title: Sexual dysfunction in middle-aged women: a multicenter Latin American study using the Female Sexual Function Index.
abstract: OBJECTIVE
  The purpose of this study was to assess the prevalence of sexual dysfunction (SD) and associated risk factors among middle-aged Latin American women using one validated instrument.
  
  
  METHODS
  The Female Sexual Function Index (FSFI) was applied to 7,243 healthy women aged 40 to 59 years who were users of 19 healthcare systems from 11 Latin American countries. An itemized questionnaire containing personal and partner sociodemographic data was also filled out.
  
  
  RESULTS
  Mean +/- SD age of surveyed women was 49.0 +/- 5.7 years, with 11.6 years of schooling on average. There were 55.1% of women who were married, 46.8% who were postmenopausal, 14.1% who used hormonal therapy (HT), and 25.6% who were sexually inactive. Among those who were active (n = 5,391), the mean +/- SD total FSFI score was 25.2 +/- 5.9 and 56.8% of them presented SD (FSFI total score <or=26.55), with a prevalence varying from 21.0% to 98.5% depending on the center. Centers were grouped in terciles (according to mean +/- SD prevalence). The tercile with higher SD prevalence (86.4%) compared with that with lower SD prevalence (32.2%) had significantly older women (49.5 +/- 5.3 vs 48.0 +/- 5.6 y) with a higher rate of vaginal dryness (60.4% vs 40.8%) and older partners (53.0 +/- 6.9 vs 50.2 +/- 7.5 y). Similarly, there was a significantly higher rate of married (68.5% vs 63.1%), postmenopausal (49.7% vs 39.3%), and HT-using women (23% vs 9.2%). There were no differences in regard to their health perception, history of oophorectomy, rape, and partner SD rate (27% vs 26.2%). The total FSFI score was significantly lower in the tercile with higher SD prevalence (22.0 +/- 5.0 vs 27.5 +/- 5.4). Logistic regression analysis was used to determine the odds ratios (95% CIs) for the main risk factors associated with SD among those who were sexually active: bad lubrication, 3.86 (3.37-4.43); use of alternative menopausal therapies, 2.13 (1.60-2.84); partner SD, 1.89 (1.63-2.20); older women (>48 y), 1.84 (1.61-2.09); bladder problems, 1.47 (1.28-1.69); HT use, 1.39 (1.15-1.68); negative perception of female health status, 1.31 (1.05-1.64); and being married, 1.22 (1.07-1.40). Protective factors were higher educational level (women), partner faithfulness, and access to private healthcare.
  
  
  CONCLUSIONS
  The prevalence of SD in this middle-aged Latin American series was found to be high, varying widely in different populations. A decrease in vaginal lubrication was the most important associated risk factor. Differences in the prevalence of risk factors among the studied groups, several of which are modifiable, could explain the variation of SD prevalence observed in this study.
authors.affiliation: Institute of Biomedicine, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, PO Box 09-01-4671, Guayaquil, Ecuador.
authors.forename: Juan E
authors.initials: JE
authors.lastname: Blümel
authors.forename: Peter
authors.initials: P
authors.lastname: Chedraui
authors.forename: German
authors.initials: G
authors.lastname: Baron
authors.forename: Emma
authors.initials: E
authors.lastname: Belzares
authors.forename: Ascanio
authors.initials: A
authors.lastname: Bencosme
authors.forename: Andres
authors.initials: A
authors.lastname: Calle
authors.forename: Maria T
authors.initials: MT
authors.lastname: Espinoza
authors.forename: Daniel
authors.initials: D
authors.lastname: Flores
authors.forename: Humberto
authors.initials: H
authors.lastname: Izaguirre
authors.forename: Patricia
authors.initials: P
authors.lastname: Leon-Leon
authors.forename: Selva
authors.initials: S
authors.lastname: Lima
authors.forename: Edward
authors.initials: E
authors.lastname: Mezones-Holguin
authors.forename: Alvaro
authors.initials: A
authors.lastname: Monterrosa
authors.forename: Desire
authors.initials: D
authors.lastname: Mostajo
authors.forename: Daysi
authors.initials: D
authors.lastname: Navarro
authors.forename: Eliana
authors.initials: E
authors.lastname: Ojeda
authors.forename: William
authors.initials: W
authors.lastname: Onatra
authors.forename: Monique
authors.initials: M
authors.lastname: Royer
authors.forename: Edwin
authors.initials: E
authors.lastname: Soto
authors.forename: Soledad
authors.initials: S
authors.lastname: Vallejo
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Tserotas
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004522:Educational Status; D015914:Estrogen Replacement Therapy; D005260:Female; D006304:Health Status; D006801:Humans; D007843:Latin America / Q000453:epidemiology; D016015:Logistic Models; D008875:Middle Aged; D016017:Odds Ratio; D017698:Postmenopause; D012307:Risk Factors; D012735:Sexual Dysfunction, Physiological / Q000175:diagnosis* / Q000453:epidemiology*; D020018:Sexual Dysfunctions, Psychological / Q000175:diagnosis* / Q000453:epidemiology*; D018454:Spouses; D014623:Vaginal Diseases; D016387:Women's Health