Female sexual dysfunction (FSD), a condition affecting women's sexual arousal, desire, orgasm, or pain, has been identified as a hidden epidemic in China with a higher incidence in rural areas compared to urban ones. A four-year prospective cohort study provides a detailed analysis of FSD's incidence and associated risk factors, shedding light on the need for targeted public health strategies. The research involved a nationally representative sample of women from six provinces in China, capturing a diverse range of geographic and socioeconomic regions. The study utilized the Female Sexual Function Index (FSFI), a widely recognized tool for evaluating sexual dysfunction, to assess participants at baseline and during the follow-up period.

The findings revealed that the median follow-up time was 4.13 years, with rural areas reporting lower FSFI scores than urban areas, indicating a higher prevalence of FSD in rural populations. The 4-year cumulative incidence of FSD was 43.07%, with rural areas showing a significantly higher risk than urban areas. The study identified several risk factors for FSD, including age over 45 years, hypertension, previous delivery, post-menopausal status, and multiparity. Additionally, urban women with pelvic inflammatory disease were found to be at an increased risk of developing sexual dysfunction. Protective factors against FSD included higher education levels, intellectual occupations, and a monthly family income above 6000 RMB/person.

The research's comprehensive approach to understanding FSD's incidence and risk factors in China is significant, as it highlights the need for public health initiatives to address this often-overlooked condition. The study's findings are particularly relevant in the context of China's "three-child policy" and the availability of pharmacological interventions for FSD. The results also offer insights for countries with similar social backgrounds and sexual cultures, emphasizing the importance of considering cultural factors and regional disparities in FSD prevalence. Despite potential limitations such as selection bias and reliance on self-reported data, the study makes a substantial contribution to the understanding of FSD in a general population, underscoring the importance of tailored public health strategies to support women's sexual health across different communities.
DOI: 10.1007/s11684-024-1096-0