Female sexual dysfunction in Lower Egypt

Sexual dysfunction in migraine-affected women: A prospective cross-sectional controlled study

Introduction

Female sexual dysfunction (FSD) is a common health problem that is inadequately investigated in Arabic countries, especially Saudi Arabia.

Aim

To assess the prevalence and trace predictors of FSD in Saudi women who suffered from migraine headaches comparable to healthy women.

Patients and methods

A prospective cross-sectional, controlled study involved 400 Saudi women complaining of migraine (Case Group) and another 400 healthy-looking Saudi women (Control Group) during three months; from January 1st, to March 31st 2023, in Jeddah city, Saudi Arabia. Data was collected by using a pre-structured Female Sexual Function Index (FSFI) questionnaire, Female Sexual Distress Scale (FSDS), Migraine Screen Questionnaire (MS-Q), with an evaluation of the severity of pain by Visual Analogue Scale (VAS), and its impact on daily activity by using both; Headache Impact Test (HIT-6) and Migraine Disability Assessment (MIDAS) Questionnaire.

Results

A total of 800 Saudi women were recruited. Their ages ranged from 18 to 45 years old. Women with abnormally low FSFI scores were 375 (93.75 %) out of 400 with migraine and 85 (21.25 %) out of 400 without migraine. The lowest FSFI scores were mainly for desire (2.75 ± 1.05) and arousal domains (3.0 ± 1.12) followed by sexual satisfaction (3.25 ± 1.30) and orgasmic domains (3.5 ± 1.15). The foremost predictive factor behind low FSFI scores and associated FSD in our study was migraine (P < 0.00001). Additional predictors of statistical significance were low educational level (P < 0.01), urban residency (P < 0.02), high parity (P < 0.02), chronic illness such as diabetes (P < 0.01), and bad habits such as smoking (P < 0.03).

Conclusion

A significant correlation exists between migraine and female sexual dysfunction (FSD). Desire and arousal dysfunctions were the most significantly affected domains followed by satisfaction and orgasmic problems.

Sexual dysfunction and quality of life in female patients with major depression disorder

Background

Major depression can negatively affect different domains in patients’ psychosexual life. Many females with depression have sexual dysfunction which goes under diagnosed leading to reduced sexual and overall health quality of life. The aim of this study is to evaluate the risk of sexual dysfunction, sexual quality of life, and general health quality of life in a sample of Egyptian females diagnosed with major depression compared to a control group.

Results

The sample consisted of 100 participants recruited by convenience sampling, divided into a case group (50 female patients diagnosed with major depression enrolled from our institute’s outpatient clinic) and a control group (50 apparently healthy matched females enrolled from employees working in the university hospitals). Patients answered The Structured Clinical Interview for DSM-IV Axis I Disorders, the Female Sexual Function Index, the Sexual Quality Of Life-Female, and the WHO Quality of Life. Descriptive data analysis showed that all patients with major depression had a higher risk of sexual dysfunction compared to 36% in the control group, with higher rates of marital conflicts, unemployment, positive psychiatric family history and lower monthly income than those in controls. Correlation analysis showed a positive correlation between the sexual quality of life in the case group and the psychosexual feelings (emotional intimacy), self-worthlessness and the total score domains of the FSFI, and a positive correlation with psychosexual feelings, sexual relationship satisfaction, and self-worthlessness domains in the control group. Female sexual functioning scores were positively correlated with most of the WHO quality of life domains in the case group.

Conclusions

Female patients with major depression are distinctly prone to sexual dysfunction and marital problems that can lead to both defective sexual and overall health quality of life. This mandates thorough screening of the psychosocial risks of sexual dysfunction in patients with depression for early management and more satisfactory quality of life.

Instruments for assessing sexual dysfunction in Arabic: A systematic literature review

Sexual health is relevant throughout a person's life; however, studying human sexuality is complex and requires particular care when working with individuals from different cultural and social backgrounds. Much of the research addressing this subject has been conducted in Western countries, and that in non-Western countries is generally based on small sample sizes. The biopsychosocial nature of sexuality and its dysfunctions should be taken into consideration given that it is indispensable when conducting and assessing sexual studies in different countries and cultures. Therefore, culturally sensitive studies that consider cultural contexts and determinants as well as social markers are needed. The topic of sexuality in Arab culture is still enigmatic. This enigma has impacted the advancement of sexual science and limited researchers, health care practitioners, and patients. Thus, the aim of this systematic literature review was to find and assemble all scales and questionnaires regarding human sexual health that have been translated into Arabic and validated in order to promote a critical analysis of the methods used in each instrument and to inform readers and researchers of the limits and potential of each scale. Electronic databases were systematically searched, and eight instruments were selected for inclusion: the Arabic Index of Premature Ejaculation (AIPE), the Sexual Health Inventory for Men (SHIM), the Arabic Female Sexual Function Index (ArFSFI), the Female Genital Self-Image Scale (AVFGSIS), the Arabic Arizona Sexual Experiences Scale (ASEX), the Egyptian Pelvic Organ Prolapse/Incontinence Sexual Questionnaire (PISQ-IR), the Saudi Arabian Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire in Arabic (PSIQ-IR), and the Arabic Female Sexual Distress Scale (FSDS). All included instruments showed good validity and reliability for the target population. Future studies are needed to develop culturally sensitive instruments.

Economic burden of female genital mutilation in 27 high-prevalence countries

Background

Female genital mutilation (FGM) is a traditional harmful practice affecting 200 million women and girls globally. Health complications of FGM occur immediately and over time, and are associated with healthcare costs that are poorly understood. Quantifying the global FGM-related burden is essential for supporting programmes and policies for prevention and mitigation.

Methods

Health complications of FGM are derived from a meta-analysis and stratified by acute, uro-gynaecological, obstetric and psychological/sexual. Treatment costs are calculated from national cohort models of 27 high-burden countries over 30 years. Savings associated with full/partial abandonment are compared with a current incidence reference scenario, assuming no changes in FGM practices.

Results

Our model projects an increasing burden of FGM due to population growth. As a reference scenario assuming no change in practices, prevalent cases in 27 countries will rise from 119.4 million (2018) to 205.8 million (2047). Full abandonment could reduce this to 80.0 million (2047), while partial abandonment is insufficient to reduce cases. Current incidence economic burden is US$1.4 billion/year, rising to US$2.1 billion/year in 2047. Full abandonment would reduce the future burden to US$0.8 billion/year by 2047.

