|Year : 2019 | Volume
| Issue : 1 | Page : 32-37
Female sexual dysfunction among women attending the family planning clinic at Aminu Kano Teaching Hospital: A cross-sectional survey
Hauwa Musa Abdullahi1, Aisha Abdurrahman2, Zainab Datti Ahmed1, Jamilu Tukur1
1 Department of Obstetrics and Gynaecology, Aminu Kano Teaching Hospital, Kano, Nigeria
2 Department of Obstetrics and Gynaecology, Federal Medical Centre, Katsina, Nigeria
|Date of Web Publication||5-Mar-2019|
Dr. Hauwa Musa Abdullahi
Department of Obstetrics and Gynaecology, Aminu Kano Teaching Hospital, Kano
Source of Support: None, Conflict of Interest: None
Background: Female sexual dysfunction (FSD) is a multifactorial condition in which individuals fail to experience satisfaction from sexual activity. Discussion on sexual function has been the subject extreme secretiveness due to cultural and religious reasons. There is paucity of data on the prevalence and risk factors of FSD in our environment. Objectives: To determine the prevalence, pattern and risk factors for FSD at Aminu Kano Teaching Hospital, Kano. Methods: It was a cross-sectional study of 342 women attending the family planning clinic at AKTH. The FSFI questionnaire was used to determine the prevalence and pattern of FSD among the patients. A section was added to the questionnaire to obtain information on the sociodemographic characteristics of the patients and the risk factors. The data was analysed using SPSS version 20.0. Chi square test and Fisher's exact test were used to test for association, a p-value of less than 0.05 was considered statistically significant. Results: The prevalence of FSD was found to be 86.0%. The most prevalent type of disorder was that of desire occurring in 91.8%, followed by disorders of lubrication (84.8%), arousal (80.7%), pain (66.4%), orgasm (41.5%) and satisfaction (31.6%). Only coital frequency (P <0.001) and chronic pelvic pain (P <0.001) were found to be significantly associated with FSD, while there was no significant association between FSD and number of years married, marital setting, hypertension, diabetes, previous abdominal or pelvic surgery, previous diagnosis of a mental or psychiatric disorder, smoking, pelvic or vaginal infection and pelvic organ prolapse. Conclusion: There is a high prevalence of FSD in our environment with disorder of desire, lubrication and arousal being the most common. Coital frequency and chronic pelvic pain were significantly associated with FSD.
Keywords: Female sexual dysfunction, Kano, pattern, prevalence, risk factors
|How to cite this article:|
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;16:32-7
|How to cite this URL:|
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 [serial online] 2019 [cited 2019 Aug 19];16:32-7. Available from: http://www.njbcs.net/text.asp?2019/16/1/32/253415
| Introduction|| |
Female sexual dysfunction (FSD) is a multifactorial condition that has anatomical, physiological, medical, psychological, and social components. Sexual dysfunction refers to a problem that occurs during the sexual response cycle that prevents the individual from experiencing satisfaction from sexual activity. FSD is defined as a disorder of sexual desire, orgasm, arousal, and sexual pain that results in significant personal distress. While there are emotional and relational elements to female sexual function and response, FSD can occur secondary to medical problems and can have an organic basis.
It is relatively difficult to estimate the prevalence of sexual dysfunction in women because the parameters used to define FSD are not as clear as those of male sexual dysfunction. Open discussions about female sexual function and dysfunction are not common in our environment due to religious and sociocultural reasons. There is evidence that many people who experience sexual dysfunction find it difficult to ask for professional help, especially females, even though females have been found to experience significantly higher sexual dysfunction than men. The prevalence of FSD in our environment is not known, though an earlier study revealed a high rate of use of unorthodox traditional sexual stimulants by women. Other studies done in Nigeria and Ghana have revealed high prevalence rates of FSD, 53.5% and 72.8%, respectively., High prevalence rates have also been reported from studies in the United States, India, and Iran, 43.0%, 55.6%, and 46.2%, respectively.,,
The female sexual response consists of four successive phases: excitement, plateau, orgasmic, and resolution phases. The most commonly used classification of FSD comes from the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM IV), in which FSD is classified into disorders of desire or interest: inhibited sexual desire and excessive sexual desire, disorder of arousal or excitement: female sexual arousal disorder, disorder of orgasm: female orgasmic disorder, and disorders of penetration: vaginismus and dyspareunia.
