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Abstract Sexuality is an important part of health, quality of life and general wellbeing). Female sexual dysfunction is highly prevalent with 60-90% rate of mild and manifest sexual dysfunction. It is an under researched and poorly understood area. Female sexual dysfunction is a multicausal and multidimensional problem combining biological, psychological and interpersonal determinants. In contrast to the wide spread interest in research and treatment of male sexual dysfunction, less attention has been paid to the sexual problems of women. A major barrier to the development of clinical research and practice has been the absence of a well defined, broadly accepted diagnostic framework and classification for female sexual dysfunction. Recent classification of female sexual dysfunction which put personal distress from the problem in consideration involved sexual desire disorder (hypoactive desire and sexual aversion), arousal disorder, orgasmic disorder and sexual pain disorders (dyspareunia, vaginsmus and other sexual pain disorders). High degree of overlap or comorbidity has been noted among the sexual disorders, particularly in recent prevalence studies of female sexual dysfunction and recent approaches view sexuality as much more complex and interactive. Sexual problem can be short term or lifelong and generalized. Assessment of female sexual dysfunction involves: (1) an evaluation of current sexual functioning including feelings and thoughts of desire and receptivity to sexual activity; (2) an accurate elucidation of Summary and Conclusion -128- the presenting problem and any comorbidity problems. (3) the formulation of ”working hypothes” of the most relevant etiological and mainting factors; (4) identification of the treatment goals and a treatment plan. Aim of the work: To asses the prevalence and predictors of female sexual dysfunction in lower Egypt represented by Dakahlia governorate. Subjects and methods: Time of the study: from June 2002 through April 2003 Subjects: A crossectional community based survey was implemented on one thousand married sexually active women between 16 & 49 years old. Research setting : The study was conducted in five districts of Dakahlia governorate; Shirbin, Bilquas, Samblawen, Dekrinis and Mansoura city, at general hospitals, maternal and child health care centers, family planning centers and some private gynecological clinics. Method: Data were collected after explaining the purpose of the study and taking women’s permission inperson using interviewing questionnaire format which included: 1- Sociodemographic characteristics of couple. 2- Reasons of attending medical services. 3- Reproductive features. 4- Measures of sexual dysfunction using 6 response items, each measuring presence of a critical symptoms or sexual problem. Taken together, these items cover the major problem areas addressed in the DSM-IV classification of American Psychiatric Summary and Conclusion -129- Association (1994) and the American Foundation of Urologic Disease new classification. Response items included : a) lacking or reduced desire for sex. b) Frequency of sexual activity. c) Arousal difficulty. d) Inability achieving orgasm. e) Physical pain during intercourse. f) Forced to have sex or not finding sex pleasurable. 5- Assessment of sexual dysfunction risk factors associated with health and life style such as experience of emotional, psychological, or stress related problems. 6- Finally local examination was done when allowed. 7- Data coded and tabulated in computer followed by statistical analysis and result interpretation. Results Randomly selected 1000 married, sexually active women aged 16- 49 years were interviewed. 936 women complied to the study and 64 women refused, with 93.6% response rate. 68.9% (645) of women have one or more sexual problem. However, 23% (215) of women are not distressed by their sexual problems and 11.5% of women suffer sexual abuse in addition to other sexual problems. Only 4.3% (40) of those women presented with such problems to the medical services. - from the women’s point of view prevalence of impotence and premature ejaculation among their husbands were 17.1% (160) and 5% (47) respectively. Summary and Conclusion -130- As regard sexual activity : - 58.5% (547) of women have sexual intercourse two to four times per week, 12.2% (114) of them have sexual intercourse once per week and 12.6% (118) have sexual intercourse once per day. - About 63.8% (597) of women were satisfied by their current frequency of sexual intercourse while 36.2% (339) of them were unsatisfied and feel that once per week is more satisfactory. Prevalence of different sex problems were as following: - Decrease or loss of libido in 49.6% (464) of women versus 3.6% (34) of them with increased desire. - 36.0% (337) of women have difficult arousal, 24.8% (232) of them have the problem occasionally versus 11.2% (105) who have the problem always. - Loss of orgasm present in 43.0% (402) of women, 10.5% (98) of women have primary anorgasmia, 6.4% (60) have secondary total anorgasmia while 26.1% (244) of women have the problem occasionally. - 31.5% (295) of women suffer dyspareunia, 4.6% of women have superficial dyspareunia and 12.5% (117) of them have deep one while 14.4% (135) of women have the pain all through. - Only 4.3% (40) of women attended medical service for sexual complaint. Women level of education, parity, circumcision status and reasons for seeking medical service in addition to gynecological surgical procedures were all good predictors for, and highly associated with FSD including abuse. Also, women’s age and menstrual pattern, appeared to impact female sexual functioning adversely but did not exhibit similar effect as regard sexual abuse, while other sociodemographic characteristics e.g duration of marriage, presence of other wife, residency, Summary and Conclusion -131- type of family and work status as well as mode of delivery, contraception, and medical disorders with their treatment were all non significant predictors of FSD. Among husbands demographic characteristics, age was a good predictor of FSD and level of education in particular was highly significant predictor of FSD including sexual abuse. Similarly, relevant medical disorders and surgical procedures affect FSD adversely. Moreover relevant drugs used by husbands and smoking exhibit high association with FSD and abuse. In contrast husband residency and work status, were not associated with elevated risk of FSD. It was not possible to predict accurately a particular sexual problem through analysis of the significant risk factors due to close association and overlap between different sexual problems. - Most of the mentioned sexual problems had gradual onset (63.1%) and stationary (48.8%) or progressive course (44.3%). - There was no obvious aggravating factor in 28.1% (181) of women, while marital disharmony, hate and unfavourable socioeconomic circumstances were the commenst aggravating factors in 28.1% (181) of women. - Sexual problems aggravated by pregnancy and delivery events in 15.7% (101) and 3.1% (20) of women respectively. Infertility was an aggravating factor in 2.3% (15) of women and contraception was a responsible factor in 3.1% (20) of them. - For most women (84.5%) there was no amilorating factor, though marital adjustment reported in 10.3% of women. Out of the 68.9% (645) of women who had sexual problem only 31.2% (201) of them agreed to have genital examination while 68.8% (444) refused, either because they did not want or because they are pregnant or they have the menstruation. Summary and Conclusion -132- - Local clinical examination showed no abnormalities in more than 80% of the examined group. - Only 7.1% (47) of women with sexual problems had received a form of treatment and 58.7% of them showed no or mild improvement while the rest showed only moderate one. |