Prevalence and risk factors of the female sexual dysfunction in a sample of infertile Iranian women

Global prevalence of post-abortion depression: systematic review and Meta-analysis

BACKGROUND

Depression after abortion is a common problem for all women of reproductive age. However, there are not any data on post-abortion depression at a global level. Consequently, the purpose of this study was to find out the global prevalence of post-abortion depression.

METHODS

The present study involved a comprehensive search of several databases, including Science Direct, Scopus, EMBSE, Google Scholar, and PubMed. The search was conducted between February 1, 2023, and March 10, 2023. The data was extracted using Microsoft Excel (version 14) and analyzed using STATA statistical software. To evaluate publication bias, a forest plot, Begg's test, and Egger's test were employed. Heterogeneity was assessed using I2, and a pooled estimated analysis was conducted. Additionally, subgroup analysis was performed based on the study continent/region, World Bank income group, screening instrument, and study design.

RESULTS

This analysis included 15 papers with a total of 18,207 research participants out of a total of 657 articles. The overall pooled prevalence of post-abortion depression was found to be 34.5% (95% CI: 23.34, 45.68), with an I2 value of 71.6%. The prevalence of post-abortion depression varied based on geographic location, World Health Organization (WHO) regions, World Bank income category, screening approach, and study design. The highest proportion of post-abortion depression was observed in Asia (37.5%), while the WHO's Eastern Mediterranean region had the greatest rate of post-abortion depression (43.1%). Lower-middle-income countries had the highest frequency of post-abortion depression (42.91%) based on World Bank economic classification. The Center of Epidemiological Studies Depression Scale was found to have the highest incidence of reported depression prevalence (30%) across diagnostic tools. Furthermore, the prevalence of depression was higher in cross-sectional study designs (36.42%) compared to cohort studies (22.7%).

CONCLUSION

In conclusion, the occurrence of post-abortion depression has been observed to be widespread globally. The prevalence of post-abortion is found to be influenced by several factors, including the methodology employed in the study, the diagnostic tool utilized, the geographical location, and the socioeconomic status of the population. Healthcare providers should prioritize the provision of post-abortion counseling, care, and emotional support to women.

Prevalence and predictors of sexual distress in married reproductive-age women: A cross-sectional study from Iran

Background and Aim

Although various surveys have been conducted for sexual problems, there is a lack of population-based studies on sexual distress in Iran. Thus, we sought to determine the prevalence and predictive factors of sexual distress in this population.

Methods

Overall, 1000 married women aged 16-49 years were enrolled in this study using the two-stage cluster sampling method. To identify sexual distress, the female sexual distress scale-revised (FSDS-R) was completed. The predictive factors were assessed using a checklist.

Results

A total of 318 women (31.8%) suffered from sexual distress. Among socio-demographic factors, satisfaction with marriage (p = 0.001), among personal factors history of infertility and fear of contracting sexually transmitted infections (p < 0.01), and among sexual and interpersonal factors satisfaction with the level of sexual desire (p = 0.01), pain during sexual intercourse (p < 0.01), premature ejaculation disorders in the partner (p < 0.05), and sexual satisfaction (p < 0.001) were significantly associated with sexual distress.

Conclusion

Clinicians should evaluate sexual distress comprehensively and consider all the related dimensions. The high overall prevalence of sexual distress, with or without an identifiable dysfunction, signals the importance of health professionals being adequately prepared to discuss sexual health concerns.

History of infertility and sexual dysfunction in midlife women: Is there a link?

BACKGROUND

Infertility has been linked with an increased risk of sexual dysfunction in reproductive-aged women, with longer periods of infertility associated with a greater risk.

AIM

The study's aim was to examine whether a history of infertility treatment in women is linked to sexual dysfunction during midlife.

METHODS

The cross-sectional study was conducted among sexually active women, between the ages of 45 and 65 years, who sought consultation at the women's health clinics at a US tertiary care center. History of infertility treatment was assessed with a single question that asked participants if they were treated for infertility in the past. The association between a history of infertility treatment and sexual dysfunction-which was diagnosed by a combination of Female Sexual Function Index score ≤26.55 and Female Sexual Distress Scale-Revised score ≥11-was assessed in a multivariable logistic regression model that adjusted for multiple confounders.

OUTCOMES

The primary outcome was sexual dysfunction in midlife women.

RESULTS

The analysis included 5912 women, with a mean age of 54.1 years. Nearly 16% of women reported receiving treatment for infertility. More than half the women (55%) had sexual dysfunction: 56.3% of those with previous fertility treatments and 54.4% of those without any fertility treatment (P = .3). Receiving treatment for infertility in the younger years did not significantly increase the odds of sexual dysfunction in midlife in univariate (odds ratio, 1.08; 95% CI, 0.94-1.24; P = .3) and multivariable analyses (odds ratio, 1.11; 95% CI, 0.96-1.29; P = .17).

CLINICAL IMPLICATIONS

While infertility is known to be predictive of sexual dysfunction in women during their reproductive years, there was no association between a history of infertility treatment and sexual dysfunction in midlife women in the current study.

STRENGTHS AND LIMITATIONS

The study used validated questionnaires accounting for sexual complaints and distress and adjusted for multiple confounding factors. Limitations include the selection bias introduced by the study of women presenting for evaluation of sexual dysfunction, which may have been a result of factors stronger than the influence of infertility. Other limitations include the study's cross-sectional nature with suboptimal racial and ethnic representation.

CONCLUSION

Although infertility is commonly associated with female sexual dysfunction in women of reproductive age, the association was not present in midlife women in the current study.

Sexual dysfunction and disorders as a consequence of infertility: a systematic review and meta-analysis

BACKGROUND

Sexuality has a key impact on quality of life and on reproductive health. Infertility often results in sexual dysfunction. Despite this close association, addressing sexuality is not a standard component of infertility counselling, especially since in most countries sexual medicine is not a core element of specialist training. Even today, many doctors and patients consider discussing sexuality to be more challenging than other aspects of reproductive medicine. The present review addresses the complex consequences of infertility on sexuality.

OBJECTIVE AND RATIONALE

Our goals were: (i) to identify the prevalence of sexual problems resulting from infertility, (ii) to evaluate characteristics of sexual difficulties and disorders resulting from infertility and (iii) to analyse factors involved in the complex association between sexual problems and infertility.