A study of the prevalence and pattern of sexual dysfunction among 212 patients attending General Hospital Benin showed that 36.3% had excitement dysfunction, 35.0% had female orgasmic dysfunction, 20.6% had premature ejaculation, 7.3% had male dyspareunia, 3.9% had female dyspareunia, and 3.9% had vaginismus. In India, the most common type of sexual disorder found was orgasmic disorder accounting for 91.7% of all FSDs and lubrication difficulty found in 89.2% of patients with FSD, while in Iran FSD was detected as a desire problem in 45.3% of women, an arousal problem in 37.5%, a lubrication problem in 41.2%, an orgasm problem in 42.0%, a satisfaction problem in 44.5%, and a pain problem in 42.5%.,
Risk factors for FSD include diabetes mellitus, cardiovascular disease, concurrence of other genitourinary disease, psychiatric/psychological disorders, other chronic diseases, and sociodemographic conditions. It has been suggested in women that decreased lubrication is significantly associated with being diabetic. Similarly, hypertension in women has been associated with decreased lubricative function and orgasmic dysfunction. Stress urinary incontinence has been found to negatively influence all aspects of women's sexual function (sexual interest, desire, arousal, lubrication, orgasm) and to be significantly correlated with dyspareunia and vaginismus. In women, a psychiatric disorder is closely associated with orgasmic dysfunction and dyspareunia.
In a study in Enugu, only age was found to predict FSD, while in India illiteracy, pelvic inflammatory disease, and endometriosis were found to be significant risk factors., In Iran, identified risk factors include educational level (which showed inverse relationship with the development of FSD), age more than 40 years, duration of marriage of 10 years or more, unemployment, having three or more children, and a sexual frequency of less than three times per week.
Various tools have been developed and validated for the diagnosis of FSD and for effectively monitoring treatment. Some of these tools include the Female Sexual Functioning Index (FSFI), the Brief Index of Sexual Functioning for Women, the Changes in Sexual Functioning Questionnaire, the Derogatis Interview for Sexual Functioning, and the Golombok Rust Inventory of Sexual Satisfaction (GRISS). The FSFI has been validated on clinically diagnosed samples of women with female sexual arousal disorder, female orgasmic disorder, and hypoactive sexual desire disorder.
Generally, there is need to improve awareness of FSD in our environment. One study carried out among educated working women in Abuja revealed that up to 42% of the respondents were not aware that FSD could be managed. This study aims to determine the prevalence, pattern, and the risk factors for FSD. This will help us to understand the burden of the problem and assist in planning treatment and counseling of patients. It will also serve as the basis for planning intervention trials in future for the management of FSD.
| Materials and Methods|| |
The study was conducted in Aminu Kano Teaching Hospital (AKTH), Kano. The hospital, located in Northern Nigeria, serves as a tertiary and referral center for Kano and its surrounding area. The family planning clinic is opened daily between 8:00 am and 4:00 pm on Mondays to Fridays. About 20 patients are seen at the clinic daily.
It was a cross-sectional study on women attending the family planning clinic at AKTH, Kano.
Sample size determination
The sample size was calculated using the formula for single proportions as follows:
where n = the required sample size; Z = the standard normal deviate, which is 1.96 at 95% confidence interval; P = the prevalence rate which was 53.5% (0.535) from a previous study in Enugu; Q = 1 − P, which is 1- 0.535, which is 0.465; d = the precision rate, which is 5% (0.05).
n = 382.3
An additional 10% was added to give a sample size of 420. These patients were recruited serially from the family planning clinic till the desired sample size was obtained.
All consenting married women in the reproductive age group of 15–49 years attending the family planning clinic at AKTH were included in the study. Non-consenting women and those who were single were excluded from the study. In addition, married women not living with their husbands within the past 4 weeks, pregnant women, and those within 2 months of delivery were excluded.
A structured section to obtain the sociodemographic characteristics and risk factors of FSD was incorporated into the FSFI questionnaire and it was administered by trained interviewers. The FSFI is a 19-item questionnaire, which was developed as a brief, multidimensional self-report instrument for assessing the fundamental dimensions of sexual function in women in the previous 4 weeks. It provides scores on the six domains of sexual function (desire, arousal, lubrication, orgasm, satisfaction, and pain) as well as a total score. Questions 1, 2, 15, and 16 are structured to have five options from 1 to 5; all the others have six options, scored from 0 to 5. Each domain score was obtained by adding each score of the domain and multiplying this result by the domain factors.
The domain factors were as follows: 0.6 for desire, 0.3 for arousal, 0.3 for lubrication, 0.4 for orgasm, 0.4 for satisfaction, and 0.4 for pain.
The FSFI total score was determined by the sum of the six domains and varied from 2 to 36, where higher scores were associated with lower level of sexual dysfunction. As proposed by Wiegel et al., an FSFI total score of 26.55 or less was indicative of sexual dysfunction (lower sexual function), and as determined by Aggarwal et al., scores of less than 4.28 on desire, 5.08 on arousal, 5.45 on lubrication, 5.05 on orgasm, 5.04 on satisfaction, and 5.51 on pain domains were used to classify participants with such dysfunctions.
