Background: Polycystic ovary syndrome (PCOS), a prevalent endocrine disorder characterized by menstrual irregularities and hyperandrogenic manifestations, has been increasingly associated with psychological distress and impaired self-image. However, results regarding sexual function (SF) in PCOS women are still controversial, and their interpretation is complicated by the use of different SF assessment tools across studies. Aim: To evaluate female sexual dysfunction in PCOS women diagnosed through modified Rotterdam criteria by conducting specific meta-analyses for each validated SF questionnaire and assess the influence of overweight/obesity (OW/O) on these outcomes. Methods: A Systematic Review (PRISMA) of 8 databases was performed until March 2024. Meta-analysis employed STATA software, employing a random-effects model to compare groups via Hedges’ g and standardized mean difference (SMD). Heterogeneity (I2 statistic; Q test) and publication bias (funnel plots; Egger’s test) were assessed. Outcomes: The influence of PCOS and OW/O on SF. Results: A total of 6171 articles were initially screened, and 40/6171 studies were included in this systematic review. Meta-analyses were performed solely for the Female Sexual Function Index (FSFI) score as it was the only SF assessment tool widely used across published studies. Pooled meta-analysis results showed that PCOS women had significantly lower FSFI scores in all fields than controls: total FSFI: -0.4 (95% CI -0.45; -0.36, I2 = 94.3%); desire: -0.22 (95% CI -0.26; -0.17, I2 = 90.8%); arousal: -0.3 (95% CI -0.34; -0.25, I2 = 94.1%); lubrication: -0.31 (95% CI -0.36; -0.26, I2 = 93%); orgasm: -0.27 (95% CI -0.32; -0.22 I2 = 89.2%); satisfaction: -0.23 (95% CI -0.28; -0.18, I2 = 81.5%); pain: -0.3 (95% CI -0.35; -0.25, I2 = 91.1%). OW/O PCOS women scored with higher lubrication scores than OW/O controls (SMD = 0.3 95% CI [0.03;0.58], P = .02, I2 = 0%). Clinical Translation: These findings emphasize the importance of incorporating SF assessments into PCOS follow-up protocols and multidisciplinary care. Strengths and Limitations: Strengths include a large cohort, analysis of an OW/O subgroup, and robust quality assessment using the Newcastle–Ottawa Scale. The main limitation was the lack of published studies using SF-assessment tools other than the FSFI, which precluded meta-analyses for other questionnaires. Conclusion: While PCOS women experience significantly impaired SF than controls, those with OW/O and PCOS may have comparable or even enhanced SF in certain domains, particularly lubrication, suggesting that the interplay between obesity and SF in PCOS women may not always be negative. By integrating routine screening with a multidisciplinary approach, we can more effectively address the sexual health challenges faced by PCOS women, ultimately empowering them to achieve optimal health and overall well-being.

Polycystic ovary syndrome (PCOS) is a prevalent condition characterized by manifestations that can influence self-image and potentially result in psychological distress; however, data from literature on sexual function (SF) in PCOS women are contradictory. We aimed to evaluate sexual dysfunction (SD) in PCOS women by carrying out a systematic review and meta-analysis, using the gold-standard assessment tool SD-diagnosis (Female Sexual Function Index:FSFI). Seven databases were analyzed until August-2023; study quality was assessed by risk of bias and Newcastle Ottawa Scale. Our analysis encompassed 25 case-control studies (9933 women). PCOS group presented significantly lower scores in arousal (MD= -0.36 CI95%-0.60;-0.11), lubrication (MD= -0.52 CI95%-0.75;-0.28), orgasm (MD= -0.39 CI95%-0.57;-0.20), satisfaction (MD= -0.32 CI95%-0.50;-0.14) and pain subdomains (MD= -0.46 CI95%-0.75;-0.16), as in overall FSFI score (MD= -2.27 CI95%-3.23;-1.31). Overweight/obese (OW/O) patients exhibited significantly higher overall FSFI than OW/O controls (MD=1.98 CI95%0.68;3.27), particularly in lubrication (MD= -0.34), orgasm (MD= -0.26) and satisfaction (MD= -0.25) subdomains. These findings offer insights regarding SD in PCOS women and emphasize the need to incorporate SF assessment into multidisciplinary care. By this way, PCOS can be also considered a gateway diagnosis to other long-term consequences. Further research should focus on controlling variables, as ethnicity, culture, religion and economic disparities.