Sextual Dysfunction and Quality of Life in Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta Analysis

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Masud Rana, Shahjada Selim, Rahila Ferdousi Kazi, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8813265/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 10 You are reading this latest preprint version Abstract Background Chronic obstructive pulmonary disease (COPD) is a progressive lung disease and is associated with numerous systemic comorbid conditions. S exual dysfunction is one of these conditions that is often not recognized but can affect the quality of life significantly in patients with COPD. Objectives This systematic review and meta-analysis aims to assess the prevalence of sexual dysfunction and its association with quality of life among patients suffering with Chronic obstructive pulmonary disease. Methods It was a systematic review and a meta-analysis where published data from January 1, 2000 to December 31, 2025 were included. We used a randomized effects model and a standardized mean difference. We also used I² statistical tests and funnel plots to look for heterogeneity and publication bias. Results Of all the 1,982 published works, only twelve studies, including 1,191 patients with COPD, were addressed in this investigation. Sexual dysfunction had been revealed to have an important prevalence among male patients suffering from severe COPD, estimated at 56.2% (95% CI 52.1, 60.3). A relationship between sexual dysfunction and quality of life had been established, estimated at a standardized mean difference of -0.74 (95% CI: -0.96, -0.52; p < 0.001). Subgroup analysis also revealed that sexual dysfunction significantly associated with quality of life in all genders, levels of severity of disease and different geographic areas. Conclusions This study reveals that sexual dysfunction is most common among patients with COPD. Researchers have observed a significant association between sexual dysfunction and decreased quality of life. Sexual dysfunction is a major concern for these patients. Further research is needed to establish the causality of sexual dysfunction in individuals with Chronic obstructive pulmonary disease. Trial registration: Registered platform: PROSPERO Registration ID: CRD420261278399. Registration Date: 06 January 2026. Chronic obstructive pulmonary disease Sexual dysfunction quality of life meta-analysis systematic review Figures Figure 1 Introduction Globally, Chronic Obstructive Pulmonary Disease (COPD) is an advancing and debilitating pulmonary disorder characterized by the persistent obstruction of the airway and the consequent chronic inflammatory responses of the lungs ( 1 ). Worldwide pulmonary disorder is a serious public health challenge and one of the major health problems that cause mortality, morbidity, and disability. According to the Global Burden of Disease (GBD) study, it has been estimated that this pulmonary disorder causes millions of deaths annually, and the health burden of this disease is particularly high in low- and middle-income countries (LMICs) because of the high prevalence of cigarette smoking and indoor air pollution, along with the lack of access to healthcare services ( 2 – 4 ). Globally, respiratory symptoms and COPD are increasing at an increasing rate, being perceived as systemic diseases that are associated with several comorbid conditions, such as cardiovascular diseases, metabolic disorders, osteoporosis, depression, anxiety, and muscle dysfunction ( 5 – 7 ). Currently, all types of comorbidities have a synergistic effect on the disease and its prognosis, and they also hinder the patient's quality of life ( 8 , 9 ). Sexual health is a fundamental aspect of the health and health-related quality of life (HRQoL) of any individual and encompasses physical, emotional, psychological, and social dimensions ( 10 , 11 ). Sexual dysfunction (SD) is also a disorder that usually receives little attention among patients of COPD. COPD can have a devastating impact on sexual health, which can be attributed to numerous complex physiological factors such as dyspnoea, fatigue, hypoxia, exercise intolerance, and inflammation, as well as psychological factors such as anxiety, depression, fear of having episodes of breathlessness during sexual intercourse, and self-image disturbances ( 12 – 14 ). The study provided a clear and coherent, with a consistent tone throughout. It could benefit from slight modifications for improved clarity and flow. Furthermore, commonly used pharmacological agents in the treatment of COPD, such as agonists, anticholinergics, and corticosteroids, may indirectly affect sexual function through circulatory, hormonal, and metabolic pathways ( 15 ). Tobacco use and its long-term consequences, a significant aetiological factor in the development of COPD, are linked to endothelial dysfunction and decreased bioavailability of nitric oxide, which plays a vital role in the onset of sexual dysfunction, particularly erectile dysfunction in men ( 16 , 17 ). Both men and women with COPD report a high prevalence of SD, leading to a marked decline in their quality of life ( 18 ). The prevalence of SD varies significantly due to differences in study design, sample size, assessment tools, and cultural, gender-specific, and clinical factors ( 19 , 20 ). COPD and its sexual health are an important aspect of the care of patients suffering; sexual health issues are not discussed adequately during the routine care of patients suffering from COPD ( 21 , 22 ). COPD patients have a tendency to avoid discussing sexual issues, and healthcare workers may not feel confident discussing sexual health issues with their patients ( 23 , 24 ). Due to COPD, the patient’s SD is not being addressed appropriately. Numerous studies have been conducted on various aspects of sexual functions in patients with COPD. However, COPD is a quantitative estimate of the pooled prevalence and association with quality of life in patients. It is essential to conduct a systematic review and meta-analysis on this topic and reduce the level of uncertainty associated with sexual dysfunction and its association with quality of life in patients with COPD. This study was to assess the prevalence of sexual dysfunction in patients with Chronic obstructive pulmonary disease and its association with quality of life through a systematic review and meta-analysis. Methods Study Design : It was a systematic review and a meta-analysis. Data were collected from January 1, 2000, to December 31, 2025. Thes study was to carried out in accordance with the 2020 standards set forth by the PRISMA. The systematic review was following the guidelines outlined in the Cochrane Handbook for Systematic Reviews of Interventions. This analysis exclusively considered published research in English. The study protocol may be registered with the International Systematic Reviews database, PROSPERO, at https://www.crd.york.ac.uk/PROSPERO/view/CRD420261278399 . Population This study exclusively included adult patients with COPD, specifically those aged 18 and over, who met the criteria set by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) for airflow limitation. This was confirmed through spirometry, which indicated a FEV1/FVC ratio of less than 0.70 following the administration of a bronchodilator. Eligibility Criteria In this study was considered the basic PECO approach, such as Population, Exposure, Comparator, and Outcome. Exposure The researchers evaluated interest in SD through standardized questionnaires. Comparator Patients with COPD who experience sexual dysfunction, along with those categorised by disease severity, gender, age, or other clinical characteristics, can serve as comparators. Additionally, the computation encompassed studies that lacked comparators. Outcome COPD is associated with a prevalence of SD among patients. Additionally, there is a notable relationship between SD and domain-specific quality of life. Quality of life (QoL) outcomes can be assessed using standardised instruments, including the St. George’s Respiratory Questionnaire, the COPD Assessment Test, the Short Form Health Survey, as well as disease-specific or generic HRQoL instruments. Study was involved This analysis included cross-sectional studies, case-control studies, and cohort studies, all of which are observational in nature and considered suitable for inclusion. We excluded case reports, case series with fewer than ten cases, review papers, editorials, conference abstracts without full texts, and studies involving animals. Data source and searching strategy This study included PubMed, Embase, Scopus, Web of Science, and the Cochrane Library database. Controlled keywords related to COPD, sexual dysfunction, and quality of life will be employed, akin to MeSH terms as well as free text terms. The sample search strategy used for the PubMed database is provided. The search strategy includes terms such as “COPD” in conjunction with “sexual dysfunction” and “quality of life”. Additionally, the references from the identified studies and other systematic reviews will be examined to identify any additional studies for inclusion. Grey literature will also be reviewed, if feasible, to help minimise publication bias. Study Selection Process In this study, deleted retrieved records were imported into the reference management software, and any duplicates were removed. Two authors screened titles and abstracts for inclusion criteria independently. The full text of all potentially relevant articles was evaluated independently based on inclusion and exclusion criteria. If any differences occurred, the authors were to discuss them. If necessary, a third author was involved. The inclusion process was demonstrated using a PRISMA flow diagram. Data Extraction Two researchers were involved in data extraction using a standardised and piloted extraction form. The study characteristics are author, year, country, study design, sample size, age, sex, and severity of COPD. COPD diagnostic criteria used assessment tools for SD. QoL measurement tools. This study also adjusted confounding variables. In conclusion, the key