停經期間婦女性功能及其相關因素之探討

Abstract

【研究背景】 隨著停經階段的進展，婦女的性功能或性生活有減少的趨勢，衝擊到生活品質及伴侶的關係。臺灣過去的研究，缺乏從不同停經階段，深入探討及比較婦女的性功能，而且停經婦女性功能的研究幾乎是從婦女的觀點分析，若能同時納入伴侶的因素，將有助於我們更多元的了解停經婦女的性功能。 【研究目的】 本研究主要是比較停經前期、停經中期、停經後期階段婦女性功能的差異，並探討不同停經階段婦女在停經症狀、尿失禁、膀胱過動症、伴侶關係的分布與差異，最後確認停經前、中、後三期每一期婦女性功能的影響因子。 【研究方法】 本研究採橫斷式研究設計，以方便取樣方式於北部一所醫學中心的婦產科、家庭醫學科門診及北部一所五年制專科學校，以結構式問卷進行資料收集。當面邀請停經婦女或請學生轉交邀請函給家長，若停經婦女同意參與研究，便邀請其異性伴侶參與問卷填寫，問卷填完放入回郵信封郵寄回來，總計收案1926位（963位停經婦女、963位異性伴侶）。 研究工具包含：女性性功能指數（FSFI）、更年期症狀量表（The Greene Climacteric Scale）、尿失禁量表（ICIQ-UI SF）、膀胱過動症量表（ICIQ-OAB）、關係評估量表（RAS）等。運用SPSS / PC 20.0進行統計分析，包括描述性統計、皮爾森相關係數、獨立樣本t檢定、配對樣本t檢定、單因子變異數分析或Kruskal - Wallis分析，以及多元迴歸。 【研究結果】 停經前期、停經中期及停經後期婦女的停經症狀，皆以性趣喪失最嚴重，而停經期間婦女尿失禁及膀胱過動症的分布，在不同停經階段沒有顯著差異性；全體停經婦女在伴侶關係的平均分數（3.73 ± 0.80），顯著低於異性伴侶在伴侶關係的平均分數（3.82 ± 0.76）（p < 0.001）。 不同停經階段婦女的整體性功能分數，以停經前期明顯最高（24.11 ± 7.44），其次是停經中期（21.92 ± 8.31），停經後期（18.71 ± 8.97）最低。性慾 / 性交構面的分數，則以停經前期婦女（16.61 ± 5.65），明顯高於停經中期婦女（15.00 ± 6.44）及停經後期婦女（12.50 ± 6.97）。同樣地，性交疼痛構面分數，由高至低依序為：停經前期（4.47 ± 1.67）、停經中期（3.97 ± 1.87）、停經後期（3.37 ± 2.05）。另一構面性滿意的分數，以停經前期（3.03 ± 0.81）明顯高於停經後期（2.85 ± 0.91）。 在控制了各停經階段婦女與異性伴侶的基本屬性後，停經前期婦女整體性功能的影響因子，包含：其他型尿失禁（β = -0.08, p = 0.043）、停經婦女的伴侶關係（β = 0.32, p < 0.001）、異性伴侶的伴侶關係（β = 0.21 , p < 0.001）；停經中期婦女整體性功能的影響因子，為停經婦女的伴侶關係（β = 0.43, p < 0.001）；停經後期婦女整體性功能的影響因子，包含：停經婦女的伴侶關係（β = 0.23, p= 0.001）、異性伴侶的伴侶關係（β = 0.29, p < 0.001）。

【結論與建議】 停經婦女的伴侶關係、異性伴侶的伴侶關係，是停經前期、停經中期及停經後期婦女性功能的重要影響因素；而罹患其他型尿失禁是影響停經前期婦女性功能的另外一個因素。建議未來可以探討影響性慾 / 性交、性滿意及性交疼痛構面的因素。另外，可以考慮檢視例如婦女的身體心像、憂鬱狀況等，與停經階段性功能的關係性；或是採縱貫性的研究方法，從婦女停經前期開始持續追蹤其性功能之變化。

