Comparative Analysis of Sexual Function and Psychological Health in Infertile Patients with Different Ovarian Dysfunctions

Comparative Analysis of Sexual Function and Psychological Health in Infertile Patients with Different Ovarian Dysfunctions | 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 Comparative Analysis of Sexual Function and Psychological Health in Infertile Patients with Different Ovarian Dysfunctions Meng Dong, Yiyang Li, Yining Li, Yixian Wang, Jichun Tan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4464614/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 Objective This study aims to evaluate and compare sexual function and psychological health among infertile patients with different ovarian dysfunctions, specifically polycystic ovary syndrome (PCOS), premature ovarian insufficiency (POI), and women with normal ovarian function, to understand the extent of sexual dysfunction associated with these conditions. Methods We conducted a cross-sectional analysis involving 340 women, categorized into three groups: PCOS, POI, and normal ovarian function (Control). Sexual function was quantitatively assessed using the Female Sexual Function Index (FSFI), which measures six dimensions of sexual function: desire, arousal, lubrication, orgasm, satisfaction, and pain. Analysis of variance (ANOVA) was employed to compare FSFI scores across the groups, followed by post-hoc tests to identify significant differences between each pair of groups. Results The mean FSFI scores were significantly lower in the POI and PCOS groups compared to the Control group ( p < 0.05). Women with POI and PCOS exhibited higher incidences of anxiety and depression. Significant differences were observed in arousal ability, vaginal lubricity, and satisfaction scores among the groups, with the Control group generally scoring higher. The incidence of lubrication disorder was highest in the PCOS group ( p < 0.05). Multivariable-adjusted analyses identified longer infertility duration and higher Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9) scores as significant predictors of sexual dysfunction. Conclusion This study highlights the significant impact of reproductive health conditions such as POI and PCOS on sexual and psychological health. The findings underscore the need for integrated care approaches that address both physical and mental health aspects in women with these conditions. By enhancing our understanding of these relationships, we can improve the quality of life for women affected by POI and PCOS. Clinicians should consider both the physiological and psychological dimensions in their treatment plans to ensure comprehensive care that addresses the full spectrum of patient needs. Polycystic Ovary Syndrome Premature Ovarian Insufficiency Sexual function Infertility Anxiety Depression Introduction Infertility is a significant global health issue, affecting approximately 10–15% of couples of reproductive age[ 1 , 2 ]. Among the myriad causes of infertility, ovarian dysfunction stands out due to its complex interactions with multiple facets of women’s health, including reproductive and sexual function. Ovarian dysfunction encompasses a variety of disorders, each characterized by distinct pathophysiological changes[ 3 ]. The most common among these are Polycystic Ovary Syndrome (PCOS) and Premature Ovarian Insufficiency (POI), which not only challenge a woman's ability to conceive but also significantly impact her sexual health. POI is a condition where the ovaries cease to function before the age of 40, characterized by menopausal symptoms such as irregular or absent periods and elevated follicle-stimulating hormone levels[ 4 ]. Affecting about 1% of women under 40, POI's causes range from genetic factors to autoimmune disorders, with significant long-term health implications including increased risks of osteoporosis and cardiovascular disease[ 5 ]. PCOS is a prevalent endocrine disorder affecting 6–12% of women globally, diagnosed by symptoms such as irregular ovulation, hyperandrogenism, and polycystic ovaries on ultrasound according to the Rotterdam criteria[ 6 ]. This syndrome not only leads to reproductive and metabolic issues like infertility and type 2 diabetes but also increases the risk of cardiovascular diseases, with its underlying causes linked to a mix of genetic and environmental factors[ 7 ]. While the reproductive consequences of ovarian dysfunctions like PCOS and POI are well-documented, there is less clarity on how these conditions affect sexual function. Sexual health is a crucial aspect of overall quality of life, influencing emotional, physical, and psychological well-being[ 8 ]. For women with ovarian dysfunction, issues such as hormonal imbalances, body image disturbances, and the psychological stress of infertility can lead to significant sexual dysfunction. However, detailed insights into the specific impacts of different types of ovarian dysfunctions on sexual function are sparse and fragmented. Exploring sexual function among women with ovarian dysfunctions is crucial for several reasons. First, it provides a deeper understanding of the broader impacts of these conditions beyond fertility alone. Second, it aids in identifying specific needs for sexual health interventions, which are often overlooked in the typical management of ovarian dysfunction. Third, understanding the variations in sexual function across different conditions can inform more personalized approaches to treatment and support for affected women. Previous research has predominantly focused on the reproductive implications of PCOS and POI, with less emphasis on other critical areas like sexual satisfaction and function [ 9 , 10 ]. Studies that do address sexual function often fail to compare different types of ovarian dysfunction, thereby missing out on potential nuances in their impacts on sexual health. Given these gaps and the critical importance of sexual health, this study aims to evaluate and compare sexual function in women diagnosed with PCOS, POI, and those with normal ovarian function using the Female Sexual Function Index (FSFI). Furthermore, doctors can provide evidence-based recommendations for addressing sexual health in the management of women with ovarian dysfunctions. By addressing these objectives, we aim to enhance the understanding of sexual health impacts associated with ovarian dysfunctions and improve clinical care for affected women. Materials and Methods Study Design and Setting This case-control study was conducted at the Reproductive Medical Centre of Shengjing Hospital affiliated with China Medical University. The study involved a survey of female sexual function and psychological health among patients with infertility. Participants Inclusion Criteria: age range from 20 to 45 years. This range includes women of reproductive age, allowing comprehensive assessment of gynecological and reproductive health issues. PCOS was diagnosed based on the Rotterdam criteria, requiring two of the following three to be present: oligo/anovulation, clinical/biochemical signs of hyperandrogenism, and polycystic ovaries. POI was defined by the cessation of ovarian function before the age of 40, including symptoms like irregular or absent periods and elevated FSH levels. Control group included women with normal ovarian function, and infertility reason due to tubal factors. Exclusion Criteria: females diagnosed with: endometriosis; diabetes; high blood pressure; lower genital tract abnormalities; genitourinary infections; genital prolapse; participants whose partners had severe male infertility or were diagnosed with sexual dysfunction. Presence of psychiatric conditions that could cause sexual dysfunction. Use of drugs affecting sexual function (e.g., selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors). Women with a total FSFI score < 8, as this implies insufficient sexual activity. Participants who did not complete the questionnaire or provided inconsistent answers (e.g., selecting “did not attempt intercourse” in one question but not in others). Assessment Tools Female Sexual Function Index (FSFI): The FSFI serves as a validated and comprehensive instrument for assessing female sexual function across six domains: desire, arousal, lubrication, orgasm, satisfaction, and coital pain. It includes 19 items, specifically designed to evaluate the individual's sexual health status over the previous four weeks. Each domain's score ranges between 1.2 to 6, with some domains allowing a minimum score of 0, culminating in a total possible score ranging from 2 to 36[ 11 ]. The FSFI demonstrates robust psychometric properties, evidenced by a Cronbach’s alpha of ≥ 0.82, underscoring its reliability across various populations, including those with gynecological disorders. In a Chinese cohort, a total FSFI score of ≤ 23.45 is indicative of potential sexual dysfunction[ 12 ]. Specific domain-related cut-off scores are as follows: ≤ 2.7 for low sexual desire, ≤ 3.15 for arousal disorder, ≤ 4.05 for lubrication disorder, ≤ 3.8 for orgasm disorder, and ≤ 3.8 for sexual pain[ 12 , 13 ]. These thresholds aid clinicians and researchers in diagnosing and evaluating the severity of sexual dysfunction among women. General Anxiety Disorder-7 (GAD-7): The GAD-7 is a concise and effective self-administered questionnaire designed to assess general anxiety symptoms. Renowned for its robust psychometric properties, the GAD-7 is widely used in clinical and research settings to screen for and monitor Generalized Anxiety Disorder (GAD). It features seven items, each scored on a 4-point Likert scale from 0 (not at all) to 3 (nearly every day), allowing for a total score range of 0 to 21. The scoring is categorized as follows: 0–4 for minimal anxiety, 5–9 for mild anxiety, 10–14 for moderate anxiety, and 15–21 for severe anxiety[ 14 ]. A score of 10 or above typically suggests moderate anxiety and warrants further assessment for GAD, while scores of 15 or higher indicate severe anxiety, necessitating comprehensive evaluation and possibly more intensive treatment. Due to its simplicity and reliability, the GAD-7 is an invaluable tool for quickly identifying anxiety levels and is suitable for use in various settings including primary care and psychiatric evaluations. Patient Health Questionnaire-9 (PHQ-9): The PHQ-9 is a widely used tool designed to assess the presence and severity of depression symptoms, recognized for its reliability, validity, and efficiency in screening across diverse populations. Comprising nine items that align with the DSM diagnostic criteria for major depressive disorder, the PHQ-9 prompts respondents to rate the frequency of depressive symptoms over the past two weeks on a four-point scale from 0 (not at all) to 3 (nearly every day), with total scores ranging from 0 to 27[ 15 ]. These scores categorize depression severity from minimal (0–4) to severe (20–27). A score of 10 or higher suggests probable major depressive disorder, indicating the need for further clinical evaluation and potential treatment. The PHQ-9's straightforward administration makes it ideal for various settings, including primary care and mental health clinics, and its successful application in similar populations underscores its effectiveness as a diagnostic and monitoring tool for depression. Statistical Analysis Data analysis was carried out using SPSS software (version 22.0; SPSS Inc., Chicago, IL, USA). Categorical variables were summarized with counts (n) and percentages (%), and continuous variables were described using counts, means, and standard deviations (SDs). The chi-square test was utilized to compare categorical variables, while one-way analysis of variance (ANOVA) was employed to analyze numerical data across three groups: PCOS, POI, and controls. This approach is particularly effective for assessing multiple comparisons, with ANOVA detecting significant differences in scores from tools like FSFI, GAD-7, and PHQ-9. Subsequent post-hoc analyses, such as Tukey’s HSD, were performed to pinpoint differences among the groups. Moreover, multivariable logistic regression was used to explore the factors affecting sexual function and related disorders, including desire, arousal, lubrication, orgasm, and coital pain. To assess the relationship between sexual function scores and psychological health, correlation coefficients (either Pearson or Spearman, based on data distribution) were calculated. Statistical significance was established at a two-tailed p -value of less than 0.05, and results were reported including p-values, odds ratios (OR), and 95% confidence intervals (CI). Results Participant Demographics and Characteristics A total of 340 participants were included in the study, divided into three groups: Premature Ovarian Insufficiency (POI) (n = 68), Polycystic Ovary Syndrome (PCOS) (n = 104), and Control (n = 168). The demographic characteristics of the participants are summarized in Table 1 . The mean age of participants in the POI group was 32.87 ± 3.97 years, in the PCOS group was 33.39 ± 4.19 years, and in the Control group was 32.74 ± 4.45 years. Statistical analysis revealed no significant difference in age among the three groups ( p > 0.05). The mean BMI was 23.88 ± 3.29 kg/m² in the POI group, 23.12 ± 3.33 kg/m² in the PCOS group, and 23.67 ± 3.33 kg/m² in the Control group. The differences in BMI among the groups were not statistically significant ( p > 0.05). Similarly, there were no significant differences in infertility duration among the groups ( p > 0.05). Smoking status, annual income, education level, stress levels, physical exercise frequency, and alcohol consumption also showed no significant differences between the groups ( p > 0.05). These findings indicate that the demographic characteristics were comparable across the study groups. Table 1 Demographic characteristics of the study