الفهرس 
FEMALE SEXUAL DYSFUNCTIONOnly 14 pages are availabe for public view
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Abstract
F
emale sexual dysfunction can be influenced by cardiac diseases like angina and myocardial infarction, which may result in reduced sexual satisfaction due to factors such as medication side effects, physical limitations, and psychological issues like anxiety and depression. Studies suggest high prevalence rates of sexual dissatisfaction and psychiatric complications post-myocardial infarction, including PTSD and depression. However, there’s a lack of understanding regarding the prevalence and risk factors of female sexual dysfunction following cardiac events, especially after percutaneous coronary intervention (PCI) in the Egyptian community. Investigating the effects of PCI on female sexual function and identifying potential psychiatric sequelae post-cardiac events are essential for improving patient care and rehabilitation efforts.
The study aimed to assess the prevalence of sexual dysfunction in females with ischemic heart disease who underwent percutaneous coronary intervention (PCI) within the past year, highlight associated risk factors, and explore correlations between sexual dysfunction post-PCI and psychiatric conditions including depression, anxiety, and PTSD.
The study was comparative cross-sectional research conducted from September 2023 to March 2024 at Ain Shams University Hospital, Cairo. It involved 90 patients divided into three groups: those with ischemic heart disease who underwent percutaneous coronary intervention (PCI), those with ischemic heart disease without PCI, and those with diabetes and hypertension without ischemic heart disease.
No significant differences in demographic and risk factors across the three groups, except for lower ejection fraction and higher angina grade in ischemic patients who underwent intervention. The median time since intervention was 6 months, with a range of 1 to 12 months, and the median number of stents inserted was 1.5, ranging from 0 to 6 stents. All patients in Groups 1 and 2 (ischemic female patients who underwent PCI and who didn’t respectively) were sexually dysfunctional, while 63.3% of patients in group 3 were sexually dysfunctional, with a highly significant difference (p < 0.001). Ischemic patients, regardless of intervention, had higher sexual dysfunction prevalence than the control group (p = 0.001). Significant differences were observed in desire, arousal, lubrication, and pain scores between ischemic and control groups, but not in orgasm and satisfaction scores.
No significant differences in depressive, anxiety, or PTSD symptoms (p > 0.05) among the three groups. Quality of life also did not significantly differ (p = 0.089). This suggests that ischemic heart disease or its intervention does not significantly affect mental health or quality of life compared to controls with similar risk factors.
Among patients who underwent intervention (group 1), those with a BMI > 25 experienced more severe sexual dysfunction, as indicated by significantly lower FSFI scores compared to those with a BMI < 25 (p = 0.023).
Individuals without hypertension in group 1 demonstrated less severe sexual dysfunction compared to those with hypertension (p = 0.035).
Age exhibited a moderate negative correlation with FSFI desire score (r = -0.490, p = 0.006) while ejection fraction showed significant positive correlations with desire score (r = 0.421, p = 0.021) and lubrication score (r = 0.409, p = 0.025).
Longer duration since intervention was associated with higher FSFI scores across all domains (p < 0.001).
No significant correlations were found between other mental health measures (BDI, HADS, PCL) and FSFI domain scores.
Multivariate linear regression analysis revealed that time since intervention was the most significant factor positively correlated with FSFI desire score (β = 0.454, p = 0.005) and lubrication score (β = 0.483, p = 0.005).
Conversely, age exhibited a negative correlation with desire score (β = -0.398, p = 0.011).
Age over 50 years, hypertension, and higher NYHA functional classes were significantly associated with depression in univariate analysis. However, only hypertension retained significance in multivariate analysis (p = 0.043, odds ratio: 26.215), while age and NYHA class did not.
Ejection fraction (EF) of 59% or lower was significantly associated with anxiety (p = 0.011, odds ratio: 11.200, 95% CI: 1.735 - 72.300).
Having more than one stent inserted was associated with PTSD in both univariate (p = 0.017, OR: 16.000) and multivariate analysis (p = 0.030, OR: 17.284)
Strengths
1. To our knowledge this is the first study in Egypt to assess the correlation between ischemic heart disease and female sexual function in patients who underwent percutaneous coronary intervention
2. Correlations were done between percutaneous coronary intervention and presence of depression, anxiety and PTSD.
3. Accepted sample size (Most of the studies involved nearly similar sample size).
Conclusions
• Females with ischemic heart disease who underwent percutaneous coronary intervention had significantly higher incidence of sexual dysfunction.
• In ischemic females who underwent intervention, time since intervention has emerged as the most important factor affecting the sexual functions with consistent trend of improvement or stabilization in various aspects of sexual function and overall function with a longer duration since the intervention.
LIMITATIONS
1- This was a comparative cross-sectional study; thus, it was hard to conclude a causal relationship between the two variables.
2- No base line assessment of sexual function before the onset of the illness or the intervention
3- No assessment or interviews with partners had been done which may represent an important confounding factor
4- No relationship with the time of onset of the disease had been done
5- The study was done among patients who attend the cardiology clinic at el-demerdash hospital who represents in most, urban residents and may not represent the who Egyptian community.
6- Egyptian females found it difficult to address their sexual problems with lack of sexual education among them making the interview embarrassing and consumed a lot of time
RECOMMENDATIONS
Clinical recommendations:
1- Increase awareness of sexual aspect and activity whenever safe after intervention among both patients and physicians.
2- Routine assessment of sexual functions among patients with ischemic heart disease
3- Modifying factors like obesity may have a role in treatment and this may be included in benefits of regime
Research recommendations:
1- Having cohort study to follow up the same patients before intervention and after the intervention
2- Multicentre study across all governments for generalization of results across Egyptian community
3- A study is needed to assess the effect of systemized sexual advices and consultation on the sexually dysfunctioning females before and after undergoing the intervention