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Abstract
Sexuality is an important part of health, quality of life and general
wellbeing). Female sexual dysfunction is highly prevalent with 60-90%
rate of mild and manifest sexual dysfunction. It is an under researched
and poorly understood area.
Female sexual dysfunction is a multicausal and multidimensional
problem combining biological, psychological and interpersonal
determinants.
In contrast to the wide spread interest in research and treatment of
male sexual dysfunction, less attention has been paid to the sexual
problems of women.
A major barrier to the development of clinical research and
practice has been the absence of a well defined, broadly accepted
diagnostic framework and classification for female sexual dysfunction.
Recent classification of female sexual dysfunction which put
personal distress from the problem in consideration involved sexual
desire disorder (hypoactive desire and sexual aversion), arousal disorder,
orgasmic disorder and sexual pain disorders (dyspareunia, vaginsmus and
other sexual pain disorders).
High degree of overlap or comorbidity has been noted among the
sexual disorders, particularly in recent prevalence studies of female
sexual dysfunction and recent approaches view sexuality as much more
complex and interactive. Sexual problem can be short term or lifelong
and generalized.
Assessment of female sexual dysfunction involves: (1) an
evaluation of current sexual functioning including feelings and thoughts
of desire and receptivity to sexual activity; (2) an accurate elucidation of
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the presenting problem and any comorbidity problems. (3) the
formulation of ”working hypothes” of the most relevant etiological and
mainting factors; (4) identification of the treatment goals and a treatment
plan.
Aim of the work:
To asses the prevalence and predictors of female sexual
dysfunction in lower Egypt represented by Dakahlia governorate.
Subjects and methods:
Time of the study:
from June 2002 through April 2003
Subjects:
A crossectional community based survey was implemented on one
thousand married sexually active women between 16 & 49 years old.
Research setting :
The study was conducted in five districts of Dakahlia governorate;
Shirbin, Bilquas, Samblawen, Dekrinis and Mansoura city, at general
hospitals, maternal and child health care centers, family planning centers
and some private gynecological clinics.
Method:
Data were collected after explaining the purpose of the study and
taking women’s permission inperson using interviewing questionnaire
format which included:
1- Sociodemographic characteristics of couple.
2- Reasons of attending medical services.
3- Reproductive features.
4- Measures of sexual dysfunction using 6 response items, each
measuring presence of a critical symptoms or sexual problem.
Taken together, these items cover the major problem areas
addressed in the DSM-IV classification of American Psychiatric
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Association (1994) and the American Foundation of Urologic
Disease new classification.
Response items included :
a) lacking or reduced desire for sex.
b) Frequency of sexual activity.
c) Arousal difficulty.
d) Inability achieving orgasm.
e) Physical pain during intercourse.
f) Forced to have sex or not finding sex pleasurable.
5- Assessment of sexual dysfunction risk factors associated with
health and life style such as experience of emotional,
psychological, or stress related problems.
6- Finally local examination was done when allowed.
7- Data coded and tabulated in computer followed by statistical
analysis and result interpretation.
Results
Randomly selected 1000 married, sexually active women aged 16-
49 years were interviewed. 936 women complied to the study and 64
women refused, with 93.6% response rate.
68.9% (645) of women have one or more sexual problem.
However, 23% (215) of women are not distressed by their sexual
problems and 11.5% of women suffer sexual abuse in addition to other
sexual problems.
Only 4.3% (40) of those women presented with such problems to
the medical services.
- from the women’s point of view prevalence of impotence and
premature ejaculation among their husbands were 17.1% (160)
and 5% (47) respectively.
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As regard sexual activity :
- 58.5% (547) of women have sexual intercourse two to four times
per week, 12.2% (114) of them have sexual intercourse once per
week and 12.6% (118) have sexual intercourse once per day.
- About 63.8% (597) of women were satisfied by their current
frequency of sexual intercourse while 36.2% (339) of them were
unsatisfied and feel that once per week is more satisfactory.
Prevalence of different sex problems were as following:
- Decrease or loss of libido in 49.6% (464) of women versus 3.6%
(34) of them with increased desire.
- 36.0% (337) of women have difficult arousal, 24.8% (232) of them
have the problem occasionally versus 11.2% (105) who have the
problem always.
- Loss of orgasm present in 43.0% (402) of women, 10.5% (98) of
women have primary anorgasmia, 6.4% (60) have secondary total
anorgasmia while 26.1% (244) of women have the problem
occasionally.
- 31.5% (295) of women suffer dyspareunia, 4.6% of women have
superficial dyspareunia and 12.5% (117) of them have deep one
while 14.4% (135) of women have the pain all through.
- Only 4.3% (40) of women attended medical service for sexual
complaint.
Women level of education, parity, circumcision status and reasons
for seeking medical service in addition to gynecological surgical
procedures were all good predictors for, and highly associated with FSD
including abuse. Also, women’s age and menstrual pattern, appeared to
impact female sexual functioning adversely but did not exhibit similar
effect as regard sexual abuse, while other sociodemographic
characteristics e.g duration of marriage, presence of other wife, residency,
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type of family and work status as well as mode of delivery, contraception,
and medical disorders with their treatment were all non significant
predictors of FSD.
Among husbands demographic characteristics, age was a good
predictor of FSD and level of education in particular was highly
significant predictor of FSD including sexual abuse. Similarly, relevant
medical disorders and surgical procedures affect FSD adversely.
Moreover relevant drugs used by husbands and smoking exhibit high
association with FSD and abuse. In contrast husband residency and work
status, were not associated with elevated risk of FSD. It was not possible
to predict accurately a particular sexual problem through analysis of the
significant risk factors due to close association and overlap between
different sexual problems.
- Most of the mentioned sexual problems had gradual onset (63.1%)
and stationary (48.8%) or progressive course (44.3%).
- There was no obvious aggravating factor in 28.1% (181) of
women, while marital disharmony, hate and unfavourable socioeconomic
circumstances were the commenst aggravating factors
in 28.1% (181) of women.
- Sexual problems aggravated by pregnancy and delivery events in
15.7% (101) and 3.1% (20) of women respectively. Infertility was
an aggravating factor in 2.3% (15) of women and contraception
was a responsible factor in 3.1% (20) of them.
- For most women (84.5%) there was no amilorating factor, though
marital adjustment reported in 10.3% of women. Out of the
68.9% (645) of women who had sexual problem only 31.2%
(201) of them agreed to have genital examination while 68.8%
(444) refused, either because they did not want or because they
are pregnant or they have the menstruation.
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- Local clinical examination showed no abnormalities in more than
80% of the examined group.
- Only 7.1% (47) of women with sexual problems had received a
form of treatment and 58.7% of them showed no or mild
improvement while the rest showed only moderate one.