Bakgrund: Förlossningsskador är vanligt förekommande och graderas på en skala mellan 1–4 beroende på typ av skada och kan påverka individens sexuella funktion samt livskvalitet. Bäckenbottenträning är en vanlig behandlingsmetod för kvinnor efter förlossning.  Syfte: Denna systematiska litteraturstudie syftade till att undersöka det aktuella vetenskapliga underlaget gällande effekten av bäckenbottenträning efter en obstetrisk skada på sexuell funktion och/eller livskvalitet, samt om bäckenbottenträning kan medföra eventuella biverkningar.  Metod: En systematisk litteraturundersökning i databaserna; PubMed, Cinahl och Scopus. De inkluderade artiklarnas risk för snedvridning granskades enligt PEDro-skalan samt enligt en lokal bedömningsmall inspirerad av GRADE  Resultat: Fem artiklar inkluderades. En av fem studier hade signifikant skillnad mellan grupp gällande sexuell funktion efter bäckenbottenträning samt en studie visade signifikant skillnad rörande symtom relaterat till sexuell funktion. En av tre visade signifikant skillnad rörande livskvalitet efter bäckenbottenträning. Tre studier granskade eventuella biverkningar av träningen och fann inga. PEDro granskningen indikerade låg risk för snedvridning i alla fem artiklar. Den lokala bedömningsmallen inspirerad av GRADE visade en mycket låg evidens för bäckenbottenträningens effekt på sexuell funktion och livskvalitet efter obstetriska skador. Konklusion: Bäckenbottenträningens effekt efter en obstetrisk skada på sexuell funktion och/eller livskvalitet har vissa signifikanta effekter. Inga rapporterade biverkningar av bäckenbottenträningen enligt de inkluderade studierna. PEDro-granskningen visade låg risk för snedvridning. På grund av studiernas heterogenitet samt en mycket låg evidensstyrka är det svårt att fastställa effekten på sexuell funktion och livskvalitet. Fler studier av hög kvalitet behövs för vidare slutsatser om detta. / Background: Birth injuries are common and rated from 1-4 depending on the type of injury and can affect the individual's sexual function and quality of life. Pelvic floor training is a common treatment method for women after childbirth. Objective: To explore the scientific evidence regarding the effect of pelvic floor training post-obstetric injury on sexual function and/or quality of life and potential side effects.   Method: A systematic literature search conducted in the databases; PubMed, Cinahl and Scopus. The article’s risk of bias was assessed using the PEDro scale and a local tool inspired by GRADE  Results: Five articles were included. One study demonstrated significant differences in sexual function between groups and one study showed difference in symptoms related to sexual function after pelvic floor training. One in three studies found improved quality of life post-training. No side effects were reported in three studies. The PEDro-scale found low risk of bias regarding all articles. Local tool inspired by GRADE assessment of certainty showed very weak evidence for training's impact after obstetric injuries on sexual function and quality of life. Conclusion: Pelvic floor training post-obstetric injury has certain significant effects on sexual function and/or quality of life. No side effects were reported, however, due to heterogeneity and very weak evidence determining it effect on sexual function and quality of life remains challenging. More high-quality studies are needed for further conclusions on this matter.