Conclusion

FGM is a human rights violation, a public health issue and a substantial economic burden that can be avoided through effective prevention strategies. While decreasing trends are observed in some countries, these trends are variable and not consistently observed across settings. Additional resources are needed to prevent FGM to avoid human suffering and growing costs. The findings of this study warrant increased political commitment and investment in the abandonment of FGM.

Effect of Urogenital Infection Educational Program on Women Knowledge and Practices

Background:

Urogenital infection is generally regarded as a silent epidemic. It is one of the major public health problems among women that causes a considerable proportion of gynecological morbidity and maternal mortality in developing countries.

Aim:

The aim of this study is to evaluate the effect of an educational program on women’s knowledge and practices about urogenital infection.

Methods:

A quasi-experimental research design was utilized in this study and was implemented at El Hadaka Maternity and Children’s Hospital (MCH) in Fayoum, Egypt. A purposive sample consisting of 50 women with ages ranging from 30 to 45 years old was considered for this study.

Two tools were used to conduct this study: a structured interview questionnaire consisting of the respondents’ demographic characteristics, knowledge, and practices regarding urogenital infection and a scale that aimed to assess their lifestyle.

Results:

The results revealed that 96% of the women have unsatisfactory knowledge about urogenital infection during the pre-intervention stage, 94% of them have satisfactory knowledge post-intervention, and 90% of them have satisfactory knowledge at follow-up, with a highly statistically significant difference at p-value < 0.01. The results also showed that 82% of the respondents have unsatisfactory practices at pre-intervention, 96% have satisfactory practices at post-intervention, and 98% of them have satisfactory practices at follow-up, with a highly statistically significant difference at p-value < 0.01.

Conclusion:

There was a significant improvement in women's knowledge and practices related to urogenital infection post-intervention and at follow-up with a p-value < 0.01. Likewise, a high positive correlation between total lifestyle, level of knowledge, and practices was noted during the pretest with a p-value < 0.01.

There is a need to provide different educational programs regarding knowledge and self-care practices for women with urogenital infection in different women's care settings.

Effect of Urogenital Infection Educational Program on Women Knowledge and Practices

Background:

Urogenital infection is generally regarded as a silent epidemic. It is one of the major public health problems among women that causes a considerable proportion of gynecological morbidity and maternal mortality in developing countries.

Aim:

The aim of this study is to evaluate the effect of an educational program on women’s knowledge and practices about urogenital infection.

Methods:

A quasi-experimental research design was utilized in this study and was implemented at El Hadaka Maternity and Children’s Hospital (MCH) in Fayoum, Egypt. A purposive sample consisting of 50 women with ages ranging from 30 to 45 years old was considered for this study.

Two tools were used to conduct this study: a structured interview questionnaire consisting of the respondents’ demographic characteristics, knowledge, and practices regarding urogenital infection and a scale that aimed to assess their lifestyle.

Results:

The results revealed that 96% of the women have unsatisfactory knowledge about urogenital infection during the pre-intervention stage, 94% of them have satisfactory knowledge post-intervention, and 90% of them have satisfactory knowledge at follow-up, with a highly statistically significant difference at p-value < 0.01. The results also showed that 82% of the respondents have unsatisfactory practices at pre-intervention, 96% have satisfactory practices at post-intervention, and 98% of them have satisfactory practices at follow-up, with a highly statistically significant difference at p-value < 0.01.

Conclusion:

There was a significant improvement in women's knowledge and practices related to urogenital infection post-intervention and at follow-up with a p-value < 0.01. Likewise, a high positive correlation between total lifestyle, level of knowledge, and practices was noted during the pretest with a p-value < 0.01.

There is a need to provide different educational programs regarding knowledge and self-care practices for women with urogenital infection in different women's care settings.

The effect of renal transplantation on female sexual function: An age-matched pair analysis

OBJECTIVES

To evaluate female sexual function (FSF) after renal transplantation (RT) and compare it to an age-matched normal females (control).

MATERIAL AND METHODS

The study included 100 sexually active RT women in child-bearing period. Sexual function was evaluated with Female Sexual Function Index (FSFI). We compared the mean scores of all domains of FSFI to an age-matched sexually active normal women. Also, we compared the current FSFI to the pre-transplant status in 54 married women before RT. Factors affecting the FSF after RT were assessed.

RESULTS

In comparison to control group, RT had statistically significant lower sexual desire (p <0.001) with no significant differences as regard arousal, lubrication, orgasm, satisfaction, pain and total FSFI score (P>0.05). Among RT, 83 % had normal sexual function and 83.7% of the control had normal sexual function (p=0.8). After RT, the FSFI score increased significantly from 20.7±5.4 to 27.8±3.1 (P<0.001) and 85.2% had normal sexual function compared to 22.2% before RT (P<0.001) with statistically significant improvement in all domains (p<0.001) except for pain score (p=0.8). Female circumcision was the only identified factor associated with FSD (P=0.02).

CONCLUSION

Successful RT significantly improves female sexual function of ESRD patients. The sexual function after RT is comparable to healthy control except for lower sexual desire.

Effectiveness of Counseling Based on Functional Analytic Psychotherapy with Enhanced Cognitive Therapy on the Sexual Quality of Life of Married Adolescent Women

OBJECTIVE

 Early marriage has many deleterious effects on the health of girls, such as sexual dissatisfaction, an inevitable result of the lack of sufficient knowledge about sexual issues at the time of the marriage. The goal of the present study was to determine the effectiveness of counseling based on functional analytic psychotherapy with enhanced cognitive therapy (FECT) on the sexual quality of life of married adolescent women.

METHODS

 This clinical trial was conducted between July and October 2019 on 150 married adolescent women who met the inclusion criteria. In the intervention group, FECT was conducted in sixteen 90-minute sessions twice a week. The Sexual Quality of Life-Female (SQOL-F) questionnaire was used. When the study ended, the control group was given the choice of receiving the same intervention as the intervention group.

RESULTS

 The paired t-test showed a significant difference between the mean score of sexual quality of life before (52.33 ± 23.09) and after (88.08 ± 10.51) counseling in the intervention group (p < 0.0001). According to the analysis of covariance, there was a significant difference between the score on sexual quality after counseling between the intervention (88.08 ± 10.51) and control (60.32 ± 23.73) groups (p < 0.0001). There was also a significant difference between the mean score on the four dimensions of sexual quality of life in the intervention group (p < 0.0001).

CONCLUSION

 The results showed that counseling based on FECT improved the sexual quality of life in all dimensions in married adolescent women.

