Sexual distress and quality of life among women with bipolar disorder

Sørensen et al. Int J Bipolar Disord (2017) 5:29 DOI 10.1186/s40345-017-0098-0 Open Access RESEARCH Sexual distress and quality of life among women with bipolar disorder Thea Sørensen1,2, A. Giraldi2,3 and M. Vinberg1,3* Abstract Background: Information on the association between bipolar disorder (BD), sexual satisfaction, sexual function, sexual distress and quality of life (QoL) is sparse. This study aims, in women with BD, to (i) investigate sexual dysfunction, sexual distress, general sexual satisfaction and QoL; (ii) explore whether sexual distress was related to affective symptoms and (iii) investigate whether QoL was associated with sexual distress. The study is a questionnaire survey in an outpatient cohort of women with BD using: Changes in Sexual Functioning Questionnaire, Female Sexual Distress Scale, Altman Self-Rating Mania Scale (ASRM), Major Depression Inventory (MDI) and The World Health Organisation Quality of Life-Brief. Results: In total, 61 women (age range 19–63, mean 33.7 years) were recruited. Overall, 54% reported sexual distress (n = 33) and 39% were not satisfied with their sexual life (n = 24). Women with BD were significantly more sexually distressed in comparison with Danish women from the background population but they did not have a higher prevalence of impaired sexual function. Better sexual function was positively associated with ASRM scores while MDI scores were associated with more distress. Finally, the group of non-sexually distressed women with BD reported higher QoL scores compared with the sexually distressed group. Conclusions: Women with BD exhibited a high prevalence of sexual distress and their sexual function seemed associated with their actual mood symptoms and perception of QoL. Keywords: Sexual distress, Sexual functioning, Quality of life, Bipolar disorder Background Sexual dysfunction is defined as an impaired sexual function that causes distress. The definition has changed several times over the course of time but a division into four categories overall has remained: desire/interest, arousal, orgasm and pain disorders (Basson et al. 2000, 2004, 2010; McCabe et al. 2016). Sexual dysfunction is caused by biological, psychological and social interactions and factors with negative influence on human well-being. Additionally, the risk of sexual dysfunction is increased by factors such as socio-economic status (Christensen et al. 2011a), psychiatric disorders (Brotto et al. 2011), partner status and the length of relationship (Hayes et al. *Correspondence: 1 Copenhagen Affective Disorder Clinic, Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Dep. 6233, Blegdamsvej 9, 2100 Copenhagen, Denmark Full list of author information is available at the end of the article 2008; Eplov et al. 2007), menopause (Ornat et al. 2013) and the side effects of psychotropic treatment (Bergh and Giraldi 2014; Serretti and Chiesa 2011a; Zemishlany and Weizman 2008). A Danish study (n = 4415) concluded that mental health problems and poor self-rated health problems were strongly associated with female sexual dysfunction (Christensen et al. 2011b). Information on the association between bipolar disorder, quality of life, sexual satisfaction, sexual function and distress is sparse. It is well known that depression and antidepressants affect sexual function negatively (Clayton et al. 2014), but only a few studies include women with BD. Besides, the studies have small study populations and different questionnaires, none of which include sexual distress (Dell’Osso et al. 2009; Ghadirian et al. 1992; Grover et al. 2014). In an Italian study (Dell’Osso et al. 2009) comparing 142 patients (60 with BD and 82 with unipolar depression) with 101 healthy controls, patients © The Author(s) 2017. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Sørensen et al. Int J Bipolar Disord (2017) 5:29 with BD reported more sexual dysfunction compared to healthy control persons. Patients with BD had increased sexual desire in comparison with patients with unipolar disorder in the Italian study. Also, the presence of periods characterised by frequent sexual partners was significantly associated with the feeling that life is not worth living and sexual dysfunction was associated with lifetime suicide attempts. Finally, a Dutch study in the general population of the Netherlands showed an association between BD and sexual dissatisfaction (Vanwesenbeeck et al. 2014). Episodes of depression or mania can be trigged by stress. Patients with BD are probably more easily distressed, and therefore, sexual distress could be a potential trigger for depression and/or mania. The possible relationship between sexual distress and affective symptoms in patients with BD has not been evaluated previously. Further, quality of life (QoL), the general well-being and observed life satisfaction in many aspects—for example, physical and psychological health, education, employment, wealth, finance, environment, social relations and sexual function—are important aspects of QoL. Patients with affective disorders have a lower score of QoL compared to the general population (Nørholm 2008; Yatham et al. 2004; Nørholm and Bech 2001). When measuring QoL, according to World Health Organisation, sexual satisfaction is included as part of the total score (WHOQOL Group 1998). To improve treatment and QoL clinically in patients with BD, it is thus important to also focus on and include sexual function. The aim of the present study was, in a cohort of women with BD, to (i) investigate sexual function, sexual distress, general sexual satisfaction and QoL; (ii) explore whether sexual distress was related to affective symptoms and (iii) investigate whether QoL was associated to sexual distress. Methods Study design Women with BD were recruited to the questionnaire survey from the waiting room at the Copenhagen Affective Disorder Clinic, Psychiatric Centre Copenhagen. The included sample was derived from 1 March to 9 May 2015 from patients attending a region-wide secondary service for patients with primary bipolar disorders. The patients received written and oral information about the project before deciding whether to participate. Further, at the time the questionnaire was answered and diagnosis confirmed, medication was assessed from the patients’ medical records. The self-assessment questionnaire included parameters, among others, previously shown to affect sexual function: basic demographic information (age, education, Page 2 of 9 civil status, sexual orientation, length of relationship, employment and information about children) (...truncated)