participants (n = 340) Characteristics POI (n = 68) PCOS (n = 104) Control (n = 168) P - value Mean ± SD / n (%) Mean ± SD / n (%) Mean ± SD / n (%) Age (years) 32.87 ± 3.97 33.39 ± 4.19 32.74 ± 4.45 0.466 BMI (kg/m 2 ) 23.88 ± 3.29 23.12 ± 3.33 23.67 ± 3.33 0.269 Infertility duration 4.72 ± 3.43 3.94 ± 3.17 a 3.74 ± 2.69 0.075 Smoking status: 0.125 Smoker 7 (10.3) 6 (5.8) 6 (3.6) Non-smoker 61 (89.7) 98 (94.2) 162 (96.4) Annual income (ten thousand yuan) 0.067 20 0 9 (8.7) 14 (8.3) Education 0.571 ≤ High school 27 (39.7) 32 (30.8) 58 (34.8) College 18 (26.5) 21 (20.2) 41 (24.4) undergraduate 20 (29.4) 41 (39.4) 54 (32.1) ≥ Postgraduate 3 (4.4) 10 (9.6) 15 (8.9) Stress in work and life 0.383 Very high 4 (5.9) 7 (6.7) 13 (7.7) High 8 (11.8) 23 (22.1) 33 (19.6) General 42 (61.8) 50 (48.1) 83 (49.4) Low 9 (13.2) 21 (20.2) 26 (15.5) None 5 (7.4) 3 (2.9) 13 (7.7) Physical exercise frequency 0.738 None 23 (33.8) 30 (28.8) 54 (32.1) < 1 time a week 26 (38.2) 46 (44.2) 58 (34.5) 1 time a week 10 (14.7) 12 (11.5) 24 (14.3) ≥ 2 times a week 9 (13.2) 16 (15.4) 32 (19.0) Drinking alcohol 0.163 Usually 1 (1.5) 0 0 Sometimes 3 (4.4) 8 (7.7) 11 (6.5) Rarely 23 (33.8) 45 (43.3) 53 (31.5) Never 41 (60.3) 51 (49.0) 104 (61.9) Data was described as mean ± SD or n (%). Abbreviations: SD, standard deviation; BMI, body mass index Table 2 Female psychological health among patients with different ovarian function POI (n = 68) PCOS (n = 104) Control (n = 168) P -value Mean ± SD / n (%) Mean ± SD / n (%) Mean ± SD / n (%) GAD-7 score 6.09 ± 2.16 5.93 ± 2.53 6.08 ± 2.41 0.872 Incidence of anxiety 0.059 Minimal 1(1.5) 11(10.6) 27(16.1) Mild 54(79.4) 74(71.2) 110(65.5) Moderate 10(14.7) 17(16.3) 28(16.7) Moderately-Severe 3(4.4) 2(1.9) 3(1.8) PHQ − 9 score 7.93 ± 2.71 7.46 ± 3.16 7.35 ± 3.01 0.407 Incidence of depression 0.048* Minimal 9 (13.2) 23(22.1) 51 (30.4) Mild 54(79.4) 77(74.0) 105(62.5) Moderate 5(7.4) 2(1.9) 9(5.4) Moderately-Severe 0 2(1.9) 3(1.8) Psychological Health Outcomes The study assessed psychological health using the Generalized Anxiety Disorder 7-item (GAD-7) scale and the Patient Health Questionnaire 9-item (PHQ-9) scale. The mean GAD-7 scores were 6.09 ± 2.16 for the POI group, 5.93 ± 2.53 for the PCOS group, and 6.08 ± 2.41 for the Control group, with no significant differences ( p > 0.05). The incidence of anxiety showed some variation, with minimal anxiety being reported by 1.5% of the POI group, 10.6% of the PCOS group, and 16.1% of the Control group, but these differences were not statistically significant ( p > 0.05). The mean PHQ-9 scores were 7.93 ± 2.71 for the POI group, 7.46 ± 3.16 for the PCOS group, and 7.35 ± 3.01 for the Control group, also showing no significant differences ( p > 0.05). However, there was a significant difference in the incidence of depression, with minimal depression reported by 13.2% of the POI group, 22.1% of the PCOS group, and 30.4% of the Control group ( p < 0.05). These findings indicate that while anxiety levels were similar across groups, depression incidence varied significantly among women with different infertility diagnoses. Sexual Health Outcomes The sexual health of the study participants was assessed using the FSFI. The results are summarized in Table 3 . The mean frequency of sexual life per month was 4.76 ± 3.00 times for the POI group, 4.89 ± 2.82 times for the PCOS group, and 4.93 ± 2.78 times for the Control group, with no significant difference among the groups ( p > 0.05). The mean FSFI scores were 26.00 ± 3.50 for the POI group, 26.13 ± 4.50 for the PCOS group, and 27.37 ± 3.24 for the Control group. There was a significant difference in FSFI scores among the groups ( p < 0.05), with the Control group having higher scores. Sexual dysfunction was reported by 20.6% of the POI group, 19.2% of the PCOS group, and 13.7% of the Control group, with no significant differences among the groups ( p > 0.05). The mean sexual desire scores were 3.19 ± 0.72 for the POI group, 3.28 ± 0.87 for the PCOS group, and 3.40 ± 0.72 for the Control group, showing no significant differences ( p > 0.05). The incidence of low sexual desire was 29.4% in the POI group, 24.0% in the PCOS group, and 17.9% in the Control group ( p > 0.05). The mean arousal ability scores were 3.83 ± 0.87 for the POI group, 3.92 ± 1.01 for the PCOS group, and 4.14 ± 0.87 for the Control group, with significant differences ( p < 0.05). The incidence of arousal disorder was 23.5% in the POI group, 22.1% in the PCOS group, and 12.5% in the Control group, indicating significant differences ( p < 0.05). The mean vaginal lubricity scores were 5.20 ± 0.71 for the POI group, 4.92 ± 0.97 for the PCOS group, and 5.23 ± 0.71 for the Control group, showing significant differences ( p < 0.05). The incidence of lubrication disorder was significantly different among the groups, with 4.4% in the POI group, 19.2% in the PCOS group, and 5.4% in the Control group ( p 0.05). The incidence of orgasm disorder was 26.5% in the POI group, 23.1% in the PCOS group, and 14.9% in the Control group ( p > 0.05). The mean satisfaction scores were 4.44 ± 0.84 for the POI group, 4.61 ± 0.97 for the PCOS group, and 4.79 ± 0.85 for the Control group, showing significant differences ( p 0.05). The incidence of coital pain was significantly different among the groups, with 10.3% in the POI group, 16.3% in the PCOS group, and 6.0% in the Control group ( p < 0.05). Table 3 Female sexual health of the study participants (n = 340) POI (n = 68) PCOS (n = 104) Control (n = 168) P -value Mean ± SD / n (%) Mean ± SD / n (%) Mean ± SD / n (%) Sexual life frequency (per month) 4.76 ± 3.00 4.89 ± 2.82 4.93 ± 2.78 0.917 FSFI score 26.00 ± 3.50 26.13 ± 4.50 a 27.37 ± 3.24 b 0.006 Incidence of sexual dysfunction 14 (20.6) 20 (19.2) 23 (13.7) 0.316 Sexual desire score 3.19 ± 0.72 3.28 ± 0.87 3.40 ± 0.72 0.149 Incidence of low desire 20 (29.4) 25 (24.0) 30 (17.9) 0.129 Arousal ability score 3.83 ± 0.87 3.92 ± 1.01 a 4.14 ± 0.87 b 0.023 Incidence of arousal disorder 16 (23.5) 23 (22.1) 21 (12.5) 0.047 Vaginal lubricity score 5.20 ± 0.71 4.92 ± 0.97 a 5.23 ± 0.71 c 0.007 Incidence of lubrication disorder 3 (4.4) 20 (19.2) 9 (5.4) 0.000 Orgasm score 4.48 ± 0.93 4.48 ± 1.02 4.71 ± 0.92 0.099 Incidence of orgasm disorder 18 (26.5) 24 (23.1) 25 (14.9) 0.075 Satisfaction score 4.44 ± 0.84 4.61 ± 0.97 a 4.79 ± 0.85 0.017 Coital pain score 4.86 ± 0.86 4.92 ± 1.02 5.10 ± 0.76 0.102 Incidence of coital pain 7 (10.3) 17 (16.3) 10 (6.0) 0.021 FSFI: Female Sexual Function Index Table 4 Factors associated with sexual dysfunction, multivariable-adjusted odds ratios and 95% confidence intervals. Independent variable Arousal disorder Coital pain Lubrication disorder Sexual dysfunction Infertility diagnosis Control 1.00 1.00 1.00 1.00 POI 0.507 (0.237-1.086) P=0.080 0.319 (0.121-0.839) P=0.021* 0.203 (0.077-0.532) P=0.001** 0.744 (0.325-1.702) P=0.484 PCOS 1.122 (0.475-2.648) P=0.793 0.444 (0.143-1.378) P=0.160 0.117 (0.027-0.512) P=0.004** 1.135 (0.435-2.963) P=0.796 Age (years) 1.078 (0.989-1.175) P=0.089 1.038 (0.926-1.164) P=0.519 1.013 (0.905-1.135) P=0.820 1.085 (0.988-1.193) P=0.089 Body mass index 0.965 (0.868-1.074) P=0.518 1.028 (0.895-1.181) P=0.692 0.987 (0.858-1.136) P=0.856 1.034 (0.921-1.161) P=0.574 Income level 1.128 (0.854-1.488) P=0.396 0.825 (0.555-1.228) P=0.344 0.937 (0.649-1.355) P=0.730 1.018 (0.746-1.391) P=0.909 Infertility duration 0.688 (0.583-0.814) P=0.000** 0.661 (0.526-0.831) P=0.000** 0.753 (0.608-0.933) P=0.009** 0.573 (0.466-0.705) P=0.000** Sexual life frequency (per month) 1.042 (0.920-1.181) P=0.515 1.003 (0.850-1.182) P=0.975 0.764 (0.621-0.940) P=0.011* 0.971 (0.841-1.121) P=0.685 Education level 0.775 (0.545-1.104) P=0.158 1.068 (0.680-1.678) P=0.775 0.751 (0.469-1.203) P=0.233 0.823 (0.562-1.205) P=0.317 Stress level 0.798 (0.553-1.151) P=0.226 1.155 (0.742-1.798) P=0.524 0.818 (0.515-1.301) P=0.397 0.764 (0.514-1.137) P=0.185 Physical exercise frequency 1.183 (0.852-1.643) P=0.315 1.182 (0.773-1.809) P=0.440 1.028 (0.670-1.578) P=0.900 1.004 (0.697-1.447) P=0.982 Smoking status 0.384 (0.086-1.720) P=0.211 0.030 (0.002-0.358) P=0.006** 0.109 (0.013-0.946) P=0.044* 0.083 (0.013-0.526) P=0.008* Drinking status 1.297 (0.748-2.248) P=0.355 0.348 (0.178-0.679) P=0.002** 0.699 (0.355-1.375) P=0.300 0.943 (0.522-1.703) P=0.846 GAD-7 0.343 (0.205-0.576) P=0.000** 0.265 (0.132-0.531) P=0.000** 0.495 (0.256-0.957) P=0.037* 0.206 (0.112-0.381) P=0.000** PHQ-9 3.478 (2.188-5.531) P=0.000** 4.307(2.294-8.087) P=0.000** 2.463 (1.380-4.397) P=0.002** 5.916 (3.330-10.510) P=0.000** * p < 0.05, ** p < 0.01 Factors Associated with Sexual Dysfunction The multivariable-adjusted analysis identified several factors associated with sexual dysfunction among the study participants. Compared to the control group, women with POI had a significantly lower risk of coital pain (OR = 0.319, p < 0.05) and lubrication disorder (OR = 0.203, p < 0.05). Women with Polycystic Ovary Syndrome (PCOS) also had a significantly lower risk of lubrication disorder (OR = 0.117, p < 0.05). Longer infertility duration was associated with a lower risk of arousal disorder (OR = 0.688, p < 0.05), coital pain (OR = 0.661, p < 0.05), lubrication disorder (OR = 0.753, p < 0.05), and overall sexual dysfunction (OR = 0.573, p < 0.05). Additionally, higher GAD-7 scores were significantly associated with an increased risk of all forms of sexual dysfunction, including arousal disorder (OR = 0.343, p < 0.05), coital pain (OR = 0.265, p < 0.05), lubrication disorder (OR = 0.495, p < 0.05), and overall sexual dysfunction (OR = 0.206, p < 0.05). Similarly, higher PHQ-9 scores were significantly associated with an increased risk of arousal disorder (OR = 3.478, p < 0.05), coital pain (OR = 4.307, p < 0.05), lubrication disorder (OR = 2.463, p < 0.05), and overall sexual dysfunction (OR = 5.916, p < 0.05). Other factors such as age, BMI, income level, education level, stress level, physical exercise frequency, smoking status, and drinking status did not show significant associations with sexual dysfunction ( p > 0.05). Discussion This study investigated the sexual and psychological health of women with POI, PCOS, and normal ovarian function (Control). Our findings indicate that overall sexual function, as measured by the FSFI, was significantly lower in women with POI and PCOS compared to the control group. Additionally, women with POI and PCOS exhibited higher incidences of anxiety and depression. Several factors, including the duration of infertility and psychological health metrics, were significantly associated with sexual dysfunction. Our results align with previous studies that have reported compromised sexual function in women with reproductive health issues. In our study, we found that patients in the POI group had the lowest total FSFI scores, accompanied by arousal disorders and the lowest scores for sexual satisfaction. A newly systematic review and meta-analysis indicated that women with POI experience substantial sexual dysfunction, including reduced desire and increased pain during intercourse[ 10 ]. A case-control study in 2019 evaluated the sexual function in 132 women, 66 with POI and 66 with normal ovarian function, it was found that women with POI had significantly lower scores in sexual function compared to controls[ 16 ]. The POI group exhibited substantial impairments in desire, arousal, orgasm, lubrication, and satisfaction, as well as in physical, mental, environmental, and social health[ 16 ]. Our study also found low scores in these domains, supporting the previous conclusion that POI adversely affects sexual function. Our findings are consistent with this, showing that the POI group had the lowest satisfaction scores and significant arousal issues. This alignment suggests a persistent pattern of sexual dissatisfaction and arousal difficulties among women with POI. While Dokras and colleagues reported elevated rates of sexual dysfunction in PCOS[ 17 , 18 ], some studies have found that the severity of sexual dysfunction in POI can be even higher. Our study's finding that POI patients had the lowest FSFI scores aligns with this view. However, POI's impact might be comparable to or less severe than other ovarian dysfunctions under certain conditions, possibly due to differences in study populations or methodologies. Researchers focused on hormonal imbalances in PCOS but also provided insights into POI[ 19 ]. The discrepancy arises in the impact on specific FSFI domains. While Yela et al. noted that lubrication issues were prevalent, our study found that arousal and satisfaction were more significantly affected in POI patients[ 20 ]. These differences could be due to variations in participant demographics, severity of symptoms, or even cultural factors affecting the perception and reporting of sexual health issues. In our study, we found that patients in the PCOS group had lower total FSFI scores compared to the control group, with significant vaginal lubrication disorders. Several studies reported elevated rates of sexual dysfunction in women with PCOS, specifically highlighting issues such as decreased desire and lubrication problems[ 17 , 18 , 21 , 22 ]. Our findings are consistent with these results, showing significantly lower FSFI scores in the PCOS group, particularly in the domain of vaginal lubrication. This alignment reinforces the understanding that PCOS negatively impacts multiple aspects of sexual function, including lubrication. Hormonal imbalances, such as elevated androgen levels in PCOS, contribute to sexual dysfunction, including lubrication issues[ 23 ]. Our study supports this mechanism, with significant lubrication disorders observed in the PCOS group, suggesting that hormonal disruptions play a critical role in the sexual health challenges experienced by women with PCOS. Veltman-Verhulst et al. highlighted the high prevalence of anxiety