Sexual dysfunction in women with newly diagnosed thyroid dysfunction: a novel report from Basrah, Iraq

Thyroid dysfunction has been proposed as a potential contributor to Female Sexual Dysfunction (FSD), yet its impact, particularly in subclinical and autoimmune forms, remains controversial, especially in culturally conservative populations. This study aimed to assess the relationship between newly diagnosed thyroid dysfunction and sexual function among married, premenopausal women in Basrah, Iraq, using the Arabic version of the Female Sexual Function Index (FSFI). Out of 673 women aged 20–48 years presenting with sexual complaints, 229 with clinically confirmed FSD were enrolled. Of these, 42 were newly diagnosed with thyroid dysfunction, either overt or subclinical, autoimmune or non-autoimmune, and served as the case group. In contrast, 187 women with normal thyroid function served as controls. Hormonal profiling included Thyroid- Stimulating Hormone (TSH), Free Thyroxine (FT4), total testosterone (TT), Sex Hormone-Binding Globulin (SHBG), Calculated Free Testosterone (cFT), Estradiol (E2), and Prolactin (PRL). FSFI domain scores and hormonal parameters were compared across groups and subgroups. Subclinical and overt thyroid dysfunction were identified in 8.3% and 10.04% of the cohort, respectively. FSFI scores were significantly low across all domains in both groups. Although the orgasm domain (p=0.043) and total FSFI score (p=0.020) showed statistical significance, the overall clinical impact was limited due to the uniformly low scores. Hormonal levels, including PRL, TT, SHBG, cFT, and E2, did not differ significantly between groups, except for higher E2 levels among women with autoimmune thyroid dysfunction (p=0.026). No significant differences in FSFI scores were observed between autoimmune and non-autoimmune groups, or between autoimmune hypothyroidism and autoimmune hyperthyroidism. These findings suggest that thyroid dysfunction, whether overt, subclinical, or autoimmune, does not appear to be a major determinant of FSD in this population. The results support a multifactorial origin of FSD and underscore the need for culturally sensitive, interdisciplinary approaches to better understand and manage sexual health concerns among women in conservative societies.