Body image disturbances in women of childbearing age with polycystic ovary syndrome: a cross-sectional study.

A total of 352 women initially met the eligibility criteria for this study. However, 19 (5.40%) were excluded due to missing data in BIDQ and SIRRS. Consequently, 333 married women were ultimately included in the analysis. In this study, the median score of body image disturbance was 12 points, ranging from 0 to 45 points. The average age of these women was 28.70 ± 3.50 years. Among them, 57 (17.12%) were housewives or unemployed. Significant variations in BID were observed among women in different occupational groups ( p  = 0.028).In addition, 71 ( 21.32% ) participants had no more than 12 years of education. In the univariate analysis of BID among patients with PCOS, variables such as education years and economic status demonstrated no significance( p  > 0.05 ). However, there were significant differences in the scores of body image disturbances among different occupations, BMI, menstrual disturbances, family history ( mother ), hair loss, acne and hirsutism ( p  < 0.05). The higher the BMI index, the more serious the body image disturbance. Bonferroni multiple mean comparison results show that, BMI ≥ 28 was significantly different from BMI 18.5–23.9 in terms of severity of body image impairment ( p  < 0.05). Workers have a higher BIDQ than Individual businesses( p  < 0.05). Those with Mild and Moderate hair loss had a higher BIDQ than those without hair loss( p  < 0.05). BIDQ with extremely mild, mild, moderate, and severe acne was found to be higher than those without acne( p  < 0.05) (Table  1 ). Table 1 Demographic and clinical information data ( n  = 333) Variable n (%) BIDQ M( P 25 , P 75 ) H/Z p Age, years -1.521 0.128 <35 311(93.39) 13.00(8.00,17.00) ≥ 35 22(6.61) 10.00(6.00,16.00) Occupation 10.915 0.028 Business or Service personnel 140(42.40) 12.00 (8.00,17.75) Enterprises and institutions 51(15.31) 14.00 (9.00,18.00) Individual businesses 63(18.92) 14.00 (10.00,19.00) Workers 22(6.61) 8.00 (5.75,14.25) Housewives or Unemployed 57(17.12) 11.00 (6.00,16.50) Years of education, years 1.196 0.550 ≤ 12 71 (21.32) 12.00 (8.00,16.50) 13 ~ 15 132 (39.64) 12.00 (7.00,18.00) ≥ 16 130 (39.04) 13.00 (9.00,17.00) Household income, RMB/month 3.285 0.511  10,000 27(8.11) 13.00 (9.50,15.00) BMI, kg/m2 15.273 0.002 <18.5 14 (4.20) 12.00 (8.00,17.00) 18.5 ~ 23.9 131 (39.34) 10.00 (7.00,15.00) 24 ~ 27.9 103 (30.93) 13.00 (8.00,18.50) ≥ 28 85 (25.53) 15.00 (11.00,19.00) Menstrual disturbances 2.700 0.007 Yes 244(73.27) 13.00(9.00,18.00) No 89(26.73) 10.00(6.00,17.00) Family history 2.240 0.025 (mother) Yes 77(23.12) 14.00(11.00,18.00) No 256(76.88) 12.00(8.00,17.00) Hair loss 35.904 <0.001 No 136(40.84) 10.00 (6.00,14.50) Mild 167(50.15) 14.00 (10.00,18.00) Moderate 26 (7.81) 17.00 (11.00,24.00) Severe 4 (1.20) 18.00 (14.00,23.50) Acne 92.317 <0.001 No 151(45.35) 9.00 (6.00,14.00) extremely mild 121(36.34) 13.00 (10.00,18.00) Mild 38(11.41) 17.00 (15.00,25.00) Moderate 17(5.10) 26.00 (19.00,31.00) Severe 6(1.80) 31.00 (29.00,38.00) Hirsutism 4.797 <0.001 Yes 147(44.14) 15.00 (10.00,21.50) No 186(55.86) 11.00 (6.00,16.00) Note The body image disorder score is non-normal distribution, using non-parametric test. Bonferroni multiple mean comparison results show that, BMI ≥ 28 was significantly different from BMI 18.5–23.9 in terms of severity of body image impairment ( p  < 0.05). Workers have a higher BIDQ than Individual businesses( p  < 0.05). Those with Mild and Moderate hair loss had a higher BIDQ than those without hair loss( p  < 0.05). BIDQ with extremely mild, mild, moderate, and severe acne was found to be higher than those without acne( p  < 0.05) Demographic and clinical information data ( n  = 333) Note The body image disorder score is non-normal distribution, using non-parametric test. Bonferroni multiple mean comparison results show that, BMI ≥ 28 was significantly different from BMI 18.5–23.9 in terms of severity of body image impairment ( p  < 0.05). Workers have a higher BIDQ than Individual businesses( p  < 0.05). Those with Mild and Moderate hair loss had a higher BIDQ than those without hair loss( p  < 0.05). BIDQ with extremely mild, mild, moderate, and severe acne was found to be higher than those without acne( p  < 0.05) In univariate analysis of BID among patients with PCOS, no significance was observed for biochemical blood indicators (follicle stimulating hormone, luteinizing hormone, estrogen, prolactin, total testosterone, and fasting blood glucose)( p  > 0.05 )(Table  2 ; Figure 1 ). Table 2 Univariate analysis of biochemical indexes and BID Variable n (%) BID M( P 25 , P 75 ) Z P Follicle stimulating hormone, mIU/ml 3.016 0.221  ≤ 5.26 83 (24.92) 13.00 (8.00,17.00)  5.27 ~ 7.34 167 (50.16) 12.00 (8.00,17.00)  >7.34 83 (24.92) 12.00 (10.00,19.00) Luteinizing hormone, mIU/ml 2.117 0.347  ≤ 4.27 83 (24.92) 11.00 (6.50,17.00)  4.28 ~ 10 167 (50.16) 12.00 (8.00,17.00)  >10 83 (24.92) 13.00 (8.00,19.00) Estrogen, pg/ml 1.325 0.516  ≤ 25.06 83 (24.92) 11.00 (8.00,18.00)  25.07 ~ 40.51 168 (50.45) 12.00 (8.00,17.00)  >40.51 82 (24.63) 14.00 (8.00,17.00) Prolactin, mIU/L 1.628 0.443  ≤ 195.52 84 (25.23) 12.50 (8.00,17.00)  195.53 ~ 367.38 166 (49.85) 13.00 (8.00,18.00)  >367.38 83 (24.92) 12.00 (8.00,16.50) Total testosterone, ng/ml 3.002 0.223  ≤ 0.4 97 (29.13) 11.00 (8.00,17.00)  0.41 ~ 0.7 165 (49.55) 12.00 (8.00,17.00)  >0.7 71 (21.32) 14.00 (8.50,18.00) Fasting blood glucose, mmol/L 5.224 0.073  ≤ 4.9 84 (25.23) 11.00 (7.00,16.00)  4.91 ~ 5.79 163(48.95) 14.00 (9.00,17.50)  >5.79 86 (25.82) 12.00 (8.00,18.00) Note The body image disorder score is non-normal distribution, using non-parametric test. Hormone grouping was divided into three groups according to the interquartile range of hormone concentration P25 and P75 Univariate analysis of biochemical indexes and BID Note The body image disorder score is non-normal distribution, using non-parametric test. Hormone grouping was divided into three groups according to the interquartile range of hormone concentration P25 and P75 Fig. 1 Univariate analysis of biochemical indexes and BIDQ. Note: * P  < 0.05, ** P  < 0.01, *** P  < 0.001. FSH: Follicle stimulating hormone, mIU/ml, LH: Luteinizing hormone, mIU/ml, E2:Estrogen, pg/ml, PRL: Prolactin, mIU/L, T:Total testosterone, ng/ml, FBG: Fasting blood glucose, mmol/L Univariate analysis of biochemical indexes and BIDQ. Note: * P  < 0.05, ** P  < 0.01, *** P  < 0.001. FSH: Follicle stimulating hormone, mIU/ml, LH: Luteinizing hormone, mIU/ml, E2:Estrogen, pg/ml, PRL: Prolactin, mIU/L, T:Total testosterone, ng/ml, FBG: Fasting blood glucose, mmol/L A univariate analysis explored the relationship between exercise, diet, family care, psychological resilience, and BID. The results indicated a significant correlation between family care and psychological resilience ( p   0.05 ) (Table  3 ; Figure 2 ). Table 3 Univariate analysis of exercise, diet, family care, and psychological resilience with BID Variable n (%) BID M( P 25 , P 75 ) Z p Exercise 0.430 0.807  Basically no movement 205(61.56) 12.50(8.00,18.00)  Moderate exercise 126(37.84) 12.50(8.00,17.00)  Love sports 2(0.60) 13.50(12.00,15.00) Diet 1.586 0.453  Meat-based food 71(21.32) 13.00(8.00,18.50)  Vegetarian-based 71(21.32) 12.00(8.50,16.50)  Half meat, half meat 191(57.36) 12.00(7.00,17.00) Score of Family Apgar Index 17.786 <0.001  Good: 7 ~ 10 186(55.86) 12.00(7.00,17.00)  Moderate: 4 ~ 6 131(39.34) 12.00(8.00,17.50)  Severe: 0 ~ 3 16(4.80) 24.50(16.50,31.00) Psychological resilience level 19.386 <0.001  Poor: ≤ 60 236(70.87) 13.00(8.00,18.00)  General: 61 ~ 69 51(15.32) 14.00(9.00,17.00)  Good: 70 ~ 79 25(7.51) 11.00(8.00,14.00)  Excellent: ≥ 80 21(6.30) 6.00(3.00,10.00) Note The body image disorder score is non-normal distribution, using non-parametric test Univariate analysis of exercise, diet, family care, and psychological resilience with BID Note The body image disorder score is non-normal distribution, using non-parametric test Fig. 2 Univariate analysis of exercise, diet, family care, and psychological resilience with BIDQ. Note: * P  < 0.05, ** P  < 0.01, *** P  < 0.001 Univariate analysis of exercise, diet, family care, and psychological resilience with BIDQ. Note: * P  < 0.05, ** P  < 0.01, *** P  < 0.001 Through analysis, it was found that sleep and intimate relationship were risk factors for body image disturbance ( p  < 0.05 ). “Extroversion” and “Lie” for the personality-trait scale: all exhibited associations with BID ( p  < 0.05) (Tables  4 and 5 ; Figs.  3 and 4 ). Table 4 Correlation between sleep, intimate relationship and BID Variable n (%) BID M( P 25 , P 75 ) Z P Total sleep score 6.827 0.033  ≤ 4 107 (32.13) 12.00 (7.00,16.00)  5 ~ 8 163 (48.95) 12.00 (8.00,17.50)  >8 63 (18.92) 15.00 (9.00,19.50) Total score of intimacy 9.501 0.009  ≤ 45 86 (25.83) 14.00 (9.00,25.00)  46 ~ 70 165 (49.55) 12.00 (8.00,17.00)  >70 82 (24.62) 12.00 (8.00,16.00) Note The body image disorder score is non-normal distribution, using non-parametric test. Sleep quality score and intimate relationship support score were divided into three groups according to quartile spacing P 25 and P 75 for analysis Correlation between sleep, intimate relationship and BID Note The body image disorder score is non-normal distribution, using non-parametric test. Sleep quality score and intimate relationship support score were divided into three groups according to quartile spacing P 25 and P 75 for analysis Table 5 Correlation between personality traits and BID note the body image disorder score is non-normal distribution, using non-parametric test. According to the scores of each