Global prevalence of female sexual dysfunction based on physical activity: a systematic review and meta-analysis | BMC Women’s Health

The present study is the first systematic review and meta-analysis on the global prevalence of female sexual dysfunction in relation to physical activity. To our knowledge, there is currently no existing systematic review study with this specific focus. This study was conducted using the meta-analysis techniques and included 7 selected original studies, all of which were cross-sectional.

In the review of 7 studies with a total sample size of 1,776, the prevalence of sexual dysfunction in women with high physical activity was estimated to be 47% (95% CI: 28.8–65.9) based on meta-analysis (p: 0.087). Moreover, in the review of 6 studies with a sample size of 2,094, the prevalence of sexual dysfunction among sedentary women was found to be 64.6% (95% CI: 44.5–80.6) based on meta-analysis (p: 0.03). This finding indicates a higher prevalence of sexual dysfunction among women with little or no physical activity.

Despite compelling evidence for a link between physical inactivity and various health outcomes, studies have shown that physical inactivity is common worldwide, with data from 122 countries showing that 31.1% of adults (15 years or older) are physically inactive [11]. The analysis of a cross-sectional study on 370 middle-aged Brazilian women showed that women with an inactive lifestyle were 78.9% sexually dysfunctional, while women with an active or very active lifestyle had lower rates of sexual dysfunction at 57.6% and 66.7%, respectively [17]. These results are in-line with the results of our meta-analysis, where inactivity is identified as one of the factors that increase the prevalence of female sexual dysfunction.

In a sample of 214 American women aged 40 to 55 who were ‘relatively active’ and ‘active’ compared to ‘inactive’ women (as assessed by the Women’s Health Assessment Scale), active and relatively active women, showed less uncomfortable sexual activity, including fewer symptoms of vaginal dryness and decreased sexual desire [22]. Furthermore, in another study, risk of sexual dysfunction (FSFI ≤ 26.55) was recorded as 67%, for 243 women out of the population of 370. This risk was strongly associated with a sedentary lifestyle, with inactive women showing a higher prevalence of sexual dysfunction compared to their active counterparts (78.9% vs. 57.6%). Therefore, similar to the results of the present study, there is an inverse relationship between both variables, where higher levels of physical activity are associated with lower prevalence of sexual dysfunction [17].

Exercise is related to various hormones such as cortisol [23], estrogen [24], prolactin [25], oxytocin [26] and testosterone [27, 28], all of which influence sexual arousal. The effects of exercise on testosterone depend on the type of exercise; for instance, resistance exercise does not increase testosterone [29, 30], while testosterone increases after aerobic exercise in premenopausal women [31]. A study showed that the level of oxytocin does not increase after certain types of exercise such as short-term and high-intensity exercise or steady running on a treadmill [25].

Randomized clinical trials on middle-aged women have also shown that aerobic exercise can lead to significant improvements in a number of menopausal symptoms such as mood and insomnia, physical and mental health, and quality of life, which may contribute to enhanced sexual performance [32].

Lee et al. evaluated 214 perimenopausal women and observed that relatively active or very active women reported lower rates of sexual dysfunction, particularly with symptoms such as vaginal dryness, and decreased libido, compared to sedentary women [22]. Dabruska et al. also studied 336 Polish women aged 45–55 years with the FSFI and IPAQ tools, and found a correlation between high levels of general physical activity and better sexual performance (32); these findings align with the results of our study.

One of the limitations of this meta-analysis is that it only included studies published in English, potentially overlooking relevant research in other languages. In addition, several studies were excluded due to low quality and insufficient reporting of prevalence data. Additionally, social factors such as presence of a life partner, sexual distress, and certain medical conditions such as pelvic floor muscles (PFM) disorders can affect sexual performance, and these factors may have not been adequately considered in the included studies.

Perspectives and implication

There is a strong connection between physical activity and major non-communicable diseases. Women’s sexual health is a vital and important part of life at any age, yet it is influenced by many factors. In this study, electronic repositories including PubMed, Google Scholar, Scopus, Web of Science, Embase, and ScienceDirect were systematically searched using specified keywords, without a lower time limit, up until July 2022. In the review of 7 studies with a total sample size of 1,776 people, the pooled prevalence of sexual dysfunction in women with physical activity was estimated to be 47%.