Metabolism and Psychosexual Health in Patients With Polycystic Ovary Syndrome: A Cross-Sectional Study

Psychosexual impairments in women with polycystic ovary syndrome (PCOS), often linked to depression, low self-esteem, and negative body image, significantly reduce quality of life. Although metabolic dysfunctions such as insulin resistance and obesity are key features of PCOS, their impact on psychosexual health remains poorly understood. This cross-sectional study aimed to examine the association between metabolic markers and psychosexual functioning in PCOS patients. Participants were recruited from the University Medical Center Mainz and diagnosed using the Rotterdam criteria. Assessments included hormonal and metabolic parameters - such as insulin resistance, body mass index (BMI), fatty liver index (FLI), and visceral adiposity index (VAI) - as well as psychosexual health, using the Female Sexual Function Index (FSFI) and the Hospital Anxiety and Depression Scale (HADS). Logistic regression analyses revealed that visceral adiposity was associated with reduced sexual desire (odds ratio (OR) 2.56, p=0.016), and higher BMI (≥25 kg/m²) with reduced sexual satisfaction (OR 3.56, p=0.049). Elevated insulin resistance (homeostatic model assessment for insulin resistance (HOMA-IR) >5) and FLI (≥60) were associated with increased anxiety and depression, respectively. Overall, higher metabolic burden correlated with impaired sexual function and mental health. These findings highlight the importance of integrating metabolic and psychosexual assessments in PCOS care to better address patients' comprehensive well-being.