Physical, mental wellbeing heightens sexual function, helps with fecundability

How much exercise a woman does as well as her mental wellbeing seem to influence her per-cycle probability of conception, according to a recent Singapore study.

Sexual problems, such as lack of lubrication and low libido, can lower the likelihood of conception in general. But sexual function is modified by certain lifestyle and behavioural factors, such that women who are physically active are less likely to have sexual problems, whereas those with depression and anxiety symptoms tend to have low sexual function, the authors noted.

“An inactive lifestyle and emotional disorder may reduce sexual desire, arousal, and satisfaction through disruption of nervous system activity and endocrine factors,” the authors pointed out. [BMC Womens Health 2018;18:108; J Sex Med 2016;13:538-571; Sex Med Rev 2018;6:548-557]

“Taken together, these findings suggest that increasing physical activity and promoting mental wellness may have the potential to improve female sexual function during the preconception period, leading to shorter time-to-pregnancy (TTP) and improved fecundability in women of reproductive age,” they added.

The authors used data from the Singapore PREconception Study of long-Term maternal and child Outcomes (S-PRESTO) and enrolled 513 women who completed the six-item Female Sexual Function Index (FSFI-6). More than half of these women (58.9 percent) had low sexual function (median FSFI-6 score ≤22). [BMC Pregnancy Childbirth 2021;21:444]

Most women said they rarely reached orgasm (18.3 percent) and had low sexual desire (14.8 percent). Others reported low sexual arousal (8.2 percent), painful intercourse (8.2 percent), rare experience of sexual lubrication (7.2 percent), and sexual dissatisfaction (4.7 percent).

Women with low vs high sexual function were more likely to be of Chinese ethnicity (80.1 percent vs 60.2 percent), underweight (11.6 percent vs 6.2 percent), physically inactive (22.8 percent vs 18.0 percent), as well as to exhibit probable depression (17.2 percent vs 5.7 percent) and probable anxiety (25.8 percent vs 13.7 percent).

Fecundability was 27-percent lower among women with low sexual function (fecundability ratio [FR], 0.73, 95 percent confidence interval, 0.54–0.99), according to discrete-time proportional hazards model controlled for age, ethnicity, education, parity, and body mass index. In general, the FRs declined with decreasing FSFI-6 scores.

Physical activity, obesity, absence of probable depression and anxiety were inversely associated with the odds of having low sexual function.

The finding on obese women having better sexual function may be attributed to the high androgen levels associated with obesity, according to the authors. Increased androgen concentration has been shown to have a positive effect on sexual desire, arousal, orgasm, and satisfaction. “Alternatively … [i]t is possible that low coital frequency, which has been commonly reported in obese women, may translate to a greater desire and arousal, leading to a better sexual function.” [Int J Impot Res 2010;22:220-226; Intern Med J 2012;42:641-651; J Sex Marital Ther 2016;42:293-296]

On the other hand, low coital frequency due to unpleasant sexual experience and difficulties with intimacy could potentially explain why fecundability is reduced in women with low sexual function, the authors said. [J Reprod Infant Psychol 2019;37:108-122; Andrology 2016;4:911-920; Hum Reprod 2014;29:1067-1075]

“Psychological distress resulting from female sexual dysfunction (FSD) may also induce an inflammatory response, whilst stress-related glucocorticoid changes mediate disruption in reproductive hormonal balance such as luteinizing hormone and melatonin, which in turn can interfere with ovulation, contributing to the delayed TTP,” they added. [Am J Reprod Immunol 2018;79:e12832; Eur J Obstet Gynecol Reprod Biol 1992;45:1-8]

Total fertility rate is already low in Singapore—about 1.10 in 2020—so greater efforts to enhance pregnancy rates are urgently needed, the authors said. They stressed that FSD and associated factors should be assessed as part of preconception care programs. “This is important as most women are not likely to seek treatment and discuss their sexual problems with physicians unless they are asked.” [https://www.singstat.gov.sg/modules/infographics/total-fertility-rate]