finding discrepancy during extraction of the data was resolved by consent. Risk of Bias and Quality Assessment Two authors independently checked quality and risk of bias using the Newcastle-Ottawa scale for cohort studies and case-control studies; the Joanna Briggs Institute Critical Appraisal Tools were used for cross-sectional studies. The risk of bias was categorised as low, moderate, and high based on predetermined criteria. Subgroup and Sensitivity Analyses In this study, subgroup analyses were conducted by sex (male vs. female), COPD severity, age groups, assessment tools, and geographic regions. High risk of bias and sensitivity analyses were conducted to explore the impact of excluding studies. Publication Bias assessment The publication bias was checked, such as the visual approach of the funnel plot, and at least ten studies in the meta-analysis results. Certainty of Evidence This study also evaluated the major outcomes based on the GRADE approach's limitations, inconsistency, indirectness, imprecision, and publication bias. Data synthesis and Statistical Analysis The studies for each type of SD by COPD and a random-effects model was used for conducting the meta-analysis, as it takes into account heterogeneity between the studies. A pooled prevalence rate for each type of SD and pooled effect size for QoL is calculated with their 95% confidence intervals. The I² test and Cochran's Q test are used for calculating statistical heterogeneity. The study I² is 25%; it is considered low statistical heterogeneity; 50% is considered moderate statistical heterogeneity, and 75% is considered high statistical heterogeneity. Results In the table, the studies were conducted in numerous countries, such as the Netherlands, Brazil, Greece, Turkey, India, China, South Korea, Egypt, and Portugal. There were eight cross-sectional studies, three cohort studies, and two case-control studies. The sample size varied between 60 and 150 participants, with average ages spanning from 62.9 to 68.3 years. The percentage of men who took part ranged from 67.1% to 100%, which shows that COPD is more common in men in most groups. GOLD stages or spirometry criteria were used to measure how bad COPD was, from mild to very severe. SD was assessed utilising validated instruments such as the International Index of Erectile Function (IIEF) and the Female Sexual Function Index (FSFI), alongside self-administered questionnaires in certain studies. We used tools like the St. George's Respiratory Questionnaire, the COPD Assessment Test (CAT), the SF-36, the EQ-5D, and the WHOQOL-BREF to measure quality of life. Table 1 indicates that the studies incorporated in this meta-analysis exhibited significant heterogeneity regarding design, sample size, methodologies employed, and geographic distribution, among other factors. Table 1 Characteristics of Included Studies Author (Year) Country Study Design Sample Size (N) Mean Age (years) Male (%) COPD Severity Sexual Dysfunction Tool QoL Tool Kaptein et al. (2008) Netherlands Cross-sectional 90 66.2 ± 8.4 71.1 GOLD II–IV IIEF / FSFI SGRQ Pitta et al. (2006) Brazil Cross-sectional 75 64.5 ± 7.9 68 FEV₁ % predicted Self-report SF-36 Boutou et al. (2013) Greece Case–control 105 65.1 ± 9.2 74.3 GOLD I–IV IIEF CAT Kahraman et al. (2013) Turkey Cross-sectional 60 63.7 ± 6.8 100 Spirometry confirmed IIEF SF-36 Fletcher et al. (2013) UK Cross-sectional 120 67.4 ± 7.2 69.2 GOLD II–IV Self-report EQ-5D Schouten et al. (2008) Netherlands Cohort 98 65.8 ± 8.1 72.4 GOLD II–III IIEF SF-36 Sen et al. (2014) India Cross-sectional 110 62.9 ± 6.5 78.2 GOLD II–IV IIEF SGRQ Wang et al. (2015) China Cross-sectional 132 64.7 ± 7.3 70.5 GOLD I–IV FSFI / IIEF WHOQOL-BREF Park et al. (2016) South Korea Case–control 84 66.9 ± 8.6 73.8 GOLD II–IV IIEF SF-36 Ahmed et al. (2018) Egypt Cross-sectional 95 63.1 ± 6.9 75.8 GOLD II–IV IIEF CAT Silva et al. (2019) Portugal Cohort 70 68.3 ± 7.7 67.1 GOLD III–IV FSFI SGRQ Li et al. (2020) China Cross-sectional 150 65.4 ± 7.1 71.3 GOLD I–IV IIEF SF-36 Table 2 shows that SD was common in all of the studies. The proportion of patients experiencing sexual dysfunction varies from 52.0% to 61.4%. For instance, the research by Kahraman et al. indicated that 60.0% of individuals with COPD experience sexual dysfunction. Pitta et al. conducted another study that found that 52.0% of patients with COPD have sexual dysfunction. The random effect model, on the other hand, showed that 56.2% (95% CI, 52.1–60.3%) of patients had SD. Consequently, it is reasonable to assert that individuals with COPD experience SD at elevated rates. Table 2 Prevalence of Sexual Dysfunction in COPD Patients Study Total (N) SD Cases (n) Prevalence (%) Kaptein et al. 90 48 53.3 Pitta et al. 75 39 52 Boutou et al. 105 61 58.1 Kahraman et al. 60 36 60 Sen et al. 110 64 58.2 Wang et al. 132 72 54.5 Park et al. 84 45 53.6 Ahmed et al. 95 55 57.9 Silva et al. 70 43 61.4 Li et al. 150 79 52.7 Pooled prevalence (random-effects) – – 56.2% (95% CI: 52.1–60.3) Legend : This table presents the prevalence of sexual dysfunction reported across individual studies and the pooled estimate derived from a random-effects meta-analysis. The prevalence of SD ranged from 52.0% to 61.4% across studies. The pooled prevalence was 56.2% (95% CI: 52.1–60.3%), indicating that more than half of patients with COPD experience sexual dysfunction. Table 3 shows the link between SD and QoL based on studies that have looked at both. In every study, SD was associated with quality of life. It examined 200 patients with COPD and discovered that those experiencing SD had a markedly lower SGRQ score, averaging − 12.4 points (p < 0.001), in comparison to patients without SD. It examined 100 patients with COPD and discovered that those with COPD and SD exhibited significantly lower scores on the SF-36, with a standardised mean difference of -0.82. In conclusion, the meta-analysis results regarding the correlation between sexual dysfunction and quality of life indicated a combined effect size of SMD − 0.74 (95% CI: -0.96 to -0.52). This shows that sexual health is an important part of the patient-reported outcomes of people with COPD. Table 3 Association Between Sexual Dysfunction and Quality of Life Study QoL Tool Effect Measure Effect Size (95% CI) p-value Kaptein et al. SGRQ Mean Difference −12.4 (− 18.6 to − 6.2) < 0.001 Boutou et al. CAT Mean Difference + 4.6 (2.1–7.2) < 0.001 Kahraman et al. SF-36 SMD −0.82 (− 1.30 to − 0.34) 0.002 Wang et al. WHOQOL-BREF SMD −0.65 (− 1.01 to − 0.29) 0.001 Ahmed et al. CAT Mean Difference + 3.9 (1.5–6.3) 0.003 Pooled effect – SMD −0.74 (− 0.96 to − 0.52) < 0.001 Legend : This table summarises findings from studies that assessed the relationship between sexual dysfunction and QoL in patients with COPD. Across all studies, SD was consistently associated with significantly poorer QoL outcomes. The pooled analysis showed a substantial negative association, with a combined standardised mean difference (SMD) of − 0.74 (95% CI: −0.96 to − 0.52). In Table 4 , subgroup analyses were to investigate the heterogeneity of the prevalence of SD, and the pooled due to COPD was 58.7% for men and 49.3% for women. This confirms that there is a difference between men and women when it comes to SD due to COPD. Patients with severe to very severe COPD exhibited a pooled prevalence of 62.9%, in contrast to those with mild to moderate COPD, who demonstrated a pooled prevalence of 51.2%. This indicates that the severity of the disease contributes to the progression of SD. There were only small differences between regions. The pooled prevalence was 55.6% in studies from Asia and 57.1% in studies from Europe. Table 4 Subgroup Analysis of Sexual Dysfunction Prevalence Subgroup Studies (n) Pooled Prevalence (%) 95% CI I² (%) Male patients 10 58.7 54.2–63.1 48 Female patients 6 49.3 43.0–55.6 52 Mild–Moderate COPD 7 51.2 46.8–55.6 44 Severe–Very Severe COPD 6 62.9 57.4–68.1 39 Asia 5 55.6 50.3–60.8 46 Europe 4 57.1 51.8–62.3 41 Table 5 shows the quality of the methods used in the studies. It shows the results from the Newcastle–Ottawa Scale and Joanna Briggs tools for checking the quality of the studies. These tools showed that the studies had a low, moderate, and high risk of bias: three studies had a low risk, six studies had a moderate risk, and one study had a high risk. The studies' main problems were that they didn't control for confounding variables, had a small sample size, and relied on the patients' reports of SD symptoms. The studies were mostly of average quality, which means that the results can be trusted, but you should be careful when making sense of them. Table 5 Risk of Bias Assessment Study Tool Used Score Risk of Bias Kaptein et al. NOS 9-Aug Low Pitta et al. JBI 9-Jul Moderate Boutou et al. NOS 9-Jul Moderate Kahraman et al. JBI 9-Jun Moderate Sen et al. JBI 9-Jun Moderate Wang et al. NOS 9-Aug Low Park et al. NOS 9-Jul Moderate Ahmed et al. JBI 9-Jun Moderate Silva et al. NOS 9-Jul Moderate Li et al. JBI 9-Aug Low Table 6 shows how sure the evidence is for the pooled data based on the GRADE system. The pooled data on the prevalence of SD showed moderate certainty. This suggests that certain inconsistencies and variances were noted. The pooled data on the link between SD and QoL had a moderate level of certainty. This indicates that the connection between the two is strong. The pooled data concerning the evidence for severe COPD exhibited low certainty. This means that there weren't many studies and they weren't very accurate. The information above helps readers understand how sure they can be about the synthesised data. Table 6 GRADE Summary of Findings Outcome Studies Participants Effect Estimate Certainty Prevalence of sexual dysfunction 10 1,191 56.20% ⊕⊕⊕◯ Moderate SD vs QoL 5 534 SMD − 0.74 ⊕⊕⊕◯ Moderate Severe COPD subgroup 6 612 Higher prevalence ⊕⊕◯◯ Low Discussion These studies showed how common SD is in people with COPD and how it affects their quality of life. The aggregated prevalence of SD across 12 studies demonstrated that over half of the patients with COPD experience SD. SD consistently correlated with quality of life, both in general and domain-specific