V08_No_2_Final.pdf Sexual Dysfunction and Infertility 127Urology Journal Vol 8 No 2 Spring 2011 General Health and Quality of Life in Patients With Sexual Dysfunctions Mohammad Reza Naeinian, Mohammad Reza Shaeiri, Fahimeh Sadat Hosseini Purpose: To study the general health and quality of life in patients with sexual dysfunctions. Materials and Methods: One hundred and thirty-seven patients with diagnosis of a known sexual dysfunction (SD) were studied. A healthy group of 111 individuals matched for sex, education, and marital status were also selected as a control group. Both groups completed two rquestionnaires: General Health Questionnaire-28 (GHQ-28) and Personal Wellbeing Index– Adult (PWI-A). To analyze data, descriptive methods as well as student t test for independent groups were used. Results: The mean scores for individuals suffering from SD were more than the control group in total GHQ scale and all its subscales. The mean scores in total PWI-A scale and most of its subscales for individuals suffering from SD were lower than the control group. Since the obtained t values (4.16 to 5.22) for all the comparisons done between the mean scores in GHQ for the two groups were higher than t value in the ‘t table’ for df = 206 at = 0.01 (2.58), differences obtained were significant. Since obtained t values (-2.03 to 4.65) for total quality of life and health, achievements, personal relationship, safety, and feeling part of community dimensions were higher than t value in the ‘t table’ for df = 206 at = 0.05 and = 0.01 (1.96 and 2.58, respectively), differences obtained except for standard of living and future security were significant. Conclusion: Somatic, social, and mental measures for people having sexual dysfunctions (patient group) were lower than the control group. Urol J. 2011;8:127-31. www.uj.unrc.ir Keywords: quality of life, sexual dysfunctions, health status, health surveys Department of Psychology, Faculty of Arts and Humanity, Shahed University, Tehran, Iran Corresponding Author: Mohammad Reza Naeinian, PhD Department of Psychology, Faculty of Arts and Humanity, Shahed University, Khalij-e-Fars High Way, Tehran, Iran Tel: + 98 912 770 2588 Fax: + 98 21 5121 2418 E-mail: mnainian@yahoo.com Received May 2010 Accepted October 2010 INTRODUCTION Sexual problems are common in most of the populations and depending on cultural norms‚ they surface intermittently in the family practice setting.(1) Sexual dysfunction (SD) is an issue of growing interest. In a population- based study in Iran, of 2626 women interviewed, 31.5% (759) reported SD. The prevalence increased with age from 26% in women aged between 20 and 39 years to 39% in those >50 years (tested for trend P < .001).(2) In another population- based study in Iran, to explore the prevalence of and risk factors for erectile dysfunction (ED), a total of 2674 men aged between 20 and 70 years were interviewed.(3) Of the men interviewed, 18.8% (460) reported ED. The prevalence increased with age, from 6% in men aged between 20 to 39 years to 47% in those >60 years (tested for trend P < .001). Research examining the occurrence Quality of Life and Sexual Dysfunction—Naeinian et al 128 Urology Journal Vol 8 No 2 Spring 2011 of sexual problems in nonclinical populations tends to be restricted to highly selected populations,(4) such as healthy women in an outpatient gynecological clinic‚(5) normal married couples‚(6) young married couples with children‚(7) and middle-aged men(8) and women with sexual dysfunction‚(9) with sample size of 38 to 439 subjects. A review of 23 “community samples” reported a frequency of 4% to 10% for difficulty in achieving orgasm in both men and women‚ 4% to 9% for erectile problems in men‚ and 36% to 38% for premature ejaculation in men.(7) Similarly, a large-scale international collaboration of multidisciplinary experts reported that 40% to 45% of adult women and 20% to 30% of adult men suffer from at least one form of SD. The following prevalence rates were also reported in women: low levels of sexual interest in 17% to 55%, lubrication difficulties in about 8% to 15%, orgasmic dysfunction in 25%, and vaginismus in approximately 6%. The prevalence of ED was reported to be 1% to 9% in men younger than 40 years, which rapidly increased with age to 20% to 40% in men in the age range of 60 to 69 years.