Sonia L. Davison

ORIGINAL RESEARCH—PSYCHOLOGY: The Relationship between Self-Reported Sexual Satisfaction and General Well-Being in Women

INTRODUCTION The extent to which low sexual function or sexual dissatisfaction in women impacts on well-being remains uncertain, yet this is a critical issue in the controversy as to the benefits of pharmacotherapy for women seeking treatment for female sexual dysfunction. Aim. To explore the relationship between well-being and self-perceived satisfaction with sexual function in women and to determine if there is an independent effect of menopausal status or age. DESIGN A community-based cross-sectional study. PATIENTS A total of 421 women, aged 18 to 65 years were recruited from the community. Women were required to self-identify at study outset as being either satisfied or dissatisfied with their sexual life and be premenopausal or postmenopausal. MAIN OUTCOME MEASURES Scores from the Psychological General Well-Being Index (PGWB), the Beck Depression Index (BDI) and a daily diary of sexual function. RESULTS A group of 349 women were included in the analysis. Total PGWB and domain scores of positive well-being and vitality were lower in dissatisfied women compared to satisfied women. PGWB total and domain scores of depressed mood, positive well-being and vitality were higher in older women. Menopause did not have an independent effect on well-being. CONCLUSIONS Women who self-identify as having sexual dissatisfaction have lower psychological general well-being. These findings reinforce the importance of addressing sexual health and well-being in women as an essential component of their health care.

Hormone replacement therapy: current controversies

Postmenopausal hormonal therapy is used to manage the climacteric symptoms that impair the quality of life of a substantial number of women. The difficulty is achieving the desired effects with minimal side‐effects and no adverse health risks. Fundamental to this is understanding the physiology of oestrogen in women and the metabolism of the therapeutic compounds. Although the effects of oral oestrogen therapy have been studied extensively, there is insufficient evidence to assess adequately the independent effects of progestin use, other oestrogen compounds, differing doses and duration of treatment. We have reviewed some basic concepts of oestrogen physiology and how these relate to exogenous oestrogen administration, the risks of greatest concern, and the role of androgens and newer treatment alternatives.

Well‐being, health‐related quality of life and cardiovascular disease risk profile in women with subclinical thyroid disease – a community‐based study

Objectives  The aim of this study was to evaluate whether subclinical thyroid disease is associated with impaired health‐related quality of life and a more adverse cardiovascular disease risk profile.

Sexual Function in Well Women: Stratification by Sexual Satisfaction, Hormone Use, and Menopause Status

INTRODUCTION Satisfaction with sexual function in community-based women has not been well-described, and little is known of differences in sexual function between pre-(PreM) and postmenopausal (PM) women. AIM The aim of this article was to describe sexual function in PreM and PM women who self-identify as being satisfied or dissatisfied with their sexual life. METHODS A cross-sectional questionnaire study was conducted among 349 sexually active community-based women, aged 20-65 years, who self-identified as being either satisfied or dissatisfied with their sexual life. MAIN OUTCOME MEASURES Scores from a daily diary of sexual function for 4 weeks, examining the frequency of sexual thoughts, interest, and activity. RESULTS One hundred and eighty-four women (53%) were PreM, and 165 (47%) were dissatisfied with their sexual life. The median number of days with sexual activity or events per month for all women was 8 (ranges 2-28 days; 2-57 events). Ninety-two percent of reported events involved a partner, 86% involved intercourse, and in 40% the woman initiated the activity. Women satisfied with their sexual life had higher frequencies of sexual thoughts, interest, events, and initiation of activity than dissatisfied women (P < 0.0001). PreM satisfied women had higher frequencies of sexual thoughts, numbers of days with sexual activity, and events per month than PM satisfied women (P < 0.05). PreM oral contraceptive pill (OCP) users had significantly lower average frequencies of sexual thoughts, interest, and days of sexual activity per month (P < 0.05), whereas PM women hormone therapy (HT) users had higher frequencies of sexual thoughts and sexual interest (P = 0.04 and P = 0.05, respectively) compared to nonusers. There were no differences in sexual function between PreM and PM women who were sexually dissatisfied. CONCLUSIONS Sexual activity mostly involved a partner, partner initiation, and intercourse. Sexually satisfied women reported more sexual thoughts, interest, events, and initiation of sexual activity than dissatisfied women. PreM sexually satisfied women reported more sexual thoughts, days with sexual activity, and sexual events per month compared to PM satisfied women. OCP and HT use appeared to have contrasting effects on sexual function.

