A COMPARATIVE STUDY OF FEMALE SEXUAL DYSFUNCTION IN A DRUG NAIVE NEWLY DIAGNOSED FEMALE DEPRESSIVE PATIENT IN A TERTIARY CARE HOSPITAL IN NORTH INDIA
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Abstract
Human sexual functioning encompasses a wide range of biological, emotional, psychological, social, and spiritual components that contribute to intimate and sexual relationships. It plays a crucial role in physical and mental well-being, directly influencing quality of life. The prevalence of sexual dysfunction in women is reported to be as high as 43%, while the incidence in men is slightly lower at 31%. Among the different types of sexual dysfunction in women,1 hypoactive sexual desire disorder (HSDD), sexual arousal disorder, orgasmic disorder,2 and pain disorders are common. Of these, HSDD and sexual arousal disorder are the most frequently encountered.
Sexual dysfunction can be multifactorial, with various psychosocial, biological, and cultural influences affecting its presentation and progression. The International Classification of Diseases, Tenth Revision (ICD-10) and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) offer diagnostic frameworks, though they may not adequately capture the diversity and complexity of sexual issues reported by patients. Aspects of sexual functioning often overlap and are influenced by factors such as generational shifts, cultural norms,3 and societal expectations, making it essential to approach the diagnosis of sexual dysfunction with a broad perspective.
Depression, recognized as a leading cause of disability worldwide, is linked to significant disruptions in sexual functioning. Research, including the Zurich cohort study, has indicated that patients with depression experience sexual problems at a rate approximately double that of non-depressed individuals.4 Furthermore, antidepressant medications, commonly prescribed to manage depressive symptoms, can induce sexual dysfunction across various stages of the sexual cycle,5 leading to concerns about patient adherence to medication. Adverse effects related to sexual functioning may result in patients discontinuing treatment, ultimately impeding the therapeutic efficacy of antidepressants. While much of the research on antidepressant-induced sexual dysfunction has focused on male patients, there is a growing recognition of the need to address sexual dysfunction in women, particularly in relation to psychotropic medication.
Despite increased research on sexual dysfunction in recent decades, knowledge regarding female sexuality has lagged behind that of male sexuality.6,7 This discrepancy is especially evident in the Indian context, where studies on sexual dysfunction in women are scarce. Moreover, cultural taboos and societal stigma surrounding open discussions of sexual issues often discourage women from seeking help or reporting sexual concerns. Few studies have specifically addressed female sexual dysfunction in the context of psychiatric conditions, particularly depression, and the impact of psychotropic medications on sexual health.8
Indian studies on sexual dysfunction have predominantly focused on male patients, with limited attention to the unique experiences of women.18-21 Research conducted by Kar and Koola (2007) 21and Avasthi et al. (2008)19 found that women in India often face sexual difficulties such as orgasmic difficulties, pain during intercourse, and reduced lubrication, yet they seldom seek clinical assistance due to cultural constraints. In a study of women attending a tertiary care hospital, 17% of the participants reported sexual difficulties3,5 with headache after sexual activity, difficulty reaching orgasm, painful intercourse, and vaginal dryness being common complaints. A more recent study by Singh et al. (2009) reported high levels of sexual dysfunction among Indian women, particularly in the areas of sexual desire, arousal, and orgasm.
Additionally, imaging studies suggest that brain regions involved in sexual arousal and response, such as the hypothalamus, anterior cingulate gyrus, and parahippocampal gyrus, exhibit lower activation in women with depression compared to healthy women. This neurological evidence highlights the complex interaction between depression and sexual functioning in women.24-26
DSM-5 has proposed a more nuanced understanding of female sexual dysfunction, including early-onset (lifelong) and late-onset (acquired) subtypes, with further specifications that consider partner factors, relationship dynamics, individual vulnerabilities, and cultural or religious influences. It is important to recognize that various factors, including psychiatric comorbidities (e.g., depression, anxiety), play a pivotal role in the manifestation of sexual dysfunction in women.
A comprehensive approach to female sexual dysfunction is necessary, particularly for women with depression, as sexual intimacy can serve as an emotional and physical buffer against life stressors. Addressing sexual dysfunction as part of the broader management of depression is crucial for improving overall quality of life. Given the paucity of research on this subject in India, further studies are needed to examine the prevalence, predictors, and consequences of female sexual dysfunction, particularly in patients with recurrent depressive disorder. This research would provide valuable insights into effective treatment strategies and enhance the understanding of female sexuality in the context of psychiatric illness. female sexual dysfunction remains a significant but under-researched issue, particularly in the context of depression and psychotropic medication use. Indian studies are needed to further explore the complexities of female sexual health, identify cultural barriers to seeking help, and inform the development of more targeted interventions to improve the sexual well-being of women with depression.27
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Dr. Aaliya Gojwari
(Pg resident), Department of psychiatry ,American international institute of medical sciences ,Udaipur, Rajasthan
Dr. Abdul Sajid
( Associate professor), Department of psychiatry ,American international institute of medical sciences ,Udaipur, Rajasthan
Dr. Shilpa Kakani
( Senior resident) Department of psychiatry ,American international institute of medical sciences ,Udaipur, Rajasthan