dimension of Eysenck, it can be divided into three groups: the score of 43.3–56.7 is intermediate, indicating that the personality is not Obvious; the scores of 38.5–43.3 and 56.7–61.5 were tendentious; the typical type was scored below 38.5 and above 61.5 Variable n (%) BID M( P 25 , P 75 ) Z P Psychoticism-P 0.377 0.828 Intermediate type 140 (42.04) 12.00 (8.00,17.00) Tendency type 125 (37.54) 12.00 (7.00,17.00) Typical type 68 (20.42) 13.00 (8.00,18.00) Extrovi-sion-E 6.007 0.050 Intermediate type 140 (42.04) 13.00 (9.00,18.00) Tendency type 67 (20.12) 15.00 (8.50,18.00) Typical type 126 (37.84) 11.00 (8.00,15.00) Neuroticism -N 0.035 0.982 Intermediate type 122 (36.64) 12.50 (8.00,17.00) Tendency type 70 (21.02) 12.00 (7.00,18.00) Typical type 141 (42.34) 12.00 (8.00,17.00) Lie-L 6.883 0.032 Intermediate type 158 (47.45) 12.00 (8.00,17.00) Tendency type 67 (20.12) 14.00(11.50,19.00) Typical type 108 (32.43) 11.50 (7.50,16.50) Correlation between personality traits and BID note the body image disorder score is non-normal distribution, using non-parametric test. According to the scores of each dimension of Eysenck, it can be divided into three groups: the score of 43.3–56.7 is intermediate, indicating that the personality is not Obvious; the scores of 38.5–43.3 and 56.7–61.5 were tendentious; the typical type was scored below 38.5 and above 61.5 Fig. 3 Correlation between sleep, intimate relationship and BIDQ. Note: * P  < 0.05, ** P  < 0.01, *** P  < 0.001 Correlation between sleep, intimate relationship and BIDQ. Note: * P  < 0.05, ** P  < 0.01, *** P  < 0.001 Fig. 4 Correlation between personality traits and BIDQ Correlation between personality traits and BIDQ A generalized linear model was employed to explore the association between BID scores and various risk factors among childbearing-age patients diagnosed with PCOS. The model encompassed occupation, acne, hair loss, hirsutism, BMI, family history, menstrual disturbance, “Extroversion”-E, “Lie”-L, sleep, intimate relationships, family care, and resilience. The results showed that occupation, BMI, hair loss, acne, hirsutism, intimacy, family care and resilience were risk factors for body image disturbance ( p  < 0.05) (Table  6 ). Table 6 Generalized linear model analysis of influencing factors affecting the BIDQ of women with PCOS Variable β SE 95% confidence interval Wald χ2 P Lower limit upper limit (Intercept) 9.432 2.302 4.921 13.944 16.791 <0.001 Occupation  Housewives or Unemployed -1.343 0.896 -3.099 0.414 2.244 0.134  Workers -3.261 1.322 -5.851 -0.670 6.086 0.014  Individual businesses 0.379 0.870 -1.325 2.084 0.190 0.663  Enterprises and institutions 0.282 0.933 -1.547 2.110 0.091 0.763  Business or Service personnel Reference - - - - - Acne  Severe 17.747 2.431 12.983 22.512 53.294 <0.001  Moderate 11.410 1.615 8.244 14.576 49.899 <0.001  Mild 6.324 1.072 4.223 8.424 34.809 <0.001  Extremely mild 2.575 0.737 1.131 4.019 12.219 <0.001  No Reference - - - - - BMI  Obesity 3.511 1.668 0.241 6.780 4.430 0.035  Overweight 2.663 1.666 -0.603 5.929 2.554 0.110  Normal 1.079 1.628 -2.112 4.270 0.439 0.507  Slender Reference - - - - - Hair loss  Severe 4.930 2.942 -0.837 10.697 2.807 0.094  Moderate 3.053 1.313 0.480 5.627 5.407 0.020  Mild 1.800 0.713 0.404 3.196 6.382 0.012  No Reference - - - - - Hirsutism  Yes 2.066 0.670 0.752 3.380 9.493 0.002  No Reference - - - - - Intimacy -0.053 0.019 -0.089 -0.016 8.084 0.004 Family care  Severe 5.455 1.614 2.291 8.619 11.419 0.001  Moderate -0.026 0.685 -1.369 1.316 0.001 0.969  Good Reference - - - - - Psychological resilience  Excellent -3.164 1.345 -5.799 -0.529 5.538 0.019  Good -1.756 1.247 -4.199 0.687 1.985 0.159  General 0.672 0.914 -1.119 2.462 0.541 0.462  Poor Reference - - - - - Generalized linear model analysis of influencing factors affecting the BIDQ of women with PCOS

In this cross-sectional survey, using a convenient sampling method, we recruited women of childbearing age diagnosed with PCOS from the reproductive center of three tertiary hospitals in Jiangsu Province between December 2022-June 2023. According to the sample survey, the sample size was determined according to the scale of outcome indicators, and the calculation formula: n= (Z 1−α/2  × σ/δ) 2 [ 21 ]. Training was provided to data collectors to ensure the accuracy and consistency of data collection. Data for this study were collected through an online platform. The study involved women seeking fertility assistance in the outpatient department of the reproductive medicine center two hours after treatment. Ethical approval for this study was obtained from the Ethics Committee of the Affiliated Hospital of Nantong University (2022-K066-01), and the study has been registered in the Chinese Clinical Trial Registry ( https://www.chictr.org.cn/ ) on December 19,2022 (ChiCTR2200066814). Inclusion