Sexual response in women with polycystic ovary syndrome: a case-control study.
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OBJECTIVE: To study genital response and sexual arousal in women with and without polycystic ovary syndrome (PCOS) and assess associations with sex steroid levels. DESIGN: This observational prospective case-control study was conducted from March 2017 until March 2020. SUBJECTS: Heterosexual women with (n = 68) and without (n = 67) PCOS, aged 18-40 years, in a steady relationship and without any comorbidities. EXPOSURE: All participants underwent an extensive medical and endocrine screening as well as assessment of genital blood flow (vaginal pulse amplitude), assessed with photoplethysmography), and sexual arousal and affect (Likert scale questionnaire) in response to erotic and vibrotactile stimulation. MAIN OUTCOME MEASURES: Vaginal pulse amplitude, lubrication, subjective sexual arousal, and affect. RESULTS: There were no significant differences in genital blood flow response and self-reported lubrication between women with and without PCOS. After adjusting for confounders, women with PCOS did report significantly lower positive affect in the fantasy and vibrotactile condition than those without PCOS. Regression analyses adjusted for confounders showed only few and weak associations of sexual responses with androgen levels explaining only a maximum of 6% of variance in all models in women with and those without PCOS. The PCOS group showed only weak associations between subjective sexual arousal and dehydroepiandrosterone (fantasy, β = 1.719, adjusted R2 = 0.020) and sex hormone binding globulin (fantasy, β = -1.728, adjusted R2 = 0.044). CONCLUSION: Women with PCOS show similar genital sexual response and lubrication but lower positive affect than those without PCOS; however, only few and weak associations with the androgen levels were found. The androgen levels are not indicative of genital response and subjective arousal. Sexual function should be discussed in clinical care and psychosexual counseling should be offered. CLINICAL TRIAL REGISTRATION NUMBER: CCMO register, NL55484.078.16.