|Year : 2019 | Volume
| Issue : 1 | Page : 61-66
Sexual dysfunction among women in a Nigerian gynecological outpatients unit
OO Ogunbode1, CO Aimakhu1, AM Ogunbode2, LA Adebusoye2, KM Owonikoko3
1 Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
2 Department of Family Medicine, University College Hospital, Ibadan, Nigeria
3 Department of Obstetrics and Gynaecology, Ladoke Akintola University of Technology, Ogbomosho, Nigeria
|Date of Web Publication||17-Apr-2019|
O O Ogunbode
Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan
Source of Support: None, Conflict of Interest: None
Background: Sexual dysfunction is an important public-health problem, which is often less reported or explored through opportunistic evaluation during medical consultations.
Objective: This study was designed to determine the prevalence and patterns of female sexual dysfunction (FSD) including the sexual quality of life among female patients attending a gynecological outpatients unit in Southwest Nigeria.
Materials and Methods: This is a cross-sectional descriptive study of 146 consenting women who attended the gynecological outpatients' clinic of the University College Hospital, Ibadan, Nigeria, during the study period. Participants were selected using multistage sampling technique. The survey instruments were previously validated questionnaires such as Sexual Function Questionnaire (SFQ28), Sexual Quality of Life-Female Questionnaire (SQOL-F), and the Family Adaptation, Partnership, Growth, Affection and Resolve (APGAR) score. The results were analyzed using Statistical Package for Social Sciences version 17 and P value was set at 5%.
Results: The mean age was 33.8 ± 5.7 years. Most (85.6%) respondents had at least one form of sexual dysfunction. The commonest dysfunction was arousal-sensation (62.4%) while the least was pain (3.4%). The mean SFQ28 and SQOL-F scores were 58.0 ± 12.57 and 28.0 ± 11.94, respectively. There were no statistically significant differences in the SFQ28 and SQOL-F scores across sociodemographic factors. Women classified as belonging to dysfunctional family on Family APGAR score similarly had poorer scores for sexual dysfunction (100%, P = 0.016).
Conclusion: FSD is common among women attending gynecological outpatients clinic. Managing clinicians should be aware of this condition and proffer appropriate care in addition to the main presenting complaint.
Keywords: Female; Nigeria; outpatients; sexual dysfunction.
|How to cite this article:|
Ogunbode O O, Aimakhu C O, Ogunbode A M, Adebusoye L A, Owonikoko K M. Sexual dysfunction among women in a Nigerian gynecological outpatients unit. Trop J Obstet Gynaecol 2019;36:61-6
|How to cite this URL:|
Ogunbode O O, Aimakhu C O, Ogunbode A M, Adebusoye L A, Owonikoko K M. Sexual dysfunction among women in a Nigerian gynecological outpatients unit. Trop J Obstet Gynaecol [serial online] 2019 [cited 2019 Jul 18];36:61-6. Available from: http://www.tjogonline.com/text.asp?2019/36/1/61/256484
| Introduction|| |
Sexual dysfunction constitutes a group of disorders affecting the sexual response and is an important public-health problem which is often less commonly researched., The fact that over the years several criteria for its definition have been adopted makes its prevalence and geographic spread difficult to ascertain. Although sexual dysfunction can occur in both genders, available studies reveal that it is more prevalent among women.,
Most of the earlier documentations of the female sexual response were in the 19th century and among different professions such as marital therapists, psychoanalysts, sexologists, gynecologists, and psychiatrists., By the mid-20th century, the categorization of the female sexual response cycle, by Masters and Johnson in 1966, gained wide acceptance and female sexual dysfunction (FSD) was classified into four groups. This remained for so long until the recent categorization into three groups (sexual interest/arousal syndrome, female orgasmic disorder, and genito-pelvic pain/penetration disorder) by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
