Sexual dysfunction in the climacteric period and associated factors / Disfunção sexual no climatério e fatores associados

Abstract Objectives: to evaluate associated factors with sexual dysfunction among middle-aged women. Methods: cross-sectional and analytical study was carried out with climacteric women attended at a Family Health Strategy Unit in the city of Montes Claros, MG. Brazil. The eligible women answered a question form containing sociodemographic, behavioral, anthropometric, gynecological factors and sexuality. The Body Mass Index and waist circumference were used to assess nutritional status and metabolic risk. To evaluate quality of life and sexual performance the Menopause Rating Scale and the Sexual Quotient - Female Version were used, respectively. Bivariate analysis and hierarchical multiple regression were used to identify associated factors with sexual dysfunction in the climacteric period. Results: among 195 women, 29.6% had sexual dysfunction. The prevalence of unsatisfactory sexual performance was higher among women who reported moderate to severe climacteric symptoms (OR=2.47) and lower schooling level was also associated (OR=1.95). However, age at menarche below 12 years (OR=0.43) and non-white (OR=0.36) seem to have a protective effect for good sexual performance. Conclusion: the prevalence of sexual dysfunction was high and the level of schooling and climacteric symptomatology were associated factors with this outcome.

Resumo Objetivos: avaliar os fatores associados à disfunção sexual entre as mulheres de meia-idade. Métodos: estudo de corte transversal e analítico realizado com mulheres climatéricas atendidas em uma Unidade de Estratégia de Saúde da Família no município de Montes Claros-MG, Brasil. As mulheres elegíveis responderam a um formulário contendo questões sociodemográficas, comportamentais, antropométricas, fatores ginecológicos e sexualidade. Utilizou-se o Índice e Massa Corporal e a circunferência da cintura para avaliar o estado nutricional e risco metabólico. Para avaliar a qualidade de vida e o desempenho sexual foram utilizados a Menopause Rating Scale e o Quociente Sexual -Versão Feminina, respectivamente. Empregou-se análise bivariada e regressão múltipla hierarquizada para identificar fatores associados à disfunção sexual no climatério. Resultados: dentre 195 mulheres, 29,6% apresentaram disfunção sexual. A prevalência de desempenho sexual insatisfatório foi maior entre as mulheres que declararam sintomas climatéricos moderados a graves (OR = 2,47) e o menor grau de escolaridade (OR = 1,95). No entanto, a idade da menarca abaixo de 12 anos (OR = 0,43) e a cor de pele não branca (OR = 0,36) parecem ter efeito protetor para o bom desempenho sexual. Conclusão: a prevalência de disfunção sexual foi elevada e o nível de escolaridade e a sintomatologia climatérica foram fatores associados a esse resultado.

Disfunción sexual en mujeres con lupus eritematoso sistémico / Sexual dysfunction in women with systemic lupus erythematosus

Introducción: la disfunción sexual (DS) es la alteración en una o varias de las fases de la actividad sexual. Puede culminar en frustración, dolor y disminución de la frecuencia de las relaciones sexuales. Objetivos: determinar la frecuencia de DS y analizar los factores asociados en pacientes con lupus eritematoso sistémico (LES). Materiales y métodos: se realizó un estudio de corte transversal. Se incluyeron pacientes femeninas con LES, entre 18 y 50 años, se excluyeron aquellas con síndrome de Sjögren, menopausia, depresión severa y analfabetas. Se evaluaron variables demográficas y de la enfermedad. Se aplicó la escala Depression Anxiety Stress Scale (DASS-21) y el Índice de Función Sexual Femenina (Female Sexual Function Index, FSFI). Se comparó con un grupo control sano. Resultados: se evaluaron 60 mujeres con LES y 63 controles. La prevalencia de DS en LES fue de 71,7% y hubo diferencias significativas en todos los dominios de la función sexual. El score total del FSFI en pacientes con LES fue menor al comparar con los controles. Según la escala DASS-21, estrés, ansiedad y depresión se observaron en al menos la mitad de mujeres lúpicas, sin embargo, no se encontró asociación entre estas variables y DS. Conclusiones: la prevalencia de DS en pacientes con LES fue elevada. Depresión, ansiedad y estrés no fueron determinantes en la presencia de DS.

Introduction: sexual dysfunction is the alteration in one or several phases of sexual activity. It can culminate in frustration, pain and a decrease in the frequency of sexual intercourse. Objectives: determine the frequency of sexual dysfunction and analyze associated factors in patients with SLE. Materials and methods: a descriptive cross-sectional study was conducted. We included patients with SLE, between 18 and 50 years of age, Secondary Sjogren's syndrome, menopause, severe depression and illiterate patients were excluded. Demographic and disease-related variables were studied. The Depression Anxiety Stress Scale (DASS-21), and the Female Sexual Function Index (FSFI) were applied. Results: sixty women with SLE and 63 controls were evaluated. The prevalence of SD in SLE was 71.7% and there were significant differences in all domains of sexual function. The total FSFI score in patients with SLE was lower when compared to controls. According to the DASS-21 scale, stress, anxiety and depression were observed in at least half of lupus women, however no association was found between these variables and SD. Conclusions: the prevalence of SD in patients with SLE was high. Depression, Anxiety, and Stress were not determinants in the presence of SD.

Sexual Function and Associated Factors in Postmenopausal Women / Função sexual e fatores associados em mulheres na pós-menopausa

Abstract Objective To assess the sexual function and associated factors in postmenopausal women. Methods This a descriptive, cross-sectional study with 380 women aged 40 to 65 years, users of public health services in 2019. Questionnaires were applied on demographic characteristics, on climacteric symptoms (menopause rating scale) and on sexual function (sexual quotient, female version). Bivariate andmultiple analyses by logistic regression were performed, with adjusted odds ratios (ORad) and 95% confidence intervals (95%CIs). Results More than half (243/64%) of the participating women were at risk of sexual dysfunction, with lower scores in the domains of sexual desire and interest, comfort, orgasm, and satisfaction. Women with a partner (ORad 2.07; 95%CI 1.03-4.17) and those who reported sleep problems (ORad 2.72; 95%CI 1.77-4.19), depressed mood (ORad 2.03; 95%CI 1.32-3.10), sexual complaints (ORad 8.16; 95%CI 5.06-13.15), and vaginal dryness (ORad 3.44; 95%CI 2.22-5.32) showed greater chance of sexual dysfunction. Conclusion There was a high prevalence of sexual dysfunction, with the influence of conjugality and climacteric symptoms on sexual function.

