Development and Validation of a Canine Health-Related Quality of Life Questionnaire and a Human-Canine Bond Questionnaire for Use in Veterinary Practice.

The use of valid questionnaires to assess dogs' health-related quality of life (HRQoL) in veterinary practice can improve canine health outcomes and communications between veterinarians and caretakers of dogs. The Canine HRQoL Questionnaire (Canine HRQoL-Q) and the Human-Canine Bond Questionnaire (HCBQ) were developed and validated to fulfill this need. A literature review, interviews with veterinarians, and focus groups with caretakers were conducted to generate questionnaire items and develop draft questionnaires, which were piloted with caretakers to establish their content validity. Measurement properties were evaluated using data from a prospective survey study (N = 327). Draft Canine HRQoL-Q and HCBQ measures were developed, including a domain structure, items, recall period, and scale/response options. Refinements were made via iterative cognitive interviews with caretakers. When no additional revisions were indicated and content validity was established, the questionnaires were psychometrically tested. Ceiling effects were observed for all items, and factor analyses indicated that the pre-specified domains are appropriate. Internal consistency was demonstrated for the HCBQ (α = 0.79-0.86) and all but the social functioning domain of the Canine HRQoL-Q (α = 0.60). Test-retest reliability for the Canine HRQoL-Q was generally moderate-to-good (with intraclass correlation coefficients (ICCs) > 0.79). Test-retest reliability for the HCBQ was moderate (ICCs: 0.70-0.79) except for the trust domain (ICC: 0.58). Known-groups validity was demonstrated via significant differences (p < 0.05) in scores for health/bonding groups. Convergent validity was supported (r > 0.40) between all domains and the total scores for both questionnaires. The Canine HRQoL-Q and the HCBQ are valid, reliable measures of canine HRQoL for use in veterinary clinics and appear to measure related but distinct concepts that contribute to canine health and wellness.

A Cross-Sectional Concept Elicitation Study to Understand the Impact of Herpes Zoster on Patients' Health-Related Quality of Life.

INTRODUCTION: After a chickenpox infection, the varicella zoster virus lies dormant in nerve cells and can be reactivated in later life to cause herpes zoster (HZ), also called shingles, a painful rash that may result in persistent postherpetic neuralgia (PHN). Treatment options are limited, and HZ/PHN may have substantial negative effects on health-related quality of life (HRQoL). This qualitative cross-sectional study explored the subjective patient experience and impact on HRQoL of HZ and PHN in adults aged ≥ 50 years in Canada. METHODS: Patients were eligible for the study if they were aged at least 50 years and had been diagnosed with HZ by a healthcare practitioner 7-60 days earlier for HZ patients and 90-365 days earlier for PHN patients. Eligible patients were invited to participate in concept elicitation interviews by telephone. Data from the interviews were transcribed and analyzed to identify key concepts related to symptoms and impacts on the patients' lives. RESULTS: A total of 32 patients participated, with a mean age of 61 years. Most (72%) were female. The most common symptoms reported were rash (n = 32), pain (n = 31), fatigue (n = 26), and itchiness (n = 20). The most commonly reported HRQoL domains affected were emotional functioning (n = 31), activities of daily living (n = 31), sleep (n = 29), physical functioning (n = 25) and hobbies (n = 21). A conceptual model was developed to summarize these symptoms and impacts. CONCLUSION: HZ negatively affected many dimensions of patients' HRQoL, particularly during the acute phase of illness. This qualitative study helps to broaden understanding of the subjective patient experience of HZ.

Letting the patients speak: an in-depth, qualitative research-based investigation of factors relevant to health-related quality of life in real-world patients with hereditary angioedema using subcutaneous C1 inhibitor replacement therapy.

