Prevalence and Factors Associated with Sexual Dysfunction among Patients Seeking Fertility Care at Two Tertiary Hospitals in Uganda: Across-sectional study

Prevalence and Factors Associated with Sexual Dysfunction among Patients Seeking Fertility Care at Two Tertiary Hospitals in Uganda: Across-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence and Factors Associated with Sexual Dysfunction among Patients Seeking Fertility Care at Two Tertiary Hospitals in Uganda: Across-sectional study Bwire Innocent, Baruti Petrus, Theoneste Hakizimana, Okot Geoffrey, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8263129/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Sexual dysfunction is a common but under-recognized problem in fertility care with potential implications on treatment outcomes. We determined the prevalence, forms and factors associated with sexual dysfunction among patients seeking fertility care at two tertiary Hospitals in Uganda. Methods A cross-sectional study was conducted at Jinja and Kayunga Regional Referral Hospitals from May to August 2025. A total of 226 participants (113 males and 113 females) seeking fertility care were consecutively recruited. A validated Arizona Sexual Experiences Scale with a cutoff of ≥ 19 was used to define sexual dysfunction. Demographic data were collected using a pre-tested questionnaire. Data was analyzed using Stata version 19. Bivariate and Multivariate analysis for associations was done with statistical significance set at p < 0.05. Results The mean age was 34.1 years (SD ± 8.3); most had secondary education, unemployed, middle income status, had no living child with Infertility for more than five years. The prevalence of sexual dysfunction was 42.5% (96/226), higher in females (52.2%, 59/113) than in males (32.7%, 37/113). Among women, the most common dysfunctions were reduced sexual desire (33.6%), orgasm difficulties (32.7%), and painful intercourse (27.4%). Among men, reduced desire (27.4%), painful intercourse (23.8%), and erectile difficulties (23.0%) predominated. Independent predictors of sexual dysfunction included age 40–49 years (aOR 2.9; 95% CI: 1.24–6.80, p = 0.014), low household income (aOR 10.7; 95% CI: 2.14–52.92, p = 0.004), absence of a living child (aOR 2.8; 95% CI: 1.28–5.10, p = 0.021), and infertility duration ≥ 5 years (aOR 7.4; 95% CI: 3.38–16.32, p = < 0.001). Being male was associated with a 52% lower likelihood of sexual dysfunction (aOR 0.48; 95% CI: 0.37–0.89, p = < 0.023). Conclusions Sexual dysfunction was common among patients with infertility, especially women thus integrating routine screening, counseling and targeted support for high‑risk groups should be prioritized in fertility care. Obstetrics & Gynecology female sexual dysfunction male sexual dysfunction infertility Uganda cross-sectional study Arizona sexual experiences scale Figures Figure 1 Figure 2 Background Sexual dysfunction refers to any difficulties occurring at any stage of the sexual response cycle including sexual desire, sexual arousal, orgasm or pain that interferes with individual sexual satisfaction¹. Globally, sexual dysfunction is more common among women with a prevalence of 41% compared to 28% in men² ³, while infertility affects one in six couples⁴. In Sub-Saharan Africa, childbearing is highly desired and not being able to bear children is harshly stigmatized in society⁵. In East Africa, infertility stands at 16.3%⁶ with Uganda reporting rates between 10% and 15%⁷. Among couples facing infertility, sexual dysfunction is common ranging from 16.1–87.1% in women and 34–58% in men⁸ ⁹ 10 . Sexual dysfunction is a common co-morbidity with infertility and significantly worsens emotional well-being, relationship satisfaction, and quality of life 11 . Men with infertility experience erectile dysfunction, premature ejaculation, and reduced sexual desire, while women often report low sexual desire, arousal, orgasmic disorders, and dyspareunia¹¹ , 12 . Multiple factors influence sexual function in couples facing infertility such as age, income, duration of marriage, education, medical conditions (such as diabetes), duration of treatment, hormonal levels, psychological status, obstetric history and number of living children 13 14 15 . The Arizona Sexual Experience Scale (ASEX) is a validated and reliable tool for assessing male and female sexual function in clinical settings with a sensitivity of 94% and a specificity of 91% making it a practical compliment to comprehensive tools like the female sexual function index (FSFI) and International Index of Erectile Function ¹⁶. The American College of Obstetricians and Gynecologists (ACOG) recommends that clinicians should initiate discussion on sexual health during routine care consultations to identify sexual dysfunctions early and reduce stigma¹⁷. In Uganda, studies on sexual dysfunction have focused on people living with human immunodeficiency virus, adult cancer patients, and general sexually active population¹⁸ 19 20 . However, the absence of locally relevant data in Ugandan infertility patients undermines the provision of integrated, patient centered fertility and sexual health services, limits clinicians’ ability to reduce stigma and offer targeted management critical to improving fertility care outcomes and guiding interventions that support sexual and reproductive well-being of the affected patients. This study thus aimed to address this knowledge gap by determining the prevalence, common forms and factors associated with sexual dysfunction in patients with infertility. Methods Study design The study employed an analytical cross-sectional design to determine sexual dysfunction among patients seeking fertility care at Kayunga and Jinja Regional Referral Hospitals. The design was appropriate as sexual dysfunction is relatively underexplored in our settings, patients present intermittently and follow-up may be challenging. Study settings Kayunga and Jinja Hospitals are public Regional Referral Hospitals located in Central and Eastern region of Uganda. Jinja Hospital is a government referral hospital located in Jinja City in Busoga region with a bed capacity of over 900 beds and acatchment population of 4.5 million people. The daily gynaecology clinic receives on average 40 infertile couples monthly Kayunga Hospital is located in Kayunga municipality in Kayunga district in Buganda region. It was recently upgraded to a 300-bed capacity regional referral hospital to decongest Mulago and Jinja hospitals with a catchment population of 2.5 million people. The gynaecology clinic has a nested fertility clinic that runs every Tuesday and thursday receives on average 30 infertile couples monthly, however during the study time fertility care was offered on all days. Study population The study population comprised 226 with 113 females and 113 males of reproductive age (18–49 years) with infertility from May 16th to August 20th, 2025. Eligibility criteria Individuals aged 18–49 years who had not achieved a pregnancy after at least 12 months of regular unprotected sexual intercourse and were seeking fertility care at Jinja or Kayunga Hospitals were eligible. Patients with pre-existing mental illness, acute medical conditions, or a history of pelvic surgery were excluded. Sample size and sampling strategy Sample size was calculated using by Kish Leslie formula 21 , at 95% confidence interval and error shown below; n= \(\:\frac{{Z}_{\alpha\:/2}^{2}*\:p(1-p)}{{d}^{2}}\) , Where n = Sample size estimate of study participants, Z α/2 = Standard Z value at 95% confidence interval, corresponding to 1.96, d = the sampling error; 5%, p = Expected proportion of sexual dysfunction in patients with infertility (16% from Stenyaeva et al., 2017). By substation, a sample size of 203 was obtained and to account for potential non-response or incomplete data, we added 10% to the sample size yielding a final minimum sample size of 226 participants. We employed consecutive sampling to obtain eligible study participants. This approach was chosen for its feasibility in a clinical setting, minimization of logistical complexity and ensures that the study population reflects the routine patient flow at Jinja and Kayunga Hospitals. 