Female Sexual Dysfunction among Kosovo Women

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_____________________________________________________________________________________________________ *Corresponding author: E-mail: drtolaj@yahoo.com;


Female Sexual Dysfunction among Kosovo Women

Hajrullah Fejza


, Ilir Tolaj


, Behrije Vishi


, Albina Fejza


, Liridona Jemini


and Minire Alilaj



Ministry of Health, Prishtina, Kosovo. 2

Faculty of Medical, University of Prishtina, Prishtina, Kosovo. 3

Regional Hospital, Ferizaj, Kosovo. 4

Department of Pharmacy, Faculty of Medical, University of Prishtina, Prishtina, Kosovo. 5

Faculty of Philosophy, University of Prishtina, Prishtina, Kosovo.

Authors’ contributions

This work was carried out in collaboration between all authors. Authors HF, IT and AF designed the study, managed questionnaire and wrote the first draft of the manuscript. Authors BV and LJ managed the literature searches developed the questionnaire and managed data collection. Authors MA, AF and HF carried out data analysis and their interpretation. All authors read and approved the final manuscript.

Article Information

DOI: 10.9734/BJMMR/2017/29615 Editor(s): (1) Domenico De Berardis, Department of Mental Health, National Health Service, Psychiatric Service of Diagnosis and Treatment, “G. Mazzini” Hospital, Italy. (2)Rui Yu, Environmental Sciences & Engineering, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, USA. Reviewers: (1) Wrishmeen Sabawoon, The University of Tokyo, Japan. (2)Ombeni Msuya, The University of Dodoma, Tanzania. (3)Switbert Rwechngura Kamazima, Muhimbili University of Health and Allied Sciences, Tanzania. (4)Yigit Akin, Izmir Katip Celebi University School of Medicine, Turkey. Complete Peer review History:http://www.sciencedomain.org/review-history/17119

Received 20th September 2016 Accepted 30th November 2016 Published 3rd December 2016


Aim: The purpose of this study was to analyze female sexual dysfunction and potential risk factors

influencing the sexual life in Kosovo’s women population.

Study Design: Cross-sectional analysis

Place and Duration of Study: This study was conducted through an online survey in Kosovo,

between May-September 2015.

Methods: A self‑administered structured questionnaire, A Brief Sexual Symptom Checklist for Women, (BSSC) was administered to assess overall satisfaction (prevalence), desire, genital sensation, lubrication, orgasm and pain. The respondent rate was 87.5% (350/400).


Results: The level of sexual dissatisfaction was 36.9%. Little or no interest in sex was reported in

32% of women, an orgasmic problem in 20%, genital sensation problem in 16.7%, a lubrication problem in 12.7% and pain during sex in 16.0%. 76.8% of women would like to talk about these problems with their doctor. Age and smoking history are the potential risk factors.

Conclusion: The level of sexually dissatisfied women in Kosovo is quite high but similar to other

studies within the field. The willing to discuss with a doctor was reported by 2/3 of respondents. The level of satisfaction is in correlation with age. The second most important risk factor is smoking.

Keywords: Sexual dysfunction; women; smoking; age; Kosovo.


Female sexual dysfunction (FSD) is relatively common, but women seldom seek medical help. An online survey of 3 807 healthy volunteers indicated that 40% of women did not discuss sexual problems with their clinician [1]. Despite of an increasing scientist’s interest in female sexual difficulty and dysfunction, the true prevalence of female sexual dysfunctions (FSD) in the general population remains a contentious issue [2]. Normal versus abnormal sexual functioning in women is poorly understood, although the concept of normal female sexual function continues to develop. A more recent international survey of 27,500 men and women 40 to 80 years of age found that 39 percent of sexually active women reported a problem with sexual activity [3].

Sex and sexual issues are still a taboo in our country and as a result no study about sexual problems has been done before. This is an effort to analyze the sexual satisfaction among women in Kosovo. Always having in mind the difficulties to obtain the data for this kind of the study, an online survey was the best choice for an initial observation. Patients and doctors have yet to establish a normal way of communication for sexual problems especially among women. A Brief Sexual Symptom Checklist (BSSC) for Women was the most appropriate tool to asses those findings.

Impaired sexual function can cause damaging effects on the self-esteem, sense of wholeness and interpersonal relationships of women [4]. As the average life expectancy of women is increasing, and has risen to well above 80 years in Western countries, quality-of-life issues, and female sexual function in particular, are gaining importance and are currently being investigated intensely [5]. The majorities of women in Kosovo are still living in big families without incomes and in case of losing their partner or partner’s inability

is very difficult or impossible to fulfill their sexual needs. This can be a big problem for those of older age and without education. A lot of them due to shame from their children do not think of remarrying or finding a sexual partner although they might be interested and in good health.

The aim of this article was to analyze data about the female sexual dysfunction in the Republic of Kosovo. Describing the willingness of women to talk about this problem with a doctor was another purpose of the study. Obtaining data about the sexuality is the first effort and a good justification to provide this research which will help on the future of local and international science.


