الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Few disorders have generated as much debate, passion, and confusion in their definition as polycystic ovary (or ovarian) syndrome (PCOS), with the possible exception of insulin resistance and the metabolic syndrome, with which it is mechanistically associated.
A critical issue remains the definition of the disorder, which not only has an important impact on the scientific investigation of the syndrome, but also implies significant consequences for individual patients.
Diagnosing a woman as having PCOS has life-long implications for her health and well-being and suggests an increased risk for diabetes, dyslipidemia, hypertension, endometrial carcinoma, infertility, and possibly cardiovascular disease, in her, her relatives, and her off-springs and has the potential of negatively impacting on her ability to access health care coverage. Consequently, the diagnosis of PCOS should not be assigned lightly, and diagnostic criteria should be used on sound data.
The costs of evaluating and caring for PCOS patients during their reproductive years can be conservatively $ 4 billion in the United States, although this estimate would be significantly higher if the costs of caring for morbidities emerging in the post-reproductive years were considered. The cost of the diagnostic evaluation accounts for a relatively minor part of the costs, slightly more than 2%. This suggests that more widespread screening for the disorder is potentially a cost-effective strategy, leading to earlier diagnosis and intervention and possibly the amelioration and prevention of serious sequalae.
Patients with PCOS have a 4-fold increased risk of developing type 2 DM, and approximately 40% of the economic burden is due to the development of this morbidity in these patients during their reproductive years. It was estimated that 12.8% of the $12.6 billion associated with the management of diabetes of patients younger than 45 years old is attributed to women with PCOS.
The conservative management of menstrual dysfunction or AUB accounts for approximately one third of all costs, which is not surprising because a majority of patients with PCOS demonstrate this abnormality. Considering the low cost of diagnosis and the high cost of the associated morbidities, aggressive identification of PCOS and prompt and early management of the associated clinical consequences represent a cost-effective strategy to reduce the considerable economic burden of this disorder.
Unfortunately, data on the prevalence of polycystic ovary syndrome in Egypt or the regional Arab countries was almost impossible. Furthermore, the basic epidemiology of polycystic ovary syndrome among Egyptian females did not capture the attention of researchers.
Moreover, the impact of polycystic ovary syndrome on the quality of life of the affected women together with their marital and sexual life and its satisfaction have not been previously studied among Egyptian females.
To overcome this gap, this study shimmer the light on the problem of polycystic ovary syndrome among a sample of women in Alexandria, detecting the prevalence of polycystic ovary syndrome together with the quality of life and sexual satisfaction of these women.
Our study showed that:
- Nearly most of the sample (66.9%) were between the age of 20 – 39 years. Meanwhile, only 1.8% of women were under the age of 20 and 31.3% were 40 years of age and above.
- Regarding the marital status, 91.4% of women were married. Divorced women were 4% becoming almost equal to widows who were 4.1% of the sample.
- Almost more than half of the women (52.5%) were illiterate or just read and write, 19.5% had primary education and 18.1% had preparatory education.
- Less than half of the women (41.8%) were working.
- As regards the educational level of the husbands, the study shows that about half of the husbands (53.3 %) were illiterate or just read and write. This was followed by 17.5% who had secondary education.
- The families were divided almost equally between those who were constituted from 3 – 4 persons (39.1%) and those who were constituted from 5 or more persons (41.3%).
- Families formed of 2 persons only constituted one fifth of the sample (19.1%). Only 3 cases were represented by a single female (0.5%).
- About 40% (37.6%) of the sampled women were before 20 years of age at marriage, compared to only 2.3% of the sampled women were above 30 years old.
- As for the other two groups of ages, the women between 20 and 24 years of age constituted 43.62% and those who were between 25 and 29 years of age were 16.45% when they got married . The mean age of women at marriage was 21.12 years with ± 3.79 years standard deviation.
- 17.5 % of these women were unlucky and failed to deliver their conceptus. 15.2 % of the females delivered only once. Almost half of the sample (45.3%) delivered two or three times, but those who delivered four or more constituted (22.0%) of the sample.
- The women who delivered once or twice successfully delivered (38.4%) live births compared to those who delivered three times and more who delivered (43.9%) live births constituting nearly half the number of the live births of the sample.
- By examination, ovarian enlargement constituted 9.5% of the females of the general sample.
- According to Rotterdam criteria for diagnosis of polycystic ovary syndrome, those women who had two or more of the preceeded major symptoms (n = 14) were suspected to have PCOS.
