P-597 Sexual function in women with Polycystic Ovary Syndrome: an updated systematic review and meta-analysis
Authors: Pastoor H , Bolt H , Burgert T , Tay C T , Mousa A , Teeda H , Laven J 
Published: June 2023

Abstract

Study question
To present a comprehensive review of the evidence on sexual function in women with polycystic ovary syndrome (PCOS) compared to women without PCOS.

Summary answer
Women with PCOS report lower sexual function and sexual satisfaction compared to women without PCOS.

What is known already
Research focusing on the psychosocial aspects of PCOS or sexual function is fairly recent and data are limited. Data are often contradicting with studies reporting no differences in sexual function in women with PCOS and studies reporting more sexual problems in women with PCOS. A meta-analysis from our group in 2018 reported lower sexual function and lower sexual satisfaction in women with PCOS compared to women without PCOS.

Study design, size, duration
A systematic review and meta-analysis of the published literature was conducted.

Participants/materials, setting, methods
Eight databases were searched from inception to August 24th 2022. Two authors independently screened articles based on pre-defined inclusion (e.g. adequate PCOS diagnosis) and exclusion criteria (e.g. hyperandrogenism caused by other diseases),assessed their quality and graded the certainty of the evidence. Review Manager was used to perform all analyses.

Main results and the role of chance
Twenty-seven articles were included, of which 23 used questionnaires and four used visual analogue scales (VAS). Pooling FSFI scores showed worse sexual function across most domains in women with PCOS, including arousal (weighted mean difference [WMD]== -0.37, P= 0.002), lubrication (WMD= -0.53, P &lt;0.001), and orgasm (WMD= -0.32, P &lt;0.001). Total sexual function (WMD= -2.47, P &lt;0.001) and sexual satisfaction (WMD= -0.42, P &lt;0.001) were also significantly lower. Selection on fertility status did not change the direction of results. VAS results were not pooled in meta-analysis due to using the same control group across the included studies. However, effects within individual VAS studies demonstrated the negative impact of excess body hair on sexuality, lower sexual attractiveness and lower sexual satisfaction in women with PCOS compared with controls, with no differences in the perceived importance of a satisfying sex life. Certainty of evidence was graded low for all included studies.
Conclusion: Women with PCOS place similar importance on sexual satisfaction as women without PCOS, yet have lower sexual function and sexual satisfaction. Distress was not assessed. Sexual function assessment, and, psychosexual counseling should be considered as part of standard care in women with PCOS.

Limitations, reasons for caution
Sexual distress was not assessed. Hence, prevalence of sexual dysfunction which requires both lower sexual function and sexual distress, remains unkown.
Certainty of evidence was graded low for all included studies.

Wider implications of the findings
Sexual function assessment, and, psychosexual counseling should be considered as part of standard care in women with PCOS.
Findings from this review have directly informed the international PCOS guideline on sexual function assessment and management.

Trial registration number
NA