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Journal of Andrology, Vol. 32, No. 2, March/April 2011 Copyright Amrican !ocity of Andrology
Sexual Dysfunction in Female Patients With Neurodermatitis
A"#$N %&'(# ('M('%CAN,) *&#!&M *(NC+*#AN,) *+,-AN %(M(#%A!,.
*+N&# /$NC -+'A!AN,. A'%&N(' /(V(C$,0 AN/ 1('/$ +2%&',)
From the * Departments of Dermatology, f Urology, 'Public Health, and Psychiatry, Faculty of Medicine, Celal ayar
Uni!ersity, Manisa, "ur#ey$
ABSTRACT: Neurodermatitis is a chronic disease affecting the patients
psychosocial status and quality of life. It is associated with a variety of
psychologic problems, including demoralization, depression, anxiety,
obsessive-compulsive disorder, and sleep disturbances. oexistence of
sexual dysfunction, especially in women, with several systemic diseases
has gained interest in recent years. In this study, we evaluated sexual
function in female patients with neurodermatitis. !e enrolled "# women
$%& patients, %' controls( in the study. )uality of life was assessed with
the *ermatology +ife )uality Index $*+)I(, and the ,emale -exual
,unction Index $,-,I( was used to determine sexual function. Individuals
with psychiatric disorders and.or those using antidepressants were
excluded. /he total *+)I score was 00.#1 2 1.'1 in patients with
/he total ,-,I score was significantly lower in patients compared with
healthy controls $33.4' 2 1.&0 and 3"."& 2 &.15, respectively6 7 8 .550(.
*omain scores of ,-,I $desire, arousal, lubrication, orgasm, and
satisfaction( except pain were significantly lower in patients with
neurodermatitis $7 8 .550(. /he pain score was also lower in patients
than controls, but the difference was not statistically significant $7 8 .
54&(. Neurodermatitis may be associated with sexual dysfunction, and
patients with neurodermatitis should be evaluated with regard to sexual
function to provide a better quality of life.
9ey words: +ichen simplex chronicus, sex, quality of life, ,emale
-exual ,unction Index, ,-,I.
J Androl 2011;32:165-169
mal 34ual dy3function ha3 rcntly 5com a
common and important halth concrn that i3
influncd 5y mdical and p3ycho3ocial factor3 6Cayan t
al, 20078 #aumann t al, 20098 :achmann, 200;8 -ay3
t al, 200;8 !gra<3 and =oodard, 200;>. $n contra3t to
5a3ic and clinical r3arch in th fild of mal 34ual
dy3function, th 34ual pro5lm3 of ?omn ha<
rci<d rlati<ly littl attntion and oftn rmain
untratd 6Ana3ta3iadi3 t al, 2002>.
#ichn 3impl4 chronicu3, al3o @no?n a3 nurodrA
matiti3 circum3cripta, i3 a <ry common chronic 3@in
di3a3 6pr3nt in up to 12B of th population> that i3
mor oftn 3n in ?omn 6%haipi3utti@ul, 1CCD8 :urgin,
200D8 !tandr and MtE, 200C>. $t i3 a33ociatd ?ith a
<arity of p3ychologic pro5lm3, including dmoraliEaA
tion, dpr33ion, an4ity, o5333i<Acompul3i< di3ordr,
and 3lp di3tur5anc3 6:urgin, 200D>. $t may al3o ha<
ngati< ffct3 on th patintF3 Guality of lif 6A5c@,
20098 Chuh t al, 200;>. %hr ar f? rport3 a5out
34ual function di3ordr3 a33ociatd ?ith 3@in di3a33
6%tirl (rmrtcan t al, 200;8 (rgun t al, 200H8 !u@an
and Manr, 200H8 Mrcan t al, 200D8 (rmrtcan, 200C>.
Corr3pondnc toI /r Aylin %iirl (rmrtcan, 229 3o@. NoI 23
!ampiyon apt, /airI 2 :orno<a/$Emir, %ur@y 6AmailI draylinturlJ>.