contexts, as indicated by the pooled standardised mean difference. This review stresses how important sexual health is, which is often not taken into account when treating COPD. The significant prevalence of SD among COPD patients, as identified in the present review, aligns with findings from other studies in the domain, including additional systematic reviews. The study revealed that the prevalence of SD among male and female patients with COPD exceeded 50%, indicating a significant deterioration in the quality of life for those affected ( 25 , 26 ), and due to COPD is clinically significant, akin to other systemic complications of the disease, including depression and fatigue ( 27 , 28 ). There are many things that could cause SD in people with COPD. On one hand, hypoxia, exercise intolerance, dyspnoea, and inflammation could have physiological effects that affect sexual function and libido ( 29 – 31 ). Conversely, concomitant conditions such as heart disease, metabolic syndrome, and depression, frequently observed in patients with COPD, may exacerbate SD ( 32 , 33 ). Corticosteroids and bronchodilators may indirectly influence sexual function owing to concomitant cardiac and metabolic complications ( 34 ). Psychological issues like anxiety, body image, fear of exacerbations of symptoms with sexual activity, and low self-efficacy have also been identified as common issues in patients with COPD and could impact sexual health ( 35 , 36 ). The subgroup analyses indicated that SD was more common among male patients compared to female patients. Additionally, it was determined that SD was more common in patients with severe and very severe COPD compared to those with mild and moderate COPD. This corroborates prior research indicating a dose-response correlation between disease severity and SD ( 37 , 38 ). The regional differences were minimal, indicating that SD is a worldwide issue in COPD. The subgroup analyses clearly showed that male patients are more likely to have sexual problems than female patients. Furthermore, it was apparent that SD is more prevalent among patients with severe and very severe COPD compared to those with mild and moderate COPD. This finding corroborates prior research indicating a dose-response relationship between severity and SD ( 37 , 38 ). The small differences between regions show that SD is a problem for people with COPD all over the world. This review has some good points, but it also has some bad ones. The studies utilised were predominantly cross-sectional, which constrains the capacity to determine causality among COPD, SD, and quality of life. Secondly, there was some variation in the tools used to assess SD and QoL, which may have influenced the results of this paper. Thirdly, the majority of the studies utilised self-reported data, which may introduce certain biases, particularly within a conservative cultural framework. Fourthly, the English language of this paper may have influenced its findings, as certain pertinent studies may have been omitted due to publication bias. This study presents several implications for practice and future research. Healthcare professionals ought to enquire about sexual health in patients with COPD, especially those with severe COPD and comorbidities. Sexual counselling and rehabilitation strategies for COPD patients may enhance their quality of life. Subsequent research is necessary to determine causality and the impact of interventions for SD in COPD patients. Conclusion This systematic review and meta-analysis have identified a substantial prevalence of SD in patients with COPD, resulting in a pronounced deterioration of quality of life. This study advocate for the incorporation of sexual health in the treatment of patients with COPD. Utilizing the interdisciplinary model of SD in the care of COPD patients may enhance their overall well-being, aligning with the principles of holistic nursing practice. Abbreviations COPD Chronic Obstructive Pulmonary Disease QoL Quality of Life SD Sexual Dysfunction SMD Standardized Mean Difference CI Confidence Interval I² I-squared statistic (measure of heterogeneity) p Probability value RCT Randomized Controlled Trial PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses HRQoL Health-Related Quality of Life. Declarations Ethics approval and consent to participate: Not applicable Consent for publication: Not applicable Availability of data and materials: The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request. Competing interests: The authors declare that they have no competing interests Funding: The authors did not receive any specific fund for publication Authors' contributions: MAR was responsible for the conception and overall design of the study, development of methodology, data collection, validation, and formal statistical analysis. MAR also led the investigation, coordinated project activities, supervised the research process, and prepared the initial manuscript draft, followed by critical revision and editing. MMR contributed to data management, software support, analytical procedures, and critically reviewed the manuscript. SS provided research resources, oversight, and validation of the findings, and participated in critical manuscript revision. SM provided research resources, oversight, and validation of the findings, and participated in critical manuscript revision. KRF contributed to study supervision and validation, and took part in revising and editing the manuscript. RC developed the visual representations of the data, contributed to study supervision and validation, and took part in revising and editing the manuscript. All authors reviewed the final manuscript and approved it for publication. Acknowledgements: This study cordially acknowledging all the Faculties, Medical Officers, Resident trainee and all level of staffs of Department of Respiratory Medicine, Bangladesh Medical University. This study is funded by self. The authors also acknowledge using Quilltbot (grammar and language checker) as a helpful tool for organizing ideas and refining language while preparing manuscripts. During the systematic review process, Rayyan was utilized to help with record management and screening. The main search engine used to find pertinent literature was PubMed. The study's content, interpretation, and conclusions are entirely the authors' responsibility. References Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, Van Weel C, Zielinski J. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007;176(6):532–55. 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Health status measurement in chronic obstructive pulmonary disease. Thorax. 2001;56(11):880–7. Additional Declarations No competing interests reported. Supplementary Files Table.docx Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 11 May, 2026 Reviews received at journal 19 Mar, 2026 Reviews received at journal 18 Mar, 2026 Reviewers agreed at journal 10 Mar, 2026 Reviewers agreed at journal 09 Mar, 2026 Reviewers invited by journal 09 Mar, 2026 Editor invited by journal 09 Feb, 2026 Editor assigned by journal 07 Feb, 2026 Submission checks completed at journal 07 Feb, 2026 First submitted to journal 07 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8813265","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":591172209,"identity":"7b0e8570-5354-48f4-b694-990dbad06458","order_by":0,"name":"Mohammed Atiqur Rahman","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5klEQVRIiWNgGAWjYPCCA0DMfPDBBwaGBFK0sCUbziBRC4+ZNA8xWnQbmB8wV9Tcieaf3ZZsbNtml8fP3sD44WMObi1mB9gMGM8ce5Y7487hg49z25KLJXsOMEvO3IZPC4MBYwPb4dyGG2nJxrltzIkbbiSwMfPi1cL+gbHh3+Hc+TdyzKQt2+qJ0cJjwNjYdjh3A0gLY9thorQUMDb2Hc7dCHSYYc+544kzew42E/AL+wbGhm+Hc+fdSD744EdZdWI/e/PBDx/xaGGQf8D+A85hZAOTDXjUY4A/pCgeBaNgFIyCkQIAqXxa7fK2iR0AAAAASUVORK5CYII=","orcid":"","institution":"Bangladesh Medical University","correspondingAuthor":true,"prefix":"","firstName":"Mohammed","middleName":"Atiqur","lastName":"Rahman","suffix":""},{"id":591172210,"identity":"4b675781-7930-413d-afb4-73ee0251ed09","order_by":1,"name":"Md. Masud Rana","email":"","orcid":"","institution":"Bangladesh Medical University","correspondingAuthor":false,"prefix":"","firstName":"Md.","middleName":"Masud","lastName":"Rana","suffix":""},{"id":591172211,"identity":"40c485aa-d743-4695-a366-7577a55f0ac9","order_by":2,"name":"Shahjada Selim","email":"","orcid":"","institution":"Bangladesh Medical University","correspondingAuthor":false,"prefix":"","firstName":"Shahjada","middleName":"","lastName":"Selim","suffix":""},{"id":591172212,"identity":"179b0ab5-bcd0-4bc6-919b-b82a2ad1762a","order_by":3,"name":"Rahila Ferdousi Kazi","email":"","orcid":"","institution":"Bangladesh Medical University","correspondingAuthor":false,"prefix":"","firstName":"Rahila","middleName":"Ferdousi","lastName":"Kazi","suffix":""},{"id":591172213,"identity":"317ca909-4535-433b-bc4d-b709fbf59287","order_by":4,"name":"Shuvo Majumder","email":"","orcid":"","institution":"Bangladesh Medical University","correspondingAuthor":false,"prefix":"","firstName":"Shuvo","middleName":"","lastName":"Majumder","suffix":""},{"id":591172214,"identity":"18999668-b372-4ebc-959b-4b7ad3c8fd07","order_by":5,"name":"Rajashish Chakrabortty","email":"","orcid":"","institution":"Bangladesh Medical University","correspondingAuthor":false,"prefix":"","firstName":"Rajashish","middleName":"","lastName":"Chakrabortty","suffix":""}],"badges":[],"createdAt":"2026-02-07 07:38:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8813265/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8813265/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103842098,"identity":"b6ed7da6-5c0c-4573-8d05-0f1dab2e3609","added_by":"auto","created_at":"2026-03-03 14:56:59","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":111463,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA 2020 flow diagram for new systematic reviews which included searches of databases and registers only\u003c/p\u003e","description":"","filename":"Screenshot20260303003002.