- All suspected cases were then subjected to ultrasound imaging and sampled for FSH: LH ratio were all proved to have PCOS.
- One third of the cases of PCOS (10 %) were of normal weight compared to (11.5%) of the general sample. Regarding overweight women, it was more obvious in the general sample (43.6%) than those of the PCOS cases (23.3%).
- Obesity was prominent in two thirds of the PCOS cases (66.7%) compared to less than half of the general sample (44.9%). The difference between cases and controls regarding obesity was not statistically significant.
- The highest concern which affected the quality of life in PCOS cases was the infertility problem with a total mean score of 82.92 ± 32.08(mean ± SD respectively) and a worst QoL level of 75%from cases of PCOS of this domain. In this infertility domain, the most important two question was “Concern about sterility” with 85.0±32.56 (mean ± SD) and 80% worst QoL, and “Fear from becoming sterile” with 85.0±26.75 (mean± SD) and 73.3% worst QoL. “Feeling sad because of fecunditiy problems” question had a 83.33±33.04 (mean± SD) and 75% worst QoL. As for the question “Lost control because of your life because of PCOS” it scored 78.33±36.40 with a 70% worst QoL.
- The following most important concern of PCOS cases affecting their quality of life was the emotion of these patients due to their disease. The emotion domain had a total mean score of (72.82±35.80) (mean ± SD) and a worst QoL of 58.7%.
- The most important question was “Feeling depressed because of PCOS” had a mean score 89.66 ± 24.57 and worst QoL of 82.8%, followed by “Time spent in anxiety about PCOS” with a mean score 87.93±25.55 and worst QoL of 79.3%. This was almost similar to the question “Low self confidence because of PCOS” which made a mean score of 86.21±29.57 and a worst QoL of 79.3%.
- The “mixed moods and feelings” gave a mean score of 86.21±22.74 with a worst QoL of 72.4%, while “time spent feeling your disease is attracting attention” had a mean score of 63.33±36.98 and worst QoL of 43.3%, which was almost near to “Easy fatigued” which had a mean score of 61.67±36.40 and worst QoL of 40%.
- Following the infertility and the emotions domains in importance to the patients of PCOS in this sample was that of increased weight problem. The weight problem domain had a total mean score of 68.00±37.67 and a worst QoL of 52.7%.
- The most important issue here was “Difficulty in maintaining appropriate weight” with a mean score of 73.33±36.51 and a worst QoL of 60%.
- This was followed by almost three equal issues which are “Concern about increase in weight”(mean score 73.33±34.07 and worst QoL 56.7%) and “Disappointment because of failure to reduce weight”(mean score 68.33±38.24 and worst QoL of 53.3%) then “Time spent to control your weight” (mean score 66.67±40.11 and worst QoL of 53.3%).
- The hair problem domain was the fourth domain in importance with a total mean score of 60.07±40.26 and a worst QoL of 44.3%. The most important question in this domain was “Embarrassment due to hair on body”. It had a mean of 70.00±38.51 a worst QoL of 56.7%. This was followed by “Feeling about hair on face” which had a mean score of 68.33±38.24 and a worst QoL of 53.3%. The last in importance was the menstrual problems domain which had a total mean score of 56.00±35.67 and a worst QoL of 32%. The most important question in this domain was about “Irregularity of duration of mensis” with a mean score of 61.67± 42.92 and a worst QoL of 50%.
- The overall score of Quality of Life in polycystic ovary cases had a mean of 67.74± 37.50 with a worst QoL of 52.1%.
- The frequency of number of sexual intercourse (at least 1 – 5 times in in the last four weeks) before the questionnaire was observed in 60% of cases compared to 43.3% of controls with a statistical significance p=0.014.
- Less than two thirds of the PCOS cases (60%) were sexually satisfied compared to 88.3% of the controls, with a statistical significance p=0.001.
- Sexual fantasies was more in PCOS cases, where the difference was statistically significant, where p=0.001.
- Increase of hair formed a negative influence on sexual self- worth of 60% of PCOS cases, with a significance p=0.001.
- The difficulty in establishing social relations was found to be in 43.3% of cases compared to only 6.7% of controls, with a statistical significance p=0.000.
- Tender touches with the husband gave 62.1% of PCOS cases complete satisfaction during sexual intercourse compared to 50.8% of controls.