A pós-menopausa inicia-se um ano após o último ciclo menstrual. A redução dos níveis de estrogênio circulante leva a alterações no aparelho genital como atrofia do epitélio do intróito vaginal e vulvar, que podem favorecer o aparecimento de incontinência urinária (IU) e disfunção sexual. O presente estudo teve como objetivo avaliar a função dos músculos do assoalho pélvico (MAP), os relatos de perda urinária e função sexual entre mulheres na pósmenopausa. Trata-se de um estudo clínico transversal que incluiu 76 mulheres na pósmenopausa. O protocolo de avaliação dos MAP incluiu a palpação vaginal utilizando a escala de Oxford modificada, e a perineometria com PeritronTM (Neen HeathCare, East Dereham, Norfolk, UK). Os relatos de incontinência urinária e a função sexual foram avaliados utilizando-se respectivamente o \"International Consultation on Incontinence QuestionnaireShort Form\" (ICIQ-SF) e o Índice de Função Sexual Feminina (IFSF). Para as variáveis categóricas foi proposto o teste exato de Fisher. Para as correlações entre as variáveis contínuas, foi proposto o coeficiente de correlação de Spearman (?), Para a correlação da avaliação da função dos MAP e da severidade com as variáveis contínuas, foi calculado o coeficiente de correlação de Kendall. Para associação da avaliação da função dos MAP e IU e avaliação da função dos MAP e a disfunção sexual foi utilizado Teste Qui-quadrado e Regressão logística simples. Das 76 mulheres avaliadas, 34 (45%) apresentavam IU, 54 (71%), tinham vida sexual ativa. A função dos músculos do assoalho pélvico de 51% das mulheres foi classificada como grau 1 e 2 segundo a escala de Oxford modificada. A média do pico de perineometria foi de 34,73 cmH2O.. Apresentaram disfunção sexual segundo o IFSF, 39 (72%) mulheres. As mulheres incontinentes tiveram escores mais baixos segundo a escala de Oxford modificada, sendo que 58% delas foram classificadas com grau 1 ou 2, comparado a 45% das mulheres continentes (p=0,18). Não houve diferença significativa na média do pico de perineometria entre as mulheres incontinentes (31,92 cmH2O) quando comparado com as continentes (37,18 cmH2O) (p=0,41). Verificou-se uma alta ocorrência de incontinência urinária e disfunção sexual entre as mulheres avaliadas, além disso a função dos MAP da maior parte delas foi deficiente / The post-menopause begins one year after the last menstrual cycle. The reduced levels of circulating estrogen leads to changes in the genital epithelium and atrophy of the vaginal opening and vulva, which may favor the onset of urinary incontinence (UI) and sexual dysfunction. The present study aimed to evaluate the function of the pelvic floor muscles, reports of urinary incontinence and sexual function in women after menopause. This is a cross-sectional clinical study included 76 postmenopausal women. The protocol for the evaluation of pelvic floor muscles included vaginal palpation using the modified Oxford scale, and with perineometry PeritronTM (Neen HealthCare, East Dereham, Norfolk, UK). The reports of urinary incontinence and sexual function were assessed using respectively the \"International Consultation on Incontinence Questionnaire-Short Form\" (ICIQ-SF) and the Female Sexual Function Index (IFSF). For categorical variables was proposed Fisher\'s exact test. For correlations between continuous variables, we proposed the Spearman correlation coefficient (?), for the evaluation of the correlation function of the PFM and the severity with continuous variables, we calculated the correlation coefficient of Kendall. To evaluate the association of PFM and function of the UI and evaluation of the role of PFM and sexual dysfunction was used chi-square and logistic regression simple. Of the 76 women evaluated, 34 (45%) had urinary incontinence, 54 (71%) were sexually active. The function of the pelvic floor muscles for 51% of women were classified as grade 1 and 2 according to the modified Oxford scale. The mean peak perineometry cmH2O was 34.73. Reported sexual dysfunction according to IFSF, 39 (72%) women. Incontinent women had lower scores according to the modified Oxford scale, in which 58% were classified as grade 1 or 2, compared to 45% of continent women (p = 0.18). There was no significant difference in mean peak perineometry between the incontinent women (31.92 cm H2O) compared to the continents (37.18 cmH2O) (p = 0.41). There was a high incidence of UI and sexual dysfunction among women evaluated in addition to pelvic floor muscle function of most of them were deficient.

