Sexual function in women with complete androgen insensitivity syndrome

Objective: To investigate sexual function in women with complete androgen insensitivity syndrome (CAIS) and to investigate the prevalence of factors that might contribute to sexual difficulties. Design: Cross sectional survey and clinical examination. Setting: Tertiary hospital multidisciplinary intersex clinic and an international peer support group for CAIS. Patient(s): Sixty-six adult women with CAIS. Intervention(s): Self-completed survey of sexual function, genital normality perceptions, and compliance and satisfaction with vaginal hypoplasia treatments. Hospital case notes review, and genital examination for prevalence of vaginal and clitoral hypoplasia. Main Outcome Measure(s): Golombok-Rust Inventory of Sexual Satisfaction (GRISS) scores of study participants were compared against the scores of the test validation population (as control). In physical examination participants, anatomical dimensions were assessed against published normal values for clitoral and vaginal sizes. Result(s): We found that 90 % of women with CAIS in this study had sexual difficulties when compared with the general female population, most commonly sexual infrequency and vaginal penetration difficulty; 77% perceived their vagina as small, but on genital examination only 35 % had vaginal hypoplasia. Conclusion(s): Androgen deficiency leads to sexual problems. Vaginal hypoplasia and negative psychological adaptation to living with an intersex condition are likely to have contributed to the high rates of sexual problems found in this study. Treatments for vaginal hypoplasia need to be evaluated with outcome studies of long-term sexual function, quality of life, and satisfaction. Clinical services for the management of intersex conditions need to be multidisciplinary and aim to optimize the patient’s physical and psychological health. (Fertil Steril 2003;80:157–64. ©2003 by American Society for Reproductive Medicine.) Key Words: Androgen insensitivity, intersex, female sexual function, long-term outcomes, vaginal hypopla