The prevalence of FSD varies across different regions depending on the tools used in its diagnosis and whether affected women consider it worrisome. Commonly used tools include the American Psychiatric Association's Diagnosis and Statistical Manual for Mental Disorder, 4th text revision, the World Health Organization's International Classification of Diagnosis (ICD-10), Profile of Female Sexual Function, Female Sexual Function Index, Golombok Rust Inventory of Sexual Satisfaction, International Index of Erectile Function, Sexual Function Questionnaire (SFQ), and other researcher-made validated questionnaires.,,,,,, Globally, It is estimated to be 30–50% in the USA, 52.2% in Turkey, 26–51% in Iran, and 5.5–18.6% in Malaysia.,,, In Nigeria, in the past decade, there seems to be a slow but steady increased interest in this area, with FSD estimated to range between 53.3% and 71.0%.,,
FSD may be lifelong, acquired, situational, or generalized and an individual may have multiple variants of sexual dysfunctions at the same time., More often, a combination of biological, physical, psychological, and emotional factors is usually involved. Studies have shown that it is influenced by parity rather than mode of delivery, harmful practices such as Female Genital Mutilation, and chronic diseases.,,, It affects the quality of life of affected individuals and in some instances has been reported as a cause of marital disharmony.,
Despite the growing concern about the impact of FSD, there is still paucity of data on this topic in Nigeria. This study was designed to obtain baseline data on the prevalence and types of FSD experienced among women attending the gynecological outpatients department while also determining its predictors. Additionally, the sexual quality of life of the respondents and the influence of Family Adaptation, Partnership, Growth, Affection, and Resolve (APGAR) on FSD and sexual quality of life were also determined.
| Materials and Methods|| |
It was a cross-sectional descriptive study among women attending the gynecological outpatients department of the University College Hospital, Ibadan, Nigeria between March 1 and July 31, 2012. Only first attendees were recruited. All consenting participants who attended the clinic during the study period were recruited while women with referral notes suggestive of gynecological malignancies or previous gynecological surgeries were excluded.
Participants were selected using multistage sampling technique. Four hospitals providing specialist gynecological care of at least the secondary level within the locality were considered in the initial phase, namely, University College Hospital Ibadan, Adeoyo Maternity Teaching Hospital (Yemetu), Adeoyo Maternity Teaching Hospital (Ring Road), and Our Lady of Apostle Catholic Hospital, Oluyoro, Oke-Offa Ibadan. The University College Hospital, Ibadan, was selected by simple random sampling while systematic sampling was used in selecting the eventual study respondents.
Prior to the commencement of the study, two female research assistants were trained on the use of the survey instrument and ethical approval was obtained. The survey instruments were previously validated tools such as Female Sexual Function Questionnaire (SFQ28), Sexual quality of life-female questionnaire (SQOL-F), and the Family APGAR score. SFQ28 consisted of 28 questions with each having between 5 and 7 possible response and scores reported in 7 domains of dysfunction. The SQOL-F aspect had 18 questions focusing on sexual self-esteem, emotional, and relationship issues. Each question was rated on a 6-point Likert scale ranging from 0 to 5. The Family APGAR scores had five components: adaptation, partnership, growth, affection, and resolve with each scored as 0 or 2.
FSD was defined as at least one score in any domain within the range, indicating high probability on the SFQ28. APGAR scores of >6 or <6 were classified as functional or dysfunctional families, respectively. The results were analyzed using Statistical Package for Social Sciences version 17.
| Results|| |
[Table 1] shows the sociodemographic characteristics plus the mean SFQ28 and SQOL-F scores of the 146 respondents. The mean age of respondents was 33.8 ± 5.7 years and the age range was 22–51 years. Most were within the age group 25–34 years (79; 54.2%) and had at least tertiary education (98; 67.1%). The common occupational groups were the skilled nonmanual (53; 36.3%) and unskilled workers (52; 35.6%). About an equal proportion of respondents were earning less than or above 25,000 Naira monthly.