Should I Seek Help for Sexual Difficulties? Middle-Aged Lebanese Women's Views

This qualitative study explored the way middle-aged Lebanese women address their sexual difficulties. Data analysis revealed three overarching themes and subthemes. From these we developed a help-seeking behavior framework for sexual difficulties. The framework focuses on: the perception of the problem, the beliefs about help-seeking and the sources of help. This framework can be used to facilitate access to personalized sexuality-related care based on a better understanding of the complex interplay of personal, socio-cultural and service-related factors that influence help-seeking behavior for sexual problems.

A new grading system for female sexual dysfunction based on the female sexual function index in Egyptian women: a cross-sectional study

Objective

To provide a grading system that accurately reflects the grades of female sexual dysfunction (FSD) severity.

Patients and methods

A cross-sectional study was conducted in Assiut University Hospital. It included 500 women who answered the Arabic version of the Female Sexual Function Index (FSFI) after getting their consent. A gradient of FSD severity was created, classifying FSD into five grades: severe, moderate, mild to moderate, mild, and no FSD.

Results

According to our grading system, FSD was detected in 339 women (67.8 %); Mild FSD in 20.4%, mild to moderate in 41.6%, moderate in 15.3%, and severe in 22.7%. Mean scores of desire show a linear trend of reduction from 3.8 in mild to 3.36 in mild to moderate to 2.25 in moderate and markedly reduced to 2.1 in severe grade. This difference was highly statistically significant (p= 0.002). The same was reported in arousal, orgasm, and satisfaction domains, while in lubrication and pain domains, the difference was not statistically significant.

Conclusion

In this study, our grading system was complementary to the FSFI. Moreover, it seems to be more practical and useful in grading the severity of FSD.

Middle-aged Lebanese women's interpretation of sexual difficulties: a qualitative inquiry

BACKGROUND

The study explores women's perception and experience of sexual difficulties. The need to address the subject was triggered by the scarcity of research that reflects on women's subjective views on sexual difficulties. This is particularly crucial for middle-aged women who frequently experience hormonal and psychosocial changes that may affect their sexual life.

METHODS

Using in-depth individual and focus groups interviews, 52 Lebanese women aged 40-55 years discussed their thoughts, feelings and behaviours concerning sexual difficulties. Women were recruited purposefully from clinical and non-clinical settings to get maximum sampling variation that provided rich information and deep understanding of the subject. Recordings were transcribed verbatim and analysed about the framework analysis. Many strategies were adopted to ensure rigour.

RESULTS

Women's narratives led to four themes: women's inability to communicate sexual desires and concerns; male sexual difficulties; marital conflicts; and sexual difficulties as context-bound. Women's sexual difficulties are driven by double standards and inhibiting sexual socialisation. Once married, many women had very challenging sexual experiences. They were obliged to silently bear their husbands' poor sexual performance to protect their masculinity and thus their social image and identity. Women's narratives also showed that marital conflicts, daily life problems as well as physical and psychological burdens further challenged their sexual wellbeing and contributed to their sexual difficulties.

CONCLUSION

The study makes a unique contribution to voicing women's views and concerns as sexuality is insufficiently researched and reported in Lebanon. It emphasises the multidimensional nature of female sexual difficulties, particularly the gender-based norms that inhibit their sexual selves and profoundly affect their sexual wellbeing and capacity to claim their sexual likes and dislikes. Findings have implications on research and practice to help women prevent and overcome their sexual difficulties.

Prevalence and Predictive Factors of Female Sexual Dysfunction in a Sample of Saudi Women

INTRODUCTION

Female sexual dysfunction (FSD) is a common health problem that is inadequately investigated in Saudi Arabia.

AIM

To assess the prevalence and predictors of FSD in a sample of Saudi women attending the primary care and gynecology clinics.

METHODS

A cross-sectional clinic-based survey involved Saudi women attending primary care and gynecology clinics in a teaching hospital in Riyadh during the period from January to June 2019. Data were collected using a structured interview questionnaire. Female sexual function has been evaluated by the Arabic version of the Female Sexual Function Index.

MAIN OUTCOME MEASURES

The main outcome measure of this study was female sexual function using the Arabic version of the Female Sexual Function Index.

RESULTS

200 Saudi women were included in this study. Their age ranged from 18 to 50 years. Most of the participants (88.5%) were fairly satisfied or satisfied with their spouse's sexual ability and 120 (60%) had a risk of FSD. Participants with FSD reported the lowest scores for arousal and desire domains (3.03 ± 1.3 and 3.12 ± 1.1, respectively) followed by orgasm domain (3.48 ± 1.4). Predictive factors for risk of FSD in our participants were age greater than 40 years (P = .012), unemployment (P = .035), low/moderate family income (P = .014), dissatisfaction with the spouse's sexual ability (P = .005), and higher weight (P = .010) and height (P = .043). Only age greater than 40 years (P = .041), low family income (P = .007), and dissatisfaction with spouse's sexual ability (P = .011) sustained independent significance in a multivariate logistic regression analysis.

CONCLUSION

A high prevalence of FSD was encountered in our sample of Saudi women. Desire and arousal were the most significantly affected domains followed by orgasmic problems. Age greater than 40 years, low socioeconomic level, and dissatisfaction with the spouse's sexual ability are the most significant predictors. Madbouly K, Al-Anazi M, Al-Anazi H, et al. Prevalence and Predictive Factors of Female Sexual Dysfunction in a Sample of Saudi Women. Sex Med 2021;9:100277.

Female Sexual Dysfunction Among a Sample of Egyptian Patients with Asthma

Background:

Despite asthma being a worldwide disease, still little awareness regarding the sexual function of asthmatic patients exists. So this study attempts to assess the Female Sexual Dysfunction (FSD) amongst Egyptian females with asthma and its burden on their quality of life.

Materials & Methods:

The sample consisted of 180 subjects, comprising 90 asthma patients and 90 healthy controls aged between 20 - 45 years old, who visited the Chest Department Outpatient Clinic of Ain Shams University Hospital between January and December 2018. We reported all the subjects' demographic and clinical data; both groups answered an Arabic version of the Female Sexual Function Index (Ar FSFI) and World Health Organization Quality of Life Questionnaire abbreviated version (WHOQL-Bref).

Results:

90% of asthmatic females had FSD; total Female Sexual Function Index score was 12.956 ± 10.3 in asthmatic females compared to 25.423 ± 5.521 in healthy controls; 45.6% of asthmatic females with sexual dysfunction had moderate asthma and 86.4% had uncontrolled asthma, 40.1% of them had a low educational level and 80.2% were unemployed.

