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Авторы с должностями и званиями:
Eyup Burak Sancak, MD, Sevilay Oguz, MD, Tugba Akbulut, MD, Aysegul Uludag, MD, Alpaslan Akbas, MD, Omer Kurt, MD, Mehmet Fatih Akbulut, MD
Выходные данные:
CUAJ — Canada’s urology journal for urologists and related specialists. Published online 2016 Jul 12.
С декабря 2013 года по июнь 2015 года мы провели ретроспективное исследование случай-контроль 115 пациенток с АГА и 97 идентичных по возрасту пациенток контрольной группы без проявлений АГА в пременопаузе, которые посетили дерматологические клиники в двух выбранных больницах. У всех женщин (212) был собран анамнез,, антропометрические данные, заполнены опросники. Индекс сексуальной дисфункции у женщин (ИСДЖ) использовался для оценки показателей женской половой дисфункции. АГА оценивалась опытным дерматологом по классификации Людвига. МС оценивался согласно критериям NCEP-ATP III.
При однофакторном анализе возраст, вес, окружность талии, окружность бедер, соотношение талия-бедро, индекс массы тела (ИМТ), АГА, МС, сердечно-сосудистые заболевания, семейное положение, артериальная гипертензия, высокая концентрация глюкозы в плазме натощак, высокий уровень триглицеридов, широкая талия, уровень общего и свободного тестостерона были связаны с наличием СДЖ. При логистическом регрессионном анализе, возраст (отношение шансов [ОШ] 1.21, 95% доверительный интервал [ДИ] 1.13−1.30; р<0,001), АГА (ОШ 3,42; 95% ДИ 1.31−8.94; р=0,017), МС (ОШ 5.39, 95% ДИ 1.34−21.62; р=0,012) и уровень свободного тестостерона (ОШ 0,18, 95% ДИ 0.09−0.37; р<0,001) коррелировали с СДЖ.
Наши исследования показали, что возраст, АГА, МС и уровень свободного тестостерона, может иметь сильное воздействие на сексуальную функцию у женщин в пременопаузе. Чтобы подтвердить этот вывод должны быть проведены дальнейшие исследования популяционного масштаба и продольного дизайна.
Ключевые слова: сексуальная дисфункция у женщин, андрогенетическая алопеция, метаболический синдром.
Table 1.
Alopecia and control patient demographic and clinical characteristics
| Variables | Female androgenetic alopecia (n=115) | Controls (n=97) | p value* |
|---|---|---|---|
| No. patients (%) | 115 (21.1) | 97 (78.9) | |
| Age (years) (mean ± SD) | 36.28 ± 8.92 | 36.07 ± 9.00 | 0.868 |
| Occupation (%) | 0.591 | ||
| Housewife | 66 (57.4) | 57 (58.8) | |
| Officer | 20 (17.4) | 22 (22.7) | |
| Worker | 13 (11.3) | 6 (6.2) | |
| Student | 4 (3.5) | 2 (2.1) | |
| Retired/unemployed | 12 (10.4) | 10 (9.7) | |
| Marital status (%) | 0.049** | ||
| Married | 98 (85.2) | 76 (78.4) | |
| Single | 15 (10.4) | 12 (12.4) | |
| Divorced/separated | 2 (1.7) | 9 (9.3) | |
| Family history (%) | 46 (40.0) | 10 (10.3) | <0.001 |
| Cardiovascular event (%) | 10 (8.7%) | 8 (8.2) | 0.907 |
| Height (cm) (mean ± SD) | 161.70 ± 6.02 | 161,87 ± 5.54 | 0.986 |
| Weight (kg) (mean ± SD) | 70.46 ± 15.85 | 65.25 ± 10.06 | 0.030 |
| Waist circumference (mean ± SD) | 90.42 ± 13.46 | 82.73 ± 10.81 | <0.001 |
| Hip circumference (mean ± SD) | 106.99 ± 10.10 | 100.25 ± 10.79 | <0.001 |
| Neck circumference (mean ± SD) | 33.54 ± 3.89 | 33.94 ± 2.78 | 0.416 |