and depression in women with PCOS, which are known to exacerbate sexual dysfunction[ 24 ]. Our findings that women with PCOS exhibited higher incidences of anxiety and depression align with this study, indicating that psychological distress is a significant factor contributing to sexual dysfunction in PCOS patients. However, some studies have reported less severe sexual dysfunction in PCOS patients, suggesting that the impact might vary based on factors such as age, body mass index (BMI), and the presence of comorbid conditions[ 25 ]. Our study found significant sexual dysfunction in PCOS patients, particularly in lubrication, which may indicate a more severe impact or differences in the study population. While Eftekhar et al. found significant issues in sexual desire and satisfaction in women with PCOS[ 2 ], our study highlighted lubrication disorders as particularly prominent. This discrepancy could arise from differences in the demographic characteristics of the study populations, variations in the diagnostic criteria for PCOS, or differences in cultural attitudes towards reporting sexual health issues. Veltman-Verhulst et al highlighted the high prevalence of anxiety and depression in women with infertility issues, including those with PCOS and POI[ 24 ]. Our results, showing higher GAD-7 and PHQ-9 scores in the POI and PCOS groups, align with these findings. The strong correlation between psychological distress and sexual dysfunction in our study further emphasizes the need to address mental health in managing sexual dysfunction in these populations. Researcher demonstrated that awareness and education about POI could mitigate some of the psychological distress and improve sexual function[ 26 ]. Our findings suggest that comprehensive care, including psychological support, is essential for improving sexual health outcomes in women with POI and PCOS. Dong et al. indicated that the duration of infertility negatively impacts sexual health, with longer durations associated with greater sexual dysfunction[ 8 ]. Our study found a similar trend, where longer infertility duration was significantly associated with lower FSFI scores and higher levels of anxiety and depression, indicating that prolonged infertility exacerbates both sexual and psychological distress. The lower FSFI scores in women with POI and PCOS suggest that these conditions significantly impair sexual function. The significant differences in arousal ability, vaginal lubricity, and satisfaction scores between the groups underscore the multifaceted nature of sexual dysfunction in these populations. The high incidence of lubrication disorder, particularly in women with PCOS, may be attributed to hormonal imbalances typical of this condition, affecting vaginal health and sexual comfort. Moreover, the strong associations between psychological health measures (GAD-7 and PHQ-9 scores) and sexual dysfunction highlight the interdependence of mental and sexual health. Anxiety and depression were found to be strong predictors of sexual dysfunction, suggesting that addressing psychological well-being is crucial in the management of sexual health issues in women with reproductive health disorders. This interrelation points to a need for comprehensive care that integrates mental health support with traditional reproductive health treatments. These findings have significant clinical implications. Healthcare providers should adopt a holistic approach when managing women with POI and PCOS, addressing both physical and psychological aspects of health. Routine screening for sexual dysfunction and mental health issues should be integrated into clinical practice for women with these conditions. Interventions such as counseling, cognitive-behavioral therapy, and appropriate medical treatments should be considered to improve overall well-being. Furthermore, patient education about the potential sexual and psychological impacts of POI and PCOS can empower women to seek help and advocate for their health. Developing tailored treatment plans that address individual needs and preferences can enhance the effectiveness of interventions and improve patient outcomes. This study boasts several strengths, including its pioneering comparison of sexual and psychological health among patients with varying ovarian functions. It features a well-defined participant group and employs validated assessment tools such as the FSFI, GAD-7, and PHQ-9. The case-control design of the study allowed for a detailed snapshot of the sexual and psychological health conditions affecting women with POI, PCOS, and normal ovarian function, providing valuable insights into the interrelations of these variables. However, there are limitations to consider. The self-reported nature of the questionnaires may introduce response bias, as participants may underreport or overreport their symptoms. Additionally, the study population, being recruited from specialized reproductive clinics, may not be representative of the general population, limiting the generalizability of our findings. Future research should focus on longitudinal studies to explore the causal relationships between reproductive health conditions and sexual dysfunction. Such studies could provide valuable insights into the progression of sexual and psychological health issues over time and identify critical intervention points. Interventional studies are also needed to evaluate the effectiveness of various treatment strategies in improving sexual and psychological health in these populations. Expanding research to include a more diverse population, including women from different socioeconomic backgrounds and ethnicities, can help generalize findings and develop tailored interventions for different demographic groups. Additionally, qualitative studies exploring women's personal experiences with POI and PCOS can provide deeper insights into the impact of these conditions on their lives and inform more empathetic and patient-centered care approaches. Conclusion This study highlights the significant impact of reproductive health conditions such as POI and PCOS on sexual and psychological health. The findings underscore the need for integrated care approaches that address both physical and mental health aspects in women with these conditions. By enhancing our understanding of these relationships, we can improve the quality of life for women affected by POI and PCOS. Clinicians should consider both the physiological and psychological dimensions of these conditions in their treatment plans, ensuring comprehensive care that addresses the full spectrum of patient needs. Declarations Acknowledgement: None Author contributions All authors have seen and approved the final version of this article. DM: designed and executed the study, gathered, analysed and interpreted the data, drafted the manuscript, and contributed to the critical discussion. LYY, LYN, WYX: recruited patients, analysed and interpreted the data and contributed to the critical discussion. TJC: acted as the supervisor, contributed to the study design, study execution, critical discussion, revised the manuscript, and approved of the final submitted version. Funding This study was granted from the Natural Science Foundation of Liaoning Province(2022-MS-185), Basic Research Projects for Higher Educational Institutions in Liaoning Province (JYTMS20230094), and the 345 Talent Project of Shengjing Hospital. Availability of data and material The datasets used and/or analyzed during the current study are available from the first author on reasonable request. Ethical approval This study was approved by the Shengjing Hospital Institutional Review Board for Research on Human Subjects (2021PS018F). Consent for publication All the authors in this paper consent to publication of the work. Conflict of interest All authors have no conflicts of interest to declare. Code availability Not applicable. References Wu, H.M., et al., Lead level in seminal plasma may affect semen quality for men without occupational exposure to lead. Reprod Biol Endocrinol, 2012. 10 : p. 91. Eftekhar, T., et al., Sexual dysfunction in patients with polycystic ovary syndrome and its affected domains. Iran J Reprod Med, 2014. 12 (8): p. 539-46. Swart, A.C., et al., Steroid hormone analysis of adolescents and young women with polycystic ovarian syndrome and adrenocortical dysfunction using UPC(2)-MS/MS. Pediatr Res, 2021. 89 (1): p. 118-126. McGlacken-Byrne, S.M. and G.S. Conway, Premature ovarian insufficiency. Best Pract Res Clin Obstet Gynaecol, 2022. 81 : p. 98-110. Chon, S.J., Z. Umair, and M.S. Yoon, Premature Ovarian Insufficiency: Past, Present, and Future. Front Cell Dev Biol, 2021. 9 : p. 672890. Liu, X., J. Zhang, and S. Wang, Global, regional, and national burden of infertility attributable to PCOS, 1990-2019. Hum Reprod, 2024. 39 (1): p. 108-118. Yadav, S., et al., Direct economic burden of mental health disorders associated with polycystic ovary syndrome: Systematic review and meta-analysis. Elife, 2023. 12 . Dong, M., et al., Impact of infertility duration on female sexual health. Reprod Biol Endocrinol, 2021. 19 (1): p. 157. Aydin, S., et al., The Role of Premature Ovarian Failure Awareness in Female Sexual Functions and Distress. J Sex Marital Ther, 2017. 43 (4): p. 354-360. van Zwol-Janssens, C., et al., Sexual function in women with premature ovarian insufficiency (POI): Systematic review and meta-analysis. Maturitas, 2024: p. 107994. Rosen, R., et al., The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther, 2000. 26 (2): p. 191-208. Lo, S.S. and W.M. Kok, Prevalence and Risk Factors for Sexual Problems and Distress in Chinese Unmarried Young Women: An Observational Study. J Sex Med, 2018. 15 (11): p. 1620-1628. Ma, J., et al., Prevalence of female sexual dysfunction in urban chinese women based on cutoff scores of the Chinese version of the female sexual function index: a preliminary study. J Sex Med, 2014. 11 (4): p. 909-919. Lowe, B., et al., Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Med Care, 2008. 46 (3): p. 266-74. Kroenke, K., R.L. Spitzer, and J.B. Williams, The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med, 2001. 16 (9): p. 606-13. Javadpour, S., et al., Assessment of premature menopause on the sexual function and quality of life in women. Gynecol Endocrinol, 2021. 37 (4): p. 307-311. Pastoor, H., et al., Sexual function in women with polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update, 2024. 30 (3): p. 323-340. Steinberg Weiss, M., et al., Lifestyle modifications alone or combined with hormonal contraceptives improve sexual dysfunction in women with polycystic ovary syndrome. Fertil Steril, 2021. 115 (2): p. 474-482. Daan, N.M., et al., Androgen levels in women with various forms of ovarian dysfunction: associations with cardiometabolic features. Hum Reprod, 2015. 30 (10): p. 2376-86. Yela, D.A., P.M. Soares, and C.L. Benetti-Pinto, Influence of Sexual Function on the Social Relations and Quality of Life of Women with Premature Ovarian Insufficiency. Rev Bras Ginecol Obstet, 2018. 40 (2): p. 66-71. Akbari Sene, A., et al., Differences in and Correlates of Sexual Function in Infertile Women with and without Polycystic Ovary Syndrome. Int J Fertil Steril, 2021. 15 (1): p. 65-72. Nohr, E.A., et al., Sexual health in parous women with a history of polycystic ovary syndrome: A national cross-sectional study in Denmark. Int J Gynaecol Obstet, 2022. 157 (3): p. 702-709. Ercan, C.M., et al., Sexual dysfunction assessment and hormonal correlations in patients with polycystic ovary syndrome. Int J Impot Res, 2013. 25 (4): p. 127-32. Veltman-Verhulst, S.M., et al., Emotional distress is a common risk in women with polycystic ovary syndrome: a systematic review and meta-analysis of 28 studies. Hum Reprod Update, 2012. 18 (6): p. 638-51. Aversa, A., et al., Fundamental Concepts and Novel Aspects of Polycystic Ovarian Syndrome: Expert Consensus Resolutions. Front Endocrinol (Lausanne), 2020. 11 : p. 516. Ates, S., et al., Sleep, depression, anxiety and fatigue in women with premature ovarian insufficiency. J Psychosom Obstet Gynaecol, 2022. 43 (4): p. 482-487. Additional Declarations No competing interests reported. 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. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4464614","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":309932647,"identity":"35e37bf2-d96a-4a57-b24a-a5f3c8829227","order_by":0,"name":"Meng Dong","email":"","orcid":"","institution":"Shengjing Hospital of China Medical University","correspondingAuthor":false,"prefix":"","firstName":"Meng","middleName":"","lastName":"Dong","suffix":""},{"id":309932648,"identity":"f3544da8-a612-49e1-999a-c2e29c0242ed","order_by":1,"name":"Yiyang Li","email":"","orcid":"","institution":"Shengjing Hospital of China Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yiyang","middleName":"","lastName":"Li","suffix":""},{"id":309932649,"identity":"7886f8b7-3e38-43f0-bf06-4f27a5880fdb","order_by":2,"name":"Yining Li","email":"","orcid":"","institution":"Shengjing Hospital of China Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yining","middleName":"","lastName":"Li","suffix":""},{"id":309932650,"identity":"e8b9c35c-76b2-4dde-bcf1-092114a95e85","order_by":3,"name":"Yixian Wang","email":"","orcid":"","institution":"Shengjing Hospital of China Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yixian","middleName":"","lastName":"Wang","suffix":""},{"id":309932651,"identity":"fc634ab5-2dd5-4b24-85be-03897ec9ea16","order_by":4,"name":"Jichun Tan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAsklEQVRIie3SMQrCQBBA0VkWtBnZNgMeYsFCAsFcJSBYeYiBwJ4hXkQsJwRSBT1Aylxggxcw6AXGTnBftcV8loEBSJKfJADEBTrHygA/yWlLjaiTheGu8Fwpk9J0U8xvD/QgJs5n1S+99zSMuLds6XJVJQNUFEbMWVZ2o02Ewh29VPrEMAX5JpF+BxSOSE1b63ZZN930pHAonavbOGsSyARs9n4Z1swvljsxUTmbJEnyp16dFDW4FplW9QAAAABJRU5ErkJggg==","orcid":"","institution":"Shengjing Hospital of China Medical University","correspondingAuthor":true,"prefix":"","firstName":"Jichun","middleName":"","lastName":"Tan","suffix":""}],"badges":[],"createdAt":"2024-05-23 06:25:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4464614/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4464614/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":59991684,"identity":"a5c52698-725d-4568-b4a2-cd162c6cedac","added_by":"auto","created_at":"2024-07-10 08:39:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":746590,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4464614/v1/ac53700a-e1e9-4025-a37c-5b6352cc4644.