Sexual function problems, sexual distress, and operationally defined female sexual dysfunction among women with infertility in southern Iran: a cross-sectional study

Infertility can negatively affect women’s sexual health. However, low sexual function and sexual distress are different concepts and should not be used interchangeably. This study aimed to estimate the prevalence of low sexual function, sexual distress, and operationally defined female sexual dysfunction (FSD) among women with infertility in southern Iran, and to examine their associations with selected sociodemographic and infertility-related characteristics. In this cross-sectional study, 455 women attending an infertility center in Bandar Abbas, southern Iran, were recruited by simple random sampling from November 2023 to September 2024. Sexual function and sexual distress were assessed using the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale-Revised (FSDS-R), respectively. Low sexual function was defined as FSFI ≤ 26.55, sexual distress as FSDS- R ≥ 11, and operationally defined FSD as the concurrent presence of both conditions. Three separate multivariable logistic regression models were fitted for low sexual function, sexual distress, and FSD. The prevalence of low sexual function, sexual distress, and FSD was 92.1%, 33.8%, and 31.6%, respectively. In the revised multivariable models, longer infertility duration was associated with higher odds of sexual distress and FSD. Compared with an infertility duration of 1 to 5 years, a duration of 16 to 25 years was associated with higher, but imprecisely estimated, odds of sexual distress (adjusted OR = 3.14, 95% CI: 1.40 to 7.09; p = 0.006) and FSD (adjusted OR = 3.07, 95% CI: 1.36 to 6.91; p = 0.007). Moderate economic status was associated with lower odds of FSD than unfavorable economic status (adjusted OR = 0.57, 95% CI: 0.35 to 0.91; p = 0.018). Estimates from the exploratory low-sexual-function model were less precise and should be interpreted cautiously because the outcome distribution was markedly imbalanced. Among women receiving infertility care in southern Iran, low sexual function was highly prevalent, whereas about one-third experienced sexual distress or met the combined criteria for FSD. Longer infertility duration was associated with higher odds of sexual distress and FSD. These findings support the importance of assessing both sexual function and sexual distress in infertility care, and of interpreting combined questionnaire-based definitions cautiously in the absence of a formal clinical diagnosis.