O-083 Sexual function in women with Premature Ovarian Insufficiency (POI): systematic review and meta-analysis
Authors: Van Zwol-Janssens C , Pastoor H , Laven J , Louwers Y , Jiskoot G 
Published: July 2024

Abstract

Study question
What is the impact of idiopathic premature ovarian insufficiency (POI) on sexual function in women?

Summary answer
Women with POI exhibit significant reduced sexual function and a higher risk of sexual dysfunction than healthy control women.

What is known already
POI is a life-changing diagnosis with profound physical and psychological consequences. The impact of POI on sexual complaints, seems multifaceted. Many women report vaginal dryness, dyspareunia (painful intercourse), and diminished libido, but also psychosexual function could be impaired, with potential effects on sexual identity, sexual function, and sexual relationships. Furthermore, the POI diagnosis can have a significant impact on a woman's self-esteem and body image, which could result in problems with sexual function. The ESHRE Guideline emphasizes the importance of providing psychological support and counseling to address the emotional and psychosexual impact of POI.

Study design, size, duration
This systematic review and meta-analysis is reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The following online databases were systematically searched: EMBASE, Medline(Ovid), Web of Science, Coachrane, PsychInfo and Google Scholar up to January 2023.

Participants/materials, setting, methods
A total of ten studies were included in the systematic review and five studies involving 352 women with POI were included in the meta-analysis. Random effects models were used for analyses, with data reported as Hedges’ g and 95% confidence interval, and the risk of heterogeneity was evaluated.

Main results and the role of chance
Eight of the ten studies concluded that women with POI have a reduced sexual function. An overall medium Hedges’ g effect size of −0.72 was found (ranging between −0.20 to −1.29) in favor of control women, with moderate heterogeneity (I2 = 64%). When we stratified studies in which women were using hormone replacement therapy (HRT) we calculated an even higher Hedges’ g effect size of −0.82 (95% CI −1.18, −0.47). Pooled data from the different FSFI domains, revealed that women with POI scored significantly lower on all domains. Especially the domain ‘dyspareunia’ exhibited the greatest dissimilarity (Hedges g of −0.63, 95%CI −0.86, −0.39) in women with POI compared to control.

Limitations, reasons for caution
We have reported a moderate heterogeneity which may be caused by differences in age, duration of diagnosis, infertility status, and socioeconomic background in the various studies. Additionally, limitations such as selection bias, data duplication, and questionnaire variation were identified.

Wider implications of the findings
The results show that women with POI have reduced sexual function, and HRT use did not improve sexual function. This suggest that oral HRT is less effective for sexual dysfunction. There could be an important role for psychological factors in improving sexual well-being among women with POI.

Trial registration number
CRD42023437203 (PROSPERO)