dysfunction and impact on quality of life in older women, specifically in the context of women with pelvic floor disorders, in order to gain further insight and enhance clinical and holistic approaches to assessment and management.

The impact of risk reducing bilateral salpingo-oophorectomy on sexual function in BRCA1/2 mutation carriers and women with Lynch syndrome: A systematic review and meta-analysis.

OBJECTIVE: In the absence of an effective screening test, women with a high genetic predisposition for ovarian cancer are recommended to undergo risk-reducing bilateral salpingo-oophorectomy (RRBSO) once childbearing is complete. This reduces the risk of ovarian cancer by up to 96%, but can result in undesirable side effects, including menopausal symptoms and sexual dysfunction. We have performed a systematic review and meta-analysis to investigate the effect of RRBSO on sexual function in women at high risk of breast/and or ovarian cancer. METHODS: A literature search of the AMED (Allied and complementary medicine), Embase and Medline databases was performed, using search terms including sexual function, risk reducing and oophorectomy. Results were filtered according to the PRISMA protocol. Quality assessment of studies was performed using the Newcastle-Ottawa scale. Data were pooled in meta-analysis. RESULTS: There were 21 eligible studies, 10 of which reported sufficient data for meta-analysis. Most studies were retrospective cohort or observational studies. Fifteen of the 21 studies (71%) reported a negative impact of RRBSO on sexual function. Participant numbers ranged from 37 to 1522. Meta-analysis was performed with studies including 3201 patients. This demonstrated that RRBSO has a statistically significant negative impact on sexual function (SMD -0.63, [-0.82, -0.44], p = 0.03). There was a trend towards reduced sexual pleasure and increased discomfort but this did not reach statistical significance. There was minimal change in the frequency of sex. There was a significant increase in vaginal dryness post-RRBSO (SMD 9.25, [3.66, 14.83], p < 0.00001). There was no significant difference in sexual function between pre-menopausal and post-menopausal RRBSO. Hormone replacement therapy (HRT) did not abolish this negative impact. CONCLUSION: Sexual function declines post RRBSO, independent of menopausal status. Comprehensive pre-operative counselling regarding anticipated menopausal and sexual symptoms is key to setting realistic patient expectations and minimising post-operative distress. Information and support regarding management of these side effects should be available to all patients.

The effect of percutaneous tibial nerve stimulation (PTNS) on sexual function: a systematic review and meta-analysis.

INTRODUCTION: Percutaneous tibial nerve stimulation (PTNS) is now an established treatment of pelvic floor dysfunction such as overactive bladder, faecal incontinence or voiding dysfunction. Prevalence of female sexual dysfunction is high in this group. We aim to examine the effect of PTNS on sexual function in this patient group by systematically reviewing the literature and pooling the data in a meta-analysis. METHODS: The literature search was conducted using the MEDLINE, Embase and CINAHL databases. Initial results yielded 74 citations. From these, nine articles met our inclusion criteria. Two articles were doubly reported, leaving seven studies in the systematic review. Only four studies reported sufficient information to be included in our meta-analysis. RESULTS: Three studies were randomised controlled trials, and five were before-after studies. The number of participants in each study ranged from 11 to 220. Four out of seven studies reported a positive effect of PTNS on sexual function. In the meta-analysis of four studies there was a significant improvement in general sexual function with PTNS (p = 0.04, SMD -0.41, CI[-0.79, -0.03], I2 = 0%). In a subgroup analysis of the bowel domain of sexual function, there was a significant improvement with PTNS (p = 0.03, MD 17.7, CI [1.92, 33.47], I2 = 0%). CONCLUSION: We report a systematic review on the effect of PTNS on sexual function. Although the studies are of small size, the results are promising in terms of a positive effect of PTNS on sexual function, and we recommend further research in this area.