The calculated

number of women required for the sample size was 74 per group;4 however, to enable analysis of the HIV-positive group alone, the required number was 188 women.17 Since the actual sample size achieved was 128, the absolute difference was 8.5%, acceptable since it is less than apply for it 10%. Information on dyspareunia in HIV-positive women is scarce, especially in middle-aged women. To the best of our knowledge, no other studies have been conducted on dyspareunia in HIV-positive women. It has been reported that sexual function in HIV-positive women may be driven principally by psychological factors and other problems related to HIV infection.17 18 This study, however, found that in the overall sample of HIV-positive and HIV-negative women dyspareunia was not affected by HIV status. This finding is in agreement with the results of another author, who also reported that few women believed HIV in itself to be the cause of any decline in their sexual functioning, since those women had good immunovirological status.10 One supposes that results would be different in a sample of women without good

HIV control. In this study, more than three-quarters of the HIV-positive patients had a CD4 cell count nadir >200 and CD4 cell counts >500 in their last evaluation, thus reflecting adequate control of the disease. This may partially explain why no association was found between HIV status and dyspareunia. In line with this, another study showed that women with CD4 counts ≤199 cells/μL reported poorer

sexual functioning compared with those whose cell count was ≥200.19 Other studies have shown that the CD4 cell count nadir may also have long-term consequences in terms of prognosis and mortality.20 Nevertheless, the CD4 cell count nadir and the last CD4 evaluation were not associated with dyspareunia in this study, probably because of the small number of women with these low values. The most important factors associated with dyspareunia in the logistic regression analysis, in HIV-positive and HIV-negative groups analysed together, and in the HIV group analysis were vaginal dryness and urinary incontinence, Cilengitide both of which are urogenital disorders associated with oestrogen deficiency. The association between vaginal dryness and pain during sexual intercourse has been well documented in the literature, in addition to its consequence on vulvovaginal health.21–23 With respect to the association between urinary incontinence and dyspareunia, the findings of this study are in agreement with the results published by Salonia et al,24 who evaluated 216 women with urinary incontinence and found 44% of dyspareunia in these women.