Relationship between hypoactive sexual desire disorder and aging

Review of low libido in women

Low libido is the most frequently reported sexual dysfunction. This is an important and complex problem with multiple causes. At present the interpretation of data on this topic remains a challenge, as the subject population is diverse and various tools are used in assessment. Coupled with this, several definitions are in use with differing emphasis on distress resulting from this state. Developments in the understanding of psychopharmacology are shedding light on the pathways involved in normal sexual response and these are being utilized in the development of treatments. This article reviews the current definitions, aetiology and treatment options and explores the recent developments in low libido in women.

Standards for clinical trials in sexual dysfunction in women: research designs and outcomes assessment

INTRODUCTION

Clinical trial design in female sexual dysfunction (FSD) is an evolving science, with some areas of controversy.

AIM

To develop an evidence-based, expert consensus-report on design of FSD clinical research.

METHODS

Literature review including the Food and Drug Administration (FDA) clinical trial guidelines with critique by six experts from three countries, modified after public presentation and debate.

MAIN OUTCOME MEASURE

Expert opinion and recommendations were based on grading of evidence based literature, internal committee dialogue, open presentation, and debate.

RESULTS

Design of clinical research for regulatory approval is driven by FDA guidelines. Diagnostic and Statistical Manual-IV definitions and consideration of comorbidity of sexual disorders may complicate patient selection and outcomes. Measures for study end points include satisfying sexual events utilizing a daily diary, sexual distress, and patient-reported outcomes measures of the construct under study. Currently, trial duration is recommended to be 6 months for efficacy trials to allow for modification of behavioral adaptations to changes in desire. Important issues include safety assessments, generalizability, having a representative study population, stratification by reproductive status, partner assessment, contextual and interpersonal factors, symptom duration and severity, management of placebo response, and drug dosing. Statistical analysis should include assessment of change from baseline to end point between study drug and placebo, determination of statistically significant change vs. clinically meaningful effects, linear mapping of all measures of the same construct, and determination of responders and remitters.

CONCLUSIONS

Future trials should include clear population definitions, direct and indirect measures of the specific FSD construct, and procedures to allow generalizability of diagnosis and treatment to the target population.

Psychobiological correlates of women's sexual interest as perceived by patients with erectile dysfunction

INTRODUCTION

We have recently reported that the perceived loss of a partner's sexual desire is independently associated with an increased incidence of major cardiovascular events in patients with erectile dysfunction (ED). No study has ever evaluated the specific impact of men's perception of women's sexual desire on male sexual function and lifestyle attitudes in ED subjects.

AIM

To evaluate the clinical correlates of the perception of a partner's sexual desire [hypoactive sexual desire (HSD)] in a consecutive series of subjects seeking medical care for ED.

METHODS

A consecutive series of 2,303 heterosexual male patients (mean age 58.1 ± 10.5) was studied.

MAIN OUTCOME MEASURES

Patients were interviewed with the Structured Interview on Erectile Dysfunction (SIEDY) structured interview. They also completed the Middlesex Hospital Questionnaire, a brief questionnaire for the screening of the symptoms of mental disorders.

RESULTS

Among the patients studied, 458 (19.9%) reported a mild loss of their partner's desire, 302 (13.1%) a moderate reduction of libido, while 118 (5.1%) complained of a complete absence of sexual interest on the part of their partner. After adjustment for confounding factors, the perceived women's HSD was associated with different sexual, lifestyle, and relational factors. In particular, more extra-marital affairs, a longer and more hostile couple relationship, as well as a stressful job and both alcohol and smoking abuse were all significantly associated with perceived women's HSD. In addition, the perceived women's moderate to severe HSD was significantly associated with severe ED and less frequent sexual intercourse. Finally, partner HSD was significantly associated with a stepwise increase of free-floating anxiety and depressive symptoms (adj. r = 0.081, P < 0.05 and 0.158, P < 0.0001, respectively).