SEARCH METHODS

A systematic search for publications containing keywords related to sexual disorders and infertility was performed via PubMed, Web of Science and Psyndex. A total of 170 manuscripts published between January 1966 and April 2021 were identified after verification of inclusion and exclusion criteria. The reference lists in these manuscripts were searched for further relevant literature. Studies were reviewed for quality-related methodological details.

OUTCOMES

Couples diagnosed with infertility have an increased risk of sexual disorders. Loss of sexual desire and erectile dysfunction are among the most frequent sexual disorders resulting from infertility. Currently available literature reflects only fragmentarily the complexity of the diverse interactions. Sexuality plays out against the backdrop of interactions among personal, cultural, infertility-related and sexuality-related factors. Considering this complexity, it is crucial to evaluate individual profiles as well as partnership interactions to avoid a negative impact of infertility on a couple's sexual life.

WIDER IMPLICATIONS

Identifying sexual disorders as relevant considerations in the context of infertility and exploring their impact during the entire course of diagnosis and treatment constitute an important contribution to comprehensively care for the couples concerned. Counselling should focus on preventing the onset and aggravation of sexual disorders. As sexuality represents a major component of quality of life and of partnership, such support may improve not only the current overall wellbeing but also the chances of a satisfactory long-term partnership and family life.

Effect of depression and anxiety on sexual functioning in couples trying to conceive with and without an infertility diagnosis

OBJECTIVE

This study examined the effects of anxiety and depression on sexual functioning in couples trying to conceive, and tested the moderating role of infertility diagnosis on this association.

DESIGN

An online questionnaire was completed by 1453 individuals in a heterosexual relationship for more than one year. The final sample had 107 couples who were actively attempting a pregnancy (63 had an infertility diagnosis; 44 were presumably fertile). Data was analyzed with the Actor-Partner Interdependence Model (APIM).

MAIN OUTCOME MEASURES

Depression and anxiety symptoms were assessed by the Hospital Anxiety and Depression Scale (HADS), and male and female sexual functioning were assessed through the International Index of Erectile Function (IIEF) and the Female Sexual Function Index (FSFI), respectively.

RESULTS

Actor effects were found between depression and sexual functioning in both men (β= -.28, p= .003) and women (β= -.43, p < .001), with no significant partner effects. The moderation analysis showed that the relationship between depression and sexual functioning is stronger in infertile men than in presumably fertile men (β= -.29; p= .002).

CONCLUSION

Psychological interventions with couples trying to conceive should address the role of depression in sexual functioning, particularly in infertile men.

Who seeks sex therapy? Sexual dysfunction prevalence and correlates, and help-seeking among clinical and community samples

Sexual dysfunctions (SD; e.g., female sexual interest/arousal disorder, erectile disorder, female orgasmic disorder, delayed ejaculation, genito-pelvic pain/penetration disorder, etc.) affect up to a third of individuals, impairing sexuality, intimate relationships, and mental health. This study aimed to compare the prevalence of SDs and their sexual, relational, and psychological correlates between a sample of adults consulting in sex therapy (n = 963) and a community-based sample (n = 1,891), as well as examine barriers to sexual health services for SD and the characteristics of individuals seeking such services. Participants completed an online survey. Analyses showed that participants in the clinical sample reported lower levels of sexual functioning and sexual satisfaction and higher levels of psychological distress than participants in the community-based sample. Moreover, higher SD rates were related to lower relational satisfaction and higher psychological distress in the community sample, and to lower sexual satisfaction in both samples. Among participants in the community sample who sought professional services for SD, 39.6% reported that they were unable to access services, and 58.7% reported at least one barrier to receiving help. This study provides important data regarding the prevalence of SD and the link between SD and psychosexual health in clinical and nonclinical samples, as well as barriers to treatment access.

The impact of obesity on fertility and sexual function in women of child bearing age

Obesity and infertility are health problems that are increasing in frequency. In this study, sexual dysfunction in obese infertile women was investigated. A total of 450 women who met the inclusion criteria were recruited for the study; 150 women who had obesity without infertility, 150 women who had obesity with infertility and 150 women with normal weight but without infertility, which was the control group. The mean age of the groups were 31.3 ± 3.9, 31.2 ± 3.8 and 31.1 ± 4.5, respectively. The participants were administered a sociodemographic data form, the Female Sexual Function Index (FSFI) and the Beck Depression Inventory following the measurement of body mass index (BMI). FSFI score below 26.55 was defined as sexual dysfunction. Our data were analysed using SPSS (Statistical Package for Social Sciences) 21.0 for Windows (SPSS Inc., Chicago, IL). FSFI scores were observed to be statistically significantly lower in the group of obese women with infertility than in the other two groups. In our study, sexual dysfunction was found to be statistically significantly higher in obese women with infertility compared to the control group. Therefore, healthcare professionals should evaluate infertility in obese women in terms of sexual dysfunction as well as infertility treatment.Impact StatementWhat is already known on this subject? Psychological problems such as depression and anxiety, changes in sex hormones, and adipokines were reported to have negative impacts on sexual functions (Plaisance et al. 2009; Kendler et al. 2010; Yaylali et al. 2010). There are also various reports stating that female infertility has negative effects on sexual satisfaction and that fertility anxiety may affect sexual functions as an independent factor (Pakpour et al. 2012; Kaya et al. 2021). Even so there is a limited amount of information concerning the effects of obesity and infertility on female sexual function.What do the results of this study add? It has been found in our study that sexual dysfunction is higher in women with obesity and infertility and that this dysfunction is correlated with BMI.What are the implications of these findings for clinical practice and/or further research? It is therefore important that healthcare professionals adopt a holistic approach that incorporates sexual health consultancy to improve the treatment and quality of life of women with obesity and infertility.

Does prevalence of sexual dysfunction differ among the most common causes of infertility? A cross-sectional study

BACKGROUND

Sexuality as a fundamental component of women's health, can be affected by infertility. The current study aimed at comparing the prevalence of sexual dysfunction among women with the most common causes of infertility.

METHODS

The current cross-sectional study was conducted on 240 infertile females with infertility due to polycystic ovary syndrome (PCOS, n = 80), endometriosis (n = 80) and male factor (n = 80) at Royan Institute for Reproductive Biomedicine (Tehran, Iran) and 160 fertile women at health care centers, between May 2016 and June 2017. Sexual function was assessed by Female Sexual Function Index (FSFI). Data were analyzed using SPSS (version 25.00) and differences were regarded statistically significant at p < 0. 05.

