Background: Ages at first date and sexual encounter have been observed to be delayed in women with Turners syndrome (TS), with late presentation and delayed puberty induction being the main culprits. There is no equivalent data in women with premature ovarian insufficiency (POI).
Objectives: We sought to assess whether age at start of oestrogen replacement therapy (ERT) and amenorrhoea status affected the age at first relationship and sexual experience and whether this differed between women with TS and POI.
Methods: This cross-sectional observational study formed part of the Reproductive Life Course Project carried out at University College London Hospitals and comprised 268 women with TS and 50 women with karyotypically normal POI. A questionnaire was used to collect data on menarche, age at diagnosis and at ERT start, whether they have been on a date, had a romantic relationship or sexual intercourse and the respective ages at first such experiences.
Results: Women with TS were older than those with POI (36.7±12.8 vs 29.0±9.4, P=<0.001), were diagnosed earlier (9.6±8.1 vs 16.3±3.9, P=<0.001) and started ERT at a younger age (15.5±6.1 vs 17.2±3.3, P=<0.001). There was no difference in the number of women with TS compared to POI who had been on a date (81.0% vs 72.0%, P=0.25), had a romantic relationship (67.6% vs 72.0%, P=0.39) or sexual intercourse (60.5% vs 70.0%, P=0.15). Moreover, there was no difference in the mean ages at first such experiences (romantic relationship 19.3±5.2 vs 18.3±2.8, P=0.54; sexual intercourse 20.9±5.8 vs 19.1±2.7, P=0.19). In TS and POI, women suffering from primary amenorrhoea (77.6% and 66.0% respectively) compared to those undergoing spontaneous menarche (20.5% and 34.0%), had a significantly delayed median age at first romantic relationship (19±0.3 vs 17±0.2, P=<0.001) and at first sexual intercourse (20±0.3 vs 18±0.4, P=<0.001). In women with primary amenorrhoea, the age at first romantic relationship/sexual intercourse was related to age of starting induction of puberty. A significantly lower percentage of women with POI and TS had their first sexual intercourse <16 years compared to that found in UK reference data (Natsal-3; 3.6% vs 18.0%, P=<0.001).
Conclusion: Primary amenorrhoea, which is often associated with later pubertal maturation, results in a delayed relationship and sexual experience in both TS and POI alike. Women undergoing puberty induction have an overall delayed mean age at first relationship and sexual experience compared to the general population.
18 - 21 May 2019
European Society of Endocrinology