Resumo Objetivo Avaliar a função sexual e fatores associados em mulheres na pósmenopausa. Métodos Este é umestudo descritivo, transversal, com380 mulheres de 40 a 65 anos, usuárias de serviços de saúde públicos em 2019. Foram aplicados questionários sobre características demográficas, sobre sintomas climatéricos (menopause rating scale) e sobre a função sexual (Quociente Sexual, versão feminina). Análises bivariada e múltipla por regressão logística foram realizadas, com cálculo de odds ratio ajustado (ORaj) e intervalos de confiança de 95% (ICs95%). Resultados Mais da metade (243/64%) das mulheres participantes no estudo apresentou risco de disfunção sexual, com escores mais baixos dos domínios desejo e interesse sexual, conforto, orgasmo e satisfação. Mulheres com companheiro (ORaj 2,07; IC95% 1,03-4,17) e aquelas que relataram problemas de sono (ORaj 2,72; IC95% 1,77-4,19), ânimo depressivo (ORaj 2,03; IC95% 1,32-3,10), queixas sexuais (ORaj 8,16; IC95% 5,06-13,15) e ressecamento vaginal (ORaj 3,44; IC95% 2,22-5,32) apresentaram maior chance de disfunção sexual. Conclusão Houve prevalência elevada de disfunção sexual, com influência da conjugalidade e dos sintomas climatéricos sobre a função sexual.

Disfunción sexual en mujeres de 60 años y más / Sexual dysfunction in women age 60 and older

La sexualidad es un aspecto importante en la calidad de vida de la mujer, sin embargo, los estudios sobre sexualidad dedicados a las mujeres de 60 años y más son escasos. El objetivo de este estudio fue determinar la prevalencia de la disfunción sexual femenina y sus dominios en mujeres de 60 años y más, e identificar la asociación entre enfermedades asociadas y consumo de medicamentos con la disfunción sexual. Se realizó un estudio descriptivo y transversal, en mujeres de 60 años y más, de La Habana, Cuba. Participaron 112 mujeres a las cuales se les aplicaron dos encuestas: el Índice de Función Sexual Femenino (IFSF) y otra que recogía antecedentes médicos y sociales. El 66,1% de las mujeres presentó algún grado de disfunción sexual, la prevalencia aumentaba con la edad. Los dominios más afectados fueron el deseo, la excitación y la lubricación. Se identificó una fuerte asociación entre la enfermedad de Parkinson, la depresión y la artrosis con la aparición de disfunción sexual en la población estudiada, así como el uso de antidepresivos, hipoglicemiantes orales y diuréticos. La disfunción sexual estuvo presente en el 100% de las mujeres octogenarias. Todas las mujeres con enfermedad de Parkinson presentaron disfunción sexual.

Sexuality is an important aspect in women's quality of life, however, sexuality studies dedicated to women age 60 and older are scarce. The objective of this study was to determine the prevalence of female sexual dysfunction and its domains in women age 60 and older, and to identify the association between diseases and drug use with sexual dysfunction. A descriptive and cross-cutting study was conducted, in women 60 years and older, in Havana, Cuba. Two surveys participated in 112 women: The Female Sexual Function Index (IFSF) and another who collected a medical and social history. 66.1% of women had some degree of sexual dysfunction, the prevalence increased with age. The domains most affected were desire, excitement, and lubrication. A strong association between Parkinson's disease, depression and osteoarthritis was identified with the onset of sexual dysfunction in the studied population, as well as the use of antidepressants, oral hypoglycemics and diuretics. Sexual dysfunction was present in 100% of octogenary women. All women with Parkinson's disease had sexual dysfunction.

Disfunção sexual em mulheres adultas atendidas no serviço de ginecologia do hospital universitário / Sexual dysfunction in adultwomen attended in the gynecology service of university hospital / Disfunción sexual en mujeres adultas atendidas en el servicio de ginecología del hospital universitario

Objetivo: Descrever o perfil sóciodemográfico, sexual e reprodutivo, e a prevalência da disfunção sexual em mulheres adultas atendidas do Hospital Universitário. Método: estudo quantitativo, descritivo e transversal. Avaliaram-se 267 mulheres adultas entre 25 e 49 anos com pelo menos uma relação sexual na vida. Resultados:constatou-se associação significativa das disfunções sexuais femininas com coitarca menor que 15 anos, frequência de uma relação sexual mensal ou menos e lactação. A prevalência de dispaurenia foi encontrada em 30,3% das entrevistadas e vaginismo em 26,2 %. Conclusão: percebe-se que medidas preventivas minimizam a ocorrência das disfunções como: facilitar o acesso à informação, promoção e prevenção de saúde, e programas de capacitação e educação permanente. É importante construir uma abordagem holística e esforço multidisciplinar, visto que a disfunção sexual feminina constitui um largo espectro de dificuldades

Objective:To describe the sociodemographic, sexual and reproductive profile, the prevalence of sexual dysfunction in adult women attended at the University Hospital. Method:quantitative, descriptive and cross-sectional study. Total of 267 adult women between the ages of 25 and 49 with at least one sexual intercourse were evaluated. Results: there was a significant association of female sexual dysfunction with coitarca younger than 15 years, frequency of monthly or less sexual intercourse, and lactation. The prevalence of dyspaurenia was found in (30.3%) of the interviewees and vaginismus in (26.2%). Conclusion: noticed that preventive measures minimize the occurrence of dysfunctions such: facilitating access to information, promotion and prevention of health, training and continuing education programs. Is important to build holistic approach and multidisciplinary effort, since female sexual dysfunction constitutes broad spectrum of difficulties

Objetivo: Describir el perfil sociodemográfico, sexual y reproductivo, la prevalencia de la disfunción sexual en mujeres adultas atendidas del Hospital Universitario. Método: estudio cuantitativo, descriptivo y transversal. Evaluaron 267 mujeres adultas entre 25 y 49 años con menos una relación sexual en vida. Resultados: se constató una asociación significativa de las disfunciones sexuales femeninas con coito menor de 15 años, frecuencia de una relación sexual mensual o menos y lactancia. La prevalencia de dispaurenia fue encontrada em (30,3%) de entrevistadas y el vaginismo (26,2%). Conclusión: percibe que medidas preventivas minimizan la ocurrencia de las disfunciones como: facilitar el acceso a información, promoción y prevención de salud, programas de capacitación y educación permanente. Es importante construir enfoque holístico y esfuerzo multidisciplinario, ya que la disfunción sexual femenina constituye un amplio espectro de dificultades