CONCLUSIONS

Perceived sexual interest (éros) on the part of the woman can be seen for men not only as a fun and enjoyable behavior, but also a safe strategy for improving a man's overall health and life expectancy.

The DSM diagnostic criteria for hypoactive sexual desire disorder in women

Hypoactive Sexual Desire Disorder (HSDD) is one of two sexual desire disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and is defined by the monosymptomatic criterion "persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity" that causes "marked distress or interpersonal difficulty." This article reviews the diagnosis of HSDD in prior and current (DSM-IV-TR) editions of the DSM, critiques the existing criteria, and proposes criteria for consideration in DSM-V. Problems in coming to a clear operational definition of desire, the fact that sexual activity often occurs in the absence of desire for women, conceptual issues in understanding untriggered versus responsive desire, the relative infrequency of unprovoked sexual fantasies in women, and the significant overlap between desire and arousal are reviewed and highlight the need for revised DSM criteria for HSDD that accurately reflect women's experiences. The article concludes with the recommendation that desire and arousal be combined into one disorder with polythetic criteria.

Sexual difficulties for persons with multiple sclerosis in New South Wales, Australia

This 1992 study was conducted to ascertain the incidence of sexual difficulties in individuals diagnosed with multiple sclerosis (MS) living in New South Wales, Australia. New South Wales is a state lying roughly 29-36 degrees south of the equator. This is currently the largest study conducted. The anonymous questionnaire completed by 283 respondents included questions on sexual difficulties, relationship satisfaction and the ability to communicate about and seek help for the sexual difficulties. In this study, 30% of respondents claimed to have sexual difficulties attributable to MS. Sexual difficulties were experienced by 51% of female and 74% of male respondents. For females, the most frequently occurring sexual symptoms were difficulty with achieving orgasm, lowered libido, dissatisfaction with sexual performance, dissatisfaction with frequency of intercourse, arousal difficulties and decreased vaginal lubrication. For males, by far the most common problem was decreased frequency of intercourse, followed by dissatisfaction with sexual performance, masturbation difficulties, difficulty with achieving vaginal orgasms, erectile dysfunctions, retarded ejaculation and premature ejaculation. Overall, females rated their sexual difficulties as 10th in order of importance of disabilities from MS and males ranked sexual difficulties as fourth in importance. For both males and females, sexual disability increased with age, relationship unhappiness and disease disability. Communicating about sexual difficulties was an issue for both males and females. Fifty five percent of males and 39% of females had been able to talk about their sexual difficulties and of these, only 29% of males and 36% of females had been able to access help for their sexual difficulty. Educational level did not predict ability to talk about, or ability to access help. There was a very low satisfaction rate for the sexual help received. The study highlights areas of need for the MS population.

Sex and reproduction: an evolving relationship

BACKGROUND

Although sexual activity has, until very recently, been essential to reproduction, this did not preclude the non-reproductive importance of sexual relationships and non-conceptive copulations. Technological advances, however, now allow for both sex without reproduction and reproduction without sex. This review summarizes social and ethical commentaries on the new relationship between sex and reproduction.

METHODS

For each main area discussed, a systematic search was made using (depending on the subject) PubMed, Medline, ScienceDirect, classic books, Google and/or religious websites. The search focused on publications between 1975 and 2009, although some materials from the first part of the 20th century were also utilized.

RESULTS

The classic picture of sex for reproduction and bonding between mating partners is increasingly being replaced by reproduction separate from sexual activity. Although not every advance in assisted reproduction produced, per se, a further separation from sexual intercourse, these two fundamental human activities are today increasingly carried out independently, as reproduction is possible, not only without sex, but even through the intervention of more than two partners. The possibility of reproduction with only one or even no gametes, although highly controversial and not yet feasible, is nonetheless being investigated.

