Fsd 3 Rev 775 17: The Benefits and Risks of Using a Custom Dashboard on Your Xbox 360

Female sexual dysfunction affects 41% of reproductive-age women worldwide, making it a highly prevalent medical issue. Predictors of female sexual dysfunction are multifaceted and vary from country to country. A synthesis of potential risk factors and protective factors may aid healthcare practitioners in identifying populations at risk, in addition to revealing modifiable factors to prevent sexual dysfunction among reproductive-age women.

One hundred thirty-five studies from 41 countries were included in the systematic review. The types of predictors varied according to the location of the study, the type of sexual regime and the level of gender inequality in that country/region. Consistently significant risk factors of female sexual dysfunction were: poor physical health, poor mental health, stress, abortion, genitourinary problems, female genital mutilation, relationship dissatisfaction, sexual abuse, and being religious. Consistently significant protective factors included: older age at marriage, exercising, daily affection, intimate communication, having a positive body image, and sex education. Some factors however had an unclear effect: age, education, employment, parity, being in a relationship, frequency of sexual intercourse, race, alcohol consumption, smoking and masturbation.

Fsd 3 Rev 775 17

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The sexual and reproductive lives of women are highly impacted by female sexual dysfunction, and a number of biological, psychological and social factors play a role in the prevalence of sexual dysfunction. Healthcare professionals who work with women should be aware of the many risk factors for reproductive-age women. Future prevention strategies should aim to address modifiable factors, e.g. physical activity and access to sex education; international efforts in empowering women should continue.

Female sexual dysfunction affects 41% of reproductive-age women worldwide, making it a highly prevalent medical issue [1]. According to the Diagnostic and Statistical Manual for Mental Disorders (5th edition, 2013), female sexual dysfunction entails the following disorders: sexual interest/arousal disorder, female orgasmic disorder and genitopelvic pain/penetration disorder [2].

Sexual dysfunction has a biopsychosocial etiology, i.e. the origin of the dysfunction may stem from a biological or organic condition, a psychological condition and/or a social condition [3]. At the level of the individual, doctors aim to determine the etiology of the dysfunction and treat it accordingly. At the level of the population, however, researchers aim to predict which factors might put one population at risk over another population. Identifying these predictors and their effect (whether protective or risk-inducing) may aid health professionals to better detect and potentially prevent sexual problems from arising.

Predictors of sexual dysfunction are numerous, and various approaches can be used to classify and assess them. The gold standard in epidemiological research is to identify the exact effect sizes of predictors, that is, the quantitative effect of a specific risk factor or protective factor in a population expressed as a measure of relative and/or attributable risk. Such quantitative analyses require a certain degree of homogeneity in the observed population as well as in the measurement of the construct of interest, and therefore often focus on a limited number of predictors. In this analysis, however, the aim was not to quantify the magnitude of the effect of a single predictor but to uncover the breadth of predictors in heterogeneous populations around the globe and to identify possible trends. In order to provide a more structured analysis of the multifaceted risk factors and protective factors in these populations, the predictors of female sexual dysfunction were examined using paradigms which focused on gender inequality.

A 2016 systematic review and meta-analysis assessed the prevalence rate of female sexual dysfunction in 215,740 reproductive-age women worldwide and found the 41% of these women report some form of female sexual dysfunction [1]. A meta-regression of the collected data showed a positive correlation between the prevalence of female sexual dysfunction and the level of gender inequality in a country (Gender Inequality Index from the United Nations Development Program) [1, 8]. Further stratification of these results by world region illustrated that more developed regions (e.g. Europe and North America) typically had rates of female sexual dysfunction below 40%, whereas developing regions such as the Middle East and Africa had rates as high as 62%. The meta-analysis also stratified the prevalence rates according to sexual regimes, as identified by the GSSAB research group. While the overall prevalence rate of female sexual dysfunction was not significantly different between the three regimes, there were in fact significantly lower rates of pain disorders, orgasm disorder and lubrication difficulties in the gender-equal regime compared to the mixed and Asian male-centered sexual regimes. The results of these two large-scale studies cannot show causality between sexual dysfunction and gender inequality, but they do underline the importance of examining sexual health outcomes in terms of the level of gender inequality in a society.

