title: Dose-response relationship between cigarette smoking and female sexual dysfunction.
abstract: OBJECTIVE
  To evaluate whether smoking is a risk factor for female sexual dysfunction (FSD) and to determine the relationship between the cumulative smoking dose and FSD in premenopausal women.
  
  
  METHODS
  The study population consisted of sexually active premenopausal women. The frequency of FSD and female sexual function index (FSFI) total score were evaluated according to the smoking status (never/former and current smokers). Evaluation of sexual function was done using FSFI questionnaire, and women with FSFI score of ≤26.55 were considered to have FSD. In current smokers, sexual function was also evaluated according to the cumulative smoking dose and nicotine dependency.
  
  
  RESULTS
  A total of 900 women were included, and the frequency of current smokers and the frequency of FSD were 62 (6.9%) and 496 (55.1%), respectively. In current smokers, the frequency of FSD was significantly higher and the median total FSFI score was significantly lower than in never/former smokers, and this difference of FSD remained significant after adjustment for confounding variables. Among current smokers, the cumulative smoking dose (pack-years) and the total FSFI score showed negative correlation, in which increased cumulative smoking dose was associated with lower total FSFI score (r=-0.278, P<0.05). In terms of nicotine dependency, the total FSFI score of moderately to heavily nicotine dependent smokers was significantly lower than that of lightly dependent smokers.
  
  
  CONCLUSIONS
  In premenopausal women, current smoking was an independent risk factor for FSD. And cumulative smoking dose and nicotine dependency were associated with higher risk of FSD.
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Joohee
authors.initials: J
authors.lastname: Choi
authors.affiliation: Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Health Promotion Center, Seoul National University Hospital, Seoul, Korea.
authors.forename: Dong Wook
authors.initials: DW
authors.lastname: Shin
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Seungmee
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Myung Jae
authors.initials: MJ
authors.lastname: Jeon
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea. ; Health Promotion Center, Seoul National University Hospital, Seoul, Korea.
authors.forename: Sun Min
authors.initials: SM
authors.lastname: Kim
authors.affiliation: Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Health Promotion Center, Seoul National University Hospital, Seoul, Korea.
authors.forename: Belong
authors.initials: B
authors.lastname: Cho
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea. ; Health Promotion Center, Seoul National University Hospital, Seoul, Korea. ; Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Seung Mi
authors.initials: SM
authors.lastname: Lee
keywords: Dose-response relationship; Female; Nicotine; Sexual dysfunctions; Smoking