'ci<d for pu5lication Jun H, 20108 accptd for pu5lication
!ptm5r D, 2010.
/+$I 10.21;7/Kandrol.110.010C9C
$n thi3 3tudy, ? compard th 34ual function in fmal
patint3 ?ith nurodrmatiti3 ?ith that in halthy
Materials and Methods
%hi3 3tudy ?a3 prformd in th drmatology outpatint clinic of
th mdical faculty of Clal :ayar &ni<r3ity, Mani3a, %ur@y. =
nrolld DC fmal participant3, including 73 patint3 ?ith
nurodrmatiti3 ?ho ?r con3cuti<ly admittd to th
drmatology dpartmnt and 7; halthy, 34ually acti< <oluntr3
a3 a control group. All participant3 ?r marrid and rportd that
thy had only 1 34ual partnr. %h 3tudy ?a3 appro<d 5y our
in3titution. All participant3 <oluntrd to participat in thi3 3tudy
and ga< informd con3nt aftr th o5Kcti<3 and mthod3 of th
3tudy ?r 4plaind.
Ag, ducation, occupation, num5r of childrn, contracpti<
mthod3, di3a3 duration, and drmatologic 4amination finding3
?r rcordd. All l3ion3 in th patint3 ?r localiEd on thir
5ac@3, ?hr nurodrmatiti3 l3ion3 ar commonly 3n. =
?antd to liminat th localiEation factor from 34ual function
and <aluat th impact3 of thi3 3@in di3a3 alon on 34ual
function. %hrfor, patint3 ?ith anognital localiEation ?r
4cludd from thi3 3tudy. 'outin 5lood count, 5iochmi3try,
rythrocyt 3dimntation rat, and urinaly3i3 ?r prformd for
ach participant. %h functional intgrity of th hypothalamoA
pituitaryAgonadal a4i3 ?a3 4amind in all participant3 5y
ma3uring th l<l3 of
166 Journal of Andrology March April 2011
Table 1. *emographic features of the participants
ontrol ;roup $n 8 %'( Neurodermatitis $n 8 %&( P
&4.' 2 #.50 &4.& 2 #.05 ."
&%." %'.1
1".4 %0.#
15 11."
0& 4
&4 &4.3
&0.5" 2 3'."3
00.#1 2 1.'1
<bbreviation: *+)I, *ermatology +ife )uality Index.
*ata are expressed as
means 2 -*.
folliclA3timulating hormon, lutiniEing hormon, 3tradiol, fr
t3to3tron, prolactin, and 34 hormonA5inding glo5ulin.
Larticipant3 3uffring from pulmonary, hpatic, hmatologic, rnal,
and ndocrin di3a33 3uch a3 dia5t3 mllitu3, a3 ?ll a3 thyroid
function di3ordr3 and inflammatory di3a33 3uch a3 rhumatoid
arthriti3, ?r 4cludd from th 3tudy. +thr 4clu3ion critria
includd prgnancy and gyncologic and 3y3tmic di3ordr3 that
might affct fmal 34ual function 3uch a3 hormonal, mu3cular,
nurologic, or cardio<a3cular di3a33 and p3ychologic di3ordr3.
Larticipant3 on antidpr33ant3 and othr drug3 that ar @no?n to
intrfr ?ith 34ual function and po3tmnopau3al ?omn
rci<ing oral or <aginal 3trogn thrapy for th pr<ntion of
climactric 3ymptom3 or <aginal dryn33 ?r al3o 4cludd from
th 3tudy.
