Original Article

Sexual Dysfunction in Women with Journal of Psychosexual Health

1(2) 129–139, 2019
© 2019 Karnataka Sexual Sciences Academy
Depressive Disorder: A Prospective, Reprints and permissions:
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Hospital Based Study DOI: 10.1177/2631831819862415
journals.sagepub.com/home/ssh

Swaleha Mujawar1, Suprakash Chaudhury1, and Daniel Saldanha1

Abstract
Background: Depression causes emotional and physical disturbances which impacts biological functions such as sleep,
appetite, libido, and disinterest in sexual function. Since discussing sexual problems is considered a taboo, there is limited data
available concerning the prevalence of sexual dysfunction in women with depression and its response to treatment.
Aim: To assess the prevalence of sexual dysfunction in females with depressive disorder and the effects of treatment.
Material and Methods: A total of 53 females with recurrent depression and age and sex matched normal control group
were included in the study with their informed consent. All the subjects were assessed with the Hamilton Rating Scale
for Depression (HAM-D), Arizona sexual experience scale (ASEX), and female sexual functioning index (FSFI), which were
re-administered after 6 weeks of treatment.
Results: There was a significant difference in the HAM-D, ASEX, and FSFI scores between index and control groups at
baseline. There was a significant correlation between the scores of HAM-D, ASEX, and FSFI before treatment. The correlation
between the HAM-D and ASEX scores after treatment was not significant. A significant correlation was found between the
HAM-D scores and the scores of arousal, lubrication, orgasm, satisfaction, pain, total domains of FSFI after treatment. No
correlation was found between the HAM-D scores and desire domain score of FSFI after treatment.
Conclusion: Women with depression have a high prevalence of sexual dysfunction. A highly significant improvement in
depression and sexual functioning was observed at the end of 6 weeks of antidepressant therapy. Despite the improvement
in sexual dysfunctions, the individual domains of sexual functions were not comparable to the normal subjects at the end of
6 weeks suggesting the need for longer treatment.

Keywords
Sexual dysfunction in women, depression, hypoactive sexual desire disorder, female sexual arousal disorder, female orgasm
disorder, pain disorders

Introduction female sexual arousal disorder, female orgasm disorder, and

pain disorders.1 Amongst them, the most commonly seen are
Human sexual functioning can be described as the the hypoactive sexual desire disorder and sexual arousal
characteristic of the way individuals feel and convey disorder.2 It can be argued that the attitude to sexual
themselves. It encompasses biological, erogenous, emotional, dysfunctions accepted by the International Classification of
social, or spiritual feelings and behaviors of humans. Good
sexual functioning is an essential constituent of life and is
1
Department of Psychiatry, Dr D.Y. Patil Medical College, Hospital & Research
important for sustaining a gratifying relationship among two
Centre, Dr D.Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
people sharing intimacy. Thus, sexual health can be considered
Corresponding author:
a crucial part of physical and mental well-being. The incidence
Suprakash Chaudhury, Department of Psychiatry, Dr D. Y. Patil Medical
of sexual problems in females is reported to be 43% and 31% College, Hospital & Research Centre, Dr D. Y. Patil Vidyapeeth, Pimpri,
in males.1 Sexual dysfunction in females can be categorized Pune, Maharashtra 411018, India.
into the following types: hypoactive sexual desire disorder, Email: suprakashch@gmail.com

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130 Journal of Psychosexual Health 1(2)

