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Try out PMC Labs and tell us what you think. Learn More. This study included 29 sexually active women with CS and 30 healthy age and body mass index matched women. Female sexual dysfunction was present in This may be related to the inhibitory effect of cortisol on sex hormones. Age, education, chronic diseases, medication, psychological and physical conditions have been shown to affect sexual function. Glucocorticoid excess causes several metabolic effects and psychiatric symptoms ranging from anxiety to frank psychosis.
Corticosteroids have a profound effect on many regulatory systems of the body, including the reproductive system. Excess adrenal androgens and cortisol both suppress gonadotropic function, which in an array of gonadal dysfunctions. Indeed, most female patients have oligomenorrhea and amenorrhea, and frequently show infertility problems.
The quality of life and depression status were also evaluated in these patients. The secondary aim of the study was to assess the correlation between sexual dysfunction and hormone levels in women with Cushing syndrome. A total of 29 sexually-active women with CS, followed up and treated at a tertiary referral center between andwere included and compared with 30 healthy age-and body mass index matched female subjects.
Exclusion criteria were usage of any drug that could possibly affect sexual or psychiatric status like oral contraceptives, heavy smoking, presence of inflammatory genital disease or vaginal discharge; musculoskeletal, neurologic, inflammatory, or clinically ificant chronic diseases, Sex dating in Cushing menopause or emergennce of these conditions during the study.
All participants had a stable heterosexual relationship and were sexually active with a normal sexually-active male partner. The frequency of sexual activity per week and personal sexual history were obtained from the subjects. Demographic features and a detailed medical history, which included the presence of any systemic disease, use of medication smenstruation status and cigarette use were obtained from all subjects.
Height and weight values were recorded to calculate the body mass index BMI. A detailed physical and gynecologic examination was performed. The therapies and remission status of CS were examined for the patient group. The same cut-off values were defined for Turkish population. All the subjects completed the Beck Depression Inventory BDIa question multiple-choice self-report inventory, which measures the severity of depression.
An analysis of the validity and reliability of its use within the Turkish population has already been conducted and a cut-off score of 17 points was determined. Validation for SF in the Turkish population was undertaken by Kocyigit et al. The diagnosis of CS was established using appropriate tests such as h urinary cortisol UFClate-night plasma or salivary cortisol, overnight 1 mg or the classic 48 h low-dose dexamethasone suppression test DST. Fasting venous blood samples were drawn into plain tubes from patients with CS and controls in their early follicular phases before nine am after overnight fasting.
All the subjects read and ed the informed consent forms before being enrolled in the study. The variables with ificance were evaluated using the Mann-Whitney U and t test to investigate differences between the groups. The were presented as median values and interquartile ranges [IQR]. Linear regression analysis was used to determine the most important predictors of FSFI. For the variables which differ ificantly between groups and could possibly affect FSFI, a hierarchical multiple regression analysis was performed.
The variables included in the model were education status categorical; over and below 8 yearsincome levels categorical; high and lowphysical-and mental health domains of SF continuousand BDI scores continuous. Table 1 shows the demographic characteristics of patient and control groups.
All of these women were receiving appropriate medical therapy and their comorbid diseases were under control. There was no ificant difference between the patient and control group in terms of age, BMI and birth settlement type. Data were expressed as median interquartile range. According to FSFI questionnaire, 24 The arousal, lubrication, the ability to achieve orgasm, pain and satisfaction subdomains of FSFI were ificantly lower in patients with CS Table 2.
Data was expressed as median interquartile range. In the correlation analysis of patients with CS, no correlation was found between basal cortisol levels and FSFI scores. We demonstrated that patients with CS exhibited higher rate of sexual dysfunction, had poorer quality of life and higher rate of depression as compared to the controls. A total of The only domain that did not differ between patients and healthy controls HCs was that of sexual desire. Similarly, patients with CS had lower quality of life scores and were additionally more depressed, in comparison to the HCs. The majority of women with CS and gonadotropin deficiency had relatively low LH and estradiol levels during early follicular phase.
