Incidence and risk factors of female sexual dysfunction in urban and rural China: a 4-year prospective cohort study

Abstract

This study aimed to investigate the incidence and risk factors for female sexual dysfunction (FSD) in urban and rural China. A prospective cohort study was conducted from February 2014 to January 2016, with follow-up from June to December 2018. Women aged ≥20 years were recruited from urban and rural areas in six provinces of China using a multistage, stratified, cluster sampling method. Sexual function was assessed using the Female Sexual Function Index questionnaire. A total of 16 827 women without sexual dysfunction at baseline participated in this study, 9489 of them (urban, 5321; rural, 4168) who had complete information from baseline to follow-up were included in the final analysis. The rate of follow-up was 68.81%, and the median follow-up time was 4.13 years. The 4-year incidence of FSD was 43.07%, with an incidence density of 12.02 per 100 person-years. In particular, the 4-year incidence and incidence density of FSD were 41.03% and 11.88 per 100 person-years in the urban group and 45.68% and 12.17 per 100 person-years in the rural group. Among women with sexual dysfunction, difficulties in sexual desire, satisfaction, and arousal were the main symptoms. In urban women, the risk factors for FSD included age ≥45 years (adjusted relative risk 1.69, 95% confidence interval 1.57–1.81), hypertension (1.31, 1.14–1.49), previous delivery (1.26, 1.13–1.41), post-menopausal status (1.20, 1.10–1.32), pelvic inflammatory disease (1.13, 1.05–1.21), and multiparity (1.11, 1.03–1.19). In the rural group, the risk factors significantly associated with FSD were age ≥45 years (1.50, 1.40–1.61), previous delivery (1.39, 1.17–1.65), hypertension (1.18, 1.06–1.30), multiparity (1.16, 1.07–1.27), and post-menopausal status (1.15, 1.07–1.23). FSD is a hidden epidemic condition in China, and the development of prevention strategies should consider the distinct risk factors present in rural and urban areas.

Keywords

female sexual dysfunction / incidence / risk factor / urban / rural / China

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Acknowledgements

This study was funded by the National Natural Science Foundation of China (No. 72104247), the National Key R&D Program of China (Nos. 2023YFC2706000 and 2023YFC2706001), and National High Level Hospital Clinical Research Funding (Nos. 2022-PUMCH-B-087 and 2022-PUMCH-A-023).

Compliance with ethics guidelines

Conflicts of Interest Haiyu Pang, Mingyu Si, Tao Xu, Zhaoai Li, Jian Gong, Qing Liu, Yuling Wang, Juntao Wang, Zhijun Xia, and Lan Zhu declare that they have no competing interests.

The study was approved by the institutional review board of Peking Union Medical College Hospital (Number: S-689, Date: 05/15/2014), and the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent was obtained from all participant for being included in the study.

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