O impacto do assoalho pélvico sobre a função sexual em mulheres na pós-menopausa
Arquivos
Data
2019-02-18
Autores
Omodei, Michelle Sako [UNESP]
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ISSN da Revista
Título de Volume
Editor
Universidade Estadual Paulista (Unesp)
Resumo
Objetivo: Avaliar a associação entre a força dos músculos do assoalho pélvico (MAP) e a função sexual em mulheres na pós-menopausa. Métodos: Realizou-se estudo de corte transversal com 156 mulheres, idade entre 45-65 anos, sexualmente ativas, em amenorreia >12 meses e sem alterações do assoalho pélvico. A função sexual foi avaliada por questionário validado, o Índice de Função Sexual Feminina (FSFI), em que escore total ≤26.5 indica disfunção sexual. A força dos MAP foi avaliada por meio da palpação vaginal bidigital, graduada 0 a 5 pela escala de Oxford, categorizados em não funcional (escores 0–1, sem contração dos MAP) e funcional (escores 2–5, com contração dos MAP). A biometria dos MAP foi realizada por ultrassom transperineal tridimensional (3D) (Voluson E6, GE) para avaliação da área total do hiato urogenital e diâmetros anteroposterior e transverso, e espessura do músculo levantador do ânus. Resultados: As participantes foram divididas de acordo com a força dos MAP, em funcional (n=93) e não funcional (n=63). Não houve diferenças entre os grupos quanto a idade, tempo de menopausa, paridade e tipo de parto e índice de massa corpórea (IMC). Foi observado maior percentual de usuárias de terapia hormonal (TH) no grupo com MAP funcional (36.6%) quando comparadas ao não funcional (12.7%) (p=0.002). Na comparação da biometria dos MAP não foram constatadas diferenças entre os grupos (p>0,05). Observou-se que as mulheres com MAP não funcional apresentaram piora na função sexual apenas no domínio desejo do FSFI (p=0.048). Foi observada fraca correlação positiva significativa entre a força dos MAP com os domínios desejo (r= 0.35, p=0.009) e dor (r=0.25, p=0.021) da função sexual. Na análise de risco, ajustado para idade, tempo de menopausa, paridade e IMC, foi observado que mulheres não usuárias de TH apresentaram risco 2.7 vezes maior para disfunção sexual (OR=2.73; IC 95% 1.11 – 6.7, p=0.029) quando comparadas as não usuárias de TH. Conclusão: Mulheres na pós-menopausa com disfunção dos MAP apresentaram piora na função sexual em relação ao domínio desejo e dor quando comparadas a mulheres com MAP funcionais.
Objective: To evaluate the association between pelvic floor muscles (PFM) strength and sexual function in postmenopausal women. Methods: An analytical cross sectional study was conducted with 226 women, aged 45-65 years, sexually active, in amenorrhea >12 months and without pelvic floor disorders or urinary incontinence. For the evaluation of sexual function, the Female Sexual Function Index (FSFI) was used (total score ≤26.5 indicates sexual dysfunction). PFM strength was assessed by bidigital vaginal palpation, graded 0 to 5 by the Modified Oxford scale, categorized as non-functional (scores 0-1, without contraction) and functional (scores 2-5, with contraction). Transperineal 3-dimensional ultrasound (Voluson E6, GE) was used to evaluate the total urogenital hiatus area, transverse and anteroposterior diameters and levator ani muscle thickness. Results: Participants were categorized as functional PFM (n=143) and nonfunctional PFM (n = 83). There were no differences between the groups in age, time since menopause, parity and type of delivery, body mass index (BMI) and waist circumference. A higher percentage of hormone therapy (HT) users was observed in the group with functional MAP (39.2%) when compared to nonfunctional (24.1%) (p=0.043). The women classified as functional PFM presented greater thickness of levator ani muscle when compared to those classified as nonfunctional (p=0.049). Women with nonfunctional PFM had worsening of sexual function in relation to the domains: desire (p =0.005), arousal (p = 0.001), orgasm (p = 0.006) and total score FSFI (0.006) when compared to functional PFM group. Significant weak and positive correlation was observed between the strength of the PFM with the desire (r= 0.25, p = 0.009) and pain (r= 0.20, p = 0.021) domains of sexual function. There was weak and positive correlation between the strength of the PFM with the domains: desire (r=0.35, p=0.0003), arousal (r=0.21, p=0.013), orgasm (r=0.23, p=0.033) and the score total FSFI (r=0.28, p=0.004) (p<0.05). Ultrasonographic levator ani muscle thickness presented a weak positive correlation with PFM strength (r=0.21, p=0.046) and with the arousal domain (r=0.23, p=0.044). In the risk analysis, adjusted for age, time since menopause, parity and BMI, it was observed that women who used menopausal hormone therapy (OR = 0.26, 95% CI 0.11-0.60, p = 0.002) and those with higher levator ani muscle thickness (OR = 0.85, 95% CI 0.73-0.98, p = 0.025) presented lower risk for sexual dysfunction. Conclusion: Postmenopausal women with PFM dysfunction presented worsening of sexual function when compared to women with functional PFM.
