Accepted for/Published in: Journal of Participatory Medicine
Date Submitted: Jan 26, 2025
Date Accepted: Jun 11, 2025
Mental and Chronic Health Conditions as Determinants of Healthcare Needs and Digital Innovations for Women with Sexual Dysfunction: Insights from a German Population-Based Study
ABSTRACT
Background:
Chronic health conditions (CHC) are a recognized risk factor for the experience of problems in sexual function (SP). Only a subset develops severe symptoms of sexual distress, the defining criterion for clinically relevant sexual dysfunction (SD) according to the ICD-11. Data on the contribution of specific CHCs to clinically relevant SD symptoms and related healthcare needs are limited, hindering targeted interventions.
Objective:
This study examines the prevalence of SP, SD, and sexual distress, associations with CHC status, SD diagnoses, and explores healthcare preferences.
Methods:
Data collection was based on a questionnaire developed with patient and public involvement and administered by YouGov to a representative sample of the adult population in Germany. Analyses of this study included women with and without CHC and different CHC subgroups (mental, gynecological, cardiovascular and metabolic, infectious and inflammatory, cancer, pain, and neurological). Outcomes measured were SP, clinically relevant SD symptoms (ICD-11 criteria), sexual distress (Female Sexual Distress Scale-Desire/Arousal/Orgasm; FSDS-DAO), and self-reported SD diagnosis. Multivariable regression and network analysis explored associations between CHC subgroups, SP, SD, and FSDS-DAO scores.
Results:
Among 1970 cis women (M=49.6 years, SD=16.0), 60.3% reported a history of CHC. The 6-month prevalence of SP was 75.2% in women with CHC compared to 62.5% in women without CHC. Clinically relevant SD symptoms were less prevalent (CHC: 19.3%, no CHC: 11.3%). Multivariable regression models showed an association for SD with CHC (2.56, 95%, CI 1.90-3.49), which was strongest for women with comorbid mental health conditions (OR 2.31, 95% CI 1.70-3.13) and cancer CHC (OR 2.00, 95% CI 1.45-2.78). Being in a relationship was a protective factor for reporting clinically relevant distress among women with CHC. Network analysis showed positive associations for SP with gynecological and mental health CHC and for SD with mental health CHC, gynecological CHC, and cancer. Women with SD reported low rates of SD diagnosis (SP: 19.4%, no SP: 10.7%, OR 2.00) and treatment (SP: 11.0%, no SP: 7.0%). Gynecologists were the most preferred healthcare providers for SD. The most commonly reported unmet need was a lack of information. Digital solutions, such as apps or websites with exercises, were desired as healthcare innovations.
Conclusions:
The burden of CHC on women's sexual health extends beyond functional sexual impairment, with high rates of clinically relevant sexual distress. Cancer and mental health conditions are the strongest predictors of reported SD. Despite the high prevalence of SD in women with CHC, access to diagnosis and treatment is limited. Digital offerings could be a promising solution to address these unmet needs.
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