Ana Lúcia Ribeiro Valadares

Prevalence of sexual dysfunction and its associated factors in women aged 40-65 years with 11 years or more of formal education: a population-based household survey.

OBJECTIVE To evaluate the prevalence of sexual dysfunction and its associated factors in middle-aged women with 11 years or more of formal education. METHODS A cross-sectional, population-based study was carried out using an anonymous, self-response questionnaire. A total of 315 Brazilian-born women, 40–65 years of age with 11 years or more of schooling, participated in the study. The instrument used in the evaluation was based on the Short Personal Experiences Questionnaire. Sexual dysfunction was calculated from the mean score of sexual responsiveness (pleasure in sexual activities, excitation and orgasm), frequency of sexual activities and libido. Sociodemographic and clinical factors were evaluated. Poisson multiple regression analysis was carried out and the prevalence ratios with respective 95% confidence intervals (95%CI) were calculated. RESULTS The prevalence of sexual dysfunction was 35.9% among our study population. Multiple regression analysis showed that sexual dysfunction was positively associated with older age (prevalence ratios=1.04; 95%CI:1.01–1.07) and with the presence of hot flashes (prevalence ratios=1.37; 95%CI:1.04–1.80). Having a sexual partner (PR=0.47; 95%CI:0.34–0.65) and feeling well or excellent (prevalence ratios= 0.68; 95%CI: 0.52–0.88) were factors associated with lower sexual dysfunction scores. CONCLUSIONS Sexual dysfunction was present in more than one-third of women that were 40–65 years of age with 11 years or more of formal education. Within that age group, older age and hot flashes were associated with higher sexual dysfunction scores, whereas feeling well and having a sexual partner were associated with better sexuality.

Sexuality in Brazilian women aged 40 to 65 years with 11 years or more of formal education : associated factors

Objective: To evaluate factors associated with the sexuality of middle-aged women. Design: Cross-sectional, population-based survey using an anonymous self-response questionnaire. A total of 276 Brazilian-born women, 40 to 65 years old with at least 11 years of formal education, participated in the study. The evaluation instrument was based on the Short Personal Experiences Questionnaire. Seven components were analyzed: satisfaction in sexual activities, orgasm, intensity of desire, self-classification of sexual life, frequency of arousal, sexual activity, and sexual fantasies. Sociodemographic, clinical, behavioral, and reproductive factors were evaluated. Data were analyzed using the &khgr;2 and Fisher exact tests and Poisson multiple regression analysis. Prevalence ratios (PRs) and their 95% CIs were calculated. Results: The median sexuality score was 9 (range, 2.45-13.77). Bivariate analysis indicated that being 50 years of age or older; in the menopausal transition or postmenopause; not having a sexual partner; reporting hot flushes, insomnia, depression, nervousness, sedentary lifestyle, arterial hypertension, or urinary incontinence; and poor self-perception of health were significantly associated with a below median sexuality score. Multiple regression analysis showed that the prevalence of below median scores was higher in older women (prevalence ratio [PR] = 1.03, 95% CI: 1.01-1.05) and in those with insomnia (PR = 1.46, 95% CI: 1.08-1.96). Having a sexual partner (PR = 0.68, 95% CI: 0.50-0.92) and feeling well (PR = 0.73, 95% CI: 0.57-0.94) was associated with a protective effect against a below median sexuality score. Conclusions: Older women and those with insomnia were more likely to have a low sexuality score, whereas those with a sexual partner and who felt well were less likely to have a low sexuality score.

Hypoactive sexual desire disorder in a population-based study of Brazilian women: associated factors classified according to their importance.

Objective: The etiology of hypoactive sexual desire disorder (HSDD) is known to be multifactorial, involving biological, psychosexual, and context-related factors. The objective of the present study was to analyze the factors associated with female HSDD and to stratify these factors according to their importance. Methods: This was a population-based, hierarchical study conducted in Brazil, based on data from previous research on the Brazilian Sexual Life Study, conducted between November 2002 and February 2003 in various Brazilian cities. The primary study consisted of a self-administered and anonymous questionnaire, addressing sociodemographic parameters, general health, life habits, behavior, and complaints related to sexual function. The association between HSDD and various other factors was assessed. The data were evaluated by hierarchical multiple regression analysis. Results: The prevalence of HSDD in this sample was 9.5%. Associations were found with cardiovascular disease, breast cancer, posttraumatic stress, poorer education level, being older, being married, a lack of information on sexuality in childhood/adolescence, and a limited sexual repertoire. Women who consumed moderate amounts of alcohol were found to be less likely to have HSDD. Conclusions: Analysis of the associated factors classified in order of importance and analysis of the characteristics of the sexual relationships provide additional information to currently available data on the traditional concepts of HSDD.

