Hypothesis / aims of study
The World Health Organization (WHO) defined obesity as a BMI ≥ 30 kg / m² and that overweight and obesity are defined as abnormal fat or excessive fat accumulation that impairs health (1).
The female sexual function represented by the sexual response and characterized by the phases of desire, excitement, orgasm, and resolution; may be influenced by psychosocial and physiological aspects. Sexual dysfunction occurs when one of the phases is compromised, being multifactorial in its etiology and complex pathophysiology. (5).
The present study aimed to verify the correlation of sexuality and obesity in women, allowing an analysis of the emotional, psychological and sexual quality of life of the evaluated group.
Study design, materials and methods
This study was carried out at the Obese Outpatient Clinic of University Hospital from March 2018 to December 2019. For the inclusion criteria, 87 obese women were invited (BMI≥30kg / m²) between 25-56 years. All patients were invited to sign the Informed Consent Form (ICF).
Inclusion criteria: accept participate in the study and sign the ICF.
The exclusion criteria: pregnancy with a history of normal birth or cesarean section in less than 6 months, previous gynecological surgeries and difficulty in participating in the process for particular reasons were excluded from the study. Those with urinary tract infections also were excluded.
Sexual function was assessed by the FSFI, which is a self-administered questionnaire translated and validated into the Portuguese (Brazilian) language and indicated for clinical and epidemiological studies. FSFI is a test with six subscales and a sum of scores that measures the degree of desire, excitement, lubrication, orgasm, satisfaction, and pain (dyspareunia).
The questionnaire consists of 19 questions about sexual activity in the last four weeks. The patient selected in each question one of the six possible alternatives that best described her situation. Alternative 0 indicated that she did not have sexual intercourse and the others ranged from 1 to 5. The analysis was performed by gathering the answers in six different domains: Desire items 1 and 2; Excitation items 3, 4, 5 and 6; Lubrication items 7, 8, 9 and 10; Orgasm items 11, 12 and 13; Satisfaction items 14, 15 and 16; Discomfort / Pain items 17, 18 and 19.
For domain scores, the individual scores are added and multiplied by the corresponding factor. To obtain the total score of the scale, the scores for each domain are added. The score 0 domain indicates that the patient reported not having sexual activity in the last four weeks.
The project is in accordance with the guidelines and regulatory standards for research involving human beings and was submitted to and approved by the Research Ethics Committee of the Hospital (number 2.320.921)
A total of 98 patients agreed to participate in the study, 5% of whom did not sign the informed consent form and 6% did not complete the questionnaire, with a total of 87 participating
Eighty-seven obese women were interviewed, and the following results were obtained in the population aged 25 - 35 years (16.50 ± 7.80), 36 - 45 years (17.47 ± 7.10), 46 - 56 years (15.00 ± 7.82).
Table 1 shows the correlation between the age group of obese women evaluated and the domains related to the female sexual function index, where it is possible to suggest that there is no correlation between the age group in obese women and sexual satisfaction.
Table 1 - Correlation between age group and FSFI domains
age group desire arousal lubricates orgasm satisfaction pain
Age Desire Excitation Lubrification Orgasm Satisfaction Pain
25 - 35 3,17 3,50 3,35 3,62 3,08 4,15
36 - 46 3,33 3,73 3,72 3,75 3,38 4,04
47 - 55 3,21 3,39 3,29 3,37 2,77 3,69
Interpretation of results
The use of questionnaires, generic or specific, as instruments for assessing the quality of life has been intensified in scientific research in recent years. This is due to the fact that there is a growing interest of health researchers in subjective methods of clinical evaluation. Thus, the patient's opinion about their health condition is valued. In the last decade, several questionnaires were developed in the area of voiding dysfunction. These instruments, usually developed in the English language, assess the impact of these disorders on the patients' quality of life. Because they are extensive, they have become inefficient and, consequently, difficult to apply in clinical practice or even in scientific research. For their use to be suitable for other languages and cultures, it is necessary to subject them to international rules of translation and cultural adaptation to the target language (Guillemin et al., 1993). In the age group of 25 - 35 years the average was 3.48 ± 0.38; 36-46 years was 3.66 ± 0.24; and 47 - 56 years old was 3.29 ± 0.30, noting that there was no significant difference between the domains evaluated.
The FSFI questionnaire applied in the proposed work gets comprehensive answers about sexual satisfaction or dissatisfaction, therefore, it was not possible to identify whether low self-esteem, embarrassment, and dissatisfaction are related to obesity or lower urinary tract syndrome / urinary incontinence, common in obese women or phycological.
The Female Sexual Function Index (FSFI) is a short scale that allows you to assess sexual function in women comprehensively. The proposed objective of this work is to assess the impact of obesity on self-esteem, quality of sexual life in women, therefore, it was not possible to assess whether the low score obtained in the proposed questionnaire is related only to obesity or other factors, such as psychological, physical or social.