and exclusion criteria: We recruited women between 20 and 49 years, typically considered the childbearing age range for women [ 22 ].The inclusion criteria were as follows: (1) Diagnosis of PCOS based on the Guidelines of the Diagnosis and Treatment of PCOS (endorsed by the endocrinology group and guideline expert group of the Chinese Medical Association Obstetrics and Gynecology Branch, 2018]) [ 23 ]. (2) Married women with a desire for fertility. Exclusion criteria were: (1) Women with severe cognitive impairment, malignant tumors, mental illness, or an inability to comprehend the questionnaire content; (2) BI alterations resulting from accidents (such as car accidents and accidental injuries), developmental malformations, and other diseases that might cause BID (such as rheumatoid arthritis and systemic lupus erythematosus); (3) Women with other medical diseases affecting fertility (such as endometriosis, hyperthyroidism, and type 2 diabetes); (4) Spouse infertility; or (5) Other medical conditions leading to BID (such as Cushing’s syndrome, non-classical congenital adrenal hyperplasia, and ovarian or adrenal androgen-secreting tumors). The Body image disturbance questionnaire (BIDQ) was employed to evaluate the BID of patients. This scale exhibited good reliability and validity, with a Content Validity Index (CVI) of 0.915 and a Cronbach’s α coefficient of 0.87. Each item yielded a Cronbach’s α coefficient ranging from 0.73 to 0.89. The scale comprises seven items, encompassing aspects such as the level of attention drawn to one’s appearance, the necessity for behavioral interventions (such as dressing), the distress stemming from BI, the social and occupational problems arising from BI, the impact of BI on social life, its influence on learning, work or other role functions, and avoidance behavior prompted by BI concerns. Each item is scored on a scale from zero to eight, with higher scores indicating more severe BID [ 24 ]. In this study, we determined the influencing factors from three levels: microsystem, mesosystem, and macrosystem based on the framework of social-ecological system theory [ 25 ]. Among them, the microsystem consists of personal characteristics and personal behaviors, including age, years of education, clinical manifestations of polycystic ovary syndrome (obesity, acne, hirsutism, menstrual disturbances), exercise, etc.; the mesosystem consists of the network of family environments, including family care and intimate relationship; and the macrosystem consists of social environmental factors, such as the area of residence and the form of health insurance. Based on this theory, relevant information was collected and the patients filled in the questionnaire by themselves, including age, occupation, years of education, household income, marital status, place of residence, and fertility requirements. Medical professionals assessed the clinical manifestations of PCOS, including obesity, infertility, acne, hirsutism, and menstrual disturbances. Data obtained by the healthcare professional in the hospital medical record system included duration of disease, treatment regimen, past history, family history, and relevant biochemical markers (follicle stimulating hormone, luteinizing hormone, prolactin, estrogen, total testosterone, fasting blood glucose). For this study, body mass index (BMI) criteria were defined as follows:  28 kg/m 2 as obesity [ 26 ]. Acne was evaluated using Pillsbury grading method, with scores assigned as follows: No acne: ‘0’ points; mild acne (acne > 2 mm, face or torso  20 or presence of pus with  20 acne): ‘4’ points; inflammatory lesions > 5 mm or cystic): ‘5’ points [ 27 ]. Menstrual disturbances: Normal menstrual cycle parameters were defined as follows: a cycle of 28 days, range: 21–35 d; menstrual period lasting 3–7 d; and the menstrual ranging from 5 to 80 mL; periodic regularity < 7 days. Any deviations from these ranges were considered menstrual disturbances characterized by abnormal vaginal bleeding [ 28 ]. Categorization of hair loss assessment [ 29 ]: no hair loss: daily hair loss of < 30 strands; mild hair loss: daily hair loss between 30 and 60 strands; moderate hair loss: daily hair loss between 60 and 100 strands; severe hair loss: ≥100 strands. Physical activity levels were divided into three categories [ 30 ]: (a) Basically no exercise: referring to routine daily activities and work, without additional physical activities, such as running, playing, swimming, or > 30 min of daily walking or other sports activities; (b) Moderate exercise: in addition to daily activities and work, > 30 min of daily walking or occasional participation in activities such as playing, running, or climbing; (c) Active in sports: referring to regular engagement in activities such as running, playing sports, swimming, and related activities. Dietary habits were classified into three levels [ 31 ]: (a) Meat-based: Dietary fat and protein accounted for ≥ 60% of the diet, with fruits and vegetables accounting for ≤40%; (b) Primarily Vegetarian: Fruits and vegetables constituted ≥ 60% of the diet, whereas fat and protein accounted for ≤40%; (c) Half meat: Approximately 50% of dietary fat and protein, combined with an equal portion of fruits and vegetables. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. This index evaluates sleep quality over the past month, comprising seven domains: subjective sleep quality, sleep duration, sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction. The overall score ranges from 0 to 21, with higher scores indicating poorer sleep quality. The Cronbach’s α coefficient for the scale was 0.783 [ 32 ]. The Eysenck Personality Questionnaire-Revised Short Scale for Chinese (EPQ-RSC) was used to measure personality traits, featuring four subscales: P (Psychoticism), E (Extraversion), N (Neuroticism), and L (Lie). The scale demonstrated good internal consistency, with a Cronbach’s α coefficient of 0.83. It comprised 48 items, with 12 allocated to each of the four dimensions. Normative data included both genders and categorized age into seven intervals: 16–19 years, 20–29 years, 30–39 years, 40–49 years, 50–59 years, 60–69 years, and > 70 years [ 33 ]. The total scores of the four scales were calculated using standardized T scores, considering age and gender norms. The formula for calculating the T score was = 50 + 10 * (the subject’s original score - the group’s average score) / standard deviation of the group’s score. Each scale had conversion scores ranging from 0 to 100 points. Based on the T score for each scale, the subjects’ personality type could be classified as follows: Intermediate type: T score between 43.3 and 56.7, indicating a less pronounced personality; Tendency type: T score between 38.5 and 43.3, or between 56.7 and 61.5; Typical type: T score  61.5. Spouse intimacy was measured using the Intimate Relationship Rating Scale (SIRRS), comprising 25 items across four dimensions: emotional support, information support, tangible support, and physical comfort. Higher scores on the scale indicate heightened perceived support from one’s spouse. Internal consistency coefficients for the four dimensions of the SIRRS ranged from 0.86 to 0.92 [ 34 ]. The Family Apgar Index (APGAR) was employed to assess the subjective satisfaction of family members regarding family function. This index comprises five dimensions: family fitness, cooperation, growth, emotion, and intimacy. The Cronbach’s α coefficient for this scale was 0.865 [ 35 ]. Psychological resilience was assessed using the Connor-Davidson resilience scale (CD-RISC), consisting of tenacity, self-reliance, and optimism. The ranking includes 25 items, with lower scores indicating lower levels of psychological resilience. The internal consistency coefficient was 0.92 [ 36 ]. Following data collection, all collected questionnaires were thoroughly checked for completeness and internal consistency to exclude missing or inconsistent data. Subsequently, the data were entered and analyzed using IBM SPSS for Windows version 26.0. Normally distributed continuous variables were presented as mean and standard deviation. Non-normal information was described using medians and quartiles, and in one-way analysis of variance, the Mann-Whitney U test was used for comparison of two independent samples, and the Kruskal-Wallis H test was used for multiple independent samples. Body image disturbances were non-normally distributed data, and generalized linear models were used to explore the correlations between occupation, acne, BMI, menstrual disturbances, family history of PCOS, hair loss, hirsutism, PSQI, EPQ-RSC, SIRRS, APGAR, CD-RISC, and BIDQ. Furthermore, influencing factors with a p -value of ≤ 0.05 in the univariate analysis were included in the generalized linear model to investigate factors affecting the BID of women with PCOS.

This study used the multi-center convenient sampling method to introduce the relevant content of body image disorder into the investigation study of PCOS patients of childbearing age in China, paying a comprehensive and systematic attention to the influencing factors of body image disorder in PCOS patients of childbearing age. Our study identified several factors positively associated with body image disturbance (BIDQ) in PCOS patients. These factors included occupation, acne, hair loss, hirsutism, BMI, family history, menstrual disturbances, personality traits, sleep, intimate relationship, family care and psychological resilience. Among these factors, occupation, BMI, acne, hair loss, hirsutism, intimate relationship, family care and resilience were included in the regression equation model of the influencing factors for BID. These findings highlight the importance of recognizing and addressing the BI concerns of patients with PCOS, particularly among obstetrics and gynecology medical professionals. Additionally, our results provide a foundation for developing targeted interventions to promote the physical and mental well-being of women with PCOS during their childbearing years.