A vida sexual no pós-parto é influenciada pelas mudanças anatômicas, hormonais, da estrutura familiar e do relacionamento com o parceiro. A redução do desejo e o medo do retorno da atividade sexual são comuns. A episiotomia parece ter impacto negativo e interferir na função sexual das mulheres neste período. Objetivo: Identificar a existência de evidências sobre o efeito da episiotomia na função sexual da mulher no pós-parto. Método: Revisão Sistemática realizada por meio da metodologia do Instituto Joanna Briggs (JBI). A pergunta desta revisão sistemática foi: a episiotomia interfere na função sexual da mulher nos 24 meses após o parto? A estratégia PICOs para a revisão foi a seguinte: P (participantes): mulheres até 24 meses após o parto vaginal de todas as paridades;I (intervenção): mulheres que tiveram parto normal com episiotomia; C (controles): mulheres que tiveram parto normal e não receberam episiotomia; O (resultados): função sexual avaliada por meio de da pontuação do Female Sexual Function Index (FSFI), tempo de retorno à atividade sexual e dispareunia;S (estudos): estudos observacionais, de coorte e transversais. Foram utilizados os descritores e as estratégias de busca específicas para cada uma das bases de dados a seguir: CINAHL, Embase, LILACS, Proquest, PubMed, ScienceDirect, Scopus e Web of Science. Os artigos selecionados segundo a estratégia PICOs foram submetidos aos critérios de análise crítica de qualidade e seus dados foram extraídos com o auxílio do JBI Meta Analysis of Statistics Assessment and Review Instrument (MAStARI), para estudos quantitativos. Cada artigo foi avaliado por dois revisores. Após a extração dos dados dos estudos os resultados foram apresentados em forma narrativa pois todas as metanalises realizadas apresentaram p<0,05 para o teste de heterogeneidade. Resultados: 784 publicações foram identificadas, 11 foram submetidas à avaliação critica, e seis estudos foram incluídos na revisão sistemática. Os dados dos estudosnão apresentaram diferença estatística significativa na função sexual com seis semanas, três e seis meses entre os grupos, o tempo de retorno à atividade sexual foi menor para mulheres que tiveram parto vaginal sem episiotomia em comparação com as que tiveram episiotomia em três estudos.Adispareunia foi analisada em apenas um estudo e apresentou maior proporção em mulheres com episiotomia, porém, sem diferença estatística. Conclusão: A realização da episiotomia pode retardar a retomada da atividade sexual no pós-parto. Os estudos com abordagem quantitativa não apresentaram evidências sobre o efeito da episiotomia na função sexual mensurada por meio do FSFI e na ocorrência de dispareunia. Sugere-se a realização de revisão de estudos qualitativos para se estudar a influência da episiotomia no pós-parto a partir das narrativas das mulheres. / The postpartum sex life is influenced by anatomical, hormonal, changes in family structure and the relationship with the partner. The reduction of desire, fear and the resumption of sexual activity are common. The episiotomy appears to provide negative consequence with sexual function of women in this period. Aim: The objective was to identify the existence of evidence on the effect of episiotomy on sexual function of women in the postpartum period. Method: This is a Systematic Review performed under Joanna Briggs Institute methodology (JBI). The question of this Systematic Review was: Does Episiotomy interferes with women sexual function in the 24 months after childbirth? The PICOs strategy for the review were as follows: P (participants): women up to 24 months after vaginal delivery of all parities. I (intervention): women who delivered vaginally with episiotomy; C (control): women who had normal delivery and did not receive episiotomy; O (results): Sexual Function assessed by Female Sexual Function Index, time to resumption of sexual activity and dyspareunia. S (studies): observational, cohort and cross-sectional studies. Descriptors and specific search strategy for each of the databases below have been applied: CINAHL, EMBASE, LILACS, Proquest, PubMed, ScienceDirect, Scopus and Web of Science. The selected articles according to Strategy PICOS were subjected to critical analysis criteria for quality and data were extracted with the aid of JBI Meta Analysis of Statistics Assessment and Review Instrument-MAStARI, for quantitative studies. Each article was assessed by two reviewers. After extracting data the outcomes were presented through narrative form due to all meta-analysys presente. Results: 784 articles were identified, 11 were subjected to critical evaluation, and these six studies were included in the systematic review. The studies did not present statistical significant difference regarding to sexual function at six weeks, three and six months between the groups, the time of resumption of sexual activity was lower for women who had vaginal delivery without episiotomy compared with those who had episiotomy in three studies. Dyspareunia was analyzed in only one study and had high proportion among women with episiotomy, however, with no statistical difference. Conclusion: The use of episiotomy may delay the resumption of sexual activity postpartum. Studies with quantitative approach presented no evidence on the effect of episiotomy in sexual function assessed by the FSFI and the occurrence of dyspareunia. We suggest including a review of qualitative studies to study the influence of postpartum episiotomy from the narratives of women.

