Pulmonary arterial hypertension increases the risk of female sexual dysfunction: a systematic review and meta-analysis

BACKGROUND: An increasing body of research has investigated the sexual functioning status in women with pulmonary arterial hypertension (PAH); yet, the evidence remains inconclusive. AIM: The aim of this study was to examine whether PAH is associated with a higher risk of female sexual dysfunction (FSD). METHODS: The electronic databases MEDLINE, Embase, Cochrane Library databases, and Google Scholar were systematically screened for eligible studies before January 27, 2025. The pooled results were calculated using a random-effects model. OUTCOMES: The strength of the association between PAH and risk of FSD was presented by calculating the relative risk (RR) with a 95% confidence interval (CI). RESULTS: A total of six studies involving 699 adult women with PAH (age range: 20-70 years) were included. High methodological quality was identified in 67% (4 out of 6) of the included studies. Synthesis results revealed that female patients with PAH had a significantly higher risk of FSD as compared to the general population who without PAH (RR = 1.80, 95%CI: 1.62 to 2.01, P < .001; heterogeneity: I2 = 23.5%, P = .258). Subgroup analyses indicated that those studies with a sample size less than 90 participants and those studies conducted in Brazil, the US, and Netherlands had a higher risk of the development of FSD. Sensitivity analyses indicated that no single study could dominate the overall synthetic RR and I2. Third, no remarkable publication bias has been detected among the six included studies. CLINICAL IMPLICATIONS: The present study confirmed that PAH significantly increased the risk FSD. STRENGTHS AND LIMITATIONS: This is the first study investigating the relationship between PAH and FSD. A lack of studies that focus on the six domains on FSD and the limited included studies. CONCLUSION: The present study supported a significant positive association between PAH and the higher risk of FSD via a meta-analysis, while the etiology of PAH-induced FSD might be attributed to a complex of multifactorial mechanisms.