【Background】 Decreases in sexual function and sexual activity occur during and after menopause. These decreases can impact quality of life and relationship intimacy. Few studies have explored the differences in sexual function among women experiencing the different stages of menopause in Taiwan. Furthermore, most analyses have explored only women’s concerns regarding the effects of menopause on sexual function. Understanding sexual partners’ concerns about menopause may enable us to gain a broader understanding of its effects on sexual function in women. 【Purposes】 The purposes of this study were to examine the differences in sexual function among women experiencing the different stages of menopause; to explore the distribution in demographic characteristics, menopause symptoms, urinary incontinence symptoms, overactive bladder symptoms, and sexual relationships with partners among women experiencing the different stages of menopause; and to identify the factors influencing sexual function in woman experiencing premenopause, perimenopause, and postmenopause. 【Methods】 This study employed a cross-sectional design and was conducted at the outpatient clinics of the obstetrics / gynecology and family medicine departments at a medical center and 5-year junior college in northern Taiwan. A convenient sample was recruited for this study. Data collected with structured questionnaire and were from women with menopause or college students who pass on an invitation to parents. If women agreed to participate, their heterosexual partners were also invited to fill out questionnaires. When participants had completed the study, they sent the questionnaires back to the researchers using a stamped envelope. Overall, 1926 participants were recruited (963 menopausal women and 963 heterosexual partners). Participants completed the Female Sexual Functioning Scale (FSFI), the Greene Climacteric Scale, the Urinary Incontinence Scale (ICIQ-UI SF), the Overactive Bladder Scale (ICIQ-OAB), and the Relationship Assessment Scale (RAS). Data were encoded and statistically analyzed using SPSS / PC 20.0. Statistical analyses included percentage, mean, standard deviation, Pearson correlation, Independent t-test, Paired t-test, the Kruskal-Wallis test or one-way ANOVA and Multiple Linear Regression. 【Results】 The most severe menopause symptom noted by premenopausal, perimenopausal and postmenopausal women was loss of sexual desire. There was no difference at different stages of menopause related to urinary incontinence and overactive bladder. Compared with their heterosexual partners, menopausal women showed lower scores（3.73 ± 0.80）on the relationship with partners（3.82 ± 0.76）（p < 0.001）. Premenopausal women exhibited higher total sexual function score（24.11 ± 7.44） and sexual desire / intercourse scores （16.61 ± 5.65）and lower dyspareunia scores（4.47 ± 1.67）than perimenopausal women, who exhibited higher sexual function （21.92 ± 8.31）and sexual desire / intercourse scores （15.00 ± 6.44）and lower dyspareunia scores（3.97 ± 1.87） than postmenopausal women（18.71 ± 8.97, 12.50 ± 6.97, 3.37 ± 2.05, respectively）. Premenopausal women exhibited higher mean sexual satisfaction scores（3.03 ± 0.81）than postmenopausal women（2.85 ± 0.91）. After controlling the demographic characteristics in menopausal women and their heterosexual partners, premenopausal women identified other type of urinary incontinence（β = -0.08, p = 0.043） and relationships with partners（β = 0.32, p < 0.001） as the factors influencing sexual function, while their sexual partners identified relationships with partners （β = 0.21, p < 0.001）as the factor influencing sexual function. Perimenopausal women identified relationships with partners（β = 0.43, p < 0.001）as the factor influencing sexual function. Postmenopausal women identified relationships with partners （β = 0.23, p= 0.001）as the factor influencing sexual function, as did their heterosexual partners（β = 0.29, p < 0.001）. 【Conclusion and Suggestions】 The most important factor influencing sexual function is the relationship with partners and relationship with heterosexual partners among premenopausal, perimenopausal and postmenopausal women. Premonpausal women having other type of urinary incontinence is another factor influencing sexual function. This study suggests focusing on aspects of sexual desire / sexual intercourse, sexual satisfaction, and pain during intercourse in order to explore the relationships with partners and urinary incontinence as the factors influencing sexual function. In addition, it may consider body image and depression to understand sexual function and influencing factors in women experiencing the different stages of menopause. Also, studies using a longitudinal design are needed to explore the changes of sexual function over the premenopausal stage.