- Deep kissing with husband gave 56.7% of PCOS cases complete satisfaction during sexual intercourse compared to 40.0% of controls.
- Holding hands with husband gave 50% of cases complete satisfaction during sexual intercourse, compared to 16.9% of controls.
- Using exciting perfumes gave 50% of cases complete satisfaction during sexual intercourse, compared to 20% of controls.
- Eating with husband gave 53.3% of cases complete satisfaction during sexual intercourse, compared to 18.3% of controls.
- Husband kissing his wife all over her body gave 53.3% of cases complete satisfaction during sexual intercourse, compared to 23.3% of controls.
- Taking off her clothes in front of the husband gave 30% of cases complete satisfaction during sexual intercourse, compared to 18.3% of controls.
- Husband fondling wife breasts gave 46.7% of cases complete satisfaction during sexual intercourse, compared to 20.0% of controls.
- Intercourse with the husband gave 70.0% of cases complete satisfaction during sexual intercourse, compared to 30.5% of controls.
- Wife kissing husband all over his body gave 50.0% of cases complete satisfaction during sexual intercourse, compared to 22.0% of controls.
- Talking with husband before, during or after intercourse gave 43.3% of cases complete satisfaction during sexual intercourse, compared to 20.0% of controls.
- Fondling husband chest gave 50.0% of cases complete satisfaction during sexual intercourse, compared to 21.7% of controls.
- Seeing husband taking off his clothes gave 70.0% of cases complete satisfaction during sexual intercourse, compared to 21.7% of controls.
- Husband exciting wife by touching her genitals gave 70.0% of cases complete satisfaction during sexual intercourse, compared to 25.0% of controls.
- Wife embracing husband gave 83.3% of cases complete satisfaction during sexual intercourse, compared to 25.0% of controls.
- Enjoying intercourse gave 66.7% of cases complete satisfaction during sexual intercourse, compared to 30.0% of controls.
- Husband and wife helping each other to take off clothes gave 50.0% of cases complete satisfaction during sexual intercourse, compared to 20.0% of controls.
- Taking bath with husband gave 26.7% of cases complete satisfaction during sexual intercourse, compared to 15.0% of controls.
- Orgasm by traditional method of intercourse gave 50.0% of cases complete satisfaction during sexual intercourse, compared to 33.9% of controls.
- Orgasm by woman touching her genitals gave 20.0% of cases complete satisfaction during sexual intercourse, compared to 15.0% of controls. gave 20.0% of cases complete satisfaction during sexual intercourse, compared to 15.0% of controls.
- Orgasm by husband kissing wife all over her body gave 43.3% of cases complete satisfaction during sexual intercourse, compared to 15.0% of controls.
- Descriptive data about sexual satisfaction, regarding sexual satisfaction score, score ranged between 28.0-85.0 and 33.0-92.0 with the mean of 63.5±15.15 and 57.2±17.07 and median 66.0 and 61.0 for PCO and control groups respectively, there were no statistical significant differences between the two studied groups regarding sexual satisfaction score.
- Regarding the category of satisfaction score, minimal satisfaction were found in 5 (16.70%) and 22 (36.70%), satisfied was found in 13 (43.30%) and 24 (40.0%) and highly satisfied was found in 12 (40.0%) and 14 (23.30%) for PCO and control groups respectively, there were no statistical significant differences between the two studied groups regarding category of sexual satisfaction score.
from our research we conclude that:
- This was the first study conducted in Alexandria, to estimate the prevalence of PCOS in a random population of married women of the reproductive age attending El-Shatby University Maternity Hospital.
- It revealed that the syndrome had a prevalence of 2 % among women of the study sample (95% CI = 0.914 – 3.116).
PCOS was more prevalent in better educated and better socioeconomic status women.
- Infertility was more distinguishable in PCOS cases, as 60% of them didn’t ever get pregnant, and 73.3% of them were nulliparous.
- It is worth mentioning that 83.3% of the cases suffered from delay of pregnancy, 66.7% were obese and 93.3% had enlarged ovaries.
- The hyperandrogenic manifestations were highly prominent in PCOS cases as acne vulgaris, acanthosis negricans, unusual hair loss and hair receding, together with 86.7% had hirsutism in 1-2 body areas.
- Familial and genetic elements were evident risk factors in causation of PCOS. Family history of PCOS was positive in 20% of the cases which led to delay in pregnancy in mothers and sisters in 20% of the cases, while family history of diabetes mellitus and obesity was found in 66.7% of cases. Menstrual irregularity as an important risk factor was found in 53.3% of cases.
