Obstet Gynecol Sci.  2015 Jul;58(4):302-308. 10.5468/ogs.2015.58.4.302.

Dose-response relationship between cigarette smoking and female sexual dysfunction

• Choi J
• Shin DW
• Lee S
• Jeon MJ
• Kim SM
• Cho B
• Lee SM

• KMID: 2314051
• DOI: http://doi.org/10.5468/ogs.2015.58.4.302

Abstract

OBJECTIVE
To evaluate whether smoking is a risk factor for female sexual dysfunction (FSD) and to determine the relationship between the cumulative smoking dose and FSD in premenopausal women.
METHODS
The study population consisted of sexually active premenopausal women. The frequency of FSD and female sexual function index (FSFI) total score were evaluated according to the smoking status (never/former and current smokers). Evaluation of sexual function was done using FSFI questionnaire, and women with FSFI score of < or =26.55 were considered to have FSD. In current smokers, sexual function was also evaluated according to the cumulative smoking dose and nicotine dependency.
RESULTS
A total of 900 women were included, and the frequency of current smokers and the frequency of FSD were 62 (6.9%) and 496 (55.1%), respectively. In current smokers, the frequency of FSD was significantly higher and the median total FSFI score was significantly lower than in never/former smokers, and this difference of FSD remained significant after adjustment for confounding variables. Among current smokers, the cumulative smoking dose (pack-years) and the total FSFI score showed negative correlation, in which increased cumulative smoking dose was associated with lower total FSFI score (r=-0.278, P<0.05). In terms of nicotine dependency, the total FSFI score of moderately to heavily nicotine dependent smokers was significantly lower than that of lightly dependent smokers.
CONCLUSION
In premenopausal women, current smoking was an independent risk factor for FSD. And cumulative smoking dose and nicotine dependency were associated with higher risk of FSD.

Keyword

Dose-response relationship; Female; Nicotine; Sexual dysfunctions; Smoking

MeSH Terms

Confounding Factors (Epidemiology)
Female
Humans
Nicotine
Risk Factors
Smoke
Smoking*
Nicotine
Smoke

Figure

• 

  Fig. 1 The relationship between cumulative smoking dose and female sexual function index (FSFI) score among current smokers (r=-0.278, P<0.05).

Reference

1. Basson R, Berman J, Burnett A, Derogatis L, Ferguson D, Fourcroy J, et al. Report of the international consensus development conference on female sexual dysfunction: definitions and classifications. J Urol. 2000; 163:888–893.

2. Nappi R, Salonia A, Traish AM, van Lunsen RH, Vardi Y, Kodiglu A, et al. Clinical biologic pathophysiologies of women's sexual dysfunction. J Sex Med. 2005; 2:4–25.

3. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA. 1999; 281:537–544.

4. Song SH, Jeon H, Kim SW, Paick JS, Son H. The prevalence and risk factors of female sexual dysfunction in young Korean women: an internet-based survey. J Sex Med. 2008; 5:1694–1701.

5. Hong H, Lee HJ, Kim SM, Jeon MJ, Shin DW, Choi HC, et al. Subclinical hypothyroidism is not a risk factor for female sexual dysfunction in Korean middle-aged women. Thyroid. 2015; [Epub]. DOI: 10.1089/thy.2015.0015.

6. Moreira ED Jr, Kim SC, Glasser D, Gingell C. Sexual activity, prevalence of sexual problems, and associated help-seeking patterns in men and women aged 40-80 years in Korea: data from the Global Study of Sexual Attitudes and Behaviors (GSSAB). J Sex Med. 2006; 3:201–211.

7. Ambrose JA, Barua RS. The pathophysiology of cigarette smoking and cardiovascular disease: an update. J Am Coll Cardiol. 2004; 43:1731–1737.

8. Tengs TO, Osgood ND. The link between smoking and impotence: two decades of evidence. Prev Med. 2001; 32:447–452.

9. Mannino DM, Klevens RM, Flanders WD. Cigarette smoking: an independent risk factor for impotence? Am J Epidemiol. 1994; 140:1003–1008.

10. Cao S, Gan Y, Dong X, Liu J, Lu Z. Association of quantity and duration of smoking with erectile dysfunction: a dose-response meta-analysis. J Sex Med. 2014; 11:2376–2384.