126 participants were recruited from Jinja Hospital (63 males and 63 females) and 100 participants from Kayunga Hospital (50 males and 50 females). Of the 226 participants, 20 individuals (8.8%) were enrolled as part of 10 couples, while the remaining 206 participants were independent. All 226 participants were recruited as individuals, however 40 participants (17.7%) were enrolled as part of 20 couples. Each partner was treated as an independent participant, with outcomes measured and analyzed separately. Data Collection Tools The Arizona Sexual Experiences Scale (ASEX) was used to assess sexual function. ASEX is a validated instrument with strong psychometric properties, valued for its brevity, simplicity, focus on core physiological aspects, and minimal item burden. It is particularly suitable for rapid screening when a global measure of sexual function is required rather than detailed domain-specific analysis.¹⁶ Patients attending the gynaecology clinics at the study sites with fertility concerns were approached and provided with study information. Those meeting eligibility criteria were invited to participate, and written informed consent was obtained. To encourage male involvement, a partner invitation strategy was employed. Following counselling, participants completed a pre-tested demographic questionnaire (available in English and translated versions of Luganda and Lusoga) and the ASEX instrument in a private setting. Pretesting of ASEX translated versions was done on 10% (13 males and 13 females) of sample size at Nile International Hospital in Jinja prior to data collection. Confidentiality was maintained by assigning serial numbers instead of personal identifiers. Interviews lasted approximately 10–15 minutes. ASEX scores were calculated, with a total score ≥ 19 indicating overall sexual dysfunction and a domain score ≥ 5 indicating domain-specific dysfunction. Painful coitus was assessed using a 0–10 numeric rating scale ²², where 0 indicated no pain, 1–3 mild pain, 4–6 moderate pain, and ≥ 7 severe pain. Participants who reported sexual health concerns were referred for appropriate clinical care. Statistical Analysis Data were coded and entered into Microsoft Excel 2013, cleaned to remove inconsistencies, and imported into Stata version 19.0 (StataCorp, Texas, USA) for analysis. Analyses were conducted at the individual level with no study site clustering. Descriptive statistics were generated to summarize participant characteristics. Categorical variables were presented as frequencies and percentages. Associations between categorical variables were assessed using the chi‑square test. To identify independent predictors of sexual dysfunction, a binary logistic regression model was employed. Variables with p < 0.20 at bivariate analysis were considered for inclusion in the multivariable model. Results are reported as adjusted odds ratios (aORs) with corresponding 95% confidence intervals (CIs). Statistical significance was set at p < 0.05. Results A total of 226 participants were enrolled, comprising 113 females and 113 males. The majority of respondents were aged 40–49 years (49.6%), had attained secondary education (48.7%), and were unemployed (67.3%). Over half were middle‑income earners (55.8%), married for five years or more (67.3%), and presented with secondary infertility (50.4%), often with no living child (49.6%). Most had experienced infertility for more than five years (77.4%) and had not received prior infertility treatment (64.6%). No statistically significant differences were observed between sites across sociodemographic and fertility-related variables. Demographic and fertility-related characteristics are summarized in Table 1 . The overall prevalence of sexual dysfunction among study participants was 42.5% (96/226) . Prevalence was significantly higher in females ( 52.2%, 59/113; 95% CI: 43.0–61.4 ) compared with males ( 32.7%, 37/113; 95% CI: 24.1–41.4 ). The proportion in females and males was significant with females having more than twice the odds of reporting sexual dysfunction compared with males ( aOR = 2.24, 95% CI: 1.31–3.85, p = 0.003 ). Adjustment for study site (Jinja vs. Kayunga) did not materially alter this association, as shown in Fig. 1 . Table 1 Socio-demographic and fertility-related characteristics of the study participants Variable Category Jinja Kayunga Total (%) P-Value Age category (years) 20–29 44 37 81(35.8) 0.76 30–39 19 14 33(14.6) 40–49 63 49 112(49.6) Level of education Tertiary Secondary Primary 41 62 22 34 48 19 75(33.2) 110(48.7) 41(18.1) 0.92 Income level(Ugx) High 35 29 64(28.3) 0.90 Middle 70 56 126(55.8) Low 21 15 36(15.9) Employment status Employed 43 31 74(32.7) 0.71 Not employed 83 69 152(67.3) Duration of Marriage (years) < 5 52 42 94(41.6) 0.78 ≥ 5 75 57 132(58.4) Type of Infertility Secondary 66 48 114(50.4) 0.66 Primary 60 52 112(49.6) Number of living children ≥ 2 children 25 17 42(18.6) 073 1 child 36 36 72(31.9) No child 53 59 112(49.6) Duration of infertility (Years) ≥ 5 99 76 175(77.4) 0.74 1,000,000 Ugx), Middle (500,000–1,000,000Ugx), low (< 500,000Ugx) Prevalence of sexual dysfunction among patients seeking fertility care In men the common forms of sexual dysfunction were Sexual desire 27.4%(31/113), painful intercourse 23.8% (27/113), and Erection dysfunction 23.0% (26/113) while in females, low Sexual desire 33.6%(38/113), Orgasmic dysfunction 32.7% (37/113) and painful intercourse 27.4% (31/113) predominated as shown in Fig. 2 below In bivariate analysis, sexual dysfunction was significantly associated with older age (40–49 years, cOR = 1.97, 95% CI: 1.01–3.83), male gender (cOR = 0.45, 95% CI: 0.27–0.77), lower income (cOR = 2.04, 95% CI: 1.11–3.75), primary infertility (cOR = 0.43, 95% CI: 0.25–0.74), absence of living children (cOR = 0.32, 95% CI: 0.16–0.65), and infertility duration ≥ 5 years (cOR = 4.08, 95% CI: 2.09–7.98). After adjustment, independent predictors of sexual dysfunction included age 40–49 years (aOR = 2.90, 95% CI: 1.24–6.80), male gender (aOR = 0.48, 95% CI: 0.37–0.89), low income (aOR = 10.70, 95% CI: 2.14–52.92), absence of living children (aOR = 2.80, 95% CI: 1.28–5.10), and infertility duration ≥ 5 years (aOR = 7.40, 95% CI: 3.38–16.31). the multivariate analysis is presented in Table 2 below. Table 2 Multivariate analysis of factors associated with sexual dysfunction in patients seeking fertility care Variable Category cOR (95% CI) p-value aOR (95% CI) P-value Age (Years) 20–29 1.00 30–39 0.58 (0.32–1.05) 0.073 0.60 (0.34–1.71) 0.366 40–49 