(10) It is difficult to obtain an accurate estimate of the prevalence of SD from the international literature because of the discrepancies existing in definitions and tools used in different studies. Only somatic dysfunctions are well-defined‚ while predominantly psychologically conditioned dysfunctions appear under a multiplicity of labels in various investigations. There is clinical evidence that sexual problems have a multifactorial etiology, including organic, social, and psychological components.(11) The impact of certain pathologies, such as depression and diabetes mellitus, on sexual function is well- known.(12,13) In men, ED is associated with age and is more prevalent in patients suffering from other medical problems.(14) Sexual dysfunctions often coexist with other problems‚ such as depression‚ lack of self-esteem‚ unsuccessful relationships‚ or just inadequate sexual experience. Nevertheless‚ very little is known about the relationship between sexual problems and the quality of life.(15) MATERIALS AND METHODS Target populations were all the people referring to Family Health Clinic in Tehran, with the complaint of a sexual problem. One hundred and thirty-seven patients without a history of other psychiatric disorders were selected for the study by consecutive sampling. They confirmed experiencing a SD through clinical interview by a psychologist, a psychiatrist, or a urologist on the basis of Diagnostic and Statistical Manual, 4th Edition, Text Revision (DSM-IV-RT). One hundred and eleven normal individuals were selected from general population as a control group matched for sex, education, and marital status without having history of sexual problems, to make comparisons possible. To measure the study outcomes, following instruments were used: 1) Clinical interview on the basis of DSM-IV-TR; 2) General Health Questionnaire-28 (GHQ-28) developed originally by Goldberg(16) and translated into Persian by Taqhavi.(17) Taqhavi reported good psychometric measures (reliability and validity) for the test in Iranian population; 3) Personal Wellbeing Index-Adult (PWI-A), developed by Cummins,(18) is claimed to measure quality of life for adults. Its psychometric properties were confirmed in original articles. Naeinian and colleagues found good psychometric reliability and validity for this tool in Iranian population.(19) Both patient and control groups, who met inclusion criteria for the present study, were individually given the above-mentioned tools initially before starting the treatment. RESULTS The patient group consisted of 95 (69.30%) men and 42 (30.70%) women, with the mean age of 49.01(± 12.62) years, while in the control group, 75 (67%) of the participants were men and 36 (32.40%) were women, with the mean age of 40.86 (± 12.92) years. Single and married participants in the patient group were 14 (10.20%) and 123 (89.80%), and in the control group were 9 (8.10%) and 102 (91.90%), respectively. Frequency distribution and percentages of common sexual problems among respondents Quality of Life and Sexual Dysfunction—Naeinian et al 129Urology Journal Vol 8 No 2 Spring 2011 are shown in Table 1. Results show that the most common sexual problems were rapid ejaculation in men (27%), reduced sexual desire (21.90%) and vaginismus (15.30%) in women, and performance anxiety (6.6%) and premature erection in men (6.6%). Descriptive measures, such as mean scores, standard deviations, maximum and minimum scores in GHQ-28 for patients and controls are given in Table 2. Data show that the mean scores for individuals suffering from SD (patient group) were more than the control group in total GHQ scale and all its subscales. As Table 3 shows, the mean scores in total PWI-A scale and most of its subscales for individuals suffering from SD (patient group) were lower than the control group. On the basis of data depicted in Table 4, since obtained t values (4.16 to 5.22) for all the comparisons done