11. Polsky JY, Aronson KJ, Heaton JP, Adams MA. Smoking and other lifestyle factors in relation to erectile dysfunction. BJU Int. 2005; 96:1355–1359.

12. Sidi H, Puteh SE, Abdullah N, Midin M. The prevalence of sexual dysfunction and potential risk factors that may impair sexual function in Malaysian women. J Sex Med. 2007; 4:311–321.

13. Cayan S, Akbay E, Bozlu M, Canpolat B, Acar D, Ulusoy E. The prevalence of female sexual dysfunction and potential risk factors that may impair sexual function in Turkish women. Urol Int. 2004; 72:52–57.

14. Oksuz E, Malhan S. Prevalence and risk factors for female sexual dysfunction in Turkish women. J Urol. 2006; 175:654–658.

15. Heatherton TF, Kozlowski LT, Frecker RC, Rickert W, Robinson J. Measuring the heaviness of smoking: using self-reported time to the first cigarette of the day and number of cigarettes smoked per day. Br J Addict. 1989; 84:791–799.

16. Cooper J, Borland R, Yong HH, McNeill A, Murray RL, O'Connor RJ, et al. To what extent do smokers make spontaneous quit attempts and what are the implications for smoking cessation maintenance? Findings from the International Tobacco Control Four country survey. Nicotine Tob Res. 2010; 12:Suppl. S51–S57.

17. Borland R, Yong HH, Balmford J, Cooper J, Cummings KM, O'Connor RJ, et al. Motivational factors predict quit attempts but not maintenance of smoking cessation: findings from the International Tobacco Control Four country project. Nicotine Tob Res. 2010; 12:Suppl. S4–S11.

18. Kim HY, So HS, Park KS, Jeong SJ, Lee JY, Ryu SB. Development of the Korean-version of Female Sexual Function Index (FSFI). Korean J Androl. 2002; 20:50–56.

19. Wiegel M, Meston C, Rosen R. The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther. 2005; 31:1–20.

20. Aslan E, Beji NK, Gungor I, Kadioglu A, Dikencik BK. Prevalence and risk factors for low sexual function in women: a study of 1,009 women in an outpatient clinic of a university hospital in Istanbul. J Sex Med. 2008; 5:2044–2052.

21. Bagherzadeh R, Zahmatkeshan N, Gharibi T, Akaberian S, Mirzaei K, Kamali F, et al. Prevalence of female sexual dysfunction and related factors for under treatment in Bushehrian women of Iran. Sex Disabil. 2010; 28:39–49.

22. Jaafarpour M, Khani A, Khajavikhan J, Suhrabi Z. Female sexual dysfunction: prevalence and risk factors. J Clin Diagn Res. 2013; 7:2877–2880.

23. Safarinejad MR. Female sexual dysfunction in a population-based study in Iran: prevalence and associated risk factors. Int J Impot Res. 2006; 18:382–395.

24. Anastasiadis AG, Davis AR, Ghafar MA, Burchardt M, Shabsigh R. The epidemiology and definition of female sexual disorders. World J Urol. 2002; 20:74–78.

25. Harte CB, Meston CM. The inhibitory effects of nicotine on physiological sexual arousal in nonsmoking women: results from a randomized, double-blind, placebo-controlled, cross-over trial. J Sex Med. 2008; 5:1184–1197.

26. Diehl A, Silva RL, Laranjeira R. Female sexual dysfunction in patients with substance-related disorders. Clinics (Sao Paulo). 2013; 68:205–212.

27. Tziomalos K, Charsoulis F. Endocrine effects of tobacco smoking. Clin Endocrinol (Oxf). 2004; 61:664–674.

28. Dennerstein L, Randolph J, Taffe J, Dudley E, Burger H. Hormones, mood, sexuality, and the menopausal transition. Fertil Steril. 2002; 77:Suppl 4. S42–S48.

29. Battaglia C, Battaglia B, Mancini F, Persico N, Nappi RE, Paradisi R, et al. Cigarette smoking decreases the genital vascularization in young healthy, eumenorrheic women. J Sex Med. 2011; 8:1717–1725.