1.97 (1.01–3.83) 0.046* 2.90 (1.24–6.80) 0.014** Gender Female 1.00 Male 0.45 (0.27–0.77) 0.003* 0.48 (0.37–0.89) < 0.023** Level of education Tertiary 1.00 Secondary 2.36 (1.39–4.02) 0.002* 1.30 (0.45–4.02) 0.593 Primary 1.96 (0.99–3.88) 0.052* 0.60 (0.16–-2.34) 0.467 Income level High 1.00 Middle 1.03 (0.60–1.77) 0.923* 0.80 (0.26–2.38) 0.674 Low 2.04 (1.11–3.75) 0.021* 10.70 (2.14–52.92) 0.004** Type of Infertility Secondary 1.00 Primary 0.43 (0.25–0.74) 0.002* 1.50 (0.54–4.37) 0.419 Number of living children ≥ 2 Children 1.00 1 Child 0.65 (0.30–1.40) 0.271 1.40 (0.55–3.64) 0.469 No Child 0.32 (0.16– 0.65) 0.002* 2.80 (1.28–5.10) 0.021** Duration of infertility (years) < 5 ≥ 5 1.00 4.08 (2.09–7.98) < 0.001* 7.40 (3.38–16.31) < 0.001** *p ≤ 0.2, **P < 0.05, cOR = crude Odds Ratio, aOR = adjusted Odds Ratio, CI = Confidence Interval Discussion The study revealed a higher burden of sexual dysfunction among women compared to men. Approximately one in two women and one in three men met the threshold for sexual dysfunction, highlighting a clear gender disparity in this study. The overall prevalence is consistent with international estimates, with women disproportionately affected, echoing findings from China and global meta-analyses 23 , 24 . .The female prevalence is comparable to Egypt (47%) and Tunisia (38%) but lower than Iran (60–65%) 25, 26, 27 likely reflecting cultural norms, age distribution, stigma, and use of ASEX rather than FSFI. ASEX, being brief and gender-neutral, quickly identifies broad sexual dysfunction but lacks domain detail, while FSFI offers subtle, female-specific insights yet is longer and less practical in mixed-gender or time-limited studies 16 . Male prevalence aligned with Turkish data (34%) and meta-analytic ranges (17.8–61.6%) 28, 29 , but was lower than reports from Iran (58%) and Nigeria (60%) 30, 31 . In the Ugandan context, where nearly one in two sexually active individuals experience some form of sexual dysfunction, the burden is intensified by cultural expectations around childbearing, limited access to fertility services, and persistent stigma surrounding disclosure of sexual difficulties. For women in particular, these pressures may compound the psychosocial impact of infertility and drive reliance on traditional medicine as a first line of care. 20 . The predominance of reduced desire and orgasmic difficulty in women mirrors Iranian data but with higher pain prevalence, while Indian studies reported more arousal and lubrication issues 32 . In men, reduced desire and erectile dysfunction were consistent with global ranges 33 and Vietnamese data 13 though pain and ejaculation issues were more prominent, possibly reflecting somatic causes such as varicocele or epididymal inflammation 34 . Variations from Chinese data, where orgasmic dysfunction predominated 35 , highlight cultural and methodological influences. The protective effect of male sex in our study may reflect under-reporting, gender differences in perception and help-seeking behaviors as men often minimize or conceal sexual difficulties, though other studies in Iran and Nigerian have found higher male risk suggesting that cultural norms and disclosure patterns strongly influence the reporting among men 36 , 37 . Age group of 40–49 years was associated with sexual dysfunction consistent with evidence that advancing age is linked to hormonal decline, comorbidities, and cumulative psychosocial strain. Prolonged infertility further compounded this risk, likely due to sustained psychological distress and relational strain, echoing findings from global meta-analyses 38 , 39 , 13 . Childlessness likely amplifies dysfunction through stigma, marital strain, and reduced intimacy. This pattern also described in sub-Saharan African studies where fertility is central to social identity. 40 Low income emerged as the strongest socioeconomic predictor, aligning with literature that financial stress and treatment costs impair sexual health highlighting the intersection of economic vulnerability and reproductive health, particularly in low‑resource settings thus the need for affordable, integrated psychosocial and clinical interventions. 38 , 11 . Our study findings support routine screening for sexual dysfunction in fertility care to promote early detection, counselling and timely intervention Strengths and limitations of the study Strengths Balanced sampling of both sexes enabled gender-stratified analyses and provided stronger insight into sex-specific patterns. Use of standardized measures enhanced comparability across subgroups. Confidentiality assurances likely reduced under-reporting of sensitive outcomes. Limitations The cross‑sectional design limits causal inference, though standardized tools and multivariable analysis strengthened the identification of associations to guide future longitudinal research. Hospital‑based recruitment may limit generalizability to the wider community. To enhance representativeness, participants were drawn from two distinct facilities serving diverse catchment populations, though potential heterogeneity between the sites is acknowledged. Reliance on self-reported outcomes may introduce social desirability and recall bias, while exclusion of patients with prior illness or pelvic surgery may result in selection bias. These risks were minimized through validated tools, confidential administration, and anonymity, with exclusions aimed at reducing confounding. Conclusions Sexual dysfunction is high among infertile patients particularly women, underscoring the need to integrate routine sexual health screening and counselling into infertility services. Domain-specific forms of low desire and orgasmic dysfunction in women; desire, erectile, and orgasmic dysfunction in men reveal that dysfunction is gender-differentiated, and thus warrants individualized assessment. Sexual dysfunction was independently associated with older age (40–49 years), low income, childlessness, and prolonged infertility (≥ 5 years), while male gender was less likely to be associated with sexual dysfunction in patients seeking fertility care Abbreviations ACOG: American College of Obstetricians and Gynecologists ASEX: Arizona Sexual Experience Scale FSFI: Female Sexual Function Index Declarations Ethics approval and consent to participate Ethical approval was obtained from the Kampala International University Research Ethics Committee under protocol number KIU‑2025‑871. Administrative clearance was also granted by Jinja Regional Referral Hospital and Kayunga Hospitals. Written informed consent was obtained from all participants prior to enrollment. Consent for publication Written informed consent was obtained from all participants for publication of anonymized study findings. Availability of data and materials The datasets used during the study are not publicly available due to the sensitive nature of the topic but are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding The authors received no specific funding for this work. Authors’ contributions BI conceived and designed the study. BI, FDW and KS contributed to data acquisition and interpretation. BI and FDW drafted and edited the manuscript. EMAT, OE, TH, OG, OS and BP provided critical analysis and revisions. All authors read and approved the final manuscript. References Pittrof R. Sexual dysfunction: definitions and classifications. In: Templeton A, Heikinheimo L, Ozturk TH, Fraser I, editors. Oxford textbook of sexual and reproductive health . 