Duration of hypertension and antihypertensive agents in correlation with the phases of female sexual response cycle Rozimah Abdul Latif a , Rosediani Muhamad a , Anne Yee Hway Ann b , Hatta Sidi c, ⁎ , Nik Ruzyanei Nik Jaafar c , Marhani Midin c , Srijit Das d , Loh Huai Seng e , Ng Chong Guan b a Department of Family Medicine, School of Medical Science, Universiti Sains Malaysia, Kota Bahru, Kelantan, Malaysia b Department of Psychological Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia c Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, 56000 Cheras, Kuala Lumpur, Malaysia d Department of Anatomy, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia e Department of Family Medicine, International Medical University, Kuala Lumpur, Malaysia Abstract Objective: This cross-sectional study aimed to determine the construct of the phases of the female sexual response cycle (SRC) in women with hypertension and their association with the duration of hypertension and types of antihypertensive agents. Methods: The sexual response phases were measured with a validated Malay version of the Female Sexual Function Index (FSFI). The correlations structure of the items of the SRC's phases (i.e. desire, arousal, orgasm, satisfaction and pain) was determined using principal component analysis (PCA), with varimax rotation method. The number of factors obtained was decided using Kaiser's criteria. A total of 348 hypertensive women were recruited for this study. Four constructs were extracted in the analysis of all subjects. Results: Using the factor analysis, the six domains (i.e. sexual desire, arousal, etc.) of the women's SRC among hypertensive women merged into 4 constructs. They were composed of (i) sexual desire and arousal, (ii) orgasm and sexual satisfaction, (iii) vaginal lubrication and (iv) sexual pain. Interestingly, vaginal lubrication stood out alone as one construct, compared to the non-hypertensive women. It was also observed that the duration of hypertension, beta blocker and diuretic antihypertensive medications had different influence on the SCR (in terms of constructs). Conclusion: Duration of hypertension and types of antihypertensive drugs may affect the components of the SRC. A clear understanding would help the clinician in strategizing the treatment approach of sexual dysfunction in women with hypertension. © 2014 Elsevier Inc. All rights reserved. 1. Introduction Sexual dysfunction in hypertension is commonly ob- served in clinical practice. It may be a consequence of the natural progression of the disease itself and/or the antihy- pertensive medications [1,2]. Although the theory of endothelial dysfunction and inflammatory markers is currently inconsistent [3], the effect of hypertension on vascular system and neural component of the genitalia, may cause a reduction in blood flow (secondary to hypertensive arteriosclerosis) and mucus secretion of the vagina, subse- quently leading to sexual dysfunction [4]. Certain antihy- pertensive medications especially the diuretics and beta blockers may have negative impact on the sexual functioning [2,5]. This creates not only adverse biochemical (increased cortisol level) but psychological reactions, which in turn exacerbate the sexual dysfunction [6]. Over the past few years, there has been a growing understanding in the differences of the SRC between males and females. While the linear model of SRC as described by Masters and Johnson was readily applied in males, Basson introduced an alternative model, known as the intimacy- based model or SRC circular model to explain the SRC in females. According to this model when a sexually neutral woman faces intimacy, she is driven by both biological (subjective arousal from non-genital and genital stimula- tions) and psychological factors (to get emotional closeness to her partner) to experience sexual arousal. What follows is an ongoing enjoyable sexual sensation which can further Available online at www.sciencedirect.com ScienceDirect Comprehensive Psychiatry 55 (2014) S7 – S12 www.elsevier.com/ Publication of this supplement was supported by Universiti Kebangsaan Malaysian Medical Centre, Kuala Lumpur, Malaysia. ⁎ Corresponding author. Tel.: +1 603 91456142; fax: +1 603 91737841. E-mail address: hattasidi@hotmail.com (H. Sidi). 0010-440X/$ – see front matter © 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.comppsych.2012.10.008