68 Sexual functions in women with bipolar disorder and their healthy spouses _____________________________________________________________________________________________________ Original article / Araştırma Sexual functions in women with bipolar disorder and their healthy spouses Ali Metehan ÇALIŞKAN,1 Duygu GÖKTAŞ,1 Mehmet ARSLAN,1 1 1 1 İkbal İNANLI, Saliha ÇALIŞIR, İbrahim EREN _____________________________________________________________________________________________________ ABSTRACT Objective: The aim of this study was to compare the sexual problem levels of female patients with bipolar disorder (BD) and their healthy spouses with those of healthy couples and to investigate potential factors that predict sexual problems. Methods: Sixty female outpatients with BD in remission and their healthy spouses were included in the study. All patients were under medication. Forty-five healthy couples comprised the control group. All participants were examined on a variety of clinical measures, including depression, marital adjustment, and sexual satisfaction. Results: Sexual satisfaction, communication and anorgasmia problems were higher for patients than for female controls. Sexual intercourse frequency, communication and total sexual problems were higher for patients’ spouses than for male controls. Logistic regression analyses for females revealed that sexual satisfaction was associated with age, depressive symptoms, and marital adjustment rather than presence of disorder. The sexual satisfaction was associated with marital adjustment rather than being spouse of a patient for males. Conclusions: After controlling for confounding factors, sexual problems of patients and their spouses are similar to those of controls. Treating the subsyndromal depressive symptoms of patients and using interventions to increase marital adjustment may improve the sexual functions of both patients and their spouses. (Anatolian Journal of Psychiatry 2019; 20(1):68-75) Keywords: bipolar disorder, sexual functions, sexuality, marital adjustment Bipolar bozukluk hastası kadınlarda ve sağlıklı eşlerinde cinsel işlevlerin değerlendirilmesi ÖZ Amaç: Bu çalışmanın amacı, bipolar bozukluk (BB) hastası kadınların ve sağlıklı eşlerinin cinsel işlev sorunlarını sağlıklı kontrollerle karşılaştırmak ve cinsel sorunları etkileyen olası öngördürücüleri belirlemektir. Yöntem: Çalışmaya BB’li 60 kadın hasta ve sağlıklı eşleri alındı. Tüm hastalar psikiyatrik tedavi görüyordu. Kontrol grubu olarak 45 sağlıklı çift alındı. Tüm katılımcılar sosyodemografik veriler, depresif belirtiler, evlilik uyumları ve cinsel işlevleri açısından değerlendirildi. Bulgular: Hastalarda cinsel doyum, iletişim ve orgazm sorunları sıklığı kadın kontrollerden daha yüksek saptandı. Hasta eşlerinde cinsel ilişki sıklığı, iletişim ve toplam cinsel sorun sıklığı erkek kontrollerden daha yüksek saptandı. Kadınlar için yapılan lojistik regresyon analizinde, cinsel sorunların yaş, depre- sif belirtiler ve evlilik uyumu ile ilişkili olduğu; ancak BB’nin olması ile ilişkili olmadığı saptandı. Erkekler için yapılan analizde, cinsel sorunların evlilik uyumu ile ilişkili olduğu, hasta eşi olmakla ilişkili olmadığı saptandı. Sonuç: Karış- tırıcı etkenler kontrol edildikten sonra, BB’li hastaların ve eşlerinin cinsel sorun sıklığının kontrollere benzer olduğu görülmüştür. Hastaların subsendromal depresif belirtilerinin tedavi edilmesi ve evlilik uyumunu artırmaya yönelik girişimlerde bulunulması hem hastaların, hem de eşlerinin cinsel işlevlerinde iyileşme sağlayabilir. (Anadolu Psiki- _____________________________________________________________________________________________________ 1 Department of Psychiatry, Konya Training and Research Hospital, Konya, Turkey Correspondence address / Yazışma adresi: Mehmet ARSLAN, MD, Babaeski State Hospital, Dindogru district, street number 434, No.2, 39200 Babaeski/Kırklareli, Turkey E-mail: [email protected] Received: May, 15th 2018, Accepted: July, 20th 2018, doi: 10.5455/apd.299185 Anatolian Journal of Psychiatry 2019; 20(1):68-75 Çalışkan et al. 69 _____________________________________________________________________________________________________ yatri Derg 2019; 20(1):68-75) Anahtar sözcükler: Bipolar bozukluk, cinsel işlevler, cinsellik, evlilik uyumu _____________________________________________________________________________________________________ INTRODUCTION partners, so that a sexual problem of one partner can lead to sexual dysfunction in the other Bipolar disorder (BD) is a chronic disorder char- partner. Besides, sexual dysfunction may also acterized by recurrent depressive and manic/ cause partners sexual dysfunction via effecting hypomanic episodes that negatively affect social marital adjustment negatively. The aim of the