Sexual
Dysfunction
in
Female
Hypertensives
Basil
N.
Okeahialam,
MBBS,
FWACP
and
Ndudim
C.
Obeka,
MBBCh,
FWACP
Jos
and
Abakaliki,
Nigeria
Purpose:
Hypertension
and
its
treatment
are
known
to
pro-
duce
sexual
dysfunction
in
males.
In
our
culture,
women
are
not
free
to
discuss
issues
of
sexuality
with
their
doctors.
Hence,
this
phenomenon
has
not
been
explored
in
them.
Notwith-
standing
this,
cases
occur
in
practice
where
noncompliance
with
dire
consequences
result
from
sexual
dysfunction.
This
study
was
done
to
determine
if
any
dysfunction
existed
among
women
as
is
commonly
reported
in
males.
Methodology:
As
part
of
a
larger
study
on
serum
uric
acid
and
lipid
profile
of
adult
Nigerian
hypertensives,
we
sought
information
on
sexual
function
in
females.
One
group
was
newly
diagnosed
and
treatment
nacive,
while
the
other
was
made
up
of
known
hypertensives
on
thiazides.
The
third
group
consisted
of
normotensive
age-matched
controls.
Findings:
Six
out
of
44
(13.6%)
in
the
first
group,
five
out
of
29
(17.2%)
in
the
second
group
and
two
out
of
43
(4.7%)
in
the
control
group
reported
sexual
dysfunction.
The
commonest
aspect
encountered
was
reduced
desire
for
intercourse.
Conclusion:
There
was
a
tendency
for
hypertensive
women
to
have
more
sexual
dysfunction
even
before
treatment
than
did
controls.
Larger
studies
should
be
undertaken
and
clinicians
should
probe
this
subject
if
poor
compliance
is
suspected.
Key
words:
sexual
dysfunction
U
hypertension
U
women's
health
©
2006.
From
the
Department
of
Medicine,
Jos
University
Teaching
Hospital,
Jos,
Nigeria
(Okeahialam)
and
Department
of
Medicine,
Ebonyi
State
Uni-
versity
Teaching
Hospital,
Abakaliki,
Nigera
(Obeka).
Send
correspondence
and
reprint
requests
for
J
Natl
Med
Assoc.
2006;98:638-640
to:
Dr.
B.N.
Okeahialam,
Department
of
Medicine,
Jos
University
Teaching
Hospital,
PMB
2076,
Jos,
Plateau
State,
Nigera;
e-mail:
INTRODUCTION
Sexuality
and
its
manifestations
are
said
to
consti-
tute
some
of
the
most
complex
aspects
of
human
behavior.'
In
females,
its
expression
is
bound
by
soci-
etal
norms.
It
is,
however,
important
in
intimate
sexu-
al
relationships.
Any
dysfunction
is
therefore
likely
to
impact
negatively
on
such
relationships.
Hyperten-
sion
is
known
to
be
associated
with
sexual
dysfunc-
tion.2
This
phenomenon
has
been
studied
more
in
males;
because
of
the
two
genders,
males
are
more
likely
to
open
up
on
such
intimate
subjects.
Women
in
Africa
tend
to
resign
to
their
fate
when
such
dysfunc-
tion
befalls
them.
Nevertheless,
it
builds
psychosocial
tension
in
them,
as
the
relationships
suffer
from
the
lack
of
consummation
with
adverse
consequences.3
Such
dysfunction
also
negatively
affects
compliance
and
quality
of
life.4
The
rate
of
dysfunction
is
said
to
be
low,5
albeit
overlooked,
in
females.6
The
available
reports
are
based
on
studies
in
the
more
advanced
countries.
We
are
not
aware
of
any
local
African
study
on
sexual
dysfunction
involving
women.
We
therefore
decided
to
look
for
sexual
dys-
function
among
our
female
hypertensives
to
see
the
pattern
in
Nigerian
Africans.