- The present study confirmed that PCOS affected adversely the quality of life and the psychological well- being of the patients .The study clarified that women of the study sample suffering from PCOS , had their main psychological distress related to infertility (75%) and emotions (58.7%) rather than menstrual irregularity problems (32%).
- Regarding obesity and hirsutism, this study revealed that half of the PCOS cases’ lives was adversely affected by them.
- Astonishingly, cases of PCOS didn’t have the expected negative impact on sexual self-worth and sexual satisfaction , and showed a limited risk of marital sexual dysfunctions. Minimal negative body image and depression affected the female self-esteem and sexual self-worth.
- Sexual satisfaction was a real controversial issue in this study, as the answers of some questions denoted poor sexual satisfaction using a certain tool, while another tool revealed no statistical significance.
Accordingly, the following recommendations are suggested:
Although polycystic ovary syndrome is an infrequent problem, it still has a tremendous impact on women’s health. Therefore, efforts are required to solve this problem at all levels.
Health Authoritiesshould investigate ways to expedite access and funding support for services that address issues arising from PCOS.
1- Improving the detection of women with PCOS on primary health care level. This could be achieved through:
(ii) Greater public awareness of PCOS among women, together with messages sent through mass media or primary health care services.
(ii) Patients with PCOS should discuss with their mothers and sisters that they have increased risk of PCOS compared with the general population. Screening of younger sisters may lead to early detection of PCOS.
(iv) Increased symptoms enquiry by primary health care professionals.
2- Greater attention should be given to the investigation about oligomenorrhoea or hirsutism by simple blood tests for detection of PCOS.
3- Screening for early detection in adolescents: Adding new activities to the school health programs to detect PCOS, and implementation of youth friendly clinics should be considered, in order to evaluate any adolescent female presenting with: Moderate or severe hirsutism, acne or androgenic alopecia, obesity with any other feature of anovulatory symptoms such as primary amenorrhea, secondary amenorrhea, oligomenorrhea and dysfunctional uterine bleeding.
4- Training of health professionals working in these clinics is mandatory.
5- Women with one or more clinical criteria or a prior diagnosis of PCOS, even in the absence of any signs or symptoms, should be referred to the gynecological endocrinology outpatient department for further investigations.
6- Women who meet the clinical/biochemical diagnostic criteria for PCOS may need further investigations to exclude other diagnosis, through discussion with/ or referral to an endocrinologist.
7- Women with a diagnosis of PCOS should be screened for type 2 diabetes and impaired glucose tolerance.
8- Women with PCOS should be screened for cardiovascular risk by determination of BMI, fasting lipid and lipoprotein levels, and metabolic syndrome risk factors.
9- Weight loss and metformin may prevent diabetes and atherosclerosis. This is based on extrapolation from clinical trials in non-PCOS populations (prediabetic and diabetic).
10- Weight reduction through prevention of excess weight gain. And for enabling weight loss, there is no specific diet, but focusing on low energy density, sustainable behavioral change, and self-weighing/monitoring regularly. After 6 months of metformin therapy in overweight women, intensive lifestyle intervention must be seeked.
11- group support for diet and exercise program may help. Reduction in body weight has been associated with improved pregnancy rates and decreased hirsutism, as well as improvements in glucose tolerance and lipid levels prevention of cardiovascular risks.
12- Lifestyle modification, including increased physical activity and healthy diet which will result in weight loss, is also likely to prevent diabetes in PCOS.
13- Women who are newly diagnosed with PCOS, should encourage their parents and siblings to have regular glucose tolerance testing for diabetes/insulin resistance.
14- Exercise physiologist for exercise motivation and physical education.
• Fertility specialist referral is appropriate in certain communities, as infertility is a major issue in worsening of the quality of life. There may be an increase in pregnancy rates by adding clomiphene to metformin, particularly in obese women with PCOS.
• Emotional health should be evaluated by routine screening for depression and /or anxiety followed by referral to emotional health support program, together with eating disorders, negative body image and low self-esteem.
• Encouragement of simple behavioral change – prioritization of healthy lifestyles, family support, lifestyle and exercise planning, pedometers, setting of small achievable goals.
• Menstrual cycle should be regulated.
• Management of hirsutism by 1st line-Cosmetic options: laser, depilatory creams, shaving, threading, plucking, shaving and electrolysis together with pharmacological therapy options.