%h 1mal !4ual 1unction $nd4 61!1$> ?a3 u3d to a3333
34ual function. $t i3 a 3lfArportd ma3ur of 34ual function
that ha3 5n <alidatd on a clinically diagno3d 3ampl of ?omn
?ith fmal 34ual arou3al di3ordr. %h Gu3tionnair i3
compo3d of 1C itm3 di<idd into ; domain3 that includ d3ir,
arou3al, lu5rication, orga3m, 3ati3faction, and pain. (ach itm i3
3cord on a 3cal of 0 6or 1> to 9 6rang for itm3 1,2,19, and 1; i3
1A9>, and ach domain i3 3cord ?ith th total of th itm3
6ma4imum 3cor3 10A20> 6'o3n t al, 2000>. -ighr 3cor3
indicat 5ttr function, and a domain 3cor of Ero indicat3 no
34ual acti<ity during th pa3t month.
Muality of lif of th patint3 ?ith nurodrmatiti3 ?a3 a3333d
?ith th %ur@i3h <r3ion of th /rmatology #if Muality $nd4
6/#M$>. %h /#M$ i3 a 10Aitm 3lfAadmini3trd in3trumnt that
ma3ur3 phy3ical function, ?or@ 3tatu3, 3ocial and 3port acti<iti3,
dpr33ion, an4ity, pain, and ?ll5ing. Mu3tion C of th /#M$
i3 a33ociatd ?ith 34ual function 6+Etur@can t al, 200;>. $t ha3
5n u3d ?orld?id in mor than 79,000 patint3 ?ith at la3t 33
diffrnt di3a33 6:a3ra t al, 200D>. $n th /#M$, highr 3cor3
3ignify poorr Guality of lif, and patint3 ?ith drmatologic
di3a33 ha< 3cor3 typically ranging from 9 to 19.
!L!! 6<r3ion 19.08 !L!! $nc, Chicago, $llinoi3> ?a3 u3d for
th 3tati3tical analy33. /ata ar 4pr33d a3 th man3 N !/.
ChiA3Guar and !tudntF3 t t3t3 ?r u3d for analy33. A <alu of
P % .09 ?a3 con3idrd 3tati3tically 3ignificant.
/mographic finding3 of th patint and control group3
ar 3ho?n in %a5l 1. Man ag3 ?r 3H.3 N C.10 yar3
6rang, 22A9C yar3> and 3H.; N C.01 yar3 6rang, 2199
yar3> for patint3 ?ith nurodrmatiti3 and control3,
r3pcti<ly. %h man num5r of childrn ?a3 2.3C for
th patint group and 2.7D for th control group.
'garding contracption, 23.2;B of th patint3 ?r
u3ing oral contracpti<3, and H;.H7B ?r u3ing
condom3. %h3 prcntag3 ?r 2;.0CB and H3.C1B
for th control group, r3pcti<ly. %h 2 group3 6patint3
and control3> ?r compara5l ?ith r3pct to ag,
occupation, and ducation 6%a5l 1>.
%h man di3a3 duration ?a3 31.0D N 2;.D2 month3,
and th total /#M$ 3cor ?a3 11.C9 N 9.;9 for th patint
group. %h 3cor3 from Gu3tion C of th /#M$ ?r al3o
<aluatd in th patint3. %hi3 Gu3tion ?a3 3cord a3 2
in 27 patint3 699.D0B> and 1 in 1C patint3 677.20B>.
%h total and indi<idual domain 3cor3 of 1!1$
ma3urmnt3 ar 3ho?n in %a5l 2. %h total 1!1$ 3cor
?a3 3ignificantly lo?r in patint3 ?ith nurodrmatiti3
compard ?ith that in halthy control3 622.H; N 9.31 and
2D.D3 N 3.90, r3pcti<ly8 L O .001>.
!parat analy33 of domain 3cor3 r<ald 3ignifA
icant dcra33 in all domain3 6d3ir, arou3al,
lu5rication, orga3m, 3ati3faction> 4cpt pain in patint3
?ith nurodrmatiti3. %h pain domain 3cor ?a3 al3o
lo?r in th patint group, 5ut th diffrnc 5t?n th
2 group3 ?a3 not 3tati3tically 3ignificant 6L O .0H3>.
