Young women distressed about their sex lives

According to a recent study, young women have very high rates of sexually related personal distress, and a concerning number of women admit poor sexual self-image. The cross-sectional survey was published in Fertility and Sterility.

Methods
Using information from the Australian Grollo-Ruzzene Foundation Young Women’s Health Study, the authors were able to collect data from 6,986 Australian women between aged 18 to 39. Participants completed the Profile of Female Sexual Function (PFSF) a 36-item, 30-day recall questionnaire that assessed separate domains of desire, arousal, orgasm, responsiveness, sexual self-image, pleasure, and sexual concerns. Responses were recorded using a 6-point Likert scale. A score < 40 for the desire domain, which includes nine items, was used to classify low “desire.” Sexually related personal distress over the past 30 days was assessed by means of the Female Sexual Distress Scale – Revised (FSDS-R), a 13-item questionnaire in which a score ≥ 11 indicates sexually related personal distress.

Findings
Almost one-third of the study participants described themselves as single, 47% had a body mass index (BMI) within the normal range and 69.4% reported being sexually active within the past 30 days. The most prevalent sexual difficulty was low sexual self-image (reported by 13.4% of women), followed by low desire (11.8%), low arousal (11.7%), low orgasm (10.8%), and low responsiveness (4.1%) The median FSDS-R score was 11.0 (IQR 2.0-22.0) and 3,508 women (50.2%, 95% CI 49.0%-51.4%) were classified as having sexually related personal distress. Median FSDS-R scores among women with low PFSF domain scores arranged from 20 to 33, while the median FSDS score for women without a low score in any PFSF domain was 7 (IQR 1-17). Low responsiveness was reported by the smallest number of women, but it had the highest median distress score and 83% of these women had a sexually related personal distress. 

Slightly over half (51.3%) of women with FSD had only one dysfunction with 40.6% having sexual self-image dysfunction. Responsiveness dysfunction was the least likely to occur on its own. Fifty-five percent of women with responsiveness had three or four other sexual dysfunctions. Furthermore, 1,440 women (20.6%, 95% CI 19.7% - 21.6%) had one or more FSDs. Of the women who had two sexual dysfunctions, the most common combinations were arousal with orgasmic dysfunction and arousal with sexual self-image dysfunction. Thirty-three percent of women with three sexual dysfunctions had desire, arousal, and sexual self-image dysfunction. 

Using multivariable risk assessments for sexual dysfunction, the authors found that a lower likelihood of desire dysfunction was significantly associated with Asian ethnicity, infertility treatment, pregnancy, and alcohol consumption. Arousal dysfunction was significantly associated with being older than 24 years, being partnered compared with being single, breastfeeding, and psychotropic drug use. Psychotropic drug users and being a current smoker were also significantly more likely to have orgasmic dysfunction. The independent risk factors for having nonspecific sexually related personal distress included taking a psychometric medication (OR 1.94, 95% CI 1.66-2.27, P < 0.001), being sexually inactive (OR 1.90, 95% CI 1.62-2.22, P < 0.001), being a smoker (OR 1.24, 95% CI 1.04-1.47, P < 0.02), paid unemployment (OR 1.20, 95% CI 1.05-1.37, P < 0.01), consuming alcohol (OR 1.16, 95% CI 1.02-1.32, P < 0.03), and having infertility treatment (OR 2.31, 95% CI 1.47-3.36, P < 0.001). 

Conclusions
The findings that one-half of young Australian women have sexually related personal distress and approximately 20% of women have at least one FSD are alarming. The most common FSD in this population is sexual self-image, which is especially alarming. While more research is needed to see if these findings are replicable in other populations, this study illustrates the need for ob/gyns to recognize personal distress signals and have an appropriate management or referral pathway in place for patients who exhibit them.