Este estudo teve como objetivo avaliar os efeitos da morbidade materna grave na saúde sexual e reprodutiva de mulheres seis meses após o evento. Estudo observacional, transversal, realizado em dois hospitais na cidade de Ribeirão Preto, São Paulo Brasil: Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto onde ficam internadas as puéperas que tiveram algum tipo de complicação na gestação (Grupo 1) e Centro de Referência em Saúde da Mulher, onde ficam internadas as puérperas de baixo risco gestacional (Grupo 2), totalizando 110 participantes, no período de maio de 2015 a agosto de 2016. A coleta de dados, a qual aconteceu da mesma forma nos dois hospitais, foi realizada em duas fases: a primeira correspondeu ao recrutamento das participantes enquanto ainda estavam internadas após o parto, onde foram obtidos os dados obstétricos, neonatais, sociodemográficos e reprodutivos diretamente do prontuário médico; a segunda ocorreu seis meses após a alta hospitalar das participantes, as quais foram contatadas via telefone para agendamento das visitas domiciliares, onde foram colhidos os dados sociodemográficos, econômicos, ginecológicos, obstétrico e os relacionados à saúde sexual, através do instrumento Female Sexual Function Index. Os dados foram analisados através do software Statistical Package for the Social Sciences e R versão 3.1.2. Foram utilizadas análises univariada e bivariada com distribuição de frequências absolutas e relativas, medidas de tendência central, variabilidade dos dados, testes Mann-Whitney, Qui-quadrado e Exato de Fisher, regressão beta inflacionada. No Grupo 1, a média de idade das mulheres foi de 30 anos, com prevalência da cor branca e a maioria solteira com relação ao estado civil, mas vivia junto com o companheiro há mais de 10 anos, enquanto no Grupo 2, a idade média foi de 27,1 anos com prevalência de cor parda, casada e com tempo de relacionamento entre dois e cinco anos. A escolaridade foi praticamente a mesma nos dois grupos, com uma média de 9,5 anos de estudo. Tanto no Grupo 1 quanto no Grupo 2, a maioria não fumava, nem fazia uso de drogas ilícitas ou bebidas alcoólicas. Enquanto no Grupo 1 a maioria havia feito cesárea, sendo 36,6% dos bebês nascidos prematuros, no Grupo 2, a maioria teve parto vaginal com apenas 7,2% dos bebês nascidos antes de 37 semanas. Das mulheres do Grupo 1, as morbidades materna grave mais frequentes foram as relacionadas aos distúrbios hipertensivos. Não houveram associações entre a ocorrência de morbidade materna grave e a predisposição à disfunção sexual, no entanto, em todos os domínios relacionados à função sexual (desejo, excitação, lubrificação, orgasmo, satisfação e dor), as mulheres do Grupo 2 tiveram melhores pontuações, no entanto com a regressão Beta inflacionada, foram encontradas associações entre os domínos orgasmo e a variável cor, domínio satisfação e a variável tempo de relacionamento e entre o domínio dor e a morbidade materna grave, demonstrando que esse grupo de mulheres sofre com dispareunia quando comparadas com as mulheres que não tiveram complicações na gestação / The objective of this study was to to evaluate the effects of severe maternal morbidity on sexual and reproductive health of women six months after the event. Cross-sectional observational study carried out in two hospitals in the city of Ribeirão Preto, São Paulo Brazil: Hospital of the Clinics of the Medical School of Ribeirão Preto, where the patients who had some kind of complication during pregnancy (Group 1) and Reference Center for Women\'s Health, where low-risk pregnancies (Group 2) are hospitalized, totaling 110 participants, from May 2015 to August 2016. Data collection, which occurred in the same way in both hospitals, was performed in two phases: the first corresponded to the recruitment of the participants while they were still hospitalized after delivery, where the obstetric, neonatal, sociodemographic and reproductive data were obtained directly from the medical record; the second occurred six months after the patients were discharged from the hospital, who were contacted by telephone to schedule home visits, where socio-demographic, economic, gynecological, obstetrical and sexual health data were collected through the Female Sexual Function Index . The data were analyzed through the software Statistical Package for the Social Sciences and R version 3.1.2. Univariate and bivariate analyzes were used with absolute and relative frequency distributions, central tendency measures, data variability, Mann-Whitney, Chi-square and Fisher Exact tests, inflated beta regression. In Group 1, the average age of the women was 30 years, with white prevalence and the majority single in relation to the marital status, but lived with the partner for more than 10 years, while in Group 2, the average age was 27.1 years old, with a prevalence of brown, married and with a relationship between two and five years. Schooling was practically the same in both groups, with an average of 9.5 years of study. In both Group 1 and Group 2, most did not smoke, nor did they use illicit drugs or alcoholic beverages. While in Group 1 the majority had delivered cesarean, with 36.6% of babies born preterm in Group 2, the majority had vaginal delivery with only 7.2% of babies born before 37 weeks. Of the women in Group 1, the most frequent severe maternal morbidities were those related to hypertensive disorders. However, in all domains related to sexual function (desire, arousal, lubrication, orgasm, satisfaction and pain), there were no associations between the occurrence of severe maternal morbidity and the predisposition to sexual dysfunction, the women in Group 2 had better scores However, with inflated beta regression, associations were found between domains orgasm and color variable, satisfaction domain and time relationship variable, and between pain domain and severe maternal morbidity, demonstrating that this group of women suffers from dyspareunia when compared with women who had no complications during pregnancy

Orientador: Eliana Aguiar Petri Nahas / 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 sex... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: 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 doma... (Complete abstract click electronic access below) / Mestre

Introdução - A disfunção sexual é uma queixa comum, porém, ainda pouco valorizada no âmbito da saúde pública, acometendo indistintamente homens e mulheres e com potenciais reflexos negativos na sua qualidade de vida e bem-estar. Objetivo - Avaliar a prevalência de disfunções sexuais e seus possíveis fatores associados entre mulheres de meia-idade residentes na Região Norte do Brasil. Métodos - Estudo transversal e prospectivo, envolvendo 1.415 mulheres entre 35 e 65 anos atendidas no Ambulatório de Ginecologia do Hospital das Clínicas do município de Rio Branco - Acre - Brasil. Para avaliar a sintomatologia menopausal e a sua função sexual, foram aplicados a Escala de Classificação da Menopausa e o Índice da Função Sexual Feminina. Na análise dos dados, usou-se o pacote estatístico Stata 10, aceitando-se um nível de significância de 5 por cento . Na análise de proporções, usou-se o teste não paramétrico do Qui-Quadrado de Pearson. No estudo dos fatores associados às disfunções sexuais, recorreu-se à análise multivariada através de regressão logística múltipla. Resultados - A média etária das mulheres estudadas foi de 47,7 (+8,5) anos. A sua maioria era de baixa escolaridade (6,4+4,6) anos completos de estudo. A menarca, em média, foi aos 13,4 (+1,6) anos. A maioria referiu gestações anteriores (4,6+2,8). Cerca de 35,9 por cento eram pós-menopáusicas, tendo a menopausa ocorrido ao redor dos 48,3 (+4,9) anos. A autopercepção de saúde foi considerada pelas entrevistadas ruim/muito ruim em 54,6 por cento . A irritabilidade foi a queixa mais frequente (78,3 por cento ), seguida pelos problemas osteoarticulares (74,8 por cento ) e ansiedade (72,7 por cento ). A prevalência de disfunção sexual foi de 62,3 por cento . Ajustados os possíveis fatores de confusão, mostraram-se associados a disfunção sexual: baixa escolaridade (OR:1,70; [IC 95 por cento :1,31-2,19]; p<0,001); sedentarismo (OR:1,73; [IC 95 por cento :1,23-2,42]; p=0,001); autopercepção de saúde ruim/muito ruim (OR:1,99; [IC 95 por cento :1,55-2,57]; p<0,001); estado de ânimo depressivo (OR:1,16; [IC 95 por cento :1,05-1,27]; p=0,002); problemas sexuais (OR:2,50; [IC 95 por cento :1,96-3,20]; p<0,001); ressecamento vaginal (OR:1,49; [IC 95 