ORIGINAL RESEARCH ARTICLE HIV-associated female sexual dysfunction – clinical experience and literature review Charlotte Bell BSc MRCP, Daniel Richardson BSc MRCP, Michelle Wall BSc RN and David Goldmeier MD FRCP Jefferiss Wing, St Mary’s Hospital, London W2 1NY, UK Summary: Women form an increasing proportion of HIV-infected individuals in the developed world. Early data suggest that women with HIV are at particular risk of developing sexual problems. The aim of this study was to describe our anecdotal experience of HIV-infected women and to ascertain their sexual dysfunction, and also to conduct a national survey to evaluate what sexual dysfunction services are provided for women in other UK HIV centres. Retrospective analysis of clinic notes of women attending our HIV clinic and letter surveys of HIV centres in the UK were carried out. About half our cohort reported that they had sexual problems or were not satisfied with sex over the preceding 12 months. Contextual issues seemed to be the commonest cause of these problems. Sixty percent of HIV physicians in the UK rarely/never ask their female HIV patients about sexual functioning. Sexual dysfunction is probably common in HIV-infected women. Most physicians seeing women with HIV in the UK do not ask about sexual functioning. ‘Physician coaching’ could help to redress this situation, so that at the least the sexual problems could be brought up in discussion. Keywords: HIV, women, sexual dysfunction Introduction ‘A man is given the choice between loving women and understanding them.’ Ninon de Lenclos (1620–1705), French Society figure. Women’s sexual lives are complex. Two important problems they face are HIV and sexual dysfunction. Understanding and helping women with such problems is difficult, not least because there is still a large knowledge gap in both these areas. The situation is not made easier by the continued marginalization of women both with and without HIV. 1,2 Furthermore, these two facets of women’s sex lives may interact such that women with HIV may well develop sexual dysfunction as a conse- quence of their illness, particularly in countries that have access to antiretroviral therapy, where sig- nificant improvement in prognosis and quality of life has occurred. 3 Attention is nowadays conse- quently shifting to address life style issues, includ- ing satisfactory sexual functioning. Female sexual dysfunction (FSD) in the general population appears to be common. Non-biased population surveys from the USA and UK suggest that the rates of sexual problems in women may be as high as 50%. 4,5 However, rates for persistent problems and for women who are distressed by their symptoms appear to be lower. 4 By the end of 2003, an estimated 37.8 million people were living with HIV worldwide, 1.5 million of whom were living in Western Europe and one million in North America. 6 The largest burden of disease, however, is in sub-Saharan Africa. In the UK, 61% of the 10,000 currently HIV- infected women are first-generation Black Africans who have acquired HIV heterosexually; however, only 8% of these women acquired their HIV through intravenous drug use. 7 A World Health Organization review of the treatment and support needs of HIV-infected women noted constraints that impinged on women’s ability to cope and their mental health. These included socioeconomic deprivation, gender inequalities, gender-based vio- lence, pregnancy and women’s role as primary care-givers. 8 A further problem is that most physicians are poorly trained to engage in mean- ingful clinical dialogue about sexual matters and seem to find it difficult to talk about these subjects. 9 On a more positive note, most genitourinary (GU) medicine/HIV centres in the UK appear to have the scope to manage sexual issues. 10 In this paper, we therefore present our clinical account of managing HIV-infected women in terms of their sexual functioning. We also present the results of a survey investigating if and how well International Journal of STD & AIDS 2006; 17: 706–709 706 Correspondence to: Dr David Goldmeier Email: david.goldmeier@st-marys.nhs.uk