Sexo e gravidez de alto risco: uma comparação da função sexual entre segundo e terceiro trimestres / High-risk sex and pregnancy: a comparison of sexual function between second and third trimesters

Objetivo: Esta pesquisa teve como objetivo avaliar o impacto da gestação sobre a função sexual feminina, comparando se houve diferença significativa entre os dois últimos trimestres gestacionais. Métodos: Foi realizada no serviço de Ginecologia e Obstetrícia do Hospital Universitário Evangélico Mackenzie, por meio do questionário Female Sexual Function Index (IFSF). Cento e quinze pacientes foram divididas em dois grupos (T2, correspondente ao segundo trimestre gestacional; T3, correspondente ao terceiro trimestre gestacional), apresentando taxa de disfunção sexual de 47,8%, prevalente em gestantes do grupo T3. Resultados: Houve diferen- ça significativa, entre o segundo e o terceiro trimestre, nas médias do IFSF e nas variáveis excitação, orgasmo e dor, resultando em disfunção sexual prevalente em gestantes do terceiro trimestre gestacional. Conclusão: Não houve diferença significativa nas variáveis desejo, lubrificação e satisfação.(AU)

Objective: The objective of this study was to evaluate the impact of pregnancy on female sexual function, comparing if there was significant difference between the last two gestational trimester. Methods: The research was accomplished in the Gynecology and Obstetrics of Mackenzie Evangelical University Hospital, applying the Female Sexual Function Index (IFSF). One hundred and fifteen patients were combined in two groups (T2 corresponding the second gestational trimester; T3 corresponding the third one), with sexual dysfunction rate of 47.8%, mainly the T3 group. Results: The IFSF's average between the second and the third gestational trimester was significantly different, also the sexual arouse, orgasm and pain variables are higher in the second trimester resulting in sexual dysfunction mostly of pregnant women in the third gestational trimester. Conclusion: The desire, lubrication and satisfaction variables did not have significant difference.(AU)

Prevalencia y caracterización de disfunciones sexuales masculinas en el personal de la Unidad Académica de Salud y Bienestar de la Universidad Católica de Cuenca, año 2019 / Prevalence and characterization of male sexual dysfunctions in the staff of the Academic Unit of Health and Welfare of the Catholic University of Cuenca, 2019

Objetivo: determinar la prevalencia y caracterizar la disfunción sexual masculina en el personal docente y administrativo de la Unidad Académica de Salud y Bienestar de la Universidad Católica de Cuenca en el 2019. Metodología: estudio cuantitativo, observacional y transversal. Se encuestaron a 114 varones que cumplieron los criterios de inclusión. El análisis se realizó mediante estadística descriptiva, para variables cuantitativas se empleó media y desviación estándar y para las cualitativas frecuencias y porcentajes. Resultados: la prevalencia de disfunciones sexuales masculinas fue de 75.4%. Un 60.5% tuvieron edades entre 20 a 39 años, 60.5% estaban casados, 87.2% religión católica, 67.4% eran docentes. Según trastornos del deseo, el 27.9% presentó hiperactividad masculina, el 18.6% fobia y un 9.3% hipoactividad; según los trastornos de excitación, el 53.5% presentó disfunción eréctil, siendo un 93.5% leve. El trastorno orgásmico y la dispareunia masculina se presentó en el 30.2% y el 29.1% respectivamente. Conclusiones: la prevalencia de disfunciones sexuales fue elevada en comparación con la bibliografía consultada

Objective: to determine the prevalence and characterize male sexual dysfunction in the teaching and administrative staff of the Academic Unit of Health and Welfare of the Catholic University of Cuenca in 2019. Methodology: It is a quantitative, observational and cross-sectional study. A total of 114 men who met the inclusion criteria were surveyed. The analysis was performed using descriptive statistics; mean and standard deviation were used for quantitative variables, and frequencies and percentages for the qualitative variables. Results: the prevalence of male sexual dysfunctions was 75.4%. The 60.5% were between 20 and 39 years old, 60.5% were married, 87.2% were Catholic, and 67.4% were teachers. According to desire disorders, 27.9% presented male hyperactivity, 18.6% phobia and 9.3% hypoactivity; according to arousal disorders, 53.5% presented erectile dysfunction, 93.5% being mild. Orgasmic disorder and male dyspareunia occurred in 30.2% and 29.1% respectively. Conclusions: the prevalence of sexual dysfunctions was high compared to the literature consulted

Impacto del embarazo en la sexualidad de las gestantes del eje cafetero (COLOMBIA) / Impact of pregnancy on the sexuality of pregnant women in the eje cafetero (COLOMBIA)

OBJETIVO: determinar la prevalencia de disfunciones sexuales en gestantes del Eje Cafetero (COLOMBIA), y evaluar su impacto en la sexualidad durante cada trimestre. MATERIAL Y MÉTODOS: estudio observacional prospectivo, de carácter descriptivo; realizado en tres clínicas privadas de nivel III en el Eje Cafetero, Colombia. Se incluyeron mujeres mayores de 18 años, con diagnóstico confirmado de embarazo en el primer trimestre, sin infecciones de transmisión sexual, embarazo de un solo feto, pareja estable y sin contraindicaciones para la actividad sexual. El muestreo fue consecutivo por conveniencia. Se aplicó el Índice de Función Sexual Femenina (IFSF) como instrumento. Se midieron variables socio-demográficas, antecedentes de salud sexual y reproductiva, y por tipo de disfunción sexual evaluada. Los datos fueron procesados con el programa de análisis estadístico SPSS, versión 19. RESULTADOS: Se analizaron 1440 gestantes. La edad media fue de 24,9 ± 6,57 años. La puntuación media del IFSF, en la población total, fue de 29,47 ± 5,48 puntos (mínimo 9,71 y máximo 30,58). La prevalencia de disfunciones sexuales en el grupo estudiado, en el primer trimestre, fue del 39,79 %, en el segundo 44,37 % y 71,87 % en el tercero. La disfunción sexual presente con más frecuencia, en la población total, fue el trastorno del deseo (71,94 %), seguido por la alteración del orgasmo (39,79 %) y, en tercer lugar, la presencia de dolor (26,45%). La satisfacción sexual disminuyó 20,62 %. CONCLUSIONES: en las mujeres del Eje Cafetero se observa un revelador impacto del embarazo en la sexualidad, lo que puede tener efectos negativos sobre el bienestar general y en la relación de pareja. Se presenta una prevalencia de disfunciones sexuales cercana a las ¾ partes de la población estudiada, caracterizadas principalmente por trastornos del deseo y del orgasmo.