Total cholesterol and triglycerides are associated with the development of new bone marrow lesions in asymptomatic middle-aged women - a prospective cohort study

IntroductionGiven the emerging evidence that osteoarthritis (OA) may have a vascular basis, the aim of this study was to determine whether serum lipids were associated with change in knee cartilage, presence of bone marrow lesions (BMLs) at baseline and the development of new BMLs over a 2-year period in a population of pain-free women in mid-life.MethodsOne hundred forty-eight women 40 to 67 years old underwent magnetic resonance imaging (MRI) of their dominant knee at baseline and 2.2 (standard deviation 0.12) years later. Cartilage volume and BMLs were determined for both time points. Serum lipids were measured from a single-morning fasting blood test approximately 1.5 years prior to the MRI.ResultsThe incidence of BML at follow-up was associated with higher levels of total cholesterol (odds ratio [OR] 1.84, 95% confidence interval [CI] 1.01, 3.36; P = 0.048) and triglycerides (OR 8.4, 95% CI 1.63, 43.43; P = 0.01), but not high-density lipoprotein (HDL) (P = 0.93), low-density lipoprotein (LDL) (P = 0.20) or total cholesterol/HDL ratio (P = 0.17). No association between total cholesterol, triglycerides, HDL, LDL or total cholesterol/HDL ratio and presence of BMLs at baseline or annual change in total tibial cartilage volume was observed.ConclusionsIn this study of asymptomatic middle-aged women with no clinical knee OA, serum cholesterol and triglyceride levels were associated with the incidence of BMLs over 2 years. This provides support for the hypothesis that vascular pathology may have a role in the pathogenesis of knee OA. Further work is warranted to clarify this and whether treatments aimed at reducing serum lipids may have a role in reducing the burden of knee OA.

Greater superior than inferior parietal lobule activation with increasing rotation angle during mental rotation: An fMRI study

Mental rotation is a task known to activate the parietal cortical regions. The present study aimed to investigate whether there is differential activation of regions within the parietal lobe and to reveal functional subspecialisation of this region by examining the effects of increasing angle of rotation. Functional magnetic resonance imaging was performed in nine healthy female subjects whilst undertaking a parametric mental rotation task. The task comprised 6 alphanumeric characters presented in their normal or mirror-reversed orientation. Behaviourally, subjects showed increased reaction times with increased angle of rotation, with differential effects between the alphanumeric characters; numbers having greater reaction times than letters. BOLD signal increase was observed bilaterally in the middle occipital gyrus and medial frontal gyrus, in the right superior and inferior parietal lobules and in the left superior temporal gyrus. Parametric increases in activation with increasing angle of rotation were observed bilaterally in the superior and inferior parietal lobules and in the right medial frontal gyrus, with greater parametric effects in the superior parietal lobules compared to the inferior parietal lobules. Our findings suggest subspecialisation of the posterior parietal lobules during mental rotation, with differential responses in the superior and inferior regions.

Endogenous androgen levels and well-being: differences between premenopausal and postmenopausal women.

Objective:We investigated whether there is a relationship between androgens levels and well-being in pre- and postmenopausal women. Design:We randomly recruited 1423 women aged 18 to 75 years from the community via the electoral roll. Each provided a morning blood sample and completed the Psychological General Well Being Index questionnaire on the same day. Women were excluded if they took medication for any psychiatric illness, had abnormal thyroid function, or had documented polycystic ovarian syndrome. Analysis was by linear regression for well-being, including demographic and lifestyle variables as well as serum levels of androgens. Results:We included 1224 women in the analysis. Being partnered was positively associated with well-being in premenopausal women. In postmenopausal women, well-being was positively related to age and exercising, whereas smoking, obesity, and postmenopausal hormone therapy use were each negatively associated with well-being. None of the measured androgens (total and free testosterone, dehydroepiandrosterone sulfate, and androstenedione) made an independent contribution to well-being in postmenopausal women (n = 603). However, for premenopausal women (n = 621), levels of dehydroepiandrosterone sulfate were independently and positively associated with the domain score for vitality. Conclusions:Our findings do not support an important independent role for androgens as determinants of well-being in postmenopausal women. That dehydroepiandrosterone sulfate alone is associated with greater vitality in premenopausal women is of interest but requires further evaluation as an a priori hypothesis in another study.