With the rise in publications on female sexual dysfunction [9], an updated summary of the predictors of female sexual dysfunction is needed. The following qualitative analysis and its narrative synthesis will summarize the risk and protective factors related to female sexual dysfunction among reproductive-age women in multiple countries and simultaneously shed further light on the aspect of gender inequality.

The methods for this systematic literature search have been developed according to the recommendations from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements [10]. This protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO): CRD42014009526 and is available in published form [11].

A standard form was designed and used to evaluate the full-text publications for inclusion. Two investigators independently assessed each publication for eligibility and compared their results. If there was a discrepancy in their assessment, a final decision was taken based on discussions with a third reviewer. For multiple publications based on a single study, the most current and/or inclusive study was selected. A second hand search was performed using the reference lists of all included articles.

Cross-sectional, cohort, and case-control studies were eligible for this systematic review. Validation studies, reviews, reports, and commentaries were not included. Clinical populations or populations of women who were surveyed for a particular disease or illness were excluded, as the purpose of this systematic review was to capture the prevalence and risk factors present in the general population. Studies that addressed FSD in infertile women or couples and studies that examined spouses and partners of men with erectile disorder were also excluded.

The research question focused on reproductive-age women in the general population. Any studies that focused primarily on menopausal, postmenopausal, pregnant, or lactating women were excluded. Because several epidemiologic studies covered a broad age range of women, a numeric cutoff was used for the studies that did not specify which women were of reproductive age. Studies were included if (i) all women surveyed were described as premenopausal, (ii) the age range of the participants was between menarche and 49 years, or (iii) data on women no older than 49 years could be extracted from the entire population.

Further details regarding the search strategy, search terms, the assessment of bias, and the meta-analytical prevalence of female sexual dysfunction have been published elsewhere or may be requested from the corresponding author [1]. The PRISMA flow chart of the 135 studies included in this systematic review can be seen in Fig. 1.

Data were extracted from the included studies using an electronic data extraction form created in Microsoft Access. The extraction form was pre-designed and pilot-tested. A pilot test was performed with 20 randomly selected publications on the prevalence of female sexual dysfunction. Based on the results of the pilot test, the form was revised by the investigators.

The type of sexual regime was based on results from the Global Study of Sexual Attitudes and Behaviors (GSSAB) which surveyed 27,500 men and women in 29 countries [7]. Using clustered data on sexual attitudes, satisfaction, behaviors, as well as prevalence rates of sexual dysfunction, Laumann et al. identified three types of sexual regimes worldwide: a gender-equal regime, a mixed male-centered regime, and an Asian sexual regime. The gender-equal sexual regime consisted primarily of Western/European nations (Austria, Belgium, France, Germany, Spain, Sweden, the United Kingdom, Mexico, Australia, Canada, New Zealand, South Africa, and the United States). The mixed male-centered sexual regime included Mediterranean countries (Algeria, Egypt, Israel, Italy, Morocco, and Turkey) as well as Korea, Malaysia, the Philippines, and Singapore. The third cluster, also considered male-centered, entailed only Asian countries: China, Indonesia, Japan, Taiwan, and Thailand (see Table 1).

The significant predictors of female sexual dysfunction were stratified according to type of sexual regime and presented in a Venn diagram or in narrative form. For the individual domains of female sexual dysfunction (desire disorder, arousal disorder, lubrication difficulties, orgasm disorder and pain disorder), a narrative synthesis of the results was given.

The significant risk factors of female sexual dysfunction were stratified according to level of human development and illustrated in the form of word clouds. Due to a large number of highly-specific medical conditions addressed in these 135 publications, only the significant risk factors which were identified in at least two separate studies were included in the word cloud. This allowed for better comparison across the levels of human development. Furthermore, the word clouds were designed to be sensitive to the number of publications in which a certain risk factor had been identified, i.e. a risk factor which was identified in four publications would be presented in a larger font in the word cloud than a risk factor identified in only two publications. For the individual domains of female sexual dysfunction (desire disorder, arousal disorder, lubrication difficulties, orgasm disorder and pain disorder), a narrative synthesis of the results was provided. 2ff7e9595c