FEMALE SEXUAL DYSFUNCTION IN LOWER EGYPT

1. A ELNashar
M Hassan
M Ibrahim
M Eldosoky
O Ali
Benha University Hospital,
Egypt Aboubakr Elnashar

2. • Sexuality is an important part of health, quality
of life and general wellbeing.
• Sexual dysfunction is more prevalent in women
than in men and is associated with various
demographic characteristics. Women of
different racial groups show different patterns of
sexual dysfunction.
• Epidemiological data on FSD are relatively
scanty and vary widely.
Epidemiological data are important:
Assess the magnitude of the problem
Develop appropriate service delivery and
resource allocation models (Edward et al., 1999).
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3. • Female circumcision is one of the
traditional practices that is still
performed in Egypt and is a possible
cause of FSD.
• To the best of our knowledge, there is
no Egyptian epidemiological study on
FSD. This fact stimulated the present
study.
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4. Aim of the work
To assess the prevalence &
associated factors of female
sexual dysfunction in lower
Egypt
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5. • A cross-sectional clinic-/hospital-based survey
was designed for implementation in married women
between 16 and 49 years.
• Sample size:
The following formula was used to estimate the
minimum sample size using Epi-Info version 5.01,
1990.
If the approximate prevalence of the problem is
34% (0.34) (Spector & Carey, 1990) and
the magnitude of the absolute sampling error that can
be tolerated "d" is 0.04 .
N= z2 pq /d2
N= (1.96)2 x 0.34 x 0.66/(0.04)2
N= 538.78
Subjects
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6. • Thus, at least 539 individuals should be
surveyed to achieve the study objective.
• A total of 1000 women were chosen to increase
the statistical reliability of the study.
• The study sample were selected from women in
Dakahlia governorate as representative of lower
Egypt:
{according to Egyptian Demographic Health Survey,
2000,
the demographic & cultural characteristics in most
governorates of lower Egypt are similar}
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7. Aboubakr Elnashar

8. •936 women complied with the study,
while 64 refused to participate, giving a
response rate of 93.6%.
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9. • The questionnaire used to
measure sexual dysfunction
comprised 6 response items,
each assessing the presence
of a critical symptom or a
sexual problem.
Method
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10. Response items included
• Lacking or having reduced sexual desire
• Frequency of sexual activity
• Arousal difficulty i.e. erection problem,
ejaculating too rapidly in men and lubrication
difficulties in women
• Inability in achieving orgasm;
• Physical pain during intercourse
• Forced to have sex
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11. • Demographic characteristics:
Age.
Duration of marriage.
Other wives.
Residence status.
Level of education.
Work & other source of income.
• Reproductive features:
Number of children
Mode of delivery
Method of birth control .
• Health and lifestyle:
Emotional and psychological causes or stress-related problems e.g.
potentially traumatic events such as sexual harassment or termination of
pregnancy, circumcision, health status and husband travelling abroad.
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12. Reason (s) of attending medical service
Total
Variable No %
936 100
239 (25.5)Accompany a patient
40 (4.3)Sex problems
180 (19.2)Obstetric reason (s)
334 (35.7)Gynecological reason (s)
143 (15.3)Family planning
The low rate of overt complaints regarding sexual problems
among Egyptian women does not indicate lack of sexual interest
but rather reflects cultural factors such as shyness,
embarrassment and reluctances of the women and lack of
physicians’ awareness and training, which lead to inadequate
identification and management of such problemsAboubakr Elnashar