CONCLUSIONS

Technological advances in the field of reproductive biology have enabled couples considered infertile to conceive and have healthy babies, causing a revolution in culture and customs. Today the independence of sex and reproduction is established and in the future human reproduction may move even further away from the sexual act, an option definitely unacceptable to some ethicists.

Level of bother and treatment-seeking predictors among male and female in-patients with sexual problems: a hospital-based study

INTRODUCTION

Despite its importance for epidemiological and clinical reasons, relatively few studies investigated determinants of bother or distress associated with sexual problems.

AIM

To assess perception of bother from sexual concerns and examine its role in predicting treatment-seeking.

MAIN OUTCOME MEASURES

The Brief Sexual Symptom Checklist and two single-item questions were used to assess type of sexual problems, level of bother, and treatment-seeking behavior.

METHODS

Participants were recruited by selecting all sequentially eligible patients in each of the hospital's clinics. The scales used were drawn from the Hospitalized and Outpatients' Profile and Expectations Study survey instrument. Data were analyzed using chi-square, Fisher's exact tests, and multivariate logistic regression models.

RESULTS

In total 415 inpatients (48% men and 52% women) participated in the study. A high prevalence of male and female sexual problems was obtained (more than 50%) with a high degree of overlap among the various sexual problems. Common profiles included lack of desire and arousal or orgasmic problems in the women (8-9%); erectile dysfunction (ED) and low desire in the men (21.7%). Forty-five percent and 34% of our male and female participants, respectively, reported moderate or severe bother with its level declining with aging only in women (P < 0.001). Degree of bother was strongly associated with ED (P = 0.005) and curved penis (P = 0.02) in men, and with difficulties reaching orgasm (P = 0.01) in women. In both genders, bother increased the likelihood of willingness to discuss the sexual problem with a physician (odds ratio [OR] 10.66 for men and OR 4.35 for women); only in women, bother was associated with treatment seeking (OR 2.81).

CONCLUSIONS

Sexual dysfunctions are not always associated with increased bother or dissatisfaction, a condition that influences treatment-seeking behavior. Such findings are of clinical importance as they aid physicians in establishing a diagnosis of a sexual disorder.

[Female sexual dysfunction]

Female sexual dysfunction (FSD) is a very common disorder in Germany with a prevalence of approximately 38%. FSD includes persistent or recurrent disorders of sexual desire, disorders of subjective or genital arousal and pain during intercourse. An overview of the epidemiology, the current definitions of the single domains of FSD, the pathophysiology and recommendations on the treatment of FSD is given.

Vaginal dryness: a comparison of prevalence and interventions in 11 countries

INTRODUCTION

There is limited research comparing cross-cultural differences in women's experiences of vaginal dryness.

AIM

To examine international differences in the prevalence of vaginal dryness, the degree to which it is experienced as problematic or bothersome, the use of lubricants to alleviate it, and women's discussion of this problem with physicians.

MAIN OUTCOME MEASURES

Questionnaire measuring the level of vaginal dryness and degree to which it is perceived as bothersome.

METHODS

The Global Survey of Sexual Attitudes and Practices was administered to 6,725 women from 11 countries: UK, Germany, Japan, Australia, Canada, Spain, Italy, Mexico, Argentina, Brazil and Thailand.

RESULTS

Prevalence of self-reported vaginal dryness varied from a minimum of 5.8% in Italy to a maximum of 19.7% in Brazil. The proportion of women with self-reported vaginal dryness who found it very bothersome varied as well (e.g., 5.6% UK, 26.4% Germany). Pain during intercourse ranged from a reported low of 3.6% in Australia to 18.6% in Brazil. Older women (50-65 years) as compared with younger women (18-34 years) reported significantly more vaginal dryness in the UK, Australia, Canada, Italy, Spain, Argentina, and Thailand (P values <0.02). The majority of women under 50 attributed vaginal dryness to inadequate sexual arousal while women over 50 believed it was because of aging or menopause. Cross-culturally, women differed substantially in the likelihood of discussing their sexual life/concerns with a physician.