RESULTS

The prevalence of female sexual dysfunction was 98.8% in women with PCOS, 100.0% in those with endometriosis, and 80.0% in those with male factor infertility. Overall, 36.2% of the enrolled fertile women were suffering from sexual dysfunction.

CONCLUSIONS

There was an association between the prevalence of female sexual dysfunction or individual domain scores of the FSFI, and infertility etiologies. Therefore, infertility care providers are required to take this into consideration and develop preventive strategies in this regard. Infertility as a major health care problem affects an estimated 8-12% of couples of reproductive age globally and sexuality as an important part of women's health, can be affected by infertility. In this study, the prevalence of sexual dysfunction among women with the most common causes of infertility has been evaluated. The present study was conducted on 240 infertile females with infertility due to polycystic ovary syndrome (PCOS, n = 80), endometriosis (n = 80) and male factor (n = 80) at Royan Institute (Tehran, Iran) and 160 fertile women at health care centers, between May 2016 and June 2017. Sexual function was assessed by Female Sexual Function Index (FSFI); a brief self-report measure of sexual functioning. Results highlight that the prevalence of sexual dysfunction in women with endometriosis and PCOS was higher than in other groups. As, the prevalence of female sexual dysfunction was 98.8% in women with PCOS, 100.0% in those with endometriosis, and 80.0% in those with male factor infertility. In total, 36.2% of the enrolled fertile women were suffering from sexual dysfunction. The results point to an association between the prevalence of female sexual dysfunction and causes of infertility. Therefore, infertility care providers are required to take this into consideration and develop preventive strategies in this regard.

Sexual Function and Satisfaction in Couples with Infertility: A Closer Look at the Role of Personal and Relational Characteristics

BACKGROUND

Research to date suggests that couples undergoing assisted reproductive technology (ART) are at a high risk of experiencing sexual difficulties.

AIM

This dyadic cross-sectional study aimed to provide a better understanding of the infertility-specific personal (ie, emotional, mind-body) and relational stressors associated with the sexual desire, orgasm, arousal, and sexual satisfaction of infertile couples seeking ART.

METHODS

The sample included 185 mixed-sex infertile couples seeking ART. Participants completed online the Fertility Quality of Life tool and either the Female Sexual Function Index or the International Index of Erectile Function. Data were analyzed using path analyses based on the Actor-Partner Interdependence Model.

OUTCOMES

Individuals' own and their partners' sexual function (desire, orgasm, arousal domains) and sexual satisfaction.

RESULTS

For men and women, infertility-related emotional stressors were associated with their own and their partner's lower sexual desire. For women, experiencing greater infertility-related emotional stressors was also associated with their partner's lower sexual satisfaction. While experiencing greater infertility-related mind-body stressors was not associated with men and women's own sexual desire, arousal, orgasm, and satisfaction, for women, it was associated with their partner's lower sexual arousal. Lastly, for men and women, infertility-related relational stressors were associated with their own lower sexual arousal, as well as with their own and their partner's lower sexual satisfaction. For women, experiencing greater relational stressors was also associated with their own lower sexual desire and orgasm.

CLINICAL IMPLICATIONS

Interventions addressing the emotional, mind-body, and relational spheres of infertile couples seeking ART may help facilitate improvements in sexual function and satisfaction and better serve their needs.

STRENGTHS & LIMITATIONS

This study included a large sample of couples. Our sample was heterogeneous with regards to couples' cause of infertility and treatment stage. The use of an infertility-related measure allowed us to better capture personal and relational stressors specific to couples seeking ART. Given the cross-sectional design of our study, causality between infertility-related stressors and sexual function and satisfaction cannot be inferred. Our sample included predominantly White, mixed-sex individuals with a high level of education, which may reduce the generalizability of our findings.

CONCLUSION

Couples' subjective experience of infertility and treatment (personal and relational stressors) seems to be strongly associated with their sexual health, allowing us to identify potential targets of intervention with couples seeking ART. S.E. Amiri, A Brassard, N.O. Rosen, et al. Sexual Function and Satisfaction in Couples with Infertility: A Closer Look at the Role of Personal and Relational Characteristics. J Sex Med 2021;18:1984-1997.

The Inferto-Sex Syndrome (ISS): sexual dysfunction in fertility care setting and assisted reproduction

PURPOSE

Infertility represents a peculiar social burden affecting more than 15% of couples, provoking it a real threat to the general quality of life and to the sexual health. The medicalization (diagnosis, therapy and follow up) of the lack of fertility is frequently a challenge in term of personal and couple's involvement. In particular, while the Assisted Reproductive Technology (ART) has allowed many infertile couples to achieve pregnancy, the therapeutic process faced by the couple bears a strong psychological stress that can affect the couple's quality of life, relationship and sexuality. Despite infertility affects both female and male sexual health, only recently the interest in the effects of ART on the couple's sexuality has grown, especially for women.

METHODS

A literature research on the sexual dysfunction in fertility care and particularly in ART setting was performed.

RESULTS

Literature largely found that intimacy and sexuality appear specifically impaired by intrusiveness of treatments and medical prescriptions. Moreover, there is a close relationship between emotional, psychological and sexual aspects, which can be integrated in the new concept of Inferto-Sex Syndrome (ISS) that can impair the ART treatment outcomes. Evidence demonstrates that the assessment of sexual function is necessary in couples undergoing diagnosis of infertility and ART.

CONCLUSION

A close relationship between infertility and sexuality, both in the female and male partners, was detected. ART treatments may heavily impact on the couple's psychosexual health. A couple-centred program for the integrated management of psychological and sexual dysfunction should be considered in the context of ART programs.

A Systemic Review on the Association Between Infertility and Sexual Dysfunction Among Women Utilizing Female Sexual Function Index as a Measuring Tool

The Center for Disease Control and Prevention describes infertility as the inability to conceive after one year or longer with adequate unprotected sex. Infertility affects both females and males, interfering with their everyday lives and significantly impacting their mental health. Sexual dysfunction is defined as an alteration of the sexual response cycle phases, preventing satisfaction during sexual activity. The prevalence of sexual dysfunction in the United States is high, with about 10%-52% among men and 25%-63% among women. Different scales can measure sexual satisfaction and double as a tool to diagnose sexual dysfunction. The Female Sexual Function Index (FSFI) is the gold standard for diagnosing sexual dysfunction in women. Overall, fertile women had a higher score on the FSFI than infertile women; however, both groups showed sexual dysfunctions even if the fertile group was classified as a mild disorder. The most common disorders were disorders of desire and lubrication. Desire and arousal dysfunction appeared more common in participants with secondary infertility, while lubrication dysfunctions were more common in older participants. In the future, it will be important to evaluate other factors that affect sexual function and fertility including mental health, male health, and couple factors.