OBJECTIVE: to determine the prevalence of sexual dysfunctions in pregnant women of the Coffee Axis, and to evaluate their impact on sexuality during each quarter. MATERIAL AND METHODS: prospective observational study, descriptive in nature; carried out in three private level III clinics in the Coffee Region, Colombia. Women over 18 years of age, with a confirmed diagnosis of pregnancy in the first trimester, without sexually transmitted infections, pregnancy with a single fetus, stable partner and without contraindications for sexual activity were included. The sampling was consecutive for convenience. The Index of Female Sexual Function (IFSF) was applied as an instrument. Socio-demographic variables, sexual and reproductive health history, and by type of sexual dysfunction evaluated were measured. The data were processed with the statistical analysis program SPSS, version 19. RESULTS: 1440 pregnant women were analyzed. The mean age was 24.9 ± 6.57 years. The mean IFSF score in the total population was 29.47 ± 5.48 points (minimum 9.71 and maximum 30.58). The prevalence of sexual dysfunctions in the studied group, in the first trimester, was 39.79%, in the second 44.37% and 71.87% in the third. The sexual dysfunction most frequently present in the total population was desire disorder (71.94%), followed by alteration of orgasm (39.79%) and, in third place, the presence of pain (26, Four. Five%). Sexual satisfaction decreased 20.62%. CONCLUSIONS: a revealing impact of pregnancy on sexuality is observed in women from the Coffee Region, which can have negative effects on general well-being and on the couple relationship. There is a prevalence of sexual dysfunctions close to ¾ parts of the population studied, characterized mainly by desire and orgasm disorders.

Evaluation of obesity influence in the sexual function of postmenopausal women: A cross- sectional study / Avaliação da influência da obesidade na função sexual de mulheres após a menopausa: um estudo transversal

Abstract Objective The incidence of obesity, which is a chronic condition, has increased in recent years. The association between obesity and female sexual dysfunction remains unclear, particularly in postmenopausal women. In the present study, we evaluated whether obesity is a risk factor for sexual dysfunction in postmenopausal women. Methods This is a cross-sectional study that analyzed data from interviews of postmenopausal women at the Climacteric Outpatient Clinic from 2015 to 2018. After applying the inclusion and exclusion criteria, 221 women aged between 40 and 65 years old were selected and invited to participate in the study. Obesity was diagnosed according to body mass index (BMI). The participants were grouped into the following BMI categories: group 1, 18.5-24.9 kg/m2 (normal); group 2, 25.0- 29.9 kg/m2 (overweight); and group 3, ≥30.0 kg/m2 (obese). Sexual function was assessed using the Female Sexual Function Index (FSFI) questionnaire. Cutoff points of ≥23 and ≥26.5 were adopted to define a diagnosis of female sexual dysfunction (FSD) based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision by the American Psychiatric Association (DSM-IV-TR). Results The desire and arousal scores were statistically higher in the normal BMI group than in the obese group (p=0.028 and p=0.043, respectively). The satisfaction scores were statistically higher in the normal BMI group than in the overweight and obese groups (p<0.05). The total FSFI score statistically differed among the BMI categories (p=0.027). Conclusion In the present study, obese and overweight postmenopausal women had higher total scores than women with normal BMI. Our results show that obese and overweight postmenopausal women had a higher index of dysfunction in desire and arousal and lower sexual satisfaction than normal-weight women.

Resumo Objetivo A incidência de obesidade, que é uma condição crônica, aumentou nos últimos anos. A associação entre obesidade e disfunção sexual feminina ainda não está clara, particularmente emmulheres após amenopausa. No presente estudo, avaliamos se a obesidade é um fator de risco para disfunção sexual em mulheres após a menopausa. Métodos Este é umestudo transversal que analisou dados de entrevistas demulheres após a menopausa no Ambulatório de Climatério a partir de 2015 até 2018. Após a aplicação dos critérios de inclusão e exclusão, 221 mulheres com idade entre 40 e 65 anos foram selecionadas e convidadas a participar do estudo. Obesidade foi diagnosticada de acordo com o índice de massa corpórea (IMC). Os participantes foram agrupados nas seguintes categorias de IMC: grupo 1: 18,5-24,9 kg/m2 (normal); grupo 2: 25,0-29,9 kg/m2 (sobrepeso); e grupo 3: ≥30,0 kg/m2 (obesidade). A função sexual foi avaliada através do questionário Female Sexual Function Index (FSFI, na sigla em inglês). Pontos de corte de ≥23 e ≥26,5 foram adotados para definir um diagnóstico de disfunção sexual feminina (DSF) com base no Manual de Diagnóstico e Estatística das Perturbações Mentais, 4ª Edição, Texto Revisto DSM-IV-TR. Resultados Os escores de desejo e excitação foram estatisticamente maiores no grupo com IMC normal do que no grupo obesidade (p=0,028 e p=0,043, respectivamente). Os escores de satisfação foram estatisticamente maiores no grupo com IMC normal do que nos grupos comsobrepeso e obesidade (p<0,05). A pontuação total do FSFI diferiu estatisticamente entre as categorias de IMC (p=0,027). Conclusão No presente estudo,mulheres após a menopausa obesas e com sobrepeso tiveram escores totais mais altos do que mulheres com IMC normal. Nossos resultados mostram que mulheres obesas e com sobrepeso após a menopausa apresentaram índices mais altos de disfunção no desejo e excitação e menor satisfação sexual do que mulheres com peso normal.