Diseases, Tenth Revision (ICD-10) and Diagnostic and consequences of this disorder. Looking from the Indian
Statistical Manual of Mental Disorders, Fifth Edition perspective, the females in India do not talk freely about
(DSM-5) may not do justice to the diverse and often sexual problems that they face. Cultural and societal views
exceptional means in which male or female patients present might be responsible for very few women coming forward
with sexual complaints. Other aspects of sexual response are with problems regarding sexuality. Hence, one finds that
also affected when one part of the sexual cycle is affected. various researches have focused on male sexual dysfunction
The prognosticators of sexual problems that people suffer but the same cannot be said for female sexual dysfunction.
from may fluctuate with time, according to “cultural shifts, The studies on sexual dysfunction in women being few, a
generational, and societal norms.”3 Hence, it is important to necessity was felt to explore the attributes of female sexual
broaden our minds and look beyond the presenting symptoms dysfunctions and its relation to underlying depression and
and find the diagnosis which fits the patient best. response to treatment. A detailed and comprehensive look
Depression was found to be the fourth most common into this condition will lead to effective treatment and better
cause of disease burden, responsible for 4.4% of total enhancement of quality of life. In view of the paucity of
disability-adjusted life years (DALYs) in the year 2000, and it Indian studies, the present work was undertaken to study the
produces the greatest amount of non-fatal burden, responsible prevalence of sexual dysfunction in females with recurrent
for almost 12% of all total years lived with disability depressive disorder.
worldwide. It is said that depression will be responsible for
the largest burden of disease illness by 2020. Depression leads
to emotional and physical problems which impact biological
Material and Methods
functions such as sleep, appetite, diminished libido, and
This prospective longitudinal study was carried out at a
disinterest in sexual function. Zurich cohorts study by Angst
tertiary care hospital and research center attached to a medical
et al shows that the prevalence of sexual problems in patients
college from July 2017 to September 2018. Institutional
with depression is approximately twice that of the controls.4
ethics committee permission was acquired before starting the
Some of the antidepressants prescribed for the depression
study. The study sample consisted of consecutive females
may cause problems in sexual functioning and may affect all
attending the outpatient department with diagnosis of
the stages of the human sexual cycle.5 Antidepressant-induced
recurrent depressive disorder (F 33) as per ICD-10 DCR9 and
sexual problems become a significant concern in the situation
meeting the inclusion and exclusion criteria. Equal number of
of management effectiveness, as antidepressants are useful
age matched female subjects without any past or family
only as long as the patient takes them regularly. Unbearable
history of psychiatric disorder formed the control or index
adverse effects can be one reason that patients do not take
group. A total of 53 females from both the groups were
medicines or stop them abruptly. Nonetheless, maximum
evaluated. The following inclusion and exclusion criteria
of the findings from research done on drug-induced sexual
were fulfilled before the subjects were taken up for the study.
dysfunctions have combined numbers for both males and
Inclusion criteria for the study or index group:
females, except a few.6,7
The understanding of female sexuality is not at par with 1. Females diagnosed to have recurrent depressive
that of male sexuality.8 In the last few decades, research disorder according to ICD DCR
in the field of sexuality has gained momentum all over the 2. 18 to 45 years of age who were sexually active
world. However, various lacunae remain in our knowledge 3. Not on any psychotropic medication or drug-free for
about sexual dysfunction in spite of advances in treatment of 6 weeks
sexual problems. In particular, our information about female 4. Willing to give consent for the study
sexual dysfunction has constantly lagged behind that of male
Exclusion criteria for the study or index group:
sexual problems. Studies on the topic of sex are scant in India
and whatever research has been done has mostly focused on 1. Who were not sexually active
sexual dysfunction in males. In fact, comparatively, not much 2. Patients requiring electroconvulsive therapy
is established about sexual behaviors, sexual attitudes, sexual 3. Those having any comorbid medical illness
fantasies, and marital functioning of Indian women. Also, there
Inclusion criteria for the control group:
is not much research from India that has assessed the presence
of sexual problems in patients who are taking psychotropic 1. 18 to 45 years of age who were sexually active
medications. While there is a handful of statistics to imply 2. Willing to give consent for the study
that women have progressive outlook towards sexuality,
Exclusion criteria for the control group:
in countries like ours conversing about sexual problems
is largely considered a taboo. Female sexual dysfunction 1. Who were not sexually active
was identified as a significant yet largely un-investigated 2. Those having any other comorbid medical illness
public health problem. There is very little population-based 3. Those with past or family history of psychiatric
data available concerning the predictors, prevalence, and disorder
Mujawar et al. 131

