|Year : 2022 | Volume
| Issue : 1 | Page : 15-20
High burden of female sexual dysfunction: An online survey of Nigerian women
Ejiroghene Martha Umuerri1, Christiana Omotola Ayandele2
1 Department of Medicine, Delta State University, Abraka; Department of Medicine, Delta State University Teaching Hospital, Oghara, Nigeria
2 GPST2 East Suffolk and North Essex trust foundation, Ipswich, IP4 5PD, HEE East of England, UK
|Date of Submission||08-Apr-2022|
|Date of Acceptance||25-Jun-2022|
|Date of Web Publication||25-Aug-2022|
Dr. Ejiroghene Martha Umuerri
Department of Medicine, Delta State University, P.M.B. 01, Abraka
Source of Support: None, Conflict of Interest: None
INTRODUCTION: Female sexual dysfunction (FSD) is common but underresearched in Nigeria.
OBJECTIVE: The objective of this study is to ascertain the prevalence and associated risk factors of FSD in Nigeria.
METHODS: A cross-sectional observational online survey of sexually active Nigerian women aged ≥18 years using the Female Sexual Function Index (FSFI). The FSFI assessed six domains: arousal, desire, lubrication, orgasm, pain, and satisfaction. Respondents with an FSFI score of <26.6 had FSD. Ethical approval was duly obtained, and the study was conducted as per Helsinki Declaration.
RESULTS: Of the 388 women that participated in the survey, 72.4% were <40 years old, 59.3% were married, 9.3% and 1.8% reported hypertension and diabetes mellitus, and 44.6% and 5.2% consumed alcohol and smoked tobacco. The mean (±standard deviation) FSFI score was 25.4 (±6.76). A total of 187 (46.7%) of the respondents had scores <26.6. Sexual domain disorders observed were desire (35, 9.0%), lubrication (49, 12.6%), satisfaction (52, 13.4%), arousal (58, 14.9%), orgasm (90, 23.2%), and pain (101, 26.0%). Respondents with sexual dysfunction were predominantly aged 50–59 years (77.8%), cohabiting (66.7%), had postgraduate education (52.6%), unemployed (62.2%), and rural dwellers (56.1%). Hypertension (57.3%), diabetes mellitus (28.6%), alcohol consumption (38.2%), and tobacco smoking (70.0%) were reported among respondents with sexual dysfunction. Respondents' sociodemographic characteristics and sexual dysfunction were not significantly associated. Tobacco smoking (P = 0.038) and alcohol consumption (P < 0.001) were associated with sexual dysfunction.
Keywords: Female sexual dysfunction, female sexual function index, Nigeria, prevalence
|How to cite this article:|
Umuerri EM, Ayandele CO. High burden of female sexual dysfunction: An online survey of Nigerian women. J Med Womens Assoc Niger 2022;7:15-20
|How to cite this URL:|
Umuerri EM, Ayandele CO. High burden of female sexual dysfunction: An online survey of Nigerian women. J Med Womens Assoc Niger [serial online] 2022 [cited 2023 Feb 7];7:15-20. Available from: http://www.jmwan.org/text.asp?2022/7/1/15/354692
| Introduction|| |
Sexual dysfunction refers to any problem that makes sexual activity undesirable or unsatisfactory. It can occur during any phase of the sexual activity cycle. Regardless of gender, four phases in the sexual response cycle have been described: desire, arousal (excitement), orgasm, and resolution phase. However, sexual dysfunction is broadly divided into disorders of desire, lubrication, arousal, orgasm, satisfaction, and pain in women.
Female sexual dysfunction (FSD) negatively impacts physical and psychosocial health. Its presence may signify underlying medical conditions such as mental health disorders, cardiovascular diseases, and gynecological disorders.,, The knowledge of the rates of occurrence of FSD and the primary risk factors for these conditions are pivotal in the risk assessment and strategies for its prevention and treatment. The Global Online Sexuality Survey was conducted across the globe to provide knowledge about sexual problems among Internet users of both sex, and it was carried out in different languages.,, However, there is a shortage of information on sexual dysfunction among Nigerian women. This survey aims to determine the prevalence and associated risk factors of FSDs among Internet users in Nigeria during the COVID-19 lockdown.
| Methods|| |
The study was a web-based observational survey of adult Nigerian women living in Nigeria between August and December 2020.