Prevalence of sexual dysfunctions and their associated factors in pregnant women in an outpatient prenatal care clinic / Prevalência de disfunções sexuais e seus fatores associados em gestantes de uma clínica de pré-natal

Abstract Objective To determine the prevalence of sexual dysfunction and its associated factors in pregnant women. Methods A descriptive, cross-sectional study including 262 pregnant women aged 18 years or older with gestational age between 10 and 35 weeks. Women with urinary tract infections and conditions of gestational risk were excluded. The Pregnancy Sexual Response Inventory (PSRI) questionnaire was used. We performed a univariate descriptive analysis, and comparisons between the mean values of the sexual function domains were made using the Student t-test. The chi-squared test was used to determine the association between the independent and dependent variables. The prevalence ratios, with their respective 95% confidence intervals, were also estimated, and a multivariate analysis was performed. Results A total of 64.9% of women reported a decrease in the frequency of sexual activity during pregnancy. Slightly more than half of the women (50.8%) were satisfied, and arousal was reported as excellent/good by 30.5% of them. The frequency of sexual difficulties/dysfunctions increased with pregnancy, rising from 5.7% to 58.8%, and pain during sexual intercourse was reported by 45.8% of them. Having higher education degree decreased the chance of being sexually dissatisfied by 50%. The total PSRI score showed a significant decrease from the prepregnancy period (mean score = 89.8, "excellent") to the pregnancy period (mean score = 59.2, "good"). Conclusion The mean sexual function score during pregnancy was classified as good, although most pregnant women reported at least one type of alteration in the sexual function domains, and the report of dissatisfaction was more frequent in women with lower schooling.

Resumo Objetivo Determinar a prevalência e fatores associados de disfunção sexual emgestantes. Métodos Estudo descritivo, transversal, incluindo 262 gestantes com idade de 18 anos ou mais, e idade gestacional entre 10 e 35 semanas. Mulheres com infecção de trato urinário e gestação de alto risco foram excluídas. O Inventário de Resposta Sexual na Gestação (Pregnancy Sexual Response Inventory, PSRI) foi utilizado. Procedeu-se à análise univariada, e as comparações entre as médias dos domínios de função sexual foram avaliadas pelo teste t de Student. Associações entre as variáveis dependentes e independentes foram determinadas por teste do qui-quadrado. Também estimou-se a razão de prevalência, com intervalo de confiança de 95%, e realizou-se análise multivariada. Resultados Um total de 64,9% das mulheres relataram diminuição na frequência de atividade sexual durante a gravidez. Pouco mais da metade das mulheres (50,8%) estavam satisfeitas, e a excitação foi relatada como excelente/boa por 30,5% delas. A frequência de dificuldades/disfunções sexuais aumentou com a gravidez, subindo de 5,7% para 58,8%, e dor na relação sexual foi relatada por 45,8% delas. Ter Ensino Superior diminuiu em 50% a chance de insatisfação sexual. O escore total do PSRI diminuiu significativamente entre o período pré-gestacional (escore médio = 89,8, "excelente") e o período gestacional (escore médio = 59,2, "bom"). Conclusão O escoremédio da função sexual durante a gestação foi classificado como bom, embora a maioria das gestantes tenha relatado pelo menos um tipo de alteração nos domínios da função sexual. O relato de insatisfação foi mais frequente nas mulheres de baixa escolaridade.

Lower urinary tract symptoms and sexual dysfunction in men with multiple sclerosis

OBJECTIVES: To assess the prevalence and interrelationship between lower urinary tract symptoms and sexual dysfunction in men with multiple sclerosis (MS). METHODS: In a cross-sectional study, we evaluated 41 men (mean age 41.1±9.9 years) with MS from February 2011 to March 2013, who were invited to participate irrespective of the presence of lower urinary tract symptoms or sexual dysfunction. Neurological impairment was assessed with the Expanded Disability Status Scale; lower urinary tract symptoms were evaluated with the International Continence Society male short-form questionnaire, and sexual dysfunction was evaluated with the International Index of Erectile Function. All patients underwent transabdominal urinary tract sonography and urine culture. RESULTS: The mean disease duration was 10.5±7.3 years. Neurological evaluation showed a median Expanded Disability Status Scale score of 3 [2-6]. The median International Continence Society male short-form questionnaire score was 17 [10-25]. The median International Index of Erectile Function score was 29 [15-46]. Twenty-nine patients (74.4%) had sexual dysfunction as defined by an International Index of Erectile Function score <45. Voiding dysfunction and sexual dysfunction increased with the degree of neurological impairment (r=0.02 [0.02 to 0.36] p=0.03 and r=-0.41 [-0.65 to -0.11] p=0.008, respectively). Lower urinary tract symptoms and sexual dysfunction also displayed a significant correlation (r=-0.31 [-0.56 to -0.01] p=0.04). CONCLUSIONS: Most male patients with MS have lower urinary tract symptoms and sexual dysfunction. The severity of the neurological disease is a predictive factor for the occurrence of voiding and sexual dysfunctions.

O impacto da disfunção sexual na qualidade de vida feminina: um estudo observacional / The impact of sexual dysfunction on the quality of life of women: an observational study

INTRODUÇÃO: A saúde sexual envolve diversos componentes em relação à sexualidade, como biológico, cultural, psicológico e social. Quando alguns desses fatores são atingidos, pode-se originar um quadro de disfunção sexual. OBJETIVO: investigar a qualidade de vida em mulheres com disfunção sexual. MATERIAIS E MÉTODOS: Estudo observacional comparativo, de corte transversal, realizado em mulheres de 18 a 59 anos do CAAP da EBMSP. Excluídas: mulheres com histórico de doença psiquiátrica grave, portadoras de doenças crônico-degenerativas neurológicas, com dispareunia de causas orgânicas, em tratamento fisioterapêutico e gestantes. Foi utilizado a FSFI ≥ 26 para o grupo com disfunção e < 26 para o grupo comparação. Instrumentos de avaliação aplicados: FSFI e 36-Item Short-Form Health Survey (SF-36). A comparação das medianas dos domínios do SF-36 e FSFI entre os grupos foi realizada pelo teste Mann-Whitney (teste não paramétrico), e das variáveis categóricas com a disfunção sexual foi feita a partir do teste qui-quadrado. RESULTADOS: Amostra 36 paciente,18 em cada grupo. As variáveis sociodemográficas e clínicas que apresentaram diferença estatística foram renda (0,001) e escolaridade (0,011). No FSFI, todos os domínios apresentaram significância (0,00). No SF-36, ao comparar os dois grupos, 06 domínios apresentaram significância estatística. CONCLUSÃO: Os resultados mostram que mulheres com disfunção sexual apresentam um impacto negativo em alguns dos aspectos da qualidade de vida. Importante salientar que, a escolaridade e a renda familiar não foram homogêneas entre os grupos, sendo assim, diante da característica do estudo, não é possível aferir relação causa e consequência na disfunção sexual com a qualidade vida das participantes. [AU]

