ORIGINAL ARTICLE Sexual dysfunction assessment and hormonal correlations in patients with polycystic ovary syndrome CM Ercan 1 , H Coksuer 1 , U Aydogan 2 , I Alanbay 1 , U Keskin 1 , KE Karasahin 1 and I Baser 1 In this controlled study, we aimed to evaluate the sexual dysfunction of patients with polycystic ovary syndrome (PCOS) in comparison to healthy controls. We enrolled 64 sexually active women in our study. The PCOS group consisted of 32 women who met the Rotterdam diagnostic criteria, and the control group was composed of 32 age-matched, healthy females. In addition to the demographic and clinical characteristics of the participants, the hormonal and biochemical parameters were also studied. All patients were invited to fill out the female sexual function index (FSFI) and Beck’s Depression Inventory questionnaires. The prevalence of sexual dysfunction in the PCOS group was similar to controls (25% vs 19%; P ¼ 0.54). No significant difference was found according to each domain score of FSFI. Significant negative correlations were found between the total FSFI scores of the PCOS group and the total (r ¼À 0.278) and free testosterone (r ¼À 0.493) levels. Although depressive scores of PCOS patients were higher, they did not show greater impaired sexual functions than age-matched controls according to their FSFI scores. Considering the multifactorial state of female sexual dysfunction, further studies are needed to clarify the impact of PCOS upon sexuality. International Journal of Impotence Research (2013) 25, 127–132; doi:10.1038/ijir.2013.2; published online 14 February 2013 Keywords: Beck’s Depression Inventory; female sexual function index; Polycystic ovary syndrome; sexual dysfunction INTRODUCTION Polycystic ovary syndrome (PCOS) is an endocrine disorder that reflects multiple potential etiologies and variable clinical presentations in women of reproductive age. The prevalence of the condition is estimated to be between 4 and 25% depending upon the definitions used for diagnosis. 1–3 PCOS manifestations include irregular menstrual cycles and polycystic ovaries in conjunction with hirsutism and/or acne; obesity is also frequently concomitant. 4 Female sexual dysfunction (FSD) is influenced by medical and psychosocial factors, and the condition has become a common and important health concern in recent years. 5–9 Sexual problems are highly prevalent in women; according to one report, B40% of women have sexual concerns, in which 12% experience distressing sexual problems. 10 Sexuality includes self- image, partnership, activity, behavior, attitudes and function. 11 Traditionally, FSD has included disorders of desire/libido, arousal, sexual pain/discomfort and inhibited orgasm. 12 Organic and psychogenic issues are both involved in the etiology of FSD. 13 Although there may be a genetic susceptibility, 14 many biological, cognitive, emotional, and social factors seem to exert a relevant influence on sexual response and enjoyment. 12,13,15,16 Alterations in the physical appareance of patients and changes in sexual hormones may lead to psychological distress in patients, which usually results in a loss of quality of life and may affect sexuality. 17,18 Several features of PCOS might have potential affects on sexual health. Women with PCOS ovulate infrequently and therefore experience an ovulatory infertility, 19 which has been linked to decreased sexual satisfaction. 20,21 A negative influence on sexuality in PCOS may be due to changes in self-image from syndrome-related hirsutism and/or acne, 22,23 whereas high androgen levels due to PCOS may or may not have beneficial sexual effects. 24–28 Obesity is another important clinical manifestation of PCOS that has been associated with decreased sexual satisfaction but not with decreased sexual activity. 29 We aimed to evaluate the sexual function of PCOS patients in comparison with healthy controls. Our hypotheses was that PCOS patients could improve their sexuality due to their high androgen levels or PCOS could exhibit a negative impact on sexuality due to changes in self-image. MATERIALS AND METHODS Study population This controlled study was conducted using data gathered from two university hospitals’ gynecology departments. The study was approved by the Institutional Review Board of Gulhane School of Medicine, and all women who took part gave written informed consent before enrolling in the study. All participants were of Caucasian descent and socially homogeneous. We included 64 otherwise healthy women who were faithfully married with an active sexual life. The study group consisted of 32 women with the diagnosis of PCOS, and the control group contained 32 age-matched, healthy, regularly menstruating, non-PCOS women who were admitted to our outpatient unit for a routine check-up within the same study interval. The health status of the participants was determined on the basis of a detailed medical history, blood chemistry tests and a comprehensive gynecological examination by the same physician (HC) (including transvaginal ultrasound) at their initial visits to detect any genital abnormality, infection, adnexal mass, atrophy or pelvic floor insufficiency. Hypothalamo-pituitary-gonadal axis functional integrity was examined via hormonal measurements of the participants. Revised Rotterdam diagnostic criteria were used to diagnose PCOS in patients who had two out of the 1 Gulhane Military Medical Faculty, Obstetrics and Gynecology Department, Etlik, Turkey and 2 Gulhane Military Medical Faculty, Family Medicine Department, Etlik, Turkey. Correspondence: Dr CM Ercan, Gulhane Military Medical Faculty, Obstetrics and Gynecology Department, Etlik, Ankara 06018, Turkey. E-mail: ercanmutlu@yahoo.com Received 2 September 2011; revised 30 November 2012; accepted 16 January 2013; published online 14 February 2013 International Journal of Impotence Research (2013) 25, 127–132 & 2013 Macmillan Publishers Limited All rights reserved 0955-9930/13 www.nature.com/ijir