A population-based study of dyspareunia in a cohort of middle-aged Brazilian women

Objective:To investigate the prevalence of dyspareunia and its associated factors in a cohort of middle-aged women. Design:A cross-sectional, population-based study was carried out using an anonymous, self-report questionnaire completed by 200 Brazilian-born women, 40 to 65 years of age, with 11 years or more of formal education. The evaluation instrument was based on the Short Personal Experiences Questionnaire. Sociodemographic, clinical, behavioral, reproductive, and partner-related factors were assessed. Poisson multiple regression analysis was performed, and prevalence ratios (PRs) with their 95% CIs were calculated. Results:The prevalence of dyspareunia was 39.5%. Multiple analysis showed that dyspareunia was more common in women who reported nervousness (PR = 1.73, 95% CI: 1.14-2.63) and depression (PR = 1.69, 95% CI: 1.09-2.61). A score of more than 3 for frequency of sexual activity (PR = 0.20, 95% CI: 0.05-0.84) and having had more than two pregnancies (PR = 0.62, 95% CI: 0.48-0.81) were factors indicative of a protective effect against dyspareunia. Conclusions:Dyspareunia was common in this cohort of middle-aged women. Nervousness and depression increased the likelihood of experiencing dyspareunia. These findings suggest that psychological symptoms should be taken into consideration in the management of the middle-aged woman with dyspareunia, and measures should be adopted to minimize the repercussions of these factors on sexuality.

The sexuality of middle-aged women with a sexual partner : a population-based study

Objective:To evaluate the factors associated with the sexuality of middle-aged women with sexual partners. Design:A cross-sectional, population-based study was carried out using an anonymous, self-response questionnaire completed by Brazilian-born women 40 to 65 years old with 11 years or more of formal education who had a sexual partner. Of the 378 women who agreed to participate in the study, 219 answered all the questions used for calculation of the sexuality score and reported having a sexual partner. The instrument was based on the Short Personal Experiences Questionnaire. Seven components were analyzed: satisfaction in sexual activities, orgasm, intensity of desire, self-classification of sexual life, and frequency of arousal, sexual activity, and sexual fantasies. Sociodemographic, clinical, behavioral, reproductive, and partner-related factors were evaluated. Poisson multiple regression analysis was performed, and prevalence ratios (PRs) with their 95% CIs were estimated. Results:The median sexuality score was 9 (range, 2.45-13.77). The prevalence of below-median scores was higher in women who lived with their sexual partner (PR = 2.07; 95% CI: 1.17-3.69), who were in the menopausal transition or were postmenopausal (PR = 1.69; 95% CI: 1.08-2.65), and who were hypertensive (PR = 1.65; 95% CI: 1.19-2.30). Sexual activities involving penetration (PR = 0.48; 95% CI: 0.31-0.73) and a score of 6 for satisfaction with partner as a lover (PR = 0.34; 95% CI: 0.20-0.60) were indicative of a protective effect against poor sexuality. Conclusions:In this cohort, the sexuality of women in midlife was negatively associated with the factors of living with a sexual partner, being in the menopausal transition or postmenopausal, and being hypertensive. Therefore, greater attention should be paid to identifying these factors, and measures should be adopted to minimize their repercussions on the sexuality of middle-aged women.

Association between different types of physical activities and quality of life in women aged 60 years or over

OBJECTIVE To evaluate the association between different types of physical activity and quality of life in a sample of women aged 60 or over. SUBJECTS AND METHODS A cross-sectional study was carried out, interviewing 271 women. Of these, 141 were recruited in a menopause outpatient clinic and 130 were recruited in a social leisure center, in Brazil. The instruments used were the International Physical Activity Questionnaire (IPAQ) version 8 and the World Health Organization Quality of Life Questionnaire specific for this age group (WHOQOL-OLD). Each IPAQ section was evaluated by multiple linear regression analysis, considering independent and confounding variables. The significance level was set at 5% and the software used was SAS version 9.1.3. RESULTS The mean age of the patients was 67.4 ± 5.3 years. The mean time devoted to physical activity was 2802.7 ± 1154.9 minutes per week. The total WHOQOL-OLD score was 66.9 ± 11.7. The past, present and future actvities (estimated β = 0.021) and, social participation (estimated β = 0.03) domains had association with IPAQ transportation section. The leisure-time domain of the IPAQ had an inverse and significant relationship with the quality of life score related to present, past and future activities (estimated β = -0.0269). CONCLUSION Quality of life was negatively influenced by leisure, but time spent in this physical activity was the shortest in comparison to other types of physical activities. In this sample, only physical activity for transportation was positively associated with a better quality of life.