Conclusion:

Jobless females with severe uncontrolled asthma and a low educational level had higher sexual dysfunction and a poor quality of life.

Socio-demographic determinants of low sexual desire and hypoactive sexual desire disorder: a population-based study in Iran

Background

Various socio-demographic factors have been introduced as the determinants of Low Sexual Desire (LSD), but whether these variables can also contribute to the Hypoactive Sexual Desire Disorder (HSDD), remains uncertain. In this study, we sought to identify the socio-demographic determinants of LSD and HSDD in Iranian women of reproductive age.

Methods

This was a population-based, cross-sectional study of 1000 married Iranian women of reproductive age (16–49 years) who met the inclusion criteria. The participants were chosen using the systematic random sampling method from all the healthcare centres in the city of Sari, Iran. LSD was defined as a score no higher than 33 on the Sexual Interest and Desire Inventory-Female (SIDI-F). The sexually-related personal distress was considered as a score of at least 11.0 on the Female Sexual Distress Scale-Revised (FSDS-R), and HSDD was determined based on the sum of those scores. Descriptive statistics were used to describe the socio-demographic characteristics and a chi-square test was run for data analysis using grouping variables. Multivariate logistic regression test was also employed to adjust the effect of confounding variables.

Results

The mean score of sexual interest/desire among women was 30.6 ± 10.5. After adjusting the effect of confounding variables, logistic regression showed that socio-demographic variables including age at first intercourse, length of marriage and the level of satisfaction with income were significantly associated with both LSD and HSDD (P < 0.01). While advancing age (P < 0.001) and body mass index (P < 0.01) were just predictors of LSD.

Conclusion

Some socio-demographic factors could predict LSD in women, while they were not associated with HSDD. In other words, some factors associated with LSD do not instigate sexually-related personal distress, which is one of the criteria necessary for the diagnosis of HSDD.

Evaluation of the relationship between sexual functions and depressive symptoms among pregnant patients during the second trimester

PURPOSE

Pregnancy is a process during which anatomical, physiological, and emotional changes occur. During this process, the sex lives of couples can be affected. Possible depressive symptoms and female sexual dysfunction can affect the relationship between partners, pregnancy-delivery process, and as a result, the newborn. The objective in the present study was to evaluate the relationship of female sexuality during pregnancy with sociodemographic parameters and depressive symptoms.

METHODS

150 pregnant women during the second trimester of their pregnancy and age-matched 150 healthy volunteers were included in the study. Sociodemographic data were recorded. "Female Sexual Function Index" (FSFI) was used to evaluate sexual functions and "Beck Depression Inventory" (BDI) was used to evaluate depressive symptoms. The data were analysed using SPSS 23 statistical software. The results were interpreted with "Independent Samples t Test", Spearman's Rho correlation coefficient, Mann-Whitney U analysis and Chi-square test, and a p value of < 0.05 was considered statistically significant.

RESULTS

It was detected that FSFI score of the pregnant group was lower compared to that of the non-pregnant group (16.953 ± 8.24; p = 0.000). There was no difference between the groups in terms of BDI scores (p = 0.100). There was no relationship between the FSFI score and the BDI score in the pregnant group (r = - 0.087; p = 0.144).

CONCLUSION

It was found that female sexual dysfunction occurs in pregnant women, depressive symptoms remained unchanged when compared to non-pregnant women and sexual functions remain unaffected.

Sexual dysfunction and associated factors among patients with epilepsy at Amanuel Mental Specialty Hospital, Addis Ababa - Ethiopia

BACKGROUND

Many patients with chronic illness have sexual dysfunction that may be related to the condition itself, drug side effects, emotional sequel, or a combination of those factors. Patients with epilepsy are no exception. Men and women with epilepsy are frequently complaining sexual dysfunction and they appear to have a higher incidence of sexual dysfunction than peoples with other chronic neurologic illness. These problems can have a substantial impact on their sexuality thus; it needs careful study and evaluation.

METHODS

Hospital based cross sectional study was conducted from January to July, 2016 among Patient with Epilepsy at Amanuel Mental Specialty Hospital. Interviewer administered Changes in Sexual Functioning Questionnaire (CSFQ-14) was used in order to assess the sexual problems. Finally, the data was analyzed by using Statistical Package for Social Science (SPSS) V-20. Descriptive statistics and logistic regression were used to describe the variables. Levels of significance of association determined at < 0.05.

RESULTS

A total of 694 respondents participated, with response rate 99.14%. Among them 576 completed all items. The result showed that 363 subjects (63.9, 95%CI = 59.5-67.7) had global sexual dysfunction. Furthermore, the rate of sexual dysfunction was reported as 55.6% (95%CI = 49.1-62.6) and 67.4% (95%CI = 62.8-72.1) in female and male participants, respectively. Among domains of sexual dysfunction; sexual arousal problem (97.8% (95%CI = 95.8-98.3)) and sexual pain problem (11.3% (95%CI = 8.8-13.9)) were the most and the least prevalent sexual dysfunctions respectively. Concerning associated factors; age grouped > 51, depression, being out of relationship or not satisfied with non-sexual aspect of relationship, being jobless and khat use has positive association with sexual dysfunction. By the other side alcohol use, level of education & age groups 18-21 years associated negatively.

CONCLUSIONS

The prevalence of sexual dysfunction among patients with epilepsy is very high; its prevalence is more among males than females. Sexual arousal problem and sexual pain problem were the most and the least prevalent sexual dysfunctions respectively.

Sexual experiences and quality of life in Turkish women using methods of contraception

The aim of this study was to examine the sexual experiences and quality of life in women using methods of contraception. The sample of this descriptive study consisted of 259 women. The data were collected by the Personal Information Form, the Arizona Sexual Experiences Scale (ASES) and the World Health Organisation Quality of Life Scale (WHOQOL-BREF). It was found that 35.1% of the women use condoms, 30.1% of them use the Intrauterine Device (IUD), 22.0% had problems using the method and 39% had the side effects while using the method. There was a statistically significant difference between the state of having problems using the methods and quality of life average scores and between the state of having side effects and sexual life and quality of life average scores (p < .05). Impact statement What is already known on this subject? Sexual problems are common health problems among women and can lead to loss of self-esteem in women, depression and emotional stress. What do the results of this study add? Women who experience problems using a contraception method have a lower quality of life. Sexual dysfunctions were higher among those who experienced side effects of the methods, quality of life scores were lower. What are the implications of these findings for clinical practice and/or further research? Health professionals should provide information and counselling about possible problems or side effects and ways to cope with these problems or side effects.

