title: Prevalence of Female Sexual Dysfunction Among Premenopausal Women: A Systematic Review and Meta-Analysis of Observational Studies.
abstract: Epidemiologic research in female sexual dysfunction (FSD) has gained momentum in recent years, particularly in clinical populations and in menopausal women. However, sexual dysfunction also affects premenopausal women in general populations. Previous literature reviews have been unable to quantify the burden of FSD in general populations. This has been due in part to different definitions of dysfunction, heterogeneous study design, and the wide variety of measurement tools used.
  
  
  
  To provide a meta-analytical estimate of the prevalence of FSD in premenopausal women.
  
  
  
  Observational studies that assessed the prevalence of FSD in premenopausal women were systematically sought in relevant databases (January 2000 through July 2014). Publications that reported the prevalence rate for at least one domain of FSD were included. A meta-analysis of prevalence rates was performed and a meta-regression was used to analyze factors of study design.
  
  
  
  Estimated prevalence rates of FSD and its domains (hypoactive sexual desire disorder, sexual aversion disorder, female sexual arousal disorder, lubrication difficulties, female orgasmic disorder, and pain disorders).
  
  
  
  After screening 9,292 results, 440 publications were retrieved for full-text review. Of these, 135 studies were included in the systematic review. Ninety-five of these studies were assessed further in a meta-analysis. There was substantial heterogeneity among studies. The prevalence of FSD in premenopausal women was estimated to be 40.9% (95% CI = 37.1-44.7, I2= 99.0%). Prevalence rates of individual sexual disorders ranged from 20.6% (lubrication difficulties) to 28.2% (hypoactive sexual desire disorder). Further analyses showed significantly higher rates of FSD in studies in Africa, studies that used non-validated assessment tools, and studies without pharmaceutical funding.
  
  
  
  Prevalence estimates of FSD vary substantially. Nonetheless, results show that FSD is a significant public health problem that affects 41% of premenopausal women around the globe. More research and improved standardization are needed in this field.
authors.affiliation: Medical Sociology, Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany. Electronic address: megan.mccool@klinik.uni-regensburg.de.
authors.forename: Megan E
authors.initials: ME
authors.lastname: McCool
authors.affiliation: Medical Sociology, Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany; Institute of Sociology, Friedrich Schiller University of Jena, Jena, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Zuelke
authors.affiliation: Metabolic and Nutritional Medicine, Dr von Hauner Children's Hospital, Ludwig Maximilians University of Munich, Munich, Germany.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Theurich
authors.affiliation: University Library of Regensburg Regensburg, Germany.
authors.forename: Helge
authors.initials: H
authors.lastname: Knuettel
authors.affiliation: Medical Sociology, Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.
authors.forename: Cristian
authors.initials: C
authors.lastname: Ricci
authors.affiliation: Medical Sociology, Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Apfelbacher
mesh_terms: D005260:Female; D006801:Humans; D009948:Orgasm; D017697:Premenopause; D015995:Prevalence; D012735:Sexual Dysfunction, Physiological / Q000453:epidemiology*; D020018:Sexual Dysfunctions, Psychological / Q000453:epidemiology*
keywords: Epidemiology; Female Sexual Difficulties; Female Sexual Dysfunction; Meta-Analysis; Prevalence; Systematic Review