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Metabolic syndrome is the key determinant of impaired vaginal lubrication in women with chronic spinal cord injury

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Abstract

Purpose

Spinal cord injury (SCI) affects sexual health of both male and female, but little attention has been given to sexuality of SCI women. Similar to penile erection, vaginal lubrication represents a neurovascular event and then both denervation and vascular damage might contribute to its impairment. Nevertheless, the relative weight of lesion location/degree and vascular risk factors in determining hypolubrication in women with SCI has not yet been investigated. The aim of this study was to recognize among putative determinants of poor sexual arousal in women with SCI, neurogenic and vascular/metabolic independent predictors of vaginal hypolubrication.

Methods

Twenty-eight consecutive female patients admitted to a rehabilitation program because of chronic SCI (≥ 1 year) underwent clinical and biochemical evaluations, including assessment of vaginal lubrication by the Female Sexual Function Index (FSFI). As, in people with SCI, waist circumference overestimates visceral fat mass due to abdominal muscle paralysis, metabolic syndrome (MetS) was defined according to specific criteria proposed for SCI population: BMI ≥ 22 kg/m2 and two or more of the following: triglycerides ≥ 150 mg/dL (or actual treatment), HDL < 50 mg/dL, hypertension (or actual treatment), fasting glucose ≥ 100 mg/dL or diabetes mellitus type 2.

Results

A FSFI lubrication sub-score < 3.6, suggestive for impaired vaginal lubrication, was exhibited by 53.7% of the study population. When compared to the group with normal lubrication, a significantly higher proportion of these women had paraplegia (93.3% vs 38.5%, p = 0.003) and met the SCI-specific criteria for MetS (73.4% vs 7.6%, p = 0.0006), whereas, no significant differences were found between the two groups in the proportion of women exhibiting the single components of MetS. At the multiple logistic regression analysis, only the presence of MetS exhibited a significant independent association with impaired vaginal lubrication (OR = 3.1, 95% CI 1.2, 5.8, p = 0.01).

Conclusions

In women with SCI, a clustering of modifiable vascular/metabolic risk factors, constituting the MetS, could contribute to sexual dysfunctions by affecting the vaginal lubrication, independently of the level of the spinal cord lesion.

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Funding

This work was supported by Ministero dell’Università e della Ricerca Scientifica, Italy.

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Authors and Affiliations

  1. Andrology Unit, Department of Life, Health and Environment Sciences, University of L’Aquila, Piazzale Tommasi 1, 67110, L’Aquila, Italy

    S. D’Andrea, C. Castellini, V. Paladino, M. Totaro, S. Francavilla, F. Francavilla & A. Barbonetti

  2. Spinal Unit, San Raffaele Institute of Sulmona, Sulmona, Italy

    S. D’Andrea & G. Felzani

Authors
  1. S. D’Andrea
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  2. C. Castellini
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  3. V. Paladino
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  4. M. Totaro
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  5. G. Felzani
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  6. S. Francavilla
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  7. F. Francavilla
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  8. A. Barbonetti
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Contributions

Conceptualization: AB, SD’A; methodology: AB, SD’A; formal analysis and investigation: AB, SD’A, CC, GF; writing-original draft preparation: SD’A, EM, VP, MT; supervision: AB, SF, GF, FF.

Corresponding author

Correspondence to A. Barbonetti.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The local ethics committee approved the study protocol.

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Informed consent was obtained from all individuals included in the study.

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D’Andrea, S., Castellini, C., Paladino, V. et al. Metabolic syndrome is the key determinant of impaired vaginal lubrication in women with chronic spinal cord injury. J Endocrinol Invest 43, 1001–1007 (2020). https://doi.org/10.1007/s40618-020-01185-w

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  • DOI: https://doi.org/10.1007/s40618-020-01185-w

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