Aim: Female sexual dysfunction (FSD) is a considerably underestimated condition. It has been repeatedly reported that patients with cardiovascular diseases (CVD) may suffer from an increased risk of FSD. However, there is still a lack of comprehensive and systematic evaluation of various CVD and FSD. We aimed to elucidate the association between CVD and FSD through a comprehensive literature review and meta-analysis.
Methods and result: The PubMed, Scopus, Embase, and Cochrane Library databases were systematically searched from inception to February 28, 2023. We identified all relevant studies reporting the risk of FSD in subjects with or without CVD. The associations between CVD and the risk of FSD were assessed by calculating pooled ORs (cross-sectional studies) and RRs (longitudinal studies) with 95% CIs. We employed random-effects models to account for potential heterogeneity, and the quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). Fifty-four articles with 148,946 individuals were included in our meta-analysis. Compared with control subjects, subjects with CVD had a 1.51-fold increased risk of FSD (OR 1.51 95% CI, 1.34-1.69, P < .001, heterogeneity I2 = 91.4%, P < .001). Subgroup analyses indicated that the association between CVD and FSD remained significant in longitudinal studies (RR 1.50 95% CI, 1.21-1.86, P < .001, heterogeneity I2 = 86.7%, P < .001). Particularly, hypertension (OR 1.41 95% CI, 1.23-1.62, P < .001, heterogeneity I2 = 82.7%, P < .001), stroke (OR 1.81 95% CI, 1.54-2.12, P < .001, heterogeneity I2 = 0%, P < .423), and myocardial infarction (OR 2.07 95% CI, 1.60-2.67, P < .001 heterogeneity I2 = 82.4%, P < .001) were significantly associated with FSD. Meta-regression revealed that the primary sources of heterogeneity in FSD are attributable to adjustments for covariates, study design, and study population.
Conclusion: Our meta-analysis indicated that patients with CVD suffer from a greater risk of developing FSD. Meanwhile, we validated these findings in longitudinal queues. Notably, conditions such as hypertension, stroke, and myocardial infarction demonstrated a significant association with the incidence of FSD.
Keywords: Cardiovascular disease; Female sexual dysfunction; Hypertension; Meta-analysis; Risk factors.
Our study provides a significant advantage as the most comprehensive systematic analysis to date. It encompassed 45 cross-sectional and 11 longitudinal studies with 148,946 patients, aiming to investigate the relationship between various types of CVD and FSD. Subgroup analyses were conducted to explore the impact of factors such as region and publication time. *Accumulating evidence strongly supports a significant link between CVD and an increased risk of FSD, especially in cases of hypertension, stroke, and myocardial infarction. These findings indicate that more attention should be paid to women’s sexual health, particularly in the presence of CVD. *Future studies are warranted to investigate the effects of pharmacological interventions on the sexual function of women affected by CVD.
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.