AIPMED

ANNALS OF IBADAN POSTGRADUATE MEDICINE

FACTORS ASSOCIATED WITH SEXUAL DYSFUNCTION AMONG FEMALE PATIENTS IN A NIGERIAN AMBULATORY PRIMARY CARE SETTING

           L.A. Adebusoye1 , O. Ogunbode2 , K.M. Owonokoko3 , A.M. Ogunbode1 , and C. Aimakhu2

  1. Department of Family Medicine, University College Hospital, Ibadan, Nigeria.
  2. Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Nigeria
  3. Department of Obstetrics and Gynaecology, Ladoke Akintola University of Technology, Ogbomosho, Nigeria. 

ABSTRACT

Background: Sexual dysfunction is a common but under-reported problem of public health importance among female adults in Nigeria. Empirical evidence on sexual dysfunction among female Nigerians is scarce. Objectives: To determine the prevalence and risk factors associated with sexual dysfunction among female patients presenting at the General Outpatient Clinic (GOPC), University College Hospital (UCH), Ibadan, Nigeria.

Methods: This was a cross-sectional study of 480 married female patients who presented consecutively at the GOPC, UCH, Ibadan, Nigeria. The 28-item Sexual Function Questionnaire (SFQ-28) was used to determine sexual dysfunction. Information on their sociodemographic characteristics, obstetric and gynecological history were obtained. Bivariate and multivariate analyses were carried out and alpha was set at 0.05.

Results: Point prevalence of sexual dysfunction was 80.0%. The most common sexual dysfunction was problems with sexual desire (99.4%), while the least common was problems with arousal cognition (5.8%). There was a significant association between the prevalence of sexual dysfunction and age, years of relationship, number of children alive, parity, level of education, age at coitarche and family dysfunction. Age (OR=0.893; 95% CI=0.821–0.972, p=0.008), parity (OR=3.093; 95% CI=1.174– 8.151, p=0.022), having family dysfunction (OR=2.096; 95% CI= 1.129–3.891, p=0.019) and having>10 years of formal education (OR=4.808; 95% CI= 2.604–8.928, p<0.0001) were found to be the predictors of sexual dysfunction.

Conclusion: Sexual dysfunction among female married adults in our setting was high. We propose that modifiable factors such as socio-demographic and gynaecological variables should be evaluated during the consultation of female patients at first contact

Keywords: Female, Sexual dysfunction, Primary care, Nigeria

Correspondence

Dr. O. Ogunbode

Department of Obs and Gynae,

College of Medicine,

University of Ibadan,

Nigeria

Email:jamchose@yahoo.co.uk


INTRODUCTION

Sexual health is an important aspect of the overall health of women with Masters and Johnson describing the 4 phases of sexual experience and response in women as excitement, arousal with plateau, orgasm and satisfaction1 . Sexual dysfunction is a disruption in this sexual response cycle which does not allow achievement of the expected outcome2 . In females, sexual dysfunction is classified into five groups which comprise disorders of arousal, aversion, desire, orgasm, and pain3,4. Krakowsky and Grober in 2018, however, divided Female Sexual Dysfunction (FSD) into four groups consisting of sexual pain, low desire, low arousal and orgasmic dysfunction4. FSD could be caused by diabetes mellitus, hypertension, arthritis, dementia, dermatologic conditions including vulvar eczema; gynaecological problems such as pelvic inflammatory disease; and spinal cord problems, pituitary tumours, and urinary incontinence5 . Sexual abuse, life stressors, interpersonal and relationship disorders are also implicated in FSD6,7 . FSD could also be associated with antipsychotics8 , antihistamines, metronidazole, antihypertensives, antiestrogens such as Tamoxifen, antiandrogens like cimetidine and spironolactone, antidepressants and alcohol6 . Other drugs which lead to FSD include antilipids, narcotics, ketoconazole and hormonal contraceptives5 .  FSD is a very important aspect of health (WHO 2016) as women constitute half of the global population and even though men are more than women in the younger age group, from age 60 years and above, women are found to be a higher proportion (54%)9 . There is a high prevalence of sexual dysfunction in both men and women6 with varying epidemiology. Globally, the prevalence of FSD falls between 35.4 – 62.1%10,11. In Northern Nigeria, the highest proportion of respondents (35.7%) defined FSD as having no desire for sex12, while authors based in South-western Nigeria in 2007, described the prevalence of FSD as 68.3%13 . FSD could be assessed by several tools including the Female Sexual Function Inventory (FSFI)14, the Sexual Dysfunction Questionnaire (SDQ)3 and the Sexual Function Questionnaire. The SFQ-34 was validated by Quirk and colleagues in 200215. Since then, there have been several adaptations of the questionnaire such as the SFQ-28 and the SFQ–V2. There are also several versions of this questionnaire adapted to countries such as the Persian version16 . A woman’s social, cultural, background, expectations, and relationships are also very important factors in sexual dysfunction1 .In various cultures, sexuality is something difficult to discuss and there is usually more emphasis on male sexual dysfunction otherwise known as Erectile Dysfunction than FSD. In fact, it is already well established that there is more sexual dysfunction in men than women and as men grow older, there is increased sexual dysfunction17. However, in women, it is difficult to measure arousal and orgasm with women not as forthcoming with reporting problems in these domains and this is compounded by confounders in women such as depression2 . Therefore, the need arose for this study to define the magnitude of FSD presently in South- western Nigeria. The aim of this study was to determine the prevalence of FSD among adult married women presenting in GOP clinic, UCH, Ibadan, Oyo State, Nigeria as well as to identify the pattern of presentation of females with FSD.