Association of depression with sexual function in women with history of recurrent pregnancy Loss: descriptive-correlational study in Tehran, Iran

PURPOSE

The present study aimed to investigate the relationship between depression and sexual function in women with recurrent pregnancy loss.

METHODS

In a cross-sectional correlational study, 130 consecutive patients with history of recurrent pregnancy loss were included who referred to Avicenna Fertility Center in Tehran, Iran during November 2018-February 2019. The outcomes were sexual dysfunction (Assessed with the Female Sexual Function Index) and depression (Evaluated with the Beck's Depression Inventory). The study data were analyzed by using Mann-Whitney and Kruskal-Wallis tests.

RESULTS

The study findings revealed that 40.8% of the participants suffered from some degrees of depression. The data analysis revealed that depression had a significant inverse correlation with sexual function and its domains (r = - 0.392, p < 0.001, R²= 0.15). The spouse' education level and economic status demonstrated a significant relationship with women's sexual function (p = 0.01, p = 0.033). A significant relationship was also detected between women's depression and economic status (p = 0.028).

CONCLUSIONS

The study findings showed that women with RPL who had severe depression indicated lower score of sexual function. Since psychological and sexual problems are not reported to health care providers due to giving priority to fertility issues or considering such issues as taboos, the assessment of sexual and mental health needs to be part of the consultation in women with history of RPL, whether the patient seeks help for depression and sexual dysfunction or not.

Evaluation of Sexual Function Among Infertile Women and Their Sexual Self-Concept

Background

The present study was designed to assess the association between sexual self-concept and sexual function in infertile women.

Methods

A study with a convenience sample of women attending a referral infertility center (Royan Institute) was conducted in Tehran, Iran, in 2017. The Multidimensional Sexual Self-Concept Questionnaire (MSSCQ) and the Female Sexual Function Index (FSFI) were used to collect data. Chi-Square, t-test, Mann-Whitney U test and logistic regression were applied to analyze the data. The significance level was set at p<0.05.

Results

The mean age of participants was 29.7±5.2 years. Overall, 152 women (60.8%) reported that they were experiencing sexual dysfunction. Comparing women with and without sexual dysfunction, there were significant differences between two groups on most measures such as sexual anxiety, sexual motivation, sexual satisfaction, and sexual depression (p<0.05). However, the results obtained from logistic regression indicated that women's and husband's age (OR for women's age=1.26, 95% CI=1.10-1.44, p<0.001; OR for husband's age=0.86, 95% CI=0.77-0.97, p=0.014), cause of infertility (OR for female factor=9.17, 95% CI=2.26-37.2, p=0.002; OR for male factor=3.90, 95% CI=1.26-12.1, p=0.018; OR for male and female factor=3.57, 95% CI=1.12-11.4, p=0.032), sexual motivation (OR=0.35, 95% CI=0.16-0.75, p= 0.007) and sexual satisfaction (OR=0.23, 95% CI=0.09-0.56, p=0.001) were significantly associated with sexual dysfunction.

Conclusion

The findings suggest that sexual motivation and sexual satisfaction are important dimensions of sexual self-concept in infertile women. Indeed, it is essential to inform policy makers and stakeholders to provide more sexual health support for this population in the process of treatment.

The prevalence of depression among Iranian infertile couples: an update systematic review and meta-analysis

Background

Depression is a common mental disorder. Infertility can lead to depression. The current systematic review and meta-analysis were conducted to estimate the pooled prevalence of depression among Iranian infertile couples. Seven electronic databases (Google Scholar, MagIran, SID, Science Direct, PubMed, Scopus, Web of Science) were searched, up to August 2019, for relevant published studies. The pooled prevalence of depression also pooled mean of depression score was determined using a random-effects model with a 95% confidence interval (95% CI). All analyses performed using Stata ver11 (Stata Corporation, College Station, TX, USA). The 0.05 was considered a significant level.

The main body

Totally, 230 studies were retrieved and 31 studies included in the meta-analysis. The pooled prevalence of depression among infertile couples was about 35.3% (95 % CI 24.1–46.5), and the prevalence of depression among females and males was 48.7% (95% CI 24.0–73.3) and 9% (95% CI 0% to 23.7%), respectively.

Conclusions

Our findings suggest a high prevalence of depression in infertile couples. The results can highlight an important and growing mental disorder among infertile couples that may be overlooked.

Effects of Hypothyroidism and Subclinical Hypothyroidism on Sexual Function: A Meta-Analysis of Studies Using the Female Sexual Function Index

Introduction

Hypothyroidism and subclinical hypothyroidism (SCH) are common metabolic diseases with severe psychological and physiological effects, which may be the risk factors of sexual dysfunction.

Aim

The purpose of this study is to explore the influence of hypothyroidism and SCH on female sexual function through systematic literature review.

Methods

Until February 2020, systematic searches were conducted on Pubmed, Web of Science, EMBASE, and Clinicalkey to obtain eligible studies to report the mean and standard deviation of Female Sexual Function Index (FSFI) in various fields in women with clinical hypothyroidism, SCH, and healthy controls. In accordance with the results of heterogeneity test, a random effect model or fixed effect model was selected to aggregate the scores of each field. The scores of female patients with hypothyroidism and healthy controls were compared using forest plot. Stata (version 15.1) uses meta-analysis.

Main Outcome Measure

Evaluation values of various fields of FSFI in clinical hypothyroidism, SCH, and healthy controls.

Results

This study included 7 studies, including 88 women with clinical hypothyroidism, 337 women with SCH, and 2056 healthy controls. Compared with healthy controls, patients with hypothyroidism scored lower in all FSFI dimensions (desire, arousal, lubrication, orgasm, satisfaction, and pain), especially in lubrication. And, only arousal and orgasm decreased in patients with SCH. Hypothyroidism (odds ratio = 3.912, P = .002) rather than SCH (odds ratio = 1.036, P = .886) was a risk factor for female sexual dysfunction.

Conclusion

Hypothyroidism does impair female sexual function to varying degrees. SCH has little effect on female sexual function. It is essential to measure and evaluate the thyroid function of women with sexual dysfunction regularly, which can help clinicians improve sexual function and sexual quality of life.

Wang Y and Wang H. Effects of Hypothyroidism and Subclinical Hypothyroidism on Sexual Function: A Meta-Analysis of Studies Using the Female Sexual Function Index. Sex Med 2020;8:156–167.