Sexual functions in pregnancy: different situations in near geography:a case study on Turkey, Iran and Greece

Purpose: This descriptive and cross-sectional study aims to determine the sexual function status of primipar and multipar pregnant women who admitted to birth clinics in Iran, Turkey and Greece and to investigate the relationship between pregnancy processes and some variables.Methodology: This descriptive and cross-sectional study population consisted of primipar/multipar pregnant women who met the research inclusion criteria, agreed to participate in the research and admitted to the Tabriz Pars Clinic in Iran, Izmir Aegean Maternity Hospital in Turkey and Thessaloniki University Hospital in Greece.Results: When the sexual problems of women are compared according to their countries,it was determined that 40% of Iranian women "can't easily share their sexuality issues with their spouses", whereas this rate was 8% in Turkey and 6.7% in Greece.Considering the prevalence of orgasmic and arousal disorder in the pre-pregnancy period,it was reported that this rate was 53% in Iran, 47% in Greece and 5.6% in Turkey.In the study, the mean "Female Sexual Function Index(FSFI)" score of Turkish women was found to be (59.83 ± 21.75), whereas the FSFI score of Iranian women was (62.86 ± 22.71) and mean FSFI score of the Greek women was (54.33 ± 21.15).Discussion: In the study, it was shown that there is a difference in the sexual problems of the women, depending on the religious and socio-cultural structure of the country they live in. For an effective case and training on sexuality,the norms and values of the society have to be understood in order to raise quality of lives and problem-free sexuality of pregnant women.

Prevalence and differences between type 1 and type 2 diabetes mellitus regarding female sexual dysfunction: a cross-sectional Egyptian study

OBJECTIVE

To evaluate the female sexual dysfunction in both type 1 and type 2 diabetes mellitus (DM).

METHODS

This cross-sectional study was carried out at Suez Canal University Hospitals from the start of February 2015 to the end of May 2016 among 189 married premenopausal women attending endocrinology and diabetology outpatient clinic for regular follow-up; 25 of whom refused to participate and 18 more were excluded due to incomplete data sets resulting in a final sample of 146 diabetic females. Ninety healthy women were recruited from the administrative staff at the hospital as a control group. Sexual dysfunction was assessed using female sexual function index (FSFI), a validated 19-item, self-administered, screening questionnaire comprising the six major sexual domains: desire, arousal, lubrication, orgasm, satisfaction and pain. Responses to each question were reported and scored on 0-5 scale with 0 representing no sexual activity and 5 suggestive of normal sexual activity.

RESULTS

Prevalence of sexual dysfunction was significantly higher in both type 1 and 2 DM groups (44 and 25%, respectively) than in the control group (9%). FSFI mean total score was significantly lower in type 1 DM (21.1 ± 3.9) than type 2 DM (26.4 ± 4.2) and both were significantly lower than the control group (31.5 ± 5.8). With regard to FSFI domains, mean values for desire, arousal, lubrication, orgasm, satisfaction and pain were significantly lower in both type 1 and type 2 DM groups when compared with the controls.

CONCLUSION

FSD is a significant health problem among premenopausal diabetic Egyptian women. Type 1 DM women were more affected than type 2 DM that in turn was more affected than healthy control females.

Predictors of female sexual dysfunction: a systematic review and qualitative analysis through gender inequality paradigms

Background

Female sexual dysfunction affects 41% of reproductive-age women worldwide, making it a highly prevalent medical issue. Predictors of female sexual dysfunction are multifaceted and vary from country to country. A synthesis of potential risk factors and protective factors may aid healthcare practitioners in identifying populations at risk, in addition to revealing modifiable factors to prevent sexual dysfunction among reproductive-age women.

Methods

Observational studies which assessed the prevalence and predictors of female sexual dysfunction in reproductive-age women were systematically sought in relevant databases (2000–2014). Significant predictors were extracted from each included publication. A qualitative analysis of predictors was performed with a focus on types of sexual regimes and level of human development.

Results

One hundred thirty-five studies from 41 countries were included in the systematic review. The types of predictors varied according to the location of the study, the type of sexual regime and the level of gender inequality in that country/region. Consistently significant risk factors of female sexual dysfunction were: poor physical health, poor mental health, stress, abortion, genitourinary problems, female genital mutilation, relationship dissatisfaction, sexual abuse, and being religious. Consistently significant protective factors included: older age at marriage, exercising, daily affection, intimate communication, having a positive body image, and sex education. Some factors however had an unclear effect: age, education, employment, parity, being in a relationship, frequency of sexual intercourse, race, alcohol consumption, smoking and masturbation.

Conclusions

The sexual and reproductive lives of women are highly impacted by female sexual dysfunction, and a number of biological, psychological and social factors play a role in the prevalence of sexual dysfunction. Healthcare professionals who work with women should be aware of the many risk factors for reproductive-age women. Future prevention strategies should aim to address modifiable factors, e.g. physical activity and access to sex education; international efforts in empowering women should continue.

Electronic supplementary material

The online version of this article (10.1186/s12905-018-0602-4) contains supplementary material, which is available to authorized users.

Factors Affecting Sexual Function in Midlife Women: Results from the Midlife Women's Health Study

OBJECTIVE

The objective of this study was to estimate the importance of risk factors affecting sexual function in sexually active midlife women.

MATERIALS AND METHODS

A cohort of 780 women undergoing the menopausal transition was surveyed each year for up to 7 years. Data were collected from sexually active women on sexual function, including frequencies of enjoyment, arousal, orgasm, passion for partner, satisfaction with partner, pain, lack of lubrication, fantasizing, and sexual activity. Data were also collected on a large number of potential risk factors for sexual dysfunction, including behaviors (smoking and alcohol use), health status (overall and frequency of different disorders), and demographic information (race, education, income, etc.). Height and weight were measured at an annual clinic visit; serum hormone concentrations were assayed using blood samples donated annually. Data on individual outcomes were examined with ordinal logistic regression models using individual as a random effect. An overall sexual function score was constructed from individual outcome responses, and this score was examined with linear regression. All factors with univariate associations of p < 0.1 were considered in multivariate model building with stepwise addition.

RESULTS

A total of 1,927 women-years were included in the analysis. Women with much more physical work than average had higher sexual function scores and higher rates of enjoyment, passion, and satisfaction. Higher family income was associated with lower sexual function score and more frequent dry sex. Married women had significantly lower sexual function scores, as did those with frequent irritability or vaginal dryness. A higher step on the Ladder of Life was associated with a higher sexual function score and higher frequency of sexual activity.

