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Middle East Fertility Society Journal
Middle East Fertility Society
ISSN: 1110-5690
Vol. 12, Num. 3, 2007, pp. 184-187
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Middle
East
Fertility
Society
Journal,
Vol.
12,
No.
3,
2007,
pp.
184-187
The
prevalence
of
sexual
dysfunctions
in
infertile
women
Naeimeh
Tayebi,
M.D.*
Seyed
Mojtaba
Yassini
Ardakani,
M.D.†
Research
and
Clinical
Center
for
Infertility,
Shahid
Sadoughi
University
of
Medical
Science,
Yazd,
Iran.
*Medical
Doctor,
Research
and
Clinical
Center
for
Infertility,
Shahid
Sadoughi
University.
Yazd,
Iran
†Assistant
Professor
of
psychiatry,
Research
and
Clinical
Center
for
Infertility,
Shahid
Sadoughi
University
of
Medical
Science,
Yazd,
Iran.
Correspondence:
Naeimeh
Tayebi,
Email:
ntayebi@yahoo.com
Received
on
June
18,
2007;
revised
and
accepted
on
July
3,
2007
Code
Number:
mf07035
ABSTRACT
Objective: Sexuality
is
an
important
and
integral
part
of
every
woman’s
life.
The
aim
of
this
study
was
to
assess
the
degree
of
sexual
dysfunction
among
infertile
women
and
its
correlation
with
age,
duration
of
marriage
and
etiology
of
infertility
in
women.
Materials
and
Methods: 300
infertile
women
who
were
referred
to
IVF
center
for
management
of
their
infertility
problem
involved
in
this
study
after
informed
consent.
They
were
asked
to
fill
a
questionnaire
that
contained
three
parts
of
demographic,
infertility
and
sexual
function
items.
Distribution
of
sexual
dysfunction
and
its
relationship
to
infertility
and
marriage
duration
were
analyzed
through
SPSS
software.
Results: The
most
common
sexual
dysfunction
was
orgasm
disorder
(83.76%)
and
the
rate
of
sexual
desire
disorder,
dyspareunia
and
vaginismus
were
80.7%,
67.7%
and
76.7%
respectively.
More
than
50%
of
cases
mentioned
decreased
frequency
of
coitus
after
diagnosis
of
infertility.
Vaginismus
and
dyspareunia
were
more
common
in
20-24
years
age
group.
Conclusion: According
to
the
high
rate
of
sexual
dysfunction
in
this
study
and
almost
the
same
rate
in
other
studies,
gynecologists
should
pay
more
attention
to
this
important
issue
and
encourage
the
patients
to
have
an
evaluation
by
a
psychiatrist
or
psychologist
Keywords: Sexual
dysfunction,
infertility.
The
sexual
response
cycle
in
women
is
mediated
by
the
complex
interplay
of
psychological,
environmental,
and
physiologic
(hormonal,
vascular,
muscular,
and
neurological)
factors.
The
initial
phase
of
the
sexual
response
cycle
is
interest
and
desire,
followed
by
the
four
successive
phases
originally
described
by
Masters
and
Johnson:
arousal,
plateau,
orgasm,
and
resolution
(1).
Types
of
sexual
disorders
that
are
more
common
in
women
include:
a)
sexual
desire
disorders b) sexual
arousal
disorders c) orgasmic
disorders
d)
sexual
pain
disorders
(vaginismus,
dyspareunia)
(2,
3).
There
is
a
complex
association
between
sexual
behavior
and
infertility.
Sexual
dysfunction
can
cause
a
delay
in
conception,
but
can
also
be
the
result
of
not
conceiving.
The
greatest
chance
of
conception
is
achieved
through
sexual
intercourse
on
multiple
occasions
during
the
fertile
period
(4).
Infertility
may
be
the
result
of
sexual
problems.
Therefore,
infertility
examination
should
include
an
evaluation
of
couple's
sexual
behavior
(5,
6).
In
many
cases,
all
infertility
treatments
have
to
be
stopped
and
psychological
aid
has
to
be
offered
for
sexual
dysfunction
(7).
Infertile
women
are
likely
to
suffer
from
numerous
psychosexual
problems.
