Incidence of sexual dysfunction in patients with obesity and overweight

Silva, Benedito Martins e; Rêgo, Lerika Moreira; Galvão, Márcio Almeida; Florêncio, Telma Maria de Menezes Toledo; Cavalcante, Jairo Calado

doi:10.1590/S0100-69912013000300006

Abstracts

OBJECTIVE: To assess the prevalence of sexual dysfunction in obese and overweight patients treated at the Professor Alberto Antunes University Hospital (HUPAA - UFAL). METHODS: This is a descriptive study. The sample consisted of overweight or obese females. Anthropometric data were collected for assessment of body mass index (BMI) and waist circumference (WC). In all subjects we measured the levels of blood glucose, total cholesterol and triglycerides. We applied a Portuguese-validated version of the Female Sexual Function Index (FSDI), which assesses sexual response as for desire, arousal, vaginal lubrication, orgasm, sexual satisfaction and pain. The total score is the sum of scores for each domain multiplied by the corresponding factor and can vary from '2 'to '36', a total score less than or equal to '26 ' being considered risky for sexual dysfunction. RESULTS: We evaluated 23 women with a mean age of 44, where 73.9% were obese and 82.6% had a highly increased risk for metabolic complications (WC e" 88cm). The increased risk for sexual dysfunction was present in 78.3% of the interviewees, causing biopsychosocial impairment. Hypertension, diabetes and dyslipidemia were present in 33.3%, 22.2% and 61.1%, respectively, of patients at risk for sexual dysfunction. CONCLUSION: The analysis of the results demonstrates the need for better research and attention of physicians to patients with obesity or overweight.

Sexuality; Sexual dysfunction, physiological; Female; Obesity; Overweight

OBJETIVO: avaliar a prevalência de disfunção sexual em pacientes com obesidade e sobrepeso atendidos no Hospital Universitário Professor Alberto Antunes (HUPAA - UFAL). MÉTODOS: trata-se de um estudo descritivo transversal. A amostra foi constituída por pacientes do sexo feminino com sobrepeso ou obesidade. Foram coletados os dados antropométricos para avaliação do índice de massa corporal (IMC) e da circunferência da cintura (CC). Em todos os indivíduos foi realizada a avaliação dos níveis séricos de glicose, colesterol total e triglicerídeos. Aplicou-se a versão validada em português do Índice de Função Sexual Feminina (IFSF), que analisa a resposta sexual quanto a desejo, excitação, lubrificação vaginal, orgasmo, satisfação sexual e dor. O escore total é a soma dos escores para cada domínio multiplicada pelo fator correspondente e pode variar de '2' a '36', considerando risco para disfunção sexual um escore total menor ou igual a '26'. RESULTADOS: foram avaliadas 23 mulheres com média de idade de 44 anos, onde 73,9% eram obesas e 82,6% apresentaram risco muito aumentado para complicações metabólicas (CC e"88cm). O risco aumentado para disfunção sexual esteve presente em 78,3% das entrevistadas, ocasionando prejuízos biopsicossociais. HAS, DM e dislipidemia estavam presentes em 33,3%, 22,2% e 61,1%, respectivamente, das pacientes sob risco para disfunção sexual. CONCLUSÃO: a análise dos resultados demonstra a necessidade de uma melhor investigação e atenção dos médicos para com pacientes com obesidade ou sobrepeso.

Sexualidade; Disfunção sexual fisiológica; Feminino; Obesidade; Sobrepeso

ORIGINAL ARTICLE

^IAssociate Professor, Faculty of Medicine, UFAL

^IIMedical School Graduate, UFAL

^IIIProfessor, School of Nutrition, UFAL

^IVAssistant Professor, Department of Biostatistics, UFAL

Correspondence

ABSTRACT

OBJECTIVE: To assess the prevalence of sexual dysfunction in obese and overweight patients treated at the Professor Alberto Antunes University Hospital (HUPAA - UFAL).