Few disorders have generated as much debate, passion, and confusion in their definition as polycystic ovary (or ovarian) syndrome (PCOS), with the possible exception of insulin resistance and the metabolic syndrome, with which it is mechanistically associated.
A critical issue remains the definition of the disorder, which not only has an important impact on the scientific investigation of the syndrome, but also implies significant consequences for individual patients.
Diagnosing a woman as having PCOS has life-long implications for her health and well-being and suggests an increased risk for diabetes, dyslipidemia, hypertension, endometrial carcinoma, infertility, and possibly cardiovascular disease, in her, her relatives, and her off-springs and has the potential of negatively impacting on her ability to access health care coverage. Consequently, the diagnosis of PCOS should not be assigned lightly, and diagnostic criteria should be used on sound data.
The costs of evaluating and caring for PCOS patients during their reproductive years can be conservatively $ 4 billion in the United States, although this estimate would be significantly higher if the costs of caring for morbidities emerging in the post-reproductive years were considered. The cost of the diagnostic evaluation accounts for a relatively minor part of the costs, slightly more than 2%. This suggests that more widespread screening for the disorder is potentially a cost-effective strategy, leading to earlier diagnosis and intervention and possibly the amelioration and prevention of serious sequalae.
Patients with PCOS have a 4-fold increased risk of developing type 2 DM, and approximately 40% of the economic burden is due to the development of this morbidity in these patients during their reproductive years. It was estimated that 12.8% of the $12.6 billion associated with the management of diabetes of patients younger than 45 years old is attributed to women with PCOS.
The conservative management of menstrual dysfunction or AUB accounts for approximately one third of all costs, which is not surprising because a majority of patients with PCOS demonstrate this abnormality. Considering the low cost of diagnosis and the high cost of the associated morbidities, aggressive identification of PCOS and prompt and early management of the associated clinical consequences represent a cost-effective strategy to reduce the considerable economic burden of this disorder.
Unfortunately, data on the prevalence of polycystic ovary syndrome in Egypt or the regional Arab countries was almost impossible. Furthermore, the basic epidemiology of polycystic ovary syndrome among Egyptian females did not capture the attention of researchers.
Moreover, the impact of polycystic ovary syndrome on the quality of life of the affected women together with their marital and sexual life and its satisfaction have not been previously studied among Egyptian females.
To overcome this gap, this study shimmer the light on the problem of polycystic ovary syndrome among a sample of women in Alexandria, detecting the prevalence of polycystic ovary syndrome together with the quality of life and sexual satisfaction of these women.
Our study showed that:
- Nearly most of the sample (66.9%) were between the age of 20 – 39 years. Meanwhile, only 1.8% of women were under the age of 20 and 31.3% were 40 years of age and above.
- Regarding the marital status, 91.4% of women were married. Divorced women were 4% becoming almost equal to widows who were 4.1% of the sample.
- Almost more than half of the women (52.5%) were illiterate or just read and write, 19.5% had primary education and 18.1% had preparatory education.
- Less than half of the women (41.8%) were working.
- As regards the educational level of the husbands, the study shows that about half of the husbands (53.3 %) were illiterate or just read and write. This was followed by 17.5% who had secondary education.
- The families were divided almost equally between those who were constituted from 3 – 4 persons (39.1%) and those who were constituted from 5 or more persons (41.3%).
- Families formed of 2 persons only constituted one fifth of the sample (19.1%). Only 3 cases were represented by a single female (0.5%).
- About 40% (37.6%) of the sampled women were before 20 years of age at marriage, compared to only 2.3% of the sampled women were above 30 years old.
- As for the other two groups of ages, the women between 20 and 24 years of age constituted 43.62% and those who were between 25 and 29 years of age were 16.45% when they got married . The mean age of women at marriage was 21.12 years with ± 3.79 years standard deviation.
- 17.5 % of these women were unlucky and failed to deliver their conceptus. 15.2 % of the females delivered only once. Almost half of the sample (45.3%) delivered two or three times, but those who delivered four or more constituted (22.0%) of the sample.
- The women who delivered once or twice successfully delivered (38.4%) live births compared to those who delivered three times and more who delivered (43.9%) live births constituting nearly half the number of the live births of the sample.
- By examination, ovarian enlargement constituted 9.5% of the females of the general sample.
- According to Rotterdam criteria for diagnosis of polycystic ovary syndrome, those women who had two or more of the preceeded major symptoms (n = 14) were suspected to have PCOS.