CONCLUSIONS

The factors associated with sexual outcome in menopausal women are complex and vary depending on the sexual outcome.

Effect of female genital mutilation/cutting; types I and II on sexual function: case-controlled study

Background

The existing literature is contradictory regarding effects of female genital mutilation/cutting (FGM/C) on sexual functions. The aim of this study was to explore the impact of type I and II FGM/C on sexual function of Egyptian women.

Methods

We recruited 197 cut women and 197 control women from those visiting Assiut University hospitals for different reasons. We asked each woman to fill the Arabic female sexual function index (FSFI) (a self reported 19-item questionnaire assessing the main domains of female sexual function). Genital Examination was done to confirm the type of FGM.

Results

Female sexual dysfunction (FSD) was found in 83.8% of FGM/C cases in contrast to 64.5% of the control. The total FSFI score in the FGM/C group (19.82 ± 7.1) was significantly lower than in the control group (23.34 ± 8.1). Concerning the types of FGM/C, type 73.6% of cases had type I and 26.4% had type II. Type I FGM/C was performed mainly by physicians (62.1%) while type II was performed mainly by midwives (44.4%).

FSD was found in 83.4% of FGM/C I cases and in 84.6% of FGM/C II cases. There was no statistically significant difference between the two types of FGM/C as regards total and individual domain scores except for the pain domain. There were significantly lower total and individual domain scores in both FGM/C types except for the desire domain compared to control.

Conclusion

In this study, FGM/C was associated with reduced scores of FSFI on all domains scores, and among both types I and II, both were associated with sexual dysfunction.

Effects of female genital mutilation/cutting on the sexual function of Sudanese women: a cross-sectional study

BACKGROUND

Female genital mutilation/cutting (FGM/C) is a cultural practice that involves several types of removal or other injury to the external female genitalia for nonmedical reasons. Although much international research has focused on the health consequences of the practice, little is known about sexual functioning among women with various types of FGM/C.

OBJECTIVE

To assess the impact of FGM/C on the sexual functioning of Sudanese women.

STUDY DESIGN

This is a cross-sectional study conducted at Doctor Erfan and Bagedo Hospital, Jeddah, Saudi Arabia. Eligible women completed a survey and a clinical examination, which documented and verified women's type of FGM/C. The main outcome measure was female sexual function, as assessed by the Arabic Female Sexual Function Index.

RESULTS

A total of 107 eligible women completed the survey and the gynecological examination, which revealed that 39% of the women had FGM/C Type I, 25% had Type II, and 36% had Type III. Reliability of self-report of the type of FGM/C was low, with underreporting of the extent of the procedure. The results showed that 92.5% of the women scored lower than the Arabic Female Sexual Function Index cut-off point for sexual dysfunction. The multivariable regression analyses showed that sexual dysfunction was significantly greater with more extensive type of FGM/C, across all sexual function domains (desire, arousal, lubrication, orgasm, satisfaction, and pain) and overall.

CONCLUSION

The study documents that a substantial proportion of women subjected to FGM/C experience sexual dysfunction. It shows that the anatomical extent of FGM/C is related to the severity of sexual dysfunction.

Prevalence of sexual dysfunction in saudi women with Type 2 diabetes: Is it affected by age, glycemic control or obesity?

Objective:

Sexual dysfunction (SD), as a diabetes mellitus (DM)-related complication, is common among patients having diabetes. This study aimed to ascertain the prevalence of SD in Saudi women with type 2 DM and to determine whether age, glycemic control, and obesity are associated with SD or not.

Methods:

A total of 275 Saudi women with type 2 diabetes took part in this cross-sectional study and filled out the Female Sexual Function Index through a fill-coded questionnaire in primary care clinics in King Khalid University Hospital, Riyadh, in the period between January 2013 and May 2013. The level of glycosylated hemoglobin and the body mass index were assessed to evaluate the DM control status and obesity among the patients.

Results:

SD was reported by 88.7% of the Saudi women with type 2 diabetes. The results showed a significant association between the presence of SD and the increase in age of patients at 92% in the age group above 50 years. Glycemic control did not show a significant association with SD. The obesity factor showed a slight increase in SD by weight, but it was not statistically significant.

Conclusion:

The prevalence of SD among the Saudi women having type 2 diabetes is high and increases with age. No association was found between SD and glycemic control.

Sexual counselling for treating or preventing sexual dysfunction in women living with female genital mutilation: A systematic review

BACKGROUND

Female sexual dysfunction is the persistent or recurring decrease in sexual desire or arousal, the difficulty or inability to achieve an orgasm, and/or the feeling of pain during sexual intercourse. Impaired sexual function can occur with all types of female genital mutilation (FGM) owing to the structural changes, pain, or traumatic memories associated with the procedure.

OBJECTIVES

To conduct a systematic review of randomized and nonrandomized studies into the effects of sexual counseling with or without genital lubricants on the sexual function of women living with FGM.

SEARCH STRATEGY

Cochrane Central Register of Controlled Trials, MEDLINE, African Index Medicus, SCOPUS, LILACS, CINAHL, ClinicalTrials.gov, Pan African Clinical Trials Registry, and other databases were searched to August 2015. The reference lists of retrieved studies were checked for reports of additional studies, and lead authors contacted for additional data.

SELECTION CRITERIA

Studies of girls and women living with any type of FGM who received counselling interventions for sexual dysfunction were included.

DATA COLLECTION AND ANALYSIS

No relevant studies that addressed the objective of the review were identified.

CONCLUSIONS

Despite a comprehensive search, the authors could not find evidence of the effects of sexual counseling on the sexual function of women living with FGM. Studies assessing this intervention are needed.

PROSPERO REGISTRATION

CRD42015024593.

Female genital mutilation: a systematic review of research on its economic and social impacts across four decades

Background

Global efforts to end female genital mutilation (FGM) have intensified in recent decades because of the rising awareness that such a practice is an act of extreme violence against women and girls. Articles on FGM have been published highlighting the combined efforts of international and non-governmental organizations, governments, as well as religious and civil society groups to end the practice. However, the consequences of this research are not well known, and it seems that the socioeconomic aspects of the practice are underreported.

Objective

This review aims to characterize over a 40-year period the scientific output on the consequences of FGM in African countries, the most affected region known for the high prevalence of FGM, and review data on the socioeconomic consequences of the practice.

