Biopsychosocial factors associated with sexual dysfunction in self-identified females in Gauteng, South Africa, during 2013- 2023

Abstract

Female sexual dysfunction (FSD) is an important component of overall sexual health. FSD can be linked to quality of life and mental disorders and is an important public health issue. The Biopsychosocial Model of Care (BPSM) defines sexual dysfunction as a complex interaction of biological (genetics, pathology, physiology), social (socio-economical, cultural, environmental, and relational) and psychological (emotions, thoughts and behavioural) factors. Few South African studies have investigated the above factors and if they influence FSD. The aim of this study was to examine the biopsychosocial factors (exposures) mentioned above and if they were associated with sexual dysfunction in self-identified females in Gauteng, South Africa, during 2013-2023. Clinical records were accessed from two sexual health clinics. These were exported to Microsoft Excel and Stata Version 18.0. A cross- sectional design was assembled to analyse a convenient sample of 1,595 patient records. Prevalence and associations were examined by different biopsychosocial exposure variables and FSD, using inferential statistics, prevalence ratios, and multivariate logistic regression models. Potential confounders included employment, relationship status, sexual orientation, concern about having a sexually transmitted infection (STI), contraception use, pain, menopausal status, amongst other biopsychosocial factors. No interactions between variables were found. The prevalence estimate of FSD was 84.17% (N = 1595). Stratified prevalence estimates of FSD by factors such as concern about sex drive, orgasm, or sexually transmitted infections, were > 90%. Prevalence ratios amongst all factors varied between 0.87-1.34. Pain during sex (AOR = 6.02, p = 0.000), concern about sex drive (AOR = 6.48, p = 0.000) and orgasm (AOR = 5.22, p = 0.000), number of sexual partners (AOR = 0.61, p = 0.000) and relationship status (AOR = 0.17, p = 0.005) were found to be significantly associated with FSD. In addition, factors such as contraception use (OR = 1.33, p = 0.048), urinary symptoms (OR = 2.22, p = 0.000), concern about STI (OR = 0.37, p = 0.000), and doing exercise (OR = 0.56, p = 0.000) were also associated with FSD and adjusted for in the final regression model. The results suggest that several biopsychosocial factors were associated with FSD and that FSD is multifactorial. Future research should focus on longitudinal, cohort and/or 10 intervention studies to determine not only association, but also temporality and ultimately causation.