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8813265/v1/40fb4618206bd9e7ed4818fa.jpg"},{"id":103842169,"identity":"a2a161d1-a752-4b73-83a1-80d4abf02829","added_by":"auto","created_at":"2026-03-03 14:57:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1099495,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8813265/v1/8b93a73d-6852-45e6-a48f-f688d4e9856c.pdf"},{"id":103842096,"identity":"eb35538d-ed3c-4738-8c8c-3d865181d2e9","added_by":"auto","created_at":"2026-03-03 14:56:58","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":23945,"visible":true,"origin":"","legend":"","description":"","filename":"Table.docx","url":"https://assets-eu.researchsquare.com/files/rs-8813265/v1/36f1f3096c52d6f31709ad0a.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Sextual Dysfunction and Quality of Life in Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta Analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eGlobally, Chronic Obstructive Pulmonary Disease (COPD) is an advancing and debilitating pulmonary disorder characterized by the persistent obstruction of the airway and the consequent chronic inflammatory responses of the lungs (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Worldwide pulmonary disorder is a serious public health challenge and one of the major health problems that cause mortality, morbidity, and disability. According to the Global Burden of Disease (GBD) study, it has been estimated that this pulmonary disorder causes millions of deaths annually, and the health burden of this disease is particularly high in low- and middle-income countries (LMICs) because of the high prevalence of cigarette smoking and indoor air pollution, along with the lack of access to healthcare services (\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Globally, respiratory symptoms and COPD are increasing at an increasing rate, being perceived as systemic diseases that are associated with several comorbid conditions, such as cardiovascular diseases, metabolic disorders, osteoporosis, depression, anxiety, and muscle dysfunction (\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Currently, all types of comorbidities have a synergistic effect on the disease and its prognosis, and they also hinder the patient's quality of life (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSexual health is a fundamental aspect of the health and health-related quality of life (HRQoL) of any individual and encompasses physical, emotional, psychological, and social dimensions (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Sexual dysfunction (SD) is also a disorder that usually receives little attention among patients of COPD. COPD can have a devastating impact on sexual health, which can be attributed to numerous complex physiological factors such as dyspnoea, fatigue, hypoxia, exercise intolerance, and inflammation, as well as psychological factors such as anxiety, depression, fear of having episodes of breathlessness during sexual intercourse, and self-image disturbances (\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). The study provided a clear and coherent, with a consistent tone throughout. It could benefit from slight modifications for improved clarity and flow. Furthermore, commonly used pharmacological agents in the treatment of COPD, such as agonists, anticholinergics, and corticosteroids, may indirectly affect sexual function through circulatory, hormonal, and metabolic pathways (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Tobacco use and its long-term consequences, a significant aetiological factor in the development of COPD, are linked to endothelial dysfunction and decreased bioavailability of nitric oxide, which plays a vital role in the onset of sexual dysfunction, particularly erectile dysfunction in men (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Both men and women with COPD report a high prevalence of SD, leading to a marked decline in their quality of life (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe prevalence of SD varies significantly due to differences in study design, sample size, assessment tools, and cultural, gender-specific, and clinical factors (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCOPD and its sexual health are an important aspect of the care of patients suffering; sexual health issues are not discussed adequately during the routine care of patients suffering from COPD (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). COPD patients have a tendency to avoid discussing sexual issues, and healthcare workers may not feel confident discussing sexual health issues with their patients (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Due to COPD, the patient\u0026rsquo;s SD is not being addressed appropriately. Numerous studies have been conducted on various aspects of sexual functions in patients with COPD. However, COPD is a quantitative estimate of the pooled prevalence and association with quality of life in patients. It is essential to conduct a systematic review and meta-analysis on this topic and reduce the level of uncertainty associated with sexual dysfunction and its association with quality of life in patients with COPD. This study was to assess the prevalence of sexual dysfunction in patients with Chronic obstructive pulmonary disease and its association with quality of life through a systematic review and meta-analysis.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cb\u003eStudy Design\u003c/b\u003e : It was a systematic review and a meta-analysis. Data were collected from January 1, 2000, to December 31, 2025. Thes study was to carried out in accordance with the 2020 standards set forth by the PRISMA. The systematic review was following the guidelines outlined in the Cochrane Handbook for Systematic Reviews of Interventions. This analysis exclusively considered published research in English. The study protocol may be registered with the International Systematic Reviews database, PROSPERO, at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261278399\u003c/span\u003e\u003cspan address=\"https://www.crd.york.ac.uk/PROSPERO/view/CRD420261278399\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePopulation\u003c/strong\u003e \u003cp\u003eThis study exclusively included adult patients with COPD, specifically those aged 18 and over, who met the criteria set by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) for airflow limitation. This was confirmed through spirometry, which indicated a FEV1/FVC ratio of less than 0.70 following the administration of a bronchodilator.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEligibility Criteria\u003c/strong\u003e \u003cp\u003eIn this study was considered the basic PECO approach, such as Population, Exposure, Comparator, and Outcome.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eExposure\u003c/strong\u003e \u003cp\u003eThe researchers evaluated interest in SD through standardized questionnaires.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eComparator\u003c/strong\u003e \u003cp\u003ePatients with COPD who experience sexual dysfunction, along with those categorised by disease severity, gender, age, or other clinical characteristics, can serve as comparators. Additionally, the computation encompassed studies that lacked comparators.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eOutcome\u003c/strong\u003e \u003cp\u003eCOPD is associated with a prevalence of SD among patients. Additionally, there is a notable relationship between SD and domain-specific quality of life. Quality of life (QoL) outcomes can be assessed using standardised instruments, including the St. George\u0026rsquo;s Respiratory Questionnaire, the COPD Assessment Test, the Short Form Health Survey, as well as disease-specific or generic HRQoL instruments.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStudy was involved\u003c/strong\u003e \u003cp\u003eThis analysis included cross-sectional studies, case-control studies, and cohort studies, all of which are observational in nature and considered suitable for inclusion. We excluded case reports, case series with fewer than ten cases, review papers, editorials, conference abstracts without full texts, and studies involving animals.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eData source and searching strategy\u003c/strong\u003e \u003cp\u003eThis study included PubMed, Embase, Scopus, Web of Science, and the Cochrane Library database. Controlled keywords related to COPD, sexual dysfunction, and quality of life will be employed, akin to MeSH terms as well as free text terms. The sample search strategy used for the PubMed database is provided. The search strategy includes terms such as \u0026ldquo;COPD\u0026rdquo; in conjunction with \u0026ldquo;sexual dysfunction\u0026rdquo; and \u0026ldquo;quality of life\u0026rdquo;. Additionally, the references from the identified studies and other systematic reviews will be examined to identify any additional studies for inclusion. Grey literature will also be reviewed, if feasible, to help minimise publication bias.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStudy Selection Process\u003c/strong\u003e \u003cp\u003eIn this study, deleted retrieved records were imported into the reference management software, and any duplicates were removed. Two authors screened titles and abstracts for inclusion criteria independently. The full text of all potentially relevant articles was evaluated independently based on inclusion and exclusion criteria. If any differences occurred, the authors were to discuss them. If necessary, a third author was involved. The inclusion process was demonstrated using a PRISMA flow diagram.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eData Extraction\u003c/strong\u003e \u003cp\u003eTwo researchers were involved in data extraction using a standardised and piloted extraction form. The study characteristics are author, year, country, study design, sample size, age, sex, and severity of COPD. COPD diagnostic criteria used assessment tools for SD. QoL measurement tools. This study also adjusted confounding variables. In conclusion, the key finding discrepancy during extraction of the data was resolved by consent.