Data Collection Tools patients were re-administered the HAM-D, ASEX, and FSFI
at the end of 6 weeks of treatment to assess their depression
Sociodemographic and clinical pro forma: A
and sexual functioning. The scales were scored as per the test
semi-structured pro forma was used to enquire about
manual and data entered in an Excel sheet.
sociodemographic details, details of psychopathology,
presence of sexual dysfunctions, and questions pertaining to
aims and objectives of the study. Statistical Analysis
The Hamilton Rating Scale for Depression (HRSD/
HAM-D): This is a 21-item scale utilized to evaluate The SPSS software package for Windows, version 20.0, was
depression. It was developed by Max Hamilton in 1960.10 It used for statistical analysis. Descriptive statistics: Data
is administered by a clinician. If the result is between 0 and summarization was carried out with the help of percentages
7, then it is interpreted as normal, 8 to 13 is mild, between and summary statistics will be with mean, range, and standard
14 and 18 is moderate, between 19 to 22 is severe, and very deviation.
severe if score is more than or equal to 23. This measure offers Inferential statistics: The frequency data was compared
reliability indexes with a Cronbach’s coefficient alpha of 0.90 using the chi-square test/Fisher’s exact test, and ordinal
and correlation at periods of 1 and 2 weeks with r = 0.80. data using the Mann-Whitney and Wilcoxon test at 5%
Arizona sexual experience scale (ASEX): This is a significance.
short scale intended for both male and females. The measure
is meant for the evaluation of sexual problems in patients
suffering from mental illnesses and also patients with Results
physical health issues. This self-report scale can be either
The present study included 53 females with recurrent
carried out by a clinician or by the patient himself or herself.
depressive disorder and an equal number of age matched
There are 5 items and each of them is scored from 1 to 6.
females were included in the control group. The mean (±SD)
Every question investigates a specific feature of sexual
age of the sample in index group was 29 years and in control
functions, that is, sexual drive, arousal, erection of penis/
group was 28 years. The age range in the index group was 18
vaginal lubrication, ability to reach orgasm, and satisfaction
to 45 years and in control group was 18 to 44 years. The
from orgasm. The final total score can range from 5 to 30.
commonest age group was 26 to 30 years in the index and
The following results give us an idea of sexual problems:
control groups. There was no significant difference in the age
total score of 19 or more, score on any one question of 5 or
distribution (Table 1).
more, scores on any three individual questions of 4 or more.
Education: There was a significant difference in the
This scale has good internal consistency and scale reliability
education distribution. Majority of the subjects had completed
with alpha = 0 .9055. It showed strong test-retest reliability
up to 10th standard in the index group and most of the subjects
with r = 0.801, P < .01 for patients and r = 0.892, P < .01 for
were graduates in the control group.
controls. This scale was used in our study to screen patients
Occupation: The commonest occupations were service
with sexual dysfunction.11
in the control group and most of the females in the index
Female sexual functioning index (FSFI): It is a brief
group were housewives. There was a significant difference
self-report scale. It was created for evaluating the main
between the occupations of the index and control groups.
elements of sexual function in females. It consists of 19
Socioeconomic status (SES): Most of the subjects in the
questions. It delivers outcomes on six areas of sexual functions,
index group belonged to lower SES while most of the subjects
that is, desire, arousal, lubrication, orgasm, satisfaction, and
in the control group were from the middle SES. A significant
pain. It also provides a total score. An overall score of 26.55
difference between the SES of the index and control group
is the ideal cutoff score for distinguishing females with or
was found.
without sexual problems.12 This scale was used to evaluate
Family history: The majority of the subjects belonging
the dimensions of various aspects of sexual dysfunction.
to the index groups did not have any family history of
depressive disorder while none of the control subjects had
Methodology a family history of depression. There was a significant
difference between the family history of depressive disorder
All the patients and people in the control group included in of the index and control groups.
the study were explained about the nature of the study and Number of children: The largest number of subjects
informed consent was taken. All patients were interviewed in from both the groups had 2 children. There was no significant
the presence of a female investigator. After that the difference between the number of children of the index and
sociodemographic data was filled up. Thereafter, all the control groups.
patients and control subjects were administered HAM-D, There was a significant difference in the HAM-D, ASEX,
ASEX, and FSFI. All the patients with depressive disorder and FSFI scores between the index and control groups before
were started on conventional lines of treatment. All the treatment (Table 2).
132 Journal of Psychosexual Health 1(2)