por cento :1,33-1,66]; p<0,001) e a fase de pós-menopausa (OR:1,82; [IC 95 por cento :1,39-2,38]; p<0,001). Conclusão - Entre a população de mulheres da Região Norte Brasileira estudada, a prevalência de disfunção sexual encontrada foi elevada e a análise dos possíveis fatores associados a sua ocorrência revelaram a influência das condições socioeconômicas, estilo de vida, além da sintomatologia e do estado menopausal, desvelando uma multidimensionalidade de aspectos biológicos e não biológicos envolvidos na sua gênese. / Introduction - Sexual dysfunction is a common complaint, under-recognized by public health services, that affects both men and women equally and has potentially negative impacts on the quality of life and general well-being of sufferers. Objective - To assess the prevalence of sexual dysfunctions, and their possible associated factors, among middle-aged women from the Northern region of Brazil. Methods - A cross-sectional, prospective study was carried out involving 1,415 women aged 35-65 years attended at the Gynecology Outpatient unit of the Clinicas Hospital of Rio Branco city - Acre state - Brazil. Menopausal symptomatology and female sexual function were assessed by applying the Menopause Rating Scale and Female Sexual Index. The Stata 10 statistics package was used for all data analysis, adopting a level of statistical significance of 5 per cent . Pearsons Chi-squared nonparametric association test was used for proportions analysis. Multivariate analysis using multiple logistic regression was employed to study the factors associated with sexual dysfunctions. Results - Mean age of the women studied was 47.7 (+8.5) years. The majority had a low educational level averaging (6.4+4.6) full years of schooling. Mean age at menarche was 13.4 (+1.6) years. The majority reported previous gestations (4.6+2.8). Approximately 35.9 per cent were post-menopausal with menopause occurring at around 48.3 (+4.9) years. Self-perceived health among respondents was rated as poor/very poor by 54.6 per cent . Irritability was the most frequent complaint (78.3 per cent ), followed by osteoarticular problems (74.8 per cent ), and anxiety (72.7 per cent ). The prevalence of sexual dysfunction was 62.3 per cent . After adjusting for potential confounding factors, the following were found to be associated with sexual dysfunction: low educational level (OR:1.70; [95 per cent CI:1.31-2.19]; p<0.001); sedentarism (OR:1.73; [95 per cent CI:1.23-2.42]; p=0.001); poor/very poor self-perceived health (OR:1.99; [95 per cent CI:1.55-2.57]; p<0,001); depressive mood (OR:1.16; [95 per cent CI:1.05-1.27]; p=0.002); sexual problems (OR:2.50; [95 per cent CI:1.96-3.20]; p<0.001); vaginal dryness (OR:1.49; [95 per cent CI:1.33-1.66]; p<0.001) and the post-menopausal stage (OR:1.82; [95 per cent CI:1.39-2.38]; p<0.001). Conclusion - A high prevalence of sexual dysfunction was found among women from Brazils Northern region, where socioeconomic conditions, lifestyle, as well as menopausal symptoms and status, influenced its occurrence, revealing a multidimensionality of biological and non-biological aspects involved in its genesis.

Introdução - A disfunção sexual é uma queixa comum, porém, ainda pouco valorizada no âmbito da saúde pública, acometendo indistintamente homens e mulheres e com potenciais reflexos negativos na sua qualidade de vida e bem-estar. Objetivo - Avaliar a prevalência de disfunções sexuais e seus possíveis fatores associados entre mulheres de meia-idade residentes na Região Norte do Brasil. Métodos - Estudo transversal e prospectivo, envolvendo 1.415 mulheres entre 35 e 65 anos atendidas no Ambulatório de Ginecologia do Hospital das Clínicas do município de Rio Branco - Acre - Brasil. Para avaliar a sintomatologia menopausal e a sua função sexual, foram aplicados a Escala de Classificação da Menopausa e o Índice da Função Sexual Feminina. Na análise dos dados, usou-se o pacote estatístico Stata 10, aceitando-se um nível de significância de 5 por cento . Na análise de proporções, usou-se o teste não paramétrico do Qui-Quadrado de Pearson. No estudo dos fatores associados às disfunções sexuais, recorreu-se à análise multivariada através de regressão logística múltipla. Resultados - A média etária das mulheres