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparative Analysis of Sexual Function and Psychological Health in Infertile Patients with Different Ovarian Dysfunctions","fulltext":[{"header":"Introduction","content":"\u003cp\u003eInfertility is a significant global health issue, affecting approximately 10\u0026ndash;15% of couples of reproductive age[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Among the myriad causes of infertility, ovarian dysfunction stands out due to its complex interactions with multiple facets of women\u0026rsquo;s health, including reproductive and sexual function. Ovarian dysfunction encompasses a variety of disorders, each characterized by distinct pathophysiological changes[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The most common among these are Polycystic Ovary Syndrome (PCOS) and Premature Ovarian Insufficiency (POI), which not only challenge a woman's ability to conceive but also significantly impact her sexual health.\u003c/p\u003e \u003cp\u003ePOI is a condition where the ovaries cease to function before the age of 40, characterized by menopausal symptoms such as irregular or absent periods and elevated follicle-stimulating hormone levels[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Affecting about 1% of women under 40, POI's causes range from genetic factors to autoimmune disorders, with significant long-term health implications including increased risks of osteoporosis and cardiovascular disease[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. PCOS is a prevalent endocrine disorder affecting 6\u0026ndash;12% of women globally, diagnosed by symptoms such as irregular ovulation, hyperandrogenism, and polycystic ovaries on ultrasound according to the Rotterdam criteria[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This syndrome not only leads to reproductive and metabolic issues like infertility and type 2 diabetes but also increases the risk of cardiovascular diseases, with its underlying causes linked to a mix of genetic and environmental factors[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. While the reproductive consequences of ovarian dysfunctions like PCOS and POI are well-documented, there is less clarity on how these conditions affect sexual function. Sexual health is a crucial aspect of overall quality of life, influencing emotional, physical, and psychological well-being[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. For women with ovarian dysfunction, issues such as hormonal imbalances, body image disturbances, and the psychological stress of infertility can lead to significant sexual dysfunction. However, detailed insights into the specific impacts of different types of ovarian dysfunctions on sexual function are sparse and fragmented.\u003c/p\u003e \u003cp\u003eExploring sexual function among women with ovarian dysfunctions is crucial for several reasons. First, it provides a deeper understanding of the broader impacts of these conditions beyond fertility alone. Second, it aids in identifying specific needs for sexual health interventions, which are often overlooked in the typical management of ovarian dysfunction. Third, understanding the variations in sexual function across different conditions can inform more personalized approaches to treatment and support for affected women. Previous research has predominantly focused on the reproductive implications of PCOS and POI, with less emphasis on other critical areas like sexual satisfaction and function [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Studies that do address sexual function often fail to compare different types of ovarian dysfunction, thereby missing out on potential nuances in their impacts on sexual health.\u003c/p\u003e \u003cp\u003eGiven these gaps and the critical importance of sexual health, this study aims to evaluate and compare sexual function in women diagnosed with PCOS, POI, and those with normal ovarian function using the Female Sexual Function Index (FSFI). Furthermore, doctors can provide evidence-based recommendations for addressing sexual health in the management of women with ovarian dysfunctions. By addressing these objectives, we aim to enhance the understanding of sexual health impacts associated with ovarian dysfunctions and improve clinical care for affected women.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Setting\u003c/h2\u003e \u003cp\u003eThis case-control study was conducted at the Reproductive Medical Centre of Shengjing Hospital affiliated with China Medical University. The study involved a survey of female sexual function and psychological health among patients with infertility.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eInclusion Criteria: age range from 20 to 45 years. This range includes women of reproductive age, allowing comprehensive assessment of gynecological and reproductive health issues. PCOS was diagnosed based on the Rotterdam criteria, requiring two of the following three to be present: oligo/anovulation, clinical/biochemical signs of hyperandrogenism, and polycystic ovaries. POI was defined by the cessation of ovarian function before the age of 40, including symptoms like irregular or absent periods and elevated FSH levels. Control group included women with normal ovarian function, and infertility reason due to tubal factors.\u003c/p\u003e \u003cp\u003eExclusion Criteria: females diagnosed with: endometriosis; diabetes; high blood pressure; lower genital tract abnormalities; genitourinary infections; genital prolapse; participants whose partners had severe male infertility or were diagnosed with sexual dysfunction. Presence of psychiatric conditions that could cause sexual dysfunction. Use of drugs affecting sexual function (e.g., selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors). Women with a total FSFI score\u0026thinsp;\u0026lt;\u0026thinsp;8, as this implies insufficient sexual activity. Participants who did not complete the questionnaire or provided inconsistent answers (e.g., selecting \u0026ldquo;did not attempt intercourse\u0026rdquo; in one question but not in others).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eAssessment Tools\u003c/h2\u003e \u003cp\u003eFemale Sexual Function Index (FSFI): The FSFI serves as a validated and comprehensive instrument for assessing female sexual function across six domains: desire, arousal, lubrication, orgasm, satisfaction, and coital pain. It includes 19 items, specifically designed to evaluate the individual's sexual health status over the previous four weeks. Each domain's score ranges between 1.2 to 6, with some domains allowing a minimum score of 0, culminating in a total possible score ranging from 2 to 36[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The FSFI demonstrates robust psychometric properties, evidenced by a Cronbach\u0026rsquo;s alpha of \u0026ge;\u0026thinsp;0.82, underscoring its reliability across various populations, including those with gynecological disorders. In a Chinese cohort, a total FSFI score of \u0026le;\u0026thinsp;23.45 is indicative of potential sexual dysfunction[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Specific domain-related cut-off scores are as follows: \u0026le; 2.7 for low sexual desire, \u0026le; 3.15 for arousal disorder, \u0026le; 4.05 for lubrication disorder, \u0026le; 3.8 for orgasm disorder, and \u0026le;\u0026thinsp;3.8 for sexual pain[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. These thresholds aid clinicians and researchers in diagnosing and evaluating the severity of sexual dysfunction among women.\u003c/p\u003e \u003cp\u003eGeneral Anxiety Disorder-7 (GAD-7): The GAD-7 is a concise and effective self-administered questionnaire designed to assess general anxiety symptoms. Renowned for its robust psychometric properties, the GAD-7 is widely used in clinical and research settings to screen for and monitor Generalized Anxiety Disorder (GAD). It features seven items, each scored on a 4-point Likert scale from 0 (not at all) to 3 (nearly every day), allowing for a total score range of 0 to 21. The scoring is categorized as follows: 0\u0026ndash;4 for minimal anxiety, 5\u0026ndash;9 for mild anxiety, 10\u0026ndash;14 for moderate anxiety, and 15\u0026ndash;21 for severe anxiety[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. A score of 10 or above typically suggests moderate anxiety and warrants further assessment for GAD, while scores of 15 or higher indicate severe anxiety, necessitating comprehensive evaluation and possibly more intensive treatment. Due to its simplicity and reliability, the GAD-7 is an invaluable tool for quickly identifying anxiety levels and is suitable for use in various settings including primary care and psychiatric evaluations.\u003c/p\u003e \u003cp\u003ePatient Health Questionnaire-9 (PHQ-9): The PHQ-9 is a widely used tool designed to assess the presence and severity of depression symptoms, recognized for its reliability, validity, and efficiency in screening across diverse populations. Comprising nine items that align with the DSM diagnostic criteria for major depressive disorder, the PHQ-9 prompts respondents to rate the frequency of depressive symptoms over the past two weeks on a four-point scale from 0 (not at all) to 3 (nearly every day), with total scores ranging from 0 to 27[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. These scores categorize depression severity from minimal (0\u0026ndash;4) to severe (20\u0026ndash;27). A score of 10 or higher suggests probable major depressive disorder, indicating the need for further clinical evaluation and potential treatment. The PHQ-9's straightforward administration makes it ideal for various settings, including primary care and mental health clinics, and its successful application in similar populations underscores its effectiveness as a diagnostic and monitoring tool for depression.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eData analysis was carried out using SPSS software (version 22.0; SPSS Inc., Chicago, IL, USA). Categorical variables were summarized with counts (n) and percentages (%), and continuous variables were described using counts, means, and standard deviations (SDs). The chi-square test was utilized to compare categorical variables, while one-way analysis of variance (ANOVA) was employed to analyze numerical data across three groups: PCOS, POI, and controls. This approach is particularly effective for assessing multiple comparisons, with ANOVA detecting significant differences in scores from tools like FSFI, GAD-7, and PHQ-9. Subsequent post-hoc analyses, such as Tukey\u0026rsquo;s HSD, were performed to pinpoint differences among the groups. Moreover, multivariable logistic regression was used to explore the factors affecting sexual function and related disorders, including desire, arousal, lubrication, orgasm, and coital pain. To assess the relationship between sexual function scores and psychological health, correlation coefficients (either Pearson or Spearman, based on data distribution) were calculated. Statistical significance was established at a two-tailed \u003cem\u003ep\u003c/em\u003e-value of less than 0.05, and results were reported including p-values, odds ratios (OR), and 95% confidence intervals (CI).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eParticipant Demographics and Characteristics\u003c/h2\u003e \u003cp\u003eA total of 340 participants were included in the study, divided into three groups: Premature Ovarian Insufficiency (POI) (n\u0026thinsp;=\u0026thinsp;68), Polycystic Ovary Syndrome (PCOS) (n\u0026thinsp;=\u0026thinsp;104), and Control (n\u0026thinsp;=\u0026thinsp;168). The demographic characteristics of the participants are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The mean age of participants in the POI group was 32.87\u0026thinsp;\u0026plusmn;\u0026thinsp;3.97 years, in the PCOS group was 33.39\u0026thinsp;\u0026plusmn;\u0026thinsp;4.19 years, and in the Control group was 32.74\u0026thinsp;\u0026plusmn;\u0026thinsp;4.45 years. Statistical analysis revealed no significant difference in age among the three groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The mean BMI was 23.88\u0026thinsp;\u0026plusmn;\u0026thinsp;3.29 kg/m\u0026sup2; in the POI group, 23.12\u0026thinsp;\u0026plusmn;\u0026thinsp;3.33 kg/m\u0026sup2; in the PCOS group, and 23.67\u0026thinsp;\u0026plusmn;\u0026thinsp;3.33 kg/m\u0026sup2; in the Control group. The differences in BMI among the groups were not statistically significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Similarly, there were no significant differences in infertility duration among the groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Smoking status, annual income, education level, stress levels, physical exercise frequency, and alcohol consumption also showed no significant differences between the groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). These findings indicate that the demographic characteristics were comparable across the study groups.