Sexual Dysfunction in Women with Hypertension: a Systematic Review and Meta-analysis

  • Larissa Marques Santana
  • Lisiane Perin
  • Rosana Lunelli
  • José Francisco Secorun Inácio
  • Clarissa Garcia Rodrigues
  • Bruna Eibel
  • Silvia GoldmeierEmail author
Guidelines/Clinical Trials/Meta-Analysis (William J. Kostis, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Guidelines/Clinical Trials/Meta-Analysis


Purpose of Review

We aimed to evaluate the prevalence of sexual dysfunction in hypertensive women and compare sexual dysfunction between hypertensive and non-hypertensive women.

Recent Findings

Conducted a systematic review in the following databases: PubMed, EMBASE, Scopus, Web of Science, IBECS, and Lilacs.

We included articles evaluating the prevalence of sexual dysfunction in a woman and/or comparing sexual dysfunction between hypertensive and non-hypertensive women. Studies were excluded if they evaluated patients with secondary hypertension, examined sexual dysfunction caused by drugs, did not distinguish by gender, or included patients with hypertension and other comorbidities/pathologies.

We conducted an I2 test to calculate heterogeneity and a meta-analysis to compare sexual dysfunction between hypertensive and non-hypertensive women. A meta-regression equation calculated the relationship between sexual dysfunction risk for hypertensive and age.

Eleven articles were included: five were included in the meta-analysis (1057 hypertensive and 715 normotensive). The prevalence of sexual dysfunction in articles varied from 14.1 to 90.1%. In the meta-analysis of the sexual dysfunction, the relative risk between hypertensive and normotensive women was found to be significant and has a high heterogeneity (I2 =92.6%, p < 0.001); the pooled results revealed a significant risk ratio of 1.81 (95% CI 1.10–2.97, p < 0.05). The relative risk for hypertensive women showed an association with age (b = 0.0333, p < 0.0001).


The studies analyzed presented significant limitations in relation to methodology and a small sample size. Consequently, the meta-analysis was highly heterogeneous and reinforced the need for further research in this area.


Hypertension Systolic Meta-analysis Women Sexuality Sexual dysfunctions Psychological 



We would like to thank the Instituto de Cardiologia do RS—Fundação Universitária de Cardiologia (IC-FUC) for assistance in developing the study.

Availability of Data and Material

It registered in the Prospero (International Prospective Register of Systematic Reviews) database under the number CRD42014008704.

Authors’ Contributions

S.M.L and P.L conceived the study, participated in the study design, and helped to draft the manuscript; I.S.F.J, L.R, R.G.C, and G.S participated in the study design and coordination, undertook data analysis, and helped to draft the manuscript; E.B and G.S participated in the study design and coordination. All authors read and approved the final manuscript.


This study was financially supported by Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul (FAPERGS).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Ethics Approval and Consent to Participate

No. 4512/10.