This
should
comple-
ment
works
from
the
west
and
open
up
foci
of
simi-
lar
studies
locally.
METHODOLOGY
Between
November
2002
and
October
2003,
as
part
of
a
larger
study
on
serum
uric
acid
and
lipid
pro-
file
in
hypertensive
adult
Nigerians,
we
sought
infor-
mation
on
sexual
function
in
female
hypertensives.
The
study
was
based
in
Jos
University
Teaching
Hos-
pital
and
was
approved
by
the
hospital
ethics
commit-
tee.
The
areas
inquired
about
included
libido,
pain
or
discomfort
during
intercourse,
and
orgasm.
There
were
three
groups
of
patients/subjects
in
the
large
study-namely,
newly
diagnosed
and
treatment-naive
hypertensives,
known
hypertensives
on
thiazide
diuretic
therapy
and
a
control
group
of
apparently
healthy
nonhypertensive
subjects.
The
females
in
these
groups
constitute
the
subject
of
this
report.
638
JOURNAL
OF
THE
NATIONAL
MEDICAL
ASSOCIATION
VOL.
98,
NO.
4,
APRIL
2006
SEXUAL
FUNCTION
IN
HYPERTENSIVE
FEMALES
Group
1
(newly
diagnosed,
treatment-naive)
sub-
jects
had
an
average
of
two
blood
pressure
readings
of
2
140/90
mmHg
on
at
least
two
separate
occa-
sions.
Blood
pressure
was
taken
in
the
standard
fash-
ion
using
a
mercury
sphygmomanometer.
There
was
no
comorbidity,
such
as
diabetes
mellitus,
sickle
cell
disease,
thyroid
disease,
liver
disease,
congestive
cardiac
failure,
ischemic
heart
disease
or
stroke
of
less
than
six
months'
duration.
They
were
also
not
pregnant.
Group
2
was
made
up
of
previously
diag-
nosed
hypertensives
on
thiazide
diuretics.
The
same
exclusion
criteria
above
also
applied
to
them.
Group
3
consisted
of
apparently
healthy
nonhypertensive
females
who
attended
the
hospital
for
minor
ail-
ments.
Patients
in
all
groups
were
matched
for
age.
RESULTS
There
were
44
females
in
group
1,
29
in
group
2
and
43
in
group
3.
The
mean
age
in
group
I
was
48.0
±
12.8
years,
46.4
±
13.1
years
in
group
2
and
50.7
±
10.8
in
group
3.
The
differences
did
not
attain
statis-
tical
significance.
Six
out
of
44,
or
13.6%,
of
patients
in
group
1
admitted
to
reduction
in
libido.
Four
out
of
29
or
13.8%
of
patients
in
group
2
also
had
a
reduction
in
libido.
Only
two
out
of
43,
or
4.7%,
of
the
controls
(group
3)
reported
a
reduction
in
libido.
The
differ-
ences
between
groups
did
not
attain
statistical
sig-
nificance.
Only
one
patient
reported
dyspareunia.
She
was
in
group
2,
the
known
hypertensives
on
thi-
azide
diuretic
treatment.
In
sum
(for
all
aspects
of
sexual
dysfunction),
group
1
had
13.6%,
group
2
had
17.2%
(5/29)
and
group
3
(controls)
had
4.7%.
This
shows
a
greater
tendency
for
hypertensives
in
either
group
(I
or
2)
to
have
reduced
libido
when
compared
with
nonhypertensive
controls.
Among
the
hypertensives,
the
tendency
was
greater
for
hypertensives
on
thiazide
therapy
than
the
newly
diagnosed
treatment-naive
group.
DISCUSSION
There
have
been
few
studies
on
sexual
dysfunc-
tion
in
female
hypertensives.4
The
importance
of
this
as
an
adverse
effect
of
medications
cannot
be
overemphasized,
as
it
constitutes
a
barrier
to
blood
pressure
control.78
To
overcome
this
obstacle
and
try
to
attain
optimal
control
of
blood
pressure,
it
behooves
all
clinicians
to
enquire
about
this.
