Introduction. Epidemiological research in female sexual dysfunction (FSD) has gained momentum in recent years,
particularly in clinical populations and among women in menopausemenopausal women. However, sexual dysfunction
also affects premenopausal women in general populations. Past literature reviews have been unable to quantify the
burden of FSD in general populations. This has been due, in part, to varying definitions of dysfunction, heterogeneous
study design, and the wide variety of measurement tools used.

Aim. To provide a meta-analytical estimate of the prevalence of FSD among premenopausal women
Methods. Observational studies which assessed the prevalence of FSD in premenopausal women were systematically
sought in relevant databases (Jan 2000-July 2014). Publications which reported the prevalence rate for at least one
domain of FSD were included. A meta-analysis of prevalence rates was performed and a meta-regression was used to
analyze factors of study design.

Main Outcome Measures. Estimated prevalence rates of FSD and its domains (hypoactive sexual desire disorder,
sexual aversion disorder, female sexual arousal disorder, lubrication difficulties, female orgasmic disorder, pain
disorders)

Results. After screening 9292 results, 440 publications were retrieved for full text review. Of these, 135 studies were
included in the systematic review. Ninety-five of these studies were further assessed in a meta-analysis. There was
substantial heterogeneity among the studies. The prevalence of FSD among premenopausal women was estimated to be
40.9% (95% CI: 37.1;44.7, I²=99.0%). Prevalence rates of the individual sexual disorders ranged between 20.6%
(lubrication difficulties) and 28.2% (hypoactive sexual desire disorder). Further analyses revealed significantly higher
rates of FSD in studies in Africa, studies using non-validated assessment tools and studies without pharmaceutical
funding.

Conclusions. Prevalence estimates of FSD vary substantially. Still, results show that FSD is a significant public health
problem which affects 41% of premenopausal women around the globe. More research and improved standardization
are needed in this field.

Systematic review registration. PROSPERO: CRD42014009526