\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\u003eDemographic characteristics of the study participants (n\u0026thinsp;=\u0026thinsp;340)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePOI (n\u0026thinsp;=\u0026thinsp;68)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePCOS (n\u0026thinsp;=\u0026thinsp;104)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;168)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e- value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD / n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD / n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD / n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32.87\u0026thinsp;\u0026plusmn;\u0026thinsp;3.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.39\u0026thinsp;\u0026plusmn;\u0026thinsp;4.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.74\u0026thinsp;\u0026plusmn;\u0026thinsp;4.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.466\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.88\u0026thinsp;\u0026plusmn;\u0026thinsp;3.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.12\u0026thinsp;\u0026plusmn;\u0026thinsp;3.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.67\u0026thinsp;\u0026plusmn;\u0026thinsp;3.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.269\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfertility duration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.72\u0026thinsp;\u0026plusmn;\u0026thinsp;3.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.94\u0026thinsp;\u0026plusmn;\u0026thinsp;3.17\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.74\u0026thinsp;\u0026plusmn;\u0026thinsp;2.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking status:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.125\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-smoker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61 (89.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98 (94.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e162 (96.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnnual income (ten thousand yuan)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.067\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39 (57.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (36.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86 (51.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (27.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (36.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43 (25.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u0026ndash;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (14.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (10.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (8.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.571\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le; High school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (39.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (30.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58 (34.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollege\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (26.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (20.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41 (24.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eundergraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (29.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (39.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54 (32.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge; Postgraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (9.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStress in work and life\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.383\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery high\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (22.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33 (19.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 (61.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50 (48.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83 (49.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (13.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (20.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (15.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (7.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical exercise frequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.738\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (33.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (28.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54 (32.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1 time a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (38.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (44.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58 (34.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 time a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (14.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (11.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;2 times a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (13.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32 (19.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrinking alcohol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.163\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUsually\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (33.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (43.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53 (31.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (60.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51 (49.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e104 (61.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eData was described as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or n (%).\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eAbbreviations: SD, standard deviation; BMI, body mass index\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \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\u003eFemale psychological health among patients with different ovarian function\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePOI (n\u0026thinsp;=\u0026thinsp;68)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePCOS (n\u0026thinsp;=\u0026thinsp;104)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;168)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD / n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD / n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD / n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGAD-7 score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.09\u0026thinsp;\u0026plusmn;\u0026thinsp;2.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.93\u0026thinsp;\u0026plusmn;\u0026thinsp;2.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.08\u0026thinsp;\u0026plusmn;\u0026thinsp;2.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.872\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncidence of anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.059\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMinimal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(10.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27(16.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54(79.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74(71.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e110(65.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(14.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17(16.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28(16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerately-Severe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePHQ \u0026minus;\u0026thinsp;9 score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.93\u0026thinsp;\u0026plusmn;\u0026thinsp;2.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.46\u0026thinsp;\u0026plusmn;\u0026thinsp;3.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.35\u0026thinsp;\u0026plusmn;\u0026thinsp;3.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.407\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncidence of depression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.048*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMinimal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (13.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23(22.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51 (30.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54(79.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77(74.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e105(62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(7.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9(5.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerately-Severe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003ePsychological Health Outcomes\u003c/h2\u003e \u003cp\u003eThe study assessed psychological health using the Generalized Anxiety Disorder 7-item (GAD-7) scale and the Patient Health Questionnaire 9-item (PHQ-9) scale. The mean GAD-7 scores were 6.09\u0026thinsp;\u0026plusmn;\u0026thinsp;2.16 for the POI group, 5.93\u0026thinsp;\u0026plusmn;\u0026thinsp;2.53 for the PCOS group, and 6.08\u0026thinsp;\u0026plusmn;\u0026thinsp;2.41 for the Control group, with no significant differences (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The incidence of anxiety showed some variation, with minimal anxiety being reported by 1.5% of the POI group, 10.6% of the PCOS group, and 16.1% of the Control group, but these differences were not statistically significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The mean PHQ-9 scores were 7.93\u0026thinsp;\u0026plusmn;\u0026thinsp;2.71 for the POI group, 7.46\u0026thinsp;\u0026plusmn;\u0026thinsp;3.16 for the PCOS group, and 7.35\u0026thinsp;\u0026plusmn;\u0026thinsp;3.01 for the Control group, also showing no significant differences (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, there was a significant difference in the incidence of depression, with minimal depression reported by 13.2% of the POI group, 22.1% of the PCOS group, and 30.4% of the Control group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). These findings indicate that while anxiety levels were similar across groups, depression incidence varied significantly among women with different infertility diagnoses.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eSexual Health Outcomes\u003c/h2\u003e \u003cp\u003eThe sexual health of the study participants was assessed using the FSFI. The results are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The mean frequency of sexual life per month was 4.76\u0026thinsp;\u0026plusmn;\u0026thinsp;3.00 times for the POI group, 4.89\u0026thinsp;\u0026plusmn;\u0026thinsp;2.82 times for the PCOS group, and 4.93\u0026thinsp;\u0026plusmn;\u0026thinsp;2.78 times for the Control group, with no significant difference among the groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The mean FSFI scores were 26.00\u0026thinsp;\u0026plusmn;\u0026thinsp;3.50 for the POI group, 26.13\u0026thinsp;\u0026plusmn;\u0026thinsp;4.50 for the PCOS group, and 27.37\u0026thinsp;\u0026plusmn;\u0026thinsp;3.24 for the Control group. There was a significant difference in FSFI scores among the groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), with the Control group having higher scores. Sexual dysfunction was reported by 20.6% of the POI group, 19.2% of the PCOS group, and 13.7% of the Control group, with no significant differences among the groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The mean sexual desire scores were 3.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.72 for the POI group, 3.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87 for the PCOS group, and 3.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.72 for the Control group, showing no significant differences (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The incidence of low sexual desire was 29.4% in the POI group, 24.0% in the PCOS group, and 17.9% in the Control group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The mean arousal ability scores were 3.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87 for the POI group, 3.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01 for the PCOS group, and 4.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87 for the Control group, with significant differences (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The incidence of arousal disorder was 23.5% in the POI group, 22.1% in the PCOS group, and 12.5% in the Control group, indicating significant differences (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The mean vaginal lubricity scores were 5.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71 for the POI group, 4.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97 for the PCOS group, and 5.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71 for the Control group, showing significant differences (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The incidence of lubrication disorder was significantly different among the groups, with 4.4% in the POI group, 19.2% in the PCOS group, and 5.4% in the Control group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The mean orgasm scores were 4.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93 for the POI group, 4.48\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02 for the PCOS group, and 4.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92 for the Control group, with no significant differences (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The incidence of orgasm disorder was 26.5% in the POI group, 23.1% in the PCOS group, and 14.9% in the Control group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The mean satisfaction scores were 4.44\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84 for the POI group, 4.61\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97 for the PCOS group, and 4.79\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85 for the Control group, showing significant differences (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The mean coital pain scores were 4.