13. Frequency, satisfaction of current frequency, and satisfying frequency
of sexual intercourse among women (No = 936)
%No
Intercourse frequency
12.6118Once/day
2.725>1/day
12.2114Once/week
58.55472-4/week
14132<1-2 / month
%NoSatisfaction prevalence
63.8597Satisfied
36.2339Not satisfied
%NoSatisfying frequency
100339Total unsatisfied women
34.21161 / week
25.7872 / week
17.1583 / week
23.078Others (>3 / week and <1/ week)
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14. Prevalence of sexual problems among
studied women according to women's
perceptions
%NoGroups
31.1291No apparent sex problems
68.9645Women with sex problems
45.9430• Distressed by them*.
23.0215• Not distressed by them
100936Total
*One hundred and eight (11.5%) women suffered from FSD &
sexual abuse
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15. Types of sexual problems among women (No
= 936).
%NoType
Desire problem
49.6464Decrease or loss of desire
3.634Increase desire
53.2498Total
Arousal problem
24.8232Occasional difficulty
11.2105Always difficult
36.0337Total
Orgasmic problem
10.598Primary anorgasmia
6.460Secondary total anorgasmia
26.1244Occasional anorgasmia
43.0402Total
Dyspareunia
4.643Superficial
12.5117Deep
14.4135All through
31.5295Total
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16. Female sexual problems relative to socio-
demographic characteristics of women
Test of
significance
p=
Women with sex
problems
Women without
sex problems
Variable
No %
645 100
No %
291 100
0.57
0.031
0.99
0.017
Age
57 (8.8)29 (10.0)< 20 years
302 (46.8)156 (53.6)20-29 years
203 (31.5)86 (29.6)30-39 years
83 (12.9)20 (6.9)40-49 years
0.72
Residency
378 (58.6)178 (61.1)Rural
267 (41.4)113 (38.8)Urban
0.94
0.83
Type of family
114 (17.8)52 (17.9)Extended Family
531 (82.3)239 (82.1)Nuclear Family
0.28
0.31
0.001
0.80
Education
179 (27.8)89 (30.6)Illiterate
98 (15.2)37 (12.7)Primary
409 (63.4)140 (48.1)Secondary
59 (9.1)25 (8.6)University
0.77
0.55
0.31
0.25
Work status
119 (18.4)56 (19.2)Professional
36 (5.6)12 (4.2)Farmer
40 (6.2)14 (4.8)Laborer
450 (69.8)209 (71.8)House wife
0.049
Circumcision status
58 (9)33 (11.3)No
587 (91)258 (88.7)Yes
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17. Female sexual abuse among participants according to
statistically significant variables of wives
Test of
significance
p=
Women with sexual
abuse
Women without sexual
abuseTotal
Variable
No 108 (100%)No 828 (100%)No 936 (100%)
0.69
0.45
0.72
0.23
Age
11 (10.2)75 (9.1)86 (9.2)< 20 years
50 (46.3)408 (49.3)458 (48.9)20-29 years
32 (29.6)257 (31.0)289 (30.9)30-39 years
15 (13.9)88 (10.6)103 (11.0)40-49 years
0.002
0.014
0.009
0.015
Education
40 (37.0)228 (27.5)268 (28.6)Illiterate
23 (21.2)112 (13.2)135 (14.4)Primary school attainment
41 (38.0)408 (49.3)449 (48)Secondary school attainment
4 (3.8)80 (9.7)84 (9.0)University graduated
0.026
0.80
0.99
0.0001
0.99
Reasons of attendance
22 (20.3)217 (26.2)239 (25.5)Accompany a patient
5 (4.6)35 (4.2)40 (4.3)Sex problems
16 (14.8)164 (19.8)180 (19.2)Obstetric reasons
52 (48.1)283 (34.2)333 (35.8)Gynaecological reasons
13 (12.0)129 (15.6)142 (15.2)Family planning
0.16
Menstrual pattern
64 (59.3)563 (68.0)627 (67.0)Normal
44 (40.7)265 (32.0)309 (33.0)Abnormal
0.40
0.001
0.002
0.001
Parity
16 (14.8)110 (13.3)126 (13.5)Nullipara
26 (24.1)408 (49.3)434 (46.4)1-2 deliveries
11 (10.2)290 (35.0)301 (32.2)3-5 deliveries
55 (50.9)20 (2.4)75 (8.1)> 5 deliveries
0.024
Circumcision status
4 (3.7)87 (10.5)91 (9.7)No
104 (96.3)741 (89.5)845 (90.3)Yes
-
0.0001
0.76
0.089
Surgical procedures
59 (54.6)572 (69.1)631 (67.4)Non
27 (25.0)110 (13.3)137 (14.6)Gynecological
16 (14.8)125 (15.1)141 (15.1)Non gynecological
6 (5.6)21 (2.5)27 (2.9)Spine and traumatic accidents
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18. Female sexual abuse among participants according to
statistically significant variables of husbands
Test of
significance
p=
Women with
sexual
Women without
sexual abuseTotal
Variable
No %
108 11.5
No %
828 88.5
No %
936 100
Age
24 (22.2)195 (23.6)219 (23.4)20-29
35 (32.4)369 (44.0)399 (42.6)30-39
19 (17.6)178 (21.4)197 (21.1)40-49
30 (27.8)91 (11.0)121 (12.9)> 50
0.001
0.014
0.003
0.008
Education
50 (46.3)221 (26.7)271 (29.0)Illiterate
23 (21.3)128 (15.5)151 (16.1)Primary school attainment
30 (27.8)341 (41.1)371 (39.6)Secondary school attainment
5 (4.6)138 (16.7)143 (15.3)University graduated
0.001
Smoking
37 (34.3)415 (50.1)452 (48.3)No
71 (65.7)413 (49.9)484 (51.7)Yes
0.967
Medical disorders*
101 (93.5)751 (90.7)852 (91.0)No
7 (6.5)77 (9.3)84 (9.0)Yes
0.001
Drugs usage**
79 (73.1)732 (88.4)811 (86.6)Non users
29 (26.9)96 (11.6)125 (13.4)Users
-
0.58
0.92
Surgical procedures
99 (91.2)732 (88.4)831 (88.8)Absent
4 (3.7)51 (6.2)55 (5.9)Varicocele & hernia repair operation
5 (4.6)45 (5.4)50 (5.3)Spine & trauma operation
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19. Aggravating factors in relation to female sexual
problems (No = 645)
%NoFactors
28.1181No aggravating factors
28.1181Unfavorable socioeconomic
16.0103Marital disharmony & hate
15.7101Pregnancy related
3.120Delivery related
3.120Contraception related
2.315Infertility related
3.724Combined factors and male or female
health problems.
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20. Ameliorating factors in relation to
female sexual problems (No = 645)
%NoFactors
84.5545No ameliorating factors
10.368Marital adjustment
5.232
Medical consultation &
treatment
Most women reported receiving no assistance for their sexual problems.
Only 5.2% (32 of the 645) with sexual problems had received treatment
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21. Conclusion
In Lower Egypt:
• FSD is a highly prevalent problem
with a low reporting and very low
treatment rates.
• The most prevalent types of FSD:
Decreased desire (49.6%),
Anorgasmia (43.0%)
Difficult arousal (36.0%)
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22. • The commonest predictors of FSD:
Unfavorable socioeconomic
circumstances
Marital disharmony
Pregnancy related events.
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23. Recommendation
• The high prevalence of FSD among apparently healthy
individuals emphasises the importance of direct questioning
about sexual function as part of the routine checklist in
gynaecology and family planning clinics
• FSD is under- researched & therefore warrants recognition as
a significant public health concern with a need for further
epidemiological research.
• Most physicians receive little or no formal training in this
critical area. Studies of physician awareness and competency
in FSD are urgently needed.
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24. Aboubakr Elnashar