HEALTH & WELLNESS

Why is no one talking about sexual dysfunction in women with PCOS?

By Ria Bhatia
06 November, 2024

From weight gain to acne and infertility, the effects of PCOS are largely known, except its impact on one’s sex life. Experts tell us how they’re closely related

It is estimated that 1 in 5 women in India—a sizeable 20 per cent—are diagnosed with polycystic ovarian syndrome (PCOS), according to a 2019 study by the Indian Journal of Medical Research. Five years later, as awareness e of PCOS grows, so too do the struggles women face beyond typical symptoms of  weight gain and fertility issues. 

If you have PCOS, the gynaecologist’s starter pack includes advice on weight loss and physical fitness coupled with prescriptions for hormonal contraceptives. You’re also informed about being more susceptible to infertility. However, the effects of PCOS on your sex life are seldom talked about openly. On account of the high range of hormonal imbalances in the body, PCOS can interfere with an effortlessly fulfilling sex life. Medical professionals tell us more about the lesser-known connection between sex and PCOS.

How PCOS adversely impacts your sex life 

Sexual dysfunction is one of the lesser-known, though pervasive, by-products of PCOS. Data suggests that the frequency of sexual dysfunction in women with PCOS was approximately 57.7 per cent, with the areas of desire and arousal being affected in 99.2 per cent and 98.5 per cent of the cases respectively. Scientifically, low arousal and sexual drive in women with PCOS is primarily linked to irregular hormone levels, says Dr Nandita Palshetkar, gynaecologist and President of the IVF Society of India (ISAR). “A common symptom of PCOS is high levels of androgens, which can disrupt the normal functioning of estrogen and progesterone, two hormones crucial for sexual arousal and lubrication,” she explains.

“High levels of androgens disrupt the normal functioning hormones crucial for sexual arousal and lubrication,” explains  Dr Nandita Palshetkar. Image: Pexels

Data suggests that the frequency of sexual dysfunction in women with PCOS was approximately 57.7 per cent. Image: Pexels

“It’s important to note that PCOS reflects a state of elevated insulin resistance, and scientifically, this can cause metabolic syndrome, which alters your sex drives as well. Due to lower libidos, women with PCOS are also at risk of what we call hypoactive sexual desire disorder (HSDD),” says Dr Yuvraj Jadeja, gynaecologist and IVF specialist. HSDD directly jeopardises your sex drive, making orgasms and lubrication tougher than usual. Sex can also become uncomfortable or more painful for women with PCOS. “The discomfort is linked to a lack of elasticity and lubrication of the vagina, leading to painful intercourse. Additionally, many women who are diagnosed with PCOS have pelvic pain or endometriosis, which exacerbates painful sex,” adds Palshetkar.

An added toll on mental health 

If you think hormonal upheaval is the only reason why having satisfying sex with PCOS becomes challenging, it isn’t always so. With PCOS comes a spate of widely-known side-effects like obesity, hirsutism, severe acne, and hair loss that are likely to impact one’s self-confidence and self-image. Highlighting this further, Jadeja says, “Through my experience, I have come across body-image issues in at least 50 to 60 per cent of females diagnosed with PCOS. Whether it’s increased weight (which is prone to occur with PCOS), darker and coarser facial and body hair, alopecia or other changes in the skin tone around the nape of the neck or other areas affected by hormonal imbalances, such symptoms can completely damage one’s self-esteem, thereby, diminishing the sexual drive.”

“PCOS IS ASSOCIATED WITH ANXIETY, DEPRESSION, EATING DISORDERS, AND BODY DISSATISFACTION, COMPOUNDING THE CONCERNS OF THE PHYSICAL SYNDROME”
Hansika Kapoor

Therapist and relationship counsellor Ruchi Ruuh shares, “Intimacy thrives when both partners can feel comfortable in the act and confident in their appearances. The visible symptoms of PCOS, like acne and facial hair, can often make women feel less attractive or ‘unfeminine,’ making sexual encounters less enjoyable or even uncomfortable as there are feelings of self-consciousness, hesitation or shame. If your partner body-shames you or makes you feel undesirable, it aggravates discomfort and self-esteem injury.”

The visible symptoms of PCOS, like acne and facial hair, can often make women feel less attractive or ‘unfeminine,’, says Ruchi Ruuh. Image: Getty

Due to lower libidos, women with PCOS are also at risk of what we call hypoactive sexual desire disorder (HSDD), says Dr Yuvraj Jadeja. Image: Pexels

Beyond the physiological aspects, PCOS can affect a woman’s mental health as well. “PCOS is associated with anxiety, depression, eating disorders, and body dissatisfaction, compounding the concerns of the physical syndrome,” states Hansika Kapoor, a psychotherapist with Monk Prayogshala. Along the same lines, Simrat Singh, a therapist with The Mood Space, says, “The mental health challenges and frustrations of having to manage a chronic health condition, to continually advocate for oneself in personal and medical spaces, and the impacts of body-related changes all contribute to an emotional shutdown response.” At times, sex might get reduced to a mundane chore, indulged solely with the intention to conceive, especially if the fear of infertility is looming.

Seeking professional help, holistically, can be game-changing

Sex and PCOS may not be the best of friends, but they don’t have to be rivals either. Seeking holistic professional guidance to tackle PCOS-related hormonal concerns, improving your mental health, and openly discussing your sexual struggles with a medical expert can be beneficial. “Working on your mental health is extremely important to have a fulfilling sex life, both from a neurobiological and psychological perspective,” says Singh. “From a neurobiological lens, neurotransmitters—including serotonin and dopamine—are intricately linked to mood regulation, reward, and sexual motivation. From a psychological perspective, cultivating a sense of safety in your body is key in experiencing pleasure for oneself and being emotionally attuned to the pleasure of one’s partner.” Citing why women should prioritise their mental health for a fulfilling sex life, Kapoor explains, “For men, sexual arousal and climax are often a straightforward and one-dimensional act, whereas for women, it is more complex—requiring an interplay of psychological, emotional, and physical factors.”

Sex therapy is an excellent outlet for both partners to unfold their gamut of emotions. Image: Pexels

One must be mindful of the changes that transpire in the body, and see a gynaecologist as soon as you notice any changes. Image: Pexels

Intimacy doesn’t always have to be about penetrative sex, says Ruuh. “Couples can start by focusing on non-sexual intimacy—building emotional closeness and cultivating a sense of security. Small gestures, quality time, and prioritising mutual understanding go a long way.” Sex therapy is another excellent outlet for both partners to unfold their gamut of emotions. While Jadeja vouches for healthier lifestyle adjustments, Palshetkar recommends hormonal therapy or counselling, if required, to treat physical complaints as well as psychological issues related to sexual health. “If you are experiencing visibly evident symptoms of PCOS or sexual dysfunction, it is quite likely that you’ve ignored the comparatively minor symptoms of PCOS like irregular periods, pelvic or abdominal pain or sudden weight gain. One must be mindful of the changes that transpire in the body, and see a gynaecologist as soon as you notice any changes,” concludes Jadeja. 

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