BACKGROUND: While many studies of effective hereditary angioedema (HAE) therapy have demonstrated improved health-related quality of life (HRQoL) using validated instruments, specific reasons behind the improved scores have never been investigated using qualitative methods. A non-interventional, qualitative research study was designed to investigate the reasons for improvements in HRQoL while using effective prophylaxis, in this case subcutaneous C1INH (C1INH[SC]) replacement therapy. METHODS: Adult patients with HAE-C1INH type 1 or 2 who had been using C1INH(SC) for ≥ 3 consecutive months were recruited through four HAE specialty practices in the US to participate in a 60-min phone interview performed by a trained qualitative research specialist (ICON plc) using a semi-structured interview guide with open-ended questions developed with the Angioedema Quality of Life (AE-QoL) items in mind. Interview transcripts were analyzed using thematic analysis methods to identify concepts (specific symptoms/impacts) and themes (higher-level categories grouping related concepts). A cross-mapping exercise was performed between interview-identified concepts and items included in the AE-QoL. RESULTS: Fourteen patients were interviewed and included in the analysis (age range, 28-82 years [mean 47.5 years]; 64% female; 93% white). In 10 interviews, patients mentioned having no or nearly no HAE attacks, no longer feeling limited by HAE, less HAE-related anxiety/worry and depression, an improved ability to travel, fewer emergency room/hospital visits, and ease of administration of C1INH(SC), including not requiring assistance from others. Other commonly expressed concepts included: increased feelings of confidence, independence, optimism, and normalcy; less absence from work/school; better productivity; improved sleep and energy; healthier family relationships; and improved cognition. While all AE-QoL items emerged from patient interviews, a number of identified concepts were not addressed by the AE-QoL, including sensitivity to various potential attack-triggers (e.g., stress/anxiety, sports), attack frequency, not having to cancel social plans, improvements in ability to perform day-to-day tasks, and a lower burden from medical visits. CONCLUSIONS: From these interviews, a large number of common themes and concepts emerged: a greater sense of freedom and normalcy, increased productivity, and improved interpersonal relationships while using convenient and effective prophylaxis. These findings provide insights into real-world experiences and the many facets of HRQoL that are important to patients with HAE-C1INH.

The Patient Experience of Premenopausal Women Treated with Bremelanotide for Hypoactive Sexual Desire Disorder: RECONNECT Exit Study Results.

Background: Hypoactive sexual desire disorder (HSDD) has a significant negative impact on women's overall health and relationships with their partners. Primary analyses from the RECONNECT clinical trials demonstrated statistically significant and clinically meaningful improvements in sexual desire and related distress with bremelanotide relative to placebo in premenopausal women with HSDD. Exit surveys and patient interviews were conducted to evaluate the impact of HSDD and bremelanotide treatment from the patient's perspective. Materials and Methods: Upon completion of the double-blind study but before participation in the open-label extension, up to 250 participants were recruited to complete the quantitative exit survey (17 questions). A subset of up to 90 patients was invited to participate in the telephone interview (17 questions). Patients who volunteered to participate remained blinded to study drug until the survey and interviews were completed. Results: Quantitative exit surveys were completed by 242 RECONNECT participants; 80 of these women also completed qualitative telephone exit interviews. Participants who received bremelanotide described increased feelings of sexual desire, physical arousal, and improvements in overall quality of their sexual activities in their partner relationship. In comparison, women taking placebo reported benefits that did not include the physiological responses described by women receiving bremelanotide, such as positive experiences of seeking HSDD treatment and improved communication with their partner. Conclusions: Exit surveys and patient interviews support the primary findings from RECONNECT and provide quantitative and qualitative assessments of the impact of HSDD on patients' quality of life and the patients' perspectives on the impact of bremelanotide. Clinical trial numbers NCT02333071, NCT02338960.

Evaluation of Two Dry Commercial Therapeutic Diets for the Management of Feline Chronic Gastroenteropathy.