Elstein
has
described
the
infertile
couples
as
potentially
having
abnormalities
of
sexual
function.Such abnormalities
Table1. The
prevalence
of
sexual
problems
in
infertile
women.
|
N
300
|
%
|
Libido
|
|
|
No
|
242
|
80.7
|
Yes
|
58
|
19.3
|
Achieving
orgasm
|
|
|
No
|
251
|
83.7
|
Yes
|
49
|
16.3
|
Sexual
arousal
|
|
|
No
|
75
|
25
|
Yes
|
225
|
75
|
Vaginismus
|
|
|
No
|
70
|
23.3
|
Yes
|
230
|
76.7
|
Dyspareunia
|
|
|
No
|
97
|
32.3
|
Yes
|
203
|
67.7
|
may
have
a
cause
and
effect
relationship
with
infertility,
or
they
may
be
incidental
to
infertility,
or
they
may
be
presented
in
the
disguise
of
infertility
(8).
Some
studies
on
sexual
problems
of
infertile
couples
are
available
in
the
literature
(9,
10,
11).
The
objective
of
this
study
was
to
assess
the
degree
of
sexual
dysfunction
among
infertile
women
and
its
correlation
with
age,
duration
of
marriage
and
etiology
of
infertility
in
women.
MATERIALS
AND
METHODS
Female
partners
of
300
consecutive
infertile
couples
were
attended
in
this
study
from
January
to
October
2006.
Permission
to
perform
this
study
was
obtained
from
the
ethics
board
of
the
committee
of
Yazd
Research
and
Clinical
Center
for
Infertility.
The
subjects
volunteered
as
participants
after
the
purpose
of
this
study
and
the
degree
of
the
participation
was
explained
to
them,
and
then
consents
were
signed.
All
of
the
educated
women
filled
the
questionnaires
by
themselves
and
the
rest
of
them
(illiterate
women)
were
interviewed
by
the
first
author
personally.
The
questions
of
the
questionnaire
were
grouped
as
follows:
1.
Infertility
status
such
as
duration
of
marriage
and
infertility,
type
of
infertility
and
personal
data
such
as
the
age
of
the
couple.
2.
Sexual
history
such
as
frequency
of
intercourse,
problems
of
desire,
arousal
and
orgasm
phases.
3.
Past
history
such
as
referring
to
the
psychiatrist
previously.
Finally,
the
data
were
analyzed
statistically
with
the
aid
of
SPSS
and
chi-square
test.
The
differences
were
considered
to
be
statistically
significant
if
P-value
was<0.05.
RESULTS
All
women
welcomed
this
detailed
questioning
about
sexual
problems
and
co-operated
well.
The
mean
age
of
women
and
men
were
27.93±4.8
and
33.48±5.6
years
respectively.
The
duration
of
marriage
and
infertility
were
7.56±4.3
and
5.42±3.2
years
respectively.
The
type
of
infertility
was
81%
primary
and
19%
secondary.
The
etiology
of
infertility
was
40%
male
factor,
44.3%
female
factor,
7.7%unknown
and
8%mixed
factors.
The
prevalence
of
the
sexual
problems
has
been
shown
in
Table
1.
58.3%
of
women
and
men
mentioned
a
reduction
in
sexual
desire
after
infertility
diagnosis
while
10.3%
of
women
and
18.7%
of
men
had
an
increase
in
sexual
desire
after
infertility
diagnosis.
In
this
study,
the
mode
of
intercourse
frequency
per
week
was
2
times.
The
intercourse
frequency
had
reduced
in
54%
of
women
and
had
increased
in
5.3%
after
infertility
diagnosis.
There
was
a
significant
difference
between
libido,
achieving
orgasm,
dyspareunia
and
vaginismus
with
the
age
of
women.
(Table2).
In
addition,
Table
3
showed
that
the
prevalence
of
vaginismus
and
dyspareunia
has
reduced
with
increasing
duration
of
marriage.
There
was
no
significant
difference
between
sexual
problems
and
etiology
of
infertility
(P-value=0.2)
85%
of
women
hadn't
referred
to
the
psychiatrist
because
of
sexual
problems
in
this
research.