- All suspected cases were then subjected to ultrasound imaging and sampled for FSH: LH ratio were all proved to have PCOS.
- One third of the cases of PCOS (10 %) were of normal weight compared to (11.5%) of the general sample. Regarding overweight women, it was more obvious in the general sample (43.6%) than those of the PCOS cases (23.3%).
- Obesity was prominent in two thirds of the PCOS cases (66.7%) compared to less than half of the general sample (44.9%). The difference between cases and controls regarding obesity was not statistically significant.
- The highest concern which affected the quality of life in PCOS cases was the infertility problem with a total mean score of 82.92 ± 32.08(mean ± SD respectively) and a worst QoL level of 75%from cases of PCOS of this domain. In this infertility domain, the most important two question was “Concern about sterility” with 85.0±32.56 (mean ± SD) and 80% worst QoL, and “Fear from becoming sterile” with 85.0±26.75 (mean± SD) and 73.3% worst QoL. “Feeling sad because of fecunditiy problems” question had a 83.33±33.04 (mean± SD) and 75% worst QoL. As for the question “Lost control because of your life because of PCOS” it scored 78.33±36.40 with a 70% worst QoL.
- The following most important concern of PCOS cases affecting their quality of life was the emotion of these patients due to their disease. The emotion domain had a total mean score of (72.82±35.80) (mean ± SD) and a worst QoL of 58.7%.
- The most important question was “Feeling depressed because of PCOS” had a mean score 89.66 ± 24.57 and worst QoL of 82.8%, followed by “Time spent in anxiety about PCOS” with a mean score 87.93±25.55 and worst QoL of 79.3%. This was almost similar to the question “Low self confidence because of PCOS” which made a mean score of 86.21±29.57 and a worst QoL of 79.3%.
- The “mixed moods and feelings” gave a mean score of 86.21±22.74 with a worst QoL of 72.4%, while “time spent feeling your disease is attracting attention” had a mean score of 63.33±36.98 and worst QoL of 43.3%, which was almost near to “Easy fatigued” which had a mean score of 61.67±36.40 and worst QoL of 40%.
- Following the infertility and the emotions domains in importance to the patients of PCOS in this sample was that of increased weight problem. The weight problem domain had a total mean score of 68.00±37.67 and a worst QoL of 52.7%.
- The most important issue here was “Difficulty in maintaining appropriate weight” with a mean score of 73.33±36.51 and a worst QoL of 60%.
- This was followed by almost three equal issues which are “Concern about increase in weight”(mean score 73.33±34.07 and worst QoL 56.7%) and “Disappointment because of failure to reduce weight”(mean score 68.33±38.24 and worst QoL of 53.3%) then “Time spent to control your weight” (mean score 66.67±40.11 and worst QoL of 53.3%).
- The hair problem domain was the fourth domain in importance with a total mean score of 60.07±40.26 and a worst QoL of 44.3%. The most important question in this domain was “Embarrassment due to hair on body”. It had a mean of 70.00±38.51 a worst QoL of 56.7%. This was followed by “Feeling about hair on face” which had a mean score of 68.33±38.24 and a worst QoL of 53.3%. The last in importance was the menstrual problems domain which had a total mean score of 56.00±35.67 and a worst QoL of 32%. The most important question in this domain was about “Irregularity of duration of mensis” with a mean score of 61.67± 42.92 and a worst QoL of 50%.
- The overall score of Quality of Life in polycystic ovary cases had a mean of 67.74± 37.50 with a worst QoL of 52.1%.
- The frequency of number of sexual intercourse (at least 1 – 5 times in in the last four weeks) before the questionnaire was observed in 60% of cases compared to 43.3% of controls with a statistical significance p=0.014.
- Less than two thirds of the PCOS cases (60%) were sexually satisfied compared to 88.3% of the controls, with a statistical significance p=0.001.
- Sexual fantasies was more in PCOS cases, where the difference was statistically significant, where p=0.001.
- Increase of hair formed a negative influence on sexual self- worth of 60% of PCOS cases, with a significance p=0.001.
- The difficulty in establishing social relations was found to be in 43.3% of cases compared to only 6.7% of controls, with a statistical significance p=0.000.
- Tender touches with the husband gave 62.1% of PCOS cases complete satisfaction during sexual intercourse compared to 50.8% of controls.
- Deep kissing with husband gave 56.7% of PCOS cases complete satisfaction during sexual intercourse compared to 40.0% of controls.