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BMC Womens Health . 2021;21(1):101. doi:10.1186/s12905-021-01239-9 Roomaney R, Kagee A, Knoll N. Infertility‑related stigma and its psychosocial impact in sub‑Saharan Africa: a systematic review. Reprod Biomed Soc Online . 2024;18:1–12. doi:10.1186/s12978-024-01858-2 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-8263129","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":554822858,"identity":"a444ed40-332a-4d71-9ab7-fd1003f4608f","order_by":0,"name":"Bwire 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1","display":"","copyAsset":false,"role":"figure","size":32130,"visible":true,"origin":"","legend":"\u003cp\u003eBar chart showing prevalence of sexual dysfunction among patients seeking fertility care\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8263129/v1/d647a75b0ddea729279fada0.png"},{"id":97892688,"identity":"be23f1cf-8092-4023-aa49-341ebeb3fec0","added_by":"auto","created_at":"2025-12-10 15:18:39","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":109523,"visible":true,"origin":"","legend":"\u003cp\u003eCommon forms of sexual dysfunction among male and female participants\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8263129/v1/84ee4a6b108796a57acbee1f.png"},{"id":99306799,"identity":"5a797395-7cca-4a63-b728-d63437d71f23","added_by":"auto","created_at":"2025-12-31 15:44:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1011044,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8263129/v1/e98c6010-0468-479e-bfb5-ac1fb7a3ea05.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003ePrevalence and Factors Associated with Sexual Dysfunction among Patients Seeking Fertility Care at Two Tertiary Hospitals in Uganda: Across-sectional study\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eSexual dysfunction refers to any difficulties occurring at any stage of the sexual response cycle including sexual desire, sexual arousal, orgasm or pain that interferes with individual sexual satisfaction\u0026sup1;. Globally, sexual dysfunction is more common among women with a prevalence of 41% compared to 28% in men\u0026sup2; \u0026sup3;, while infertility affects one in six couples⁴.\u003c/p\u003e\u003cp\u003eIn Sub-Saharan Africa, childbearing is highly desired and not being able to bear children is harshly stigmatized in society⁵. In East Africa, infertility stands at 16.3%⁶ with Uganda reporting rates between 10% and 15%⁷. Among couples facing infertility, sexual dysfunction is common ranging from 16.1\u0026ndash;87.1% in women and 34\u0026ndash;58% in men⁸ ⁹ \u003csup\u003e10\u003c/sup\u003e. Sexual dysfunction is a common co-morbidity with infertility and significantly worsens emotional well-being, relationship satisfaction, and quality of life\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Men with infertility experience erectile dysfunction, premature ejaculation, and reduced sexual desire, while women often report low sexual desire, arousal, orgasmic disorders, and dyspareunia\u0026sup1;\u0026sup1;\u003csup\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eMultiple factors influence sexual function in couples facing infertility such as age, income, duration of marriage, education, medical conditions (such as diabetes), duration of treatment, hormonal levels, psychological status, obstetric history and number of living children\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe Arizona Sexual Experience Scale (ASEX) is a validated and reliable tool for assessing male and female sexual function in clinical settings with a sensitivity of 94% and a specificity of 91% making it a practical compliment to comprehensive tools like the female sexual function index (FSFI) and International Index of Erectile Function \u0026sup1;⁶.\u003c/p\u003e\u003cp\u003eThe American College of Obstetricians and Gynecologists (ACOG) recommends that clinicians should initiate discussion on sexual health during routine care consultations to identify sexual dysfunctions early and reduce stigma\u0026sup1;⁷.\u003c/p\u003e\u003cp\u003eIn Uganda, studies on sexual dysfunction have focused on people living with human immunodeficiency virus, adult cancer patients, and general sexually active population\u0026sup1;⁸ \u003csup\u003e19 20\u003c/sup\u003e. However, the absence of locally relevant data in Ugandan infertility patients undermines the provision of integrated, patient centered fertility and sexual health services, limits clinicians\u0026rsquo; ability to reduce stigma and offer targeted management critical to improving fertility care outcomes and guiding interventions that support sexual and reproductive well-being of the affected patients. This study thus aimed to address this knowledge gap by determining the prevalence, common forms and factors associated with sexual dysfunction in patients with infertility.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design\u003c/h2\u003e\u003cp\u003eThe study employed an analytical cross-sectional design to determine sexual dysfunction among patients seeking fertility care at Kayunga and Jinja Regional Referral Hospitals. The design was appropriate as sexual dysfunction is relatively underexplored in our settings, patients present intermittently and follow-up may be challenging.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy settings\u003c/h3\u003e\n\u003cp\u003eKayunga and Jinja Hospitals are public Regional Referral Hospitals located in Central and Eastern region of Uganda. Jinja Hospital is a government referral hospital located in Jinja City in Busoga region with a bed capacity of over 900 beds and acatchment population of 4.5\u0026nbsp;million people. The daily gynaecology clinic receives on average 40 infertile couples monthly\u003c/p\u003e\u003cp\u003eKayunga Hospital is located in Kayunga municipality in Kayunga district in Buganda region.\u003c/p\u003e\u003cp\u003eIt was recently upgraded to a 300-bed capacity regional referral hospital to decongest Mulago and Jinja hospitals with a catchment population of 2.5\u0026nbsp;million people. The gynaecology clinic has a nested fertility clinic that runs every Tuesday and thursday receives on average 30 infertile couples monthly, however during the study time fertility care was offered on all days.\u003c/p\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003eThe study population comprised 226 with 113 females and 113 males of reproductive age (18\u0026ndash;49 years) with infertility from May 16th to August 20th, 2025.\u003c/p\u003e\n\u003ch3\u003eEligibility criteria\u003c/h3\u003e\n\u003cp\u003eIndividuals aged 18\u0026ndash;49 years who had not achieved a pregnancy after at least 12 months of regular unprotected sexual intercourse and were seeking fertility care at Jinja or Kayunga Hospitals were eligible. Patients with pre-existing mental illness, acute medical conditions, or a history of pelvic surgery were excluded.