INTRODUCTION: Sexual health involves several components in relation to sexuality, such as biological, cultural, psychological and social. When some of these factors are reached, a picture of sexual dysfunction may result. OBJECTIVE: To investigate quality of life in women with sexual dysfunction. MATERIALS AND METHODS: A cross-sectional, observational, observational study of 18- to 59-year-old women from the EBMSP CAAP. Excluded: women with a history of severe psychiatric illness, carriers of neurological chronic degenerative diseases, with dyspareunia of organic causes, in physiotherapeutic treatment and pregnant women. FSFI ≥ 26 was used for the group with dysfunction and <26 for the comparison group. Assessment instruments applied: FSFI and 36-Item Short-Form Health Survey (SF-36). The comparison of the medians of the SF-36 and FSFI domains between the groups was performed by the Mann-Whitney test (non-parametric test), and the categorical variables with the sexual dysfunction were done using the chi-square test. RESULTS: Sample 36 patient, 18 in each group. The sociodemographic and clinical variables that presented statistical difference were income (0.001) and schooling (0.011). In the FSFI, all domains presented significance (0.00). In the SF-36, when comparing the two groups, 06 domains presented statistical significance. CONCLUSION: The results show that women with sexual dysfunction have a negative impact on some aspects of quality of life. It is important to emphasize that schooling and family income were not homogeneous between the groups, so, due to the characteristics of the study, it is not possible to measure cause and consequence relationship in sexual dysfunction with quality of life of the participants. [AU]

Hypertension as a risk factor for female sexual dysfunction: cross-sectional study / Hipertensão como fator de risco para disfunção sexual feminina: estudo transversal / La hipertensión como un factor de riesgo para la disfunción sexual femenina: estudio transversal

ABSTRACT Objective: to evaluate the sexual dysfunction in hypertensive patients compared to normotensive patients. Method: this was a cross-sectional study. Samples were composed of 54 hypertensive patients and 54 normotensive patients. The female sexual dysfunction was evaluated by the Female Sexual Function Index (FSFI). Results: the average FSFI score differed highly between hypertensive and normotensive patients (22.4± 7.4 versus 26.8 ±5.4, p< 0.001). Among hypertensive patients, 63% showed sexual dysfunction in opposition to 39% of normotensive patients (p=0.02). Hypertensive women had 1.67 more chances of showing the dysfunction than women with normal blood pressure. Conclusion: the sexual dysfunction prevalence is higher in hypertensive than in normotensive women hence, hypertension is a potentiator factor for female sexual dysfunction.

RESUMO Objetivo: avaliar a disfunção sexual em pacientes hipertensas em comparação com pacientes normotensas. Método: estudio transversal. Las muestras estaban compuestas por 54 pacientes hipertensos y 54 normotensos. La disfunción sexual femenina fue evaluada por el Índice de Función Sexual Femenina (FSFI). Resultados: a pontuação média do FSFI foi muito diferente entre pacientes hipertensas e normotensas (22,4 ± 7,4 versus 26,8 ± 5,4, p <0,001). Da amostra de pacientes hipertensas, 63% apresentaram disfunção sexual, ante 39% da amostra de pacientes normotensas (p=0,02). As mulheres hipertensas apresentaram 1,67 vezes mais chances de ter a disfunção do que mulheres com pressão arterial normal. Conclusão: a prevalência de disfunção sexual é maior em mulheres hipertensas do que em mulheres normotensas. Portanto, a hipertensão é um fator que potencializa a disfunção sexual feminina.

RESUMEN Objetivo: evaluar la disfunción sexual en pacientes hipertensos en comparación con pacientes normotensos. Método: estudio transversal. Las muestras estaban compuestas por 54 pacientes hipertensos y 54 normotensos. La disfunción sexual femenina fue evaluada por el Índice de Función Sexual Femenina (FSFI). Resultados: el puntaje FSFI promedio fue muy diferente entre pacientes hipertensos y normotensos (22.4±7.4 versus 26.8 ± 5.4, p<0.001). El 63% de los pacientes de la muestra de hipertensos demonstraron disfunción sexual, en oposición al 39% de la muestra de pacientes normotensos (p=0,02). Las mujeres hipertensas presentaron 1.67 más posibilidad de mostrar la disfunción que las mujeres con presión arterial normal. Conclusión: la prevalencia de disfunción sexual es mayor en mujeres hipertensas que en mujeres normotensas. Entonces, la hipertensión es un potenciador de la disfunción sexual femenina.

Self-reported assessment of female sexual function among Brazilian undergraduate healthcare students: a cross-sectional study (survey)

ABSTRACT BACKGROUND: The present study aimed to evaluate female sexual function among young undergraduate women. DESIGN AND SETTING: Cross-sectional survey conducted among Brazilian undergraduate students. METHODS: This study used online questionnaires to assess sociodemographic and health-related data and used the Brazilian version of the Female Sexual Function Index (FSFI) among female undergraduate students aged 18 to 25 years who were regularly enrolled in undergraduate healthcare courses. The FSFI is composed of 19 items that measure female sexual function over the last four weeks, in six domains: desire and subjective stimulation, sexual arousal, lubrication, orgasm, satisfaction and pain or discomfort. RESULTS: Among the 149 female undergraduate students evaluated, 43 (28.8%) presented sexual dysfunction (score < 26.55). Health conditions were not associated with female sexual dysfunction. Among the women with sexual dysfunction, all domains of the sexual response cycle were affected (P < 0.001). CONCLUSIONS: Sexual dysfunction was identified in at least a quarter of these young undergraduate women and it was not associated with gynecological problems, menstrual cycles, dysmenorrhea, contraceptive use or physical activity.

Sexual function of undergraduate women: a comparative study between Brazil and Italy / La función sexual de universitarias: estudio comparativo entre Brasil e Italia / Função sexual de universitárias: estudo comparativo entre Brasil e Itália

ABSTRACT Objective: to evaluate the sexual function of Italian and Brazilian nursing students using the Female Sexual Function Index (FSFI), to estimate the prevalence of sexual dysfunctions and related factors. Method: this is a cross-sectional study involving 84 Brazilian and 128 Italian undergraduate. For the evaluation of sexual function, the Female Sexual Function Index (FSFI) questionnaire was used. Results: Italian women presented significantly higher sexual dysfunction index (n=78/60.9%) than the Brazilian women (n=32/38.1%) (p=0.00). Only the "desire" and "excitation" domains showed no difference between groups. Younger, single and without a steady relationship women had a higher rate of sexual dysfunction (p<0.05). Conclusion: the high rate of sexual dysfunction in a young public suggests the need for more research to increase knowledge about the influence of psychosocial and related factors on female sexual function, directing care towards the promotion of sexual and reproductive health.