Potential respondents were sexually active women aged 18 years or more. Participation in the survey was entirely voluntary, and participants' anonymity and confidentiality were maintained. Invitations to participate in the survey were randomly sent to potential respondents through WhatsApp, one of Nigeria's most frequently used social media handles. Eligible respondents were sexually active women aged at least 18 years. The survey questionnaire was made available only to consenting respondents. A formal ethical approval (HREC/PAN/2020/025/0367) was obtained before the conduct of the study.
The study instrument was a Google Form document with sequential questions. The questionnaire contained sociodemographic characteristics, cardiovascular risk factors, and sexual function. The 19-item Female Sexual Function Index (FSFI) questionnaire assessed sexual function. The FSFI has been previously validated as a valuable tool to assess sexual health among Nigerian women. The FSFI tests have six domains (number of questions): desire (2), arousal (4), lubrication (4), orgasm (3), sexual satisfaction (3), and pain (3). All domains except for desire and sexual satisfaction have a score range of 0–5 per question. The desire and sexual satisfaction score range are 1–5 per question. Domain disorder is scored as: desire (<4), arousal (<10), lubrication (<10), orgasm (<8), sexual satisfaction (<8), and pain (<10). The overall cutoff FSFI score is 26.6. Respondents with scores of at least 26.6 had no sexual dysfunction, while those <26.6 had dysfunction using the FSFI.
Obtained data were exported from Google Sheets to the International Business Machine Statistical Product and Service Solution (IBM-SPSS) version 23 (IBM Corp., Armonk, NY, USA) for analysis. Analyzed data were summarized and presented as text and tables. Analyzed data were summarized as frequencies, percentages, and measures of central tendency (mean, standard deviation, median, and mode) are presented in text, tables, and charts. The Chi-square tested the associations between categorical variables. The difference in means of continuous variables was tested using the independent t-test. Binary logistic regression was used to explore further the relationship between sexual dysfunction and the characteristics of the respondents. The level of statistical significance was P < 0.05 at a 95% confidence interval (CI).
| Results|| |
Three hundred and eighty-eight women completed the study questionnaire. The respondents' estimated mean, median, and modal ages were 34, 33, and 25 years. More than 70% of the respondents were aged <40 years. Most of the women were married (59.3%), had more than primary education (98.5%) and working (89.9%). [Table 1] shows the sociodemographic characteristics and cardiovascular risk profile of the respondents.
|Table 1: Sociodemographic profile and cardiovascular risk factors of respondents|
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Using the FSFI cutoff of 26.6, 184 (47.4%) respondents had sexual dysfunction. The mean (±standard deviation) FSFI score was 25.4 ± 6.76 (total population), 29.97 ± 2.18, 95% CI: 29.67–30.27 (no sexual dysfunction), and 20.3 ± 6.48, 95% CI: 19.37–21.26 (sexual dysfunction). The difference in mean FSFI score between respondents with and without sexual dysfunction was statistically significant (P < 0.001, 95% CI of the difference = 8.711–10.605).
[Table 2] shows the frequency of sexual disorders by domain tested. Respondents with sexual dysfunction had significantly higher disorders across the six domains tested. The most frequently encountered problems with sexual functioning were orgasm (90, 23.2%) and dyspareunia (101, 26.0%). About half of the respondents with sexual dysfunction had problems with orgasm (87, 47.3%) and pain (86, 46.7) compared with 3 (1.5%) and 15 (7.4%), respectively, among respondents without sexual dysfunction [Table 2].
Respondents with sexual dysfunction were found to be predominantly sexual dysfunction mainly was found among respondents aged 50–59 years (77.8%), cohabiting (66.7%), had a postgraduate level of education (52,6%), unemployed (62.2%), lived in rural areas (56.1%), and the South-East geopolitical zone (62.5%) [Table 3]. However, the association between sexual dysfunction and the sociodemographic characteristics of the respondents was not statistically significant [Table 3]. Furthermore, hypertension and diabetes mellitus were not found to be significantly associated with sexual dysfunction [Table 3]. In contrast, consumption of alcoholic beverages, tobacco smoking, and antihypertensive medication use was significantly associated with sexual dysfunction [Table 3].
|Table 3: Association between sociodemographic profile, cardiovascular risk factors, and female sexual dysfunction|
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Sociodemographic variables and cardiovascular risk factors with P < 0.2 obtained using Chi-square test [Table 3] were further analyzed using binary logistic regression to determine their relationship with sexual dysfunction among the respondents. The significant predictors of sexual dysfunction were residence (adjusted odds ratio [95% CI] =0.487 [0.279–0.847], P = 0.011), alcohol consumption (adjusted odds ratio [95% CI] =2.264 [1.447–3.541], P < 0.001), and tobacco smoking (adjusted odds ratio [95% CI] =0.243 [0.085–0.697], P = 0.008).
