Journal of Womens Health, Issues and Care ISSN: 2325-9795

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Research Article, J Womens Health Issues Care Vol: 4 Issue: 6

Prevalence and Self-Management of Female Sexual Dysfunction among Women in Six Regions of Ghana: A Cross- Sectional Study

Emelia P Imbeah1, Barima A Afrane1, Irene A Kretchy1*, Joseph A Sarkodie2, Franklin Acheampong3, Samuel Oppong1 and Patrick Amoateng4
1Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, University of Ghana, College of Health Sciences, Legon, Ghana
2Department of Pharmacognosy and Herbal Medicine, School of Pharmacy, University of Ghana, College of Health Sciences, Legon, Ghana
3Department of Pharmacy, Korle-Bu Teaching Hospital, Accra, Ghana
4Department of Pharmacology and Toxicology, School of Pharmacy, University of Ghana, College of Health Sciences, Legon, Ghana
Corresponding author : Irene A. Kretchy
Department of Pharmacy Practice and Clinical Pharmacy, University of Ghana School of Pharmacy, College of Health Sciences, Legon, Ghana
Tel: +233-244-217845
E-mail: [email protected]
Received: September 29, 2015 Accepted: November 18, 2015 Published: November 20, 2015
Citation: Imbeah EP, Afrane BA, Kretchy IA, Sarkodie JA, Acheampong F (2015) Prevalence and Self-Management of Female Sexual Dysfunction among Women in Six Regions of Ghana: A Cross-Sectional Study. J Womens Health, Issues Care 4:6. doi:10.4172/2325-9795.1000212

Abstract

Background: Female sexual dysfunction (FSD) is widespread and a relevant health condition among women. Few women seek medical care, yet, the patronage of female sex-enhancing agents from the pharmacies, chemical and herbal shops have increased in recent times. The study sought to determine the prevalence and self-management of FSD among Ghanaian women. Methods: A community-based cross-sectional study was conducted using structured questionnaires to elicit descriptive accounts of sexual experiences, help-seeking behaviours and measures taken to manage the sexual problems. Two hundred and seven (207) sexually active women aged 18 years and above were interviewed from six out of the ten regions in Ghana. Results: The majorities of the respondents was married (53.1%), had tertiary education (74.4%) and were within the ages of 18-29 (52.4%). Of all the respondents, 44.3% were not aware of FSD. The overall prevalence of FSD was 45.6%. The most prevalent sexual problems were pain during sex (72.9%), lubrication difficulties (72.3%), arousal disorder (70.3%), desire disorder (54.2%) and sexual dissatisfaction (27.1%). Only 22.5% of the respondents with FSD sought formal medical help. The reasons for not seeking formal help included the perception that FSD was normal (50.0%), personal embarrassment (19.2%) and time constraints (15.4%). About 57% of the respondents had self-managed at least one sexual problem. Counselling (31.2%), use of vaginal lubricants (24.1%), and sex and relationship strategies (23.4%) were the most cited options for managing FSD. Overall, 85.0% of women perceived the management options were effective. Only 1% of the respondents experienced side effects (vaginal itching) when vaginal lubricants and vaginal herbal preparations were employed. Conclusion: Women in Ghana experience female sexual dysfunction making it a health concern requiring recognition and intervention.

Keywords:

Keywords

Female sexual dysfunction; Help-seeking behaviour; Ghana; Women

Introduction

Sexual dysfunction is a widespread and relevant public health problem occurring commonly in women than in men [1]. Marthol et al. [2] defined sexual dysfunction as disturbances in sexual desire with psycho-physiological changes that characterize the sexual response and cause marked distress and interpersonal difficulty. Female Sexual Dysfunction (FSD) has been used to depict various sexual problems such as low sexual desire or interest, reduced arousal, orgasmic difficulties and pain during sex [2].
Female sexual dysfunction is multifactorial in terms of etiology. It may be caused by psychological, physiological and sociological factors [3]. FSD is widespread and affects women in different countries, cultures and age groups. In Ghana, the prevalence of FSD has reported previously as 72.8% [4].
Although not life threatening, FSD can have profound effects on the physical and mental well-being of women. It may contribute to infertility, low self-esteem, and emotional burden and can have overwhelming effects on their relationships with their sexual partners [5].
Generally, little is known about the help-seeking behaviour of women with sexual problems and how such women self-manage their condition. Past studies have also shown that only a small proportion of women with sexual problems seek medical attention [6,7,8].
Despite the reported high prevalence of female sexual dysfunction in Ghana and the likely complications it may have on women, the Standard Treatment Guidelines of Ghana gives no procedures for the assessment and management of women with sexual problems. Furthermore, little is known about the help-seeking behaviour of women with FSD and the measures taken by these women to manage their condition(s). Therefore, this study sought to 1. Assess the level of awareness of FSD among women. 2. Assess the help-seeking behaviour of women with FSD, 3. Identify the measures taken by these women to manage FSD and 4. Evaluate the perceived effectiveness, safety and adverse effects, if any, associated with these remedies.