Design

A systematic review of literature was done, looking at the following databases: PubMed, Embase, CINAHL, BDSP, Web of Science, PsycINFO, FRANCIS, Sociological Abstracts, WHOLIS, RERO, and SAPHIR. The analysis was limited to articles concerning the African continent, published in English and French, from January 1, 1972, to December 31, 2011.

Results

One hundred ninety-eight articles were reviewed. More than half of the articles were published during the last decade of the study period. The majority of papers were published in biomedical journals (64.1%). Most studies looked at Africa as a region (33.3%). Nigeria was the single country most investigated (19.2%), followed by Egypt (10.6%). Most first authors were affiliated to non-African countries (60.6%): among them 21.2% were US-based, 4% were from African institutions, and 16.2% from Nigeria.

The medical and psychological consequences (51.5%) and the prevalence and ethics of the practice (34.4%) were the most frequently investigated topics. The socioeconomic consequences were addressed in a minority of the papers (14.1%): they were classified into direct economic consequences (2.5%), school attendance (1%), marriageability (2%), sexual and marital consequences (3.5%), fertility (2.5%), domestic violence (1%), and discrimination (1.5%).

Conclusions

The publication of articles on the consequences of FGM is increasing, but there is little research on the socioeconomic consequences of the practice. More scientific data focusing on this dimension is necessary to strengthen prevention, advocacy, and intervention campaigns.

Factors Affecting Sexual Activity in Midlife Women: Results from the Midlife Health Study

BACKGROUND

The objective of this study was to identify (1) the importance of a number of potential factors affecting the likelihood of sexual activity in perimenopausal women and (2) the likelihood of a number of barriers to sexual activity.

METHODS

A cohort of 780 women undergoing menopausal transition was surveyed annually for up to 7 years. Data were collected on sexual activity and, if not sexually active, reasons for no sexual activity, as well as a number of potential risk factors. Height and weight were measured at an annual clinic visit; serum hormone concentrations were assayed using blood samples donated annually. Data were examined with logistic regression models using the individual as a random effect, with subset analysis of nonsexually active women to determine the likelihood of each barrier. All factors with univariate associations of p < 0.1 were considered in multivariate model building with stepwise addition.

RESULTS

A total of 2440 woman-years were included in the analysis of sexual activity. The likelihood of sexual activity increased for women living with a partner, with perceived quality of life, and with less frequent hot flashes. Among 513 woman-years reporting no sexual activity, women living with a partner and women reporting frequent fatigue were less likely to lack a sexual partner, but were more likely to have sexual difficulties. Women with more physical work than average and women with higher serum estradiol levels were less likely to have sexual difficulties.

CONCLUSIONS

The factors associated with sexual activity in menopausal women are complex, indicating that an individualized approach to improving sexual activity is required.

Assessment of female sexual function in a group of uncircumcised obese Egyptian women

The aim of the present study was to assess female sexual function in an obese group (250 women) and to compare it with a control group (100 women), among 25-35-year-old uncircumcised Egyptian women, using female sexual function index (FSFI) score. FSFI total score of ⩽ 26.55 was considered diagnostic of Female Sexual Dysfunction (FSD). The percentage of FSD in the obese group was 73.6% while it was 71% in the control group, which was statistically insignificant (P > 0.05). The difference between both groups regarding the total (FSFI) score was insignificant (P > 0.05), but arousal and satisfaction domains scores were significantly lower in the obese group. In the obese group, a strong negative correlation between body mass index and arousal, orgasm and the total FSFI score was found. Women with excessive obesity had the lowest total FSFI score. In the obese group, college graduates had the highest total scores and all domain scores of FSFI followed by high school graduates while the least educated women had the lowest scores and when these subgroups were compared, significant differences were found among them. We conclude that in uncircumcised 25-35-year-old Egyptian women, obesity is not a major detrimental factor for FSD, but it may affect some sexual domains such as arousal and satisfaction, although excessive obesity is associated with FSD. Also, educational and cultural factors may have an impact on perception of sex and pleasure.

Arabic validation of the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR)

INTRODUCTION AND HYPOTHESIS

Our aim was to translate then assess the reliability of the culturally adapted Pelvic Organ Prolapse/Incontinence Sexual Function Questionnaire, International Urogynecological Association (IUGA)-Revised (PISQ-IR) to assess sexual health among Arabic-speaking women with pelvic floor disorders.

METHODS

PISQ-IR was modified to consider cultural characteristics of the Middle East. The final reliability study included 172 women with urinary incontinence (UI) and/or pelvic organ prolapse (POP). Participants completed the questionnaire twice: at enrollment and 2 weeks later.

RESULTS

Among sexually active women, good internal consistency was observed for five of the six scales in the adapted instrument: Global Quality (Cronbach's coefficient α = 0.86), Condition Impact (α = 0.87), Desire (α = 0.82), Condition Specific (α = 0.74), and Partner Related (α = 0.75). Internal consistency was acceptable for the Arousal Orgasm subscale (α = 0.66). However, among not sexually active women, internal consistency was poor (α <0.6) for all four scales. Lin's concordance correlation coefficient measuring agreement between test and retest measurements [Lin's concordance correlation coefficient (CCC); a value of 1 represents perfect agreement] ranged from 0.81 to 0.87 for the not sexually active scales, except for condition impact (CCC = 0.63.) For sexually active women, CCC was typically stronger, ranging from 0.85 to 0.96.

CONCLUSIONS

PISQ-IR questionnaire is easy to administer and reliable for assessing sexual function in sexually active Arabic women with POP and UI, but internal consistency is poor for Arabic women not sexually active.

The assessment of sexual dysfunction in Egyptian women with lower urinary tract symptoms

Introduction

Female sexual dysfunction (FSD) has been reported in 46% of women with lower urinary tract symptoms (LUTS). FSD is a common health problem that remains under-investigated, especially in Eastern communities, where discussion of the issue is considered a taboo. In this study we determined the prevalence of various subtypes of FSD in relation to LUTS in women in Ismailia, Egypt.

Patients and methods

This was a case-control study to assess FSD in women with LUTS in comparison to normal women. In all, 101 women patients attending the Urology clinic at our institution were divided into two groups, a study group of 52 with LUTS and a control group of 49 with no LUTS. Validated Arabic versions of the FSD index and the Bristol questionnaire were used to assess the participants, and the data analysed statistically.

Results

FSD was diagnosed in 75 of the 101 patients (74%); 87 (86%) reported hypoactive sexual desire, 61 (60%) reported sexual arousal disorder, 56 (55%) had lubrication disorders, 65 (64%) complained of orgasmic deficiency, 36 (36%) had satisfaction disorder, and 59 (58%) had sexual pain disorder (e.g., dyspareunia or non-coital genital pain). Arousal, satisfaction, orgasmic and lubrication disorders were more common in the women with LUTS. There was no statistically significant difference in desire disorders between the groups.