\u003c/p\u003e\n\u003ch3\u003eSample size and sampling strategy\u003c/h3\u003e\n\u003cp\u003eSample size was calculated using by Kish Leslie formula \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e, at 95% confidence interval and error shown below; n= \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\frac{{Z}_{\\alpha\\:/2}^{2}*\\:p(1-p)}{{d}^{2}}\\)\u003c/span\u003e\u003c/span\u003e,\u003c/p\u003e\u003cp\u003eWhere \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;Sample size estimate of study participants, Z\u003csub\u003eα/2\u003c/sub\u003e = Standard Z value at 95% confidence interval, corresponding to 1.96, d\u0026thinsp;=\u0026thinsp;the sampling error; 5%, p\u0026thinsp;\u003cb\u003e=\u003c/b\u003e\u0026thinsp;Expected proportion of sexual dysfunction in patients with infertility (16% from Stenyaeva et al., 2017).\u003c/p\u003e\u003cp\u003e By substation, a sample size of 203 was obtained and to account for potential non-response or incomplete data, we added 10% to the sample size yielding a final minimum sample size of 226 participants. We employed consecutive sampling to obtain eligible study participants. This approach was chosen for its feasibility in a clinical setting, minimization of logistical complexity and ensures that the study population reflects the routine patient flow at Jinja and Kayunga Hospitals. 126 participants were recruited from Jinja Hospital (63 males and 63 females) and 100 participants from Kayunga Hospital (50 males and 50 females). Of the 226 participants, 20 individuals (8.8%) were enrolled as part of 10 couples, while the remaining 206 participants were independent. All 226 participants were recruited as individuals, however 40 participants (17.7%) were enrolled as part of 20 couples. Each partner was treated as an independent participant, with outcomes measured and analyzed separately.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eData Collection Tools\u003c/h2\u003e\u003cp\u003eThe \u003cb\u003eArizona Sexual Experiences Scale (ASEX)\u003c/b\u003e was used to assess sexual function. ASEX is a validated instrument with strong psychometric properties, valued for its brevity, simplicity, focus on core physiological aspects, and minimal item burden. It is particularly suitable for rapid screening when a global measure of sexual function is required rather than detailed domain-specific analysis.\u0026sup1;⁶\u003c/p\u003e\u003cp\u003ePatients attending the gynaecology clinics at the study sites with fertility concerns were approached and provided with study information. Those meeting eligibility criteria were invited to participate, and written informed consent was obtained. To encourage male involvement, a partner invitation strategy was employed. Following counselling, participants completed a pre-tested demographic questionnaire (available in English and translated versions of Luganda and Lusoga) and the ASEX instrument in a private setting. Pretesting of ASEX translated versions was done on 10% (13 males and 13 females) of sample size at Nile International Hospital in Jinja prior to data collection. Confidentiality was maintained by assigning serial numbers instead of personal identifiers. Interviews lasted approximately 10\u0026ndash;15 minutes. ASEX scores were calculated, with a \u003cb\u003etotal score\u0026thinsp;\u0026ge;\u0026thinsp;19\u003c/b\u003e indicating overall sexual dysfunction and a \u003cb\u003edomain score\u0026thinsp;\u0026ge;\u0026thinsp;5\u003c/b\u003e indicating domain-specific dysfunction. Painful coitus was assessed using a \u003cb\u003e0\u0026ndash;10 numeric rating scale\u003c/b\u003e\u0026sup2;\u0026sup2;, where 0 indicated no pain, 1\u0026ndash;3 mild pain, 4\u0026ndash;6 moderate pain, and \u0026ge;\u0026thinsp;7 severe pain. Participants who reported sexual health concerns were referred for appropriate clinical care.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eData were coded and entered into Microsoft Excel 2013, cleaned to remove inconsistencies, and imported into Stata version 19.0 (StataCorp, Texas, USA) for analysis.\u003c/p\u003e\u003cp\u003eAnalyses were conducted at the individual level with no study site clustering. Descriptive statistics were generated to summarize participant characteristics.\u003c/p\u003e\u003cp\u003eCategorical variables were presented as frequencies and percentages. Associations between categorical variables were assessed using the chi‑square test. To identify independent predictors of sexual dysfunction, a binary logistic regression model was employed. Variables with p\u0026thinsp;\u0026lt;\u0026thinsp;0.20 at bivariate analysis were considered for inclusion in the multivariable model. Results are reported as adjusted odds ratios (aORs) with corresponding 95% confidence intervals (CIs). Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 226 participants were enrolled, comprising 113 females and 113 males. The majority of respondents were aged 40\u0026ndash;49 years (49.6%), had attained secondary education (48.7%), and were unemployed (67.3%). Over half were middle‑income earners (55.8%), married for five years or more (67.3%), and presented with secondary infertility (50.4%), often with no living child (49.6%). Most had experienced infertility for more than five years (77.4%) and had not received prior infertility treatment (64.6%). No statistically significant differences were observed between sites across sociodemographic and fertility-related variables.\u003c/p\u003e\u003cp\u003eDemographic and fertility-related characteristics are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eThe overall prevalence of sexual dysfunction among study participants was \u003cb\u003e42.5% (96/226)\u003c/b\u003e. Prevalence was significantly higher in females (\u003cb\u003e52.2%, 59/113; 95% CI: 43.0\u0026ndash;61.4\u003c/b\u003e) compared with males (\u003cb\u003e32.7%, 37/113; 95% CI: 24.1\u0026ndash;41.4\u003c/b\u003e). The proportion in females and males was significant with females having more than twice the odds of reporting sexual dysfunction compared with males (\u003cb\u003eaOR\u0026thinsp;=\u0026thinsp;2.24, 95% CI: 1.31\u0026ndash;3.85, p\u0026thinsp;=\u0026thinsp;0.003\u003c/b\u003e). Adjustment for study site (Jinja vs. Kayunga) did not materially alter this association, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\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\u003eSocio-demographic and fertility-related characteristics of the study participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\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=\"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\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eJinja\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eKayunga\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTotal (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\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\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAge category (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20\u0026ndash;29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e81(35.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.76\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30\u0026ndash;39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e33(14.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40\u0026ndash;49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e112(49.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLevel of education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTertiary\u003c/p\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e41\u003c/p\u003e\u003cp\u003e62\u003c/p\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e34\u003c/p\u003e\u003cp\u003e48\u003c/p\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e75(33.2)\u003c/p\u003e\u003cp\u003e110(48.7)\u003c/p\u003e\u003cp\u003e41(18.