Sexual dysfunction and distress in premenopausal women with migraine: association with depression, anxiety and migraine-related disability

DOI: https://doi.org/10.1038/s41443- 018- 0049- z

Abstract-Summary Migraine is a chronic disorder associated with impaired quality of life as well as sexual function.

Data about the sexual distress in women with migraine were lacked. This study aimed to determine the incidence and associated risk factors of both

sexual function and distress in premenopausal women with migraine.

Fifty-five women reported to have sexual dysfunction. Any headache-related feature including MIDAS and VAS scores, depression or

anxiety was found to be related with sexual dysfunction.

Sexual distress was noted in 37 cases, and depression, VAS and MIDAS scores

were significantly higher in women with sexual distress.

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2 Mechanisms

This study showed that women with migraine should be screened both for sexual dysfunction and distress to help clinicians dealing with sexual medicine to improve the standart of patient care in their regular practice.

Extended: Migraine is a chronic headache disorder that is known to affect both

the quality of life and sexual functions negatively.

Introduction Comorbid psychiatric problems including depression and anxiety are more preva- lent in women with migraine and these mood disorders, especially depression, were known to affect overall and sexual functions [701].

Although the prevalence and associated factors of sexual dysfunction in migraine patients were investigated in several studies [700, 702–704], data about the sexual distress in women with migraine were limited to one study and it is obvious that this issue deserves more intensive research [705].

It is reported that the prevalence of sexual problems associated with menopause among women between the ages of 50 and 65 years was 72% in menopausal women, while this rate was found as 38% in women of reproductive ages [706].

Since migraine is mostly seen in women of reproductive ages and menopause is associated with an increased rate of sexual dysfunction, only premenopausal women were included in this study.

The aim of this study is not only to evaluate the rate and risk factors of sexual dysfunction but also to investigate the incidence and associated factors of sexual distress in a larger patient population consisting of premenopausal women with migraine.

Materials and Methods According to those criteria, nine patients were excluded due to previous diagnosis of depression or anxiety, five patients were excluded because of having no regular sexual intercourse during the last few months, five patients were not included due to having diabetes mellitus and four were also because of having hypertension.

The patients were then transferred to a private room to complete migraine dis- ability assessment scale (MIDAS), female sexual function index (FSFI), female sexual distress scale-revised (FSDS-R) and the hospital depression and anxiety scale (HADS).

FSDS-R is a 13-item patient-reported outcome measure that is used to evaluate

sexual activity-related personal distress in women over the last 4 weeks [707].

Turkish version of this scale was successfully cross-validated, and a diagnostic cut-off score of >11.5 was accepted to be highly effective in differentiation of women with hypoactive sexual desire disorder (HSDD) and other FSD and those without FSD [708].

2.5 Hormones

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Results The mean total FSFI score of the women was 19.25 ± 8.18.

It was determined that there was no significant correlation between total FSFI

score or any domain and age, education level and employment status.

Presence of sexual distress was also not correlated with FSFI total (p = 0.476, r = −0.98), desire (p = 0.817, r = −0.032), arousal (p = 0.906, r = 0.016), lubrication (p = 0.729, r = 0.048), orgasm (p = 0.409, r = 0.113), satisfaction (p = 0.224, r = 0.166) or pain (p = 0.633, r = 0.066) domain scores.

It was not correlated with total FSFI score (p = 0.288, r = −0.146), arousal (p = 0.925, r = −0.013), lubrication (p = 0.130, r = −0.207), orgasm (p = 0.572, r = −0.78), satisfaction (p = 0.947, r = −0.009) and pain (p = 0.412, r = −0.113) domains.

Discussion The present study was conducted to determine the incidence of sexual dysfunction and distress in women with migraine and whether those disorders were associated with migraine-related features, depression and anxiety.

Approximately, two thirds of women with sexual dysfunction reported sexual distress which was also found to be related to the presence of depression, severity of pain and migraine-related disability.

This is the first study investigating the incidence of sexual distress and its asso- ciation with migraine-related characteristics including frequency, severity and dis- ability in a large, relatively young cohort of women with migraine.

Although several studies addressing the prevalence of sexual dysfunction in women suffering from migraine were performed, sexual distress was poorly inves- tigated in that patient population.

Further studies should be performed in order to determine the factors associated

with sexual distress in women with migraine.

This is the first study investigating the factors associated with sexual distress in

relatively younger women with migraine.

Conclusion It can be concluded that sexual distress, in addition to sexual dysfunction, should be included in screening measures of women with migraine to help clinicians dealing with sexual medicine to improve the standart of patient care in their regular practice. Special attention should be given to the ones whose MIDAS and VAS scores

were high and who had depression.

Acknowledgement A machine generated summary based on the work of Kucukdurmaz, Faruk; Inanc, Yılmaz; Inanc, Yusuf; Resim, Sefa. 2018  in International Journal of Impotence Research.

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2 Mechanisms

Migraine start, course and features over the cycle of combined hormonal contraceptive users with menstrual migraine— temporal relation to bleeding and hormone withdrawal: a prospective diary-based study