- Email: [email protected]
O-70
post-test was completed 6 weeks after the last treatment date to allow time for the body to assimilate the changes and undergo a full menstrual cycle. RESULTS: Although the FSFI was designed to evaluate the relative degree of dysfunction within the individual domains, there is obvious overlap among the 6 categories. The Wilcoxon Sign-Rank Test (2-sided) was used on the paired post-test/pre-test differences. It showed a statistically significant improvement (P ⫽⬍0.001) on the overall full scale score, as well as on each of the 6 individual domains: Desire (p ⫽ 0.011); Arousal (p ⫽ 0.004); Lubrication (p ⫽ 0.001); Orgasm (p ⫽ 0.004); Satisfaction (p ⫽ 0.005); and Pain (p ⬍0.001). CONCLUSION: Many aspects of sexual dysfunction in patients with endometriosis appear to be treatable by a non-pharmaceutical, non-surgical pelvic physical therapy technique. The therapy should be considered as a new adjuvant to existing medical and gynecologic treatments. Supported by: None.
Monday, October 23, 2006 4:30 pm O-69 FACTORS ASSOCIATED WITH SEXUAL FUNCTION DURING THE MENOPAUSAL TRANSITION. C. R. Gracia, E. W. Freeman, M. D. Sammel, H. Lin, Penn Ovarian Aging Study Group. Univ of Pennsylvania, Philadelphia, PA. OBJECTIVE: Currently, the physiologic changes involved with sexual dysfunction among women during the late reproductive years have not been clearly defined; however, the etiology appears to be multi-factorial including psycho-social and physiologic factors. In preliminary studies, we have shown that fluctuation in total testosterone is associated with decreased sexual interest among a cohort of middle-aged women approaching menopause. The objective of this study was to further examine the relationship between reproductive hormonal dynamics and sexual function, assessed by a validated sexual function instrument among a cohort of women approaching the transition to menopause. DESIGN: Prospective Cohort Study. MATERIALS AND METHODS: This research is part of a well-established parent study, the Penn Ovarian Aging Study, which is a large-scale longitudinal study of over 400 healthy women between the ages of 35-47 examining the natural progression of ovarian function during the transition to menopause. For three years subjects were assessed at yearly intervals during the first 6 days of the menstrual cycle with hormone measurements (Estradiol, FSH, LH, SHBG, DHEAS, Total Testosterone), anthropometric measures, and extensive questionnaires including the Female Sexual Function Index. For the purposes of statistical analysis, the sexual function outcome was dichotomized due to its bimodal distribution, with a score less than 20 defining sexual dysfunction. Univariate analyses were first performed to assess the association between the hormones (i.e. mean, median, slope and variability) and other variables of interest and sexual function. Secondly, to adjust for the influence of other covariates, separate hormonespecific multivariable logistic regression models were created using a backwards elimination strategy to examine the influence of hormones on sexual function adjusting for the effect of potential confounders. Domains of sexual functioning were also analyzed. RESULTS: In univariate analyses, sexual dysfunction was significantly associated with low DHEAS levels, advanced menopausal stage, obesity, African American race, the presence of children under 18 years of age living at home, anxiety, depression, lack of a sexual partner, smoking, and alcohol use. No significant associations were noted between sexual function and other reproductive hormone levels or variability, including free testosterone. The final multivariable model revealed that sexual dysfunction increased with advanced menopausal status, with postmenopausal women being 2.3 times as likely to experience sexual dysfunction compared to premenopausal women. DHEAS levels were protective of sexual dysfunction (OR ⫽ 0.63, 95% CI 0.47-0.84) while factors associated with sexual dysfunction included absence of a sexual partner (11.2, 95% CI 6.9-18.1), high anxiety (3.8, 95% CI 1.6-9.2), and children under the age of 18 living at home (1.6, 95% CI 1.6-2.5). Lubrication, orgasm and pain were specific aspects of sexual functioning negatively affected by menopause. CONCLUSION: Several factors associated with decreased sexual function during the menopausal transition include: low DHEAS, absence of a sexual partner, anxiety, and children under the age of 18 living at home.
S30
Abstracts
Supported by: NIH, R01-AG-12745 and ACOG/Solvay Pharmaceuticals Research Award in Menopause.