CONCLUSION

Women from different countries differ substantially in their experiences, concerns, and reports of vaginal dryness/sexual pain, as well as their familiarity with personal lubricants as a treatment. Researchers should assess the prevalence and degree of the bother of vaginal dryness in order to make international comparisons of the burden of this condition.

New attitudes to sexuality in the menopause: clinical evaluation and diagnosis

Sexuality is a critical issue at menopause for many women. Several biological, psychological and socio-relational factors are related to women's sexual health and they may negatively affect the entire sexual response cycle, inducing significant changes in desire, arousal, orgasm and satisfaction. Age- and menopause-related events may impair the integrity of multiple biological systems involved in the normal sexual response of women, including hormonal environment, neuromuscular substrates and vascular supplies. Sex hormones, namely low levels of estradiol, physical and mental well-being and, very importantly, feelings for partner are extremely relevant for women's sexuality in natural menopause. Even a significant lack of androgens, as more frequently occurs in surgical menopause, has a negative impact on women's desire and sexual responsiveness. Sexual history and clinical evaluation may help doctors to accurately diagnose sexual symptoms causing personal and relational distress and to identify the best therapeutic approach.

Quality of Sexual Life and Menopause

The importance of female sexual fulfillment is increasingly recognized in today's society. Women's sexual lives continue well into the menopausal years and beyond; however, the impact of menopause on the quality of that sexual life has not been comprehensively studied in the medical literature. This review attempts to clarify the impact of the physiological, psychological and psychosocial changes occurring at midlife that may affect women's quality of sexual life. Pharmaceutical and psychological interventions that may assist in improving the quality of sexual life of menopausal women are discussed. Female sexuality is complex and not fully understood and, consequently, controversy frequently arises in the discussion of female sexual problems and their treatment. This article highlights some of these controversies and provides a future perspective on how the impact of menopause on the quality of sexual life may be more cohesively investigated.

Testosterone increases amygdala reactivity in middle-aged women to a young adulthood level

Testosterone modulates mood and sexual function in women. However, androgen levels decline with age, which may relate to the age-associated change in sexual functioning and the prevalence of mood and anxiety disorders. These effects of testosterone are potentially mediated by the amygdala. In the present study, we investigated whether the age-related decline in androgen levels is associated with reduced amygdala activity, and whether exogenous testosterone can restore amygdala activity. Healthy young and middle-aged women participated during the early follicular phase of the menstrual cycle, and amygdala responses to biologically salient stimuli were measured with functional magnetic resonance imaging (fMRI). Androgen levels were lower in middle-aged than young women, which was associated with decreased amygdala reactivity. Endogenous testosterone levels correlated positively with amygdala reactivity across the young and middle-aged women. The middle-aged women received a single nasal dose of testosterone in a double-blind, placebo-controlled, crossover manner, which rapidly increased amygdala reactivity to a level comparable to the young women. The enhanced testosterone levels correlated positively with superior frontal cortex responses and negatively with orbitofrontal cortex responses across individuals, which may reflect testosterone-induced changes in amygdala regulation. These results show that testosterone modulates amygdala reactivity in women, and suggest that the age-related decline in androgen levels contribute to the decrease in amygdala reactivity.

Female sexual dysfunction, sexual distress, and compatibility with partner

INTRODUCTION

Few studies have looked at prevalence estimates for female sexual dysfunctions in combination with personal distress, although existing diagnostic criteria for sexual disorders include both aspects. Further, the variation in female sexual function has been shown to be largely explained by unique nongenetic factors. Such factors may include partner sexual function and perception of sexual compatibility with a partner, factors which may also be associated with sexual distress.

AIM

We investigated the association between female sexual dysfunction and distress as well as their association with partner compatibility.

