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Female sexuality and vaginal health across the menopausal age

Cagnacci, Angelo MD, PhD1; Venier, Martina MD1; Xholli, Anjeza MD1; Paglietti, Chiara MD1; Caruso, Salvatore MD2 for the ANGEL Study

doi: 10.1097/GME.0000000000001427
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Objective: The primary aim was to evaluate changes in female sexuality across the menopausal period, and the secondary objective was to test the associations of female sexuality domains with vaginal atrophy and its symptoms.

Methods: A cross-sectional multicenter study was performed involving 518 women, 40 to 55 years of age, consulting outpatient gynecological services at 30 centers across Italy. Vaginal atrophy was identified by the contemporaneous presence of a pH >5, subjective vaginal dryness, and an objective sign. The relationships between vaginal atrophy and its main symptoms (vaginal dryness and dyspareunia), and Female Sexual Function Index (FSFI) score and its domains (desire, arousal, orgasm, dyspareunia, lubrication, and sexual satisfaction) were analyzed.

Results: The prevalence of sexual dysfunction, as defined by a FSFI score <26.55, was 70.6%, increasing from 55% in the years 40 to 45, to 82.8% (P < 0.01) in the years 52 to 55 of age. Mean FSFI score decreased from 40 to 45, to 46 to 48 years of age (23.13 ± 9.76 vs 19.49 ± 9.88; P < 0.05), and from 48 to 51, to 52 to 55 years of age (21.3 ± 8.06 to 17.59 ± 9.11; P < 0.01). Independent determinants of FSFI were age, vaginal atrophy, and the presence of vaginal dryness and dyspareunia (R2 0.208; P = 0.011). FSFI score was independently correlated (R2 0.116) with weight (CR −0.067; 95% confidence interval [CI] −0.126, −0.006; P < 0.032), menopausal status (CR −2.406; 95% CI −4.180, −0.63; P < 0.008), and vaginal dryness (CR −5.647; 95% CI −7.677, −3.618; P < 0.0001). Vaginal dryness was the only variable correlated independently with each FSFI domain, including desire (also correlated with menopausal status), arousal (with age and menopausal status), lubrication (with age), orgasm (with age), satisfaction (with vaginal atrophy and being an ex-smoker), and dyspareunia (with age and spontaneously referred dyspareunia).

Conclusions: In the perimenopausal years, FSFI score decreases and sexual dysfunction increases by about 30%. Vaginal dryness is the symptom of vaginal atrophy most closely related to all domains of female sexuality.

1Obstetrics and Gynecology Unit, Department of Obstetrics and Gynecology, University of Udine, Udine, Italy

2Obstetrics and Gynecology Unit, Department of Obstetrics and Gynecology, University of Catania, Catania, Italy.

Address correspondence to: Angelo Cagnacci, MD, PhD, Ginecologia e Ostetricia, Azienda Sanitaria Universitaria Integrata di Udine, Piazzale della Misericordia 15, 33100 Udine, Italy. E-mail: angelocag318@yahoo.com

Received 14 May, 2019

Revised 25 July, 2019

Accepted 25 July, 2019

Participants of the “An evaluation of Genitourinary symptoms in perimenopausal women (ANGEL) study” by the Italian Menopause Society (SIM): Algeri M, Donvito G (Clusone), Bastianelli C (Roma), Cagnacci A, Palma F, Napolitano A (Modena), Capobianco G, Dessole S (Sassari), Cianci A, Caruso S (Catania), Cinque B, Dati S (Roma), Cioffi GP (Battipaglia), Costantino D (Ferrara), D’Anna R (Messina), De Leo V (Siena), Di Carlo C (Napoli), Di Francesco A, Di Renzo G, Baldoni A (Perugia), Lorefice R (Lanciano), Ferrazzi E, Valente I (Milano), Gambacciani M (Pisa), Gambera A (Brescia), Greco P, Bonaccorsi G (Ferrara), Guaschino S, Tredici Z (Firenze), Labanchi R, Chiacchio A (Lagonegro), Lanzone A, Villa P (Roma), Lello S, Capozzi A (Roma), Leo L, Salvatores M (Aosta), Marchesoni D, Vogrig E (Udine), Perrone A, Segatore M, Pallone B (Roma), Petruzzelli F, Libergoli A (Foggia), Roccamorena A (Catanzaro), Scarciglia M (Lecce), Serracchioli R, Meriggiola C (Bologna), Surico N, Zorzeti Cigna S (Novara), Zullo F, Delfini R (Catanzaro), Giovannini P (Roma).

Funding/support: Partially funded by an unrestricted grant from the Italian Menopause Society (SIM). Grant: SIM 001-2015.

Financial disclosure/conflicts of interest: None reported.

© 2019 by The North American Menopause Society.