Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Monash Centre for Health Research and Implementation, School of Clinical Sciences, Monash University and Monash Health, Melbourne, Victoria, Australia.
Hum Reprod Update. 2024 May 2;30(3):323-340. doi: 10.1093/humupd/dmad034.
Polycystic ovary syndrome (PCOS) is a common and distressing endocrine disorder associated with lower quality of life, subfertility, diabetes, cardiovascular disease, depression, anxiety, and eating disorders. PCOS characteristics, its comorbidities, and its treatment can potentially influence sexual function. However, studies on sexual function in women with PCOS are limited and contradictory.
The aim was to perform a systematic review of the published literature on sexual function in women with PCOS and assess the quality of the research and certainty of outcomes, to inform the 2023 International Guidelines for the Assessment and Management of PCOS.
Eight electronic databases were searched until 1 June 2023. Studies reporting on sexual function using validated sexuality questionnaires or visual analogue scales (VAS) in PCOS populations were included. Random-effects models were used for meta-analysis comparing PCOS and non-PCOS groups with Hedges' g as the standardized mean difference. Study quality and certainty of outcomes were assessed by risk of bias assessments and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) method according to Cochrane. Funnel plots were visually inspected for publication bias.
There were 32 articles included, of which 28 used validated questionnaires and four used VAS. Pooled Female Sexual Function Index (FSFI) scores in random-effects models showed worse sexual function across most subdomains in women with PCOS, including arousal (Hedges's g [Hg] [95% CI] = -0.35 [-0.53, -0.17], I2 = 82%, P < 0.001), lubrication (Hg [95% CI] = -0.54 [-0.79, -0.30], I2 = 90%, P < 0.001), orgasm (Hg [95% CI] = -0.37 [-0.56, -0.19], I2 = 83%, P < 0.001), and pain (Hg [95% CI] = -0.36 [-0.59, -0.13] I2 = 90%, P < 0.001), as well as total sexual function (Hg [95% CI] = -0.75 [-1.37, -0.12], I2 = 98%, P = 0.02) and sexual satisfaction (Hg [95% CI] = -0.31 [-0.45, -0.18], I2 = 68%, P < 0.001). Sensitivity and subgroup analyses based on fertility status and body mass index (BMI) did not alter the direction or significance of the results. Meta-analysis on the VAS studies demonstrated the negative impact of excess body hair on sexuality, lower sexual attractiveness, and lower sexual satisfaction in women with PCOS compared to controls, with no differences in the perceived importance of a satisfying sex life. No studies assessed sexual distress. GRADE assessments showed low certainty across all outcomes.
Psychosexual function appears to be impaired in those with PCOS, but there is a lack of evidence on the related distress scores, which are required to meet the criteria for psychosexual dysfunction. Health care professionals should discuss sexual function and distress and be aware of the multifactorial influences on sexual function in PCOS. Future research needs to assess both psychosexual function and distress to aid in understanding the degree of psychosexual dysfunction in PCOS. Finally, more diverse populations (e.g. non-heterosexual and more ethnically diverse groups) should be included in future studies and the efficacy of treatments for sexual dysfunction should also be assessed (e.g. lifestyle and pharmacological interventions).
多囊卵巢综合征（PCOS）是一种常见且令人痛苦的内分泌疾病，与生活质量降低、生育能力下降、糖尿病、心血管疾病、抑郁、焦虑和饮食失调有关。PCOS 的特征、合并症及其治疗方法可能会影响性功能。然而，关于 PCOS 女性性功能的研究有限且存在矛盾。
本研究旨在对已发表的关于 PCOS 女性性功能的文献进行系统综述，并评估研究的质量和结果的确定性，以为 2023 年国际 PCOS 评估和管理指南提供信息。
直到 2023 年 6 月 1 日，我们在 8 个电子数据库中进行了检索。研究使用验证过的性功能问卷或视觉模拟量表（VAS）评估 PCOS 人群的性功能。采用随机效应模型比较 PCOS 组和非 PCOS 组，使用 Hedges'g 作为标准化均数差进行 meta 分析。根据 Cochrane，通过偏倚风险评估和推荐评估、制定与评估（GRADE）方法评估研究质量和结果的确定性。通过视觉检查漏斗图评估发表偏倚。
共纳入 32 篇文章，其中 28 篇使用了验证过的问卷，4 篇使用了 VAS。在随机效应模型中，女性性功能指数（FSFI）的汇总评分表明，PCOS 女性在大多数子领域的性功能较差，包括性欲（Hedges's g [Hg] [95% CI] = -0.35 [-0.53, -0.17]，I² = 82%，P < 0.001）、润滑（Hg [95% CI] = -0.54 [-0.79, -0.30]，I² = 90%，P < 0.001）、性高潮（Hg [95% CI] = -0.37 [-0.56, -0.19]，I² = 83%，P < 0.001）和疼痛（Hg [95% CI] = -0.36 [-0.59, -0.13]，I² = 90%，P < 0.001），以及总体性功能（Hg [95% CI] = -0.75 [-1.37, -0.12]，I² = 98%，P = 0.02）和性满足感（Hg [95% CI] = -0.31 [-0.45, -0.18]，I² = 68%，P < 0.001）。基于生育状态和体重指数（BMI）的敏感性和亚组分析并未改变结果的方向或意义。对 VAS 研究的 meta 分析表明，与对照组相比，PCOS 女性多余的体毛会对性功能产生负面影响，降低性吸引力和性满足感，而对性生活满意的重要性没有差异。没有研究评估性功能障碍。GRADE 评估表明，所有结果的确定性都较低。
PCOS 患者的精神性功能似乎受损，但有关相关痛苦评分的证据不足，而这是确定精神性功能障碍的必要条件。医疗保健专业人员应讨论性功能和痛苦，并意识到 PCOS 性功能障碍的多因素影响。未来的研究需要评估精神性功能和痛苦，以帮助了解 PCOS 中精神性功能障碍的程度。最后，未来的研究应包括更多样化的人群（例如非异性恋和更多种族多样化的群体），并评估治疗性功能障碍的疗效（例如生活方式和药物干预）。
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