Psychosocial Consequences of Female Infertility in Iran: A Meta-Analysis

Background: Although not a life-threatening condition, infertility does influence various aspects of life. Based on a meta-analysis of the relevant literature, the aim of this study is to identify the psychosocial consequences of infertility in Iranian women. Methods: Comprehensive Portal of Human Sciences, Magiran, Scientific Information Database, Noormags, MEDLIB, ScienceDirect, Google Scholar, Medline, and ProQuest were the databases searched from inception (1999) to 2018. To maximize the comprehensiveness of the search, the reference lists of all the relevant papers identified were manually examined. The evaluation of the content was based on PRISMA guidelines, and Comprehensive Meta-Analysis software was used for data analysis. Results: Based on the analysis of 124 quantitative papers, the psychosocial consequences of infertility in women in Iran can be classified into 14 categories: psychological well-being (effect size = 3.10), adaptation to infertility (effect size = 2.71), quality of life (effect size = 1.83), depression (effect size = 1.80), anxiety (effect size = 1.72), marital relationships (effect size = 1.37), personality disorders (effect size = 1.37), violence (effect size = 1.31), social support (effect size = 0.90), self-efficacy (effect size = 0.90), coping strategies (effect size = 0.84), irrational thoughts (effect size = 0.77), somatization disorders (effect size = 0.65), and sexual dysfunction (effect size = 0.55). Conclusion: Considering the wide-ranging psychosocial consequences of infertility in women, it is necessary for treatment to account for psychological factors.

INFERTILITY AND SEXUAL DYSFUNCTIONS: A SYSTEMATIC LITERATURE REVIEW

This study aimed to investigate whether infertility and its treatment affect couple sexuality. A systematic literature review was performed, focusing on female and male sexual dysfunctions due to infertility. The method was descriptive, using a meta-synthesis of scientific research published between 2012 and 2017 in the English language. The search for suitable studies was carried out with the research databases Medline, CINAHL, PubMed and ScienceDirect using the following keywords: infertility, sexual dysfunctions, couple. It can be concluded that infertility negatively affects the sexuality of an infertile couple, which is further proven by a high percentage of sexual dysfunctions (43%-90% among women and 48%-58% among men). Couples report less satisfaction with sexuality. Since lower satisfaction and dysfunctions are closely connected with infertility and its treatment, couples might benefit from sexual therapy and support during the process of infertility treatment. Further research should focus on the evaluation of different psychological interventions that would address sexuality in couples when diagnosed and treated for infertility.

Genital tract infection and associated factors affect the reproductive outcome in fertile females and females undergoing in vitro fertilization

Assisted reproductive techniques including in vitro fertilization (IVF) are being used increasingly worldwide and screening for genital tract infections (GTIs) is recommended prior to treatment as their presence may affect the success rate of IVF. The current study aimed to assess the possible associations between GTI-associated factors and reproductive outcome in a group of reproductive age fertile females and infertile females receiving IVF. A total of 111 infertile women enrolled in an IVF programme (Group A) and 104 fertile women (mothers of at least one child; Group B) underwent microbiological screening of vaginal and cervical samples. All samples were cultured using different protocols for aerobic pathogens, bacterial vaginosis (BV), Ureaplasma urealyticum, Mycoplasma hominis, Chlamydia trachomatis and human papilloma virus (HPV). Although each group were comparable in age, more infertile women were >30 years (P=0.0064), had a higher education level (P=0.0001) and were smokers (P=0.007). Only BV (P=0.0013) was more prevalent in Group A. Of the 111 infertile females who were scheduled for IVF, 32 females had a successful pregnancy (Group C) and 79 females exhibited IVF failure (Group D). Tubal factor (P=0.012), estradiol-2 (E2) levels <2,500 pg/ml (P=0.0009) and Mycoplasma infection (P=0.003) were identified to be the strongest predictors of IVF failure. The current study determined certain GTI-associated factors that may contribute to infertility in Greek females of reproductive age as well as other risk factors associated with failure in patients undergoing IVF. Further studies are required to confirm this conclusion.

Psychometric characteristics of the FertiQoL questionnaire in a German sample of infertile individuals and couples

BACKGROUND

FertiQoL is a questionnaire internationally developed to measure fertility-specific quality of life. It has been validated with infertile populations in many countries and used in several studies focusing on the psychosocial consequences of infertility in Europe, Asia, and North America.

METHODS

Over a period of two years, 596 infertile women and men took part in the study conducted at three German fertility clinics. Psychometric properties of FertiQoL were tested by performing confirmatory factor analyses, calculating average variance extracted values, reliability and correlation coefficients. Hierarchical regression analyses were conducted to determine the relations between FertiQoL subscales and both sociodemographic and medical variables. Individual and cross-partner effects were tested for.

RESULTS

The confirmatory factor analyses conducted on our FertiQoL data supported the original four-factor solution for both women and men but, resulted in some unsatisfactory indices. Family and friends' support items loaded weakly on the Social subscale of FertiQoL (.27 and .34 in women, .32 and .19 in men). The Emotional and Mind/Body subscales revealed a strong intercorrelation (r = .77, p < .001 in women, r = .74, p < .001 in men). Women scored lower than men on the Emotional and Mind/Body subscales only, and they reported better fertility-specific relational QoL. In women, the perceived cause of infertility and already mothering a child related significantly to individual FertiQoL scores, while in men, age, educational level, and the duration of their wish for a child had an impact on the FertiQoL subscales (all p < .05). The men's educational level, the women's educational level, and the subjective perceived medical cause of fertility problems exerted cross-partner effects on QoL (all p < .05).

CONCLUSIONS

Our study results represent a contribution both to research and clinical practice. The findings suggest the importance of considering the personal experience of infertility in different cultural and gender specific settings and that the strong connections between the emotional, physical, and cognitive aspects of an individual's fertility-specific quality of life should be regarded as a more coherent system.