Management of feline chronic gastroenteropathies has included intervention with both veterinary therapeutic formulas designed to manage non-specific gastrointestinal disorders and those designed with limited novel or hydrolyzed ingredients for management of food-responsive enteropathies and steroid-responsive enteropathies (inflammatory bowel disease). There have been few studies evaluating the use of dietary intervention for the management of feline chronic gastroenteropathy. This prospective, multi-center study evaluated the use of two commercially available feline veterinary therapeutic dry diets designed to manage non-specific gastrointestinal disorders in 28 cats with a history of chronic vomiting and/or diarrhea. The majority of cats enrolled in the study had a history of vomiting (n = 25), with a smaller number having a history of concurrent diarrhea (n = 2) or diarrhea alone (n = 3). Cats were excluded if diagnostic tests identified any systemic or infectious disease that could be associated with the clinical signs of vomiting or diarrhea, and if they were panhypoproteinemic, hypoalbuminemic, hypocobalaminemic, or had a Spec fPL ≥5.4 µg/L. Cats were randomized to one of two veterinary therapeutic diets for 4 weeks. Feeding of both therapeutic diets resulted in a numeric reduction in the number of vomiting episodes over the 4-week period, but no significant differences were seen between dietary interventions. When looking within dietary groups, significant differences were seen in cats fed Diet A with reductions of 69.1, 73.3, and 63.2% (p values of 0.008, 0.003, and 0.029) in weeks 2, 3, and 4, respectively, when compared to week 0. The probability of vomiting also showed significant reductions in cats fed Diet A between weeks 0 and 2, 3, and 4, with odds ratios of 0.008, 0.005, and 0.005, respectively (p values of 0.038, 0.23, and 0.23). Results of this study demonstrate that a veterinary therapeutic gastrointestinal formula can be effective in the management of feline chronic vomiting. Cats that fail to respond to this dietary approach after a 2- to 4-week trial may benefit from a limited novel or hydrolyzed ingredient formula and may require additional diagnostics to better characterize the underlying disease.

Development and initial validation of the Cat HEalth and Wellbeing (CHEW) Questionnaire: a generic health-related quality of life instrument for cats.

OBJECTIVES: The aims of the study were to define factors that owners consider relevant to the health-related quality of life (HRQoL) of cats, to develop an instrument based on this information, and to evaluate the validity and reliability of the final instrument (the Cat HEalth and Wellbeing [CHEW] Questionnaire). METHODS: Psychometric research techniques and guidance from the US Food and Drug Administration on outcome measures were used to develop a valid and reliable instrument. Fifty-four cat owners and caregivers participated in the qualitative research, while 1303 cat owners were included in the quantitative validation phase (development dataset, n = 648; validation dataset, n = 655). A random subset of cat owners (n = 391) also participated in test-retest evaluation. Qualitative research was used to generate a draft instrument, which was then subjected to quantitative validation techniques. These included item reduction, domain identification, data quality assessment, and exploratory and confirmatory analysis to develop a final instrument, which underwent confirmatory reliability and validity assessment. RESULTS: A draft instrument with 11 domains and 100 items based on qualitative research underwent online quantitative validation testing which refined the instrument to eight domains and 33 items. Confirmatory reliability and validity assessment showed that the final instrument had good validity, was able to discriminate between cats by age and overall health status, and demonstrated good internal and test-retest reliability. CONCLUSIONS AND RELEVANCE: The CHEW Questionnaire was developed and validated. Additional research is needed to verify its ability to differentiate cats with and without disease, and to assess its potential as a screening tool.

Characteristics and impact of interrupted sleep in women with overactive bladder.

Women who self-report symptoms of overactive bladder (OAB), including nocturia, experience significant sleep deficits and a diminished quality of life. These deficits and their impacts are greater among women who awaken two or more times per night. When evaluating patients with OAB, it is important for clinicians to assess sleep habits and practices in addition to bladder symptoms to fully gauge the health and well-being of women with OAB.

Patient satisfaction with the benefits of overactive bladder treatment: exploration of influencing factors and development of a satisfaction assessment instrument.

