ORLANDO, Nov. 12 -- For the first time, researchers have linked high blood pressure to sexual problems in women, according to a study reported today at the American Heart Association's 70th Scientific Sessions.
Difficulty in achieving orgasm and inadequate vaginal lubrication were associated with high blood pressure in women, according to the researchers. Sexual problems, such as impaired erection or ejaculation in men, also have been associated with high blood pressure, but these problems have been attributed to the antihypertensive drugs used to treat high blood pressure, a condition that plays a role in causing heart attack and stroke. Now researchers have evidence, in the largest survey to date, that high blood pressure itself may depress sexual response.
The possibility that high blood pressure and the drugs to combat it both can affect sexual behavior has received little attention in research and requires further study, says Laurie E. Duncan, M.D., who presented the study's findings today, representing Bassett Healthcare and the Mary Imogene Bassett Research Institute in Cooperstown, New York.
The researchers studied 211 premenopausal Caucasian women. Half of them had high blood pressure. In self-administered questionnaires and telephone interviews, they answered questions about sexual function, including: desire, arousal, and attainment of orgasm, pain during sex, quality of relationship, satisfaction with relationship, frequency of sexual activity, and medical history.
Because high blood pressure is relatively rare in younger women, co-author Carol Lewis, Sc.D., M.P.H., says the researchers had to search through four-and one-half years of patient records at Bassett's facilities to identify a sufficient number of women in this age range. Their database covered nine counties and included medical records from more than 3,300 outpatient visits. No major differences were found in the quality, desire, arousal, frequency and satisfaction between the women with and without high blood pressure. However, women with high blood pressure reported less vaginal lubrication and more difficulty achieving orgasm, whether or not they took medication. That finding surprised the researchers.
"We felt if we were going to find an effect it would most likely be a drug effect, and we found that it did not seem to have to do with drugs, but with hypertension," says Duncan.
High blood pressure -- which is a reading that is 140/90 millimeters of mercury or greater -- affects an estimated 46.5 percent of women between ages 55 and 64 years, increasing to more than 60 percent of women between 65 and 74 and more than three-fourths of women over age 75. High blood pressure can be dangerous because it places the heart and blood vessels under greater strain than normal. This can contribute to heart attacks, strokes and kidney failure.
Sexual problems in men are simpler to study because problems with erection and ejaculation associated with antihypertensive medication can be more easily measured, say the scientists. Not every man has a reaction to a given class of drugs and changing to a different medication may eliminate most adverse reactions.
"The comment frequently made in studies that have looked only at men is that women needed to be studied, but studying women went beyond the scope of that particular piece of research," Duncan says. "We tried to address those problems by designing a questionnaire that looked at both emotional and physiological aspects of sexual functioning.
"Essentially, all the work on the effects of antihypertensive drugs has been done on men and then generalized to women."
The researchers, who stressed that their findings are preliminary, say this aspect of their research should be applied to men, namely, the importance of physicians asking about sexuality.
"The point has been made that if doctors do not ask specific questions about sexual problems, patients -- both male and female -- will not feel free to discuss such issues," says Duncan.
"Sexuality is a very private thing. People are quite often distraught and embarrassed about problems and are unlikely to bring them up to their physicians. It is the physician's role to ask the right questions and to make the patient feel safe enough to share painful information."
Duncan realized the depth of the research gap in sexual function when she developed the survey questionnaire as part of her British medical degree in the late 1980s. "I was unable to find one study that specifically addressed sexuality in hypertensive women," she says, adding that a few studies have been published since then. Spurred by her discoveries, she decided to undertake the most thorough survey to date on the subject and won a E. Donnall Thomas research scholarship at Bassett Healthcare in rural upstate New York to carry out the work.
Duncan and Lewis' co-authors are Paul Jenkins, Ph.D., and Thomas Pearson, M.D., Ph.D.
###