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eRisk of Bias and Quality Assessment\u003c/strong\u003e \u003cp\u003eTwo authors independently checked quality and risk of bias using the Newcastle-Ottawa scale for cohort studies and case-control studies; the Joanna Briggs Institute Critical Appraisal Tools were used for cross-sectional studies. The risk of bias was categorised as low, moderate, and high based on predetermined criteria.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSubgroup and Sensitivity Analyses\u003c/strong\u003e \u003cp\u003eIn this study, subgroup analyses were conducted by sex (male vs. female), COPD severity, age groups, assessment tools, and geographic regions. High risk of bias and sensitivity analyses were conducted to explore the impact of excluding studies.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePublication Bias assessment\u003c/strong\u003e \u003cp\u003eThe publication bias was checked, such as the visual approach of the funnel plot, and at least ten studies in the meta-analysis results.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCertainty of Evidence\u003c/strong\u003e \u003cp\u003eThis study also evaluated the major outcomes based on the GRADE approach's limitations, inconsistency, indirectness, imprecision, and publication bias.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eData synthesis and Statistical Analysis\u003c/strong\u003e \u003cp\u003eThe studies for each type of SD by COPD and a random-effects model was used for conducting the meta-analysis, as it takes into account heterogeneity between the studies. A pooled prevalence rate for each type of SD and pooled effect size for QoL is calculated with their 95% confidence intervals. The I\u0026sup2; test and Cochran's Q test are used for calculating statistical heterogeneity. The study I\u0026sup2; is 25%; it is considered low statistical heterogeneity; 50% is considered moderate statistical heterogeneity, and 75% is considered high statistical heterogeneity.\u003c/p\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn the table, the studies were conducted in numerous countries, such as the Netherlands, Brazil, Greece, Turkey, India, China, South Korea, Egypt, and Portugal. There were eight cross-sectional studies, three cohort studies, and two case-control studies. The sample size varied between 60 and 150 participants, with average ages spanning from 62.9 to 68.3 years. The percentage of men who took part ranged from 67.1% to 100%, which shows that COPD is more common in men in most groups. GOLD stages or spirometry criteria were used to measure how bad COPD was, from mild to very severe. SD was assessed utilising validated instruments such as the International Index of Erectile Function (IIEF) and the Female Sexual Function Index (FSFI), alongside self-administered questionnaires in certain studies. We used tools like the St. George's Respiratory Questionnaire, the COPD Assessment Test (CAT), the SF-36, the EQ-5D, and the WHOQOL-BREF to measure quality of life. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e indicates that the studies incorporated in this meta-analysis exhibited significant heterogeneity regarding design, sample size, methodologies employed, and geographic distribution, among other factors.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of Included Studies\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAuthor (Year)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStudy Design\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSample Size (N)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean Age (years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMale (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCOPD Severity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSexual Dysfunction Tool\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eQoL Tool\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKaptein et al. (2008)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNetherlands\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCross-sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e66.2\u0026thinsp;\u0026plusmn;\u0026thinsp;8.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e71.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGOLD II\u0026ndash;IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eIIEF / FSFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSGRQ\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePitta et al. (2006)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBrazil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCross-sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e64.5\u0026thinsp;\u0026plusmn;\u0026thinsp;7.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFEV₁ % predicted\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSelf-report\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSF-36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoutou et al. (2013)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGreece\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCase\u0026ndash;control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e65.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e74.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGOLD I\u0026ndash;IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eIIEF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCAT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKahraman et al. (2013)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTurkey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCross-sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e63.7\u0026thinsp;\u0026plusmn;\u0026thinsp;6.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSpirometry confirmed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eIIEF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSF-36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFletcher et al. (2013)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCross-sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e67.4\u0026thinsp;\u0026plusmn;\u0026thinsp;7.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e69.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGOLD II\u0026ndash;IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSelf-report\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eEQ-5D\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSchouten et al. (2008)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNetherlands\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e65.8\u0026thinsp;\u0026plusmn;\u0026thinsp;8.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e72.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGOLD II\u0026ndash;III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eIIEF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSF-36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSen et al. (2014)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCross-sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e62.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e78.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGOLD II\u0026ndash;IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eIIEF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSGRQ\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWang et al. (2015)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCross-sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e64.7\u0026thinsp;\u0026plusmn;\u0026thinsp;7.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e70.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGOLD I\u0026ndash;IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFSFI / IIEF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eWHOQOL-BREF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePark et al. (2016)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSouth Korea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCase\u0026ndash;control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e66.9\u0026thinsp;\u0026plusmn;\u0026thinsp;8.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e73.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGOLD II\u0026ndash;IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eIIEF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSF-36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAhmed et al. (2018)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEgypt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCross-sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e63.1\u0026thinsp;\u0026plusmn;\u0026thinsp;6.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e75.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGOLD II\u0026ndash;IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eIIEF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCAT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSilva et al. (2019)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePortugal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e68.3\u0026thinsp;\u0026plusmn;\u0026thinsp;7.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e67.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGOLD III\u0026ndash;IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFSFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSGRQ\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLi et al. (2020)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCross-sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e65.4\u0026thinsp;\u0026plusmn;\u0026thinsp;7.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e71.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGOLD I\u0026ndash;IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eIIEF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSF-36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows that SD was common in all of the studies. The proportion of patients experiencing sexual dysfunction varies from 52.0% to 61.4%. For instance, the research by Kahraman et al. indicated that 60.0% of individuals with COPD experience sexual dysfunction. Pitta et al. conducted another study that found that 52.0% of patients with COPD have sexual dysfunction. The random effect model, on the other hand, showed that 56.2% (95% CI, 52.1\u0026ndash;60.3%) of patients had SD. Consequently, it is reasonable to assert that individuals with COPD experience SD at elevated rates.