Sexual Function and Libido Loss in Female Climbers-A Cross-Sectional Study

Aim: Increasing female participation in elite sports has highlighted the need to better understand how intensive training affects reproductive health and sexual function. The aim of this cross-sectional study was to assess the prevalence of libido loss and sexual dysfunction in female climbers and to explore potential associations with low energy availability within the "relative energy deficiency in sports" framework. Methods: This is a cross-sectional multinational cohort study of female climbers as well as non-athletic controls from Switzerland, Germany, Austria, and Italy, to investigate female sexual function in athletes compared to a non-athletic control group from the general population through specific questionnaires, e.g., eating disorder screening (EDE-QS), sexual function (FSFI-d), low energy availability (LEAF-Q), and estrogen deficiency symptoms (MRS-II). A nonparametric procedure was used to check whether distribution differences between the groups were detectable. Where distributional differences were statistically detectable, selected parameters were considered as covariates in an analysis of covariance (ANCOVA). This has been carried out with the following covariates: LEAF- Q, MRS-II-score, age, BMI, and subjective satisfaction. Only participants without the signs of an eating disorder (normal EDE-QS scores) were included in this study. Results: A total of 173 women were included (elite: n = 31, amateur: n = 55, controls: n = 87). No significant differences in overall sexual function (FSFI-d total score) (p = 0.518) and libido (p = 0.610) were observed between groups in unadjusted analyses. However, after adjustment for relevant covariates, including MRS-II score and subjective sexual satisfaction, elite climbers demonstrated significantly lower FSFI-d scores compared to controls (p = 0.018). Notably, elite climbers reported higher subjective sexual satisfaction than controls (p = 0.002). Conclusions: While overall sexual function did not differ in unadjusted analyses, adjusted comparisons suggest that elite climbers may experience subtle differences in sexual function.