During enrollment of study participants, between January 1, 2006 and April 1, 2007, a total of 420 women were approached for participation, and 344 (82%) enrolled. Of the enrolled participants, 305 (89%) completed the questionnaire. Within this cohort of 305 women, 80 (27%) were seeking treatment of pelvic floor conditions, 69 (23%) came for treatment of other gynecologic complaints, and the remaining 152 (50%) were seeking annual gynecologic care [8
]. Our analysis is limited to the 96% (292/305) of this cohort who specifically completed the FSDS portion of the questionnaire.
Seventy-six women (26%) were classified as reporting sexual distress. Information regarding general population characteristics and sexual distress is summarized in . Women with sexual distress were more likely than those without distress to be younger in age (55.2 ± 1.0 years vs. 56.7 ± 0.8 years, P = 0.017 had higher mean CESD scores [16.6 vs. 9.5, P = 0.001]). Overall, 63% of our population was menopausal, and we found no significant association between menopausal status and sexual distress (P = 0.814). Additionally, 14% (24/175) of our study population who answered reported use of hormonal therapy.
Characteristics of women with and without sexual distress according to FSDS* score
Fifteen percent (14/80) of single and 31% (62/136) of married participants were sexually distressed. Regarding general partner status, 289/292 women answered the question, “Do you have a current sexual partner?” Of these respondents, 75.8% (219/289) of women answered “yes” to this question, with 84% (184/219) classifying their partnership as a marriage. With regard to sexual preference, 94.5% (276/292) of participants indentified themselves as heterosexual, 1.7% (5/292) as “lesbian/gay,” 0.7% (2/292) as “bisexual,” and four women of the 292 (1.4%) declined to answer this question. Furthermore, 6.6% (19/288) of our population considered themselves a victim of rape and 11.1% (32/289) considered themselves a victim of sexual abuse. Sexually distressed women were more likely to report being a victim of sexual abuse vs. nondistressed women (P = 0.001).
Race, education, BMI, hysterectomy status, gravidity, and number of years spent with current partner did not differ significantly between women with and without sexual distress.
describes relationships between different sexual complaints and sexual distress, as measured by the FSDS. Virtually all sexual complaints were significantly more common among women with distress. Compared to their nondistressed counterparts, sexually distressed women were more likely to report less enjoyment of sexual activity (73.3% vs. 28%, P = 0.001), decreased arousal (56.8% vs. 25.1%, P = 0.001), infrequent orgasm (54% vs. 28.8%, P = 0.001), dyspareunia (39.7% vs. 10.6%, P = 0.001), decreased frequency of sexual activity (76% vs. 57.7%, P = 0.005), decreased partner satisfaction (34.2% vs. 11.6%, P = 0.001), or less passionate love for one’s partner (42.9% vs. 19.9%, P = 0.001). Sexually distressed participants were also more likely than those without distress to report urinary incontinence with sexual activity (9% vs. 1.3%, P = 0.005), avoidance of sexual activity due to vaginal bulge (13.9% vs. 1%, P = 0.001), or restriction of sexual activity due to fear of urinary incontinence (14.9% vs. 0.5%, P = 0.001). Presence of sexual thoughts in the last month and partner difficulty with sexual performance were not significantly related to higher FSDS scores. With respect to the four items that correspond to the recognized types of female sexual dysfunction (arousal, orgasm, pain, and libido), 192 of 292 participants (65.8%) reported at least one of these sexual complaints. Specifically, 88 (30.1%) reported one sexual complaint, 35 (12%) reported two sexual complaints, 57 (19.5%) reported three sexual complaints, and 12 (4.2%) reported four sexual complaints. The most frequent isolated complaints were dyspareunia and decreased libido. Furthermore, there was a significant association between presence of sexual distress and increasing number of complaints (P = 0.001).
Table 2 Evaluation of sexual complaints using the PISQ§  and PEQ‡  for women with and without sexual distress according to FSDS† score
Because women with sexual complaints often voiced multiple sexual problems, we used a multivariate model to investigate which sexual symptoms were most significantly associated with distress. This included the general descriptive variables age and CESD score. Regarding sexual complaints, we included statistically significant variables from our univariate analysis that best captured the defined types of sexual dysfunction: arousal, orgasm, dyspareunia, and libido. Our final model suggested that sexual distress is positively associated with dyspareunia (odds ratio [OR] 3.11, P = 0.008) and increasing CESD score (OR 1.05, P = 0.006), and inversely related to subjective feelings of arousal during sexual activity (OR 0.19, P = 0.001).
Prior research has suggested that age might modify the relationship between sexual complaints and sexual distress. Specifically, one study found that sexually related distress was more common in younger women, despite the observation that sexual complaints were more common in older women [4
]. Therefore, we refit our multivariable model, with age as an interaction variable. However, after controlling for dyspareunia, problems with subjective arousal, and CESD score, age was not a significant predictor of distress. Additionally, age was not found to be a moderating variable when considering the relationship between sexual complaints and distress. In other words, younger women with complaints like dyspareunia and arousal problems were just as likely to be distressed as older women with these symptoms.