Table
2. The
association
between
sexual
problems
and
the
age
of
infertile
women.
|
20-24year
|
25-29year
|
>30year
|
P-value
|
|
|
|
|
|
Total
of
patients
|
75
|
127
|
98
|
0.009
|
Libido
|
|
|
|
|
No
|
60
(80%)
|
104
(81.9%)
|
78
(79.6%)
|
|
Yes
|
15
(20%)
|
23
(18.1%)
|
20
(20.4%)
|
|
Achieving
orgasm
|
|
|
|
0.049
|
No
|
59(78.7%)
|
103(81.1%)
|
89(90.8%)
|
|
Yes
|
16(21.3%)
|
24(18.9%)
|
9(9.2%)
|
|
Dyspareunia
|
|
|
|
0.014
|
No
|
14(18.7%)
|
46(36.2%)
|
37(37.8%)
|
|
Yes
|
61(81.3%)
|
81(63.8%)
|
61(62.6%)
|
|
Vaginismus
|
|
|
|
0.028
|
No
|
57(76%)
|
29(22.8%)
|
23(23.5%)
|
|
Yes
|
18(24%)
|
98(77.2)
|
75(76.5%)
|
|
DISCUSSION
Infertility
may
interact
with
a
woman's
sexual
expression
by
causing
or
exacerbating
sexual
problems
as
a
consequence
of
the
diagnosis,
investigation
and
treatment
of
infertility.
Conversely,
sexual
problems
may
contribute
in
infertility.
However,
it
is
important
to
bear
in
mind
that
a
sexual
problem
is
a
disorder
only
if
the
women
perceives
it
to
be
so,
with
impaired
sexual
desire
as
the
most
common
presentation
(12).
In
our
study,
the
most
common
sexual
problems
in
infertile
females
were
anorgasmia
(83.7%)
and
decreased
libido
(80.7%)
while
Jindal
et
al
(1996)
with
evaluation
of
200
Indian
infertile
women
showed
that
decreased
frequency
of
intercourse
and
anorgasmia
were
the
most
common
problems
identified
(13).
Table
3. The
association
between
vaginismus
and
dyspareunia
with
duration
of
marriage.
|
<8year
|
>8year
|
P-value
|
|
|
|
|
Dyspareunia
|
|
|
0.02
|
No
|
42(26.9%)
|
55(38.2%)
|
|
Yes
|
114(73.1%)
|
89(61.8%)
|
|
Vaginismus
|
|
|
0.04
|
No
|
36(23.1%)
|
110(76.4%)
|
|
Yes
|
120(76.9%)
|
34(23.6%)
|
|
The
prevalence
of
difficulty
with
sexual
arousal,
dyspareunia
were
25%
and
67.7%
respectively
while
Audu's
study
(2002)
on
97
Nigerian
infertile
women
showed
that
the
prevalence
of
difficulty
with
sexual
arousal
and
dyspareunia
was
20.6%
and
57.7%
respectively
(14).
Jain
and
associates
(2000)
have
indicated
that
sexual
problems
in
infertile
women
consisting
of
dyspareunia,
decreased
libido,
and
orgasmic
failure
were
the
most
common
problems
in
their
study
(15).
In
our
previous
study
on
fertile
women,
30%
of
patients
didn’t
have
sexual
desire.
26.1%
weren’t
able
to
achieve
orgasm
and
17.1%
had
problem
with
sexual
arousal.
Also,
47.1%
and
23.5%
had
dyspareunia
and
vaginismus
respectively
(16).In
recent
study,
the
prevalence
of
all
sexual
problems
has
increased
in
infertile
women
with
comparison
to
fertile
women.
Ponholzer
et
al
(2005)
showed
that
the
prevalence
of
pain
disorders
were
more
frequent
in
women
aged
20-39
years.
Also,
in
their
study,
the
prevalence
of
female
sexual
dysfunction
increased
with
increasing
age
of
women
(17).
In
our
study,
the
prevalence
of
pain
disorders
such
as
vaginismus
and
dyspareunia
were
more
in
women
aged
20-24
years
than
the
other
groups.
Ramazanzadeh
et
al
(2006)
concluded
that
sexual
desire
and
frequency
of
coitus
has
reduced
in
200
male
partners
of
infertile
couples
after
infertility
diagnosis
(18)
while
our
results
indicated
that
sexual
desire
and
frequency
of
coitus
in
infertile
women
has
reduced
significantly
after
infertility
diagnosis.
In
this
study,
only
15%
of
patients
had
been
referred
to
the
psychiatrist
because
of
sexual
problems.
Despite
the
importance
of
these
issues
to
their
health
care,
many
women
find
it
difficult
to
talk
to
the
physicians
about
sexual
concerns,
and
many
physicians
are
uncomfortable
discussing
sexual
issues
with
their
patients
(19).
ACKNOWLEDGMENT
The
authors
express
their
thanks
to
Fatemeh
Mosavi
for
her
cooperation.
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