Sexuality and Polycystic Ovary Syndrome

Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder in women of reproductive age, affecting 5-24% of this population. It is associated with various reproductive, aesthetic, and metabolic issues that can cause psychological stress and impact sexual function, with rates of sexual dysfunction in women with PCOS ranging from 27.2% to 62.5%. The role of androgens in sexual function in women with PCOS is unclear. Obesity, a common condition in PCOS, has been linked to sexual dysfunction, but its independent role is controversial. PCOS is also associated with an increased prevalence of anxiety and depressive symptoms, which can contribute to sexual dysfunction. A 2021 study showed that lifestyle interventions, with or without combined oral contraception (COC), improved sexual function in women diagnosed with sexual dysfunction. In subjects with severe obesity, significant weight loss of around 30% of initial weight was associated with a notable improvement in sexual function. Even a smaller weight reduction of around 6% seemed to improve the sphere of desire in all PCOS patients. The study found that COC therapy did not seem to impact sexual function. Intrauterine devices releasing Levonorgestrel (LNG-IUD) are an interesting alternative to COC, as they do not seem to alter the sexual profile. Improvement in depressive symptoms was weakly associated with an improvement in the total Female Sexual Function Index (FSFI) score. The document concludes that women with PCOS are more at risk of developing an alteration of sexual function compared to controls, with the most involved domains being arousal, lubrication, orgasmic ability, and sexual satisfaction. PCOS can also be associated with difficulties in starting couple relationships and reduced self-esteem in this area, correlated with discomfort towards body image (hair loss, hirsutism, acne, overweight). The role of the typically high levels of androgens in the sexuality of these patients has not yet been clarified. The data on therapeutic outcomes related to the sexual sphere suggest a benefit following lifestyle interventions aimed at weight loss, while the effect of contraceptive therapy (in particular, COC) is less clear.