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.92\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eIncome level(Ugx)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e64(28.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMiddle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e126(55.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e36(15.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eEmployment status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e74(32.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.71\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e152(67.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eDuration of Marriage (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e94(41.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.78\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e132(58.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eType of Infertility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e114(50.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.66\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e112(49.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eNumber of living children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;2 children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e42(18.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e073\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 child\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e72(31.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo child\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e112(49.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eDuration of infertility (Years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ge; 5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e175(77.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.74\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e51(22.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrior infertility treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e84(37.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.77\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e142(62.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cem\u003e%=percentage, Ugx\u0026thinsp;=\u0026thinsp;Ugandan shillings, P-values obtained using Pearson Chi‑square test, High (\u0026gt;\u0026thinsp;1,000,000 Ugx), Middle (500,000\u0026ndash;1,000,000Ugx), low (\u0026lt;\u0026thinsp;500,000Ugx)\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003ePrevalence of sexual dysfunction among patients seeking fertility care\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eIn men the common forms of sexual dysfunction were Sexual desire 27.4%(31/113), painful intercourse 23.8% (27/113), and Erection dysfunction 23.0% (26/113) while in females, low Sexual desire 33.6%(38/113), Orgasmic dysfunction 32.7% (37/113) and painful intercourse 27.4% (31/113) predominated as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e below\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eIn bivariate analysis, sexual dysfunction was significantly associated with older age (40\u0026ndash;49 years, cOR\u0026thinsp;=\u0026thinsp;1.97, 95% CI: 1.01\u0026ndash;3.83), male gender (cOR\u0026thinsp;=\u0026thinsp;0.45, 95% CI: 0.27\u0026ndash;0.77), lower income (cOR\u0026thinsp;=\u0026thinsp;2.04, 95% CI: 1.11\u0026ndash;3.75), primary infertility (cOR\u0026thinsp;=\u0026thinsp;0.43, 95% CI: 0.25\u0026ndash;0.74), absence of living children (cOR\u0026thinsp;=\u0026thinsp;0.32, 95% CI: 0.16\u0026ndash;0.65), and infertility duration\u0026thinsp;\u0026ge;\u0026thinsp;5 years (cOR\u0026thinsp;=\u0026thinsp;4.08, 95% CI: 2.09\u0026ndash;7.98).\u003c/p\u003e\u003cp\u003eAfter adjustment, independent predictors of sexual dysfunction included age 40\u0026ndash;49 years (aOR\u0026thinsp;=\u0026thinsp;2.90, 95% CI: 1.24\u0026ndash;6.80), male gender (aOR\u0026thinsp;=\u0026thinsp;0.48, 95% CI: 0.37\u0026ndash;0.89), low income (aOR\u0026thinsp;=\u0026thinsp;10.70, 95% CI: 2.14\u0026ndash;52.92), absence of living children (aOR\u0026thinsp;=\u0026thinsp;2.80, 95% CI: 1.28\u0026ndash;5.10), and infertility duration\u0026thinsp;\u0026ge;\u0026thinsp;5 years (aOR\u0026thinsp;=\u0026thinsp;7.40, 95% CI: 3.38\u0026ndash;16.31). the multivariate analysis is presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e below.\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\u003eMultivariate analysis of factors associated with sexual dysfunction in patients seeking fertility care\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\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=\"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\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ecOR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eaOR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAge (Years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20\u0026ndash;29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30\u0026ndash;39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.58 (0.32\u0026ndash;1.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.073\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.60 (0.34\u0026ndash;1.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.366\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40\u0026ndash;49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.97 (1.01\u0026ndash;3.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.046*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.90 (1.24\u0026ndash;6.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.014**\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.45 (0.27\u0026ndash;0.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.003*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.48 (0.37\u0026ndash;0.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.023**\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eLevel of education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTertiary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.36 (1.39\u0026ndash;4.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.002*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.30 (0.45\u0026ndash;4.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.593\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.96 (0.99\u0026ndash;3.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.052*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.60 (0.16\u0026ndash;-2.34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.467\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eIncome level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMiddle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.03 (0.60\u0026ndash;1.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.923*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.80 (0.26\u0026ndash;2.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.674\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.04 (1.11\u0026ndash;3.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.021*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e10.70 (2.14\u0026ndash;52.