| Discussion|| |
FSD is underresearched but thought to be highly prevalent among women irrespective of mental or organic illnesses. The assertion is confirmed in this study as about half of the respondents (46.7%) had sexual dysfunction. Indeed, the high prevalence of FSD in this study is comparable with other general population-based studies from Nigeria and worldwide.,,, Nwagha et al., reported the prevalence of 53.5% among women in a university community in South-East Nigeria, and Imbeah et al. reported 45.6% in a nationwide survey in Ghana. Compared with women drawn from the general population, the burden of FSD appears to be more among women with mental disorders and organic illnesses such as diabetes mellitus and retroviral disease. For example, hospital-based studies among Nigerian women show that about 9 out of 10 women have FSD: 88.0% with diabetes mellitus, 89.2% with retroviral disease, and 95.7% with mental disorders. Sexual dysfunction in women results in poor quality of life and may be a manifestation of an underlying illness. Thus, it is prudent to routinely assess the sexual health status of women during clinical encounters, irrespective of the reason for the visit using simple assessment tools.
The mean scores in each of the six domains of sexual function tested were significantly lower among respondents who had FSD. Disorders of orgasm and pain were the most encountered domains in this study. Respondents with FSD commonly had orgasm disorder (47.3%), closely followed by dyspareunia (46.7%). Safarinejad also reported problems with orgasm as the most frequently encountered sexual disorder. Dyspareunia was also a common domain disorder among respondents with no sexual dysfunction (7.4%). Sexual desire was the minor problem identified in this study. This finding is contrary to reports from other studies in which desire was a common sexual disorder.,, Indeed, reports from existing literature show varying patterns and frequencies of sexual domain disorders.,,, The lack of trend in patterns domain disorders may be attributable to the fluid and multifactorial causes of sexual dysfunction, including psychosocial factors such as relationship-related disharmony, financial pressures, family size, and biological factors including the presence of physical or mental illnesses. However, the index study is limited in its scope and cannot make factual inferences on reasons for the observed pattern of sexual disorders.
In this study, the prevalence of sexual dysfunction was not significantly associated with sociodemographic characteristics (age, marital status, educational status, occupation, religion, place of residence, and geopolitical zone). Unlike previous studies that found age to be significantly associated with FSD. Like erectile dysfunction, FSD is linked with atherosclerotic cardiovascular risk factors such as hypertension,, and diabetes,, In this study, neither hypertension nor diabetes mellitus was significantly associated with FSD. On the contrary, tobacco smoking and consumption of alcohol, behavioral cardiovascular risk factors, were found to be substantially associated with FSD.
The inconsistency in the factors associated with FSD in this study compared with previous reports may not be unrelated to some limitations in the methodology. The index study was online; thus, reporting bias was not unlikely, especially as the presence of hypertension and diabetes mellitus could not be verified. It is noteworthy that undiagnosed hypertension and undiagnosed diabetes mellitus are common in Nigeria and indeed among Africans.,, This study is also limited in not seeking possible confounders such as frequency of sexual activity, spouse-related issues such as age, and psychosocial issues such as marital disharmony.
| Conclusion|| |
About half of the respondents in the index study had sexual dysfunction using the FSFI. Problems with desire were the least encountered in this study, while most women with FSD had dyspareunia and orgasmic disorders. Consumption of alcoholic beverages and tobacco smoking were significantly associated with FSD.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Rowland DL, Gutierrez BR. Human sexual response, phases of. In: Wenzel A, editor. The SAGE Encyclopedia of Abnormal and Clinical Psychology. Thousand Oaks: SAGE Publications, Inc; 2017. p. 1705-6.
McCabe MP, Sharlip ID, Atalla E, Balon R, Fisher AD, Laumann E, et al
. Definitions of sexual dysfunctions in women and men: A consensus statement from the fourth international consultation on sexual medicine 2015. J Sex Med 2016;13:135-43.
Jha S, Thakar R. Female sexual dysfunction. Eur J Obstet Gynecol Reprod Biol 2010;153:117-23.
Basson R, Gilks T. Women's sexual dysfunction associated with psychiatric disorders and their treatment. Womens Health (Lond) 2018;14:1745506518762664.
Scardi S. Sexual activity in women with cardiovascular disease: A literature review. G Ital Cardiol (Rome) 2017;18:781-6.
Shaeer O, Shaeer K, Shaeer E. The Global Online Sexuality Survey (GOSS): Female sexual dysfunction among Internet users in the reproductive age group in the Middle East. J Sex Med 2012;9:411-24.