Ermertcan et al Female Sexuality in Neurodermatitis 167
Nurodrmatiti3 i3 a chronic, 3<rly pruritic di3ordr
charactriEd 5y 1 or mor lichnifid plaGu3 in ?hich
th 3@in i3 thic@nd and thr ar accntuatd 3@in
mar@ing3. $t affct3 adult3, prdominantly from ag3 30
to 90 yar3. =omn ar affctd mor commonly than
mn. $t may lad to dmoraliEation, 3lp di3tur5anc3,
an4ity, dpr33ion, o5333i<Acompul3i< di3ordr, and
di3tr33 through it3 impact on th patintF3 ?llA5ing
6:urgin, 200D>. $f th patint 3uffr3 from p3ychologic
pro5lm3, th l3ion3 ar mor li@ly to 5 pr3i3tnt
6!tandr and MtE, 200C>. =hthr motional factor3
ar 3condary to th primary drmatologic di3a3 or
thy ar primary and cau3ati< 6altring prcption of
itch> i3 unclar. $t ha3 5n po3tulatd that nurotran3A
mittr3 that affct mood, 3uch a3 dopamin, 3rotonin,
and opioid pptid3, modulat prcption of itch <ia
d3cnding 3pinal path?ay3 6:urgin, 200D>.
Co4i3tnc of 34ual dy3function, 3pcially fmal
34ual dy3function, ?ith diffrnt di3a33 ha3 gaind
intr3t in rcnt yar3 6Cayan t al, 20078 #aumann t al,
20098 :achmann, 200;8 -ay3 t al, 200;8 !gra<3 and
=oodard, 200;>. Numrou3 3tudi3 ha< 5n prformd
in othr di3ciplin3 of mdicin a5out 34ual dy3function
6Monga t al, 1CCD8 Am5lr t al, 20018 ,o3oglu t al,
20098 %i@iE t al, 2009>.
%h impact of nurodrmatiti3 on 34ual function i3 of
intr3t 5cau3 th di3a3 can limit a pr3onF3 a5ility to
prform 33ntial lif ta3@3 and 3ocial rol3. Moro<r,
34ual dy3function may al3o cau3 3ignificant pr3onal
di3tr33 and ngati<ly impact Guality of lif
6%haipi3utti@ul, 1CCD8 A5c@, 20098 Chuh t al, 200;8
:urgin, 200D>. $n our 3tudy, ? u3d th /#M$ to
<aluat th Guality of lif of patint3. %h man /#M$
3cor of 11.C9 i3 3imilar to th man 3cor3 of 11.20 and
10.93 rportd for atopic drmatiti3 and p3oria3i3,
r3pcti<ly 6:a3ra t al, 200D>. %h 3cor3 on Gu3tion C
of th /#M$ 3ho?d that nurodrmatiti3 affctd 34ual
function in our patint3. Con3i3tnt ?ith thi3 o53r<ation,
pr<iou3 3tudi3 ha< r<ald a highr pr<alnc of
34ual dy3function in patint3 ?ith chronic pain 6Monga
t al, 1CCD8 Am5lr t al, 2001>. !4ual dy3function in
fmal patint3 ?ith fi5romyalgia ha3 5n dmon3tratd
6%i@iE t al, 2009>, and 34ual 3tatu3 and rctil
dy3function in patint3 ?ith chronic o53tructi<
pulmonary di3a3 ha< 5n 3ugg3td 6,o3oglu t al,
2009>. !4ual dy3function 3tudi3 on othr 3y3tmic
di3a33, 3uch a3 dia5t3 mllitu3, chronic li<r di3a3,
allrgic rhinoconKuncti<iti3, pilp3y, chronic rnal
failur, and multipl 3clro3i3 ha< al3o 5n prformd
6(rmrtcan, 200C>.
$n drmatology, th 3tudy of thi3 3u5Kct i3 Guit n?.