TRIAL REGISTRATION

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Prevalence of Sexual Dysfunction among Infertile Women in Iran: A Systematic Review and Meta-analysis

Infertile women are at a higher risk of sexual dysfunction compared to fertile women. Infertility is a major source of stress, anxiety, and depression, which strongly affects sexual health. The aim of this study is to estimate the prevalence of female sexual dysfunction (FSD) among infertile Iranian women. We searched the main international databases (Web of Science, PubMed, Medline, and Scopus) and national databases (Scientific Information Database, Magiran, and IranMedex) from their inception until April, 2017. Due to heterogeneity between the studies, the extracted data were pooled using a random-effects model by Stata software. Out of 313 retrieved studies, we included 18 studies of 3419 infertile women in the meta-analysis. The pooled prevalence of FSD was 64.3% [95% confidence interval (CI): 53.3-75.3]. Our findings revealed that sexual desire (59.9%, 95% CI: 38.7-81.2) was the most prevalent disorder and vaginismus (19.2%, 95% CI: 11.3-27.2) was the least prevalent among infertile women. The results of our metaanalysis suggested that more than 64% of infertile Iranian women reported sexual dysfunction, which was meaningfully high. This study also showed that sexual desire was significantly more common than other sexual dysfunction dimensions and the prevalence of vaginismus was the least common.

Effect of intrauterine insemination treatment on sexual function and quality of life for infertile women

Objectives:

To evaluate the effect of intrauterine insemination (IUI) on sexual functioning, quality of life and psychological well-being.

Methods:

One hundred and thirty four infertile women going to IUI treatment as study group and 134 women who do not report any infertility complaint attending to gynecology clinic for routine control as control group were enrolled. Demographic data of the patients were collected. Patients were asked to complete Female Sexual Functioning Index (FSFI), Beck Depression Inventory (BDI) and SF 36 form.

Results:

Total FSFI score (mean±SD) for study group was 23.4±4.1 and 24.8±3.4 for control group (p<0.05). This means a lower sexual function for patients going to IUI. There were also statistically significant differences according to subscales of FSFI scores for sexual desire, arousal and satisfaction. Mean±SD scores for Beck Depression Inventory analysis was 18.6±9.8 for study group and 18.5±7.1 for control group. According to SF-36 scores, there were statistically significant differences between the groups for four subscales: Role physical,bodily pain,general health and vitality.

Conclusions:

Going to an IUI treatment has negative effects on FSFI scores and some of SF 36 scores but we did not find a significant negative effect on BDI scores.

Comparative Effectiveness of Antidepressant Medication versus Psychological Intervention on Depression Symptoms in Women with Infertility and Sexual Dysfunction

Background

Fertility loss is considered as a challenging experience. This study was conducted to compare the effectiveness of antidepressant medication and psychological intervention on depression symptoms in women with infertility and sexual dysfunctions (SD).

MATERIALS AND METHODS

This randomized, controlled clinical trial study was completed from December 2014 to June 2015 in Babol, Iran. Of the 485 participants, 93 were randomly assigned in a 1:1:1 ratio to psychosexual therapy (PST), bupropion extended-release (BUP ER) at a dose of 150 mg/d, and control (no intervention) groups. The beck depression inventory (BDI) was completed at the beginning and end of the study. Duration of study was eight weeks. Statistical analyses were performed by using paired-test and analysis of covariance.

RESULTS

The mean depression score on the BDI was 22.35 ± 8.70 in all participants. Mean BDI score decreased significantly in both treatment groups (PST: P<0.0001, BUP: P<0.002) from baseline to end of the study, whereas intra-individual changes in BDI score were not significant in the control group. The decrease in mean BDI score was greater with PST compared to BUP treatment (P<0.005) and the control group (P<0.0001). The PST group showed greater improvement in depression levels (severe to moderate, moderate to mild) in comparison with the two other groups (P<0.001). Drug treatment was well tolerated by the participants in the BUP group.

CONCLUSION

PST can be a reliable alternative to BUP ER for relieving depression symptoms in an Iranian population of women with infertility and SD (Registration number: IRCT2015042721955N2).

Comparison of Sexual Problems in Fertile and Infertile Couples

Introduction: Infertility is known to have a negative effect on couple's life and in most cases it has a profound impact on sexual relations. Sexual problems may be the cause of infertility or may arise as a result of infertility. The aim of this study was to compare the sexual problems in fertile and infertile couples. Methods: This cross-sectional study was performed on 110 infertile and 110 fertile couples referring to Montaserieh infertility center and five health centers in Mashhad which were selected as class clustering method and easy method. Data collection tools included demographic questionnaires and Golombok-Rust Inventory. The collected information was analyzed by SPSS software and descriptive and inferential statistics. Results: No significant difference was found between fertile 26 (17, 37) and infertile 26(18, 37) women in terms of total score of sexual problems and other aspects of sexual problems (except infrequency). The women in the fertile group had higher infrequency than infertile women. Total score of sexual problems in fertile men was 18.5 (13, 27) and in infertile men 25 (19, 31) and the difference was statistically significant. Infertile men reported more problems in no relation, impotency and premature ejaculation compared to fertile men. Men in both fertile and infertile group reported more sexual problems than women. Conclusion: In view of the more frequent sexual problems in infertile men than infertile women, it seems that it is necessary to pay more attention to sexual aspects of infertility in men and design the training programs for sexual and marital skills in infertility centers.

Sexual dysfunction in infertile women: A systematic review and meta-analysis

OBJECTIVE

This study aimed to assess the prevalence of sexual dysfunction and Female Sexual Function Index (FSFI) score in women with infertility.

STUDY DESIGN

A systematic search of the literature was conducted using PubMed, EMBASE, IBECS, and LILACS. The search was limited to articles published from January 2000 to September 2016, without language restriction. Data were analyzed using Stata 12.0. Random effects meta-analyses in weighted mean difference (WMD) were performed for six comparative studies (infertility versus fertility). Heterogeneity was estimated using I². Moreover, to explore the heterogeneity sources among the studies, meta-regression analyses were also performed. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation guidelines, and risk of bias, with a graphic funnel.

RESULTS

Meta-analysis was performed in 11 of 13 comparative studies. The result indicated a significant association between an increase in sexual dysfunction and infertility in women (WMD=-0.16, 95% confidence interval=-0.254 to -0.084, p<0.001), and high heterogeneity between studies was noted (I²=98.6%, p<0.000). Meta-regression analysis did not indicate heterogeneity (I²=0.00%). We also performed a meta-analysis of individual FSFI domains in 10 studies. Infertile women had problems with lubrication, orgasm, and satisfaction. Meta-regression analysis also showed that heterogeneity had no influence on the final results of all the analyses.

CONCLUSIONS

Infertility was associated with an increase in female sexual dysfunction. The most affected areas of sexual function were lubrication, orgasm, and satisfaction.

