Female sexual dysfunction: prevalence and risk factors in a cohort of women living with HIV in Italy

Background: Female sexual dysfunction (FSD) has an impact on the lives of many women, and it is inadequately investigated by medical professionals in women living with HIV (WLWH). Aim: In the present study, the aim was to investigate the prevalence and risk factors of sexual dysfunction (SD) in a cohort of WLWH using the Female Sexual Function Index (FSFI) questionnaire. Methods: This monocentric cross-sectional study was conducted at the ASST Spedali Civili of Brescia, Italy, between April 2023 and August 2023. To assess SD, the FSFI questionnaire was administered in accordance with current European AIDS Clinical Society guidelines to all consecutive cisgender adult WLWH who presented to our unit of Infectious Diseases. We used FSFI < 26.55 to identify participants at risk of SD. Participants were divided into two groups based on the pathological cut-off of FSFI score. Outcome: Comparison of demographic characteristics, menopausal status, and comorbidities among the two different groups of WLWH. Results: The questionnaire was offered to 371 women and 179 (48.2%) completed it. Of the 192 (51,8%) excluded, there were 129 women who declined to participate and 63 who were unable to do so due to a language barrier. Two-thirds (117/179) of individuals declared sexual intercourse in the previous month and were considered. Among those who completed the questionnaire, 36% scored below the FSFI total cut-off, indicating increased risk of SD. The most frequently impaired domains were desire (56.4%) and lubrication (52.1%). The correlation between age and total FSFI score was significant (P = .008), as well as menopausal women obtained lower FSFI scores (P = .0004). Clinical Implications: Age and menopausal status are substantial factors influencing sexual functionality. Strengths and Limitations: This study is limited by its reliance on self-reported data and a sample size that may be insufficient for detecting subtle effects. However, it leverages the well-validated FSFI tool and benefits from trusted questionnaire administration by HIV healthcare providers. Conclusion: Sexual dysfunction in menopausal WLWH has a high prevalence (36%). Interestingly, around 67% of women declined to investigate and deal with sexual issues.