The significance of BI among women with PCOS has been steadily increasing (( 37 – 38 ). To the best of our knowledge, this study represents a rare instance where BIDQ measures have been utilized to assess BID. Our findings revealed that BIDQ is affected by patients’ physiological, psychological and social aspects. Occupation, BMI, hair loss, acne, hirsutism, intimate relationships, family care and psychological resilience were significant predictors of BID. In terms of physiological factors, BIDQ was significantly associated with hair loss, acne, hirsutism, and BMI. PCOS often causes changes in external symptoms of the body due to endocrine disturbances (( 39 – 40 ). Our investigation highlights that hair loss, acne, and hirsutism influence the BI. Those with Mild and Moderate hair loss had a higher BIDQ than those without hair loss( p  < 0.05). BIDQ with extremely mild, mild, moderate, and severe acne was found to be higher than those without acne( p  < 0.05). This phenomenon could be attributed to women with PCOS frequently perceiving a misalignment between their BI and societal aesthetic standards, impacting their overall well-being. Our findings align with the results reported by Behboodi, M.Z. et al. [ 11 , 41 ]. Therefore, medical staff need to carefully observe and comprehensively evaluate the explicit symptoms of PCOS patients, in order to better understand the physical and mental status of patients, and to develop targeted treatment programs to improve the overall health of patients, in order to promote their comprehensive health. Besides, contemporary society places a pervasive emphasis on being “thin and beautiful.” This emphasis has been shown to induce body dissatisfaction in patients with PCOS, with BMI emerging as a significant factor [ 42 ], management of BMI is the key to the treatment of PCOS [ 43 ]. Women who are obese are particularly vulnerable to experiencing appearance-related anxiety, which can precipitate psychological challenges and social barriers [ 44 ].Our study unveiled a specific correlation between BMI and BID. The higher the BMI index, the more serious the body image disturbance. The degree of body image disturbance in BMI ≥ 28 was more serious than that in BMI 18.5 ~ 23.9, and the difference was significant ( p <0.05 ).Obesity leads to a decline in self-esteem and a negative BI, leading to psychological distress among women with PCOS. Therefore, vigilance regarding their BMI is paramount in treating patients with PCOS. In terms of psychological factors, the exacerbations of symptoms associated with PCOS exert detrimental effects on patients’ psychological well-being [ 45 – 48 ]. Our study found that there is a significant correlation between psychological resilience and body image disturbance. The lower the level of psychological resilience, the longer the body image obstacle. High levels of stability could empower individuals with PCOS to effectively manage stress, anxiety, depression, and other negative emotions constructively and optimistically [ 49 ]. Therefore, we should pay attention to the impact of psychological resilience on patients' physical and mental health, and take multi-level and multi-level preventive measures to improve their psychological resilience level and improve patients' mental health status, so as to improve patients' satisfaction with body image disturbance. In addition, personality is an integration of internal tendencies and psychological traits that influence an individual’s behavior in the process of social adaptation. A one-way analysis of factors revealed a correlation between personality with tendencies toward Extrovi-sion-E and Lie-L and body image disturbances. This may be related to traits such as extroversion, sociability, desire for excitement, risk-taking, and showing maturity and composure through masking. Individuals who are introverted, reserved and tend to hide their inner feelings are more likely to experience body image dissatisfaction and anxiety due to over-scrutinization and thus fall into body image disturbance [ 50 ]. Although the statistical correlation between personality and body image disturbance was not significant at the time of multifactorial analysis, it may be a factor that influences body image disturbance and deserves the attention of clinical healthcare professionals. In Chinese social culture, infertility may cause patients to suffer from family and social discrimination, resulting in feelings of