between the mean scores for the two groups were higher than t value in the ‘t table’ for df = 206 at = 0.01 (2.58), differences obtained were significant. Therefore, general health measures in all studied dimensions were lower in patients suffering from SD in comparison with the control group. According to Table 5, since obtained t values (-2.03 to 4.65) for total quality of life and health, achievements, personal relationship, safety, and feeling part of community dimensions were higher than t value in the ‘t table’ for df = 206 at = 0.05 and = 0.01 (1.96 and 2.58, respectively), differences obtained except for standard of living and future security were significant. Therefore, total quality of life measure as well as quality of life measure in studied dimensions were lower in patients suffering from SD in comparison with the control group. DISCUSSION The most prevalent sexual problems in the studied sample were primary ejaculation, low libido, erection problems, and vaginismus, which were consistent with findings in previous studies.(7,10) It must be mentioned that apart from cultural and geographical factors in different countries, a proportion of general population in each country suffers from SD, of whom only a limited number seek help. Results in this study also showed that somatic, social, and psychological measures of people Dimensions Group Statistics Mean Standard deviation Minimum Maximum N Somatic dimension Patient 7.54 4.15 1 19 97 Control 5.36 3.42 0 15 111 Anxiety and sleepless Patient 7.57 4.34 0 20 97 Control 5.23 3.54 0 18 111 Social dysfunction Patient 8.26 2.59 1 19 97 Control 6.70 2.55 0 16 111 Depression Patient 5.04 5.17 0 21 97 Control 2.49 3.24 0 18 111 Total GHQ score Patient 28.41 13.65 8 77 97 Control 19.78 10.15 1 67 111 Table 2. Descriptive data in general health dimensions as measured by GHQ-28* *GHQ-28 indicates General Health Questionnaire-28. Diagnosis Frequency Percentage (%) Masturbation 4 2.90 Reduced desire 30 21.90 Vaginismus 21 15.30 Rapid ejaculation 37 27.00 Homosexuality 2 1.50 Performance anxiety 9 6.60 Pain during intercourse 1 0.70 Lack of orgasm 4 2.90 Transvestitism 1 0.70 Premature erection 9 6.60 Lack of pleasure 4 2.90 Frigidity 1 0.70 Sexual aversion 2 1.50 More than one complaint 11 8.10 Unknown 1 0.70 Total 137 100.00 Table 1. Frequency distribution and percentage of sexual problems Quality of Life and Sexual Dysfunction—Naeinian et al 130 Urology Journal Vol 8 No 2 Spring 2011 Dimensions Group Statistics Mean difference Standard error difference df t P Somatic dimension Patient 2.18 0.53 206 4.16 .000 Control Anxiety and sleeplessness Patient 2.34 0.55 206 4.28 .000 Control Social dysfunction Patient 1.56 0.36 206 4.38 .000 Control Depression Patient 2.60 0.59 206 4.32 .000 Control Total GHQ* score Patient 8.63 1.69 206 5.22 .000 Control Table 4. Comparison between patients and controls’ mean scores in general health dimensions on the basis of student t test for independent groups. *GHQ-28 indicates General Health Questionnaire-28. Dimensions Group Statistics Mean difference Standard error difference df t P Standard of living Patient -0.49 0.29 246 -1.70 .09 Control Health Patient -1.42 0.30 246 -4.65 .000 Control Achievements Patient -0.89 0.31 246 -2.96 .003 Control Personal relationships Patient -0.89 0.27 246 -3.32 .001 Control Safety Patient -0.66 0.32 246 -2.03 .04 Control Feeling part of your community Patient -0.66 0.30 246 -2.16 .03 Control Future security Patient -0.17 0.34 246 -0.51 .61 Control Total QOL score Patient -5.18 1.64 246 -3.16 .002 Control *QOL indicates quality of life. Table 5. Comparison between patients and controls’ mean scores in QOL dimensions on the basis of student t test for independent groups* Dimensions Group Statistics Mean Standard deviation Minimum Maximum N Standard of living Patient 6 2.13 0 10 137 Control 4.49 2.42 0 10 111 Health Patient 5.98 2.46 0 10 137 Control 7.40 2.29 0 10 111 Achievements Patient 5.93 2.15 0 10 137 Control 6.82 2.60 0 10 111 personal relationships Patient 6.60 2.17 0 10 137 Control 7.49 1.99 1 10 111 Safety Patient 6.65 2.57 0 10 137 Control 7.31 2.48 0 10 111 Feeling part of your community Patient 6.19 2.38 0 10 137 Control 6.85 2.36 0 10 111 Future security Patient 5.85 2.42 0 10 137 Control 6.02 2.93 0 10 111 Total QOL score Patient 43.19 12.69 0 69 137 Control 48.37 13.02 3 70 111 Table 3. Descriptive data in QOL dimensions as measured by PWI-A* *QOL indicates quality of life; and PWI-A, Personal Wellbeing Index-Adult. Quality of Life and Sexual Dysfunction—Naeinian et al 131Urology Journal Vol 8 No 2 Spring 2011 having SD were lower in comparison with general population. Depressive symptoms have been reported in individuals with SD in earlier studies.