Do women with Polycystic Ovary Syndrome (PCOS) experience sexual arousal?

Sexual Function in Women with Polycystic Ovary Syndrome (PCOS)

Women with PCOS experience sexual arousal, but often have impaired sexual function across multiple domains including arousal, lubrication, orgasm, and satisfaction compared to women without PCOS. 1

Sexual Function Impairments in PCOS

• Sexual dysfunction is highly prevalent in women with PCOS, with studies reporting rates of 57.7% to 62.5% 2, 3
• The arousal domain is one of the most commonly affected areas of sexual function in women with PCOS, with impairment reported in 93.8-98.5% of cases 2, 3
• Women with PCOS demonstrate significantly lower scores in arousal (4.48 vs 5.04, p<0.001), lubrication (4.69 vs 5.29, p<0.001), orgasm (4.11 vs 4.78, p=0.001), satisfaction (4.78 vs 5.22, p=0.016), and total sexual function scores compared to women without PCOS 4
• Meta-analysis shows worse sexual function across multiple domains in women with PCOS, including arousal, lubrication, orgasm, pain, total sexual function, and sexual satisfaction 1

Contributing Factors to Sexual Dysfunction in PCOS

Hormonal and Physiological Factors

• Anovulation appears to be a major determinant of sexual impairment in PCOS - women with ovulatory PCOS show less sexual dysfunction than those with anovulatory PCOS 4
• Chronic anovulation is a key diagnostic criterion for PCOS and contributes to sexual dysfunction 5
• Hyperandrogenism (elevated testosterone levels) can have complex effects on sexual function - while causing symptoms like hirsutism that may negatively impact body image, testosterone levels have been positively correlated with sexual satisfaction in some studies 6
• BMI has a significant effect on sexual desire and arousal in women with PCOS (p=0.02) 2

Psychological Factors

• Women with PCOS who have symptoms of depression and anxiety are significantly more likely to suffer from sexual dysfunction than those without these symptoms (p=0.04 and p=0.03 respectively) 3
• Stress symptoms are associated with higher orgasm dysfunction in women with PCOS (p=0.02) 3
• PCOS is associated with psychological comorbidities including depression, poor self-esteem, anxiety, body image issues, and social isolation, which can all impact sexual function 7
• Almost half of women with PCOS report that the disorder has a great impact on their sex life 6

Clinical Implications

• Healthcare providers should screen all PCOS patients for sexual function using validated questionnaires such as the Female Sexual Function Index (FSFI) 2
• Treatment approaches should address both the physical and psychological aspects of PCOS that contribute to sexual dysfunction 3
• Management of anovulation through appropriate hormonal treatments may help improve sexual function in women with PCOS 4
• Mental health support should be considered as part of comprehensive PCOS management, as depression and anxiety significantly contribute to sexual dysfunction 3

Common Pitfalls to Avoid

• Failing to address sexual function as part of routine PCOS management 2
• Overlooking the psychological impact of PCOS on sexual function and quality of life 3
• Not recognizing that anovulation, rather than just physical symptoms like hirsutism, may be a primary driver of sexual dysfunction in PCOS 4
• Assuming that all domains of sexual function are equally affected - arousal and lubrication are particularly impacted in women with PCOS 2, 3