Monday, October 23, 2006 4:45 pm O-70 SEXUAL FUNCTION, QUALITY OF LIFE AND THEIR CORRELATES IN THE FEMALE PARTNER OF INFERTILE COUPLES. J. P. Mulhall, A. Shindel, C. Naughton, M. Ohebshalom, C. Nelson. Weill Medical Coll of Cornell Univ & Memorial Sloan Kettering Cancer Center, New York, NY; Washington Univ Medical School, St. Louis, MO; Weill Medical Coll of Cornell Univ, New York, NY; Memorial Sloan Kettering Cancer Center, New York, NY. OBJECTIVE: Infertility has been associated with increased levels of anxiety and stress for both male and female partners. Little information exists on the association between infertility and depression or reduced QOL. This study was undertaken to define the impact of in fertility on the QOL, sexual health and depression status of women in infertile couples. DESIGN: Prospective, multi-center, analysis. MATERIALS AND METHODS: Couples presenting for the evaluation and treatment of infertility completed a series of validated inventories. The female member completed the Female Sexual Function Index (FSFI), CES-D for depression, SF-36 for quality of life and the self-esteem and relationship (SEAR) questionnaire. The male partner also completed QOL inventories and the international index of erectile function (IIEF). Demographic, fertility and comorbidity information was also recorded. Descriptive statistical analysis was performed and logistic regression was used to define predictors of questionnaire scores. RESULTS: 103 patients constitute the study population. Mean female and male age was 32⫾4.5 and 36⫾7 years respectively. 90% of couples were married. Mean duration of relationship and marriage were 39⫾36 and 23.5⫾34 months respectively. Mean duration of attempted conception was 13⫾14 months. On CES-D, 23% of women had moderate and 14% had severe depression. With regard to QOL, on the SF-36, women reported significantly worse Mental Health subscale scores (mean⫽47.8, p⬍0.05) compared to normative values. The mean FSFI score was 18.2⫾4 (maximum score of 36). The factors associated with FSFI scores included time to conceive (r⫽-0.22, p⬍0.05) and CES-D scores (r⫽0.24, p⬍0.05). The mean total SEAR score was 32.5⫾13.5 (maximum score of 70). Factors associated with total SEAR scores were: relationship duration (r⫽0.25, p⬍0.05), duration married (r⫽0.39, p⬍0.01), time trying to conceive (r⫽0.47, p⬍0.01), SF-36 mental health scores (r⫽-0.38, p⬍0.01), FSFI total scores(r⫽0.41, p⬍0.01), and male IIEF scores (r⫽-0.25, p⬍0.05). Multivariable analysis indicated that time to conceive, SF-36 mental health scores, FSFI total scores, and male sexual function scores were significant predictors of SEAR scores. CONCLUSION: These data indicate that women in infertile relationships have a significant incidence of mental health derangement and many have documented depression. Furthermore, there is a significant incidence of sexual dysfunction and reduced self-esteem which are impacted upon by relationship factors, fertility factors and male sexual function. Supported by: None.
Monday, October 23, 2006 5:00 pm O-71 SEXUALITY TALKS: DISPARITIES BETWEEN ASIAN AMERICANS AND CAUCASIANS. B. Kuang, N. Mahutte, K. Heyman, S. Ouhilal. Dartmouth Coll, Lebanon, NH; Dartmouth Medical School, Lebanon, NH. OBJECTIVE: To compare Asian American and Caucasian student experiences in speaking with their parents about sexuality and reproduction. DESIGN: Cross sectional survey of undergraduate students at an Ivy League institution.
Vol. 86, Suppl 2, September 2006
Monday, October 23, 2006 4:30 pm O-69 FACTORS ASSOCIATED WITH SEXUAL FUNCTION DURING THE MENOPAUSAL TRANSITION. C. R. Gracia, E. W. Freeman, M. D. Sammel, H. Lin, Penn Ovarian Aging Study Group. Univ of Pennsylvania, Philadelphia, PA. OBJECTIVE: Currently, the physiologic changes involved with sexual dysfunction among women during the late reproductive years have not been clearly defined; however, the etiology appears to be multi-factorial including psycho-social and physiologic factors. In preliminary studies, we have shown that fluctuation in total testosterone is associated with decreased sexual interest among a cohort of middle-aged women approaching menopause. The objective of this study was to further examine the relationship between reproductive hormonal dynamics and sexual function, assessed by a validated sexual function instrument among a cohort of women approaching the transition to menopause. DESIGN: Prospective Cohort Study. MATERIALS AND METHODS: This research is part of a well-established parent study, the Penn Ovarian Aging Study, which is a large-scale longitudinal study of over 400 healthy women between the ages of 35-47 examining the natural progression of ovarian function during the transition to menopause. For three years subjects were assessed at yearly intervals during the first 6 days of the menstrual cycle with hormone measurements (Estradiol, FSH, LH, SHBG, DHEAS, Total Testosterone), anthropometric measures, and extensive questionnaires including the Female Sexual Function Index. For the purposes of statistical analysis, the sexual function outcome was dichotomized due to its bimodal distribution, with a score less than 20 defining sexual dysfunction. Univariate analyses were first performed to assess the association between the hormones (i.e. mean, median, slope and variability) and other variables of interest and sexual function. Secondly, to adjust for the influence of other covariates, separate hormonespecific multivariable logistic regression models were created using a backwards elimination strategy to examine the influence of hormones on sexual function adjusting for the effect of potential confounders. Domains of sexual functioning were also analyzed. RESULTS: In univariate analyses, sexual dysfunction was significantly associated with low DHEAS levels, advanced menopausal stage, obesity, African American race, the presence of children under 18 years of age living at home, anxiety, depression, lack of a sexual partner, smoking, and alcohol use. No significant associations were noted between sexual function and other reproductive hormone levels or variability, including free testosterone. The final multivariable model revealed that sexual dysfunction increased with advanced menopausal status, with postmenopausal women being 2.3 times as likely to experience sexual dysfunction compared to premenopausal women. DHEAS levels were protective of sexual dysfunction (OR ⫽ 0.63, 95% CI 0.47-0.84) while factors associated with sexual dysfunction included absence of a sexual partner (11.2, 95% CI 6.9-18.1), high anxiety (3.8, 95% CI 1.6-9.2), and children under the age of 18 living at home (1.6, 95% CI 1.6-2.5). Lubrication, orgasm and pain were specific aspects of sexual functioning negatively affected by menopause. CONCLUSION: Several factors associated with decreased sexual function during the menopausal transition include: low DHEAS, absence of a sexual partner, anxiety, and children under the age of 18 living at home.
