Is PCOS messing with our sex lives too?

PCOS and sex - what does research say?

Hello everyone

Let’s talk about sex. We talk so much about our ovaries and reproductive system but never about the fun part of having ovaries.

There is a myth that might say because we have high testosterone, we should have a higher sex appetite. That’s the hormone that men use as an excuse for their high sex drive. “I am just full of testosterone., honey”. Jokes aside, is this true?

How do you feel about your sex life?

I have included at the end of this article a tool they use in research to assess sexual dysfunction - aka if there is something wrong. Let’s first see what the research says.

The research

In research, investigations about sex life are under the umbrella of sexual dysfunction. There are a few ways of measuring it, but the most used seems to be the Female Sexual Function Index (FSFI). It measures six different domains: desire, arousal, lubrication, orgasm, satisfaction and pain. This is the tool I included it at the bottom of this article.

FSFI

A systemic review published in 2024 looked at 32 studies done on women with PCOS and their sex lives. Here are the findings:

Sexual Arousal

Women with PCOS experience moderately reduced sexual arousal compared to women without PCOS. This means we may have more difficulty becoming sexually excited or interested during intimate situations. The research considers it to have a small to medium effect in statistical terms, so I wouldn't be too worried.

Lubrication

The most significant difference was found in lubrication, where women with PCOS showed more challenges. This means we may experience inadequate vaginal lubrication during sexual activity, which can lead to discomfort or pain. This was the most significant difference found among all aspects of sexual function studied.

Orgasm

We also show moderate difficulties with orgasm function. This suggests we may experience more challenges reaching orgasm or may find their orgasms less satisfying compared to women without PCOS.

Pain During Sex

Women with PCOS also reported more pain during sexual activity than expected.

Sexual Satisfaction

Overall, sexual satisfaction was lower among women with PCOS. This means they generally reported being less satisfied with their sexual experiences, though this difference was smaller than some of the other aspects measured.

So you are telling me that on top of everything else, we are also having bad sex?

Why?

Appearance

Well, there are the obvious physical manifestations of PCOS. Women with PCOS report lower sexual attractiveness and reduced sexual satisfaction when hirsutism is present. I think here there is a significant societal problem - when the image of “sexy” that gets fed to us is small, petite women, it’s hard to feel sexy in any other type of body. If you add in the extra weight, acne and the ups and downs of PCOS, I can see how feeling desirable can be challenging.

But is there more of a physiological problem?

Estrogen

Estrogen does a lot of behind-the-scenes work to keep vaginal tissue healthy and well-lubricated. It helps maintain blood flow, keeps the tissue thick and elastic, and supports the production of natural lubrication — all of which make sex more comfortable and pleasurable. For us, estrogen levels can be relatively low or out of balance compared to androgen levels. This hormonal imbalance can cause changes in vaginal tissue that are pretty similar to what happens during menopause — things like thinner vaginal walls, less blood flow, and reduced natural lubrication. When estrogen drops, the vaginal tissue can become more delicate and less responsive during sexual activity, which can make intimacy feel uncomfortable or even painful.

Androgens

As we mentioned above, even though women with PCOS often have higher androgen levels, this doesn’t automatically translate to better sexual function. It’s not a simple “more androgens = better sex” situation. Instead, the relationship seems to work more like a threshold — once you have enough androgens, having more doesn’t necessarily improve sexual function.

Inflammation

I love how everything is just connected in our body. Insulin resistance and the general higher inflammation state affect sexual function by altering blood flow, tissue health, and hormonal signalling, leading to a less happy sex life.

The solution

Getting your PCOS in control is something we learn every Sunday at The PCOS Newsletter. If you are enjoying the newsletter, consider becoming a paid subscriber. Anyone upgrading for the yearly subscription can get a free session with me where they can ask me any questions they would like about their PCOS.

Tool - FSFI

I have put the questionnaire they use in these research papers in a spreadsheet for you to try. Remember that clinicians usually use these tools to help you understand them deeply. Taking this will only give you an indication of whether something needs to be looked into further. Aslo please note that the results are useful if you are sexually active.

The questionnaire:

Please make a copy and try it here: Sexual dysfunction questionnaire

See you next Sunday,

Francesca

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References

Conte, F., Banting, L., Teede, H.J., Stepto, N.K., Boyle, J.A., Gibson-Helm, M., Thangaratinam, S., Dokras, A., Karro, H., Jiskra, J., Saei Ghare Naz, M., Tay, C.T., Piltonen, T., Boivin, J., & Milsom, I. (2024). Sexual function in women with polycystic ovary syndrome: a systematic review and meta-analysis. Human Reproduction Update, 30(3), 323-352. https://pmc.ncbi.nlm.nih.gov/articles/PMC11063549/

Chongcharoen, P., Choobun, T. and Khanuengkitkong, S. (2024) ‘Female sexual function index for screening of female sexual dysfunction using DSM‑5‑TR criteria in Thai women: a prospective cross‑sectional diagnostic study’, PLoS One, 19(2), e0298935. doi: 10.1371/journal.pone.0298935.