|Table 1: Sociodemographic characteristics and mean FSD/FSQ scores of respondents|
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Highest SFQ28 scores were observed among respondents in age group 25–34 (86.2 ± 13.0), with tertiary education (86.4 ± 13.4), unemployed (86.9 ± 17.6), earning more than 100,000 Naira monthly (90.1 ± 9.2), married for more than 10 years (88.4 ± 9.8), and nulliparous (86.5 ± 12.0) while highest SQOL-F scores were obtained among women greater than 45 years (52.4 ± 10.5), with primary education (53.4 ± 11,8), unskilled (52.0 ± 13.5), earning less than 10,000 Naira (54.6 ± 12.6), less than 10 years married (49.6 ± 11.5), and at least four parous experiences (57.3 ± 8.5).
[Figure 1] shows the prevalence of FSD among the respondents with 125 (85.6%) having at least 1 form of reported sexual dysfunction. Most FSD related to arousal phase of the female sexual response. Of the eight domains, the commonest dysfunction was arousal (sensation) (62.4%) while the least was pain (3.4%). This is shown in [Figure 2].
Using the Family APGAR scoring, 28 respondents (19.2%) were classified as dysfunctional families. The entire respondent in the dysfunctional family group (100%) had at least one form of FSD compared to 82.2% among those with normal families (P = 0.016). This is shown in [Figure 3].
|Figure 3: Relationship between family APGAR and female sexual dysfunction. P = 0.266; Chi-square = 1.235|
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[Table 2] shows the associations between sociodemographic characteristics and FSD. Only the income of the respondents was statistically significant in relation to the prevalence of FSD. Women in the extremes of income groups had the highest prevalence of FSD. Using the SFQ28 scores, there were no statistically significant differences across sociodemographic factors like age groups, parity, number of children alive, monthly income, and number of years married.
| Discussion|| |
Although an estimate of FSD from global and a few African studies puts it at less than 50% of the population,,,, the FSD prevalence of 85.6% found in this study is higher than previously reported in Nigeria. This may be attributed to the fact that our study utilized the use of a validated survey instrument, which was interviewer administered for completeness by well-trained personnel. Even in both developing and developed countries, the use of structured validated instruments tends to yield higher prevalence of SD.,,,
The threshold adopted in this study as defining FSD as any one of the reported domains of sexual dysfunction could also have played a role. This is supported by the study of Fajewonyomi et al. in Ile-Ife where similar methodology to this study was adopted and 63% of their study population had FSD, although they used a self-developed questionnaire. On the other hand, both of these studies were done in the hospital setting among women presenting at the gynecological outpatient units and the possibility of underlying gynecological or psychological issues contributing to the high prevalence cannot be confidently overruled.
This study also showed that although these patients came to the clinic for other conditions, many of them were suffering silently from FSD and these were not reported. This may be due to the reluctance of women to discuss sexual matters as previously documented in an African population, and even in developed countries, these women rather present with other medical conditions rather than sexual dysfunction., It is therefore pertinent that health-care providers should deliberately seek information relating to sexual dysfunction so that affected women can benefit from appropriate care and intervention.
The commonest type of dysfunction observed from our study was arousal sensation (62.4%) while the least was pain (3.4%). This is unlike as a few other Nigerian studies had reported orgasmic disorders as the most common form. Arousal has to do with sexual stimulation and is facilitated by adequate foreplay. This observation may be explained by the male dominance in sexual matter, which is common in the African setting. Women are reluctant to initiate or dictate sex so as not to be perceived as promiscuous. They also do not negotiate sex and most often sacrifice their satisfaction for their partners. The fear of divorce and marital disharmony also makes the women to be docile. All these factors could then lead to poor lubrication and lack of interest in sex.