This
is
more
so
when
it
has
been
found
that
even
before
ini-
tiation
of
treatment,
women
with
hypertension
had
difficulties
achieving
sexual
satisfaction
as
well
as
poor
lubrication.9
In
the
experience
of
one
team
member
(BNO),
noncompliance
with
catastrophic
consequences
may
derive
from
sexual
dysfunction
even
in
females.
This
study,
albeit
on
small
numbers,
shows
that
there
was
a
greater
tendency
for
hypertensive
women
with
or
without
treatment
to
have
low
libido
compared
with
age-matched
controls.
The
differ-
ence,
however,
did
not
achieve
statistical
signifi-
cance.
This
may
require
a
larger
sample
to
demon-
strate.
Only
one
patient
reported
dyspareunia
consequent
upon
inadequate
lubrication.
She
was
on
thiazide
diuretics,
a
group
of
drugs
known
to
worsen
sexual
problem.10
The
results
here
should
be
taken
as
preliminary
and
show
only
the
tip
of
the
iceberg.
Females
are
more
reserved
in
our
culture
and
are
less
likely
to
discuss
such
sensitive
subjects.
In
our
experience,
they
generally
tend
to
parry
questions
on
this
subject
and
speak
philosophically.
It
could
also
be
that
the
general
clinic
settings
with
nurses,
attendants
and,
occasionally,
medical
students
do
not
give
them
the
desired
level
of
privacy
to
open
up
on
such
a
sensitive
matter.
The
sexual
response
cycle
in
women
is
similar
to
a
large
extent
with
that
of
males,
hence
antihyperten-
sives
should
cause
similar
adverse
effects.'0
During
excitement
and
in
response
to
parasympathetic
sig-
nals,
more
blood
flows
into
the
pelvis
and
breast.'
This
causes
an
increase
in
size
of
the
erectile
tissue
as
well
as
increase
in
mucus
secretion"
and
prepares
the
vagina
for
penile
reception.
If
the
small
caliber
ves-
sels
are
narrowed
by
hypertensive
arteriosclerosis,
the
above
would
not
occur.
Also,
if
in
treating
hyperten-
sion
the
blood
pressure
drops
rapidly
beyond
that
nec-
essary
to
fill
the
pelvic
vessels,
a
similar
consequence
would
be
expected.
The
stress
and
frustration
attend-
ing
this
situation
could
create
an
adverse
biochemical
milieu
(high
catecholamine
and
cortisol
levels)
that
would
impair
blood
pressure
control
as
well
as
exac-
erbating
the
sexual
dysfunction.12
We
suspect
that
as
in
males,
female
hypertensives
are
burdened
with
sexual
dysfunction.
This
has
not
been
borne
out
here,
because
differences
did
not
achieve
sta-
tistical
significance.
The
difference
may
require
a
larger
sample
to
emerge,
although
cultural
inhibitions
on
women
making
discussion
of
sexuality
a
taboo
could
have
affected
the
figures.
Currently,
we
are
in
the
process
of
designing
a
larger
study
on
the
subject.
To
preserve
total
quality
of
life
as
well
as
ensure
compli-
ance,
physicians
should
no
longer
shy
away
from
dis-
cussing
the
subject.
If
the
women
perceive
their
sexual
dysfunction
to
be
due
to
antihypertensive
treatment,
it
could
be
a
barrier
to
blood
pressure
control.
ACKNOWLEDGEMENT
We
thank
Isa
Mailafia,
the
hospital
statistician,
for
helping
out
with
the
analysis
and
statistics.
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RH,
Grandits
GA,
Prineas
RJ,
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Lang
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VOL.
98,
NO.
4,
APRIL
2006
639
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