Table 1. Demographic Characteristics of Individuals in the Index and Control Group

Characteristics Index Group Control Group Chi-Square Test/Fisher’s

N % N % Exact Test Value (P)
Age group <20 2 3.8 2 3.8
20-25 17 32.1 12 22.6
Chi-square = 5.26
26-30 18 33.9 22 41.5 P = .39 NS
31-35 7 13.2 13 24.5
36-40 6 11.3 2 3.8
41-45 3 5.7 2 3.8
Education ≤Primary 3 5.7 1 1.9 Chi-square = 16.53
SSC 22 41.5 5 9.4
HSC 13 24.5 21 39.6 P < .01 S
Graduate 15 28.3 26 49.1
Occupation Housewife 29 54.7 9 17.0
Self-employed 13 24.5 11 20.8 Chi-square = 36.97
Farmer 7 13.2 1 1.9 P < .001 S
Service 4 7.5 32 60.4
Socioeconomic status Low 40 75.4 11 20.8 Chi-square = 29.62
Middle 13 24.5 42 79.2 P < 0.05 S
Family history of depression Yes 13 24.5 0 0 Fisher’s exact test
No 40 75.4 53 100 P = .001 S
Number of children 0 5 9.4 1 1.8 Chi-square = 5.13
1 7 13.2 14 26.4 P = .16
2 34 64.1 32 60.3 NS
3 7 13.2 6 11.3
Abbreviations: S, significant; NS, not significant.

Table 2. Comparison of Scores Between Index and Control Groups Before Treatment

Depressed Women Control Group Mann-Whitney U Test

Rating Scale Mean (SD) Median Mean (SD) Median Z score P value
HAM-D 14.8 (4.4) 14 2.05 (1.7) 2 –8.899 .000
ASEX 17.75 (6.7) 17 9.53 (4.9) 8 –8.899 .000
FSFI total 20.67 (8.9) 20.5 54.00 (25.6) 60 –5.840 .000
Desire 2.54 (1.6) 1.8 6.17 (2.2) 6 –7.198 .000
Arousal 2.56 (1.7) 2.4 8.43 (4.6) 10 –5.399 .000
Lubrication 3.00 (1.7) 3 11.98 (6.6) 13 –5.682 .000
Orgasm 3.29 (1.76) 3.6 8.32 (4.69) 10 –5.552 .000
Satisfaction 4.22 (1.69) 4 10.33 (4.3) 11 –6.701 .000
Pain 4.98 (1.8) 6 8.94 (6.1) 11 –3.532 .000
Mujawar et al. 133

Table 3. Comparison of Scores Obtained by Patients with Depression Before and After Treatment

Depressed Women Wilcoxon Test

At Baseline Mean After Treatment Mean
Rating Scale (SD) Median (SD) Median Z Score P Value
HAM-D 14.88 (4.4) 14 7.45 (2.9) 7 –6.344 .000
ASEX 17.75 (6.7) 17 9.60 (4.2) 9 –5.989 .000
FSFI total 20.67 (8.9) 20.5 24.15 (7.1) 24.1 –5.206 .000
Desire 2.55 (1.6) 1.8 3.27 (1.4) 3 –4.014 .000
Arousal 2.56 (1.7) 2.4 3.24 (1.6) 3 –4.646 .000
Lubrication 3.00 (1.7) 3 3.70 (1.4) 3.3 –4.180 .000
Orgasm 3.29 (1.8) 3.6 3.87 (1.5) 4 –4.031 .000
Satisfaction 4.22 (1.7) 4 4.77 (1.21) 4.8 –3.400 .001
Pain 4.98 (1.9) 6 5.29 (1.7) 6 –3.089 .002