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.004**\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eType of Infertility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.43 (0.25\u0026ndash;0.74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.002*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.50 (0.54\u0026ndash;4.37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.419\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eNumber of living children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;2 Children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 Child\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.65 (0.30\u0026ndash;1.40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.271\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.40 (0.55\u0026ndash;3.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.469\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo Child\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.32 (0.16\u0026ndash; 0.65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.002*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.80 (1.28\u0026ndash;5.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.021**\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of infertility (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e \u003cp\u003e\u0026ge;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003cp\u003e4.08 (2.09\u0026ndash;7.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.40 (3.38\u0026ndash;16.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001**\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e*p\u0026thinsp;\u0026le;\u0026thinsp;0.2, **P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, cOR\u0026thinsp;=\u0026thinsp;crude Odds Ratio, aOR\u0026thinsp;=\u0026thinsp;adjusted Odds Ratio, CI\u0026thinsp;=\u0026thinsp;Confidence Interval\u003c/h2\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study revealed a higher burden of sexual dysfunction among women compared to men. Approximately one in two women and one in three men met the threshold for sexual dysfunction, highlighting a clear gender disparity in this study. The overall prevalence is consistent with international estimates, with women disproportionately affected, echoing findings from China and global meta-analyses \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. .The female prevalence is comparable to Egypt (47%) and Tunisia (38%) but lower than Iran (60\u0026ndash;65%) \u003csup\u003e25, 26, 27\u003c/sup\u003e likely reflecting cultural norms, age distribution, stigma, and use of ASEX rather than FSFI. ASEX, being brief and gender-neutral, quickly identifies broad sexual dysfunction but lacks domain detail, while FSFI offers subtle, female-specific insights yet is longer and less practical in mixed-gender or time-limited studies\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eMale prevalence aligned with Turkish data (34%) and meta-analytic ranges (17.8\u0026ndash;61.6%) \u003csup\u003e28, 29\u003c/sup\u003e, but was lower than reports from Iran (58%) and Nigeria (60%) \u003csup\u003e30, 31\u003c/sup\u003e. In the Ugandan context, where nearly one in two sexually active individuals experience some form of sexual dysfunction, the burden is intensified by cultural expectations around childbearing, limited access to fertility services, and persistent stigma surrounding disclosure of sexual difficulties. For women in particular, these pressures may compound the psychosocial impact of infertility and drive reliance on traditional medicine as a first line of care.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe predominance of reduced desire and orgasmic difficulty in women mirrors Iranian data but with higher pain prevalence, while Indian studies reported more arousal and lubrication issues \u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. In men, reduced desire and erectile dysfunction were consistent with global ranges \u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e and Vietnamese data \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e though pain and ejaculation issues were more prominent, possibly reflecting somatic causes such as varicocele or epididymal inflammation \u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. Variations from Chinese data, where orgasmic dysfunction predominated \u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e, highlight cultural and methodological influences.\u003c/p\u003e\u003cp\u003eThe protective effect of male sex in our study may reflect under-reporting, gender differences in perception and help-seeking behaviors as men often minimize or conceal sexual difficulties, though other studies in Iran and Nigerian have found higher male risk suggesting that cultural norms and disclosure patterns strongly influence the reporting among men\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e,\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e. Age group of 40\u0026ndash;49 years was associated with sexual dysfunction consistent with evidence that advancing age is linked to hormonal decline, comorbidities, and cumulative psychosocial strain. Prolonged infertility further compounded this risk, likely due to sustained psychological distress and relational strain, echoing findings from global meta-analyses\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eChildlessness likely amplifies dysfunction through stigma, marital strain, and reduced intimacy. This pattern also described in sub-Saharan African studies where fertility is central to social identity.\u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eLow income emerged as the strongest socioeconomic predictor, aligning with literature that financial stress and treatment costs impair sexual health highlighting the intersection of economic vulnerability and reproductive health, particularly in low‑resource settings thus the need for affordable, integrated psychosocial and clinical interventions.\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e .\u003c/p\u003e\u003cp\u003eOur study findings support routine screening for sexual dysfunction in fertility care to promote early detection, counselling and timely intervention\u003c/p\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eStrengths and limitations of the study\u003c/h2\u003e\u003cdiv id=\"Sec14\" class=\"Section3\"\u003e\u003ch2\u003eStrengths\u003c/h2\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eBalanced sampling of both sexes enabled gender-stratified analyses and provided stronger insight into sex-specific patterns.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eUse of standardized measures enhanced comparability across subgroups.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eConfidentiality assurances likely reduced under-reporting of sensitive outcomes.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eThe cross‑sectional design limits causal inference, though standardized tools and multivariable analysis strengthened the identification of associations to guide future longitudinal research.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eHospital‑based recruitment may limit generalizability to the wider community. To enhance representativeness, participants were drawn from two distinct facilities serving diverse catchment populations, though potential heterogeneity between the sites is acknowledged.