Sexual dysfunctions in women in premenopause
Romashchenko, O1; Biloholovska, V1; Melnykov, S1; Babych, O1; Myronenko, N1; Khodzhava, M1
1: SI 'Institute of Urology of the NAMS of Ukraine', Ukraine
Objective. To determine the frequency and spectrum of female sexual dysfunctions (FSD) in premenopause.
Material and Methods. Average age of the beginning of menopause in Ukraine is 48.3 years. A psychological, sexological and gynaecological examination of 37 women aged from 46 to 48 with regular menstrual cycle was carried out. Sexological examination included: interview method questionnaire; the first-order estrogenic zones sensitivity determination (vibro-testing); genitals vascular responses value (duplex Doppler scanning of clitoris vessels in XARIA TOSHIBA machine before and after video-erotic stimulation); levels determination of estradiol (E2), total and free testosterone, and sex hormone-binding globulin(SHBG) in dynamics.
Results. Dyspareunia (21.6%) developed in last 1-2 years against the background of lubrication disturbance and was accompanied by the reduction of libido (18.9%), formation of secondary anorgasmia (15.4%) and disharmony in relations of partners (18.9%). Doppler scanning of clitoris vessels registered hypokinemia rate at rest 1.7-2.5 cm/sec and in 30 minutes after video-erotic stimulation – 3.7-4.5 cm/sec. It did not change among the 15.4% of women with FSD (dyspareunia, reduction of sexual desire, anorgasmia) and was 0.9 to 1.4 cm/sec. Vibro test determination of marginal sensitivity of erogenous zones of first rank detected the increase in pain susceptibility of first order erogenous zones. The patients with sexual dysfunctions had reduced E2 concentration in blood (in 1.2-1.5 times) and free testosterone index reduction (in 1.3-1.5 times) in comparison to women with the preserved sexual health. Treatment of female sexual dysfunctions was based on the principles of interdisciplinary approach: both individual and couple psychotherapy, local use of suppositories with estriol and a course of plasmotherapy. The couple’s sexual harmony was achieved.
Conclusions. Dyspareunia is a primary sign of genitourinary disorders at the background of changes of hormonal homeostasis and requires timely adequate reaction. FSD prevention has to be conducted in premenopause, to be complex and to take into account the general state, age changes (namely it has to improve clitoral sensation and vaginal lubrication) of a woman and psychological problems of spouses in a single context.
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