METHODS

In order to assess sexual function and distress, the Female Sexual Function Index and seven items from the Female Sexual Distress Scale were used in a population-based sample of 5,463 women, aged 18-49 years. The women were, based on cutoff points, classified as either having neither dysfunction nor distress, one of them, or both, separately for each dysfunction. Further, the associations between partner compatibility, distress, and sexual dysfunctions were analyzed. Sexual compatibility with partner was investigated by using several items exploring, for example, amount of foreplay, interest in sex, and communication about sexual matters.

MAIN OUTCOME MEASURES

Associations between partner compatibility and female sexual function and sexual distress.

RESULTS

The proportion of women reporting both sexual dysfunction and distress ranged from 7% to 23%, depending on the dysfunction. Desire disorders followed by orgasmic disorders were most common. All compatibility variables were significantly associated with distress and with most of the sexual dysfunctions. The main complaints of the women were "too little foreplay" (42%) and "partner is more interested" (35%). The women feeling distress or having a sexual dysfunction reported more incompatibility with partner compared with functional women.

CONCLUSIONS

The findings highlight the importance of addressing partner compatibility for successful treatment and counseling of female sexual dysfunctions.

Sexual function, dysfunction, and sexual distress in a prospective, population-based sample of mid-aged, Australian-born women

INTRODUCTION

Previous, population-based studies investigating the risk factors for sexual distress have not drawn on longitudinal data.

AIMS

Determine the prevalence of sexual distress and dysfunction, explore factors associated with/predictive of sexual distress, and describe changes in sexual function over a decade in a population-based sample of mid-aged women.

METHODS

Eleven-year prospective study of Australian-born women, aged 45-55 years, and menstruating at baseline. Short Personal Experiences Questionnaire (SPEQ) was completed in years 1 to 8 and 11 of follow-up. Female Sexual Distress Scale (FSDS) was completed in the 11th year of follow-up.

MAIN OUTCOME MEASURES

Validated outcome measures were the SPEQ (total sex score <or=7 indicates low sexual function) and FSDS (score >or=15 indicates sexual distress).

RESULTS

Two hundred fifty-seven women were interviewed in the 11th year of follow-up. All domains of sexual function declined significantly in the decade studied. Women using hormone therapy in year 11 had significantly greater responsivity and higher frequency of sexual activities than nonusers. Two hundred four women completed both the FSDS and SPEQ questionnaires. One hundred sixty-six (81%) women had an SPEQ score <or=7 of whom 34 (17% of the total sample) had an FSDS score >or=15, and were classified as having female sexual dysfunction. The multiple logistic regression analysis found that female sexual distress was concurrently associated with higher depression scores (odds ratio [OR] 1.31, 95% confidence interval [CI] 1.10, 1.56) and more negative feelings for partner (OR 0.49, 95% CI 0.32, 0.76) and predicted by prior negative feelings for partner (OR 0.31, 95% CI 0.14, 0.70), and a greater decline in total sex score (OR 0.77, 95% CI 0.59, 0.99).

CONCLUSIONS

By the end of the sixth decade, women have low levels of sexual function. Hormone therapy may help these women maintain sexual function. A minority of these mostly postmenopausal women are significantly distressed about low sexual function. Sexual distress is associated with depression and relationship factors.

Prevalence and risk factors for low sexual function in women: a study of 1,009 women in an outpatient clinic of a university hospital in Istanbul

INTRODUCTION

Sexual functioning is a common and multidimensional problem, associated with multiple biological, medical, psychological, sociocultural, political, economic, and interpersonal factors.

AIM

The study was planned to determine the prevalence and risk factors for low sexual function in women in an outpatient clinic of a university hospital in Istanbul.

METHODS

Totally, 1,009 women over 20 years of age or their healthy female companions were interviewed in the outpatient clinics of the Department of Internal Medicine in a university hospital in Istanbul.

MAIN OUTCOME MEASURES

Female Sexual Function Index (FSFI) was used to evaluate sexual function.