We also studied the influence of sociodemographic characteristics such as age groups, parity, number of children alive, monthly income, and years married on the prevalence of SD. With the hormonal changes that occur with increasing age, it is thought that the prevalence of SD in the elderly should increase. This sex hormone affects libido, vaginal lubrication, and distortion of the pelvic anatomy, which may result in difficult sex. However, this study did not show any statistically significant differences across the age groups. This does not mean that sexual dysfunction is not present but affected women may not consider it worrisome and so unreported.
Childbirth is an important landmark that is well celebrated, strongly emphasized, and looked forward to in the African population. Women who are not able to get pregnant are often stigmatized and seen as outcast. Mothers in developing countries are also mostly of high parity because of the preference for large families and low usage of contraception. These women are also likely not to attend antenatal clinic, have delivery conducted by nonskilled attendant, and more likely to have obstetrics morbidities. Even without complications, repeated childbirth weakens the pelvic floor and may result in urogenital prolapse, which may affect sexual satisfaction. The cumulative expected effect is poorer scores for sexual dysfunction; however, this was not observed in this study. This may be due to the fact that only 2.7% of our study population had more than three previous parous experiences and as such the sample size may not be powered enough to observe any statistically significant difference.
Despite all these above observations, the SFQ28 scores obtained across the study population were not statistically significant when compared to the sociodemographic factors. However, a major outcome of this study is the role of the family type on FSD. Although the prevalence of FSD was high among the study population generally, all those women with dysfunctional families had FSD. This shows that functional families may help reduce the prevalence of FSD. It will need to be explored whether there are also other contributing factors.
| Conclusion|| |
This study has shown that FSD is underreported and common among women attending gynecological outpatients' clinic. Attending clinicians should be aware of this condition and proffer appropriate care in addition to the main presenting complaint. There is also the need for further studies on this silent condition.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Fajewonyomi BA, Orji EO, Adeyemo AO. Sexual dysfunction among female patients of reproductive age in a hospital setting in Nigeria. J Heal Popul Nutr 2007;25:101-6.
Ojomu F, Thacher T, Obadofin M. Sexual problems among married Nigerian women. Int J Impot Res 2007;19:310-6.
Rosen RC. Prevalence and risk factors of sexual dysfunction in men and women. Curr Psychiatry Rep 2000;2:189-95.
Lewis RW, Fugl-Meyer KS, Bosch R, Fugl-Meyerr AR, Laumann EO, Lizza E, et al
. Epidemiology/risk factors for sexual dysfunction. J Sex Med 2004;1:35-9.
Angel K. The history of 'Female Sexual Dysfunction' as a mental disorder in the 20th
century. Curr Opin Pscychiatry 2010;23:536-41.
Hatzichristou D, Rosen RC, Broderick G, Clayton A, Cuzin B, Derogatis L, et al
. Clinical evaluation and management strategy for sexual dysfunction in men and women. J Sex Med 2004;1:49-57.
Masters W, Johnson V. The sexual response cycle. In: Brown L editor. Human Sexual Response. Little Brown & Company: Boston; 1966. p. 3-8.
American Psychiatry Association. Diagnostics and Statistical Manual of Mental Disorders. 5th
ed. American Psychiatric Association; 2013.
Meston C, Derogatis L. Validated instruments for assessing female sexual function. J Sex Marital Ther 2002;28:155-64.
Weigel M, Meston C, Rosen R. The female sexual function index (FSFI): Cross-validation and development of clinical cutoff scores. J Sex Marital Ther 2005;31:1-20.
Rizvi SJ, Yeung NW, Kennedy SH. Instruments to measure sexual dysfunction in community and psychiatric populations. J Psychosom Res 2011;70:99-109.
Kukkonen TM. Devices and methods to measure female sexual arousal. Sex Med Rev 2015;3:225-44.
Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, et al
. The female sexual function index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 2000;26:191-208.
Erbil N. Prevalence and risk factors for female sexual dysfunction among Turkish women attending a maternity and gynecology outpatient clinic. Sex Disabil 2011;29:377-86.