Conclusions

FSD and its subtypes are more prevalent in women with LUTS in this sample of Egyptian women.

Orgasmic dysfunction among Malay diabetic women in Malaysia

OBJECTIVES

The present study aimed to determine the prevalence and associated factors of orgasmic dysfunction among Malay women with type 2 diabetes mellitus in Malaysia.

METHODS

This cross-sectional study involved 347 women (174 non diabetic and 173 diabetic subjects) who attended the diabetic clinic in a university hospital. Orgasmic dysfunction was assessed using the orgasmic subscale of Malay Version of the Female Sexual Function Index (MVFSFI). Sociodemographic information of the subjects was collected with a pre-designed questionnaire.

RESULTS

Prevalence of orgasmic dysfunction among Malay women was 13.3% and 10.3% in type 2 diabetes mellitus and control group, respectively. However, the difference was not statistically significant. Multivariate logistic regression analysis showed that unemployment (Adjusted Odds Ratio, AOR=2.69, 95% CI=1.22, 5.97) and lower academic status (AOR=0.35, 95% CI=0.17, 0.72) were significantly associated with sexual orgasmic dysfunction in diabetic women.

CONCLUSION

Orgasmic dysfunction was highly prevalent among the Malay women regardless of the diabetic state. It is recommended that orgasmic dysfunction in women with diabetes should be assessed during routine clinical health visit to the hospital for early treatment.

The effects of Femore™ cream on sexual dysfunction in Turkish women

AIMS AND OBJECTIVES

To investigate the effects of Femore™ cream on sexual dysfunction in menopause and women's satisfaction levels.

BACKGROUND

The recent interest of public and the world of medicine in female sexual function have led to a rapid increase in the number of studies on the subject.

DESIGN

The study was designed as an observational intervention study.

METHODS

The research data were collected by using a Women Information Form consisting of 13 items; a Sexual Function Index to measure sexual function; and a Satisfaction Determination Form to determine the level of satisfaction with the medical service the women received for the problems with their reproductive organs. The study was conducted with 29 menopausal women who complied with the inclusion criteria.

RESULTS

It was found that women's average age was 52·6; that the average menarche age was 13·0; and that the average menopause age was 46·2. The major complaint of nearly all the women who were aware of their sexual dysfunction was vaginal dryness, and it was concluded that they took no precautions against this problem. The total scores obtained from the Sexual Function Index were reported to be an average of 18·8 ± 4·2 before use of Femore™ cream and an average of 42·3 ± 2·0 after use of Femore™ cream. The average score concerning satisfaction with the use of Femore™ cream was noted to be 9·06 ± 0·40.

CONCLUSIONS

The study results suggested that applying Femore™ cream had positive influences on sexual dysfunction and all subdomains.

RELEVANCE TO CLINICAL PRACTICE

Women's sexual health can therefore be assessed at primary care centres, and it is considered that health professionals employed at these centres, a majority of whom are female nurses and obstetricians, can play an important role in guiding women on the issue.

Investigating the sexual function and its associated factors in women with chronic illnesses

AIMS AND OBJECTIVES

To evaluate sexual dysfunction and the factors that affect sexual dysfunction in women with chronic disease.

BACKGROUND

Sexual dysfunction is one of the most common problems in women with chronic disease. There is limited understanding of the related factors of sexual dysfunction in women with chronic disease, with research currently limited to other problems and problems related to chronic diseases.

DESIGN

This research was conducted as a descriptive survey.

METHODS

This study involved 100 female inpatients at clinics of internal medicine of a university hospital. Data were collected with a patients identification form and a female sexual function index (KCFI). Kruskal-Wallis test, test of significance of difference between two means and test of significance of difference between two pairs were used in the data analysis.

RESULTS

Sixty-five percentage of women in the sample were defined to have sexual dysfunction. The majority of women expressed pain during sexual intercourse, problems in orgasm and satisfaction, and reluctance to have sex. Older age, being unemployed, being in menopause, fatigue, sleep disorder, and pain and weakness in extremities were the factors that were found to significantly affect the prevalence of sexual dysfunction (p < 0.05).

CONCLUSIONS

This study concluded that sexual function of women with chronic disease is affected negatively. Chronic disease-related symptoms, experienced changes in the body and psychosocial problems are changing the lives of women. Ultimately, these changes also affect sexual activity.

RELEVANCE TO CLINICAL PRACTICE

Determination of the factors affecting sexual activity in women with chronic disease is important for women' ability to cope with sexual dysfunction and keep it under control. To be able to accomplish this, it is necessary for healthcare personnel, the partners and family to work together.

Patterns of help-seeking in women when problems arise in their sexual life: a discussion paper

AIMS AND OBJECTIVES

To explore patterns of help-seeking in women who have sexual dysfunction and the implications for nursing practice.

BACKGROUND

Female sexual dysfunction is a common problem that is under-reported and untreated. Barriers to help-seeking reported in existing literature relate to the perception among many women that sexual dysfunction is: part of the normal ageing process; not bothersome or does not exist; an issue that health professionals are reluctant to address; a taboo subject. However, little is known about patterns of help-seeking in women with sexual problems. This leaves a potential gap in nursing knowledge regarding appropriate, supportive strategies.

DESIGN

Discursive inquiry framed theoretically by Vogel's model.

METHODS

A literature review was undertaken by searching relevant databases. A combination of keywords was used to identify peer-review papers relating to women's help-seeking behaviour for sexual dysfunction. Vogel's model was used as a framework to extract relevant information from the papers and structure the discussion.

RESULTS

Vogel's model comprises four steps: encoding and interpreting, generating options, decision-making and evaluation of behaviour. Using this stepwise approach helped elucidate the complex mechanisms associated with help-seeking in a structured manner. The key issues associated with help-seeking intention are concerned with women's personal awareness of and interaction with the environment.

CONCLUSIONS

Vogel's model offers a new approach to understanding the dynamics that underpin women's decisions to seek professional help when sexual concerns arise and also provides a useful framework for nurses to consider women's specific sexual concerns.

RELEVANCE TO CLINICAL PRACTICE

Implications for nursing practice are focused on public awareness, women's empowerment and the provision of effective sexual health care. Because sexual dysfunction is a global phenomenon, it is likely that the discussion in this paper will be relevant to an international, nursing readership.