S30
Abstracts
Supported by: NIH, R01-AG-12745 and ACOG/Solvay Pharmaceuticals Research Award in Menopause.
Monday, October 23, 2006 4:45 pm O-70 SEXUAL FUNCTION, QUALITY OF LIFE AND THEIR CORRELATES IN THE FEMALE PARTNER OF INFERTILE COUPLES. J. P. Mulhall, A. Shindel, C. Naughton, M. Ohebshalom, C. Nelson. Weill Medical Coll of Cornell Univ & Memorial Sloan Kettering Cancer Center, New York, NY; Washington Univ Medical School, St. Louis, MO; Weill Medical Coll of Cornell Univ, New York, NY; Memorial Sloan Kettering Cancer Center, New York, NY. OBJECTIVE: Infertility has been associated with increased levels of anxiety and stress for both male and female partners. Little information exists on the association between infertility and depression or reduced QOL. This study was undertaken to define the impact of in fertility on the QOL, sexual health and depression status of women in infertile couples. DESIGN: Prospective, multi-center, analysis. MATERIALS AND METHODS: Couples presenting for the evaluation and treatment of infertility completed a series of validated inventories. The female member completed the Female Sexual Function Index (FSFI), CES-D for depression, SF-36 for quality of life and the self-esteem and relationship (SEAR) questionnaire. The male partner also completed QOL inventories and the international index of erectile function (IIEF). Demographic, fertility and comorbidity information was also recorded. Descriptive statistical analysis was performed and logistic regression was used to define predictors of questionnaire scores. RESULTS: 103 patients constitute the study population. Mean female and male age was 32⫾4.5 and 36⫾7 years respectively. 90% of couples were married. Mean duration of relationship and marriage were 39⫾36 and 23.5⫾34 months respectively. Mean duration of attempted conception was 13⫾14 months. On CES-D, 23% of women had moderate and 14% had severe depression. With regard to QOL, on the SF-36, women reported significantly worse Mental Health subscale scores (mean⫽47.8, p⬍0.05) compared to normative values. The mean FSFI score was 18.2⫾4 (maximum score of 36). The factors associated with FSFI scores included time to conceive (r⫽-0.22, p⬍0.05) and CES-D scores (r⫽0.24, p⬍0.05). The mean total SEAR score was 32.5⫾13.5 (maximum score of 70). Factors associated with total SEAR scores were: relationship duration (r⫽0.25, p⬍0.05), duration married (r⫽0.39, p⬍0.01), time trying to conceive (r⫽0.47, p⬍0.01), SF-36 mental health scores (r⫽-0.38, p⬍0.01), FSFI total scores(r⫽0.41, p⬍0.01), and male IIEF scores (r⫽-0.25, p⬍0.05). Multivariable analysis indicated that time to conceive, SF-36 mental health scores, FSFI total scores, and male sexual function scores were significant predictors of SEAR scores. CONCLUSION: These data indicate that women in infertile relationships have a significant incidence of mental health derangement and many have documented depression. Furthermore, there is a significant incidence of sexual dysfunction and reduced self-esteem which are impacted upon by relationship factors, fertility factors and male sexual function. Supported by: None.
Monday, October 23, 2006 5:00 pm O-71 SEXUALITY TALKS: DISPARITIES BETWEEN ASIAN AMERICANS AND CAUCASIANS. B. Kuang, N. Mahutte, K. Heyman, S. Ouhilal. Dartmouth Coll, Lebanon, NH; Dartmouth Medical School, Lebanon, NH. OBJECTIVE: To compare Asian American and Caucasian student experiences in speaking with their parents about sexuality and reproduction. DESIGN: Cross sectional survey of undergraduate students at an Ivy League institution.
Vol. 86, Suppl 2, September 2006