Depoimentos de mulheres sobre a menopausa e o tratamento de seus sintomas

OBJECTIVE To evaluate the perception of a group of women from Belo Horizonte, Minas Gerais, Brasil, with respect to menopause and its treatment. METHODS A secondary analysis was performed on data from a population-based, cross sectional study carried out with 378 Brazilian born women between 40 and 65 years of age, with 11 years or more of formal education. Some women added spontaneous comments to the end of the questionnaire on sexuality handed out by research assistants and self-responded anonymously. There were those who provided comments at the end of the questionnaire and those who did not. The groups were compared with respect to sociodemographic and reproductive characteristics using Pearsons chi-square test. Comments were transcribed in their entirety to a computerized file for thematic content analysis, and units of meaning were identified and classified. RESULTS Approximately one-third of the women (114/378) provided comments. Significantly more women with lower income levels provided comments as compared to those with higher income levels. The principal identified categories of analysis were: a) uncertainty and/or confusion, mainly with regard to anguish, stress and doubts about menopause; b) symptoms that lead to negative feelings, such as hot flushes, vaginal dryness and mood changes; and c) hormone replacement therapy, fears and perception of a lack of conviction in the physicians who prescribe it. CONCLUSION The comments indicate that more attention must be given to the problems perceived in climacteric women with a special emphasis on those of the lower incomes levels.OBJETIVO: Avaliar a percepcao de um grupo de mulheres de Belo Horizonte (MG) sobre a menopausa e seu tratamento. METODOS: Realizou-se analise secundaria de dados de estudo populacional de corte transversal com 378 mulheres brasileiras natas, de 40 a 65 anos, com 11 anos ou mais de educacao formal. Avaliaram-se os relatos escritos espontaneamente ao final de um questionario sobre sexualidade, entregue por auxiliares de pesquisa e auto-respondido anonimamente. As mulheres foram alocadas em dois grupos: as que escreveram comentarios ao final do questionario e as que nao escreveram. Compararam-se os grupos em relacao as caracteristicas sociodemograficas e reprodutivas por meio do teste Qui quadrado de Pearson. Os comentarios foram transcritos na integra para arquivo computadorizado para realizar a analise tematica de seu conteudo, identificando-se e categorizando-se as unidades de significado. RESULTADOS: Aproximadamente um terco das mulheres escreveu comentarios (114/378), o que foi significativamente mais frequente entre as mulheres com menor renda familiar. As principais categorias de analise identificadas foram: a) inseguranca/confusao, com as principais ideias referentes a angustia, estresse e duvidas sobre a menopausa; b) sintomas que provocam sentimentos negativos, como ondas de calor, secura vaginal e alteracoes de humor; c) terapia de reposicao hormonal, medos e sentimentos da falta de conviccao por parte dos medicos em prescreve-la. CONCLUSAO: Os comentarios indicam a necessidade de dar mais atencao aos problemas percebidos no climaterio, particularmente direcionada as mulheres menos favorecidas economicamente.

Physical activity and quality of life in women aged 60 or older: associated factors

PURPOSE to evaluate the level of physical activity, quality of life and associated factors in women aged 60 or older. METHODS a cross-sectional study was conducted on 271 women who go to a Leisure Center and women attended at a menopause ambulatory in Campinas (SP). The women were invited to take part in the research, carried out through interviews. The instruments used were the version 8 of the International Physical Activity Questionnaire (IPAQ) modified for the elderly population in order to evaluate their physical activity, and the World Health Organization Questionnaire of Quality of Life specific for this group (WHOQOL-OLD) to evaluate their quality of life. IPAQ results were assessed using tertiles. The association between the WHOQOL-OLD and the IPAQ results and subject characteristics was assessed by the Students t test, Mann-Whitney test and multiple analyses. RESULTS the average age of women was 67.4 ± 5.3 years. Among these women, 33% were classified as being less active. Analysis of each physical activity domain showed that 60.8% of the time was spent in sitting activities (1,701.6 ± 986.1 minutes/week). Multiple analyses indicated that attending a leisure center in Campinas (SP) and being 70 years old or older increased the chances of engaging in moderate-intensity or vigorous-intensity physical activity by 11.4 and 2.8 times, respectively. The average quality of life score was 66.9 ± 11.7. The highest value was observed in the domain related to sensory abilities (72.0 ± 18.8) and the lowest value was related to autonomy (60.3 ± 16.2). Linear regression showed that a good self-perception of health increased the quality of life score by 7.3 points, the use of a bigger amount of medication decreased it by 4.4 points and the performance of moderate or vigorous physical exercise increased the score by 4.8 points. CONCLUSION women spend prolonged periods of time in sitting activities. The importance of engaging in moderate/vigorous-intensity physical activity is evident for obtaining a good quality of life.