Grewal GS, Gill JS, Sidi H, Gurpreet K, Jambunathan ST, Suffee NJ, et al
. Prevalence and risk factors of female sexual dysfunction among healthcare personnel in Malaysia. Compr Psychiatry 2014;55:S17-22.
Berman JR. Physiology of female sexual function and dysfunction. Int J Impot Res 2005;17(Suppl 1):S44-51.
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.
Nwagha UI, Oguanuo TC, Ekwuazi K, Olubobokun TO, Nwagha TU, Onyebuchi AK. Prevalence of sexual dysfunction among females in a university community in Enugu, Nigeria. Niger J Clin Pract 2014;17:791-6.
] [Full text]
Nicolosi A, Buvat J, Glasser DB, Hartmann U, Laumann EO, Gingell C. Sexual behaviour, sexual dysfunctions and related help seeking patterns in middle-aged and elderly Europeans: The global study of sexual attitudes and behaviors. World J Urol 2006;24:423-8.
Ohl LE. Essentials of female sexual perspective. Urol Nurs 2007;27:57-64.
Botros SM, Abramov Y, Miller J-JR, Sand PK, Gandhi S, Nickolov A, et al
. Effect of parity on sexual function: An identical twin study. Obstet Gynecol 2006;107:765-70.
Berg RC, Denison E. Does female genital mutilation/cutting (FGM/C) affect women's sexual functioning? A systematic review of the sexual consequences of FGM/C. Sex Res Soc Policy 2012;9:41-56.
Dossenbach M, Hodge A, Anders M, Molnár B, Peciukaitiene D, Krupka-Matuszczyk I, et al
. Prevalence of sexual dysfunction in patients with schizophrenia: International variation and underestimation. Int J Neuropsychopharmacol 2005;8:195-201.
Akinpelu AO, Osose AA, Odole AC, Odunaiya NA. Sexual dysfunction in Nigerian stroke survivors. Afr Health Sci 2013;13:639-45.
Okeahialam BN, Obeka NC. Sexual dysfunction in female hypertensives. J Natl Med Assoc 2006;98:638-40.
Lew-Starowicz M, Rola R. Prevalence of sexual dysfunctions among women with multiple sclerosis. Sex Disabil 2013;31:141-53.
Lema VM. Unconsummated Marriage in Sub-Saharan Africa: Case Reports. Afr J Reprod Health 2014;18:159-66.
Oksuz E, Malhan S. Prevalence and risk factors for female sexual dysfunction in Turkish women. J Urol 2005;175:654-8.
Read S, King M, Watson J. Sexual dysfunction in primary medical care: Prevalence, characteristics and detection by the general practitioner. J Public Health Med 1997;19:387-91.
Rosen RC, Taylor JF, Leiblum SR, Bauchman GA. Prevalence of sexual dysfunction in women: Results of a survey study of 329 women in an outpatient gynecological clinic. J Sex Marital Ther 1993;19:171-88.
Osborn M, Hawton K, Gath D. Sexual dysfunction among middle aged women in the community. Br Med J 1988;296:959-62.
Singh J, Tharyan P, Kekre N, Singh G, Gopalakrishnan G. Prevalence and risk factors for female sexual dysfunction in women attending a medical clinic in south India. J Post Grad Med 2009;55:113-20.
Amidu N, Owired W, Gyasi-Sa R, Wood C, Quaye L. Sexual dysfunction among married couples living in Kumasi metropolis, Ghana. BMC Urol 2011;3:3-7.
Hassanin I, Helmy Y, Fathala M, Shahin A. Prevalence and characteristics of female sexual dysfunction in a sample of women from Upper Egypt. Int J Gynecol Obstet 2010;108:219-23.
Okiria EM. Perspectives of sexuality and aging in the African culture: Eastern Uganda. Int J Sociol Anthropol 2014;6:126-9.
Worly B, Gospal M, Arya L. Sexual dysfunction among women of low-income status in an urban setting. Int J Gynaecol Obstet 2010;111:241-4.
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2]