Evaluation of sexual function in women with polycystic ovary syndrome

Introduction: Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disorder during the reproductive period. Obesity, infertility, hirsutism, anxiety, and depression, which are frequently observed together with PCOS, may cause deterioration in sexual function. It is known that sexual functions are affected by many factors. In many studies, the factors affecting sexual functions in PCOS patients were examined separately, but no studies were found that assessed age, duration of intercourse, body mass index (BMI), infertility history, hirsutism, mood, body image, pelvic floor disorders, hormonal changes as a whole. This study aims to assess the potential associations between the impact PCOS has on sexual functions and pelvic floor function, body image, and mental health by comparing women with PCOS to healthy controls. Secondly, to evaluate whether the phenotypically hyperandrogenic subgroup primarily exhibits increased sexual desire and its effect on other sexual functions. Materials and Methods: This study was conducted with the patients that are between the ages of 18-49, are sexually active and are in a heterosexual relationship who applied to Ankara University Faculty of Medicine, Department of Obstetrics and Gynecology outpatient clinic between January 2022 and February 2023. The PCOS group, aka study group, included women with PCOS diagnosed according to the 2003 Rotterdam Criteria. The control group is formed by patients with regular menstrual cycles and are not hirsute, who applied to the outpatient clinic for routine control or infertility. Demographic characteristics (age, education and employment status, marital status, duration of intercourse, history of infertility and parity), physical examination findings (BMI, waist/hip ratio, pelvic organ prolapse), ultrasonography findings (antral follicle number and ovarian volume) and questionnaire scores (Female Sexual Function Index (FSFI), Depression-Anxiety-Stress Scale Short Form (DASS), Body Esteem Scale (BES) and Pelvic Floor Distress Inventory Short Form (PFDI-20)) was compared between the PCOS and control groups. On the 3rd day of the menstrual cycle, the hormonal profile of women who were diagnosed with PCOS was evaluated. The effects of BMI, age, duration of intercourse, presence of infertility, and Ferriman Gallway Score on sexual functions were evaluated with Univariate Regression Analysis. Patients were divided into four groups according to the presence of hyperandrogenemia and hyperandrogenic symptoms and their relationship with sexual function was evaluated. The relationship between FSFI and total testosterone, dehydroepiandosterone, sex hormone binding globulin, and free androgen index (FAI) and BES, DASS, PFDI-20 was evaluated seperately. Statistically significant factors were included in the Multivariate Regression Analysis. Results: 117 patients in the PCOS group and 109 patients in the control group participated in the study. Sexual dysfunction was observed in 58.1% of the patients in the PCOS group and 40.4% (n=0,008) of those in the control group. Total FSFI (p=0.008), arousal (p=0.005) and pain (p=0.047) scores of patients with PCOS were significantly lower than the control group. When PCOS phenotypes were compared with the control group (group B was not included in the analysis due to insufficient number of patients), total FSFI scores and arousal and orgasm subscales were significantly lower in group D. When other questionnaires were evaluated, BES (p<0.001), PFDI-20 (p=0.023) and anxiety subscale (p=0.006) scores of DASS were observed worse in PCOS group than controls. Infertility history and duration of intercourse were found to have a negative effect on lubrication. No correlation was observed between the presence of hyperandrogenemia and hyperandrogenic symptoms and sexual functions. When the effects of Ferriman Gallway Score, testosterone, sex hormone binding globulin and FAI on sexual functions were examined, no significant effect was found except for the pain subscale. There was a positive correlation between FSFI and BES, and a negative correlation between FSFI and both DASS and PFDI-20. Arousal subscale was found to be positively correlated with BES and negatively correlated with DASS. DASS and PFDI-20 results were observed to be effective on the orgasm subscale. A strong negative correlation was found between the PFDI-20 and the pain subscale. In the Multivariate Regression Analysis, when the factors affecting sexual functions were evaluated, education level and DASS on arousal, relationship duration, history of infertility, and PFDI-20 on lubrication, sex hormone binding globulin, history of infertility, and PFDI-20 on pain were found to be significant together. Conclusion: It was observed that sexual dysfunction was more common in PCOS patients compared to healthy controls. These women are also at risk for body image deterioration, anxiety, and pelvic floor dysfunction. Any effects of hyperandrogenemia and hyperandrogenic symptoms on sexual functions were not observed.