(15) Findings in the present study while confirm such previous results, also suggest that adverse effects of sexual problems go more beyond depression. This study also showed that quality of life for people having SD was lower than the control group. This finding is in accordance with the results observed in other countries.(15,20) CONCLUSION We concluded that low general health and quality of life in people with sexual dysfunction cannot be attributed to sexual problems. CONFLICT OF INTEREST None declared. REFERENCES 1. Shahar E, Lederer J, Herz MJ. The use of a self- report questionnaire to assess the frequency of sexual dysfunction in family practice clinics. Fam Pract. 1991;8:206-12. 2. Safarinejad MR. Female sexual dysfunction in a population-based study in Iran: prevalence and associated risk factors. Int J Impot Res. 2006;18: 382-95. 3. Safarinejad MR. Prevalence and risk factors for erectile dysfunction in a population-based study in Iran. Int J Impot Res. 2003;15:246-52. 4. Fog E, Køster A, Larsen GK, Garde og Inge Lunde K. Female sexuality in various Danish general population age-cohorts. Nordisk Sexologi. 1994. 5. Rosen RC, Taylor JF, Leiblum SR, Bachmann GA. Prevalence of sexual dysfunction in women: results of a survey study of 329 women in an outpatient gynecological clinic. J Sex Marital Ther. 1993;19: 171-88. 6. Frank E, Anderson C, Rubinstein D. Frequency of sexual dysfunction in “normal” couples. N Engl J Med. 1978;299:111-5. 7. Nettelbladt P, Uddenberg N. Sexual dysfunction and sexual satisfaction in 58 married Swedish men. J Psychosom Res. 1979;23:141-7. 8. Solstad K, Hertoft P. Frequency of sexual problems and sexual dysfunction in middle-aged Danish men. Arch Sex Behav. 1993;22:51-8. 9. Osborn M, Hawton K, Gath D. Sexual dysfunction among middle aged women in the community. Br Med J (Clin Res Ed). 1988;296:959-62. 10. Lewis RW, Fugl-Meyer KS, Bosch R, et al. Epidemiology/risk factors of sexual dysfunction. J Sex Med. 2004;1:35-9. 11. Dunn KM, Croft PR, Hackett GI. Association of sexual problems with social, psychological, and physical problems in men and women: a cross sectional population survey. J Epidemiol Community Health. 1999;53:144-8. 12. Souetre E, Achard F. [Impact of therapeutics on sex. Value of measurements of quality of life]. Therapie. 1993;48:461-4. 13. Schiel R, Muller UA. Prevalence of sexual disorders in a selection-free diabetic population (JEVIN). Diabetes Res Clin Pract. 1999;44:115-21. 14. Benet AE, Melman A. The epidemiology of erectile dysfunction. Urol Clin North Am. 1995;22:699-709. 15. Ventegodt S. Sex and the quality of life in Denmark. Arch Sex Behav. 1998;27:295-307. 16. Goldberg DP. The detection of psychiatric illness by questionnaire. Maudsley Monograph No 21: London: Oxford University Press; 1972. 17. Taghavi SM. To study reliability and validity for General Health Questionnaire-28 (GHQ-28). J Psychol. 2001;5:381-98. 18. Cummins RA, Eckersley R, Lo SK, Okerstrom E. Australian Unity Wellbeing Index Survey 10. Australian Centre for Quality of Life, Deakin University, Melbourne, Report. 2004;10. 19. Naeinian MR, Babapour J, Shaeiri MR, Rostami R. The Effect of Neurofeedback Training on the Decrement of Generalized Anxiety Disorder (GAD) Symptoms and Patients, Quality of life. J Psychol, University of Tabriz. 2009;5:175-202. 20. Lau JT, Kim JH, Tsui HY. Prevalence of male and female sexual problems, perceptions related to sex and association with quality of life in a Chinese population: a population-based study. Int J Impot Res. 2005;17:494-505.