Objective: To evaluate the association between pelvic floor muscles (PFM) strength and sexual function in postmenopausal women. Methods: An analytical cross sectional study was conducted with 226 women, aged 45-65 years, sexually active, in amenorrhea >12 months and without pelvic floor disorders or urinary incontinence. For the evaluation of sexual function, the Female Sexual Function Index (FSFI) was used (total score ≤26.5 indicates sexual dysfunction). PFM strength was assessed by bidigital vaginal palpation, graded 0 to 5 by the Modified Oxford scale, categorized as non-functional (scores 0-1, without contraction) and functional (scores 2-5, with contraction). Transperineal 3-dimensional ultrasound (Voluson E6, GE) was used to evaluate the total urogenital hiatus area, transverse and anteroposterior diameters and levator ani muscle thickness. Results: Participants were categorized as functional PFM (n=143) and nonfunctional PFM (n = 83). There were no differences between the groups in age, time since menopause, parity and type of delivery, body mass index (BMI) and waist circumference. A higher percentage of hormone therapy (HT) users was observed in the group with functional MAP (39.2%) when compared to nonfunctional (24.1%) (p=0.043). The women classified as functional PFM presented greater thickness of levator ani muscle when compared to those classified as nonfunctional (p=0.049). Women with nonfunctional PFM had worsening of sexual function in relation to the domains: desire (p =0.005), arousal (p = 0.001), orgasm (p = 0.006) and total score FSFI (0.006) when compared to functional PFM group. Significant weak and positive correlation was observed between the strength of the PFM with the desire (r= 0.25, p = 0.009) and pain (r= 0.20, p = 0.021) domains of sexual function. There was weak and positive correlation between the strength of the PFM with the domains: desire (r=0.35, p=0.0003), arousal (r=0.21, p=0.013), orgasm (r=0.23, p=0.033) and the score total FSFI (r=0.28, p=0.004) (p<0.05). Ultrasonographic levator ani muscle thickness presented a weak positive correlation with PFM strength (r=0.21, p=0.046) and with the arousal domain (r=0.23, p=0.044). In the risk analysis, adjusted for age, time since menopause, parity and BMI, it was observed that women who used menopausal hormone therapy (OR = 0.26, 95% CI 0.11-0.60, p = 0.002) and those with higher levator ani muscle thickness (OR = 0.85, 95% CI 0.73-0.98, p = 0.025) presented lower risk for sexual dysfunction. Conclusion: Postmenopausal women with PFM dysfunction presented worsening of sexual function when compared to women with functional PFM.
Descrição
Palavras-chave
Menopausa, Função sexual, Músculos do assoalho pélvico, Ultrassom transperineal tridimensional (3D), Menopause, Sexual function, Pelvic floor muscle, 3-dimensional transperineal ultrasound