Nimir t al 61CCH> compard 34ual 5ha<ior3 in
patint3 ?ith p3oria3i3, nurodrmatiti3, and control3.
Latint3 ?ith 3@in di3a33 had a 3ignificantly impaird
34ual lif, compard ?ith halthy control3 6Nimir t
al, 1CCH>. *upta and *upta 61CCH> rportd that 70.DB of
patint3 ?ith p3oria3i3 4pr33d that thir 34ual acti<ity
had dimini3hd 3inc th on3t of thir 3@in di3a3.
!ampogna t al 6200H> in<3tigatd th 34ual lif in
patint3 ?ith p3oria3i3 ?ith 2 drmatologyA 3pcific
Gu3tionnair3 6!@ind4A2C and /#M$> and 2 p3oria3i3A
3pcific Gu3tionnair3 6L3oria3i3 /i3a5ility $nd4 PL/$Q
and $mpact of L3oria3i3 on Muality of #if Mu3tionnair
P$L!+Q>. +f C3; patint3, 39.9B 6L/$> to H1.3B 6$L!+>
rportd 34ual pro5lm3 5cau3 of p3oria3i3. Mrcan t
al 6200D> u3d th AriEona !4ual (4princ !cal
6A!(R> to compar 34ual function in 31 patint3 ?ith
nurodrmatiti3, 27 patint3 ?ith p3oria3i3, and 33
control ca33. %hy found that th nurodrmatiti3 group
had mor 34ual pro5lm3 than th p3oria3i3 group and
th control group. !u@an and Manr 6200H> u3d th
A!(R to 4amin 34ual pro5lm3 in 90 patint3 ?ith
<itiligo, 90 patint3 ?ith chronic urticaria, and 90 halthy
control3. %h total 3cor3 of th A!(R in th fmal
patint group3 ?r 3ignificantly highr than tho3 in
control3. %h 3cor for 3ati3faction from orga3m in mal
patint3 ?a3 l33 than that in control3. $n mn,
diffrnc3 in othr 3u5itm 3cor3 of A!(R ?r not
3ignificant 5t?n th patint group3 and control3.
Muality of lif 3cal3 and 34ual function 3cal3
applid to 5oth ?omn and mn 6g, A!(R> ha< 5n
u3d in currnt pu5lication3. *nral halth Gu3tionA
nair3 and drmatologyA3pcific Guality of lif 3cal3
may ha< 3om Gu3tion3 a5out 34ual lif, 5ut thy do
not 3pcifically <aluat 34ual pro5lm3. :cau3
fmal and mal 34ual function3 ar phy3iologically
diffrnt ntiti3, gndrA3pcific 34ual function 3cal3,
3uch a3 1!1$ and $ntrnational $nd4 of (rctil 1unction
Mu3tionnair 6$$(1> ar prfrrd 6(rmrtcan, 200C>.
!4ual function in patint3 ?ith p3oria3i3 ?a3 a3333d
5y (rmrtcan t al 6200;>, ?ho u3d th 1!1$ to 4amin
fmal 34ual function and $$(1 to 4amin mal 34ual
function. %hy found that th total 1!1$ 3cor ?a3
3ignificantly lo?r in fmal patint3 ?ith p3oria3i3 ?ith
Table 2. !" total score and scores for each domain of
female se#ual function$
ontrol ;roup $n 8
Neurodermatitis $n 8
%&( P
*esire %.5' 2 5.4" 3.#4 2 5."# .550
<rousal %.'5 2 5.4" &.%0 2 5.#"
+ubrication %.#% 2 5.44 &."" 2 0.5# .550
=rgasm 1.5' 2 5.'# &."' 2 0.3#
-atisfaction 1.&0 2 5.'0 %.&5 2 0.35
7ain %."" 2 5.#3 %.%0 2 0.%% .54&
,-,I /otal 3"."& 2 &.15 33.4' 2 1.&0
<bbreviation: ,-,I, ,emale -exual ,unction Index.
