MENTAL HEALTH, SEXUALITY, AND ETHICS Differences in prevalence of sexual dysfunction between primary and secondary infertile women Ugur Keskin, M.D., a Hakan Coksuer, M.D., b Sadettin Gungor, M.D., a Cihangir Mutlu Ercan, M.D., a Kazim Emre Karasahin, M.D., a and Iskender Baser, M.D. a a Department of Obstetrics and Gynecology, Gulhane Military Medical Academy and Medical School, Ankara; and b Department of Obstetrics and Gynecology, School of Medicine, Dumlipinar University, Kutahya, Turkey Objective: To examine the impact of type of infertility on female sexual function. Design: Comparison of female sexual function index and prevalence in primary infertile women and secondary infertile women. Setting: Hospital. Patient(s): One hundred twenty-two primary infertile and 51 secondary infertile women. Intervention(s): Questionnaires (Female Sexual Function Index [FSFI] and Beck Depression Inventory). Main Outcome Measure(s): Prevalence of dysfunction in primary and secondary infertile women. Result(s): The prevalence of female sexual dysfunction was 64.8% (n ¼ 79) and 76.5% (n ¼ 39) in primary infer- tile and secondary infertile women, respectively. In analyses of mean overall and subgroup scores of FSFI, there were significant differences between primary and secondary infertile women in the mean scores of orgasm, satisfaction, and total FSFI. Backward logistic regression identified a model with four significant predictors of sex- ual dysfunction (group, age, income level, and educational level). Secondary infertile women had a 9.5-fold higher risk of sexual dysfunction than primary infertile women after adjustment for confounding factors. Conclusion(s): There was a higher prevalence of sexual dysfunction in secondary infertile women. Secondary infertile women have decreased sexual desire, orgasm, and satisfaction compared with primary infertile women. (Fertil Steril Ò 2011;96:1213–7. Ó2011 by American Society for Reproductive Medicine.) Key Words: Infertility, female sexual dysfunction, depression, secondary infertile women Sexual function is an important component of health and quality of life. Although sexual problems are related to both partners, sexual problems are highly prevalent in women: approximately 95% of women have one and more sexual concerns (1). Female sexual func- tion is multifactorial in nature, comprising psychosocial, neurologic, and hormonal processes. Approximately half of women with sexual complaints in the general population consult their gynecologist (2). Identifying specific risk factors may allow for earlier diagnosis and treatment of sexual dysfunction, thereby increasing quality of life. Life stressors, such as those related to medical illness and relation- ships, are important to address when evaluating a woman with sex- ual dysfunction. As a common health problem, infertility (3) affects approxi- mately 20% of all couples (4) and is associated with significant psy- chosocial impact and, therefore, may be one such stressor. Only a few studies have looked at the impact of infertility on female sex- ual dysfunction, and they have demonstrated that sexual complaints are more common in infertile women and that these women are more prone to depression, anxiety, and stress (5–8). Higher levels of stress were related to decreased satisfaction in the marital relationship and quality of life. However, to the best of our knowledge, there has been no study pointing out the differences in sexual function between primary and secondary infertile women. The objective of this study was to further examine the impact of type of infertility on female sexual function, with the use of validated questionnaires. MATERIALS AND METHODS Institutional review board approval was obtained from by the Gulhane Military Medical Academy, Division of Ethics Committee. Written, informed consent was obtained from all volunteers before the study. Women attending the outpatient clinics of the obstetrics and gynecology department for gynecologic care and infertility were consecutively identified upon their presentation at the outpatient desk and were asked to complete a demographic survey and an inventory of sexual function and depression. To avoid possible confounding factors, exclusion criteria included male infertility, genital prolapse, lower genital tract abnormality, genitourinary in- fection, use of medications (antidepressant drugs such as selective serotonin reuptake inhibitors and Serotonin and norepinephrine reuptake inhibitors (SNRI); antipsychotic drugs, benzodiazepine; anticholinergic drugs due to sexual side effects), and lack of heterosexual partner. All women who had stable, heterosexual relationships and who were sexually active in the last 4 weeks were included in the study. The study protocol was explained, complete privacy was assured, and voluntary participation was emphasized. Then the women self-completed the Received May 18, 2011; revised and accepted August 5, 2011; published online August 30, 2011. U.K. has nothing to disclose. H.C. has nothing to disclose. S.G. has noth- ing to disclose. C.M.E. has nothing to disclose. K.E.K. has nothing to disclose. I.B. has nothing to disclose. Reprint requests: Ugur Keskin, M.D., GATA Kadın Hastalıkları ve Do gum Anabilim Dalı, 06018 Etlik, Ankara, Turkey (E-mail: drugurkeskin@ gmail.com). 0015-0282/$36.00 Fertility and Sterility â Vol. 96, No. 5, November 2011 1213 doi:10.1016/j.fertnstert.2011.08.007 Copyright ª2011 American Society for Reproductive Medicine, Published by Elsevier Inc.