- Holding hands with husband gave 50% of cases complete satisfaction during sexual intercourse, compared to 16.9% of controls.
- Using exciting perfumes gave 50% of cases complete satisfaction during sexual intercourse, compared to 20% of controls.
- Eating with husband gave 53.3% of cases complete satisfaction during sexual intercourse, compared to 18.3% of controls.
- Husband kissing his wife all over her body gave 53.3% of cases complete satisfaction during sexual intercourse, compared to 23.3% of controls.
- Taking off her clothes in front of the husband gave 30% of cases complete satisfaction during sexual intercourse, compared to 18.3% of controls.
- Husband fondling wife breasts gave 46.7% of cases complete satisfaction during sexual intercourse, compared to 20.0% of controls.
- Intercourse with the husband gave 70.0% of cases complete satisfaction during sexual intercourse, compared to 30.5% of controls.
- Wife kissing husband all over his body gave 50.0% of cases complete satisfaction during sexual intercourse, compared to 22.0% of controls.
- Talking with husband before, during or after intercourse gave 43.3% of cases complete satisfaction during sexual intercourse, compared to 20.0% of controls.
- Fondling husband chest gave 50.0% of cases complete satisfaction during sexual intercourse, compared to 21.7% of controls.
- Seeing husband taking off his clothes gave 70.0% of cases complete satisfaction during sexual intercourse, compared to 21.7% of controls.
- Husband exciting wife by touching her genitals gave 70.0% of cases complete satisfaction during sexual intercourse, compared to 25.0% of controls.
- Wife embracing husband gave 83.3% of cases complete satisfaction during sexual intercourse, compared to 25.0% of controls.
- Enjoying intercourse gave 66.7% of cases complete satisfaction during sexual intercourse, compared to 30.0% of controls.
- Husband and wife helping each other to take off clothes gave 50.0% of cases complete satisfaction during sexual intercourse, compared to 20.0% of controls.
- Taking bath with husband gave 26.7% of cases complete satisfaction during sexual intercourse, compared to 15.0% of controls.
- Orgasm by traditional method of intercourse gave 50.0% of cases complete satisfaction during sexual intercourse, compared to 33.9% of controls.
- Orgasm by woman touching her genitals gave 20.0% of cases complete satisfaction during sexual intercourse, compared to 15.0% of controls. gave 20.0% of cases complete satisfaction during sexual intercourse, compared to 15.0% of controls.
- Orgasm by husband kissing wife all over her body gave 43.3% of cases complete satisfaction during sexual intercourse, compared to 15.0% of controls.
- Descriptive data about sexual satisfaction, regarding sexual satisfaction score, score ranged between 28.0-85.0 and 33.0-92.0 with the mean of 63.5±15.15 and 57.2±17.07 and median 66.0 and 61.0 for PCO and control groups respectively, there were no statistical significant differences between the two studied groups regarding sexual satisfaction score.
- Regarding the category of satisfaction score, minimal satisfaction were found in 5 (16.70%) and 22 (36.70%), satisfied was found in 13 (43.30%) and 24 (40.0%) and highly satisfied was found in 12 (40.0%) and 14 (23.30%) for PCO and control groups respectively, there were no statistical significant differences between the two studied groups regarding category of sexual satisfaction score.
from our research we conclude that:
- This was the first study conducted in Alexandria, to estimate the prevalence of PCOS in a random population of married women of the reproductive age attending El-Shatby University Maternity Hospital.
- It revealed that the syndrome had a prevalence of 2 % among women of the study sample (95% CI = 0.914 – 3.116).
PCOS was more prevalent in better educated and better socioeconomic status women.
- Infertility was more distinguishable in PCOS cases, as 60% of them didn’t ever get pregnant, and 73.3% of them were nulliparous.
- It is worth mentioning that 83.3% of the cases suffered from delay of pregnancy, 66.7% were obese and 93.3% had enlarged ovaries.
- The hyperandrogenic manifestations were highly prominent in PCOS cases as acne vulgaris, acanthosis negricans, unusual hair loss and hair receding, together with 86.7% had hirsutism in 1-2 body areas.
- Familial and genetic elements were evident risk factors in causation of PCOS. Family history of PCOS was positive in 20% of the cases which led to delay in pregnancy in mothers and sisters in 20% of the cases, while family history of diabetes mellitus and obesity was found in 66.7% of cases. Menstrual irregularity as an important risk factor was found in 53.3% of cases.
