Medication Use and Sexual Function: A Population-Based Study in Middle Aged Women
Authors: Gueldini de Moraes Anna Valéria , Ribeiro Valadares Ana Lúcia , Lui Filho Jeffrey Frederico , Costa-Paiva Lúcia , Pedro Adriana Orcesi 
Published: July 2019

ABSTRACT

Introduction
Medications used to treat chronic diseases have contributed to increasing longevity and improving quality of life. These medications are considered an indispensable resource in the management of most treatable diseases. However, they can affect sexual function through their effects on the central or the peripheral nervous system or due to hormonal effects.

Aim
To evaluate the association between the use of medication for chronic diseases and sexual dysfunction in Brazilian women 45–60 years of age.

Methods
A secondary analysis of household survey data from a previous cross-sectional, population-based study conducted with a sample of 749 women of a population of 257,434 female urban residents in the age bracket of interest. Sexual function was evaluated using the Short Personal Experiences Questionnaire (SPEQ). Associations between the use of medication and sexual function were evaluated, as were correlations with other variables.

Main Outcome Measure
We found associations of the individual SPEQ domains with the use of some medications.

Results
Mean age of participants was 52.5 ± 4.4 years. Mean age at menopause was 46.5 ± 5.8 years. The overall prevalence of medication use was 68.8%, with the drugs predominantly consisting of those used for cardiovascular diseases. In the Poisson regression analysis, sexual dysfunction, as based on the overall SPEQ score, was associated with sexual inactivity (prevalence ratio [PR] = 4.05; 95% CI 3.16–5.20; P &lt; .001), a sedentary lifestyle (PR = 1.49; 95% CI 1.06–2.09; P = .021), and untreated anxiety (PR = 1.44; 95% CI 1.08–1.92; P = .014). Analysis of the individual SPEQ domains revealed that women who scored low in the desire domain were more likely to use antihypertensive agents (P = .019), whereas a lower score for the arousal domain was associated with the use of antidepressants, with treatment for osteoarticular diseases and with polypharmacy (P = .003). Women with lower scores in the satisfaction domain were more likely to use antidepressants, drugs for osteoarticular diseases, diabetes medication, and polypharmacy (P = .019). A lower score in the orgasm domain was associated with the use of antidepressants, the treatment of osteoarticular diseases, and diabetes (P &lt; .001). Hormone therapy proved protective against loss of libido (P = .036).

Clinical Implications
Some medications can interfere with sexual function negatively and, clinicians have to be aware of it to choose the treatment with fewer collateral effects.

Strength & Limitations
The strength of our study is the large, population-based sample of middle-aged women evaluated for sexual dysfunction with the SPEQ. However, it was a self-reported cross sectional study.

Conclusion
This study found no association between the use of medication for chronic diseases and the overall SPEQ score, whereas untreated anxiety was 1 of the main factors associated with female sexual dysfunction. On the other hand, medical treatments were found to contribute to lower scores in the different sexual function domains. Common drug culprits included antihypertensives, antidepressants, treatment for osteoarticular disease, diabetes medications, and polypharmacy. Hormone therapy protected against loss of libido.