INTRODUCTION: Patient-reported outcome (PRO) instruments are useful for assessing treatment success in patients with overactive bladder (OAB). PROs such as the OAB Questionnaire (OAB-q) and Patient Perception of Bladder Condition (PPBC) focus more on OAB symptoms than satisfaction. We describe the development of the Patient Satisfaction with Treatment Benefit (PSTB) questionnaire, and examine the face, content and criterion validity of this tool in a study of darifenacin treatment in OAB patients who expressed dissatisfaction with prior antimuscarinic therapy. METHODS: The PSTB questionnaire was created based on treatment-related items identified as relevant to OAB patients in exploratory interviews, then refined to comprise an Overall Satisfaction question and 23 items addressing specific treatment benefits using a 5-point Likert scale. The PSTB questionnaire was completed at last visit by 473 patients participating in an open-label, 12-week study of darifenacin treatment. Factors driving Overall Satisfaction were explored by investigating its relationship to PPBC, bladder symptom diaries and specific benefits assessed by the PSTB. RESULTS: At study end, mean Overall Satisfaction score was 3.1, corresponding to "satisfied." Overall Satisfaction correlated strongly with each specific benefit in the PSTB, and with PPBC and OAB symptoms at last visit, but more weakly with change from baseline PPBC/symptoms. Satisfaction at last visit was higher for patients with mild/moderate versus severe problems on baseline PPBC. CONCLUSIONS: Patients' reported satisfaction appears to reflect their current status rather than improvement over time. The PSTB tool may have a place alongside other symptom-based instruments. Further testing is required to validate these findings.

The prevalence of hypoactive sexual desire disorder in surgically menopausal women: an epidemiological study of women in four European countries.

INTRODUCTION: Insufficient documentation exists regarding the prevalence of hypoactive sexual desire disorder (HSDD) in surgically menopausal (SM) women in European countries. Women who have undergone hysterectomy and bilateral oophorectomy experience a loss of ovarian hormones. Inclusion of these women in an epidemiological study provided the opportunity to study biological and cultural impacts on sexual function. AIM: The aim of this study was to compare the prevalence of HSDD among SM women in France, Germany, Italy, and the United Kingdom, as well as the relationship between low sexual desire and sexual activity or behavior, and sexual or partner relationship satisfaction. METHODS: Cross-sectional survey of a convenience sample of 427 SM women aged 20-70 years. Main Outcome Measures. The desire domain of the Profile of Female Sexual Function (PFSF) to identify women with low sexual desire, Personal Distress Scale (PDS) to measure distress caused by low sexual desire, and a sexual activities measure. Women with low sexual desire who were distressed were classified as having HSDD. RESULTS: SM women having low sexual desire ranged from 35% (United Kingdom) to 44% (Italy); of these women, 16% (Germany) to 56% (France) were distressed because of their low sexual desire. Overall, SM women classified with HSDD ranged from 7% (Germany) to 22% (France). A strong positive correlation was observed between sexual desire and arousal, orgasm, and sexual pleasure in all countries (P < 0.001). Low sexual desire leads to less sexual activity, more dissatisfaction with sex life and partner relationship, and more negative emotional or psychological states, than normal desire in each country. CONCLUSIONS: A similar percentage of SM women with low sexual desire were found across countries suggesting the role of biological factors (i.e., losing ovarian hormones) in determining sexual desire. Differences in the percentage of SM women with HSDD suggest a role for cultural factors in determining how low sexual desire is perceived.

Clinically relevant changes in sexual desire, satisfying sexual activity and personal distress as measured by the profile of female sexual function, sexual activity log, and personal distress scale in postmenopausal women with hypoactive sexual desire disorder.

INTRODUCTION: Transdermal testosterone patch (TTP) treatment produced statistically significant improvements in a satisfying sexual activity (SSA), sexual desire, and personal distress in postmenopausal women suffering from hypoactive sexual desire disorder (HSDD), but clinical significance of these changes was not determined. AIM: To quantify the magnitude of change in three principal outcomes measures determined by HSDD patients as associated with the perception of meaningful benefit with TTP therapy. METHODS: The criteria for defining responders were determined using anchoring methodology and receiver operating characteristics analysis to establish minimum important differences (MIDs) in a representative subsample of 132 patients in two randomized, controlled trials in surgically menopausal women with HSDD (N = 1,094). Perceived benefit was established based upon the question "Overall, would you say that you experienced a meaningful benefit from the study patches?". These data defined responders and established MIDs for changes in sexual desire, SSA, and personal distress. The MIDs were applied to the two trials to establish responder rates in each treatment group. MAIN OUTCOME MEASURES: Changes in score that correspond to the MID for sexual desire, SSA, and personal distress, and responder rates in each treatment group based upon these values. RESULTS: Increases in frequency of SSA of greater than 1 activity/4 weeks, increases in sexual desire score of > or = 8.9, and decreases in the personal distress score of > or = 20.0 were identified as threshold improvements best able to differentiate responders and nonresponders. The responder rate was significantly higher (P < 0.001) in the testosterone group vs. placebo for all three outcomes measures (sexual desire, 50% vs. 34%; SSA, 44% vs. 30%; personal distress, 51% vs. 39%). CONCLUSIONS: Changes in sexual desire, SSA, and personal distress observed with TTP treatment in surgically menopausal women with HSDD were clinically significant and were associated with a meaningful treatment benefit.