Table 4. Comparison of Scores Between Index and Control Groups After Treatment

Depressed Women Control Group Mann-Whitney U Test

Rating Scale Mean (SD) Median Mean (SD) Median Z score P value
HAM-D 7.45 (2.9) 7 2.05 (1.7) 2 –-8.171 .000
ASEX 9.60 (4.2) 9 9.53 (4.9) 8 –.697 .486
FSFI total 24.15 (7.1) 24.1 54.00 (25.6) 60 –5.063 .000
Desire 3.27 (1.4) 3 6.17 (2.2) 6 –6.591 .000
Arousal 3.24 (1.6) 3 8.43 (4.6) 10 –5.300 .000
Lubrication 3.70 (1.4) 3.3 11.98 (6.6) 13 –5.547 .000
Orgasm 3.87 (1.5) 4 8.32 (4.69) 10 –5.383 .000
Satisfaction 4.77 (1.21) 4.8 10.33 (4.3) 11 –6.580 .000
Pain 5.29 (1.7) 6 8.94 (6.1) 11 –3.415 .000

Table 5. Table Showing the Spearman’s Correlations Between the Scores of HAM-D with ASEX and FSFI (Desire, Arousal, Lubrication,
Orgasm, Satisfaction, Pain, Total) in the Index Group Before Treatment

HAMD ASEX Desire Arousal Lubrication Orgasm Satisfaction Pain TFSFI

HAMD CC 1.000 .583** –.502** –.529** –.561** –.470** –.373** –.275* –.520**
S . .000 .000 .000 .000 .000 .006 .047 .000
ASEX CC .583** 1.000 –.743** –.735** –.572** –.521** –.373** –.278* –.611**
S .000 . .000 .000 .000 .000 .006 .044 .000
Desire CC –.502** –.743** 1.000 .913** .766** .683** .546** .317* .831**
.000 .000 . .000 .000 .000 .000 .021 .000
Arousal CC –.529** –.735** .913** 1.000 .807** .735** .647** .370** .875**
S .000 .000 .000 . .000 .000 .000 .006 .000
Lubrication CC –.561** –.572** .766** .807** 1.000 .838** .775** .486** .903**
S .000 .000 .000 .000 . .000 .000 .000 .000
Orgasm CC –.470** –.521** .683** .735** .838** 1.000 .858** .675** .930**
S .000 .000 .000 .000 .000 . .000 .000 .000
(Table 5 Continued)
134 Journal of Psychosexual Health 1(2)

(Table 5 Continued)

HAMD ASEX Desire Arousal Lubrication Orgasm Satisfaction Pain TFSFI

Satisfaction CC –.373** –.373** .546** .647** .775** .858** 1.000 .702** .885**
S .006 .006 .000 .000 .000 .000 . .000 .000
Pain CC –.275* –.278* .317* .370** .486** .675** .702** 1.000 .638**
S .047 .044 .021 .006 .000 .000 .000 . .000
TFSFI CC –.520** –.611** .831** .875** .903** .930** .885** .638** 1.000
S .000 .000 .000 .000 .000 .000 .000 .000 .
Abbreviations: CC, correlation coefficient; S, sig. (2-tailed).
Notes: * Correlation is significant at the 0.05 level (2-tailed).
** Correlation is significant at the 0.01 level.

Table 6. Table Showing the Correlations Between the Scores of HAM-D with ASEX and FSFI in the Index Group After Treatment

HAMD ASEX Desire Arousal Lubrication Orgasm Satisfaction Pain TFSFI

HAMD CC 1.000 .224 –.094 –.396** –.430** –.373** –.344* –.271* –.379**
S . .107 .504 .003 .001 .006 .012 .050 .005
ASEX CC .224 1.000 –.194 –.227 –.343* –.370** –.371** –.177 –.386**
S .107 . .163 .102 .012 .006 .006 .204 .004
Desire CC –.094 –.194 1.000 .622** .631** .538** .451** .092 .671**
S .504 .163 . .000 .000 .000 .001 .512 .000

