Association of PCOS and Its Clinical Signs with Sexual Function among Iranian Women Affected by PCOS
Somayeh Hashemi, MS; Fahimeh Ramezani Tehrani, MD; Maryam Farahmand, MS; and Mahnaz Bahri Khomami, MS
ONLINE: July 4 – The Journal of Sexual Medicine
Polycystic ovary syndrome (PCOS) is an endocrine disorder that affects about 5% – 10% of women of reproductive age worldwide and 15% of women in Iran.
Symptoms include irregular menstrual cycles, polycystic ovaries, and hyperandrogenemia (marked by hirsutism, acne, alopecia, seborrhea, obesity, and infertility).
PCOS can cause emotional distress, low self-esteem, relationship problems, and sexual dysfunction. Women may feel less feminine because of changes in their appearance. Fears of infertility and other health issues are also common.
Past research on PCOS and sexual function has had mixed results. Some studies have shown that PCOS interferes with sexual function; others have found no association.
However, the cultural and religious backgrounds of women with PCOS can play a role. The authors of this study took this into account.
“Although PCOS is a common disorder and its clinical signs influence sexual function, the evidence on this topic surprisingly is limited. Considering the effect of cultural and religious backgrounds of females suffering from PCOS and the lack of knowledge regarding sexual function in Muslim women affected by PCOS, the present study seemed necessary, which is why we aimed to investigate the association of PCOS and its clinical signs with sexual function among a population of married Iranian women affected by the condition” they wrote.
Selection and Description of Participants
Five hundred ninety-one married women between the ages of 18 and 45 were screened for the study. Women with psychological disorders or cardiovascular diseases were excluded.
In face-to-face interviews with trained staff, the women provided demographic information, details about their reproductive and gynecologic history, hyperandrogenic symptoms, and family history of hirsutism and irregular menstrual cycles.
During physical examinations, researchers evaluated the following: body weight, height, waist circumference (WC), hip circumference (HC), blood pressure, body mass index (BMI), acne, menstrual cycles (for women on hormonal medication), and hirsutism.
The women also completed the 19-item Female Sexual Function Index (FSFI) questionnaire, which assesses six domains of female sexual function: desire, arousal, lubrication, orgasm, satisfaction, and pain during sexual intercourse. Responses applied to the previous four weeks. Higher scores on the FSFI indicate better sexual function. Women with scores below 28.7 were considered to have sexual dysfunction.
PCOS was defined in accordance with the Rotterdam criteria, which require the presence of two or more of the following:
• Hyperandrogenemia and/or hyperandrogenism
• Polycystic ovaries (PCOs)
Five-hundred thirty-five women met the study’s eligibility requirements. Their mean age was 30.6 years. One hundred twenty-eight women were infertile; 407 women were fertile.
The women’s mean FSFI scores 25.8 ± 5.9. Considering the percentage of women whose score was below the cutoff point for dysfunction, the study indicated that 63.5% of the women had sexual dysfunction. The rates of sexual dysfunction for other individual FSFI domains were:
Other important statistics included the following:
• 50.6% of the women had acne.
• 48% had alopecia.
• 27.2% had hirsutism.
• 60.9% had android obesity.
• The prevalence rate of infertility was 23.9%.
Infertility and hair loss had “significant adverse effects” on sexual function.
The infertile women had significantly higher rates of total sexual dysfunction and higher rates of dysfunction in the individual FSFI domains, except for desire and pain.
Infertile women also tended to be older, had been married longer, and had higher values for BMI and waist circumference.
Among infertile women, 39% had female-factor infertility and 7.2% had male-factor infertility. For 27.3%, the factor of infertility was not known.
The mean rank of FSFI scores was significantly lower for women with female-factor infertility.
This study showed that over 60% of women with PCOS have sexual dysfunction. The highest rates of dysfunction were in the lubrication and arousal domains, which is consistent with previous research. Overall sexual dysfunction may be related to poor self-esteem and poor body satisfaction, although some researchers feel that PCOS-related dysfunction stems more from health-related concerns rather than social ones or living conditions.
The authors were surprised to find that obesity, acne, and irregular menstrual cycles were not associated with sexual function in this study group.
In this study, women with hirsutism had lower FSFI scores than women without the condition, although the difference was not significant. This may be explained by the fact that hirsutism can interfere with psychological wellness. It is “considered as one of the most stressful characteristics of PCOS and is widely known to have a negative impact on sexual health,” the authors explained.
Women who experienced hair loss were also more likely to have sexual dysfunction than those who did not. The authors noted, “Our results may be justified through the importance of hair in a woman's identity; it is believed that women's feelings of femininity, sexuality, and attractiveness are noticeably linked to their hair. Therefore, androgenic hair loss is a stressful experience and can seriously affect their self-esteem and body image.”
A logistic regression model showed that infertility was the only factor affecting sexual function in PCOS women. Infertile women had the lowest FSFI scores and higher rates of dysfunction in the domains of satisfaction, orgasm, lubrication, and arousal. Infertility, the authors said, “has profound social and personal implications that are strongly associated with the sociocultural, religious, and ethnic factors.” Infertile Muslim women may feel guilt, despair, and experience marital problems all of which may play a role in their sexual functioning.
The authors noted study limitations. This study had no control group. It also did not exclude women whose husbands had sexual problems or those with sexually-transmitted infections. These factors can affect female sexual function.
Strengths included the large sample size and the thorough clinical evaluation of the participants, they said.
The authors suggested that infertility be “highly considered” when treating sexual dysfunction in women with PCOS. They also suggested that future research focus on endocrine, psychological, and interpersonal confounders “to clarify the associations between sexual dysfunction and infertility.”