The frequency of sexual intercourse reported by women: a review of community-based studies and factors limiting their conclusions.

INTRODUCTION: A range of methodological inconsistencies has the potential to affect reported prevalence rates of sexual intercourse. AIMS: We reviewed published studies of sexual intercourse frequency reported by women and associated factors. METHODS: Literature search of electronic databases. Inclusion criteria for selected cross-sectional studies were population and community-based studies of frequency of intercourse in women published in English or German languages with sample size greater than 300. Longitudinal studies were selected if duration was at least 1 year and samples were not clinically based. MAIN OUTCOME MEASURES: Frequency of sexual intercourse/activities and any associated factors. RESULTS: There was a great deal of variation in the mean frequency of intercourse across all age groups with higher rates reported by European and American women. There was a reduction in frequency of sexual intercourse from age 50 among women from Europe and the United States. Asian women reported increasing rates through the age group 20-30 followed by a decline. Change with age was not as evident among African and South American studies. Factors most often associated with the frequency of sexual intercourse were age, parity, duration of relationship, pregnancy, time, relationship status, fertility intentions, and contraception. CONCLUSIONS: There is variation in reported frequency of sexual intercourse between studies, age groups, and continents. Some of the variation may be due to variation in definitions, study designs, and methods suggesting a need for greater consistency in research practice.

Development and validation of a new screening tool for hypoactive sexual desire disorder: The Brief Profile of Female Sexual Function (B-PFSF).

AIM: To develop a screening tool to allow a postmenopausal woman to determine whether to seek evaluation for hypoactive sexual desire disorder (HSDD). METHODS: The Brief Profile of Female Sexual Function (B-PFSF) was developed using items from the Profile of Female Sexual Function (PFSF) and the Personal Distress Scale (PDS). Logistic regression analysis was used to select items best able to discriminate between women with HSDD (n = 743) and controls (n = 226) and a screening cut-off score was identified. Cross-validation analyses were conducted using PFSF and PDS responses from an independent group of 147 HSDD women and 104 controls. Forty cognitive interviews were additionally conducted to assess validity of the final tool. RESULTS: A seven-item instrument was found to provide good discrimination between postmenopausal women with HSDD and controls and to be a reliable and valid tool. Ninety-six percent of women with HSDD and 97% of control women in the independent validation were classified correctly using the identified cut-off score. In the cognitive interviews, all women stated that the questionnaire was easy to complete and covered relevant aspects of sexual function. CONCLUSION: The Brief Profile of Female Sexual Function (B-PFSF) is psychometrically valid and appropriate for use as a self-administered screening tool.

Evaluation of the clinical relevance of benefits associated with transdermal testosterone treatment in postmenopausal women with hypoactive sexual desire disorder.

