Sexual function in women with Polycystic Ovary Syndrome: the role of psychological factors.
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BACKGROUND: Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder in women of fertile age. It is associated with somatic and psychological comorbidities and lower sexual function. AIM: To study which psychosocial factors predict sexual dysfunction, and dyadic and solitary sexual desire in women with PCOS. METHODS: This is an observational case control study amongst healthy heterosexual women with (n = 68) and without PCOS (n = 67), aged 18-40 years, in a steady relationship. All participants filled out questionnaires on sexuality (sexual function, sexual distress, sexual desire), psychosocial factors (general self-esteem, relationship satisfaction, body image, body self-consciousness, sexual esteem, sexual abuse), and mental health (anxiety and depression). Standard multiple regression analyses were performed to assess which factors predict sexual dysfunction and dyadic and solitary sexual desire. OUTCOMES: sexual dysfunction, dyadic sexual desire, solitary sexual desire. RESULTS: Women with PCOS reported significantly more often sexual dysfunction (41.2% vs. 11.9%, P < .001, φ: 0.331) and lower dyadic sexual desire (P: .005, η: 0.057), but no difference in solitary sexual desire (P: .160, η: 0.015) compared to women without PCOS. Also, women with PCOS reported significantly less positive body image (P: .012, η: 0.047), higher body self-consciousness (P: .011, η: 0.048), higher anxiety (P: .002, η: 0.072), higher depression scores (P: .006, η: 0.055), more sexual abuse experiences (P: .009, φ: 0.225), and less relationship satisfaction (P: .017, η: 0.042). No differences in general self-esteem (P: .169, η: 0.014) were found in contrast to sexual esteem (P: .021, η: 0.039). Body self-consciousness (P: .05, r = 0.242), depression (P: <.001, r = .357), relationship satisfaction (P: .05, r = -0.286), and sexual esteem (P: <.001, r = 0.644) showed significant correlations with sexual dysfunction; and sexual esteem (P: <.001, r = -0.475) and use of the combined oral contraceptive pill (P: .05, r = -0.270) with dyadic sexual desire. Regression showed the strongest associations (all P: <.001) between sexual esteem and sexual dysfunction and dyadic sexual desire, and between depression and sexual dysfunction with moderate explained variance. CLINICAL IMPLICATIONS: Sexual function should be discussed with women with PCOS and psycho-education on the association with sexual esteem and depression given. Other common psychosocial comorbidities in PCOS should be screened. Refer for psychotherapy or a tailormade psychosexual treatment including interventions targeted on sexual esteem and depression. STRENGTHS AND LIMITATIONS: Strengths are the broad assessment of psychosocial factors and sexual distress. A weakness is the relatively healthy population possibly underestimating the effect of psychosocial factors. CONCLUSION: Sexual dysfunction and dyadic sexual desire in women with PCOS are predicted by depression and sexual esteem suggesting psychosexual counseling might be helpful.