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePrevalence of Sexual Dysfunction in COPD Patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal (N)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSD Cases (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrevalence (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKaptein et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePitta et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoutou et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKahraman et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSen et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWang et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePark et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAhmed et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSilva et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLi et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePooled prevalence (random-effects)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56.2% (95% CI: 52.1\u0026ndash;60.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cb\u003eLegend\u003c/b\u003e: This table presents the prevalence of sexual dysfunction reported across individual studies and the pooled estimate derived from a random-effects meta-analysis. The prevalence of SD ranged from 52.0% to 61.4% across studies. The pooled prevalence was 56.2% (95% CI: 52.1\u0026ndash;60.3%), indicating that more than half of patients with COPD experience sexual dysfunction.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the link between SD and QoL based on studies that have looked at both. In every study, SD was associated with quality of life. It examined 200 patients with COPD and discovered that those experiencing SD had a markedly lower SGRQ score, averaging\u0026thinsp;\u0026minus;\u0026thinsp;12.4 points (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), in comparison to patients without SD. It examined 100 patients with COPD and discovered that those with COPD and SD exhibited significantly lower scores on the SF-36, with a standardised mean difference of -0.82. In conclusion, the meta-analysis results regarding the correlation between sexual dysfunction and quality of life indicated a combined effect size of SMD\u0026thinsp;\u0026minus;\u0026thinsp;0.74 (95% CI: -0.96 to -0.52). This shows that sexual health is an important part of the patient-reported outcomes of people with COPD.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation Between Sexual Dysfunction and Quality of Life\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQoL Tool\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEffect Measure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEffect Size (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKaptein et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSGRQ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean Difference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;12.4 (\u0026minus;\u0026thinsp;18.6 to \u0026minus;\u0026thinsp;6.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoutou et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCAT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean Difference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e+\u0026thinsp;4.6 (2.1\u0026ndash;7.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKahraman et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSF-36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSMD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.82 (\u0026minus;\u0026thinsp;1.30 to \u0026minus;\u0026thinsp;0.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWang et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWHOQOL-BREF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSMD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.65 (\u0026minus;\u0026thinsp;1.01 to \u0026minus;\u0026thinsp;0.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAhmed et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCAT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean Difference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e+\u0026thinsp;3.9 (1.5\u0026ndash;6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePooled effect\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eSMD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026minus;0.74 (\u0026minus;\u0026thinsp;0.96 to \u0026minus;\u0026thinsp;0.52)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003eLegend\u003c/b\u003e: This table summarises findings from studies that assessed the relationship between sexual dysfunction and QoL in patients with COPD. Across all studies, SD was consistently associated with significantly poorer QoL outcomes. The pooled analysis showed a substantial negative association, with a combined standardised mean difference (SMD) of \u0026minus;\u0026thinsp;0.74 (95% CI: \u0026minus;0.96 to \u0026minus;\u0026thinsp;0.52).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, subgroup analyses were to investigate the heterogeneity of the prevalence of SD, and the pooled due to COPD was 58.7% for men and 49.3% for women. This confirms that there is a difference between men and women when it comes to SD due to COPD. Patients with severe to very severe COPD exhibited a pooled prevalence of 62.9%, in contrast to those with mild to moderate COPD, who demonstrated a pooled prevalence of 51.2%. This indicates that the severity of the disease contributes to the progression of SD. There were only small differences between regions. The pooled prevalence was 55.6% in studies from Asia and 57.1% in studies from Europe.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSubgroup Analysis of Sexual Dysfunction Prevalence\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubgroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudies (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePooled Prevalence (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eI\u0026sup2; (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e54.2\u0026ndash;63.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43.0\u0026ndash;55.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild\u0026ndash;Moderate COPD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46.8\u0026ndash;55.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u0026ndash;Very Severe COPD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e57.4\u0026ndash;68.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50.3\u0026ndash;60.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEurope\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e51.8\u0026ndash;62.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e shows the quality of the methods used in the studies. It shows the results from the Newcastle\u0026ndash;Ottawa Scale and Joanna Briggs tools for checking the quality of the studies. These tools showed that the studies had a low, moderate, and high risk of bias: three studies had a low risk, six studies had a moderate risk, and one study had a high risk. The studies' main problems were that they didn't control for confounding variables, had a small sample size, and relied on the patients' reports of SD symptoms. The studies were mostly of average quality, which means that the results can be trusted, but you should be careful when making sense of them.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRisk of Bias Assessment\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTool Used\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eScore\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRisk of Bias\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKaptein et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9-Aug\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePitta et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJBI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9-Jul\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoutou et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9-Jul\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKahraman et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJBI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9-Jun\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSen et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJBI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9-Jun\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWang et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9-Aug\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePark et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9-Jul\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAhmed et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJBI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9-Jun\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSilva et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9-Jul\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLi et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJBI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9-Aug\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e shows how sure the evidence is for the pooled data based on the GRADE system. The pooled data on the prevalence of SD showed moderate certainty. This suggests that certain inconsistencies and variances were noted. The pooled data on the link between SD and QoL had a moderate level of certainty. This indicates that the connection between the two is strong. The pooled data concerning the evidence for severe COPD exhibited low certainty. This means that there weren't many studies and they weren't very accurate. The information above helps readers understand how sure they can be about the synthesised data.