Shaeer O, Shaeer K. The Global Online Sexuality Survey (GOSS): Erectile dysfunction among Arabic-speaking internet users in the Middle East. J Sex Med 2011;8:2152-60.
Shaeer O, Shaeer K. The Global Online Sexuality Survey (GOSS): The United States of America in 2011. Chapter I: Erectile dysfunction among English-speakers. J Sex Med 2012;9:3018-27.
Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, et al
. The Female Sexual Function Index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 2000;26:191-208.
Nwagha UI, Oguanuo TC, Ekwuazi K, Olubobokun TO, Nwagha TU, Onyebuchi AK, et al
. Prevalence of sexual dysfunction among females in a university community in Enugu, Nigeria. Niger J Clin Pract 2014;17:791-6.
] [Full text]
Adegunloye OA, Ezeoke GG. Sexual dysfunction – A silent hurt: Issues on treatment awareness. J Sex Med 2011;8:1322-9.
Imbeah EP, Afrane BA, Kretchy IA, Sarkodie JA, Acheampong F. Prevalence and self-management of female sexual dysfunction among women in six regions of Ghana: A cross-sectional study. J Womens Health Issues Care 2015;4:6.
Oksuz E, Malhan S. Prevalence and risk factors for female sexual dysfunction in Turkish women. J Urol 2006;175:654-8.
Milić Vranješ I, Jakab J, Ivandić M, Šijanović S, Zibar L. Female sexual function of healthy women in eastern Croatia. Acta Clin Croat 2019;58:647-54.
Safarinejad MR. Female sexual dysfunction in a population-based study in Iran: Prevalence and associated risk factors. Int J Impot Res 2006;18:382-95.
Ogbera AO, Chinenye S, Akinlade A, Eregie A, Awobusuyi J. Frequency and correlates of sexual dysfunction in women with diabetes mellitus. J Sex Med 2009;6:3401-6.
Agaba PA, Meloni ST, Sule HM, Agaba EI, Idoko JA, Kanki PJ. Sexual dysfunction and its determinants among women infected with HIV. Int J Gynaecol Obstet 2017;137:301-8.
Adesola AO, Oladeji B. Prevalence and correlates of sexual dysfunction among patients with mental disorders in a tertiary hospital in Southwest Nigeria. S Afr J Psychiatr 2021;27:1575.
Adebusoye LA, Ogunbode O, Owonokoko KM, Ogunbode AM, Aimakhu C. Factors associated with sexual dysfunction among female patients in a Nigerian ambulatory primary care setting. Ann Ib Postgrad Med 2020;18:9-17.
Abdullahi HM, Abdurrahman A, Ahmed ZD, Tukur J. Female sexual dysfunction among women attending the family planning clinic at Aminu Kano Teaching Hospital: A cross-sectional survey. Niger J Basic Clin Sci 2019;16:32-37. [Full text]
Okeahialam BN, Ogbonna C. Impact of hypertension on sexual function in women. West Afr J Med 2010;29:344-8.
Choy CL, Sidi H, Koon CS, Ming OS, Mohamed IN, Guan NC, et al
. Systematic review and meta-analysis for sexual dysfunction in women with hypertension. J Sex Med 2019;16:1029-48.
Pontiroli AE, Cortelazzi D, Morabito A. Female sexual dysfunction and diabetes: A systematic review and meta-analysis. J Sex Med 2013;10:1044-51.
Rahmanian E, Salari N, Mohammadi M, Jalali R. Evaluation of sexual dysfunction and female sexual dysfunction indicators in women with type 2 diabetes: A systematic review and meta-analysis. Diabetol Metab Syndr 2019;11:73.
Umuerri EM, Ogbemudia EJ. High burden of undiagnosed hypertension among young Nigerian adults: A cause for concern. Trop J Health Sci 2021;28:36-42.
Ataklte F, Erqou S, Kaptoge S, Taye B, Echouffo-Tcheugui JB, Kengne AP. Burden of undiagnosed hypertension in sub-saharan Africa: A systematic review and meta-analysis. Hypertension 2015;65:291-8.
International Diabetes Federation. Diabetes Atlas. 10th
ed. Brussels, Belgium: International Diabetes Federation; 2017. Available from: http://www.diabetesatlas.org
. [Last accessed on 2022 Apr 06].
Asmelash D, Asmelash Y. The burden of undiagnosed diabetes mellitus in adult African population: A systematic review and meta-analysis. J Diabetes Res 2019;2019:4134937.
[Table 1], [Table 2], [Table 3]