Influence of social determinants of health and emotional health factors on female sexual health

Context: Sexual well-being is an important aspect of a woman’s quality of life. Persistent and distressful sexual problems are defined as female sexual dysfunction (FSD),, which can increase the risk of physical and emotional health problems‥ The causes of FSD include multiple biopsychosocial, cultural and interpersonal factors. Social determinants of health (SDOH) are non -medical factors such as housing, poverty and literacy which can influence a wide range of health, functioning, and quality-of-life outcomes.

Objective: To examine the impact of SDOH and emotional health factors on female sexual health using validated questionnaire scores like the Female Sexual Function Index (FSFI), Female Sexual Distress Score (FSDS) and Female Sexual Distress-Revised Score (FSDS-R).

Study design/analysis: A retrospective chart review was conducted on adult patients referred to Women’s Health(WH) at Mayo Clinic between 1/2022-1/2023 for sexual health or menopause consultations. The study analyzed the association between several SDOH factors and emotional factors on female sexual health.

Setting/data set: Inclusion criteria: all patients referred to WH from 1/2022 - 1/2023 who completed the questionnaires. Exclusion criteria: patients who did not have SDOH data or complete the questionnaires.

Population studied: All adult female patients referred to WH for sexual health or menopause consultations over the specified one-year study period.

Outcome Measures: Primary outcome measures included FSFI score with a dysfunction threshold of ≤ 26.55, and the FSDS ≥ 11 for measuring sexual distress. Clinical factors included age, BMI, depression (PHQ-9 score), anxiety (GAD-7 score), alcohol use (AUDIT score) and social determinants like transportation, food insecurity and housing stability.

Results: Among 422 patients, 346 had an FSFI score ≤ 26.55 and 250 had an FSDS ≥11. Notable correlations included higher BMI with lower FSFI scores (p<0.001) and increased anxiety (p< 0.001), depression (p=0.003) and lifetime drug use (p<0.001) with higher FSDS scores. However, SDOH variables such as marital status, education level, transportation and housing did not show significant impact.

Conclusion: Female Sexual Dysfunction correlates strongly with mood disorders, substance use disorders and higher BMI. Sexual distress strongly correlated with mental health and substance use disorders signifying their critical influence on female sexual well-being.