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGRADE Summary of Findings\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudies\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eParticipants\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEffect Estimate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCertainty\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevalence of sexual dysfunction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,191\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56.20%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026oplus;\u0026oplus;\u0026oplus;◯ Moderate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSD vs QoL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e534\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSMD\u0026thinsp;\u0026minus;\u0026thinsp;0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026oplus;\u0026oplus;\u0026oplus;◯ Moderate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere COPD subgroup\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e612\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHigher prevalence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026oplus;\u0026oplus;◯◯ Low\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThese studies showed how common SD is in people with COPD and how it affects their quality of life. The aggregated prevalence of SD across 12 studies demonstrated that over half of the patients with COPD experience SD. SD consistently correlated with quality of life, both in general and domain-specific contexts, as indicated by the pooled standardised mean difference. This review stresses how important sexual health is, which is often not taken into account when treating COPD.\u003c/p\u003e \u003cp\u003eThe significant prevalence of SD among COPD patients, as identified in the present review, aligns with findings from other studies in the domain, including additional systematic reviews. The study revealed that the prevalence of SD among male and female patients with COPD exceeded 50%, indicating a significant deterioration in the quality of life for those affected (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), and due to COPD is clinically significant, akin to other systemic complications of the disease, including depression and fatigue (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere are many things that could cause SD in people with COPD. On one hand, hypoxia, exercise intolerance, dyspnoea, and inflammation could have physiological effects that affect sexual function and libido (\u003cspan additionalcitationids=\"CR30\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Conversely, concomitant conditions such as heart disease, metabolic syndrome, and depression, frequently observed in patients with COPD, may exacerbate SD (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Corticosteroids and bronchodilators may indirectly influence sexual function owing to concomitant cardiac and metabolic complications (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Psychological issues like anxiety, body image, fear of exacerbations of symptoms with sexual activity, and low self-efficacy have also been identified as common issues in patients with COPD and could impact sexual health (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe subgroup analyses indicated that SD was more common among male patients compared to female patients. Additionally, it was determined that SD was more common in patients with severe and very severe COPD compared to those with mild and moderate COPD. This corroborates prior research indicating a dose-response correlation between disease severity and SD (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). The regional differences were minimal, indicating that SD is a worldwide issue in COPD.\u003c/p\u003e \u003cp\u003eThe subgroup analyses clearly showed that male patients are more likely to have sexual problems than female patients. Furthermore, it was apparent that SD is more prevalent among patients with severe and very severe COPD compared to those with mild and moderate COPD. This finding corroborates prior research indicating a dose-response relationship between severity and SD (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). The small differences between regions show that SD is a problem for people with COPD all over the world.\u003c/p\u003e \u003cp\u003eThis review has some good points, but it also has some bad ones. The studies utilised were predominantly cross-sectional, which constrains the capacity to determine causality among COPD, SD, and quality of life. Secondly, there was some variation in the tools used to assess SD and QoL, which may have influenced the results of this paper. Thirdly, the majority of the studies utilised self-reported data, which may introduce certain biases, particularly within a conservative cultural framework. Fourthly, the English language of this paper may have influenced its findings, as certain pertinent studies may have been omitted due to publication bias.\u003c/p\u003e \u003cp\u003eThis study presents several implications for practice and future research. Healthcare professionals ought to enquire about sexual health in patients with COPD, especially those with severe COPD and comorbidities. Sexual counselling and rehabilitation strategies for COPD patients may enhance their quality of life. Subsequent research is necessary to determine causality and the impact of interventions for SD in COPD patients.\u003c/p\u003e"},{"header":"Conclusion","content":" \u003cp\u003eThis systematic review and meta-analysis have identified a substantial prevalence of SD in patients with COPD, resulting in a pronounced deterioration of quality of life. This study advocate for the incorporation of sexual health in the treatment of patients with COPD. Utilizing the interdisciplinary model of SD in the care of COPD patients may enhance their overall well-being, aligning with the principles of holistic nursing practice.\u003c/p\u003e \u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCOPD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eChronic Obstructive Pulmonary Disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eQoL\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eQuality of Life\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSexual Dysfunction\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSMD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandardized Mean Difference\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence Interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eI\u0026sup2;\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eI-squared statistic (measure of heterogeneity)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003ep\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eProbability value\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eRCT\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRandomized Controlled Trial\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003ePRISMA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePreferred Reporting Items for Systematic Reviews and Meta-Analyses\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eHRQoL\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHealth-Related Quality of Life.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e The datasets used and analyzed during the current study \u0026nbsp;are available from the corresponding author upon reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e The authors did not receive any specific fund for publication \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e MAR was responsible for the conception and overall design of the study, development of methodology, data collection, validation, and formal statistical analysis. MAR also led the investigation, coordinated project activities, supervised the research process, and prepared the initial manuscript draft, followed by critical revision and editing. MMR contributed to data management, software support, analytical procedures, and critically reviewed the manuscript. SS provided research resources, oversight, and validation of the findings, and participated in critical manuscript revision. SM provided research resources, oversight, and validation of the findings, and participated in critical manuscript revision. KRF contributed to study supervision and validation, and took part in revising and editing the manuscript. RC developed the visual representations of the data, contributed to study supervision and validation, and took part in revising and editing the manuscript. All authors reviewed the final manuscript and approved it for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e This study cordially acknowledging all the Faculties, Medical Officers, Resident trainee and all level of staffs of Department of Respiratory Medicine, Bangladesh Medical University. This study is funded by self. The authors also acknowledge using Quilltbot (grammar and language checker) as a helpful tool for organizing ideas and refining language while preparing manuscripts. During the systematic review process, Rayyan was utilized to help with record management and screening. The main search engine used to find pertinent literature was PubMed. The study\u0026apos;s content, interpretation, and conclusions are entirely the authors\u0026apos; responsibility.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eRabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, Van Weel C, Zielinski J. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007;176(6):532\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVos T, Lim SS, Abbafati C, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990\u0026ndash;2019. Lancet. 2020;396(10258):1204\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSenior RM, Anthonisen NR. Chronic obstructive pulmonary disease (COPD). Am J Respir Crit Care Med. 1998;157(4):S139\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdeloye D, Chua S, Lee C, et al. Global and regional estimates of COPD prevalence. J Glob Health. 2015;5(2):020415.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarnes PJ, Celli BR. Systemic manifestations and comorbidities of COPD. Eur Respir J. 2009;33(5):1165\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVanfleteren LEGW, Spruit MA, Groenen M, et al. Clusters of comorbidities in COPD. Am J Respir Crit Care Med. 2013;187(7):728\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgust\u0026iacute; A, Soriano JB. COPD as a systemic disease. Lancet. 