Testosterone improves verbal learning and memory in postmenopausal women: Results from a pilot study

OBJECTIVE To explore the effects of testosterone on cognitive performance in healthy postmenopausal women. STUDY DESIGN Open-label pilot study. Nine postmenopausal women on non-oral hormone replacement therapy, aged 47-60 years received transdermal testosterone spray for 26 weeks. A control group of 30 women provided normative data for comparison. MAIN OUTCOME MEASURES Scores from a computerized cognitive test battery performed pre- and post treatment, at 0 and 26 weeks. RESULTS There were no differences between treatment/normative groups in any parameter at baseline. At week 26 scores for the International Shopping list task including delayed recall (verbal learning and memory) and the continuous paired associate learning task (visual learning and memory) were significantly higher in the treatment group as compared to the normative group (p<0.05). Significant improvements from baseline were observed for the International Shopping list delayed recall (verbal learning and memory) and Groton Maze recall tasks (visual learning and memory) for the treatment group (both p<0.05), after 26 weeks. There were no significant differences between baseline and week 26 in the normative group. In the regression analysis which modeled the score at week 26, and which included a bootstrapping approach, the beta coefficient for the treatment group was statistically significant when age and baseline score were taken into account for the International Shopping list task including delayed recall (both p<0.02). CONCLUSION Testosterone improved cognitive performance in the domain of verbal learning and memory in a pilot study of healthy postmenopausal women and is worthy of further exploration in a randomized placebo controlled study.

Androgenic hormones and aging--the link with female sexual function.

In women, sexual function, hormones and aging are inextricably related. Sexual activity in women involves interest and motivation, the ability to become aroused and achieve orgasm, the pleasure of the experience and subsequent personal satisfaction. Androgens, as endogenous hormones or given as a therapy, potentially influence female sexual function, with research into the effects of exogenous androgens in women mostly devoted to effects on sexual desire. Some studies have been conducted to delineate the effects of testosterone on arousal, however arousal determined by laboratory measures does not always correlate with subjective reporting of a sensation of arousal. Overall large randomised controlled trials of exogenous testosterone show benefits over placebo on sexual desire, arousal, orgasm, pleasure and satisfaction. The aspects of consideration of androgen therapy for women that continue to stimulate debate in this therapeutic area include whether female sexual dysfunction is a condition that merits pharmacotherapy, how effective is such treatment and whether testosterone therapy is safe.

Pharmacokinetics and Acute Safety of Inhaled Testosterone in Postmenopausal Women

This was a preliminary feasibility study to assess the pharmacokinetics and acute safety of a single dose of orally inhaled testosterone via the AERx system, a novel handheld aerosol delivery system in postmenopausal women. Twelve postmenopausal women stabilized on oral estrogen therapy were treated with a single dose of testosterone (0.1, 0.2, or 0.3 mg) by inhalation. Plasma concentrations of sex steroids were measured between 1 and 360 minutes. Pulmonary and cardiovascular adverse events were monitored. Inhaled testosterone produced a dose‐dependent increase in plasma total and free testosterone. At the highest dose (0.3 mg), total and free testosterone increased from baseline (mean ± SD, 0.6 ± 0.3 nmol/L, 2.5 ± 1.0 pmol/L) to maximum levels of 62.6 ± 20.4 nmol/L (total) and 168.2 ± 50.2 pmol/L (free), occurring 1 to 2 minutes after dosing. A 2‐compartment model best described the free and total testosterone pharmacokinetic profile. Dihydrotestosterone levels were higher than baseline at 60 minutes (P < .0002). Estradiol did not vary, but sex hormone binding globulin and albumin fell. There were no adverse events related to the treatment. Administration of inhaled testosterone is safe and achieves a supraphysiologic “pulse” kinetic profile of total and free testosterone with a rapid return to pretreatment levels.