Discussion:
While there are many studies in the literature showing the positive
effects of smoking cessation on ED in men,10 there are
very few studies showing the relationship between FSD and
smoking,11 and moreover, there are no studies
investigating the effect of smoking cessation on FSD.
Sexual activity is process including desire, desire, arousal,
lubrication, orgasm and satisfaction follows each other in women. Many
psycho-physiological mechanisms such as hormonal, vascular and neural
play a role in this process.14 Risk factors that lead
to decreased blood flow of female external genital organs cause
impairment in the arousal and lubrication phases. Disruption in these
stages can cause dyspareunia, preventing sexual intercourse from
reaching orgasm and satisfaction, and may lead to FSD. There are studies
in the literature showing that clitoral vascularization and clitoral
tissue perfusion are associated with FSD in healthy
women.15,16 It has been revealed that smoking, which
is one of the main risk factors of cardiovascular and cerebrovascular
diseases, decreases genital vascularization.15-17Also, the anti-estrogenic effect of smoking causes a decrease in
estrogen levels, which leads to a decrease in blood flow of the genital
organs.15-17 The reduction in genital vascularization
(especially the impairment of the clitoral tissue perfusion), negatively
affects the arousal and lubrication phases, which are very important for
orgasm and satisfaction.18 Coppalo et al. demonstrated
that clitoral tissue perfusion was worse in women with FSD according to
FSFI total scores.16 However, no difference was found
between the groups in terms of smoking.16 Choi et al.
showed that women who had a smoking history, had lower FSFI total score
and sub-domain scores than women who did not smoke.11Similarly, in our study, we demonstrated that there was a significant
decrease in the total scores of the FSFI questionnaire and especially in
the arousal and lubrication domain scores in smoking patients.
In this study, it was shown that there is an inverse relationship
between smoking duration and total FSF scores and sub domain scores.
Choi et al. demonstrated that there was a dose-response relationship
between smoking and FSD.11 They found that higher
cumulative smoking (package years) was related to lower total FSFI
score.11 The findings of this study and our study may
be important in terms of showing that the effects of smoking on female
sexual functions are time and dose dependent.
There are studies in the literature that show that the deterioration in
women’s sexual health for various reasons, affects the QOL of women. It
has been demonstrated in studies conducted in women with depression,
menopause, and salpingo-oophorectomy to reduce the risk of breast cancer
that FSD has a negative impact on QOL.19-21 Goldenberg
et al showed that there was a negative relationship between smoking and
QOL and that this relationship was directly proportional to the number
of cigarettes smoked.22 In this study, we demonstrated
that smoking causes FSD and negatively affects the QOL in all
sub-domains. We also showed that there was a relationship between
severity of FSD and QOL sub-domain scores. It can be deduced from the
findings of our study that, smoking both negatively affects the QOL by
causing FSD and that smoking has a direct negative effect on QOL. In
addition, it can be deduced that smoking cessation may lead to
improvement in FSD, thus both the improvement in FSD and the elimination
of the negative effect caused by smoking can increase the QOL.
Although there are studies evaluating the effect of smoking cessation on
QOL in the literature, there are no studies investigating the effect of
smoking cessation on FSD.23,24 In this study, unlike
the literature, changes in FSD and QOL in female smoking patients after
smoking cessation were evaluated together. Our results showed that
smoking cessation significantly improved both FSFI total and sub-domain
scores and SF-36 sub-domain scores especially physical and emotional
role subdomain scores. The reasons for the improvement in FSD after
smoking cessation may be the increase in blood flow in the genital area,
especially in the vagina and clitoral tissue; the decrease in oxidative
stress, and the disappearance of the anti-estrogenic effects of smoking.
As a result of these pathophysiological improvements, the increase in
blood supply in the vagina and clitoral tissue can lead to an
improvement in arousal and lubrication and resulting ease of reaching
orgasm and satisfaction. Also, improvement in lubrication may prevent
pain during sexual intercourse. These improvements mentioned above may
also explain the improvement in FSD and thus the improvement in QOL, as
shown in the results of our study.
In this study, the positive effects of smoking cessation were mostly
observed in the arousal, lubrication and orgasm sub-domains of the FSFI
questionnaire and in the sub domains of the SF-36 questionnaire where
the physical and emotional role problems were evaluated. According to
these results, it can be concluded that FSD, which is in the arousal,
lubrication and orgasm stages, causes physical and emotional problems in
women and impairs the QOL.