P-689 Sexual response in women with Polycystic Ovary Syndrome
Authors: Pastoor H , Laan E , Laven J , Both S 
Published: July 2024

Study question

Are genital response and subjective sexual response different between women with and without PCOS and what is the relationship with sex steroid levels?

Summary answer

No difference in genital sexual response was found, but women with PCOS report lower subjective sexual response. The relationship with androgens is limited.

What is known already

The literature shows that women with polycystic ovary syndrome (PCOS) report lower sexual function and higher sexual distress compared to healthy control women. Whether genital sexual responses are impaired in PCOS is unknown. A symptom of PCOS is hyperandrogenism, which can influence sexual response. In this study, we assessed genital and subjective sexual responses and their relationship with androgen levels in women with and without PCOS.

Study design, size, duration

This observational prospective case control study with 135 women (68 PCOS, 67 control) was conducted from March 2017 until March 2020.

Participants/materials, setting, methods

Women with PCOS and healthy controls, aged 18-40 years, in a steady relationship and without any comorbidities were included. All participants underwent an extensive medical and endocrine assessment. Genital response (vaginal pulse amplitude (VPA) using photoplethysmography) was assessed in various erotic stimulus conditions (fantasy, vibration, film, film-vibration). Subjective sexual arousal, affect, and vaginal lubrication were assessed using questionnaires. Associations with Testosterone, Androstenedione, dehydroepiandrosterone (DHEA), sex hormone-binding globulin (SHBG) and Free Androgen Index (FAI) were calculated.

Main results and the role of chance

Women with PCOS showed higher androgen levels and used less often oral contraceptive pills (COCP).

No significant differences were found between the groups in self-reported vaginal lubrication, VPA baseline or VPA change scores in the different erotic stimulus conditions.

Women with PCOS reported significantly lower positive affect (fantasy: 3.87±1.35 vs 4.40±1.07 P=0.012; vibration: 3.72±1.33 vs 4.24±1.34 P=0.025; film-vibration: 4.17±1.48 vs 4.77±1.36 P=0.016) sexual arousal (film-vibration: 4.64±1.43 vs 5.23±1.35, P=0.014) and genital sensations (film-vibration: 4.62±1.56 vs 5.24±1.32 P=0.013) compared to women without PCOS.

Multiple regression analyses showed only few significant results. Analyses for the total group showed negative associations between SHBG and lubrication (β=-1.588, P=0.050, Adj R2=0.029), and SHBG and positive affect (vibration: β=-1.040, P=0.039, Adj R2=0.032) indicating lower lubrication and lower positive affect with higher SHBG levels. No associations were found for VPA.

Adjusted regression analyses (age, relationship duration, COCP) for both groups separately showed a positive association in the PCOS group between DHEA and sexual arousal (fantasy: β = 1.719, P=0.049, Adj R2=0.020) and a negative association of SHBG with sexual arousal (fantasy: β=-1.728, P=0.020, Adj R2=0.044) indicating higher sexual arousal with higher DHEA and lower SHBG. Explained variance was below 5%. No associations were found for the control group.

Limitations, reasons for caution

Studying genital sexual response with photoplethysmography potentially creates selection bias by self-selection of women who are willing to participate in this kind of research. Differences in age and COCP use between the groups might have skewed genital sexual response outcomes.

Wider implications of the findings

Genital sexual response and lubrication are not different between women with and without PCOS. However, subjective sexual response is lower. Androgen levels are not indicative of genital response and subjective arousal. Sexual function should be discussed in clinical care and psychosexual counseling should be offered.

Trial registration number

NL55484.078.16