exclusion and isolation. This interaction forms a vicious circle. Related studies have pointed out that family support is essential for the rehabilitation of patients [ 51 ]. In this study, it was found that spouse intimacy and family care were the potential influencing factors of body image disturbance. For women with fertility requirements, their self-esteem tends to be diminished, and they harbor heightened fears of negative evaluations of their appearance. The burden of this disturbance could directly influence the quality of intimate relationship, posing significant risks to the physical and mental well-being of both partners, thereby adversely impacting family harmony (( 52 – 53 ). Consequently, family and spousal support is crucial for patients with PCOS [ 51 ]. Family members should pay attention to creating a good family environment to alleviate the excessive attention of PCOS patients to body image disturbances. Peer understanding and positive emotional support from family members can help patients relax, and timely psychological guidance can help patients effectively relieve stress and continuously improve their self-emotional management ability. Moreover, our study found that different occupations may also contribute to body image disturbances in women with PCOS of childbearing age. Long-term infertility may lead to increasing medical costs and treatment time, bring a heavy burden to the family, and have a serious impact on the career of the patient, forming a vicious circle. In this case, body image impairment was more significant. The results were consistent with those of T. Jannink [ 54 ]. A study from Portugal [ 55 ] also pointed out that unemployment may be more likely to lead to the appearance of body image disturbances. Nowadays, with the improvement of women’s social status and the intensification of social competition, women not only need to deal with family affairs, but also need to bear more social responsibility and economic pressure, which increases their psychological and spiritual pressure. PCOS patients need frequent offline visits, and the nature of work may have different effects on them. Medical professionals should take a variety of measures when managing PCOS patients of childbearing age with fertility needs, and pay attention to the patient ‘s body image from the physiological, psychological and social levels. First, adjust lifestyle through personalized health management plans, such as improving diet, increasing exercise, and regular work and rest to control weight and improve endocrine function and reduce explicit symptoms. At the same time, regular monitoring of physiological indicators and adjustment of management to prevent complications. At the psychological level, psychological support and counseling, such as cognitive behavioral therapy, relaxation training and stress management strategies, are provided to alleviate negative emotions. Encourage patients to participate in support groups and mental health education to improve self-regulation. In addition, medical professionals can comprehensively popularize the etiology, symptoms, diagnosis and treatment of PCOS to patients and their families by organizing educational activities and health lectures, and provide professional guidance in nutrition, exercise, and drug treatment to improve their awareness of PCOS and strengthen their awareness of health management. At the same time, medical professionals should actively promote communication and communication between patients and family members, and build a family support system full of warmth, understanding and support. Such support not only helps patients’ mental health, but also enhances their courage and self-confidence in facing challenges and improves their ability to resist setbacks. Several factors could constrain the generalizability of the study’s findings. In clinical work, medical professionals should also pay attention to the influencing factors such as sleep and personality of such patients. Although these variables are not statistically correlated with body image disturbances in multivariate analysis, clinical experience suggests that these may be factors affecting body image disturbances. There may be more factors that influence BIDQ, and in future studies, more factors such as anxiety, depression, and sexual satisfaction will be included to analyze their correlation with BIDQ. It is essential to acknowledge that the small sample size might not have fully represented the broader PCOS population. Therefore, additional research is required to explore the BI experiences of women with PCOS. Moreover, the subjective nature of BI measurement could affect the accuracy of the results. At last, different factors affecting body image may occur in different populations, further studies are needed in different communities of women.

Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism, anovulation, and polycystic ovary morphology [ 1 ]. Despite extensive research, the precise cause of PCOS remains elusive, although it is hypothesized to result from a complex interplay between genetic and environmental factors [ 2 ]. PCOS profoundly impacts women’s reproductive and metabolic health in their childbearing years [ 3 ], leading to endocrine and metabolic disturbances [ 4 ]. According to the National Institutes of Health, PCOS affects approximately 5 million women worldwide, with a global incidence rate of 4–8% [ 5 ], rendering it a significant public health concern. The primary clinical manifestations of PCOS are attributed to excessive androgen production, leading to anovulation, polycystic ovary morphology, irregular or absent menstrual cycles, acne, and hirsutism. Secondary manifestations encompass various metabolic, cardiovascular, and psychological disturbances [ 6 ].PCOS is one of the most common causes of female infertility, affecting approximately 50–70% of patients with anovulatory infertility [ 7 ].PCOS often causes psychological, life, family, and social distress to married women, which in turn exacerbates negative perceptions of self-body image [ 8 ].Patients with PCOS frequently require long-term modifications to their lifestyle, dietary habits, exercise routines, medication use, and psychological well-being. However, there are currently no effective and safe treatments available to comprehensively address all the pathological symptoms of PCOS [ 9 ]. Changes in PCOS related symptoms could significantly impact body image satisfaction [ 10 – 13 ]. Body image (BI) pertains to an individual’s perception and thoughts regarding their physical appearance and body’s functional state [ 14 ]. It constitutes a complex and multidimensional concept that evolves throughout one’s lifespan, shaped by self-perception, emotions, and social and cultural factors, including aesthetics, public opinion, and media influence [ 15 ]. BI encompasses two crucial elements: the assessment of self-standards and an individual’s perception of their body at a given moment. Deviations in either of these assessments could lead to BI disturbances, termed body image disturbances (BID) [ 16 ]. Adverse perceptions of BI frequently encompass dissatisfaction with one’s appearance, diminished femininity, reduced sexual attractiveness, and the adoption of unhealthy behaviors. Furthermore, it serves as a predictor of anxiety and depression [ 17 ]. Present research on BI predominantly concentrates on specific populations, such as patients with cancer, adolescents, obese children, menopausal women, individuals affected by COVID-19, those with mental health conditions, pregnant/lactating mothers, and individuals with endocrine disturbances [ 18 ]. Limited studies have explored BID in women with PCOS. Research has indicated that Chinese women might exhibit a higher prevalence of BID than women in other nations, attributable to negative perceptions of Chinese women’s introverted traits and the influence of Oriental culture on self-assessment [ 19 ]. Chinese women with PCOS experience pronounced appearance-related anxiety [ 20 ]. Symptoms related to PCOS, such as obesity, hirsutism, and acne, correlate with an individual’s perception of their BI. Women with PCOS are more prone to alterations in their physical appearance than women of childbearing age without PCOS; hence, they frequently exhibit heightened concerns about their self-image. These body image fluctuations could precipitate psychological problems, particularly when coupled with hormonal changes. Consequently, it is imperative to prioritize the BI concerns of women with PCOS. In China, significant progress has been achieved in researching BID resulting from medical conditions, particularly among patients with breast cancer, burns, and autoimmune diseases. However, limited research has focused on BID among women with PCOS in China, highlighting the necessity for further investigation. The aim of this study was to investigate the current status and factors affecting body image disturbances in patients with polycystic ovary syndrome in the reproductive age group.