Examining the Evidence
Is personal distress an important measure when assessing sexual dysfunction?
Female sexual function is a common problem, with prevalence estimated in the range of 43%. 1 According to Shifren and colleagues, “Most epidemiologic definitions of female sexual dysfunction refer to sexual problems without requiring sexually related personal distress to be present, whereas current diagnostic guidelines from the American Psychiatric Association and Food and Drug Administration require personal distress as part of the diagnostic criteria for ‘dysfunction.’”
In the survey described by this study, which had a response rate of 63% (n=31,581), female heads of household 18 years of age and older were asked to evaluate their sexual function using the female short-form Changes in Sexual Functioning Questionnaire and the Female Sexual Distress Scale. The prevalence of any sexual problem was 44.2%, with the most common problems being:
- low desire (38.7%)
- low arousal (26.1%)
- orgasmic dysfunction (20.5%).
Dyspareunia was not assessed in this survey because a physical examination is required.
How the findings broke down by age
The prevalence of sexual problems increased with age:
- Among women 18 to 44 years old, 27.2% reported a problem with desire, arousal, orgasm, or a combination of the three.
- Among women 45 to 64 years old, the prevalence was 44.6%.
- Among women 65 years and older, the prevalence of one or more of these problems was 80.1%.
As for personal distress, it was:
- highest (14.8%) among respondents 45 to 64 years old
- lowest (8.9%) among women 65 years or older
- intermediate (10.8%) in women 18 to 44 years old.
The prevalence of distress associated with desire and arousal problems followed the same pattern. A higher prevalence of distressing desire problems also was seen in women who had health problems and in those who were menopausal. The prevalence of distressful orgasmic dysfunction was similar in middle-aged and older women.
Medical problems associated with a higher prevalence of distressing problems of desire were depression, thyroid dysfunction, anxiety, and urinary incontinence.
Strengths and weaknesses of the study
The large sample size, wide age range, and use of verified instruments to measure sexual problems and related distress were all strengths of this study.
However, to increase response rates to “sensitive” questions, the authors used a research panel that was not randomly chosen. As a result, respondents may have been more health-conscious and self-aware than otherwise would have been the case; they also may have had more time to answer mailed questionnaires.
The fact that sexual problems and distress were self-reported without clinical evaluation also may have biased the findings slightly. Because the study was cross-sectional, cause and effect could not be established.
WHAT THIS EVIDENCE MEANS FOR PRACTICE
Although sexual problems are common among women in the United States, this survey confirms that distress caused by these problems is considerably less widespread. Sexual problems increase with age, but related distress is most common in women at midlife (45 to 64 years old).
Women’s health clinicians who elicit a history of sexual dysfunction should determine the level of distress that is present before deciding to address the problem.—ANDREW M. KAUNITZ, MD
1. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors [published erratum appears in JAMA. 1999;281:1174]. JAMA. 1999;281:537-544.