Gebelerde cinsel fonksiyon değerlendirmesi: Serum androjen ve fetal cinsiyet ilişkisi

Year 2019, , 64 - 69, 15.06.2019

Bahar Sarıibrahim Astepe

https://doi.org/10.16948/zktipb.533351

Abstract

Giriş:
Hamilelik
sırasında fiziksel ve hormonal değişiklikler sonucunda kadınların cinsel
sağlığı önemli derecede etkilenmektedir.

Amaç:
Hamile Türk kadınlarda cinsel değişiklikler ile androjenik hormonlar ve fetal
cinsiyet ilişkisini değerlendirmek.

Metod:
Bu kesitsel çalışma Kadın Hastalıkları ve Doğum Kliniği'nde değerlendirilen 194
sağlıklı gebeyi içermektedir. Gebe kadınlar, Kadın cinsel işlev ölçeği(KCİÖ) ve
sosyodemografik özelliklerle ilgili sorular 
içeren ,kendi kendine uygulanan bir anket doldurdu. Serum androjenleri
aynı zamanda çalışıldı. FSFI toplam ve altgrup 
puanları, maternal serum total testosteron , dehidroepiandrosteron
sülfat(DHEAS) ve 1-4 delta androstenedion düzeyleri ölçüldü.

Bulgular:
Türk gebe kadınlarda %68 oranında cinsel işlev bozukluğu bulundu. Cinsel işlev
bozukluğu oranı, gebelik boyunca KCİÖ'nin toplam ve altgrup puanlarını içerir.
KCİÖ'nin toplam ve altgrup puanları trimesterlar arasında farklılık göstermese
de , gebelik haftası ilerledikçe orgazm altgrup puanının azaldığı bulundu.
Bunun yanında gebelik haftası ilerledikçe toplam testosteron artışıyla beraber
DHEAS düzeyinin azaldığı görüldü. Kız fetüslü kadınlarda KCİÖ puanları ve
trimesterlar arasında androjen düzeyleri değerlendirildiğinde, üçüncü
trimesterdaki total testosteron düzeyi ,birinci ve ikinci trimester
düzeylerinden daha yüksek bulundu. Ayrıca ilk trimesterdaki DHEAS düzeyleri
ikinci ve üçüncü trimester seviyelerinden 
yüksek bulundu. Erkek fetüsü olan kadınlarda trimesterlar arasında
androjen düzeyleri, KCİÖ toplam ve altgrup puanları açısından anlamlı bir fark
yoktu.

Sonuç:
Türk gebe kadınlarda yüksek bir cinsel işlev bozukluğu oranı (%68) bulundu.
Toplam testosteron, DHEAS ve KCİÖ orgazm altgrup skorunun trimesterlar arasında
farklılık gösterdiği bulundu. Sağlık hizmeti sunanlar antenatal muayenelerde cinsel
sağlık konusunda  danışmanlık için daha
çok zaman ayırmalı ve cinsel sağlık ve sorunlar hakkında konuşmak için gebeleri
teşvik etmelidirler.

Keywords

Cinsel sağlık, gebe, androjen, fetüs

Assesment of female sexual function of pregnant women: Relation with serum androgens and fetal gender

Abstract

Introduction: As a result of physical and hormonal changes during pregnancy sexual
health of women affected significantly.

Aim: To
evaluate sexual changes related to androgenic hormones and fetal gender in
pregnant Turkish women.

 Methods: This cross-sectional study included 194 healthy pregnant
women evaluated at Obstetrics and Gynecology Clinics.
Pregnant women completed a self-administered questionnaire including  the Female Sexual Function Index (FSFI) and
questions related to socio-demographic characteristics. Serum androgens were
run simultaneously.

Main outcome measures: FSFI total and domain scores , the level of maternal serum total testosterone,
Dehydroepiandrosterone sulphate
(DHEAS) and 1-4 delta androstenedione 
were measured.

Results: There was
a rate of 68%  sexual dysfunction among
Turkish pregnant women. The sexual dysfunction rate comprises the total and
domain scores of FSFI throughout the pregnancy. Although the total and domain
scores of FSFI did not differ between trimesters, orgasm domain scores were
found to be  decreasing with increasing
gestational age. Along with an increase in total testosterone, the DHEAS level
decreases with increasing gestational age. When the women with female fetus
were evaluated for FSFI scores and androgen levels between trimesters, the mean
level of total testosterone in third trimester was higher than the levels of
first and second trimesters besides the mean level of DHEAS in the first
trimester was higher than the levels of second and third trimesters. There was
not any significant difference according to the androgen levels, FSFI total and
domain scores between trimesters of the women with male fetus.

