BACKGROUND Polycystic ovary syndrome (PCOS) is a common and distressing endocrine disorder associated with lower quality of life, subfertility, diabetes, cardiovascular disease, depression, anxiety, and eating disorders. PCOS characteristics, its comorbidities, and its treatment can potentially influence sexual function. However, studies on sexual function in women with PCOS are limited and contradictory. OBJECTIVE AND RATIONALE The aim was to perform a systematic review of the published literature on sexual function in women with PCOS and assess the quality of the research and certainty of outcomes, to inform the 2023 International Guidelines for the Assessment and Management of PCOS. SEARCH METHODS Eight electronic databases were searched until 1 June 2023. Studies reporting on sexual function using validated sexuality questionnaires or visual analogue scales (VAS) in PCOS populations were included. Random-effects models were used for meta-analysis comparing PCOS and non-PCOS groups with Hedges’ g as the standardized mean difference. Study quality and certainty of outcomes were assessed by risk of bias assessments and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) method according to Cochrane. Funnel plots were visually inspected for publication bias. OUTCOMES There were 32 articles included, of which 28 used validated questionnaires and four used VAS. Pooled Female Sexual Function Index (FSFI) scores in random-effects models showed worse sexual function across most subdomains in women with PCOS, including arousal (Hedges’s g [Hg] [95% CI] = −0.35 [−0.53, −0.17], I2 = 82%, P < 0.001), lubrication (Hg [95% CI] = −0.54 [−0.79, −0.30], I2 = 90%, P < 0.001), orgasm (Hg [95% CI] = −0.37 [−0.56, −0.19], I2 = 83%, P < 0.001), and pain (Hg [95% CI] = −0.36 [−0.59, −0.13] I2 = 90%, P < 0.001), as well as total sexual function (Hg [95% CI] = −0.75 [−1.37, −0.12], I2 = 98%, P = 0.02) and sexual satisfaction (Hg [95% CI] = −0.31 [−0.45, −0.18], I2 = 68%, P < 0.001). Sensitivity and subgroup analyses based on fertility status and body mass index (BMI) did not alter the direction or significance of the results. Meta-analysis on the VAS studies demonstrated the negative impact of excess body hair on sexuality, lower sexual attractiveness, and lower sexual satisfaction in women with PCOS compared to controls, with no differences in the perceived importance of a satisfying sex life. No studies assessed sexual distress. GRADE assessments showed low certainty across all outcomes. WIDER IMPLICATIONS Psychosexual function appears to be impaired in those with PCOS, but there is a lack of evidence on the related distress scores, which are required to meet the criteria for psychosexual dysfunction. Health care professionals should discuss sexual function and distress and be aware of the multifactorial influences on sexual function in PCOS. Future research needs to assess both psychosexual function and distress to aid in understanding the degree of psychosexual dysfunction in PCOS. Finally, more diverse populations (e.g. non-heterosexual and more ethnically diverse groups) should be included in future studies and the efficacy of treatments for sexual dysfunction should also be assessed (e.g. lifestyle and pharmacological interventions).

中文翻译：

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多囊卵巢综合征女性的性功能：系统评价和荟萃分析


背景 多囊卵巢综合征 （PCOS） 是一种常见且令人痛苦的内分泌疾病，与生活质量降低、生育力低下、糖尿病、心血管疾病、抑郁、焦虑和饮食失调有关。PCOS 特征、其合并症及其治疗可能会影响性功能。然而，关于 PCOS 女性性功能的研究有限且相互矛盾。目标和基本原理 目的是对已发表的关于 PCOS 女性性功能的文献进行系统评价，并评估研究质量和结果确定性，为 2023 年 PCOS 评估和管理国际指南提供信息。检索方法 检索了截至 2023 年 6 月 1 日的 8 个电子数据库。纳入了使用 PCOS 人群中经过验证的性行为问卷或视觉模拟量表 （VAS） 报告性功能的研究。随机效应模型用于 meta 分析，比较 PCOS 组和非 PCOS 组，以 Hedges' g 作为标准化平均差。根据 Cochrane 通过偏倚风险评估和建议、评估、开发和评价分级 （GRADE） 方法评估研究质量和结局质量。目视检查漏斗图的发表偏倚。结果 共纳入 32 篇文章，其中 28 篇使用经过验证的问卷，4 篇使用 VAS。随机效应模型中的汇总女性性功能指数 （FSFI） 评分显示，PCOS 女性在大多数子领域的性功能较差，包括性唤起（Hedges 的 g [Hg] [95% CI] = -0.35 [-0.53， -0.17]，I2 = 82%，P < 0.001），润滑（Hg [95% CI] = -0.54 [-0.79， -0.30]，I2 = 90%，P < 0.001），性高潮（Hg [95% CI] = -0.37 [-0.56， -0.19]，I2 = 83%， P < 0.001） 和疼痛 （Hg [95% CI] = -0.36 [-0.59， -0.13] I2 = 90%，P < 0.001），以及总性功能 （Hg [95% CI] = -0.75 [-1.37， -0.12]，I2 = 98%，P = 0.02）和性满意度 （Hg [95% CI] = -0.31 [-0.45， -0.18]，I2 = 68%，P < 0.001）。基于生育状况和体重指数 （BMI） 的敏感性和亚组分析没有改变结果的方向或显着性。对 VAS 研究的荟萃分析表明，与对照组相比，过多的体毛对 PCOS 女性的性行为、较低的性吸引力和较低的性满意度有负面影响，令人满意的性生活的感知重要性没有差异。没有研究评估性困扰。GRADE 评估显示所有结局的质量都较低。更广泛的影响 PCOS 患者的性心理功能似乎受损，但缺乏相关痛苦评分的证据，而这些评分是满足性心理功能障碍标准所必需的。医疗保健专业人员应讨论性功能和性困扰，并了解对 PCOS 性功能的多因素影响。未来的研究需要评估性心理功能和痛苦，以帮助了解 PCOS 中性心理功能障碍的程度。最后，更多样化的人群（例如 非异性恋和种族更多样化的群体）应纳入未来的研究，并且还应评估性功能障碍治疗的疗效（例如 生活方式和药物干预）。