A Survey of Female Sexual Functioning in the General Dutch Population

Background: After the diagnosis and treatment of disease, a major barrier to research on psychosexual functioning is the lack of a consistent estimate for the prevalence of female sexual dysfunction in the general population.

Aim: To clarify the prevalence of age-related female sexual functioning in the general population.

Methods: A sample was compiled by random selection of women from the general population in the northern part of the Netherlands and was categorized by age. Women completed the Female Sexual Function Index (FSFI), personal medical items and daily activities, the Body Image Scale, the SF-36 Health Survey, the Hospital Anxiety and Depression Scale, and the Multidimensional Fatigue Inventory. Participants' representativeness was assessed by comparing their characteristics with data from the Dutch Central Agency for Statistics and the Dutch Health Monitor. General health, fatigue, and well-being were compared with national or international data.

Outcomes: Age-related total and domain scores of the FSFI.

Results: We evaluated female sexual functioning of 521 sexually active women. For women 20 to 80 years old, sexual functioning showed wide variance and was poor in 28% of all sexually active women, with FSFI scores being below the defined clinical cutoff (FSFI score <26.55). Although sexual activity and functioning significantly decreased with increasing age, sexual satisfaction decreased only non-significantly.

Clinical Implications: This study provides valuable age-specific ranges for female sexual functioning in the general population and can inform upcoming clinical studies.

Strengths and Limitations: This is the largest study on female sexual function in a representative Dutch population using internationally validated tools and described by age categories, providing valuable information that can help in the understanding of how female sexual function changes with age. The FSFI has been criticized for not assessing personal distress related to sexual problems, so the lack of the Female Sexual Distress Scale in our study is an unfortunate shortcoming. The high rate of sexual inactivity (31%) resulted in fewer women being available to evaluate sexual functioning, but this could reflect the actual level of sexual (in) activity among women in a general population.

Conclusion: FSFI total and domain scores showed wide variation across all age categories, but overall, one in four sexually active women scored below the diagnostic cutoff score. Sexual activity and functioning also decreased with age, whereas sexual satisfaction decreased only slightly.