Research Studies | The Canadian Continence Foundation

Research Studies

Sexual dysfunction among young married women in southern India

Varghese KM, Bansal R, Kekre AN, Jacob KS. Int Urogynecol J 2012; 23: 1771-1774.

Why they did the study

Female sexual disorders [FSD] are a complex set of prevalent but poorly studied consequences of pelvic floor dysfunction that are associated with multiple biological, medical and psychological risk factors. Epidemiological data on FSD from many countries including the Indian subcontinent is limited. The objective of this study was to determine the status and prevalence of FSD among women in southern India, identify factors associated with FSD and assess their impact on quality of life.

How they did it

This was a cross-sectional hospital-based study carried out on 150 women relatives and friends who accompanied patients attending the obstetrics and gynecology clinic in Southern India. Participants were married women aged between 20 and 55 years who were living with their husbands for at least 6 months preceding the interview. Women who were temporarily separated from their husbands for more than 3 months and those who had genital malignancies or abdominal or genital surgery in the past 12 months were excluded.

Study subjects were interviewed using 3 instruments. The Female Sexual Function Index [FSFI] has 6 domains (hypoactive sexual desire, arousal, lubrication, orgasm, satisfaction, and pain) and 19 questions. The Clinical interview for Diagnostic and Statistical Manual IV [DSM IV] criteria for FSD is a semi-structured clinical interview tool to establish sexual dysfunction. The categories include hypoactive desire; arousal, orgasmic, genital pain disorders; and vaginismus. The interview also included inquiry whether these categories caused marked distress or interpersonal difficulty that was not due to any other medical or psychiatric disorder and substance use. The World Health Organization Quality of Life-BREF [WHOQOL-BREF] is an abbreviated version of the WHOQOL-100 to assess quality of life [QOL]. This instrument assesses the individual’s perceptions in context of their culture and value systems, and their personal goals, standards, and concerns. It comprises 26 items that measure the following broad domains: physical health, psychological health, social relationships and environment.

The sample size was based on a previously reported prevalence of FSD in the region of 73 % with a precision of 8 % and 95 % confidence interval.

What they found

The majority of participants were younger women (32.7 ± 7.2 years) who had been married for more than 10 years with their last child born 8 years ago and were premenopausal and currently using contraception.

One third of women reported a FSD. The common disorders were orgasmic dysfunction (18 %), hypoactive desire (16.6 %) and arousal disorders (14.6 %). Twenty-one (42.8 %) of those with sexual disorders reported a single disorder whereas 15 (30.6 %) reported two conditions. The factors associated with any DSM IV diagnosis of FSD on bivariate analysis were lower income, lower education, greater number of children, use of contraception and lower husband’s education. On multivariate logistic regression, only lower income and contraceptive use were risk factors.

Women with any DSM IV diagnosis of sexual disorder had a poorer QOL (p = 0.002) in general and had impaired social relationships (p = 0.001) and lower environmental scores (p = 0.005) in particular.

Why it matters

Female sexual disorders are one of the main manifestations of pelvic floor dysfunction in women that have a significant negative impact on the QOL. These disorders are usually associated with other pelvic floor dysfunction conditions such as urinary incontinence, pelvic organ prolapse and fecal incontinence. However, there is a dearth of information in the urogynecolgical literature about the prevalence, risk factors, diagnosis, impact and management of FSD compared to these conditions. In particular, there are very few studies about FSD in non-western women.

The findings of this study suggest that about one third of young Indian married women who were not complaining as patients surprisingly had sexual disorders according to DSM IV standards. Orgasmic disorder was surprisingly common as was hypoactive desire and arousal in this population of relatively young women in a stable marital relationship. Sexual dysfunction was also clearly associated with poor QOL particularly in social relationships.

This study, however, is not expected to determine the risk factors of FSD because the study design was cross-sectional and without a control group. The sampling technique of self-selection of a cohort of women also introduces selection bias. Further longitudinal and controlled studies of a randomly-selected community sample of women are needed to identify the risk factors of FSD and to verify these findings.

Next question

Female sexual disorders are highly prevalent conditions affecting 20–50 % of women but are often not recognized, poorly diagnosed and improperly managed compared to other pelvic floor dysfunctions like urinary incontinence, pelvic organ prolapse and fecal incontinence. The main reason is that the majority of women feel embarrassed to volunteer this private and intimate information to their health care provider. Routine screening for FSD using one of the available validated questionnaires, therefore, should be standard practice during the clinical interview in those women presenting with other symptoms of pelvic floor dysfunction. Sensitivity to cultural beliefs and ethnic background and awareness of their important influence on women’s attitudes to sexual health and care seeking are of paramount importance in eliciting FSD at the clinical consultation in multi-cultural societies.

Further research should focus on establishing a standardized terminology and simple diagnostic criteria for FSD. This should assist in developing evidence-based clinical guidelines and evaluation algorithms that would eventually improve identification, counseling, timely referral and management of women with FSD. More importantly, ethnographical and sociological studies on women’s perceptions, knowledge and attitude regarding sexual function and the adverse impact of sexual disorders in different cultures are urgently needed.

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