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86 for the POI group, 4.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02 for the PCOS group, and 5.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76 for the Control group, with no significant differences (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The incidence of coital pain was significantly different among the groups, with 10.3% in the POI group, 16.3% in the PCOS group, and 6.0% in the Control group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFemale sexual health of the study participants (n\u0026thinsp;=\u0026thinsp;340)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePOI (n\u0026thinsp;=\u0026thinsp;68)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePCOS (n\u0026thinsp;=\u0026thinsp;104)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;168)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD / n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD / n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD / n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSexual life frequency (per month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.76\u0026thinsp;\u0026plusmn;\u0026thinsp;3.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.89\u0026thinsp;\u0026plusmn;\u0026thinsp;2.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.93\u0026thinsp;\u0026plusmn;\u0026thinsp;2.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.917\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFSFI score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.00\u0026thinsp;\u0026plusmn;\u0026thinsp;3.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.13\u0026thinsp;\u0026plusmn;\u0026thinsp;4.50 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.37\u0026thinsp;\u0026plusmn;\u0026thinsp;3.24 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncidence of sexual dysfunction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (20.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (19.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (13.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.316\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSexual desire score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.149\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncidence of low desire\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (29.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (24.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (17.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.129\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArousal ability score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncidence of arousal disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (23.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (22.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaginal lubricity score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncidence of lubrication disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (19.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (5.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrgasm score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.48\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.099\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncidence of orgasm disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (26.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (23.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSatisfaction score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.44\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.61\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.79\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoital pain score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.102\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncidence of coital pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (16.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eFSFI: Female Sexual Function Index\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \n\u003cdiv style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;border:none;border-bottom:none black 1.0pt;padding:0in 0in 0in 0in;margin-right:0in;'\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:0in;border:none;padding:0in;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eTable 4\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eFactors associated with sexual dysfunction, multivariable-adjusted odds ratios and 95% confidence intervals.\u003c/span\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003ctable style=\"width: 6.5e+2pt;order-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120.5pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cdiv style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;border:none;border-bottom:none black 1.0pt;padding:0in 0in 0in 0in;'\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;border:none;padding:0in;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eIndependent variable\u003c/span\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cdiv style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;border:none;border-bottom:none black 1.0pt;padding:0in 0in 0in 0in;'\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;border:none;padding:0in;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eArousal disorder\u003c/span\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.55pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cdiv style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;border:none;border-bottom:none black 1.0pt;padding:0in 0in 0in 0in;'\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;border:none;padding:0in;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eCoital pain\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.7pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cdiv style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;border:none;border-bottom:none black 1.0pt;padding:0in 0in 0in 0in;'\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;border:none;padding:0in;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eLubrication disorder\u003c/span\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.55pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cdiv style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;border:none;border-bottom:none black 1.0pt;padding:0in 0in 0in 0in;'\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;border:none;padding:0in;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eSexual dysfunction\u003c/span\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120.5pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eInfertility diagnosis\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;text-indent:19.6pt;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.55pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;text-indent:19.6pt;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.7pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;text-indent:19.6pt;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.55pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;text-indent:19.6pt;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120.5pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;text-indent:6.0pt;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eControl\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e1.00\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.55pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e1.00\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.7pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e1.00\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.55pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e1.00\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120.5pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;text-indent:6.0pt;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003ePOI\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.507 (0.237-1.086) P=0.080\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.55pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:red;'\u003e0.319 (0.121-0.839) P=0.021*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.7pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:red;'\u003e0.203 (0.077-0.532) P=0.001**\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.55pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.744 (0.325-1.702) P=0.484\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120.5pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;text-indent:6.0pt;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003ePCOS\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e1.122 (0.475-2.648) P=0.793\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.55pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.444 (0.143-1.378) P=0.160\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.7pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:red;'\u003e0.117 (0.027-0.512) P=0.004**\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.55pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e1.135 (0.435-2.963) P=0.796\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120.5pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eAge (years)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e1.078 (0.989-1.175) P=0.089\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.55pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e1.038 (0.926-1.164) P=0.519\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.7pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e1.013 (0.905-1.135) P=0.820\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.55pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e1.085 (0.988-1.193) P=0.089\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120.5pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eBody mass index\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.965 (0.868-1.074) P=0.518\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.55pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e1.028 (0.895-1.181) P=0.692\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.7pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.987 (0.858-1.136) P=0.856\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.55pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e1.034 (0.921-1.161) P=0.574\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120.5pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eIncome level\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e1.128 (0.854-1.488) P=0.396\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.55pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.825 (0.555-1.228) P=0.344\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.7pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.937 (0.649-1.355) P=0.730\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.55pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e1.018 (0.746-1.391) P=0.909\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120.5pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eInfertility duration\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:red;'\u003e0.688 (0.583-0.814)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:red;'\u003eP=0.000**\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.55pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:red;'\u003e0.661 (0.526-0.831)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:red;'\u003eP=0.000**\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.7pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:red;'\u003e0.753 (0.608-0.933)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:red;'\u003eP=0.009**\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.55pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:red;'\u003e0.573 (0.466-0.705)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:red;'\u003eP=0.000**\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120.5pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eSexual life frequency (per month)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e1.042 (0.920-1.181) P=0.515\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.55pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e1.003 (0.850-1.182) P=0.975\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.7pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:red;'\u003e0.764 (0.621-0.940) P=0.011*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.55pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.971 (0.841-1.121) P=0.685\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120.5pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eEducation level\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.775 (0.545-1.104) P=0.158\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.55pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e1.068 (0.680-1.678) P=0.775\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.7pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.751 (0.469-1.203) P=0.233\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.55pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.823 (0.562-1.205) P=0.317\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120.5pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eStress level\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.798 (0.553-1.151) P=0.226\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.55pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e1.155 (0.742-1.798) P=0.524\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.7pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.818 (0.515-1.301) P=0.397\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.55pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.764 (0.514-1.137) P=0.185\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120.5pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003ePhysical exercise frequency\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e1.183 (0.852-1.643) P=0.315\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.55pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e1.182 (0.773-1.809) P=0.440\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.7pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e1.028 (0.670-1.578) P=0.900\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.55pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e1.004 (0.697-1.447) P=0.982\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120.5pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eSmoking status\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.384 (0.086-1.720) P=0.211\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.55pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:red;'\u003e0.030 (0.002-0.358) P=0.006**\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.7pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:red;'\u003e0.109 (0.013-0.946) P=0.044*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.55pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:red;'\u003e0.083 (0.013-0.526) P=0.008*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120.5pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eDrinking status\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e1.297 (0.748-2.248) P=0.355\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.55pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:red;'\u003e0.348 (0.178-0.679) P=0.002**\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.7pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.699 (0.355-1.375) P=0.300\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.55pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.943 (0.522-1.703) P=0.846\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120.5pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eGAD-7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:red;'\u003e0.343 (0.205-0.576)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:red;'\u003eP=0.000**\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.55pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:red;'\u003e0.265 (0.132-0.531)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:red;'\u003eP=0.000**\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.7pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:red;'\u003e0.495 (0.256-0.957)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:red;'\u003eP=0.037*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.55pt;border: none;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.206 (0.112-0.381)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:red;'\u003eP=0.000**\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003ePHQ-9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:red;'\u003e3.478 (2.188-5.531) P=0.000**\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.55pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:red;'\u003e4.307(2.294-8.087) P=0.000**\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.7pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:red;'\u003e2.463 (1.380-4.397) P=0.002**\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.55pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 14.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:red;'\u003e5.916 (3.330-10.510) P=0.000**\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e* \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05, ** \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.01\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eFactors Associated with Sexual Dysfunction\u003c/h2\u003e \u003cp\u003eThe multivariable-adjusted analysis identified several factors associated with sexual dysfunction among the study participants. Compared to the control group, women with POI had a significantly lower risk of coital pain (OR\u0026thinsp;=\u0026thinsp;0.319, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and lubrication disorder (OR\u0026thinsp;=\u0026thinsp;0.203, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Women with Polycystic Ovary Syndrome (PCOS) also had a significantly lower risk of lubrication disorder (OR\u0026thinsp;=\u0026thinsp;0.117, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Longer infertility duration was associated with a lower risk of arousal disorder (OR\u0026thinsp;=\u0026thinsp;0.688, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), coital pain (OR\u0026thinsp;=\u0026thinsp;0.661, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), lubrication disorder (OR\u0026thinsp;=\u0026thinsp;0.753, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and overall sexual dysfunction (OR\u0026thinsp;=\u0026thinsp;0.573, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Additionally, higher GAD-7 scores were significantly associated with an increased risk of all forms of sexual dysfunction, including arousal disorder (OR\u0026thinsp;=\u0026thinsp;0.343, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), coital pain (OR\u0026thinsp;=\u0026thinsp;0.265, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), lubrication disorder (OR\u0026thinsp;=\u0026thinsp;0.495, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and overall sexual dysfunction (OR\u0026thinsp;=\u0026thinsp;0.206, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Similarly, higher PHQ-9 scores were significantly associated with an increased risk of arousal disorder (OR\u0026thinsp;=\u0026thinsp;3.478, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), coital pain (OR\u0026thinsp;=\u0026thinsp;4.307, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), lubrication disorder (OR\u0026thinsp;=\u0026thinsp;2.463, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and overall sexual dysfunction (OR\u0026thinsp;=\u0026thinsp;5.916, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Other factors such as age, BMI, income level, education level, stress level, physical exercise frequency, smoking status, and drinking status did not show significant associations with sexual dysfunction (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study investigated the sexual and psychological health of women with POI, PCOS, and normal ovarian function (Control). Our findings indicate that overall sexual function, as measured by the FSFI, was significantly lower in women with POI and PCOS compared to the control group. Additionally, women with POI and PCOS exhibited higher incidences of anxiety and depression. Several factors, including the duration of infertility and psychological health metrics, were significantly associated with sexual dysfunction.\u003c/p\u003e \u003cp\u003eOur results align with previous studies that have reported compromised sexual function in women with reproductive health issues. In our study, we found that patients in the POI group had the lowest total FSFI scores, accompanied by arousal disorders and the lowest scores for sexual satisfaction. A newly systematic review and meta-analysis indicated that women with POI experience substantial sexual dysfunction, including reduced desire and increased pain during intercourse[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. A case-control study in 2019 evaluated the sexual function in 132 women, 66 with POI and 66 with normal ovarian function, it was found that women with POI had significantly lower scores in sexual function compared to controls[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The POI group exhibited substantial impairments in desire, arousal, orgasm, lubrication, and satisfaction, as well as in physical, mental, environmental, and social health[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Our study also found low scores in these domains, supporting the previous conclusion that POI adversely affects sexual function. Our findings are consistent with this, showing that the POI group had the lowest satisfaction scores and significant arousal issues. This alignment suggests a persistent pattern of sexual dissatisfaction and arousal difficulties among women with POI.\u003c/p\u003e \u003cp\u003eWhile \u003cb\u003eDokras and colleagues\u003c/b\u003e reported elevated rates of sexual dysfunction in PCOS[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], some studies have found that the severity of sexual dysfunction in POI can be even higher. Our study's finding that POI patients had the lowest FSFI scores aligns with this view. However, POI's impact might be comparable to or less severe than other ovarian dysfunctions under certain conditions, possibly due to differences in study populations or methodologies. Researchers focused on hormonal imbalances in PCOS but also provided insights into POI[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The discrepancy arises in the impact on specific FSFI domains. While Yela et al. noted that lubrication issues were prevalent, our study found that arousal and satisfaction were more significantly affected in POI patients[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. These differences could be due to variations in participant demographics, severity of symptoms, or even cultural factors affecting the perception and reporting of sexual health issues.\u003c/p\u003e \u003cp\u003eIn our study, we found that patients in the PCOS group had lower total FSFI scores compared to the control group, with significant vaginal lubrication disorders. \u003cb\u003eSeveral\u003c/b\u003e studies reported elevated rates of sexual dysfunction in women with PCOS, specifically highlighting issues such as decreased desire and lubrication problems[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Our findings are consistent with these results, showing significantly lower FSFI scores in the PCOS group, particularly in the domain of vaginal lubrication. This alignment reinforces the understanding that PCOS negatively impacts multiple aspects of sexual function, including lubrication. Hormonal imbalances, such as elevated androgen levels in PCOS, contribute to sexual dysfunction, including lubrication issues[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Our study supports this mechanism, with significant lubrication disorders observed in the PCOS group, suggesting that hormonal disruptions play a critical role in the sexual health challenges experienced by women with PCOS. \u003cb\u003eVeltman-Verhulst et al.\u003c/b\u003e highlighted the high prevalence of anxiety and depression in women with PCOS, which are known to exacerbate sexual dysfunction[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Our findings that women with PCOS exhibited higher incidences of anxiety and depression align with this study, indicating that psychological distress is a significant factor contributing to sexual dysfunction in PCOS patients.\u003c/p\u003e \u003cp\u003eHowever, some studies have reported less severe sexual dysfunction in PCOS patients, suggesting that the impact might vary based on factors such as age, body mass index (BMI), and the presence of comorbid conditions[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Our study found significant sexual dysfunction in PCOS patients, particularly in lubrication, which may indicate a more severe impact or differences in the study population. While Eftekhar et al. found significant issues in sexual desire and satisfaction in women with PCOS[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], our study highlighted lubrication disorders as particularly prominent. This discrepancy could arise from differences in the demographic characteristics of the study populations, variations in the diagnostic criteria for PCOS, or differences in cultural attitudes towards reporting sexual health issues.\u003c/p\u003e \u003cp\u003eVeltman-Verhulst et al highlighted the high prevalence of anxiety and depression in women with infertility issues, including those with PCOS and POI[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Our results, showing higher GAD-7 and PHQ-9 scores in the POI and PCOS groups, align with these findings. The strong correlation between psychological distress and sexual dysfunction in our study further emphasizes the need to address mental health in managing sexual dysfunction in these populations. Researcher demonstrated that awareness and education about POI could mitigate some of the psychological distress and improve sexual function[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Our findings suggest that comprehensive care, including psychological support, is essential for improving sexual health outcomes in women with POI and PCOS.\u003c/p\u003e \u003cp\u003eDong et al. indicated that the duration of infertility negatively impacts sexual health, with longer durations associated with greater sexual dysfunction[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Our study found a similar trend, where longer infertility duration was significantly associated with lower FSFI scores and higher levels of anxiety and depression, indicating that prolonged infertility exacerbates both sexual and psychological distress.\u003c/p\u003e \u003cp\u003eThe lower FSFI scores in women with POI and PCOS suggest that these conditions significantly impair sexual function. The significant differences in arousal ability, vaginal lubricity, and satisfaction scores between the groups underscore the multifaceted nature of sexual dysfunction in these populations. The high incidence of lubrication disorder, particularly in women with PCOS, may be attributed to hormonal imbalances typical of this condition, affecting vaginal health and sexual comfort.