METHODS: This is a descriptive study. The sample consisted of overweight or obese females. Anthropometric data were collected for assessment of body mass index (BMI) and waist circumference (WC). In all subjects we measured the levels of blood glucose, total cholesterol and triglycerides. We applied a Portuguese-validated version of the Female Sexual Function Index (FSDI), which assesses sexual response as for desire, arousal, vaginal lubrication, orgasm, sexual satisfaction and pain. The total score is the sum of scores for each domain multiplied by the corresponding factor and can vary from '2 'to '36', a total score less than or equal to '26 ' being considered risky for sexual dysfunction.

RESULTS: We evaluated 23 women with a mean age of 44, where 73.9% were obese and 82.6% had a highly increased risk for metabolic complications (WC e" 88cm). The increased risk for sexual dysfunction was present in 78.3% of the interviewees, causing biopsychosocial impairment. Hypertension, diabetes and dyslipidemia were present in 33.3%, 22.2% and 61.1%, respectively, of patients at risk for sexual dysfunction.

CONCLUSION: The analysis of the results demonstrates the need for better research and attention of physicians to patients with obesity or overweight.

Key words: Sexuality. Sexual dysfunction, physiological. Female. Obesity. Overweight.

INTRODUCTION

Abdominal obesity (android or central obesity) is characterized by deposition of adipose tissue in the abdominal region and is considered a risk factor for various morbidities, such as cardiovascular disease (CVD), hypertension (HT), diabetes mellitus (DM), hypercholesterolemia, and some forms of cancer, in addition to representing different risk when compared to other forms of body fat distribution ¹.

A survey conducted by the Brazilian Ministry of Health in 2009 showed that the frequency of overweight and obesity increased in men and women. Currently, 13.9% of adults are obese, with the rate higher among women (14%) than among men (13.7%), while 46.6% of Brazilian adults are overweight, with higher rate among men (51%) than among women (42.3%) ².

In this context, obesity, similar to other cardiovascular risk factors, is associated with the development of male and female sexual dysfunctions resulting from the deleterious effects on vascular and endothelial functions ³.

Sexual dysfunctions are common among women, affecting 20-50% of them ⁴. An American study has shown that these disorders are more frequent in women (43%) than in men (31%) and are related to demographic characteristics such as age and educational level ⁵. In Portugal, there was a prevalence of 40.4% ⁶, and in Brazil, 49% of women reported at least one sexual dysfunction ^4,7.

Female sexual disorders involve aspects such as sexual desire, arousal, orgasm, and dyspareunia. The syndromes of clitoral and vaginal vascular insufficiency are directly related to decreased genital blood flow secondary to atherosclerosis of the hypogastric and pudendal arteries. Although a variety of medical and psychogenic disorders result in decreased clitoral engorgement, vascular insufficiency is a major cause of sexual dysfunction³.

The aim of this study was to evaluate the incidence of sexual dysfunction in women with obesity and overweight treated at the Professor Alberto Antunes University Hospital, Federal University of Alagoas (HUPAA - UFAL).

METHODS

This was a cross-sectional study conducted between March and October 2010 that evaluated female patients treated at outpatient basis at Nutrition clinic of Professor Alberto Antunes University Hospital - HUPAA / UFAL.

The study was approved by the Ethics in Research Committee of the Federal University of Alagoas, number 000440/2010-98.

All patients were informed about the questionnaire they would answer and signed an informed consent form.

We included women aged over 30 years with body mass index (BMI) e" 25Kg/m2. Patients undergoing treatment for current or prior sexual dysfunction or who had undergone radio and / or chemotherapy treatment were excluded.

Female sexual function was analyzed using the Female Sexual Function Index (FSDI). A validated Portuguese version was applied ⁸, which is a brief, self-administered questionnaire and assesses female sexual response as for sexual desire, sexual arousal, vaginal lubrication, orgasm, sexual satisfaction and pain.

The questionnaire consists of 19 questions and presents scores on each component. The response options are scored between '0 'and '5', increasingly, except in matters of pain, in which the score is inverted. The total score is the sum of scores for each domain multiplied by the corresponding factor and can vary from '2 'to '36', a total score £ 26 being considering risky for sexual dysfunction (Table 1).

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A survey of sexual function was followed by the acquisition of anthropometric data to assess body mass index (BMI) and waist circumference (WC). The cutoff points, according to the World Health Organization (WHO) are, for women: WC equal to or greater than 80 cm, which means an increased risk for metabolic complications; and WC equal to or greater than 88cm, which reflects a highly increased risk for metabolic complications.