Arousal CC –.396** –.227 .622** 1.000 .701** .536** .607** .413** .795**
S .003 .102 .000 . .000 .000 .000 .002 .000
Lubrication CC –.430** –.343* .631** .701** 1.000 .740** .714** .310* .866**
S .001 .012 .000 .000 . .000 .000 .024 .000
Orgasm CC –.373** –.370** .538** .536** .740** 1.000 .789** .449** .848**
S .006 .006 .000 .000 .000 . .000 .001 .000
Satisfaction CC –.344* –.371** .451** .607** .714** .789** 1.000 .432** .894**
S .012 .006 .001 .000 .000 .000 . .001 .000
Pain CC –.271* –.177 .092 .413** .310* .449** .432** 1.000 .510**
S .050 .204 .512 .002 .024 .001 .001 . .000
TFSFI CC –.379** –.386** .671** .795** .866** .848** .894** .510** 1.000
S .005 .004 .000 .000 .000 .000 .000 .000 .
Abbreviations: CC, correlation coefficient; S, sig. (2-tailed).
Notes: * Correlation is significant at the 0.05 level (2-tailed).
** Correlation is significant at the 0.01 level.

There was a significant difference between the HAM-D, There was a significant positive correlation between
ASES, and FSFI scores in depressed patients before and after the scores of HAM-D and ASEX scores in the index group
treatment (Table 3). before treatment. There was a significant negative correlation
There was a significant difference in the HAM-D score between the scores of HAM-D and all the domains of FSFI
between the index and control groups after treatment. There (desire, arousal, lubrication, orgasm, satisfaction, pain, total)
was no significant difference in the ASEX score between the at baseline in the patients suffering from depression (Table 5).
index and control groups after treatment. Thus, the scores are There was a positive correlation between the HAM-D and
comparable between the index and control groups showing ASEX scores after treatment, but it was not significant. There
that the patients have improved to near normality. However, was a significant negative correlation between the scores of
there was a significant difference in the FSFI scores between HAM-D and arousal, lubrication, orgasm, satisfaction, pain,
the index and control groups after treatment (Table 4). total domains of FSFI after treatment in the patients suffering
Mujawar et al. 135