INTRODUCTION: Postmenopausal women with hypoactive sexual desire disorder (HSDD) experienced statistically significant improvements in the frequency of satisfying sexual activity, sexual desire, and distress with testosterone treatment in phase III trials, but it was not known whether the magnitude of these effects was clinically meaningful. The clinical relevance study was designed to answer this question. AIM: To evaluate the clinical relevance of the treatment benefits. METHODS: This study involved a representative sample of 132 surgically postmenopausal women with HSDD who were enrolled in two randomized, placebo-controlled trials (N = 1094) assessing the efficacy and safety of transdermal testosterone treatment (300 mcg/day) for 6 months. At the end of the studies, prior to unblinding, a sample of women (12%) was interviewed concerning their experiences with the treatment. MAIN OUTCOME MEASURES: Women were asked "Overall, would you say that you experienced a meaningful benefit from the study patches?" Changes in the efficacy end points in the double-blind studies were compared for the women who did and did not experience an overall meaningful benefit. RESULTS: Overall, 33 of 64 women (52%) who received testosterone reported experiencing a meaningful treatment benefit, compared with 21 of 68 women (31%) who received placebo (P = 0.025). Among the women who identified themselves as experiencing a meaningful benefit, the mean (SE) change from baseline in 4-week frequency of satisfying sexual activity was 4.4 (0.76), in desire score was 21.0 (2.78), moving from "seldom" to "sometimes" feeling sexual desire, and in distress score was -36.5 (3.96), moving from "often" to "seldom" being distressed. Among the women who identified themselves as not experiencing a meaningful benefit, the mean (SE) change from baseline in 4-week frequency of satisfying sexual activity was 0.5 (0.31), in desire score was 2.9 (1.42), and in distress score was -8.8 (2.23). CONCLUSIONS: Surgically menopausal women with HSDD in these studies received clinically meaningful benefits, including improvements in satisfying sexual activity, sexual desire, and personal distress.

A symptomatic approach to understanding women's health experiences: a cross-cultural comparison of women aged 20 to 70 years.

OBJECTIVES: To determine patterns of symptoms across age groups, identify symptom groups associated with ovarian hormonal depletion or other variables, and develop a prediction model for each symptom. DESIGN: This was a cross-sectional survey of 4,517 women ages 20 to 70 years recruited from market research panels in the United States, United Kingdom, Germany, France, and Italy using a self-report questionnaire that included general health information and a checklist of 36 symptoms. Stepwise regression was used to determine for each symptom how prevalence varied with age, indicators of menopausal hormonal changes, and the effects of other explanatory variables, including body mass index, morbidity, and country. Hierarchical clustering was used to group symptoms. RESULTS: Six groups of symptoms were found, of which two groups, with seven symptoms in total, were related to markers of menopausal hormonal change: a group consisting of hot flashes and night sweats and a second group including poor memory; difficulty sleeping; aches in the neck, head, and shoulders; vaginal dryness; and difficulty with sexual arousal. Physical and mental morbidity affected estimates of the prevalence of all symptoms. Psychological symptoms declined with age from a maximum prevalence before age 40. Certain physical symptoms increased with age and body mass index. Clustering identified three country groups: (1) US and UK women; (2) French and Italian women; and (3) German women. There were marked differences in prevalence between countries for certain physical and psychological symptoms. CONCLUSIONS: The seven symptoms most linked to menopausal hormonal change should form part of any future menopause symptom list. Physical and mental morbidity affect symptom prevalence and should be measured.

Relationship between hypoactive sexual desire disorder and aging.

OBJECTIVE: Explore the association between Hypoactive Sexual Desire Disorder (HSDD) and aging. The American Foundation of Urologic Disease and the American Psychiatric Association stipulate that HSDD is only diagnosed when both low sexual desire and sexually related personal distress are present. DESIGN: Community-based, cross-sectional study. SETTING: Europe (UK, Germany, France, Italy) and the USA. PATIENT(S): Women aged 20-70 in sexual relationships participating in the Women's International Study of Health and Sexuality (n=1998 Europe, n=1591 USA). INTERVENTION(S): No interventions were administered. MAIN OUTCOME MEASURES: Self-administered questionnaire that included two validated instruments: Profile of Female Sexual Function(c) measured sexual desire; Personal Distress Scale(c) measured sexual distress. Women with low desire and distress were considered to have HSDD. RESULTS: The proportion of European women with low desire increased from 11% amongst women aged 20-29 years to 53% amongst women aged 60-70 years. The proportion of American women with low desire displayed a trend towards an increase with age. In the 20-29 year age group 65% of European women and 67% of American women with low sexual desire were distressed by it. This decreased to 22% and 37%, respectively, in the 60-70 year age group. In Europe and the USA the prevalence of HSDD in the population did not change significantly with age (6-13% in Europe, 12-19% in the USA). CONCLUSIONS: The proportion of women with low desire increased with age while the proportion of women distressed about their low desire decreased with age. Consequently, the prevalence of HSDD remained essentially constant with age. This may explain why no association between HSDD and age is often reported in the literature.