| Waist to hip ratio (mean ± SD) | 0.84 ± 0.07 | 0.82 ± 0.06 | 0.034 |
| Body mass index (mean ± SD) | 26.94 ± 5.81 | 24.92 ± 3.80 | 0.009 |
| High FPG (%) | 17 (14.8) | 7 (7.2) | 0.083 |
| Hypertension (%) | 32 (27.8) | 16 (16.5) | 0.050 |
| Large waist (%) | 67 (58.3) | 34 (35.1) | 0.001 |
| High TG (%) | 20 (17.4) | 7 (7.2) | 0.027 |
| Low HDL (%) | 64 (55.7) | 63 (64.9) | 0.169 |
| Metabolic syndrome (%) | 28 (24.3) | 14 (14.4) | 0.071 |
| Total testosterone (mean ± SD) | 0.38 ± 0.19 | 0.36 ± 0.19 | 0.461 |
| Free testosterone (mean ± SD) | 1.70 ± 0.83 | 0.32 ± 0.12 | 0.041 |
| FSFI score (mean ± SD) | 25.43 ± 6.88 | 27.55 ± 5.58 | 0.047 |
| Female sexual dysfunction (%) | 60 (52.2) | 35 (36.1) | 0.019 |
| Desire disorder (%) | 62 (53.9) | 26 (26.8) | <0.001 |
| Arousal disorder (%) | 35 (30.4) | 17 (17.5) | 0.030 |
| Lubrication disorder (%) | 47 (40.9) | 32 (32.9) | 0.237 |
| Orgasmic disorder (%) | 48 (41.7) | 32 (32.9) | 0.237 |
| Satisfaction disorder (%) | 42 (36.5) | 26 (26.8) | 0.131 |
| Sexual pain disorder (%) | 40 (34.8) | 41 (42.3) | 0.264 |
*statistically significant at p<0.05;
**Mann-Whitney U test was performed to test the significance of pairwise differences for using Bonferroni correction to adjust for multiple comparisons; FPG: fasting plasma glucose HDL: high-density lipoprotein; SD: standard deviation; TG: trigyceride.
Fig. 1.
The relationship between Female Sexual Function Index (FSFI) scores with metabolic syndrome (MetS) and androgenetic alopecia (AGA).
Table 2.
The relationship of AGA, MetS, and female sexual function
| Androgenetic alopecia n=115 | Control n=97 | Total | p value** | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Total | Metabolic syndrome (+) n= 28 | Metabolic syndrome (−) n=87 | p value* | Total | Metabolic syndrome (+) n=14 | Metabolic syndrome (−) n=83 | p value* | |||
| FSD (%) | 60 (52.2) | 24 (85.7) | 36 (41.3) | <0.001 | 35 (36.1) | 11 (78.5) | 24 (28.9) | <0.001 | 95 (44.8) | 0.019 |
| FSFI score | 25.19 ± 7.06 | 23.19 ± 4.95 | 25.84 ± 7.53 | 0.036 | 27.55 ± 5.58 | 22.59 ± 7.18 | 28.39 ± 4.8 | 0.004 | 26.27 ± 6.53 | 0.047 |
| Desire score | 3.06 ± 0.98 | 2.83 ± 0.90 | 3.14 ± 1.01 | 0.142 | 3.56 ± 1.02 | 2.95 ± 1.25 | 3.65 ± 0.94 | 0.017 | 3.29 ± 1.03 | <0.001 |
| Arousal score | 4.90 ± 1.82 | 4.42 ± 1.49 | 5.05 ± 1.89 | 0.112 | 5.27 ± 1.74 | 4.38 ± 2.03 | 5.42 ± 1.65 | 0.040 | 5.06 ± 1.78 | 0.189 |
| Lubrication score | 5.71 ± 1.93 | 5.21 ±1.55 | 5.87 ± 2.01 | 0.116 | 6.12 ± 1.78 | 4.95 ± 2.12 | 6.32 ± 1.65 | 0.035 | 5.90 ± 1.87 | 0.136 |
| Orgasm score | 3.67 ± 1.16 | 3.54 ± 1.09 | 3.71 ± 1.19 | 0.485 | 4.00 ± 0.92 | 3.30 ± 1.18 | 4.12 ± 0.82 | 0.002 | 3.82 ± 1.07 | 0.096 |
| Satisfaction score | 3.85 ± 1.13 | 3.70 ± 1.01 | 3.90 ± 1.16 | 0.416 | 4.07 ± 0.91 | 3.22 ± 1.17 | 4.22 ± 0.77 | 0.008 | 3.95 ± 1.04 | 0.262 |
| Pain | 4.09 ± 1.22 | 3.70 ± 1.02 | 4.21 ± 1.25 | 0.055 | 4.08 ± 1.23 | 3.69 ± 1.11 | 4.14 ± 1.23 | 0.202 | 4.09 ± 1.22 | 0.626 |
*statistically significant at p<0.05;
**this p value is compared to the AGA and control patients; AGA: androgenetic alopecia; FSD: female sexual dysfunction; FSFI: Female Sexual Function Index; MetS: metabolic syndrome.