Conclusion: We found a high sexual dysfunction rate (68%) among pregnant Turkish
women. The level of total testosterone, DHEAS and FSFI orgasm domain were found
to be different between trimesters. Healthcare providers should provide more
time for counseling about sexuality and encourage pregnant women to talk about sexual
health and problems during antenatal visits.

References

• 1. Ribeiro MC, Nakamura MU, Scanavino Mde T TM, R M. Female sexual function and gestational diabetes. J Sex Med. 2012;9:786–92.
• 2. Kerdarunsuksri A MS. Attitudes and sexual function in Thai pregnant women. J Med Assoc Thai. 2010;93:265–71.
• 3. GS SMAA. Predictors of sexual function during pregnancy.Journal of Obstetrics and Gynaecology. J Obs Gynaecol. 2015;Early onli.
• 4. Alessandra Plácido Lima LeiteI; Ana Aurélia Salles Campos; Antonio Roberto Cardoso Dias; Abes Mahmed Amed; Eduardo De Souza; Luis Camano. Prevalence of sexual dysfunction during pregnancy. pregnancy Rev Assoc Med Bras. 2009;55(5).
• 5. Pauleta J, Pereira NM GL. Sexuality during pregnancy. J Sex Med. 2010;7:136-142.
• 6. Bogren L.Y. Changes in sexuality in women and men during pregnancy. Arch Sex Behav. 1991;20:35-45.
• 7. Read J. ABC of sexual health: Sexual problems associated with infertility, pregnancy, and ageing. BMJ. 2004;329:559–61.
• 8. Farage M MH. Lifetime changes in the vulva and vagina. Arch Gynecol Obs. 2006;273:195–202.
• 9. Kitzinger S. Woman’s experience of sex. UK Dorling Kindersley Ltd. 1983.
• 10. Jessica Murtagh, CNM, MSN R. Female Sexual Function, Dysfunction, and Pregnancy: Implications for Practice. J Midwifery Womens Heal. 2010;55(5):438-446.
• 11. Daucher J, Clark KA, Stolz DB, Meyn LA MP. Adaptations of the rat vagina in pregnancy to accommodate delivery. Obs Gynecol. 2007;109:128–35.
• 12. Tarig Elraiyah, Mohamad Bassam Sonbol, Zhen Wang TK, Noor Asi, Chaitanya Undavalli, Mohammad Nabhan OA, Larry Prokop, Victor M. Montori and MHM. The Benefits and Harms of Systemic Dehydroepiandrosterone (DHEA) in Postmenopausal Women With Normal Adrenal Function: A Systematic Review and Meta-analysis. J Clin Endocrinol Metab. 2014;99(10):3536–3542.
• 13. Sarah Wåhlin-Jacobsen, MD,* Anette Tønnes Pedersen, MD, PhD,† Ellids Kristensen, MD ‡, Nanna Cassandra Læssøe, MD,* Marika Lundqvist, MSc,§ Arieh S. Cohen, MSc P, David M. Hougaard, MD, Dr.Med,§ and Annamaria Giraldi, MD P. Is There a Correlation Between Androgens and Sexual Desire in Women? J Sex Med. 2015;12:358–373.
• 14. Yves Morel, Florence Roucher , Ingrid Plotton , Claire Goursaud , Véronique Tardy D. Evolution of steroids during pregnancy: Maternal, placental and fetalsynthesis. fetalsynthesis Ann d’Endocrinologie. 2016;77(2):82-89.
• 15. Martin Hill, Andrea Paˇskováb, Radmila Kanˇcevaa, Marta Velíkováa, Jana Kubátováa, Lyudmila Kanchevaa, Karolína Adamcováb, Michaela Mikeˇsováb, ZdenˇekˇZiˇzkab, Michal Kouck´yb, HanaˇSarapatkovác, Viktor Kaˇcerb, Petr Matuchaa MMA. Steroid profiling in pregnancy: A focus on the human fetus. J Steroid Biochem Mol Biol. 2014;139:201-222.
• 16. Oksuz, E. and Malhan S. Reliability and validity of the Female Sexual Function Index in Turkish population. Sendrom. 2005;17:54.
• 17. Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R FDD. The Female Sexual Function Index(FSFI):A multidimensional self-report instrument for the assesment of female sexual function. J Sex Marital Ther. 2000;26:191-208.
• 18. Oksuz E MS. Prevalence and risk factors for female sexual dysfunction in Turkish women. J Urol. 2006;175:654–658.
• 19. Seven M.Akyüz A GS. Predictors of sexual function during pregnancy.Journal of Obstetrics and Gynaecology. J Obstet Gynaecol (Lahore). 2015;Early onli:1-5.