RESULTS

The mean age of women was 38.62 +/- 12.82 and 22.2% of women were postmenopausal. The mean FSFI score was found to be 24.25 +/- 9.50 out of a maximum total score of 36. Based on the total FSFI score, 43.4% of the women had scores less then 26. The mean domain scores were: desire 3.14 +/- 1.47, arousal 3.60 +/- 1.85, lubrication 4.53 +/- 2.01, orgasm 4.02 +/- 1.97, satisfaction 4.27 +/- 1.64, and pain 4.69 +/- 1.96 out of a maximum domain score of six. The rate of low sexual function by the age groups were 22% for those 20-29 years, 39.7% for those 30-39 years, 50.2% for those 40-49 years, 71.3% for those 50-59 years, 82.9% for those 60-64 years, and 87.8% for those 65 and over. Lower educational level, menopause, depression, presence of sexual dysfunction in their partner, and contraceptive use were found to be significantly associated with low sexual function in women.

CONCLUSIONS

The prevalence of low sexual function in women was found to significantly increase with age. The most significantly affected domains were desire and arousal followed by orgasmic problems, satisfaction, and pain, respectively.

Use of the Italian translation of the Female Sexual Function Index (FSFI) in routine gynecological practice

AIMS

To investigate domains of sexual function in healthy women attending a gynecological office for routine annual check-up using the Italian translation of the Female Sexual Function Index (FSFI) according to age, reproductive status and hormonal treatments; and to confirm the usefulness of the FSFI in detecting relevant clinical entities.

METHODS

Of 720 women (age range 18-65 years), 564 (78%) filled in a short anamnestic questionnaire and the FSFI assessing desire, arousal, lubrication, orgasm, satisfaction and pain. A semi-structured DSM-IV-TR clinical interview was administered to a convenience sample of women selected according to the quartile distribution of the median full scale FSFI score. Analysis of data was performed by frequency tables and non-parametric statistics.

RESULTS

The median full scale score of FSFI in our study population was 27.6 (lower quartile: 18.7, upper quartile: 30.9) and the percentage of women under the lower quartile of the distribution was 24.4%. Sexual function decreased progressively with age, being significantly lower after 30 years and after 60 years (chi(2) = 52.6; p = 0.0001). Menopausal women had significantly lower median FSFI full scale score compared with fertile women and women who used oral contraception (OC) (p < 0.0001 for both), while users of hormone replacement therapy (HRT) displayed better overall sexual function than untreated postmenopausal women (p < 0.005). A positive diagnosis of female sexual dysfunction (FSD) was evident only in young women scoring under the lower quartile of the distribution (cut-off score: 23.4 for women not taking OC and 20.8 for OC users), while older women were dysfunctional also above the lower quartile of the distribution (cut-off score: 14.1 for menopause, 18.5 for HRT) of the FSFI full scale score.

CONCLUSIONS

The FSFI is a powerful screening tool for FSD, especially in young fertile women, and may be used effectively in routine gynecological practice.

Androgen therapy for loss of desire in women: is the benefit worth the breast cancer risk?

OBJECTIVE

To contrast the limited evidence that androgen therapy is an effective treatment for low sexual desire in women with the extensive literature suggesting that androgens promote breast cancer.

DESIGN

Evidence from population studies of women is reviewed on the association between endogenous androgen levels and sexual function or satisfaction. Recent randomized trials of testosterone therapy for low desire are critiqued in terms of methodology and generalizability. Research on endogenous testosterone levels and breast cancer risk in both premenopausal and postmenopausal women is summarized, as are recent studies of androgenic hormonal therapy and breast cancer risk.

SETTING

Literature review.

PATIENT(S)

Not applicable.

INTERVENTION(S)

Not applicable.

MAIN OUTCOME MEASURE(S)

Not applicable.