and professional functionality.1 Various studies present study was to evaluate sexual function- have shown that most patients with BD also nality in female patients with BD and in their experience subsyndromal symptoms in euthy- healthy husbands and to investigate potential mic periods and that those symptoms are asso- factors affecting sexual functionality. ciated with decreased functionality in many areas.2-4 The literature on sexual functionality in METHODS BD is quite limited, and most data are derived from studies conducted several decades ago. Study setting and subjects A negative association has been reported This study was conducted in the Konya Training between BD and sexual functionality.5,6 Hariri et and Research Hospital Psychiatry Clinic. al. reported that patients with BD in remission Subjects were selected among outpatients who experienced more sexual problems than did sequentially applied to the Mood Disorders Unit healthy controls.7 Likewise, Sorensen et al. from January 2015 to August 2015.Seventy two found that the sexual distress level was higher in married heterosexual female outpatients who female patients with BD than in controls.8 were treated in the Mood Disorders Unit and diagnosed with BD-I or II in remission according Psychotropic drugs used in BD treatment are to DSM-IV-TR, along with their healthy spouses known to cause sexual dissatisfaction.9,10 or physical disease were planned to be included Furthermore, subsyndromal symptoms experi- in the study. Twelve couples were not included enced during euthymic periods and the negative as they refused to take part in the study. Thus, consequences of the disorder can negatively 60 female patients and their healthy spouses affect sexual functionality.11 In addition, epi- were included in the study. The control group sodes are also reported to affect sexuality was 45 married healthy heterosexual couples through increases in hypersexuality and risky who were selected randomly. sexual behaviors during hypomanic and manic periods and decreases in sexual desire during Inclusion criteria for patients diagnosed with BD depressive periods.12 were: age between 18 and 65 years, being married to the same spouse for at least one year Self-reporting of sexual dysfunctions in the and being sexually active during the past one psychiatric patient population tends to be low month, being in the euthymic period for a mini- and is mostly disregarded by clinicians.13,14 How- mum six months (Hamilton Depression Rating ever, sexual dissatisfaction is associated with Scale [HDRS] score 7 or below, Young Mania declines in quality of life, increased interpersonal Rating Scale [YMRS] score 5 or below) and relationship problems, impairments in marital using the same treatment for a minimum of two adjustment and treatment non-adherence.8,11,15 months. These intervals were determined ac- Sexual dissatisfaction, therefore can negatively cording to the arrangement of the final mainte- affect functionality and the course of BD. More- nance treatment. over, episodes can also be triggered by stress in BD, and sexual dysfunction can be a source of Inclusion criteria for the patients’ spouses were stress that triggers the episodes. To our know- age between 18 and 65 years and being physi- ledge, no study has yet been carried out in this cally and psychiatrically healthy. Healthy coup- area. les meeting the criteria for patients’ spouses were included as controls. To date, very few research studies have as- sessed sexual functionality in the partners of Exclusion criteria for all participants were any patients with BD, although a decline in the sexual known other medical diseases (e.g. diabetes, satisfaction level has been reported for the hypertension, thyroid disease, urological, infec- patients’ partners following the onset of the dis- tious, neurological and gynecological disorders order.16 Sexual functions are mutually affected in that can lead to sexual dysfunction), mental Anadolu Psikiyatri Derg 2019; 20(1):68-75 70 Sexual functions in women with bipolar disorder and their healthy spouses _____________________________________________________________________________________________________ retardation, a history of drug addiction or abuse, v22.0 for Windows. and being pregnant or in postpartum period for Descriptive statistics, included the average, females. Patients with a history of sexual dys- standard deviation (SD) and median, were used function or hypersexuality before BD diagnosis for continuous data, whereas frequency and or diagnosed with any psychiatric Axis I disorder percentages were used for discrete data. The other than BD were also excluded. Kolmogorov-Smirnov/Shapiro-Wilk test was Informed signed consent was obtained from all conducted to evaluate the