Female Sexual Dysfunction Among the Wives of Opioid-Dependent Males in Iran

Background

Opiate abuse in males has significant effects on their sexual functions. In contrast, sexuality in females is a multidimensional issue that can strongly be affected by several factors in their partners. However, only a limited number of studies have assessed the role of males’ opioid dependency in their female partners’ sexual function.

Objectives

The present study aimed to evaluate the effect of males’ opioid dependency on their wives’ sexual function compared to the sexual function of the females whose husbands were not opioid dependent.

Patients and Methods

This study included 340 women who were selected through convenience sampling and divided into a control (females whose husbands were not opioid dependent) and a case group (women whose husbands were opioid dependent). The data were collected through an interview according to the DSM-IV-R criteria for female sexual dysfunctions by a senior female medical student who was one of the researchers. Finally, the data were entered into the SPSS statistical software (v. 15) and analyzed using the t-test and chi-square test.

Results

According to the results, the frequency of hypoactive sexual desire disorder and sexual aversion disorder in the control group was significantly higher than that of the case group (P < 0.05).

Conclusions

The results showed that having an addicted husband could strongly affect some sexual domains in women. It could change the pattern of desire and motivation for sexual contact in females and alter their attitude toward the sexual relationship, thereby causing disturbances in the females’ normal sexual function.

Effects of Infertility Etiology and Depression on Female Sexual Function

Sexual dysfunction is common in women with infertility and interferes with the marital relationship. The study aims to compare sexual function among women with different infertility causes. The authors used a cross-sectional study design with 142 infertile women. Sexual functions and depression prevalence of infertile women were assessed using the Female Sexual Function Index and the Beck Depression Inventory. The prevalence of female sexual dysfunction was 43.3% (n = 13) in the female infertility group (Group A), 54.8% (n = 17) in the male infertility group (Group B), and 51.9% (n = 42) in the unexplained infertility group (Group C). There was no statistically significant difference in the prevalence of sexual dysfunction between the groups (p =.635). There was no significant difference in mean Beck Depression Inventory scores between the groups (p =.832). However, Beck Depression Inventory scores and depression prevalence were significantly higher in women with sexual dysfunction (p <.001). The total Female Sexual Function Index score and all subgroup scores were inversely correlated with the Beck Depression Inventory score (p <.01). Infertile women with sexual dysfunction were more likely to have depressive symptoms. Psychiatric assessment should be introduced in the management of infertility.

Sexual Satisfaction and Sexual Reactivity in Infertile Women: The Contribution of The Dyadic Functioning and Clinical Variables

Background

Infertility is a factor which has been linked to higher prevalence of sexual dysfunctions in women; however, ambiguous results have been reported about the impact of infertility on women’s sexual satisfaction. The purpose of this study was to compare sexual and dyadic functioning in infertile and fertile women. Furthermore, the associations between sexual variables and clinical variables (depressive symptoms, period trying to conceive, and treatment period) were assessed in infertile women sample.

Materials and Methods

The cross-sectional study involved 50 women with the history of infertility and 50 fertile women recruited from the general population. The Sexual Satisfaction Scale (SSS), Mell-Krat Scale (women’s version), Family Assessment Measure (FAM-III), and Beck Depression Inventory (BDI) were administered to all participants.

Results

Infertile women reported lower sexual satisfaction and more maladaptive patterns of dyadic functioning in comparison to the control group. As many as 45 (90%) of infertile women, compared to 13 (26%) of the control group, reported the scores on the Mell-Krat Scale indicative of the presence of dysfunctions in sexual reactivity (P≤0.001). Infertile women reported significantly higher levels of depressive symptoms than the women from the control group (P≤0.001). Negative correlations were observed between sexual satisfaction and dyadic functioning in both groups (P≤0.05); however, the patterns of these associations were different in infertile and fertile women. For example, negative correlations were found between satisfaction with control and task accomplishment, role performance, affective involvement, and values and norms in infertile women. However, these relationships were not observed in the control group. No correlations were revealed between sexual reactivity and dyadic functioning in infertile women and the control group. Negative correlations were observed between satisfaction with control and relationship duration and treatment period as well as between sexual reactivity and period of trying to conceive. Multiple regression analyses also revealed different predictors of sexual satisfaction in both groups: affective involvement (P≤0.05) and relationship duration (P≤0.05) in infertile women, whereas communication (P≤0.05), affective expression (P≤0.05) and depressive symptoms (P≤0.05) in the control group.

Conclusion

Infertility is an important factor affecting sexual and dyadic functioning and is linked to higher depressive symptoms in infertile women.

Female sexual distress in infertile Turkish women

Objective:

To evaluate the effect of infertility on sexual distress in women attending the infertility clinic.

Materials and Methods:

In a cross-sectional study we evaluated sexual distress among 88 women who attended the infertility clinic in our institute between January and June 2015. All women who were experiencing primary or secondary infertility during the study sampling were included in the sudy. Sexual distress was measured using the Female sexual distress scale-revised (FSDS-R), a cross-validated patient-reported outcomes measure. Correlations of FSDS-R with patient characteristics and laboratory measurements were calculated using Spearman’s rank correlation tests.

Results:

With the exceptions of the age of couples and serum anti-mullerian hormone (AMH) levels, no predictor of high sexual distress was found in the univariate analysis when comparing groups with regard to the FSDS-R cut-off score. The mean age of the sexually distressed women (33.6±5.8 years vs. 29.3±5.1 years) and their partners (35.4±4.8 years vs. 31.6±4.2 years) was significantly higher than those of the non distressed women, according to a FSDS-R score over 11 (p<0.05). The serum level of AMH was significantly lower in infertile women with high total sexual distress scores (1.4 vs. 7.6 ng/mL (p<0.001)).

Conclusion:

In infertile women, age of woman, age of partner, and serum AMH levels are related with the hope of women to have a child despite an association with sexual distress. Serum AMH, which is perceived as necessary for fertility, had a significant inverse correlation with levels of sexual stress.

A Study of Couple Burnout in Infertile Couples

Introduction:

Infertility is a major crisis that can cause psychological problems and emotionally distressing experiences, and eventually affect a couples’ relationship. The objective of this study is to investigate couple burnout in infertile couples who were undergoing treatmentat the Infertility Clinic of Yazd, Iran.

Method:

The present study is a cross-sectional descriptive one on 98 infertile couples referringto the Infertility Centerof Yazd, Iran, who were chosen on a simple random sampling basis. The measuring tools consisted of the Couple Burnout Measure (CBM) and a demographic questionnaire. The collected data were analyzed using SPSS 16 and the statistical tests of ANOVA and t-test. P-values less than 0.05 were considered as significant.