Methods

Study design and setting
A community-based cross-sectional study was conducted in six regions in Ghana namely; Greater Accra, Ashanti, Western, Central, Brong-Ahafo and Eastern regions. These six regions are densely populated and were chosen to allow for generalization of results for the entire country.
Participants
This study approached 305 women, aged 18 years and above, selected randomly from the six regions irrespective of religious, social and educational backgrounds. Only women in heterosexual relationships were included in the study. Women who were not sexually active were excluded. The minimum sample size was determined by the sample size formula; N=Z2 P (1-P)/ d2, where P is the highest prevalence rate of 72.8% as reported by [4], Z is the confidence level of 95% (1.96), d is the allowed error of 0.05 [9].
Data collection tools
A questionnaire comprising of questions on the background of respondents (age, marital status, highest level of education, occupation, region and religious affiliation), self-reported FSD, helpseeking behaviour and the treatment/management options for FSD was employed in this study.
Self-reported sexual problems of desire, arousal, lubrication, orgasm, satisfaction and pain were measured with the Female Sexual Function Index (FSFI). This tool consisted of 19 questions covering 6 domains namely; desire (Q1-Q2), arousal (Q3-Q6), lubrication (Q7- Q10), orgasm (Q11-Q13), satisfaction (Q14-16) and pain (Q17-Q19). Though FSFI was developed based on the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria for female sexual arousal disorder (FSAD), it been shown to discriminate reliably between FSAD and the other five domains as well as the full scale score [10]. Internal consistency of 0.89-0.96 (Cronbach’s alpha) and test-retest reliabilities (Cohen’s kappa) of 0.79-0.86 have been reported to be within the acceptable range [10]. In this study, response to each question related to the previous 3 months and were scored either from 0 (no sexual activity) or 1 (indicative of dysfunction) to 5 (suggestive of normal sexual activity).
Help-seeking behaviour among women with FSD was assessed by asking the question: “Have you ever sought any help from healthcare professionals for your problem?” A list of healthcare providers was given and more than one option could be selected. ‘Formal Help’ was used to represent help sought from healthcare providers such as obstetricians/ gynecologists, general medical practitioners, psychiatrists, psychologists, pharmacists, nurses, whereas ‘Informal Help’ was used to designate help from persons other than healthcare providers (sexual partners, friends, co-workers, family members etc.). Reasons for not seeking professional help were then explored.
The final section of the questionnaire explored the options available for self-managing female sexual dysfunction in the country and the responses noted.
Women who could not read and understand the English language were interviewed in Twi (the dominant local language). The data collection tool was pre-tested on a sample of 20 respondents and found to be reliable with a Cronbach’s alpha of 0.81. In addition, responses in the local language version were professionally translated from Twi to English to ensure that the exact responses were conveyed in both languages. Averagely, each interview lasted about 20 minutes.

Ethics

Approval to conduct the study was given by the research committee of School of Pharmacy, University of Ghana. The study was strictly voluntary. Written and verbal (for women who could not read) informed consent were sought from the respondents. Participants were not required to supply any information that would reveal their identities. Data provided by all the participants were anonymously and confidentially handled.

Data Analysis

Data obtained by the FSFI were analyzed by first obtaining domain scores for the 6 domains as outlined in the computational formula by Rosen et al. [10]. This was done by adding the scores of the individual questions that made up the domain and by multiplying the sum by the domain factor provided in the FSFI for each domain. The full scale score (for overall sexual dysfunction) was obtained by adding the 6 domain scores. Data on the sexual dysfunction, help-seeking behaviour and management options for FSD were analyzed using the 20th version of the Statistical Package for Social Sciences (SPSS). Graphical displays such as frequency tables were used to describe the data.