RESUMEN Objetivo: evaluar la función sexual de académicas italianas y brasileñas de enfermería utilizando el Female Sexual Function Index (FSFI), estimar el predominio de las disfunciones sexuales y los factores relacionados. Método: estudio transversal, de lo cual participaron 212 universitarias, siendo 84 brasileñas y 128 italianas. Para evaluar la función sexual, se utilizó el cuestionario Female Sexual Function Index(FSFI). Resultados: Las italianas presentaron índice de disfunción sexual significativamente superior (n=78/60,9%) en comparación con el de las brasileñas (n=32/38,1%) (p=0,00). Sólo los dominios "deseo" y "excitación" no presentaron diferencia entre los grupos. Las mujeres más jóvenes, solteras y sin relación estable presentaron un índice de disfunción sexual más alto (p<0,05). Conclusión: el elevado índice de disfunción sexual en un público tan joven sugiere la necesidad de realizar más investigaciones que incrementen el conocimiento sobre la influencia de los factores psicosociales y relacionales en la función sexual femenina, dirigiendo el cuidado para la promoción de la salud sexual y reproductiva.

RESUMO Objetivo: avaliar a função sexual de acadêmicas de enfermagem italianas e brasileiras utilizando o Female Sexual Function Index (FSFI), estimar a prevalência das disfunções sexuais e os fatores relacionados. Método: estudo transversal, o qual participaram 212 universitárias, sendo 84 brasileiras e 128 italianas. Para a avaliação da função sexual, empregou-se o questionário Female Sexual Function Index (FSFI). Resultados: As italianas apresentaram índice de disfunção sexual significativamente superior (n=78/60,9%) do que as brasileiras (n=32/38,1%) (p=0,00). Apenas os domínios "desejo" e "excitação" não apresentaram diferença entre os grupos. As mulheres mais jovens, solteiras e sem relacionamento estável apresentaram índice de disfunção sexual maior (p<0,05). Conclusão: o elevado índice de disfunção sexual em um público tão jovem sugere a necessidade da realização de mais investigações que incrementem o conhecimento sobre a influência dos fatores psicossociais e relacionais na função sexual feminina, direcionando o cuidado para a promoção da saúde sexual e reprodutiva.

The influence of mode of delivery on neonatal and maternal short and long-term outcomes

ABSTRACT OBJECTIVE: To evaluate the impact of mode of delivery on breastfeeding incentive practices and on neonatal and maternal short and long-term complications. METHODS: A cohort study was conducted between June 2015 and April 2016 with 768 puerperal women from 11 maternities in Sergipe, interviewed in the first 24 hours, 45-60 days and 6-8 months after delivery. Associations between breastfeeding incentive practices, neonatal and maternal, both short-term and late complications, and the exposure variables were evaluated by the relative risk (95%CI) and the Fisher exact test. RESULTS: The C-section newborns had less skin-to-skin contact immediately after delivery (intrapartum C-section: 0.18, 95%CI 0.1-0.31 and elective C-section: 0.36, 95%CI 0.27-0.47) and less breastfeeding within one hour of birth (intrapartum C-section: 0.43, 95%CI 0.29-0.63 and elective C-section: 0.44, 95%CI 0.33-0.59). Newborns from elective C-section were less frequently breastfed in the delivery room 0.42 (95%CI 0.2-0.88) and roomed-in less 0.85 (95%CI 0.77-0.95). Women submitted to intrapartum C-section had greater risk of early complications 1.3 (95%CI 1.04-1.64, p = 0.037) and sexual dysfunction 1.68 (95%CI 1.14-2.48, p = 0.027). The frequency of neonatal complications, urinary incontinence and depression according to the mode of delivery was similar. CONCLUSIONS: The C-section was negatively associated with breastfeeding incentive practices; in addition, C-section after labor increased the risk of early maternal complications and sexual dysfunction.

Disfunções sexuais nos três trimestres gestacionais / Sexual dysfunction in three gestational trimesters

Introdução: Dificuldades sexuais são bastante frequentes durante a gestação, pelas mudanças hormonais e emocionais deste período.Objetivo: Avaliar a prevalência de disfunções sexuais nos três trimestres gestacionais. Métodos: Pesquisa observacional com 140 mulheres de 7 unidades básicas de saúde de um município do interior do RS. Foram aplicadosuma ficha de avaliação e o Female Sexual Function Index. Foi realizada a estatística descritiva para representação dos grupos e o teste de normalidade de Kolmogorov-Smirnov para os testes de hipóteses com nível de significância de 5%. Resultados: Houve alta prevalência de disfunção sexual, com diferença entre o primeiro e o segundo trimestres (p 0,018), e entre o primeiro e o terceiro trimestres (p 0,014). Conclusão: Houve alta prevalência de disfunção sexual (33,04%), sendo os domínios mais afetados a satisfação (100%), lubrificação (94,69%), orgasmo (94,59%) e excitação (91,89%). Identificou-se aumento das disfunções sexuais com a evolução da gestação.

Introduction: Sexual difficulties are quite frequent during gestation, due to the hormonal and emotional changes of this period. Objective: To evaluate the prevalence of sexual dysfunction in the three gestational trimesters. Methods: Observational research with 140 women from 7 basic health units of a municipality in the interior of RS. An evaluation form and the Female Sexual Function Index were applied. Descriptive statistics were performed for group representation and the Kolmogorov-Smirnov normality test was used for hypothesis tests with a significance level of 5%. Results: There was a high prevalence of sexual dysfunction, with a difference between the first and second quarters (p 0.018), and between the first and third quarters (p 0.014). Conclusion: There was a high prevalence of sexual dysfunction (33.04%), with satisfaction (100%), lubrication (94.69%), orgasm (94.59%) and excitation (91.89%) being the most affected domains. It was identified an increase of the sexual dysfunctions with the evolution of the gestation.