estudadas foi de 47,7 (+8,5) anos. A sua maioria era de baixa escolaridade (6,4+4,6) anos completos de estudo. A menarca, em média, foi aos 13,4 (+1,6) anos. A maioria referiu gestações anteriores (4,6+2,8). Cerca de 35,9 por cento eram pós-menopáusicas, tendo a menopausa ocorrido ao redor dos 48,3 (+4,9) anos. A autopercepção de saúde foi considerada pelas entrevistadas ruim/muito ruim em 54,6 por cento . A irritabilidade foi a queixa mais frequente (78,3 por cento ), seguida pelos problemas osteoarticulares (74,8 por cento ) e ansiedade (72,7 por cento ). A prevalência de disfunção sexual foi de 62,3 por cento . Ajustados os possíveis fatores de confusão, mostraram-se associados a disfunção sexual: baixa escolaridade (OR:1,70; [IC 95 por cento :1,31-2,19]; p<0,001); sedentarismo (OR:1,73; [IC 95 por cento :1,23-2,42]; p=0,001); autopercepção de saúde ruim/muito ruim (OR:1,99; [IC 95 por cento :1,55-2,57]; p<0,001); estado de ânimo depressivo (OR:1,16; [IC 95 por cento :1,05-1,27]; p=0,002); problemas sexuais (OR:2,50; [IC 95 por cento :1,96-3,20]; p<0,001); ressecamento vaginal (OR:1,49; [IC 95 por cento :1,33-1,66]; p<0,001) e a fase de pós-menopausa (OR:1,82; [IC 95 por cento :1,39-2,38]; p<0,001). Conclusão - Entre a população de mulheres da Região Norte Brasileira estudada, a prevalência de disfunção sexual encontrada foi elevada e a análise dos possíveis fatores associados a sua ocorrência revelaram a influência das condições socioeconômicas, estilo de vida, além da sintomatologia e do estado menopausal, desvelando uma multidimensionalidade de aspectos biológicos e não biológicos envolvidos na sua gênese. / Introduction - Sexual dysfunction is a common complaint, under-recognized by public health services, that affects both men and women equally and has potentially negative impacts on the quality of life and general well-being of sufferers. Objective - To assess the prevalence of sexual dysfunctions, and their possible associated factors, among middle-aged women from the Northern region of Brazil. Methods - A cross-sectional, prospective study was carried out involving 1,415 women aged 35-65 years attended at the Gynecology Outpatient unit of the Clinicas Hospital of Rio Branco city - Acre state - Brazil. Menopausal symptomatology and female sexual function were assessed by applying the Menopause Rating Scale and Female Sexual Index. The Stata 10 statistics package was used for all data analysis, adopting a level of statistical significance of 5 per cent . Pearsons Chi-squared nonparametric association test was used for proportions analysis. Multivariate analysis using multiple logistic regression was employed to study the factors associated with sexual dysfunctions. Results - Mean age of the women studied was 47.7 (+8.5) years. The majority had a low educational level averaging (6.4+4.6) full years of schooling. Mean age at menarche was 13.4 (+1.6) years. The majority reported previous gestations (4.6+2.8). Approximately 35.9 per cent were post-menopausal with menopause occurring at around 48.3 (+4.9) years. Self-perceived health among respondents was rated as poor/very poor by 54.6 per cent . Irritability was the most frequent complaint (78.3 per cent ), followed by osteoarticular problems (74.8 per cent ), and anxiety (72.7 per cent ). The prevalence of sexual dysfunction was 62.3 per cent . After adjusting for potential confounding factors, the following were found to be associated with sexual dysfunction: low educational level (OR:1.70; [95 per cent CI:1.31-2.19]; p<0.001); sedentarism (OR:1.73; [95 per cent CI:1.23-2.42]; p=0.001); poor/very poor self-perceived health (OR:1.99; [95 per cent CI:1.55-2.57]; p<0,001); depressive mood (OR:1.16; [95 per cent CI:1.05-1.27]; p=0.002); sexual problems (OR:2.50; [95 per cent CI:1.96-3.20]; p<0.001); vaginal dryness (OR:1.49; [95 per cent CI:1.33-1.66]; p<0.001) and the post-menopausal stage (OR:1.82; [95 per cent CI:1.39-2.38]; p<0.001). Conclusion - A high prevalence of sexual dysfunction was found among women from Brazils Northern region, where socioeconomic conditions, lifestyle, as well as menopausal symptoms and status, influenced its occurrence, revealing a multidimensionality of biological and non-biological aspects involved in its genesis.