from depression. No significant correlation was found reported to have a greater frequency of sexual problems like
between the scores of HAM-D and desire score of FSFI in the decreased libido, when compared to the normal population.24
index group after treatment (Table 6). The above studies are in agreement with our study which also
revealed that most of the patients having depression were in
the early and late 20s age group (Table1).
Discussion Education: Our finding revealed 41% of patients had
completed their education till 10th standard in the index
The study was carried out at a tertiary care hospital situated in
group and subjects from control group were mostly graduates.
an urban area and the patients had cooperated in the study to
Numerous papers report early-onset mental illnesses to
the best of their ability. The primary aim of the study was to
be linked to the cessation of education in the patients.25-28
assess the occurrence of sexual problems in women with
Though disruptive behavioral disorders and bipolar disorders
recurrent depressive disorder and also to find out the types of
are likely to have a strong association, depression also
sexual dysfunction in them. Later the changes in sexual is related with around 60% more likelihood of inability
functioning after treatment with conventional antidepressants to finish secondary school when compared to the youth in
were measured and the association between the control group high income nations. However, in the lower-income nations
and the index group was analyzed. these adverse effects may have been weaker. Being educated
Methods: The subjects in the study included 53 females helps in increasing awareness regarding sexuality and helps
attending the outpatient department who were diagnosed curb beliefs and taboos. In India it is only recently that sex
with recurrent depressive disorder according to ICD-10 education has started in schools and is given in 8th and 9th
DCR and who met the inclusion and exclusion criteria. An standard when adolescent girls achieve menarche. However,
equal number of age matched female subjects without any it is embroiled in many controversies. None of our sample
past of family history of psychiatric disorder were taken had received any sex education during schooling (Table1).
as control group. A similar study was done in China where Occupation: Keeping with the cultural traditions of
they validated a Chinese version of the brief index of sexual India, majority of the sample were home makers in the index
functioning in females and compared a normal population group. Even though depression is reported to be associated
and Han Chinese population suffering from depression. with being without a job, most researchers stressed the
They used 3 types of subjects which included 63 patients influence of losing a job on depression instead of depression
with depression who were not on any treatment, 50 patients being a reason for loss of job.29 A current study supported
with recurrent depression who had remitted with treatment, the latter suggestion by showing that a prior psychiatric
and 92 controls who had no psychiatric illnesses.13 Other disorder and the age of completing school at the time of
research studies done on this topic have not had a control interview predicted the unemployment and work problems
group for comparing the depressive group with the general that the patient might have.30 Nevertheless, these relations
population.14-19 A control group was thus taken in this study were only considerable in higher income nations, suggesting
to find the various associations with the index group that may the possibility that depressive disorders might affect the
bring out a meaningful outcome. occupational performance more as the operative intricacy
of the job rises. Our study sample consisted mostly of
Sociodemographic Profile housewives and though their functioning for doing household
work reduced, the study did not evaluate it in detail and
Age: The study reveals highest prevalence of depression further work focusing on this issue might be needed.
between the age group of 20-29 years. Earlier epidemiological SES: The subjects in the study group were mostly from
reports have observed that age of onset of depression is lower and middle SES. Certainly, it has been recognized from
considerably earlier when compared to most of the other a long time that people from lower SES suffer an unequal
long-standing illnesses. The median age of onset for amount of the burden and consequences of several diseases,
depression was found to be in the early-to-mid-20s, but the compared to those who are from a higher SES.3,31,32 In keeping
risk continues throughout the life.20-22 The median age of with these findings, previous epidemiological studies have
onset was reported to be in the first half of the 20s in almost found that depression is more common among people with
all nations except for Japan where it is more common in the lower than higher SES,33-34 though it could be confounded by
late 20s and the Czech Republic where it is more common in the fact the tertiary care center where this study was done
early 30s. The risk was found to be relatively less in the catered to persons from lower SES. However, there should
earlier part of life, which then rises in adolescence period and be more focus on patients from lower SES so that proper
keeps increasing till the later part of the 20s, and ultimately treatment could be delivered to those in need.
declining in subsequent years. Researchers have discovered Number of children: The maximum number of subjects
that nearly one-third of females belonging to age groups of 18 from both the groups had two children. No significant
to 59 years stated feeling an absence of desire to have sex in difference between number of children of the index and
the past year.3,23 People suffering from mood disorders were control groups was found (Table 1). Hence, we can infer
136 Journal of Psychosexual Health 1(2)

that both the groups were comparable in terms of number antidepressants, a statistically significant difference was
of children. found. Hence, we can infer that though improvement in
depression was observed on follow-up but the patients were
not comparable to normal subjects. This suggests that there is
Comparison of HAM-D, ASEX, and FSFI further scope for improvement and longer treatment might
Scores Between Index and Control Groups lead to even more improvement. There was no significant
Before Treatment difference in the ASEX scores between index and control
groups after 6 weeks of treatment. Hence, the sexual
It was found that there was a significant difference in the functioning improved so much so that it was comparable to
HAM-D scores when it was compared between index and those of the control group. It was observed that there was a
control groups before starting treatment. This shows that significant difference in the FSFI scores between index and
depression was highly prevalent in the index group. When control groups after 6 weeks of treatment with antidepressants.
ASEX and FSFI scores were compared between index and This indicates that even though the patients showed
control groups before treatment, a significant difference was improvement in their sexual functioning after treatment, the
found. This shows that the patients taken for the study group individual domains of sexual functions were not comparable
had clinically significant problems in areas of sexual to their peers who were not suffering from any depression or
functioning and depression prior to starting treatment and mental illness when FSFI was used. This could be because
were very different from their peers in the control group who ASEX assesses sexual dysfunction and FSFI assesses the
did not suffer from depression. Previous reports also individual dimensions of sexual functions. Hence, it shows
corroborate our findings wherein they show higher levels of that there is scope for further improvement in their depressive
sexual dysfunction in depressed patients as compared to non- features and that their sexual problems may take more time to
depressed patients.35 Sexual problems and dissatisfaction decrease if treatment is given for longer periods of time. This
with sex were commonly associated with depression. There emphasizes the need for treating depression for optimal
was a significant difference in all the domains of the FSFI periods of time along with monitoring of the sexual
scores when a comparison was done between index and dysfunctions.
control groups before treatment. When all the patients were
studied for the domains of sexual functioning, it was found
that sexual dysfunction is very prevalent in the index group Correlations Between the Scores of
affecting nearly all areas of sexual functioning. HAM-D, ASEX, FSFI (Desire, Arousal,
Lubrication, Orgasm, Satisfaction,
Comparison of HAM-D, ASEX, and FSFI Pain,Total) in the Index Group Before
Scores Before and After Treatment Treatment