Results

Out of the 305 women who consented to the study, 207 (67.9%) completed their questionnaires.
Characteristics of respondents
The majority of the respondents (52.4%) were between the ages of 18 and 29 years, 53% were married, 87% had attained a minimum of secondary school education and 95.2% were Christians. Most of the participants came from the Brong Ahafo region (Table 1).
Table 1: Socio-demographic Characteristics of Respondents.
Level of awareness, definition and possible causes of FSD
Almost half of the respondents (44.3%) were unaware of FSD (Table 2). Out of the women who reported having knowledge of FSD (50.7%), 16.9% gave wrong definitions. The majority of the women understood FSD as pain or discomfort during sex (41.7%), disturbance in the normal sexual response (30.2%) and lack of desire for sex (24%). Prominent among the possible causes of FSD cited were stress (30.9%), medical and hereditary conditions (20.2%), previous sexual abuse (16%), unpreparedness (8.5%), and ageing (8.5%).
Table 2: Awareness of FSD, Definition and Possible Causes.
Experience of FSD and help-seeking behaviour of women with FSD
Almost half of the respondent (45.6%) had female sexual dysfunction. Many of them had experienced at least one problem with sex. Pain during sex was the most reported sexual problem (72.9%), followed by lubrication difficulties (72.3%), arousal disorder (70.3%), desire disorder (69.7%), orgasmic disorder (54.2%) and sexual dissatisfaction (27.1%) (Table 3).
Table 3: Experience of FSD and Help-Seeking Behaviour of women with Self-Reported FSD.
Most of the women who reported experiencing sexual problems did not seek any help for their condition (49.3%). Out of those who sought help, only 22.5% disclosed their condition to healthcare providers (formal help). Reasons for not seeking formal help included the thought that experiencing sexual problems was normal (50.0%), personal discomfort and embarrassment (19.3%), time constraints (15.4%), lack of privacy during hospital visits (14.4%) and the notion that healthcare providers cannot solve sexual problems. Most of the women who sought formal and informal help consulted gynecologists and sexual partners respectively (Tables 3 and 4).
Table 4: Self-Management of FSD; Measures, Perceived Effectiveness and Side Effects.
Self-management of FSD: Measures, perceived effectiveness and side effects
More than half of the respondents (56.5%) had self-managed at least one sexual problem. The most cited measures taken by women to self-manage their condition included seeking informal counsel (31.2%), and the use of vaginal lubricants (24.1%) whereas others resorted to the use of herbal preparations (5.7%), sex toys (2.1%), vibrators (2.1%), hormonal therapy (2.1%) and aphrodisiacs (1.4%).
On the whole, more than half of the women who employed these measures saw them to be effective and safe (Figures 1 and 2) except for complains about vaginal irritation. Vaginal lubricants greatly reduced pain during sex; Aphrodisiacs increased satisfaction with sex; sex toys and mechanical aids increased desire for sex and enhanced orgasm whereas counseling enhanced orgasm and improved the relationship between users and their sexual partners.
Figure 1: Perceived effectiveness of management options for FSD.
Figure 2: Perceived Benefits of Management Options for FSD.

