Exploratory Description and Longitudinal Modeling of Predictors of Sexual Function and Satisfaction Post-Myocardial Infarction

Abstract

Myocardial infarction (MI) negatively impacts many aspects of a patient’s quality of life, one of which is sexual function. Though sexual function is a crucial component of quality of life for many individuals, it is critically understudied in the post-MI population. The lack of evidence has left health care providers and patients unsure on how sexual function components change when facing an acute or chronic illness, and what options are available to assist with maintaining optimal sexual function. Identification of modifiable predictors of both increased and decreased function is paramount before effective interventions can be developed. Therefore, the purpose of this dissertation was to illuminate the changes in sexual function over time and apply exploratory modeling to examine potential predictors of function in patients post-MI. The specific aims of this dissertation were three-fold including:

1. Describe sexual function and satisfaction in a population of adults within two weeks and at three months post-MI, and examine changes from two weeks post-MI to three months post-MI.

2. Determine the impact of depression, fear, anxiety, and use of coping strategies on predicting sexual function, satisfaction, and activity at three months post-MI.

3. Describe the relationships between the biopsychosocial domains of sexual function and satisfaction at two weeks post-MI.

A total of 99 patients in a Midwestern hospital were approached out of 395 screened. Of these, 63 provided informed consent (consent/decline rate 63.6%). Participants were mailed surveys at two weeks and three months following discharge from the hospital for an MI. Sexual function data was captured with a multidimensional instrument, the Female/Male Sexual Function Index. Additionally, anxiety, depression, coping strategies, and sexual fear data were gathered using validated survey instruments. Cross-sectional and longitudinal description were performed, and linear and logistic regressions were utilized to examine associations with function and activity at three months. Eighteen participants returned all survey data (response rate 33%). There were three major findings from this dissertation. The first finding was that physical components of function (i.e. erection, orgasm), were poorly correlated with psychosocial components (i.e. sexual satisfaction) at both two weeks and three months post discharge for MI. The second finding was that sexual function scores improved among male participants within the first few months of discharge (18.8%), particularly among those who were sexually active at three months. The third finding was that sexual function was negatively associated with sexual fear, and positively associated with utilization of problem-solving and support-seeking coping strategies at three months. Furthermore, problem-solving and support-seeking strategies revealed a statistically significant association with function at three months, though clinically insignificant. Problem-solving and support-seeking strategies were also identified as positive predictors of sexual function in the models. Altogether, these results, while modest, help to contribute to our understanding of sexual function post-MI, particularly in a short-term capacity post discharge. The studies herein provide some intriguing avenues for predictive research to elucidate the relationship between utilization of coping strategies with sexual function. This study also provided information on functional components at a short time post-MI, which providers and patients can utilize to understand what to expect after discharge. However, additional research is also needed with a more generalizable population to further explore the potential relationships observed in this dissertation. Additional descriptive work should also include more females and a broader distribution of racial minorities.