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eReliance on self-reported outcomes may introduce social desirability and recall bias, while exclusion of patients with prior illness or pelvic surgery may result in selection bias. These risks were minimized through validated tools, confidential administration, and anonymity, with exclusions aimed at reducing confounding.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eSexual dysfunction is high among infertile patients particularly women, underscoring the need to integrate routine sexual health screening and counselling into infertility services. Domain-specific forms of low desire and orgasmic dysfunction in women; desire, erectile, and orgasmic dysfunction in men reveal that dysfunction is gender-differentiated, and thus warrants individualized assessment. Sexual dysfunction was independently associated with older age (40\u0026ndash;49 years), low income, childlessness, and prolonged infertility (\u0026ge;\u0026thinsp;5 years), while male gender was less likely to be associated with sexual dysfunction in patients seeking fertility care\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eACOG: American College of Obstetricians and Gynecologists\u003c/p\u003e\n\u003cp\u003eASEX: Arizona Sexual Experience Scale\u003c/p\u003e\n\u003cp\u003eFSFI: Female Sexual Function Index\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Kampala International University Research Ethics Committee under protocol number KIU‑2025‑871. Administrative clearance was also granted by Jinja Regional Referral Hospital and Kayunga Hospitals. Written informed consent was obtained from all participants prior to enrollment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from all participants for publication of anonymized study findings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used during the study are not publicly available due to the sensitive nature of the topic but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no specific funding for this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBI conceived and designed the study. BI, FDW and KS contributed to data acquisition and interpretation. BI and FDW drafted and edited the manuscript. EMAT, OE, TH, OG, OS and BP provided critical analysis and revisions. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003ePittrof R. Sexual dysfunction: definitions and classifications. In: Templeton A, Heikinheimo L, Ozturk TH, Fraser I, editors. \u003cem\u003eOxford textbook of sexual and reproductive health\u003c/em\u003e. Oxford: Oxford University Press; 2021. p. 391\u0026ndash;400. doi:10.1093/med/9780198839606.003.0035\u003c/li\u003e\n \u003cli\u003eMcCool ME, Zuelke A, Theurich MA, Knuettel H, Ricci C, Apfelbacher C. 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Differences in prevalence of sexual dysfunction between primary and secondary infertile women. \u003cem\u003eFertil Steril\u003c/em\u003e. 2011;96(5):1213\u0026ndash;7. doi:10.1016/j.fertnstert.2011.08.007\u003c/li\u003e\n \u003cli\u003eDong Y, Zhang H, Zhang Y, Xu Y, Sun Y, Wang N, et al. Sexual dysfunction in infertile women: prevalence and associated factors. \u003cem\u003eBMC Womens Health\u003c/em\u003e. 2021;21(1):101. doi:10.1186/s12905-021-01239-9\u003c/li\u003e\n \u003cli\u003eRoomaney R, Kagee A, Knoll N. Infertility‑related stigma and its psychosocial impact in sub‑Saharan Africa: a systematic review. \u003cem\u003eReprod Biomed Soc Online\u003c/em\u003e. 2024;18:1\u0026ndash;12. doi:10.1186/s12978-024-01858-2\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Kampala International University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"female sexual dysfunction, male sexual dysfunction, infertility, Uganda, cross-sectional study, Arizona sexual experiences scale","lastPublishedDoi":"10.21203/rs.3.rs-8263129/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8263129/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eSexual dysfunction is a common but under-recognized problem in fertility care with potential implications on treatment outcomes. We determined the prevalence, forms and factors associated with sexual dysfunction among patients seeking fertility care at two tertiary Hospitals in Uganda.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cross-sectional study was conducted at Jinja and Kayunga Regional Referral Hospitals from May to August 2025. A total of 226 participants (113 males and 113 females) seeking fertility care were consecutively recruited. A validated Arizona Sexual Experiences Scale with a cutoff of \u0026ge;\u0026thinsp;19 was used to define sexual dysfunction. Demographic data were collected using a pre-tested questionnaire. Data was analyzed using Stata version 19. Bivariate and Multivariate analysis for associations was done with statistical significance set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe mean age was 34.1 years (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;8.3); most had secondary education, unemployed, middle income status, had no living child with Infertility for more than five years. The prevalence of sexual dysfunction was 42.5% (96/226), higher in females (52.2%, 59/113) than in males (32.7%, 37/113). Among women, the most common dysfunctions were reduced sexual desire (33.6%), orgasm difficulties (32.7%), and painful intercourse (27.4%). Among men, reduced desire (27.4%), painful intercourse (23.8%), and erectile difficulties (23.0%) predominated. Independent predictors of sexual dysfunction included age 40\u0026ndash;49 years (aOR 2.9; 95% CI: 1.24\u0026ndash;6.80, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.014), low household income (aOR 10.7; 95% CI: 2.14\u0026ndash;52.92, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004), absence of a living child (aOR 2.8; 95% CI: 1.28\u0026ndash;5.10, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.021), and infertility duration\u0026thinsp;\u0026ge;\u0026thinsp;5 years (aOR 7.4; 95% CI: 3.38\u0026ndash;16.32, \u003cem\u003ep\u0026thinsp;=\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.001). Being male was associated with a 52% lower likelihood of sexual dysfunction (aOR 0.48; 95% CI: 0.37\u0026ndash;0.89, \u003cem\u003ep\u0026thinsp;=\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.023).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eSexual dysfunction was common among patients with infertility, especially women thus integrating routine screening, counseling and targeted support for high‑risk groups should be prioritized in fertility care.\u003c/p\u003e","manuscriptTitle":"Prevalence and Factors Associated with Sexual Dysfunction among Patients Seeking Fertility Care at Two Tertiary Hospitals in Uganda: Across-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-08 10:43:43","doi":"10.21203/rs.3.rs-8263129/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"931b5851-26a6-4445-9c6c-c5f31e71610a","owner":[],"postedDate":"December 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":59047812,"name":"Obstetrics \u0026 Gynecology"}],"tags":[],"updatedAt":"2025-12-08T10:43:44+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-08 10:43:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8263129","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8263129","identity":"rs-8263129","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}