Sexual dysfunction in Chinese women at different reproductive stages and the positive effect of hormone replacement therapy in the early postmenopause

Abstract

Objectives

The aims of the study were to investigate female sexual dysfunction (FSD) at different reproductive stages and the effect on FSD of hormone replacement therapy (HRT).

Methods

Participants (N = 524) were divided into six groups according to the Stages of Reproductive Aging Workshop (STRAW + 10): reproductive age (R), early (ET)/late (LT) menopausal transition, early (EP)/late (LP) postmenopause and early postmenopause in women using HRT (EP-HRT; oestradiol sequentially combined with dydrogesterone). The Female Sexual Function Index (FSFI) was used to assess FSD. Univariate and multivariate logistic regression analysis was carried out to predict FSD risk factors.

Results

There was an increase in FSD in groups EP and LP, but not in groups R, ET and LT; most FSFI scores were lower in groups EP and LP than in groups R, ET and LT (p < .05). There was no difference in FSD between groups EP and LP, but lubrication and pain scores were higher in group EP (p < .05). The prevalence of FSD was lower in group EP-HRT; most FSFI scores were higher in group EP-HRT compared with group EP as control (p < .05). Further risk factors for FSD were identified as neutral and dissatisfied marital relations, lower educational level and smoking (p < .05).

Conclusion

We report a clear association between deteriorating sexual function and increasing STRAW + 10 classification, suggesting the consequence of decreasing ovarian function. HRT containing ‘natural hormones’ was shown to have a beneficial effect on FSD. The results are reported here for the first time in Chinese women.

摘要

目的：探讨不同生殖衰老分期的中国女性性功能障碍情况以及激素替代治疗(HRT)对女性性功能障碍(FSD)的影响。

方法：根据生殖衰老分期研讨会(STRAW+10)将研究对象(N=524)分为6组：生育期组(R)、绝经过渡期早期组(ET)/晚期组(LT)、绝经后早期组(EP)/晚期组(LP)和绝经后早期组应用HRT者(EP-HRT；应用雌二醇与地屈孕酮的周期序贯方案)。采用女性性功能指数量表(FSFI)评估FSD。采用单因素和多因素logistic回归分析预测FSD危险因素。

结果：与R组、ET组和LT组相比, EP组和LP组的FSD比例明显升高, 而R组、ET组和LT组间比较, FSD的比例无明显差异；EP组和LP组的FSFI评分明显低于R组、ET组和LT组(p < 0.05)。EP组与LP组间FSD的比例比较差异无统计学意义(p > 0.05), 但EP组的阴道润滑障碍及性交痛的评分明显高于LP组(p < 0.05)。与EP组比较, EP-HRT组的FSD的比例明显降低, EP-HRT组的FSFI评分明显升高(p < 0.05)。婚姻关系不满意、受教育程度较低及吸烟均是导致女性性功能障碍的危险因素(p < 0.05)。

结论：本研究发现, 女性性功能障碍与生殖衰老分期的升高有明显的相关性, 提示了卵巢功能下降会导致女性性功能障碍。含“天然激素”的HRT对FSD有益, 此研究结果是中国的首次报道。

Keywords:

• Female sexual dysfunction
• FSFI
• hormone replacement therapy
• quality of life
• STRAW + 10 criteria

Acknowledgements

We thank Xingming Li (Capital Medical University, Beijing) for his assistance in analysing the statistical data. We also thank all participants and staff at the study sites for their cooperation.

Author contributions

RJ, XR and AOM contributed to the conception and design of the study. XX, YY, JC, LZ, BW, SQ and ZD contributed to the acquisition of data, and RJ and XR to the analysis and interpretation of data. RJ, XR and AOM drafted the article, and XR and AOM revised it critically. All authors read and approved the final manuscript.

Disclosure statement

The authors declare there is no conflict of interest associated with this manuscript.

Additional information

Funding

This study was supported by the first Beijing maternal and child health specialist demonstration units ‘Menopausal Health Specialist’ [[2017]35], the China Health Promotion Foundation [CHPF-2018-OP-11], Beijing Municipal Administration of Hospitals’ Ascent Plan [DFL20181401] and the China International Talent Exchange Association Medical Health Technology Innovation and Talent Training Special Fund [2017041900004, 2018042000001].