title: Body image is a major determinant of sexual dysfunction in stable HIV-infected women.
abstract: BACKGROUND
  Prevalence and factors associated with sexual dysfunction in HIV-positive women are poorly known.
  
  
  METHODS
  This was a cross-sectional study in a cohort of HIV-infected women. Clinically stable women were invited to participate in a female sexual dysfunction (FSD) evaluation with Female Sexual Function Index (FSFI) exploring desire, arousal, lubrication, orgasm, pain and satisfaction. An FSFI score <23 was used for defining FSD. Variables evaluated included body appearance satisfaction, interference of body changes with habits, social life and attitudinal aspects of body image, health-related quality of life, hormonal assessment, menopause, cumulative exposure to antiretroviral drug classes and immune-virological parameters. Lipodystrophy was defined according to the HIV Outpatient Study definition.
  
  
  RESULTS
  A total of 185 women completed the FSFI. The mean (+/-SD) age was 42 years (+/-5), 27% had CDC stage C, the mean (+/-SD) CD4+ T-cell count was 508 cells/microl (+/-251) and median HIV RNA was 1.7 log10 copies/ml (interquartile range 1.7-2.6). Among 161 evaluable patients, 59 (32%) reported FSD. In a multiple linear regression analysis, desire, arousal and satisfaction domains were associated with interference of body changes with habits, social life and attitudinal aspects of body image (beta = 0.22, 95% confidence interval [CI] 0.06-0.37; beta = 0.29, 95% CI 0.10-0.48; and beta = 0.20, 95% CI 0.02-0.38, respectively). Lubrication and orgasm domains were associated with body image satisfaction (beta = -0.49, 95% CI -0.88 - -0.10 and beta = -0.58, 95% CI -1.00 - -0.16, respectively). No significant associations with sex hormones, CDC stage, CD4+ T-cell count, HIV RNA viral load and cumulative exposure to antiretroviral drug classes were found. In women with FSD, severity of self-perceived abdominal fat accumulation showed a trend towards lower FSFI scores (ANOVA P = 0.02).
  
  
  CONCLUSIONS
  FSD was highly prevalent in this cohort. Self-perceived body changes was identified as its major determinant.
authors.affiliation: Universita di Modena e Reggio Emilia, Modena, Italy.
authors.forename: Kety
authors.initials: K
authors.lastname: Luzi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Guaraldi
authors.forename: Rita
authors.initials: R
authors.lastname: Murri
authors.forename: Maria
authors.initials: M
authors.lastname: De Paola
authors.forename: Gabriella
authors.initials: G
authors.lastname: Orlando
authors.forename: Nicola
authors.initials: N
authors.lastname: Squillace
authors.forename: Roberto
authors.initials: R
authors.lastname: Esposito
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Rochira
authors.forename: Rochira
authors.initials: R
authors.lastname: Vincenzo
authors.forename: Lucia
authors.initials: L
authors.lastname: Zirilli
authors.forename: Esteban
authors.initials: E
authors.lastname: Martinez