This was done using SPSS statistical software version 20.0. Data were presented as numbers and percentages, and as mean and standard deviation in tables. Chi-square and Fisher's exact tests were used to test for associations. A P value of less than 0.05 was considered statistically significant.
Ethical clearance was obtained from the ethics committee of AKTH, Kano. The study objective was explained to the patients; confidentiality and anonymity were assured. A written informed consent was obtained from all patients before participation. Patients were informed that participation was voluntary, and they could terminate the interview at any time they wished. They were also informed that failure to consent to the study would not affect their routine care and would have no consequences at all. Patients found to have FSD were counseled and managed appropriately.
| Results|| |
A total of 420 questionnaires were distributed and filled, but only 342 were included in the analysis (81.4%). The rest were either not returned or had missing data. [Table 1] shows the sociodemographic characteristics of the respondents. Most of the patients (74.6%) were 30 years or less. The mean age of the respondents was 21.1 ± 6.52 years. Most of the respondents (87.7%) were Hausa, and the majority of the respondents had tertiary level of education (58.9%). In addition, the majority were of low parity (66.1%) and the commonest marital setting was monogamous (75.1%).
[Table 2] shows the prevalence and pattern of FSD among the respondents. The prevalence of FSD was 86.0%. The most prevalent type of disorder was that of desire occurring in 91.8%, followed by disorders of lubrication (84.8%), arousal (80.7%), pain (66.4%), orgasm (41.5%), and satisfaction (31.6%).
|Table 2: Prevalence and pattern of female sexual dysfunction among respondents|
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[Table 3] shows the risk factors of FSD among the respondents. The majority of the respondents (60.5%) had been married for less than 10 years. There was no significant association between the number of years married and FSD (P = 0.078), and between the marital setting and FSD (P = 0.074). The coital weekly frequency was less than 3 in most of the respondents (95.9%). There was a significant association between coital frequency and FSD (P < 0.001). Only 10.2% and 2.0% of the respondents had been diagnosed with hypertension and diabetes in the past, respectively, and both were not significantly associated with FSD (P = 0.564 and 0.343, respectively). About 12% of the respondents had a previous pelvic surgery (P = 0.815), 1.2% had a previous diagnosis of a mental or psychiatric disorder (P = 0.455), while only 0.3% smoke (P = 0.860). There was no significant association between these factors and FSD. About 31% of the respondents had been diagnosed with a pelvic and/or vaginal infection and 1.8% had been diagnosed with pelvic organ prolapse within the past 4 weeks and there was no significant association between both PID (P = 0.239) and pelvic organ prolapse (P = 0.401) with FSD. Up to 31.9% of the respondents had been diagnosed with chronic pelvic pain within the past 4 weeks, and there was a significant association between chronic pelvic pain and FSD (P < 0.001).
| Discussion|| |
The prevalence of FSD was found to be 86.0% in this study. This is higher than 53.5% found in Enugu, and also higher than the rates found in Iran (46.2%) and the United States (43.0%)., This may probably be due to sociocultural differences, as open discussions on sexual problems and sex education are considered taboos due to sociocultural reasons in our environment. As a result, women with FSD might not be aware that a problem exists, or that they could seek and get medical help. They may also be too shy to discuss their problems with anyone because of the social implications of these discussions, allowing the problem to persist. All these could have led to higher prevalence of FSD observed. The lower prevalence in the Enugu study might also be due to differences in the study areas. It is possible that being in a university campus could expose women to sexual education and this might explain the lower levels of SD found there. Similarly in the United States, lower levels of FSD might have been observed due to more exposure to sex education and less rigid sociocultural practices. Sex education has been proposed as one of the preventive strategies for FSD, though further studies need to be done to determine its role in reducing the prevalence of FSD. The high rate of FSD found in this study was, however, similar to 72.8% reported in Ghana.
The pattern of FSD showed disorder of desire to be the most prevalent occurring in 91.8% of the respondents. This was followed by disorders of lubrication (84.8%), arousal (80.7%), pain (66.4%), orgasm (41.5%), and satisfaction (31.6%). Disorder of desire was also found to be the most common type of FSD in the Iranian study, though it was found in a lower proportion of the respondents (45.3%). In a study in Benin, arousal disorder was the most common type occurring in 36.3%, while in an Indian study the most common type was disorder of orgasm which occurred in 91.7% of the respondents., The high prevalence of disorder of desire may be due to anxiety and societal expectation, as women are traditionally expected to play a passive role in sex.
Large differences have been found in the prevalence of FSD between countries., These may be due to difference in medical and psychological factors, particularly in the settings of possible socioeconomic, cultural, and racial differences, the clinical definition used for each dysfunction, the subjects that were included in the study, and their educational levels.