Sexual dysfunction in females with depression: a cross-sectional study / Disfunção sexual em mulheres com depressão: um estudo transversal

Abstract Introduction Female sexual dysfunction (FSD) in depression albeit common is strikingly understudied. The condition, if addressed properly, can be readily cured, improving the quality of life of the patient. Methods A consecutive sample of drug-naïve married female patients with depression was assessed. Depression was diagnosed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Depression severity was assessed using the Hamilton Depression Rating Scale (HAM-D), and sexual dysfunction, the Female Sexual Function Index (FSFI). Results Sexual dysfunction was found in 90% of the patients in our study. Patients with medical comorbidities showed a significant decrease in the desire subset of the FSFI (Mann-Whitney U=11.0, p=0.009), however there was no significant association with other subsets. Patients who expressed passive death wishes had higher scores on all indicators of sexual function and a significantly higher score in the orgasm subset of the FSFI (Mann-Whitney U=11.0, p=0.009). Conclusion The study showed a high prevalence of FSD in depressed females regardless of type and severity of depression. Depression with medical comorbidities was associated with a significant decrease in desire. Patients who expressed passive death wishes showed improved sexual function and significantly better orgasm.

Resumo Introdução Disfunção sexual feminina (DSF) na depressão, apesar de comum, é pouco estudada. Se tratada adequadamente, a condição pode ser prontamente curada, aumentando a qualidade de vida da paciente. Métodos Foi avaliada uma amostra consecutiva de mulheres casadas, virgens de tratamento, com depressão. A depressão foi diagnosticada utilizando a Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). A gravidade da depressão foi avaliada utilizando a Escala de Avaliação de Depressão de Hamilton (HAM-D), e a disfunção sexual, com o Índice da Função Sexual Feminina (Female Sexual Function Index, FSFI). Resultados Foi observada disfunção sexual em 90% das pacientes do estudo. As pacientes com comorbidades médicas mostraram uma diminuição significativa no subdomínio desejo da FSFI (Mann-Whitney U=11,0, p=0,009), porém não houve associação significativa com os outros subdomínios. Pacientes que expressaram desejos passivos de morte apresentaram escores mais altos em todos os indicadores de função sexual e um escore significativamente mais alto no subdomínio orgasmo da FSFI (Mann-Whitney U=11,0, p=0,009). Conclusão O estudo revelou uma alta prevalência de DSF em mulheres deprimidas, independentemente do tipo e da severidade da depressão. A depressão com comorbidades médicas foi associada a uma diminuição significativa do desejo. Pacientes que expressaram desejos passivos de morte mostraram função sexual melhor e orgasmo significativamente melhor.

Are the women with Sjögren's Syndrome satisfied with their sexual activity? / As mulheres com síndrome de Sjögren estão satisfeitas com sua atividade sexual?

ABSTRACT Objective: Females with Sjögren's Syndrome (SS) often experience vaginal dryness and dyspareunia, along with glandular and extraglandular symptoms. We aimed to evaluate sexual function and life quality in women with SS. Methods: Forty-six premenopausal women with SS and 47 age-matched controls were studied. Age, duration of the disease, medications, and comorbid diseases were noted. Participants completed 36-Item Short Form Health Survey (SF-36) and Female Sexual Function Index (FSFI). Patients were asked about vaginal discharge and itching in the last month, and if they informed their rheumatologists about any sexual problems. Gynecologic examinations were performed and vaginal smears were taken on each participant. Results: The median total scores of FSFI were significantly lower in the SS group than the controls [17.12 (2.4-27.8) and 27.4 (16.9-36.0), respectively, p < 0.001]. In the SS group, 37 (80.4%) and in the control group 18 (38.3%) of patients were sexually dissatisfied (p < 0.001). Vaginal dryness and lubricant use were significantly increased in patients with SS compared to controls (p < 0.001). Life quality scores were significantly lower in patients with SS than the controls (p < 0.001). Vaginal dryness was negatively correlated with FSFI total (r = −0.312, p = 0.035) and subscores except desire and arousal. Physical functioning, role physical and role emotional scores were positively correlated with total FSFI scores (r = 0.449, p = 0.002, r = 0.371, p = 0.011, r = 0.299, p = 0.043, respectively). Conclusions: Women with SS experience less satisfaction with sexual activity, which can be affected by age, vaginal dryness, physical pain, and impaired function due to the disease. Therefore, rheumatologists should pay attention to these symptoms and management.

RESUMO Objetivo: As mulheres com síndrome de Sjögren (SS) muitas vezes experimentam secura vaginal e dispareunia, juntamente com sintomas glandulares e extraglandulares. Este estudo objetivou avaliar a função sexual e a qualidade de vida de mulheres com SS. Métodos: Estudaram-se 46 mulheres pré-menopáusicas com SS e 47 controles pareados por idade. Avaliaram-se a idade, a duração da doença, os medicamentos usados e as comorbidades. As participantes preencheram o questionário de qualidade de vida 36-Item Short Form Health Survey(SF-36) e o Female Sexual Function Index (FSFI). As pacientes foram perguntadas quanto à presença de corrimento e prurido vaginal no último mês e se haviam informado a seus reumatologistas sobre quaisquer problemas sexuais. Fizeram-se exames ginecológicos e esfregaços vaginais de todas as participantes. Resultados: A mediana do escore total do FSFI foi significativamente menor no grupo SS do que no grupo controle [17,12 (2,4 a 27,8) e 27,4 (16,9 a 36), respectivamente, p < 0,001]. Nos grupos SS e controle, 37 (80,4%) e 18 (38,3%) das pacientes estavam sexualmente insatisfeitas, respectivamente (p < 0,001). A presença de secura vaginal e o uso de lubrificantes foram significativamente mais frequentes em pacientes com SS em relação aos controles (p < 0,001). Os índices de qualidade de vida foram significativamente menores nas pacientes com SS do que nos controles (p < 0,001). A secura vaginal esteve negativamente correlacionada com o FSFI total (r = −0,312 p = 0,035) e com todos os seus subescores, exceto desejo e excitação. Os escores de capacidade funcional, aspecto físico e aspecto emocional se correlacionaram positivamente com a pontuação total do FSFI (r = 0,449, p = 0,002; r = 0,371, p = 0,011; r = 0,299, p = 0,043, respectivamente). Conclusões: As mulheres com SS têm menor satisfação com a atividade sexual, o que pode ser afetado pela idade, secura vaginal, dor física e função prejudicada em razão da doença. Portanto, os reumatologista devem prestar atenção a esses sintomas e seu tratamento.