BMI was calculated by dividing weight (kg) by the square of height (m²), considering normal values from 20 to 24.9 kg/m², overweight from 25 to 29.9 kg/m² and obesity e" 30Kg/m².

In all subjects the levels of blood glucose, total cholesterol and triglycerides were assessed.

RESULTS

We evaluated 23 women with a mean age of 44 years, range 30-65, and BMI e" 25Kg/m². Of these, 73.9% were obese and 82.6% had a highly increased risk for metabolic complications (WC e" 88 cm).

The prevalence of increased risk of sexual dysfunction was 78.3% of the patients. The average total FSDI score was 18.3, ranging from 3.2 to 34.2.

The most frequently found sexual dysfunctions in the study were the lack of desire (with a mean score of 2.8) and lack of arousal (mean score 2.4), while satisfaction and lubrication had the highest mean scores, of 3.5 and 3.3, respectively (Figure 1).

Among the patients with increased risk for sexual dysfunction (with a total score e" 26), all had at least one risk factor for sexual dysfunction, including high blood pressure (HT), diabetes mellitus (DM), dyslipidemia, cardiovascular disease (CVD) and smoking. Dyslipidemia and hypertension had a higher prevalence, with 61.1% and 33.3%, respectively (Figure 2).

DISCUSSION

Female sexual dysfunction has a multifactorial etiology, has a high prevalence and is rarely investigated by physicians, either due to embarrassment or to ignorance about the research methods. Although there are psychosocial factors and marital relationship difficulties that interfere with sexual response, there is evidence of a complex pathophysiology and, just recently, there has been a greater focus on women's sexual problems ^9-12. It is noteworthy that overweight and obesity are considered risk factors for male sexual dysfunction; the same relationship regarding sexual function in women remains unclear, though ¹³.

In this study, the prevalence of increased risk for sexual dysfunction was 78.3%, with an average total score of 18.3. These indices were comparable to the ones of another study, in which the frequency in patients with obesity and overweight was 86% and the mean total FSDI score was 22.1 ¹³.

The most frequent alterations were lack of desire and lack of arousal, with mean scores of 2.8 and 2.4, respectively. Desire and arousal disorders are among the most common problems in clinical practice, because there is a high correlation between both¹⁴. Nevertheless, in a survey of the Brazilian population ⁹, the main disorders are the absence of orgasm and lack of sexual desire, which is considered the most common sexual disorder among women.

Few studies have evaluated the relationship between FSDI and body weight. A search using the FSDI performed with obese patients and a control group showed that there is no statistically significant relationship between obesity and sexual dysfunction, which was present in 50 and 41% of obese patients and in the control group, respectively ^13,15.

All patients with increased risk for sexual dysfunction had at least one risk factor for the disorder, with a predominance of dyslipidemia (61.1%) and hypertension (33.3%). Risk factors for sexual disorders can be organic, psychosocial and sociodemographic, and affect women in different stages of life. Epidemiological studies show a correlation of dysfunction with hypertension, diabetes, hormonal deficiencies, cardiovascular disease, neurological disorders, alcoholism, smoking and use of drugs and medicines ¹⁶.

The investigation of sexual dysfunction in women with metabolic syndrome compared with a control group showed that patients with metabolic syndrome have a higher prevalence of sexual dysfunction, with reduced average FSDI total score (23.2), and satisfaction index (3.5) when compared to FSDI (30.1) and satisfaction index (4.7) in the control group. However, more research is needed to determine the impact of metabolic syndrome on female sexual function ¹¹.

In this context, the indices relating to sexual dysfunctions are diverse according to the methods of assessment (individual interview or questionnaire), to the population groups assessed and to diagnostic definitions ^9,10.

The change in lifestyle is an effective strategy to reduce the prevalence of sexual dysfunction in obese women, this way improving the endothelial function ¹⁷. Although obesity does not appear to represent one of the major contributing factors, it affects various aspects of sexuality, and the result analysis shows the need for better research and attention of physicians for patients with obesity and overweight.

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