Sexual function in middle-aged Latin American women as determined by the Female Sexual Function Index: improving global acceptance of the use of validated measures of sexual function.

T he Collaborative Group for Research of the Climacteric in Latin America (REDLINC), with its most recent publication in this volume of Menopause, provides a much needed examination of sexuality in Latin American women while also offering some important parallels to other research on female sexual disorders. First, and perhaps most obvious, just as research on female sexual function, in general, has lagged greatly behind research on male sexual function, there has been even less research published on the sexual function and dysfunction of women from Latin American countries and, specifically, on postmenopausal women. This is true despite the fact that sexual problems are typically one of the most frequently reported health concerns of women presenting to menopause clinics. However, of late, there has been increasing interest in determining just what the prevalence is of sexual problems and disorders in women, and a number of recent epidemiologic studies have greatly advanced our knowledge. The REDLINC article on the prevalence and associated risk factors of sexual disorders in middle-aged Latin American women now adds much needed information on this population. Furthermore, by analyzing sociodemographic characteristics as possible risk factors for sexual disorders, this cross-sectional research provides information that may be relevant to women even beyond the Latin American countries included. That is, each REDLINC center, while able to hold culture (Latin), religion (Catholic), and ethnic origin (Mestizo: Spaniard/Indigenous) constant, allowed for comparisons of other sociocultural variables such as age, educational level, marital status, hormone therapy use, health, history of sexual trauma, and male partner sexual dysfunction. The results from this large, albeit cross-sectional, sample of 7,243 women aged 40 to 59 years confirm results from other longitudinal studies looking at variables related to age and menopause and their impact on sexual function. The women who reported being sexually inactive were significantly older (note the limited age range from 40 to 59 y), less educated, less healthy, more likely to be postmenopausal, and less likely to use hormone therapy. Although the results indicate that the women from these Latin American countries are more likely to be sexually active than women studied in other countries (74.4%, n = 5,391), the aggregate prevalence of sexual problems in those reporting being sexually active was 56.8%, which is slightly higher than that of most of the large epidemiologic studies of women in other countries. Furthermore, the rates were quite variable based on the location of the REDLINC center (eg, 53.4% in Caracas, Venezuela, vs 84.7% in Cochambamba-I, Bolivia). The authors suggest that their results emphasize the importance of individual risk factors for sexual problems, with differences even within groups in the same city possibly reflecting the impact of ethnic and cultural factors as well as socioeconomic factors. Because of this significant variability in the prevalence rates of sexual problems among REDLINC centers, ranging from 21.0% in Cartagena, Columbia, to 98.5% in Quito, Ecuador, the authors grouped the REDLINC centers into tertiles based on their mean prevalence of sexual problems to assess what other factors beyond the sociocultural might explain such differences. Based on a logistic regression analysis, four main factors were associated with sexual problems in women who were sexually active: poor vaginal lubrication, the use of alternative therapies, older age, and partner sexuality. Except for the use of alternative therapies, these factors indicate that Latin American women may share many of the same general risk factors for sexual problems as those of aging women in other countries and cultures. The second interesting parallel to research in female sexual function notable in this study is the REDLINC group’s focus on a single validated instrument, the Female Sexual Function Index (FSFI). The FSFI is a brief, multidimensional selfreport instrument used for assessing key dimensions of sexual function in women. The scale consists of 19 items that measure sexual function over the past 4 weeks and provides domain scores in six areas: sexual desire, arousal, lubrication, orgasm, satisfaction, and pain. Since its development in 2000, the FSFI has undergone further psychometric study, which has confirmed the initial factor structure and its excellent reliability and validity. Its scale structure is clear and, relevant to this study, replicable in other languages. A recent study proposed that participants scoring 26 or lower on the total FSFI score should be considered at risk for sexual dysfunction and be further evaluated. The FSFI is frequently used in clinical trials and is becoming the criterion standard for the evaluation of women with sexual problems. Even Avis et al acknowledge the limitation of their analysis of sexual function in the Study of Women’s Health Across the Nation because of the lack of inclusion of a validated sexual function questionnaire and specifically reference the FSFI. In justifying the choice of the FSFI for this study, the authors should be lauded for pointing out that, despite the Food and Drug Administration’s guidance that frequency of satisfying sexual events