RESULT(S)

Endogenous androgen levels are not correlated with sexual desire in population-based studies of aging women. Factors that are strongly associated with low desire include pain with sexual activity, emotional distress, life stress, and relationship conflict. The efficacy of testosterone therapy for women's desire problems is modest. Expectancy effects were not adequately controlled in randomized trials. Epidemiological findings agree that higher endogenous serum androgen levels confer increased breast cancer risk both before and after menopause. Androgenic hormonal replacement regimens also increase the risk of breast cancer.

CONCLUSION(S)

Testosterone supplementation should not be prescribed to women with low sexual desire unless long-term studies can demonstrate its efficacy and safety. Treatments for low sexual desire in women should address its common correlates: relationship distress, emotional distress, and dyspareunia.

The epidemiology of sexual dysfunctions

INTRODUCTION

Epidemiology can be defined as the population study of the occurrence of health and disease. The knowledge of the rates of occurrence of sexual dysfunctions and the primary risk factors for these conditions is very important to assist in assessing the risk and planning treatment and prevention programs in sexual medicine.

AIM

Review modern studies of the prevalence and incidence of sexual dysfunction in an effort to establish a consensus concerning the frequency of occurrence of these conditions, and review the strengths and liabilities of design methodology in the field.

MAIN OUTCOME MEASURE

Review of peer-reviewed literature.

RESULTS

The findings suggest that sexual dysfunctions are highly prevalent in our society worldwide, and that the occurrence of sexual dysfunctions increases directly with age for both men and women. There is also a strong support for the finding that although the frequency of symptoms increases with age, personal distress about those symptoms appears to diminish as individuals become older. An additional uniform result was that specific medical conditions and health behaviors represent major risk factors for sexual disorders, and that many of these health conditions also have a strong positive relationship with age.

CONCLUSIONS

Progress has been made concerning both the number and quality of epidemiologic prevalence studies in sexual medicine; however, there is a paucity of studies of the incidence of these conditions. Because reliable incidence data are critical for prevention and treatment planning, the design and execution of the incidence trials should become a high priority for the field. In addition, repeated calls for the development of a new systematic and integrated diagnostic system in sexual medicine were also evident, because of the perception by many that the imprecision of our current diagnostic system represents the "rate-limiting step" for the epidemiology of the field. The review suggests that although much has been accomplished in the past 15-20 years, much remains to be done.

Modeling response rates in surveys of female sexual difficulty and dysfunction

INTRODUCTION

Studies that address sensitive topics, such as female sexual difficulty and dysfunction, often achieve poor response rates that can bias results. Factors that affect response rates to studies in this area are not well characterized.

AIM

To model the response rate in studies investigating the prevalence of female sexual difficulty and dysfunction. Methods. Databases were searched for English-language, prevalence studies using the search terms: sexual difficulties/dysfunction, woman/women/female, prevalence, and cross-sectional. Studies that did not report response rates or were clinic-based were excluded. A multiple linear regression model was constructed.

MAIN OUTCOME MEASURES

Published response rates.

RESULTS

A total of 1,380 publications were identified, and 54 of these met our inclusion criteria. Our model explained 58% of the variance in response rates of studies investigating the prevalence of difficulty with desire, arousal, orgasm, or sexual pain (R(2) = 0.581, P = 0.027). This model was based on study design variables, study year, location, and the reported prevalence of each type of sexual difficulty. More recent studies (beta = -1.05, P = 0.037) and studies that only included women over 50 years of age (beta = -31.11, P = 0.007) had lower response rates. The use of face-to-face interviews was associated with a higher response rate (beta = 20.51, P = 0.036). Studies that did not include questions regarding desire difficulties achieved higher response rates than those that did include questions on desire difficulty (beta = 23.70, P = 0.034).

CONCLUSION

Response rates in prevalence studies addressing female sexual difficulty and dysfunction are frequently low and have decreased by an average of just over 1% per anum since the late 60s. Participation may improve by conducting interviews in person. Studies that investigate a broad range of ages may be less representative of older women, due to a poorer response in older age groups. Lower response rates in studies that investigate desire difficulty suggest that sexual desire is a particularly sensitive topic.