Hypoactive sexual desire disorder in postmenopausal women: US results from the Women's International Study of Health and Sexuality (WISHeS).

OBJECTIVE: To determine the prevalence of hypoactive sexual desire disorder (HSDD) among US women by reproductive status and age and to explore the correlates of sexually related distress. DESIGN: The Women's International Study on Health and Sexuality questionnaire was mailed to a national sample of US women in 2000. The survey included validated questionnaires: the Short Form-36, which measures overall health status; the Profile of Female Sexual Function, which assesses sexual desire; and the Personal Distress Scale, which measures distress caused by low desire. Four groups of women were studied: surgically postmenopausal, aged 20 to 49 years and 50 to 70 years; premenopausal, aged 20 to 49 years; and naturally postmenopausal, aged 50 to 70 years. Clinically derived cutoff Profile of Female Sexual Function and Personal Distress Scale scores were used to classify women with HSDD and determine its prevalence. The relations between sexual desire and frequency of sexual activity or relationship satisfaction were assessed. Overall health status of HSDD women and women with normal desire were compared. RESULTS: The prevalence of HSDD ranged from 9% in naturally postmenopausal women to 26% in younger surgically postmenopausal women. The prevalence of HSDD was significantly greater among surgically postmenopausal women, aged 20 to 49 years, than premenopausal women of similar age, whereas there were no significant differences in the prevalence between surgically postmenopausal women, aged 50 to 70 years, and naturally postmenopausal women. For many women, HSDD was associated with emotional and psychological distress as well as significantly lower sexual and partner satisfaction. HSDD was also associated with significant decrements in general health status, including aspects of mental and physical health. CONCLUSIONS: HSDD is prevalent among women at all reproductive stages, with younger surgically postmenopausal women at greater risk, and is associated with a less active sex life and decreased sexual and relationship satisfaction.

Hypoactive sexual desire disorder in menopausal women: a survey of Western European women.

INTRODUCTION: The prevalence of hypoactive sexual desire disorder (HSDD) in menopausal women and the frequency of sexual activity, sexual behavior, and relationship or sexual satisfaction associated with HSDD have not been studied using validated instruments to identify women with HSDD. AIMS: To determine: (i) the prevalence of HSDD among women who have undergone hysterectomy and bilateral oophorectomy (surgical menopause) with that of premenopausal or naturally menopausal women; (ii) the relationship between low sexual desire and sexual activity and behavior; and (iii) the relationship between low sexual desire and sexual or partner relationship satisfaction. METHODS: Cross-sectional survey of 2,467 European women aged 20-70 years, resident in France, Germany, Italy, and the United Kingdom. Measures were the Profile of Female Sexual Function (PFSF), Personal Distress Scale (PDS), and a sexual activities measure. OUTCOME MEASURES: Clinically derived cutoff scores for the desire domain of the PFSF and the PDS were used, sequentially, to classify women as having low sexual desire and to further classify these women with low desire as distressed or nondistressed. Thus, women with HSDD had low sexual desire and were distressed by their low desire. The analysis population included 1,356 women who had current sexual partners and were surgically menopausal, regularly menstruating, or naturally postmenopausal. RESULTS: A greater proportion of surgically menopausal women had low sexual desire compared with premenopausal or naturally menopausal women (odds ratio [OR] = 1.4; confidence interval [CI] = 1.1, 1.9; P = 0.02). Surgically menopausal women were more likely to have HSDD than premenopausal or naturally menopausal women (OR = 2.1; CI = 1.4, 3.4; P = 0.001). Sexual desire scores and sexual arousal, orgasm, and sexual pleasure were highly correlated (P < 0.001), demonstrating that low sexual desire is frequently associated with decreased functioning in other aspects of sexual response. Women with low sexual desire were less likely to engage in sexual activity and more likely to be dissatisfied with their sex life and partner relationship than women with normal desire (P < 0.001). CONCLUSIONS: Surgically menopausal women are at increased risk for HSDD. HSDD is associated with diminished sexual and partner relationship satisfaction and negative emotional states.