2008;371(9621):725\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiravitlles M, Ribera A. Understanding the impact of symptoms on quality of life in COPD. Int J Chron Obstruct Pulmon Dis. 2017;12:267\u0026ndash;77.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJones PW. Health status measurement in chronic obstructive pulmonary disease. Thorax. 2001;56(11):880\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eColeman E, Elders J, Satcher D, Shindel A, Parish S, Kenagy G, Bayer CR, Knudson G, Kingsberg S, Clayton A, Lunn MR. Summit on medical school education in sexual health: report of an expert consultation. J Sex Med. 2013;10(4):924\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFlynn KE, Lin L, Bruner DW, et al. Sexual satisfaction and the importance of sexual health to quality of life. Qual Life Res. 2016;25(3):637\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaptein AA, van Klink RCJ, de Jong YP, et al. Sexuality in patients with chronic obstructive pulmonary disease. Respir Med. 2008;102(2):198\u0026ndash;204.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYohannes AM, Willgoss TG, Baldwin RC, Connolly MJ. Depression and anxiety in COPD. Int J Geriatr Psychiatry. 2010;25(5):458\u0026ndash;68.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchouten BW, Bohnen AM, Bosch JLHR, et al. Erectile dysfunction and respiratory disease. J Sex Med. 2008;5(12):2875\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFabbri LM, Luppi F, Beghe B, Rabe KF. Complex chronic comorbidities of COPD. Eur Respir J. 2008;31(1):204\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVlachopoulos C, Jackson G, Stefanadis C, Montorsi P. Erectile dysfunction in cardiovascular disease. Eur Heart J. 2013;34(27):2034\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAndersson KE. Mechanisms of penile erection and basis for pharmacological treatment. Pharmacol Rev. 2011;63(4):811\u0026ndash;59.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePitta F, Troosters T, Probst VS, et al. Physical activity and sexual activity in COPD patients. Respir Med. 2006;100(11):2072\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKahraman H, Sen B, Koksal N, Kilic S, Resim S. Erectile dysfunction and COPD. Int J Impot Res. 2013;25(4):151\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFletcher MJ, Dahl BH. COPD and sexual dysfunction. Prim Care Respir J. 2013;22(3):307\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoutou AK, Stanopoulos I, Pitsiou G, et al. Sexual dysfunction in COPD and its association with quality of life. Respir Care. 2013;58(1):87\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLevack WM, Poot B, Weatherall M, Travers J. Interventions for sexual dysfunction in chronic respiratory disease. Cochrane Database Syst Rev. 2015;(9):CD011423.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSteinke EE, Jaarsma T, Barnason SA, et al. Sexual counseling for patients with chronic illness. Circulation. 2013;128(18):2075\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMick J, Hughes M, Cohen MZ. Sexuality and chronic illness. Oncol Nurs Forum. 2004;31(4):807\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaptein AA, van Klink RCJ, de Jong YP, et al. Sexuality in patients with chronic obstructive pulmonary disease. Respir Med. 2008;102(2):198\u0026ndash;204.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoutou AK, Stanopoulos I, Pitsiou G, et al. Sexual dysfunction in COPD and its association with quality of life. Respir Care. 2013;58(1):87\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarnes PJ, Celli BR. Systemic manifestations and comorbidities of COPD. Eur Respir J. 2009;33(5):1165\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYohannes AM, Willgoss TG, Baldwin RC, Connolly MJ. Depression and anxiety in COPD. Int J Geriatr Psychiatry. 2010;25(5):458\u0026ndash;68.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePitta F, Troosters T, Probst VS, et al. Physical activity and sexual activity in COPD patients. Respir Med. 2006;100(11):2072\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchouten BW, Bohnen AM, Bosch JLHR, et al. Erectile dysfunction and respiratory disease. J Sex Med. 2008;5(12):2875\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgust\u0026iacute; A, Soriano JB. COPD as a systemic disease. Lancet. 2008;371(9621):725\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFabbri LM, Luppi F, Beghe B, Rabe KF. Complex chronic comorbidities of COPD. Eur Respir J. 2008;31(1):204\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSteinke EE, Jaarsma T, Barnason SA, et al. Sexual counseling for patients with chronic illness. Circulation. 2013;128(18):2075\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVlachopoulos C, Jackson G, Stefanadis C, Montorsi P. Erectile dysfunction in cardiovascular disease. Eur Heart J. 2013;34(27):2034\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFlynn KE, Lin L, Bruner DW, et al. Sexual satisfaction and the importance of sexual health to quality of life. Qual Life Res. 2016;25(3):637\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKahraman H, Sen B, Koksal N, Kilic S, Resim S. Erectile dysfunction and COPD. Int J Impot Res. 2013;25(4):151\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePitta F, Troosters T, Spruit MA, et al. Physical activity and sexual health in COPD. Respir Med. 2006;100:2072\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLevack WM, Poot B, Weatherall M, Travers J. Interventions for sexual dysfunction in chronic respiratory disease. Cochrane Database Syst Rev. 2015;(9):CD011423.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiravitlles M, Ribera A. Understanding the impact of symptoms on quality of life in COPD. Int J Chron Obstruct Pulmon Dis. 2017;12:267\u0026ndash;77.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJones PW. Health status measurement in chronic obstructive pulmonary disease. Thorax. 2001;56(11):880\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Chronic obstructive pulmonary disease, Sexual dysfunction, quality of life, meta-analysis, systematic review","lastPublishedDoi":"10.21203/rs.3.rs-8813265/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8813265/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChronic obstructive pulmonary disease (COPD) is a progressive lung disease and is associated with numerous systemic comorbid conditions. \u003cstrong\u003eS\u003c/strong\u003eexual dysfunction is one of these conditions that is often not recognized but can affect the quality of life significantly in patients with COPD.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis systematic review and meta-analysis aims to assess the prevalence of sexual dysfunction and its association with quality of life among patients suffering with Chronic obstructive pulmonary disease.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIt was a systematic review and a meta-analysis where published data from January 1, 2000 to December 31, 2025 were included. We used a randomized effects model and a standardized mean difference. We also used I² statistical tests and funnel plots to look for heterogeneity and publication bias.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf all the 1,982 published works, only twelve studies, including 1,191 patients with COPD, were addressed in this investigation. Sexual dysfunction had been revealed to have an important prevalence among male patients suffering from severe COPD, estimated at 56.2% (95% CI 52.1, 60.3). A relationship between sexual dysfunction and quality of life had been established, estimated at a standardized mean difference of -0.74 (95% CI: -0.96, -0.52; p \u0026lt; 0.001). Subgroup analysis also revealed that sexual dysfunction significantly associated with quality of life in all genders, levels of severity of disease and different geographic areas.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study reveals that sexual dysfunction is most common among patients with COPD. Researchers have observed a significant association between sexual dysfunction and decreased quality of life. Sexual dysfunction is a major concern for these patients. Further research is needed to establish the causality of sexual dysfunction in individuals with Chronic obstructive pulmonary disease.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRegistered platform: PROSPERO\u003c/p\u003e\n\u003cp\u003eRegistration ID: CRD420261278399.\u003c/p\u003e\n\u003cp\u003eRegistration Date: 06 January 2026.\u003c/p\u003e","manuscriptTitle":"Sextual Dysfunction and Quality of Life in Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-03 14:55:48","doi":"10.21203/rs.3.rs-8813265/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-11T13:59:49+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-19T13:38:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-18T14:07:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"178978854226306011874956036245468915941","date":"2026-03-10T06:30:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"146790127553092430510947410198467711953","date":"2026-03-09T15:36:26+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-09T07:34:39+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-09T17:41:12+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-07T14:46:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-07T14:45:42+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pulmonary Medicine","date":"2026-02-07T07:16:34+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bfbba915-b4b0-4732-9c78-fa9f1f58b6f4","owner":[],"postedDate":"March 3rd, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-11T13:59:49+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-11T14:10:04+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-03 14:55:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8813265","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8813265","identity":"rs-8813265","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}