The high prevalence of lubrication disorder could be due to lack of sexual interest as evident by the high rates of disorders of desire and arousal. Interestingly, despite the high prevalence of FSD and the high prevalence of disorders of desire, arousal, and lubrication, only 31.6% of the respondents had a disorder of satisfaction. This may probably be because of generally low levels of awareness about FSD and sex education such that majority do not even recognize they have a problem and they have thus learnt to accept their current situation and are satisfied with it.
The factors found to be significantly associated with FSD in this study were coital frequency (P < 0.001) and diagnosis of chronic pelvic pain within the past 4 weeks (P < 0.001). There was no significant association found between FSD and the number of years married, marital setting, hypertension, diabetes, previous abdominal or pelvic surgery, previous diagnosis of a mental or psychiatric disorder, smoking, pelvic or vaginal infection, and pelvic organ prolapse. Other studies have also found low coital frequency and pelvic infection to be significantly associated with FSD., The low coital frequency could have resulted from presence of the FSD, while chronic pelvic pain could have led to aversion to sex which could explain the high rates of disorders of desire, arousal, and lubrication.
The study is not without limitations. The main limitation was that the diagnosis of some of the risk factors such as hypertension, diabetes, and pelvic organ prolapse were not verified clinically or in the laboratory, rather only self-reporting was used, and therefore some of the respondents who could have had some of these problems but were undiagnosed could have been missed.
| Conclusion|| |
FSD is a common problem experienced by many females and yet there is difficulty in asking for professional help. There is therefore the need to create awareness about the condition and also conduct an in-depth research to understand the burden of the problem and assist in planning treatment and counseling of patients. It will also serve as the basis for planning intervention trials in future.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Anastasiadis AG, Davis AR, Ghafar MA, Burchardt M, Shabsigh R. The epidemiology and definition of female sexual disorders. World J Urol 2002;20:74-8.
Chen CH, Lin YC, Chiu LH, Chu YH, Ruan FF, Liu WM, et al.
Female sexual dysfunction: Definition, classification, and debates. Taiwan J Obstet Gynecol 2013;52:3-7.
Raina R, Pahlajani G, Khan S, Gupta S, Agarwal A, Zippe CD. Female sexual dysfunction: Classification, pathophysiology, and management. Fertil Steril 2007;88:1273-84.
Berman JR. Physiology of female sexual function and dysfunction. Int J Impot Res 2005;17 Suppl 1:S44-51.
Ekele BA. Sexual dysfunction. In: Kwawukume Emuveyan EE, editors. Comprehensive Obstetrics in the Tropics. 1st
ed. Dansoman, Accra: Asante and Hitcher Printing Press Limited; 2002. p. 182-6.
Audu IO, Ahmed MH. Psychosexual problems among Kaduna polytechnic students. Nig Med Pract 1998;16:635.
Abdullahi H, Tukur J. Sexual stimulants and their effects on women of reproductive age group in Kano, Northern Nigeria. Niger J Basic Clin Sci 2013;10:13-6. [Full text]
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]
Amidu N, Owiredu WK, Woode E, Addai-Mensah O, Quaye L, Alhassan A, et al.
Incidence of sexual dysfunction: A prospective survey in Ghanaian females. Reprod Biol Endocrinol 2010;8:106.
Aggarwal RS, Mishra VV, Panchal NH, Deshchougule VV, Jasani AF. Sexual dysfunction in women: An overview of risk factors and prevalence in Indian women. J South Asian Feder Obst Gynae 2012;4:134-6.
Jaafarpour M, Khani A, Khajavikhan J, Suhrabi Z. Female sexual dysfunction: Prevalence and risk factors. J Clin Diagn Res 2013;7:2877-80.
Eze GO. Pattern of sexual dysfunction in general hospital setting in Benin City, Nigeria (Dissertation). West Afr Postgrad Med Coll 1994.
Lewis RW, Fugl-Meyer KS, Bosch R, Fugl-Meyer AR, Laumann EO, Lizza E, et al.
Epidemiology/risk factors of sexual dysfunction. J Sex Med 2004;1:35-9.
Meston CM, Derogatis LR. Validated instruments for assessing female sexual function. J Sex Marital Ther 2002;28 Suppl 1:155-64.
Meston CM. Validation of the female sexual function index (FSFI) in women with female orgasmic disorder and in women with hypoactive sexual desire disorder. J Sex Marital Ther 2003;29:39-46.
Aisuodionoe-Shadrach OI. Perceptions of female sexual health and sexual dysfunction in a cohort of urban professional women in Abuja, Nigeria. Niger J Clin Pract 2012;15:80-3. [Full text]
Wiegel M, Meston C, Rosen R. The female sexual function index (FSFI):Crossvalidation and development of clinical cut-off scores. J Sex Marital Ther 2005;31:120.
Guirgus WR. No sex please (part II) lack of desire in women. Sex Med Postgrad Doc Afr 1995;15:52-6.
[Table 1], [Table 2], [Table 3]