Table 3.
The association of FSD with patient demographics, cardiovascular risk factors, clinical variables, and AGA
| Univariate analysis | Logistic regression analysis | |||||
|---|---|---|---|---|---|---|
|
|
|
|||||
| OR | 95% CI | p value* | OR | 95% CI | p value* | |
| Age (years) | 1.17 | 1.12−1.22 | <0.001 | 1.21 | 1.13−1.30 | <0.001 |
| Height (cm) | 0.97 | 0.92−1.02 | 0.183 | |||
| Weight (kg) | 1.03 | 1.00−1.05 | 0.011 | |||
| Waist circumference | 1.05 | 1.02−1.07 | <0.001 | |||
| Hip circumference | 1.03 | 1.00−1.06 | 0.009 | |||
| Neck circumference | 1.04 | 0.96−1.13 | 0.287 | |||
| WHR ≥0.85 | 1.89 | 1.09−3.29 | 0.024 | |||
| BMI | 1.09 | 1.03−1.16 | 0.002 | |||
| Alopecia | 1.93 | 1.11−3.36 | 0.019 | 3.42 | 1.31−8.94 | 0.017 |
| CVE | 3.55 | 1.22−10.35 | 0.020 | |||
| Metabolic syndrome | 5.27 | 1.33−20.92 | <0.001 | 5.39 | 1.34−21.62 | 0.012 |
| Occupation** | 1.43 | 0.79−2.58 | 0.233 | |||
| Marital status*** | 2.29 | 1.07−4.90 | 0.033 | |||
| HT | 3.20 | 1.63−6.31 | 0.001 | |||
| High FPG | 2.75 | 1.12−6.76 | 0.022 | |||
| Large waist | 3.17 | 1.80−5.58 | <0.001 | |||
| High TG | 3.40 | 1.42−8.18 | 0.004 | |||
| Low HDL | 0.66 | 0.38−1.16 | 0.152 | |||
| Total testosterone | 1.83 | 0.45−7.51 | 0.047 | |||
| Free testosterone | 0.365 | 0.2−0.57 | <0.001 | 0.18 | 0.09−0.37 | <0.001 |
*statistically significant at p<0.05;
**unemployed vs. employed;
***single vs. couple; AGA: androgenetic alopecia; BMI: body mass index; CVE: cardiovascular event; FPG: fasting plasma glucose; FSD: female sexual dysfunction; HDL: high-density lipoprotein; HT: height; TG: triglyceride; WHR: waist-to-hip ratio.
Female sexual dysfunction in androgenetic alopecia: Case-control study
From December 2013 to June 2015, we performed a case-control, prospective study of 115 patients with AGA and 97 age-matched control patients without AGA from among premenopausal women who visited dermatology clinics of the two reference hospitals. Comprehensive history, anthropometric measurements, and questionnaire administration were performed for each of the total of 212 women. The Female Sexual Function Index (FSFI) was used to assess the key dimensions of female sexual function. AGA was assessed and graded by an experienced dermatologist according to Ludwig’s classification. The MetS assessment was made according to the NCEP-ATP III criteria.
In univariate analysis, age, weight, waist circumference, hip circumference, waist-to-hip ratio, body mass index (BMI), AGA, MetS, cardiovascular event, marital status, hypertension, high fasting plasma glucose, high triglyceride, large waist, total testosterone, and free testosterone were associated with presence of FSD. In logistic regression analysis, age (odds ratio [OR] 1.21, 95% confidence interval [CI] 1.13−1.30; p<0.001), AGA (OR 3.42, 95% CI 1.31−8.94; p=0.017), MetS (OR 5.39, 95% CI 1.34−21.62; p=0.012), and free testosterone (OR 0.18, 95% CI 0.09−0.37; p<0.001) were independently associated with FSD.
Our study suggests that age, AGA, MetS, and free testosterone may have strong impact on sexual function in premenopausal women. Further studies with population-based and longitudinal design should be conducted to confirm this finding
Keywords: female sexual dysfunction, androgenetic alopecia, metabolic syndrome