*ata are expressed
as means 2 -*.
-tudents t test.
168 Journal of Andrology March April 2011
or ?ithout dpr33ion compard ?ith halthy control3.
%h $$(1 total 3cor ?a3 al3o 3ignificantly lo?r in mal
patint3 ?ith p3oria3i3 ?hn compard ?ith halthy
control3. !4ual function in fmal and mal patint3
?ith chronic hand cEma ?a3 al3o in<3tigatd 5y
(rgun t al 6200H>. %h total 1!1$ 3cor ?a3 3ignificantly
dcra3d in patint3 ?ith hand cEma. %h total 1!1$
3cor ?a3 3ignificantly lo?r in fmal patint3 ?ith
hand cEma ?ith dpr33ion than in patint3 ?ith hand
cEma ?ithout dpr33ion. $n mn, th total $$(1 3cor
?a3 3ignificantly dcra3d in patint3 ?ith hand cEma
compard ?ith halthy control3.
Nill and 'idly 62001> rportd that anognital lichn
3clro3u3 may commonly cau3 34ual dy3function.
+thr <ul<ar drmato33 3uch a3 p3oria3i3, 35orrhic
drmatiti3, 3Guamou3 cll hyprpla3ia, lichn 3impl4
chronicu3, contact drmatiti3, and ro3i< lichn planu3
can r3ult in <ul<odynia, dy3parunia, and 34ual
dy3function 6/a<i3 and -utchi3on, 1CCC8 :urro?3 t al,
200D>. :cau3 anognital 3@in l3ion3 may r3ult in
difficulti3 in 34ual function, ? did not includ patint3
?ith anognital nurodrmatiti3 in our 3tudy.
$n our 3tudy, ? <aluatd 34ual function u3ing
Gu3tion C of th /#M$ and th 1!1$. According to
Gu3tion C of th /#M$, 34ual function ?a3 affctd in
our patint3 ?ith nurodrmatiti3. =hn ? loo@d at th
total and indi<idual 3cor3 from th 1!1$, th total 3cor
?a3 3ignificantly dcra3d in fmal patint3 ?ith
nurodrmatiti3 compard ?ith that in control3. Analy33
of ach domain 3ho?d that 3cor3 for d3ir, arou3al,
lu5rication, orga3m, and 3ati3faction ?r 3ignificantly
dcra3d in th3 patint3. %h pain 3cor ?a3 al3o
lo?r in th patint group than in th control group,
although th diffrnc ?a3 not 3tati3tically 3ignificant.
A3 o53r<d in Nimir t al 61CCH> and Mrcan t al
6200D>, ? conclud that nurodrmatiti3 oftn r3ult3 in
34ual dy3function. = al3o conclud that
nurodrmatiti3 ha3 ffct3 particularly on th d3ir,
arou3al, lu5rication, orga3m, and 3ati3faction componnt3
of 34ual function in fmal patint3.
Nurodrmatiti3 or lichn 3impl4 chronicu3 i3 an
oftn 3ymptomatic 3@in condition, and patint3 ?ith
nurodrmatiti3 may ha< clinical 3ymptom3 3uch a3
itching, 5urning, or 3tinging. Nurodrmatiti3 may al3o
ha< ngati< ffct3 on th patintF3 Guality of lif and
34ual lif 5cau3 it affct3 3lfAprcption and 3ocial
rlation3hip3 of th patint3. = propo3 that a
5iop3ycho3ocial approach to managmnt i3 <ry
important in patint3 ?ith nurodrmatiti3 and that thy
3hould 5 al3o a3333d ?ith rgard to 34ual function to
pro<id a 5ttr Guality of lif.
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5ha<ior3. -nt ' -mpot 1es$ 200981HI3CA9H.
Mrcan !, Altunay $,, /mir :, A@pinar A, ,ayaoglu !. !4ual
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