• 20. Guleroğlu TF. BN. Evaluation of sexual functions of the pregnant women. J Sex Med. 2014;11:146-153.
• 21. Gokyildiz Ş BN. The effects of pregnancy on sexual life. J Sex Marital Ther. 2005;31:201-215.
• 22. Lee JT, Lin CL, Wan GH LC. Sexual positions and sexual satisfaction of pregnant women. J Sex Marital Ther. 2010;36:408-420.
• 23. Aytul Corbacıoğlu Esmer, Aysu Akca, Ozgur Akbayır, Behiye Pınar Cilesiz Goksedef V lale B. Female sexual function and associated factors during pregnancy. J Obstet Gynaecol Res. 2013;39(6):1165-1172.
• 24. Cara Ninivaggio & Rebecca G. Rogers & Lawrence Leeman & Laura Migliaccio, Qualls DT& C. Sexual function changes during pregnancy. Int Urogynecol J. 2017;28(6):923-929.
• 25. Aslan G, Aslan D, Kizilyar A, Ispahi C EA. A prospective analysis of sexual functions during pregnancy. Int J Impot Res. 2005;17:154-157.
• 26. Farage M MH. Lifetime changes in the vulva and vagina. Arch Gycol Obs. 2006;273:195-202.
• 27. K von S. Sexuality during pregnancy and after childbirth: a meta content analysis of 59 studies. J Psychosom Res. 1999;47:27-49.
• 28. TY R. Pelvic floor involvement in male and female sexual dysfunction and the role of pelvic floor rehabilitation in treatment: A literature review. J Sex Med. 2007;4:4-13.
• 29. Otubu JAM, Olusanya O, Okoko A, Lar C JT. Sexuality during pregnancy in healthy Nigerians. Afr Med J. 1988;12:856-861.
• 30. Kukkonen TM, Binik YM, Amsel R CS. Thermography as a physiological measure of sexual arousal in both men and women. J Sex Med. 2007;4:93-105.
• 31. Pauls R, Mutema G, Segal J, Silva WA KS, Dryfhout Ma V KM. A prospective study examining theanatomic distribution of nerve density in the human vagina. J Sex Med. 2006;3:979-987.
• 32. Gökyıldız Şule BKN. The Effects of pregnancy on Sexual Life. J Sex Marital Ther. 2005;31:201-215.
• 33. Macdonald PC SP. Origin of estrogen in women pregnant with ananencephalic fetus. J Clin Invest. 1965;44:465-474.
• 34. Bulent Erol, Oner Sanli, Duzgun Korkmaz, Ayse Seyhan TAK. A Cross-sectional Study of Female Sexual Function and Dysfunction During Pregnancy. J Sex Med. 2007;4:1381-1387.
• 35. Shaeen S, HinesM, Newson RB, Wheeler M HD, Strachan DP JR. Maternal testosterone in pregnancy and atopic outcomes in childhood. Allergy 200.
• 36. Carlsen, S.M., Romundstad, P., Jacobsen G. Early second- trimester maternal hyperandrogenemia and subsequent preeclampsia: a prospective study. Acta Obs Gynecol Scand. 2005;84:117-121.
• 37. Gol, M., Altunyurt, S., Cimrin, D., Guclu, S., Bagci, M., Demir N. Different maternal serum hCG levels in pregnant women with female and male fetuses: does fetal hypophyseal–adrenal– gonadal axis play a role? J Perinat Med. 2004;32:342-345.
• 38. Tuutti, E.K., Hamalainen, E.K., Sainio, S.M., Hiilesmaa VK, Turpeinen, U.L., Alfthan, H.V., Stenman UH. Serum testosterone levels during early pregnancy in patients developing preeclampsia. Scand J Clin Lab Invest. 2011;71:413-418.
• 39. van de Beek, C., Thijssen, J.H., Cohen-Kettenis, P.T. van G, S.H., Buitelaar JK. Relationships between sex hormones assessed in amniotic fluid, and maternal and umbilical cord serum: what is the best source of information to investigate the effects of fetal hormonal exposure? Horm Behav. 2004;46:663-669.
• 40. van de Beek, C., van Goozen, S.H., Buitelaar, J.K. C-K, P.T. Prenatal sex hormones (maternal and amniotic fluid) and gender-related play behavior in 13-month-old infants. Arch Sex Behav. 2009;38:6-15.
• 41. Troisi, R., Potischman, N., Johnson, C.N., Roberts, J.M. L, D., Harger, G., Markovic, N., Siiteri, P., Hoover RN. Estrogen and androgen concentrations are not lower in the umbilical cord serum of pre-eclamptic pregnancies. Cancer Epidemiol Biomarkers Prev. 2003;12:1268-1270.