Discussion

Generally, research has shown that unlike male sexual dysfunction, female sexual dysfunction is a topic that is least talked about in various societies [8,11]. Consequently, more than half of the respondents in this study were ignorant of FSD. Some (10.6%) of the women who reported that they were aware of FSD also gave completely wrong descriptions and definitions for female sexual dysfunction. The perception that it is a taboo for women to openly discuss sexual issues and the fact that most studies have only focused on male sexual problems may have accounted for the significant unawareness of FSD among the study participants. Therefore, there is a need for massive public education on this topic among Ghanaian women and the public as a whole. Such educative programs may be held on the media, at public gatherings, or at the community level and must focus on normal and abnormal female sexuality, causes of FSD, treatment options available for FSD and options for seeking help.
With documented evidence suggesting that FSD is as a result of several causes [1,12,13], results from this study also revealed several possible factors that may cause female sexual problems. Most of the cited causes cut across four main areas namely, psychological (past sexual abuse, fear), physical (medical conditions), emotional (stress, anxiety, depression) and aging. Stress, the most cited cause of FSD in this study (30.9%), has also been shown to cause a decrease in sexual desire, arousal and orgasm [14,15].
The prevalence of FSD in this study was found to be 45.6% thus, affirming the existence of FSD among Ghanaian women in such a proportion that should not be overlooked. However, the prevalence of FSD in this study was relatively lower than that obtained by Amidu et al. [5] and his colleagues in a work done in Kumasi (72.8%) using the Golombok Rust Inventory of Sexual Function (GRISS) Scale [4]. The difference in the prevalence could be attributed to differences in the number of participants, geographical locations, the time period for the study and the scales employed in measuring FSD.
The most prevalent areas of sexual difficulties were pain during sex/dyspareunia (72.9%), followed by lubrication difficulties (72.3%), arousal difficulties (70.3%), desire difficulties (69.7%) and orgasmic difficulties (54.2%). Sexual dissatisfaction was the least reported sexual problem. These disorders have also been reported with dyspareunia being cited as the most prevalent sexual problem [16].
With the high prevalence rates of sexual problems recorded, one would expect more women with sexual problems to seek medical attention. However, similar to findings of related studies, nearly onehalf of the participants with self-reported sexual problems did not seek any kind of help for their problems [8,17]. Perhaps these women did not seek help because they thought sexual problems were normal and there was no need worrying about their condition so long as they were able to satisfy the sexual needs of their partners. This finding also suggests that the severity of FSD vary among women thus, the help seeking behaviour of women experiencing sexual problems depends on the perceived severity of the problem.
Of the women who sought help, a high proportion (43.5%) opted for informal help (i.e. they discussed their problems with sexual partners, friends, co-workers and family members) whereas 22.5% sought formal help (i.e. they confided in healthcare providers such as general practitioners, gynecologists, pharmacists, and nurses). Studies conducted by Shifren et al. [8] and Mercer et al. [16] showed similar results. The most cited reasons for not seeking formal help were the perception that FSD was normal and part of life, personal discomfort or embarrassment and time constraints. The lack of privacy during hospital visits and the belief that healthcare providers could not be of help were also cited by a substantial portion of the respondents which is consistent with other studies [8,11]. There is therefore the need to educate women on the complications of FSD and the benefits that can be obtained from seeking formal help. Women could be given some privacy during hospital visits in order to encourage them to discuss their problems freely. Furthermore, healthcare providers could be educated on ways of initiating healthy sexual conversations with their female patients without making them feel uncomfortable and shy.
More than half of the participants in this study had self-managed their problems. This agrees with the finding of the study conducted by Danquah et al. [18] in Ghana where 46% of the respondents were reported to have used a myriad of sex enhancing agents for decreased libido, female orgasmic disorder and vaginal tightening.
The most reported measures for self-managing FSD in this study were informal counseling (32%), the use of vaginal lubricants (24.1%) and sex and relationship strategies (23.4%). Prolonged foreplay, caressing, change in sexual positions and effective communications were the most employed sex and relationship strategies by women in managing sexual problems. Few women also employed other measures such as sex toys, mechanical aids, topical local anesthetics, hormone replacement therapy, and herbal preparations. Comparable with other studies, most of the users of these options (>60%) perceived them to be effective in managing sexual problems [13,19]. Among the users of these options, a user of vaginal lubricants and a user of topical (vaginal) herbal preparations, complained of vaginal irritation and itching. Certain herb-based lubricants are known to contain extracts of aloe and lavender, which may be responsible for the irritations or allergic reactions. The possible reason for conventional lubricants to precipitate allergic reactions in the form of vaginal irritations in some susceptible users has been attributed to the product osmolality [20]. None of the users of the other management options reported any side or adverse effects. Thus, suggesting that these measures could be used to manage FSD with little or no problems. Primary healthcare providers could therefore be educated on these management options to enable them offer counseling and education to women who complain of sexual problems.
The findings from this study are preliminary thus, leaving room for researchers to further examine and explore other possible aspects of FSD such as female genital mutilation.

Conclusion

Female sexual dysfunction (FSD) is prevalent in the Ghanaian society. Most women with sexual dysfunction either do nothing about their condition or self-manage them. There is thus, the need for public education programs to educate women on the causes and effects of FSD as well as the options available for treating sexual problems. Healthcare providers could also be trained on how to assess, diagnose and manage FSD appropriately. Additionally, health providers, particularly, pharmacists, doctors and nurses could include education on FSD to their routine management of women in order to improve female sexual health in general.

Acknowledgments

The authors wish to thank all the women who participated in this study and the school authorities at School of Pharmacy, University of Ghana, Legon.

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