Psychosocial Determinants of Sexual Dysfunction in Women with Major Depressive Disorder: A Comprehensive Study

Background: Sexual dysfunction (SD) is common in women with Major Depressive Disorder (MDD), yet its psychosocial and clinical determinants in low-resource settings remain insufficiently characterised. Objective: To quantify prevalence and domains of SD, and evaluate associations with depression severity, socio-demographic, behavioural, and clinical variables among reproductive-age Bangladeshi women with MDD. Methods: A cross-sectional study was performed at Sylhet MAG Osmani Medical College Hospital (Sept 2018–Aug 2020). Sixty-eight married women (18–45 yr) meeting DSM-5 MDD criteria were enrolled. Depression severity was assessed using the Bangla DASS-21; sexual function by the Female Sexual Function Index (FSFI). Variables included age, BMI, parity, illness duration, income, education, marital satisfaction, social support, antidepressant dose, physical activity, and comorbid anxiety. Analyses applied descriptive statistics, Chi-square, t-tests, Pearson/Spearman correlations, and multiple linear regression (significance p<0.05). Results: Mean age was 32.6 ± 6.1 yr; BMI 24.8 ± 3.9 kg/m²; median illness duration 18 mo (IQR 12–30). Overall SD prevalence was 72.1%. Domain frequencies: desire 64.7%, arousal 58.8%, lubrication 52.9%, orgasm 50.0%, satisfaction 48.5%, pain 33.8%. FSFI total (22.4 ± 5.3) inversely correlated with depression severity (r = –0.62, p<0.001). Higher BMI predicted reduced lubrication (β = –0.29, p=0.015). Parity ≥2 associated with lower orgasm scores (mean 3.2 ± 1.1 vs 4.0 ± 1.2; t=2.41, p=0.019). Illness duration >24 mo linked to poorer desire (χ²=6.72, p=0.01). Social support (MOS-SSS) correlated positively with satisfaction (r=0.44, p=0.002). Regular physical activity was protective (FSFI mean 25.6 ± 4.8 vs 20.9 ± 5.2; p=0.001). Comorbid anxiety increased pain scores (β=0.31, p=0.012). Antidepressant dose (fluoxetine-equivalent) predicted orgasmic dysfunction (β=–0.34, p=0.006). Final regression (age, BMI, support, activity, anxiety, income, antidepressant dose) explained 52% of FSFI variance (adjusted R²=0.52). Conclusion: SD affects most women with MDD and is significantly shaped by depression severity, BMI, parity, treatment dose, social support, and lifestyle factors. Multidimensional screening and interventions are recommended.