Hormonal Contraception and Female Sexuality: Position Statements from the European Society of Sexual Medicine (ESSM)
Hormonal Contraception and Female Sexuality: Position Statements from the European Society of Sexual Medicine (ESSM)
复制标题
DOI：
10.1016/j.jsxm.2019.08.005
复制
发表时间：
2019-11-01
影响因子：
3.5
通讯作者：
Vignozzi, Linda
中科院分区：
文献类型：
--
作者：
Both, Stephanie;Lew-Starowicz, Michal;Vignozzi, Linda
简介： 激素避孕在世界范围内有多种不同的形式。对副作用和健康问题的恐惧是不使用或停止使用避孕药具的主要原因。尽管避孕药具的安全性和有效性已得到广泛研究，但人们对其对女性性功能的影响知之甚少，而且有关该主题的证据也存在争议。目的：回顾有关激素避孕药对女性性行为影响的现有证据，以便代表欧洲性医学学会提供立场声明和临床实践建议。方法：对文献进行全面审查。主要结果指标：对女性性行为的几个方面进行了调查，包括欲望、性高潮功能、润滑和外阴阴道症状、盆底和泌尿系统症状、伴侣偏好、关系和性满意度。对于每个主题，根据不同类型的激素避孕药（雌激素-孕激素联合方法、仅孕激素方法以及口服或非口服选择）对数据进行分析。结果：根据牛津循证医学中心 2011 年证据水平标准和关于该主题的具体声明，总结了欧洲性医学学会的立场，制定了建议。临床意义：没有足够的证据来制定明确的算法来管理激素避孕引起的性功能障碍，在得出结论之前需要进一步研究。医疗保健提供者有必要进行仔细的基线心理、性和关系评估，以评估随访时激素避孕药的最终效果。优点和局限性：所有研究均经过专家小组评估，为临床实践提供建议。结论：激素避孕药对性功能的影响尚未得到充分研究，并且仍然存在争议。现有证据表明，少数女性在一般性反应、性欲、润滑、性高潮和关系满意度方面经历了性功能的变化。导致性欲减退和外阴阴道萎缩等性困难的病理生理机制仍不清楚。关于激素避孕药与盆底功能和泌尿系统症状之间的相关性，没有足够的证据。版权所有 (C) 2019，国际性医学学会。由爱思唯尔公司出版。保留所有权利。
Introduction: Hormonal contraception is available worldwide in many different forms. Fear of side effects and health concerns are among the main reasons for not using contraceptives or discontinuing their use. Although the safety and efficacy of contraceptives have been extensively examined, little is known about their impact on female sexual function, and the evidence on the topic is controversial.Aim: To review the available evidence about the effects of hormonal contraceptives on female sexuality in order to provide a position statement and clinical practice recommendations on behalf of the European Society of Sexual Medicine.Methods: A comprehensive review of the literature was performed.Main Outcome Measure: Several aspects of female sexuality have been investigated, including desire, orgasmic function, lubrication and vulvovaginal symptoms, pelvic floor and urological symptoms, partner preference, and relationship and sexual satisfaction. For each topic, data were analyzed according to the different types of hormonal contraceptives (combined estrogen-progestin methods, progestin-only methods, and oral or non-oral options).Results: Recommendations according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence criteria and specific statements on this topic, summarizing the European Society of Sexual Medicine position, were developed. Clinical Implications: There is not enough evidence to draw a clear algorithm for the management of hormonal contraception-induced sexual dysfunction, and further studies are warranted before conclusions can be drawn. A careful baseline psychological, sexual, and relational assessment is necessary for the health care provider to evaluate eventual effects of hormonal contraceptives at follow-up. Strengths & Limitations: All studies have been evaluated by a panel of experts who have provided recommendations for clinical practice.Conclusion: The effects of hormonal contraceptives on sexual function have not been well studied and remain controversial. Available evidence indicates that a minority of women experience a change in sexual functioning with regard to general sexual response, desire, lubrication, orgasm, and relationship satisfaction. The pathophysiological mechanisms leading to reported sexual difficulties such as reduced desire and vulvovaginal atrophy remain unclear. Insufficient evidence is available on the correlation between hormonal contraceptives and pelvic floor function and urological symptoms. Copyright (C) 2019, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.