There was a significant difference in the HAM-D scores There was a noteworthy positive correlation between the
before and after treatment in this study. This shows an scores of HAM-D and ASEX scores in the index group before
improvement in their depressive features as is evidenced by treatment. There was a considerable negative correlation
the improvement in the scores. This was corroborated by between the scores of HAM-D and all the domains of FSFI
numerous studies which also exhibited an improvement in comprising of domains of desire, arousal, lubrication, orgasm,
symptoms of depression after treating with antidepressants.36-38 satisfaction, and pain and also the total score at baseline in the
It was found that a there was a significant difference between patients suffering from depression. It has been found in other
the ASEX and FSFI scores before and after treatment in this studies also that depression often leads to difficulty in sexual
study. The areas of improvement included a correction in the arousal, amongst other sexual dysfunctions.39 Hence, this
sex drive, and physiologic and psychological arousal. Hence, throws light on the fact that we should be extremely vigilant
we can infer that sexual problems reduced and there was an with females presenting to our clinics with depression and
improvement in the sexual functioning after the patients should regularly ask them for sexual problems as they may
were treated with antidepressants. not tell it themselves even if the problem is present. Indian
women being reticent about sex would not have reported
problems in all these areas unless being enquired about the
Comparison of HAM-D, ASEX, and FSFI same. Depressive disorders and its consequences on sexual
Scores Between Index and Control Groups functions hinder the quality of life and hence should be
After Treatment evaluated so that the approach treats all the underlying
problems. Assessing the sexual problems and dealing with
When a comparison was done in the HAM-D scores between them effectively will give rise to accurate treatment and an
index and control groups after 6 weeks of treatment with overall better improvement of the patients.
Mujawar et al. 137

Correlations Between the Scores of Clinical Implications

HAM-D, ASEX, FSFI (Desire, Arousal,
Lubrication, Orgasm, Satisfaction, Pain, This study helps us to know the high prevalence of sexual
dysfunction in depressed females before starting the treatment,
Total) in the Index Group After Treatment emphasizing on inquiring about sexual dysfunction in
depressed patients, especially females. It emphasizes the need
There was a positive correlation between the scores of
for awareness about the various aspects of sexuality and the
HAM-D and ASEX scores after treatment but it was not
need for education for early detection and treatment of sexual
significant. There was a significant negative correlation
dysfunction in depressed females. Since the patients may not
between the scores of HAM-D and domains of FSFI including come up with this particular problem on their own, it is
arousal, lubrication, orgasm, satisfaction, pain and also total extremely important to ask about sexual problems in
FSFI score after treatment in the patients suffering from depressed females and treat them accordingly so that the
depression. No significant correlation was found between the patients improve maximally.
scores of HAM-D and desire score of FSFI in the index group
after treatment. Thus, we can infer that the overall sexual Declaration of Conflicting Interests
functions definitely improved after 6 weeks of treatment with
The authors declared no potential conflicts of interest with respect to
conventional antidepressants with a reduction in depression.
the research, authorship, and/or publication of this article.
However, residual effect on sexual functioning still remains
in the domains of arousal, lubrication, orgasm, satisfaction,
Funding
and pain. This shows that as depression improves, sexual
functioning also improves which has been corroborated in The authors received no financial support for the research,
authorship, and/or publication of this article.
many earlier studies40-43 which showed that females with
depressive disorders have more sexual dysfunctions at
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