The Prevalence of the Components of Low Sexual Function and Associated Factors in Middle‐Aged Women

INTRODUCTION Female sexual function depends on biological, psychological, and sociocultural contexts. AIM The objective of the present study was to evaluate the prevalence of low levels of functioning in each of the sexual function domains (desire, arousal, and orgasm) and the factors associated with these phenomena, as well as to assess the frequency of sexual activity in this same sample population. METHODS A cross-sectional, population-based study was conducted using an anonymous self-response questionnaire completed by 378 Brazilian-born women of 40-65 years of age with 11 years or more of formal education. The evaluation instrument was based on the Short Personal Experiences Questionnaire. RESULTS The prevalence of low sexual desire was 60.6%; low arousal, 37%; and low orgasmic function, 31.1%. Multiple regression analysis showed that having a sexual partner (prevalence ratio [PR] = 0.69, confidence interval [CI] = 0.53-0.90) and nervousness (PR = 1.33, CI = 1.01-1.75) were factors associated with low sexual desire. Aging (PR = 1.04, CI = 1.02-1.06), having a sexual partner (PR = 0.57, CI = 0.41-0.81), feeling well/excellent (PR = 0.59, CI = 0.41-0.85), and having hot flashes (PR = 1.47, CI = 1.01 = 2.15) were factors found to be associated with low sexual arousal. Having a sexual partner (PR = 0.55, CI = 0.42-0.71), feeling well/excellent (PR = 0.68, CI = 0.49-0.94), and having hot flashes (PR = 2.08, CI = 1.43 = 3.04) were factors found to be associated with low sexual orgasmic function. Having a sexual partner (PR = 0.47, CI = 0.38-0.58), feeling well/excellent (PR = 0.78, CI = 0.69-0.89), and having hot flashes (PR = 1.15, CI = 1.05-1.26) were factors found to be associated with a frequency of sexual activity of once a week or less. CONCLUSIONS In this sample of middle-aged women, low sexual desire was the most prevalent sexual problem. These results highlight the importance of identifying and treating factors associated with each individual component of low female sexual function.

Menopausal symptoms and associated factors in HIV-positive women.

OBJECTIVE To evaluate menopausal symptoms and their associated factors in HIV-positive women. METHODS A cross-sectional study was conducted with 537 women of 40-60 years of age, 273 of whom were HIV-positive and 264 HIV-negative. The women were interviewed to obtain data on their sociodemographic characteristics and menopausal symptoms. RESULTS The mean age of the seropositive women was 47.7±5.8 years compared to 49.8±5.3 for the seronegative women (p<0.001). Bivariate analysis showed a lower prevalence of vasomotor symptoms in the seropositive group (p=0.009), specifically hot flashes (p<0.002) and sweating (p=0.049). Vaginal dryness was also less prevalent in this group (p<0.005). There were no statistically significant differences between the groups with respect to depression or insomnia. Multiple analysis showed that hot flashes were associated with being peri- or postmenopausal (PR=2.12; 95%CI: 1.52-2.94). Vaginal dryness was less common in women without a partner (PR=0.67; 95%CI: 0.49-0.90) and was associated with older age (PR=1.03; 95%CI: 1.01-1.06) and being in the peri- or postmenopause (PR=1.69; 95%CI: 1.10-2.60). Depression was inversely associated with being employed (PR=0.74; 95%CI: 0.58-0.96) and directly associated with the presence of chronic diseases (PR=1.30; 95%CI: 1.01-1.067). Insomnia was associated with a lower body mass index (PR=0.96; 95%CI: 0.95-0.97) and with being peri- or postmenopausal (PR=1.48; 95%CI: 1.11-1.97). No correlation was found between HIV serological status and any of the menopausal symptoms. CONCLUSIONS In this study, after controlling for confounding variables, HIV infection was not found to be associated with vasomotor, genitourinary or psychological symptoms or with insomnia.