Decreased sexual desire and distress symptoms: an analysis among urban Chinese women

Background: Despite China's national women's development policies aimed at enhancing female sexual health, research on hypoactive sexual desire disorder (HSDD) remains insufficient, hindering its clinical diagnosis and treatment. Aim: We aimed to explore the primary self-reported contributing factors for decreased sexual desire among Chinese women of childbearing age and to characterize their experiences of sexual distress symptoms. Methods: An online cross-sectional survey was conducted from April to July 2020. A total of 3443 valid responses (valid response rate 82.6%) from adult Chinese women were analyzed. Outcomes: Data included demographics and the Decreased Sexual Desire Screener (DSDS) adapted to assess HSDD symptoms. Results: Respondents were primarily Chinese urban women of childbearing age (median 26, interquartile range 23-30). "Stress and fatigue" was the primary self-reported contributing factor to decreased sexual desire (53.6%, n = 1846). The prevalence of this factor remained high after standardization for demographic variables (standardized rates ranged from 50.1% to 55.2%). Furthermore, this factor was more prevalent among women with higher levels of education (compared to "middle school," adjusted ORs ranged from 1.52 to 1.86 across education subgroups). Specifically, intense work pressure was associated with decreased sexual desire attributed to various factors (compared to "moderate," adjusted ORs ranged from 1.29 to 1.86). Overall, 18.8% (n = 648) were not satisfied with their level of sexual desire or interest, 40.2% (n = 1383) were bothered by their decreased sexual desire, and 63.6% (n = 2190) wanted it to increase. A total of 5.7% (n = 195) of our participants were at high risk for HSDD (defined by our criteria). Clinical Implications: This study identified key factors influencing decreased sexual desire in Chinese urban women of childbearing age, challenges a simple deficit-based model of HSDD, and highlights a significant unmet need for sexual well-being services. Strengths and Limitations: This first large-scale study on the drivers and related distress symptoms of decreased sexual desire in Chinese women addresses a critical knowledge gap. Caution is warranted, however, in interpreting the findings as the cross-sectional design and online sample limit generalizability, and the assessment tools used have not been rigorously validated in a Chinese population. Conclusion: Decreased sexual desire was prevalent in Chinese urban women of childbearing age and was mostly associated with self-reported stress and fatigue, especially work pressure; notably, the majority of Chinese women desired higher level of sexual desire.