October 30, 2004
The study was based on a self-administered 143-item questionnaire. This included a French translation of the Female Sexual Functioning Inventory (FSFI), 5 sections of the Derogatis Sexual Functioning Inventory (DSFI) and open questions regarding sexual functioning. FSFI was first developed for use in clinical trials to assess domains of sexual function, such as arousal, orgasm, satisfaction and pain. DSFI measures psychopathology, mood, body image and global sexual satisfaction.
Patients completed the survey anonymously after being asked by their usual physician to participate. The patients' mean scores were compared to age-matched controls who were HIV-uninfected women working as healthcare workers in the unit where the study was being conducted.
The mean age was 38. The mean CD4+ cell count was 517 cells/mm3. At the time of the study, 51/57 were on HAART. Twenty-seven of the women had children, with 70% of those children living with them. Thirty of the women had a regular sexual partner.
Prior to receiving their HIV diagnosis, 19.3% reported some degree of sexual dysfunction, 35.1% after HIV infection and 51.8% after starting HAART. Of the 30 who had a regular sexual partner, 53.5% reported severe or very severe (S/VS) loss of libido, 45% reported S/VS orgasm perturbation (disorder) and 37.5% reported S/VS dyspareunia (genital pain just before, during or after intercourse).
When asked if a specific event could account for these disturbances, knowledge of serostatus, body modification and treatment onset were listed by 67.7, 35.4 and 29%, respectively. The mean scores of the FSFI and the domains of the DSFI were not statistically significantly different between groups.
When the investigators compared the 2 groups regarding all questionnaire items, they found 12 issues to be highly statistically significant for the HIV-infected group: feeling afraid in open spaces, nausea, hot or cold spells, numbness or tingling in parts of one's body, feeling weak in parts of one's body, thoughts of death/dying, feeling miserable, feeling contented, thoughts of ending one's life, trouble getting one's breath, "I'm too fat" and "I'm too thin."
A high prevalence of sexual dysfunction in women with good CD4+ cell counts on HAART was found. Decrease/loss of libido and orgasm perturbation were the most common problems. Interestingly, 19.3 and 35.1% of the women had these same problems before finding out they were infected with HIV and before initiating HAART, respectively.
Because 67.7% of the women reported knowledge of serostatus as a specific event heralding sexual dysfunction, the authors theorized that simply being on treatment may be a source of psychological distress for the women, resulting in sexual dysfunction, rather than the medications directly causing the dysfunction.
The authors point to HIV as the underlying cause of the 12 items found to be statistically significantly different from controls. They attribute the lack of difference in FSFI and DSFI scores between the test and control groups to underlying sexual psychopathology in the controls who were healthcare givers for these HIV-infected women.
While the high level of sexual dysfunction on open-ended questions in HIV-infected women is consistent with the current body of literature, the lack of difference between test and control subjects on standardized validated scales is problematic in this study. Further research using controls who aren't healthcare workers having regular contact with chronically ill HIV-infected patients would be useful.
The authors point that questions about sexual dysfunction should be as commonplace as those about mood, nutrition, etc. is an important take-home message. Their postulate that early treatment of sexual dysfunction may improve mood, medication adherence and quality of life is an important consideration and provides a good framework for future research in this often ignored arena.