\u003c/p\u003e \u003cp\u003eMoreover, the strong associations between psychological health measures (GAD-7 and PHQ-9 scores) and sexual dysfunction highlight the interdependence of mental and sexual health. Anxiety and depression were found to be strong predictors of sexual dysfunction, suggesting that addressing psychological well-being is crucial in the management of sexual health issues in women with reproductive health disorders. This interrelation points to a need for comprehensive care that integrates mental health support with traditional reproductive health treatments.\u003c/p\u003e \u003cp\u003eThese findings have significant clinical implications. Healthcare providers should adopt a holistic approach when managing women with POI and PCOS, addressing both physical and psychological aspects of health. Routine screening for sexual dysfunction and mental health issues should be integrated into clinical practice for women with these conditions. Interventions such as counseling, cognitive-behavioral therapy, and appropriate medical treatments should be considered to improve overall well-being.\u003c/p\u003e \u003cp\u003eFurthermore, patient education about the potential sexual and psychological impacts of POI and PCOS can empower women to seek help and advocate for their health. Developing tailored treatment plans that address individual needs and preferences can enhance the effectiveness of interventions and improve patient outcomes.\u003c/p\u003e \u003cp\u003eThis study boasts several strengths, including its pioneering comparison of sexual and psychological health among patients with varying ovarian functions. It features a well-defined participant group and employs validated assessment tools such as the FSFI, GAD-7, and PHQ-9. The case-control design of the study allowed for a detailed snapshot of the sexual and psychological health conditions affecting women with POI, PCOS, and normal ovarian function, providing valuable insights into the interrelations of these variables. However, there are limitations to consider. The self-reported nature of the questionnaires may introduce response bias, as participants may underreport or overreport their symptoms. Additionally, the study population, being recruited from specialized reproductive clinics, may not be representative of the general population, limiting the generalizability of our findings.\u003c/p\u003e \u003cp\u003eFuture research should focus on longitudinal studies to explore the causal relationships between reproductive health conditions and sexual dysfunction. Such studies could provide valuable insights into the progression of sexual and psychological health issues over time and identify critical intervention points. Interventional studies are also needed to evaluate the effectiveness of various treatment strategies in improving sexual and psychological health in these populations. Expanding research to include a more diverse population, including women from different socioeconomic backgrounds and ethnicities, can help generalize findings and develop tailored interventions for different demographic groups. Additionally, qualitative studies exploring women's personal experiences with POI and PCOS can provide deeper insights into the impact of these conditions on their lives and inform more empathetic and patient-centered care approaches.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study highlights the significant impact of reproductive health conditions such as POI and PCOS on sexual and psychological health. The findings underscore the need for integrated care approaches that address both physical and mental health aspects in women with these conditions. By enhancing our understanding of these relationships, we can improve the quality of life for women affected by POI and PCOS. Clinicians should consider both the physiological and psychological dimensions of these conditions in their treatment plans, ensuring comprehensive care that addresses the full spectrum of patient needs.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgement:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have seen and approved the final version of this article. DM: designed and executed the study, gathered, analysed and interpreted the data, drafted the manuscript, and contributed to the critical discussion.\u0026nbsp;LYY, LYN, WYX: recruited patients, analysed and interpreted the data and contributed to the critical discussion. TJC: acted as the supervisor, contributed to the study design, study execution, critical discussion, revised the manuscript, and approved of the final submitted version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was granted from the Natural Science Foundation of Liaoning Province(2022-MS-185), Basic Research Projects for Higher Educational Institutions in Liaoning Province (JYTMS20230094), and the 345 Talent Project of Shengjing Hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the first author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Shengjing Hospital Institutional Review Board for Research on Human Subjects (2021PS018F).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the authors in this paper consent to publication of the work.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have no conflicts of interest to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCode availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWu, H.M., et al., \u003cem\u003eLead level in seminal plasma may affect semen quality for men without occupational exposure to lead.\u003c/em\u003e Reprod Biol Endocrinol, 2012. \u003cstrong\u003e10\u003c/strong\u003e: p. 91.\u003c/li\u003e\n\u003cli\u003eEftekhar, T., et al., \u003cem\u003eSexual dysfunction in patients with polycystic ovary syndrome and its affected domains.\u003c/em\u003e Iran J Reprod Med, 2014. \u003cstrong\u003e12\u003c/strong\u003e(8): p. 539-46.\u003c/li\u003e\n\u003cli\u003eSwart, A.C., et al., \u003cem\u003eSteroid hormone analysis of adolescents and young women with polycystic ovarian syndrome and adrenocortical dysfunction using UPC(2)-MS/MS.\u003c/em\u003e Pediatr Res, 2021. \u003cstrong\u003e89\u003c/strong\u003e(1): p. 118-126.\u003c/li\u003e\n\u003cli\u003eMcGlacken-Byrne, S.M. and G.S. 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Kok, \u003cem\u003ePrevalence and Risk Factors for Sexual Problems and Distress in Chinese Unmarried Young Women: An Observational Study.\u003c/em\u003e J Sex Med, 2018. \u003cstrong\u003e15\u003c/strong\u003e(11): p. 1620-1628.\u003c/li\u003e\n\u003cli\u003eMa, J., et al., \u003cem\u003ePrevalence of female sexual dysfunction in urban chinese women based on cutoff scores of the Chinese version of the female sexual function index: a preliminary study.\u003c/em\u003e J Sex Med, 2014. \u003cstrong\u003e11\u003c/strong\u003e(4): p. 909-919.\u003c/li\u003e\n\u003cli\u003eLowe, B., et al., \u003cem\u003eValidation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population.\u003c/em\u003e Med Care, 2008. \u003cstrong\u003e46\u003c/strong\u003e(3): p. 266-74.\u003c/li\u003e\n\u003cli\u003eKroenke, K., R.L. Spitzer, and J.B. Williams, \u003cem\u003eThe PHQ-9: validity of a brief depression severity measure.\u003c/em\u003e J Gen Intern Med, 2001. \u003cstrong\u003e16\u003c/strong\u003e(9): p. 606-13.\u003c/li\u003e\n\u003cli\u003eJavadpour, S., et al., \u003cem\u003eAssessment of premature menopause on the sexual function and quality of life in women.\u003c/em\u003e Gynecol Endocrinol, 2021. \u003cstrong\u003e37\u003c/strong\u003e(4): p. 307-311.\u003c/li\u003e\n\u003cli\u003ePastoor, H., et al., \u003cem\u003eSexual function in women with polycystic ovary syndrome: a systematic review and meta-analysis.\u003c/em\u003e Hum Reprod Update, 2024. \u003cstrong\u003e30\u003c/strong\u003e(3): p. 323-340.\u003c/li\u003e\n\u003cli\u003eSteinberg Weiss, M., et al., \u003cem\u003eLifestyle modifications alone or combined with hormonal contraceptives improve sexual dysfunction in women with polycystic ovary syndrome.\u003c/em\u003e Fertil Steril, 2021. \u003cstrong\u003e115\u003c/strong\u003e(2): p. 474-482.\u003c/li\u003e\n\u003cli\u003eDaan, N.M., et al., \u003cem\u003eAndrogen levels in women with various forms of ovarian dysfunction: associations with cardiometabolic features.\u003c/em\u003e Hum Reprod, 2015. \u003cstrong\u003e30\u003c/strong\u003e(10): p. 2376-86.\u003c/li\u003e\n\u003cli\u003eYela, D.A., P.M. Soares, and C.L. Benetti-Pinto, \u003cem\u003eInfluence of Sexual Function on the Social Relations and Quality of Life of Women with Premature Ovarian Insufficiency.\u003c/em\u003e Rev Bras Ginecol Obstet, 2018. \u003cstrong\u003e40\u003c/strong\u003e(2): p. 66-71.\u003c/li\u003e\n\u003cli\u003eAkbari Sene, A., et al., \u003cem\u003eDifferences in and Correlates of Sexual Function in Infertile Women with and without Polycystic Ovary Syndrome.\u003c/em\u003e Int J Fertil Steril, 2021. \u003cstrong\u003e15\u003c/strong\u003e(1): p. 65-72.\u003c/li\u003e\n\u003cli\u003eNohr, E.A., et al., \u003cem\u003eSexual health in parous women with a history of polycystic ovary syndrome: A national cross-sectional study in Denmark.\u003c/em\u003e Int J Gynaecol Obstet, 2022. \u003cstrong\u003e157\u003c/strong\u003e(3): p. 702-709.\u003c/li\u003e\n\u003cli\u003eErcan, C.M., et al., \u003cem\u003eSexual dysfunction assessment and hormonal correlations in patients with polycystic ovary syndrome.\u003c/em\u003e Int J Impot Res, 2013. \u003cstrong\u003e25\u003c/strong\u003e(4): p. 127-32.\u003c/li\u003e\n\u003cli\u003eVeltman-Verhulst, S.M., et al., \u003cem\u003eEmotional distress is a common risk in women with polycystic ovary syndrome: a systematic review and meta-analysis of 28 studies.\u003c/em\u003e Hum Reprod Update, 2012. \u003cstrong\u003e18\u003c/strong\u003e(6): p. 638-51.\u003c/li\u003e\n\u003cli\u003eAversa, A., et al., \u003cem\u003eFundamental Concepts and Novel Aspects of Polycystic Ovarian Syndrome: Expert Consensus Resolutions.\u003c/em\u003e Front Endocrinol (Lausanne), 2020. \u003cstrong\u003e11\u003c/strong\u003e: p. 516.\u003c/li\u003e\n\u003cli\u003eAtes, S., et al., \u003cem\u003eSleep, depression, anxiety and fatigue in women with premature ovarian insufficiency.\u003c/em\u003e J Psychosom Obstet Gynaecol, 2022. \u003cstrong\u003e43\u003c/strong\u003e(4): p. 482-487.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"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":"Polycystic Ovary Syndrome, Premature Ovarian Insufficiency, Sexual function, Infertility, Anxiety, Depression","lastPublishedDoi":"10.21203/rs.3.rs-4464614/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4464614/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study aims to evaluate and compare sexual function and psychological health among infertile patients with different ovarian dysfunctions, specifically polycystic ovary syndrome (PCOS), premature ovarian insufficiency (POI), and women with normal ovarian function, to understand the extent of sexual dysfunction associated with these conditions.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe conducted a cross-sectional analysis involving 340 women, categorized into three groups: PCOS, POI, and normal ovarian function (Control). Sexual function was quantitatively assessed using the Female Sexual Function Index (FSFI), which measures six dimensions of sexual function: desire, arousal, lubrication, orgasm, satisfaction, and pain. Analysis of variance (ANOVA) was employed to compare FSFI scores across the groups, followed by post-hoc tests to identify significant differences between each pair of groups.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe mean FSFI scores were significantly lower in the POI and PCOS groups compared to the Control group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Women with POI and PCOS exhibited higher incidences of anxiety and depression. Significant differences were observed in arousal ability, vaginal lubricity, and satisfaction scores among the groups, with the Control group generally scoring higher. The incidence of lubrication disorder was highest in the PCOS group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Multivariable-adjusted analyses identified longer infertility duration and higher Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9) scores as significant predictors of sexual dysfunction.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study highlights the significant impact of reproductive health conditions such as POI and PCOS on sexual and psychological health. The findings underscore the need for integrated care approaches that address both physical and mental health aspects in women with these conditions. By enhancing our understanding of these relationships, we can improve the quality of life for women affected by POI and PCOS. Clinicians should consider both the physiological and psychological dimensions in their treatment plans to ensure comprehensive care that addresses the full spectrum of patient needs.\u003c/p\u003e","manuscriptTitle":"Comparative Analysis of Sexual Function and Psychological Health in Infertile Patients with Different Ovarian Dysfunctions","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-05 12:09:12","doi":"10.21203/rs.3.rs-4464614/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":"e505d08d-9600-4967-9b6c-f726fc77d49a","owner":[],"postedDate":"June 5th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-10T08:31:17+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-05 12:09:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4464614","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4464614","identity":"rs-4464614","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}