Socio-demographic determinants of low sexual desire and hypoactive sexual desire disorder: a population-based study in Iran

Hamzehgardeshi et al. BMC Women’s Health https://doi.org/10.1186/s12905-020-01097-0 (2020) 20:233 RESEARCH ARTICLE Open Access Socio‑demographic determinants of low sexual desire and hypoactive sexual desire disorder: a population‑based study in Iran Zeinab Hamzehgardeshi1,2, Mina Malary3* , Mahmood Moosazadeh4,5, Soghra Khani1,2,6, Mehdi Pourasghar7 and Narges Alianmoghaddam8 Abstract Background: Various socio-demographic factors have been introduced as the determinants of Low Sexual Desire (LSD), but whether these variables can also contribute to the Hypoactive Sexual Desire Disorder (HSDD), remains uncertain. In this study, we sought to identify the socio-demographic determinants of LSD and HSDD in Iranian women of reproductive age. Methods: This was a population-based, cross-sectional study of 1000 married Iranian women of reproductive age (16–49 years) who met the inclusion criteria. The participants were chosen using the systematic random sampling method from all the healthcare centres in the city of Sari, Iran. LSD was defined as a score no higher than 33 on the Sexual Interest and Desire Inventory-Female (SIDI-F). The sexually-related personal distress was considered as a score of at least 11.0 on the Female Sexual Distress Scale-Revised (FSDS-R), and HSDD was determined based on the sum of those scores. Descriptive statistics were used to describe the socio-demographic characteristics and a chi-square test was run for data analysis using grouping variables. Multivariate logistic regression test was also employed to adjust the effect of confounding variables. Results: The mean score of sexual interest/desire among women was 30.6 ± 10.5. After adjusting the effect of confounding variables, logistic regression showed that socio-demographic variables including age at first intercourse, length of marriage and the level of satisfaction with income were significantly associated with both LSD and HSDD (P < 0.01). While advancing age (P < 0.001) and body mass index (P < 0.01) were just predictors of LSD. Conclusion: Some socio-demographic factors could predict LSD in women, while they were not associated with HSDD. In other words, some factors associated with LSD do not instigate sexually-related personal distress, which is one of the criteria necessary for the diagnosis of HSDD. Keywords: Women’s health, Sexual behavior, Sexual dysfunction, Reproductive health, Iran *Correspondence: 3 Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Haft‑e Tir Square, Po Box 7394736147, Shahroud, Iran Full list of author information is available at the end of the article Background Hypoactive Sexual Desire Disorder (HSDD) is one of the most common types of female sexual dysfunction that can affect women of all ages. It is worth noting that HSDD is different from Low Sexual Desire (LSD) often experienced in daily life [1]. A sexual complaint can only be considered a sexual disorder when the diagnostic and statistical criteria for sexual dysfunctions are met and © The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Hamzehgardeshi et al. BMC Women’s Health (2020) 20:233 when that sexual problem has caused personal distress [2]. According to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IVTR), an LSD which can cause significant personal distress is the primary indicator of HSDD. However, in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), HSDD is categorized under the Female Sexual Interest/Arousal Disorder (FSIAD), which is a controversial reform. Regardless of the benefits of amendment in diagnostic criteria, decades of research based on the DSM-IV-TR criteria for the diagnosis of HSDD has shaped the basis of our understanding of LSDrelated distress’ primary symptoms, epidemiology, and clinical management [3]. Also, arguments about the epidemiology of FSIAD have been based on the extrapolation of studies using HSDD rather than FSIAD criteria [4]. According to a European study of women with LSD, the prevalence of LSD varies from 11 to 53%. However, only 22–65% of those women with LSD reported that experiencing LSD-related distress which is required for the diagnosis of HSDD [5]. Sexual desire is a multi-factorial and multidimensional phenomenon which may differ significantly amongst individuals due to their cultural values that need to be addressed accordingly [6]. For example, HSDD may root in biological, psychological, sexual, and social factors [7]. According to an international study of sexual health, women diagnosed with HSDD reported greater sexual and marital dissatisfaction, hopelessness, frustration, anger, loss of femininity, and low self-esteem compared to those women without HSDD [8]. Various studies have yielded different results regarding the socio-demographic factors affecting LSD and HSDD. Although some of those studies pointed out that the risk of LSD and HSDD increases with age [7, 9, 10], a European study reported that only LSD is associated with ageing [5]. Understanding the role of socio-demographic factors is essential in screening individuals for LSD and HSDD. So far, very few international studies have been conducted in this field. Although social determinants of sexual satisfaction in Iranian women have been studied [11], no studies have been conducted in Iran to identify the socio-demographic factors associated with LSD and HSDD among reproductive-age married women. Therefore, we sought to investigate the socio-demographic factors associated with LSD and HSDD. It is hoped that raising awareness regarding this issue among Iranian women could be a major step forward in planning future national policies aimed at promoting women’s sexual and reproductive health. Page 2 of 9 Methods Design and data collection This population-based, cross-sectional study was conducted with a 2-stage cluster sampling design in Sari (...truncated)