Consent for Publication

Ethical approval was obtained from the Ethical Committee, Foundation University of Cardiology for conducting the research study.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    •• Doumas M, Tsiodras S, Tsakiris A, Douma S, Chounta A, Papadopoulos A, et al. Female sexual dysfunction in essential hypertension: a common problem being uncovered. J Hypertens. 2006;24(12):2387–92 Used the same method and the same instrument to evaluate sexual dysfunction.CrossRefGoogle Scholar
  2. 2.
    Grimm RH Jr, Grandits GA, Prineas RJ, McDonald RH, Lewis CE, Flack JM, et al. Long-term effects on sexual function of five antihypertensive drugs and nutritional hygienic treatment in hypertensive men and women: Treatment of Mild Hypertension Study (TOMHS). Hypertension. 1997;29(1 Pt 1):8–14.CrossRefGoogle Scholar
  3. 3.
    Pop D, Dădârlat A, Zdrenghea D. Novel cardiovascular risk markers in women with ischaemic heart disease. Cardiovasc J Afr. 2014;25(3):137–41.CrossRefGoogle Scholar
  4. 4.
    Fagard R. Reappraisal of the European guidelines on hypertension management: the European Society of Hypertension Task Force document: a short review. Pol Arch Med Wewn. 2010;120(1–2):31–5.PubMedGoogle Scholar
  5. 5.
    Leite APL, Moura ES, Campos AAS, Mattar R, Souza E, Camano L, et al. Validation of the female sexual function index in Brazilian pregnant women. Rev Bras Ginecol Obstet. 2007;29(8):396–401.CrossRefGoogle Scholar
  6. 6.
    Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA. 1999;281(6):537–44.CrossRefGoogle Scholar
  7. 7.
    Basson R. Recent advances in women’s sexual function and dysfunction. Menopause. 2004;11(6 Pt 2):714–25.CrossRefGoogle Scholar
  8. 8.
    Hayes R, Dennerstein L. The impact of aging on sexual function and sexual dysfunction in women: a review of population based studies. J Sex Med. 2005;2(3):317–30.CrossRefGoogle Scholar
  9. 9.
    Kloner RA, Reffelmann T. Sexual function in hypertensive patients receiving treatment. Vasc Health Risk Manag. 2006;2(4):447–55.CrossRefGoogle Scholar
  10. 10.
    •• Kütmeç C, Yurtsever S. Effects of sexual function of essential hypertensions in women. Eur J Cardiovasc Nurs. 2011;10(1):56–63 Used the same method and the same instrument to evaluate sexual dysfunction.CrossRefGoogle Scholar
  11. 11.
    Taylor J. 2013 ESH/ESC Guidelines for the management of arterial hypertension. Eur Heart J. 2013;34:2159–219.CrossRefGoogle Scholar
  12. 12.
    Okeahialam BN, Obeka NC. Sexual dysfunction in female hypertensives. J Natl Med Assoc. 2006;98(4):638–40.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Monterrosa-Castro A, Márquez-Veja J, Arteta-Acosta C. Sexual dysfunction in climacteric women of African descent from the Colombian Caribbean region. IATREIA. 2014;27(1):31–41.Google Scholar
  14. 14.
    • Chen X, Zhang Q, Tan X. Prevalence of sexual activity and associated factors in hypertensive males and females in China: a cross-sectional study. BMC Public Health. 2012;18:12–364 Evidence of sexual dysfunction among hypertensive patients.Google Scholar
  15. 15.
    • Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097 Used as protocols for systematic review (PRISMA).CrossRefGoogle Scholar
  16. 16.
    • Burchardt M, Burchardt T, Anastasiadis AG, Kiss AJ, Baer L, Pawar RV, et al. Sexual dysfunction is common and overlooked in female patients with hypertension. J Sex Marital Ther. 2002;28(1):17–26 Evidence of sexual dysfunction among hypertensive patients.CrossRefGoogle Scholar
  17. 17.
    Abdo CH, Oliveira WM Jr, Moreira ED Jr, Fittipaldi JA. Prevalence of sexual dysfunctions and correlated conditions in a sample of Brazilian women--results of the Brazilian study on sexual behavior (BSSB). Int J Impot Res. 2004;16(2):160–6.CrossRefGoogle Scholar
  18. 18.
    • Latif RA, Muhamad R, Ann AY, Sidi H, NikJaafar NR, Midin M, et al. Duration of hypertension and antihypertensive agents in correlation with the phases of female sexual response cycle. Compr Psychiatry. 2012;55(Suppl 1):S7–12 Evidence of sexual dysfunction among hypertensive patients.PubMedGoogle Scholar
  19. 19.
    •• Franciscis P, Mainini G, Messalli EM, Trotta C, Luisi A, Laudando E, et al. Arterial hypertension and female sexual dysfunction in postmenopausal women. Clin Exp Obstet Gynecol. 2013;40(1):58–60 Used the same method and the same instrument to evaluate sexual dysfunction.PubMedGoogle Scholar
  20. 20.
    •• Abdul Latif R, Muhamad R, Kanagasundram S, Sidi H, NikJaafar NR, Midin M, et al. Risk and associated factors of female sexual orgasmic disorder in women with hypertension in Malaysia. Asia Pac Psychiatry. 2013;5(Suppl 1):21–6 Used the same method and the same instrument to evaluate sexual dysfunction.CrossRefGoogle Scholar
  21. 21.
    Spatz ES, Canavan ME, Desai MM, Krumholz HM, Lindau ST. Sexual activity and function among middle-aged and older men and women with hypertension. J Hypertens. 2013;31(6):1096–105.CrossRefGoogle Scholar
  22. 22.
    •• Nascimento ER, Maia ACO, Nardi AE, Silva AC. Sexual dysfunction in arterial hypertension women: the role of depression and anxiety. J Affect Disord. 2015;181:96–100 Used the same method and the same instrument to evaluate sexual dysfunction.CrossRefGoogle Scholar
  23. 23.
    Loney PL, Chambers LW, Bennett KJ, Roberts JG, Stratford PW. Critical appraisal of the health research literature: prevalence or incidence of a health problem. Chronic Dis Can. 1998;19(4):170–6.PubMedGoogle Scholar
  24. 24.
    Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60.CrossRefGoogle Scholar
  25. 25.
    Borenstein M, Hedges LV, Higgins LPT, Rothstein HR. Introduction to meta-analysis. 1st ed. Chichester: John Wiley and Sons; 2009.CrossRefGoogle Scholar
  26. 26.
    • Viechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Softw. 2010;36:1–48 Used R language software.CrossRefGoogle Scholar
  27. 27.
    Bhavsar V, Bhugra D. Cultural factors and sexual dysfunction in clinical practice. Adv Psychiatr Treat. 2013;19(2):144–52.CrossRefGoogle Scholar
  28. 28.
    Berman JR, Adhikari SP, Goldstein I. Anatomy and physiology of female sexual function and dysfunction: classification, evaluation and treatment options. Eur Urol. 2000;38(1):20–9.CrossRefGoogle Scholar
  29. 29.
    Munarriz R, Kim SW, Kim NN, Traish A, Goldstein I. A review of the physiology and pharmacology of peripheral (vaginal and clitoral) female genital arousal in the animal model. J Urol. 2003;170(2 Pt 2):S40–4.PubMedGoogle Scholar
  30. 30.
    Argun B, Aran S, Altıntaş R, Tunçkale A, Özkara H, Alıcı B, et al. Female sexual dysfunction in patients with hypertension. VI National Congress of Andrology; 2005.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Larissa Marques Santana
    • 1
  • Lisiane Perin
    • 2
  • Rosana Lunelli
    • 2
  • José Francisco Secorun Inácio
    • 2
  • Clarissa Garcia Rodrigues
    • 2
  • Bruna Eibel
    • 2
  • Silvia Goldmeier
    • 2
    Email author
  1. 1.Universidade Federal de Ciências da Saúde de Porto Alegre (UFSCPA)Porto AlegreBrazil
  2. 2.Instituto de Cardiologia do RS – Fundação Universitária de Cardiologia (IC-FUC)Porto AlegreBrazil

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