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Obesity is a major epidemic and is increasing in prevalence worldwide. The health problems and consequences of obesity include cardiovascular disease (CVD) risk factors, such as hypertension, hyperlipidemia, glucose intolerance and diabetes mellitus. Each of these abnormalities directly promotes atherosclerosis. More recently, visceral obesity has been shown to be independently associated with abnormalities of both the ventricular and vascular structure and function. The mechanisms by which they occur remain incompletely defined. Cardiovascular magnetic resonance imaging (CMR) offers several advantages for evaluation of cardiac structure and function in the obese. The high accuracy and reproducibility of the technique allows for detection of very small changes in ventricular volumes, mass, ejection fraction, and cardiac output with a relatively small sample size, as compared with echocardiography. In this thesis we investigated whether cardiovascular magnetic resonance imaging can better characterize possible cardiac abnormalities associated with obesity, in the absence of other confounding comorbidities. Obesity is associated with myocardial and vascular function, the extent of reversibility of these abnormalities with rapid acute weight loss remains uncertain. Therefore the first aim of the study was to (i) determine the relationship between obesity and left ventricular structure and function using magnetic resonance imaging, and (ii) the acute effects of rapid diet-induced weight loss on cardiac and vascular function in normal obese and obese diabetic men. Erectile dysfunction is related to cardiovascular risk factors such as obesity by an impairment of endothelial function. Therefore, symptoms of erectile dysfunction are probably to precede cardiovascular disease and events. The second aim of this study was to (i) determine the relationship between obesity and erectile function (EF), sexual desire (SD), lower urinary tract symptoms (LUTS) and quality of life (QOL) measures in obese males, and (ii) determine the effects of rapid diet-induced weight loss on EF, SD, LUTS and QOL measures in normal obese and obese diabetic men. In this group of men, obesity was associated with mild/moderate erectile dysfunction, and significant LUTS, which together with sexual desire improved following rapid diet induced weight loss, but was not directly related to the amount of weight loss or changes in measured metabolic state. Pericardial adipose tissue (PAT) covers 80% of the heart and constitutes 20% of its weight. PAT mass is related to the amount of abdominal fat and the risk of coronary atherosclerosis. Epicardial fat mass may be a sensitive indicator of cardiovascular risk. The third aim of this study was to (i) determine the relationship between obesity and PAT volume and (ii) effectively evaluate the impact of caloric restriction and associated weight reduction on epicardical fat volume via cardiac magnetic resonance imaging (CMR). This is the first study to show a reduction in PAT volume is associated with caloric restriction. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1352389 / Thesis (Ph.D.) - University of Adelaide, School of Medicine, 2009

Obesity is a major epidemic and is increasing in prevalence worldwide. The health problems and consequences of obesity include cardiovascular disease (CVD) risk factors, such as hypertension, hyperlipidemia, glucose intolerance and diabetes mellitus. Each of these abnormalities directly promotes atherosclerosis. More recently, visceral obesity has been shown to be independently associated with abnormalities of both the ventricular and vascular structure and function. The mechanisms by which they occur remain incompletely defined. Cardiovascular magnetic resonance imaging (CMR) offers several advantages for evaluation of cardiac structure and function in the obese. The high accuracy and reproducibility of the technique allows for detection of very small changes in ventricular volumes, mass, ejection fraction, and cardiac output with a relatively small sample size, as compared with echocardiography. In this thesis we investigated whether cardiovascular magnetic resonance imaging can better characterize possible cardiac abnormalities associated with obesity, in the absence of other confounding comorbidities. Obesity is associated with myocardial and vascular function, the extent of reversibility of these abnormalities with rapid acute weight loss remains uncertain. Therefore the first aim of the study was to (i) determine the relationship between obesity and left ventricular structure and function using magnetic resonance imaging, and (ii) the acute effects of rapid diet-induced weight loss on cardiac and vascular function in normal obese and obese diabetic men. Erectile dysfunction is related to cardiovascular risk factors such as obesity by an impairment of endothelial function. Therefore, symptoms of erectile dysfunction are probably to precede cardiovascular disease and events. The second aim of this study was to (i) determine the relationship between obesity and erectile function (EF), sexual desire (SD), lower urinary tract symptoms (LUTS) and quality of life (QOL) measures in obese males, and (ii) determine the effects of rapid diet-induced weight loss on EF, SD, LUTS and QOL measures in normal obese and obese diabetic men. In this group of men, obesity was associated with mild/moderate erectile dysfunction, and significant LUTS, which together with sexual desire improved following rapid diet induced weight loss, but was not directly related to the amount of weight loss or changes in measured metabolic state. Pericardial adipose tissue (PAT) covers 80% of the heart and constitutes 20% of its weight. PAT mass is related to the amount of abdominal fat and the risk of coronary atherosclerosis. Epicardial fat mass may be a sensitive indicator of cardiovascular risk. The third aim of this study was to (i) determine the relationship between obesity and PAT volume and (ii) effectively evaluate the impact of caloric restriction and associated weight reduction on epicardical fat volume via cardiac magnetic resonance imaging (CMR). This is the first study to show a reduction in PAT volume is associated with caloric restriction. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1352389 / Thesis (Ph.D.) - University of Adelaide, School of Medicine, 2009