Studies investigating the prevalence of FSD in different endocrine diseases have shown decreased FSFI scores in patients with acromegaly and type 2 diabetes mellitus in comparison to the healthy subjects. However, scores of these two domains were ificantly lower in women with CS relative to healthy women. Additionally women with CS had lower scores in lubrication, satisfaction and pain domains of FSFI when compared Sex dating in Cushing the healthy women. An important point in our study was that HC group had higher socio-cultural status and income level than women with CS. There is paucity of data in the literature to establish an association between FSD and chronic hypercortisolism.
On the other hand, some data have suggested that, in patients with CS, FSD may be related to the low hormone levels caused by the inhibitory effect of hypercortisolism on gonadotropin release. This might in part explain the higher rate of sexual dysfunction in CS group. In our study, patients with CS had lower estradiol levels than HCs. As estrogen has a crucial role on maintaining the integrity of vaginal tissues, estradiol levels might also affect sexuality besides the inhibitory effects of high cortisol levels on gonadotropic hormones.
Estrogen deficiency in sexual dysfunction by causing vaginal atrophy and dyspareunia. Furthermore arousal, sexual interest and response also decrease secondarily to estrogen deficiency. Sexual hormones interact with neurotransmitters in the central nervous system, where the equilibrium between excitatory and inhibitory factors can control sexual functioning. This may be associated with late-onset hypogonadism and decreased libido in both men and women.
This might be one of the possible factors contributing to the sexual dysfunction in women with CS. Hypercortisolism does not only affect sexual function but also le to several comorbidities which themselves might deteriorate sexual well-being. Diabetes, hypertension, cardiovascular diseases, coagulopathy and hypothyroidism are more frequently seen in CS. Seven of eight domains from the SF had ificantly lower scores in the Sex dating in Cushing with CS. We had chosen SF for evaluating quality of life in our subjects because SF is a health questionnaire which can easily predict well-beings of both the patients and the healthy control group.
Women with CS were found to be more depressed than the HCs. The relation between depression and chronic hypercortisolism is very well known. Dysregulation of the biomarker cortisol suggests the presence of an abnormal limbic system drive on the hypothalamic-pituitary-adrenal axis in primary depression.
Most patients described short spells of sadness, whereas others experienced constant hopelessness. Exposure to supraphysiologic stress-level concentrations of cortisol for a long time may be the cause of depression. The positive correlation between cortisol levels and BDI scores in our study confirm this hypothesis.
In addition, there was Sex dating in Cushing negative correlation between the SF and BDI scale scores, which could confirm that wellbeing may be directly affected by physiologic mood. Although women with CS have a worse quality of life and more severely depressive mood, we have demonstrated that CS per se affected FSFI independently. There are some limitations that must be considered when interpreting these. First, the small of the patients may limit the statistical ificance of the obtained. Secondly, the patient and control groups were not totally homogeneous, differences such as income level and education status could have affected our.
However, this is the first study which evaluated sexual dysfunction in women with CS. In conclusion, majority of women with CS in our study had sexual dysfunction. Sexual dysfunction is a multifactorial condition and our findings supported this notion. Additionally, we found that income levels, physiologic mood, wellbeing and sex hormone status are important factors in FSD. Further large-scale multi-center studies are needed to clarify the impact of these factors on the pathogenesis of FSD in CS. This research did not receive any specific grants from any funding agencies in the public, commercial, or not-for-profit sector.
Informed Consent: Informed consent was obtained from all individual participants included in the study. Peer-review: Externally peer-reviewed. Author Contributions: Concept — P. Conflict of Interest: Authors have no conflicts of interest to declare.
Financial Disclosure: The authors declared that this study has received no financial support. National Center for Biotechnology InformationU. Journal List Turk J Urol v. Turk J Urol. Published online Jul 1. Author information Article notes Copyright and information Disclaimer. Corresponding author.
Received Aug 28; Accepted Apr Copyright by Turkish Association of Urology. This article has been cited by other articles in PMC. Material and methods This study included 29 sexually active women with CS and 30 healthy age and body mass index matched women.Sex dating in Cushing
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Sex and Cushing’s