Results:

The results show that infertile women experience higher levels of couple burnout than their husbands (p<0.001). Also, a comparison of the scales of couple burnout—psychological burnout (p<0.01), somatic burnout (p<0.01), and emotional burnout (p<0.001)—between wives and husbands show that women are at greater risk.

Conclusion:

Infertile couples’ emotional, mental, and sexual problems need to be addressed as part of the infertility treatment programs, and psychotherapists should be included in the medical team.

Effect of Infertility on Sexual Function: A Cross-Sectional Study

INTRODUCTION

Sexual dysfunction is an important psychological disorder that may increase in infertile couples.

AIM

To evaluate the effect of infertility on sexual function in women attending in private and public institutions in Ilam during 2013.

MATERIALS AND METHODS

In a cross - sectional study evaluated the sexual function among 384 women attending in health care centers of Ilam western of Iran during 2013. Participants were divided in two groups, fertilities and infertilities women. Data was collected by trained research midwives using demographic and FSFI questionnaires. SPSS software Package 16 was used to analyse the data of this project. Differences were regarded statistically significant with an alpha error of 0.05.

RESULTS

The mean age was 29.29 ± 6.7 years in fertile and 31.74 ± 8.07 in infertile women. Significant difference was reported in mean age between fertile and infertile women (p=0.014). The Mean± SD of all demissions of female sexual function was difference between fertile and infertile women. Sexual function was lower in infertile women.

CONCLUSION

All dimensions of sexual function were lower in infertile women in compared with fertile women. Further research should be done on this subject and ways to address such problems should be found.

Female sexual dysfunction in patients with spinal cord injury: a study from Iran

OBJECTIVES

We assess the prevalence of sexual dysfunction in patients with spinal cord injury (SCI), compare sexual function and sexual distress between female patients with SCI and gender-matched healthy controls, and address risk factors associated with sexual dysfunction among Iranian female patients with SCI.

SETTING

Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.

METHODS

Eligible Iranian female patients with SCI were included in this cross-sectional study. They were asked to provide sociodemographic information, and complete the Female Sexual Function Index, Hospital Anxiety and Depression Scale and Female Sexual Distress Scale-Revised questionnaire.

RESULTS

Of the 105 patients participated in this study, the average age was 41.0 (s.d.=10.1) years. Women with SCI reported significantly higher levels of sexual dysfunction compared with normal controls. Approximately, 88% of SCI patients reported at least one type of sexual dysfunction, whereas only 37% of healthy controls reported sexual dysfunction. Lack of vaginal lubrication was reported more frequent in SCI patients compared with controls. Women with SCI reported a significantly higher level of sexual distress compared with healthy women. Sexual dysfunction was observed to be significantly higher in older patients, those with less education, patients with complete lesions, those with sexual distress and patients who were anxious and depressed.

CONCLUSION

Sexual dysfunction is highly prevalent among Iranian women with SCI. Sexual dysfunction is associated with age, education, symptoms of depression and anxiety and level of injury. Sexual counseling during the rehabilitation period may help to prevent sexual dysfunction following SCI.

Sexual function of women practicing sex in nonconventional settings

The quality of sexual intercourse in the context of conjugal visits by women to their jailed partners is unknown. This study aimed to assess the quality of the sex lives and psychological conditions of women attending conjugal visits with their jailed inmate partners. This controlled study involved 124 women between the ages of 18 to 40 years who engaged in sexual relations with their inmate partners (conjugal visit group) or with their partners at home (control group). Sexual function was assessed using a semi-structured questionnaire and the Female Sexual Function Index, and psychological parameters were evaluated using the Hospital Anxiety and Depression scale. The total Female Sexual Function Index scores was similar in the 2 groups. The percentage of women reporting good quality of the relationship was significantly higher in the conjugal visit group. Also, the Hospital Anxiety and Depression scale scores were higher in the conjugal visit group. Depression was a risk factor for sexual dysfunction and had a negative effect on scores in the desire, excitement, lubrication, and sexual satisfaction domains, whereas anxiety was associated with lower sexual desire scores. A regular + poor quality of the relationship and being religious were factors associated with sexual dysfunction. Sexual practices in jail were not a risk for sexual dysfunction in this sample.

Factors associated with sexual function in Iranian women with type 2 diabetes mellitus: partner relationship as the most important predictor

Background:

No comprehensive study has been conducted on risk factors of sexual dysfunction in women with diabetes mellitus.

Objectives:

The aim of this study was to consider all possible influencing variables including hormonal, physical and, psychological status, socioeconomic status, and dietary intake to get more accurate and reliable results.

Patients and Methods:

Sexual function was assessed by Iranian validated female sexual function index (FSFI).The variables of the study were demographic and diabetes-related factors, stress-depression, physical activity, blood pressure, anthropometric measurements, lipid profile, cortisol, sex and thyroid hormones, 25-hydroxy vitamin D, and dietary intake.

Results:

Among all investigated variables, partner relationship showed a strong positive association with FSFI (β = 1.93 ± 0.41, P < 0.0001). In addition, not considering partner relationship, FSFI showed a significant negative association with age (β = -0.19 ± 0.20, P = 0.04), stress-depression score (β = -0.08 ± 0.04, P = 0.04), DD (β = -0.03 ± 0.01, P = 0.04), and systolic blood pressure (β = -0.14 ± 0.06, P = 0.03). Significant associations between FSFI and serum sex hormones and other biochemical were found in neither postmenopausal nor non-menopausal women. The means of SFSI in postmenopausal women were greater than non-menopausal (P = 0.02).

Conclusions:

It seems that in our population, female sexual function was much more than just a hormonal or physical problem and psychological factors, especially partner relationship and stress-depression, are the most determinants. In addition, age, duration of challenging with disease, and the lack of controlling systolic blood pressure were common factors that decreased sexual function.

Sexual disorders in infertile couples: an update

PURPOSE OF REVIEW

The aim of this review is to examine the medical literature published in 2011-2012 on reports of sexual disorders in infertile couples.

RECENT FINDINGS

Ten articles on sexual disorders in infertile couples were traced. The results were very inconsistent, and the response rates of the studies were low.

SUMMARY

Divergent samples and assessment instruments, together with low or unknown responder rates, mean that there are no valid findings about sexual disorders in infertile couples. Further research will have to find an appropriate way of addressing these methodological shortcomings. Recent studies on infertile men and their sexuality are definitely underrepresented.