- The present study confirmed that PCOS affected adversely the quality of life and the psychological well- being of the patients .The study clarified that women of the study sample suffering from PCOS , had their main psychological distress related to infertility (75%) and emotions (58.7%) rather than menstrual irregularity problems (32%).
- Regarding obesity and hirsutism, this study revealed that half of the PCOS cases’ lives was adversely affected by them.
- Astonishingly, cases of PCOS didn’t have the expected negative impact on sexual self-worth and sexual satisfaction , and showed a limited risk of marital sexual dysfunctions. Minimal negative body image and depression affected the female self-esteem and sexual self-worth.
- Sexual satisfaction was a real controversial issue in this study, as the answers of some questions denoted poor sexual satisfaction using a certain tool, while another tool revealed no statistical significance.
Accordingly, the following recommendations are suggested:
Although polycystic ovary syndrome is an infrequent problem, it still has a tremendous impact on women’s health. Therefore, efforts are required to solve this problem at all levels.
Health Authoritiesshould investigate ways to expedite access and funding support for services that address issues arising from PCOS.
1- Improving the detection of women with PCOS on primary health care level. This could be achieved through:
(ii) Greater public awareness of PCOS among women, together with messages sent through mass media or primary health care services.
(ii) Patients with PCOS should discuss with their mothers and sisters that they have increased risk of PCOS compared with the general population. Screening of younger sisters may lead to early detection of PCOS.
(iv) Increased symptoms enquiry by primary health care professionals.
2- Greater attention should be given to the investigation about oligomenorrhoea or hirsutism by simple blood tests for detection of PCOS.
3- Screening for early detection in adolescents: Adding new activities to the school health programs to detect PCOS, and implementation of youth friendly clinics should be considered, in order to evaluate any adolescent female presenting with: Moderate or severe hirsutism, acne or androgenic alopecia, obesity with any other feature of anovulatory symptoms such as primary amenorrhea, secondary amenorrhea, oligomenorrhea and dysfunctional uterine bleeding.
4- Training of health professionals working in these clinics is mandatory.
5- Women with one or more clinical criteria or a prior diagnosis of PCOS, even in the absence of any signs or symptoms, should be referred to the gynecological endocrinology outpatient department for further investigations.
6- Women who meet the clinical/biochemical diagnostic criteria for PCOS may need further investigations to exclude other diagnosis, through discussion with/ or referral to an endocrinologist.
7- Women with a diagnosis of PCOS should be screened for type 2 diabetes and impaired glucose tolerance.
8- Women with PCOS should be screened for cardiovascular risk by determination of BMI, fasting lipid and lipoprotein levels, and metabolic syndrome risk factors.
9- Weight loss and metformin may prevent diabetes and atherosclerosis. This is based on extrapolation from clinical trials in non-PCOS populations (prediabetic and diabetic).
10- Weight reduction through prevention of excess weight gain. And for enabling weight loss, there is no specific diet, but focusing on low energy density, sustainable behavioral change, and self-weighing/monitoring regularly. After 6 months of metformin therapy in overweight women, intensive lifestyle intervention must be seeked.
11- group support for diet and exercise program may help. Reduction in body weight has been associated with improved pregnancy rates and decreased hirsutism, as well as improvements in glucose tolerance and lipid levels prevention of cardiovascular risks.
12- Lifestyle modification, including increased physical activity and healthy diet which will result in weight loss, is also likely to prevent diabetes in PCOS.
13- Women who are newly diagnosed with PCOS, should encourage their parents and siblings to have regular glucose tolerance testing for diabetes/insulin resistance.
14- Exercise physiologist for exercise motivation and physical education.
• Fertility specialist referral is appropriate in certain communities, as infertility is a major issue in worsening of the quality of life. There may be an increase in pregnancy rates by adding clomiphene to metformin, particularly in obese women with PCOS.
• Emotional health should be evaluated by routine screening for depression and /or anxiety followed by referral to emotional health support program, together with eating disorders, negative body image and low self-esteem.
• Encouragement of simple behavioral change – prioritization of healthy lifestyles, family support, lifestyle and exercise planning, pedometers, setting of small achievable goals.
• Menstrual cycle should be regulated.
• Management of hirsutism by 1st line-Cosmetic options: laser, depilatory creams, shaving, threading, plucking, shaving and electrolysis together with pharmacological therapy options.