The study was conducted between May and September of 2015 in Kosovo, involving 350 women living in households from different socio-cultural areas. The sample is convenience. We contacted 400 women aged 18-65 year, among whom 350 (87.5%) were included, since 50 (12.5%) did not give their consents to participate in this study. Women were divided into 4 groups according to their age: 18- 25 years (n = 55), 26– 35 years (n = 126), 36–50 years (n = 109) and above 50 years (n = 60). A self‑administered structured questionnaire, A Brief Sexual Symptom Checklist for Women (BSSC), an American College of Obstetricians and Gynecologists Guideline on Sexual Dysfunction in Women, was administered to assess sexual satisfaction, desire, genital sensation, lubrication, orgasm and pain. BSSC was developed for screening purposes and addresses the level of satisfaction with sexual problems [the major outcome measure in sexual health]. Statistical analysis was performed using the Statistical

Package for the Social Science (SPSS) software


considered as statistically significant. The acceptance to fulfill and return the questionnaire was considered as consent to participate in the study. From the total number (50/400) did not give their consent to participate in the survey.


Overall, 400 questionnaire were distributed to assess the sexual dysfunction among women in Kosovo. Table 1 presents general characteristics of the participants, a few findings obtained by research and the willingness of women to talk about sexual problems with a doctor. The FSD rate was 36.9% while 76.8% from the whole sample were ready to talk about their problems with a doctor.

Table 1. General characteristic of the participants and findings

Variable Value (n=350)

Age groups (%)

18< 25 55 (15.7)

26-35 126 (36.0)

36-50 109 (31.1)

50 + 60 (17.1)


Primary school 30 (8.6) High school 96 (27.4)

Graduate 224 (64.0)

Civil status

Married 107 (30.6)

Not married 243 (69.4)

Smoking history

Yes 119 (34.0)

No 229 (66.0)

Occupational stress

Yes 207 (59.1)

No 44 (12.6)

Unemployed 99 (28.3)

Sexually satisfied

Yes 221 (63.1)

No 129 (36.9)

Would you talk about it with a doctor


Yes 152 (76.8)

No 46 (33.2)

The FSD is higher among older population (56.7%) on the group above 50 years while the group of less than 25 years this was only 29.1%. Smoking positive history had statistically significance findings whereas education, occupational stress and civil status did not show any significance (Table 2).

The main sexual problem identified among participants was little or no interest in sex (44) with almost half of them in the age group above 50 years. The second sexual problem was reaching an orgasm (22) where the dominant

age groups were between 26-50 years, (Table 3).


Female sexual dysfunction is a worldwide problem with prevalence range 24-76% [2]. Our findings show that the level of sexually dissatisfaction is 36.9%. Having in mind the characteristics of our population, the overall level of sexual education, culture and religion this is not a negative finding considering that other studies show much higher prevalence of sexual dissatisfaction. Further study with different methods and frame time should be done in the future. These findings are age related, (56.7%) and belong to the above 50 years’ age group. Positive smoking history was shown as a potential risk factor for FSD (51.9% vs. 23.7%). Smoking among women in Kosovo has a high rate and it comes perhaps due to lack of other activities and social problems. The most prevalent problem in our study was little or no interest in sex (34.1%), followed by problem reaching orgasm (17%), pain during sex (15.5%), decreased vaginal lubrication (13.9%) and decreased vaginal sensation (6.2%). Little interest for sexual activity is higher in older age groups due to reasons mentioned above: chronic illness, loss of their partners, culture, religion and limitation to travel abroad. Lack of sexual education in our country could be a reason for many sexual dysfunctions. Even in medical school students do not have any modules for sexual education. Vaginal lubrication or dryness is unknown term for majority of women here. The majority of women in Kosovo do not have any idea about lubrications substances. Lubricants are known to solve problem of dry vagina and pain during sexual activity.


Table 2. Potential risk factors for FSD

Risk factor Sexually satisfied (n=221)

Sexually not satisfied (n=129)

Chi square P value

Age group

< 25 39(70.9) 16(29.1)

26-35 88(69.8) 38(30.2) 13.99 P < .05

36-50 68(62.4) 41(37.6)

>50 26(43.3) 34(56.7)


Primary school 18(60.0) 12(40.0)

High school 54(56.2) 42(43.8) 3.18 P=.05

Graduate 149(66.5) 75(33.5)

Civil status

Married 61 (57.0) 46(43.0) 2.98 P=.05

Not married 160(65.8) 83(34.2)


Yes 133(64.2) 74(35.8) 1.35 P=.05

No 28(63.6) 16(36.4)

Unemployed 60 (60.6) 39 (39.4)


Yes 52(43.7) 67(56.3) 28.6 P < .05

No 167(62.9) 62(37.1)

Pearson Chi-square test is used to test p-value

Table 3. Correlation between sexual problems and participants age

Parameters < 25 year 26-35 36-50 50 + Total P value

Little or no interest in sex

4 (9.1%) 5 (11.4%) 16 (36.4%) 19 (43.2%) 44 (100.0%)

Decreased genital sensation

0 (0.0%) 4 (50.0%) 4 (50.0%) 0 (0.0%) 8 (100.0%)

Decreased vaginal lubrication

3 (16.7%) 0 (0.0%) 3 (16.7%) 12 (66.7%) 18 (100.0) P < .05

Problem reaching orgasm

3 (13.6% 8 (36.4%) 8 (36.4%) 3 (13.6%) 22 (100.0%)

Pain during sex 3 (15.0%) 14 (70.0%) 3 (15.0%) 0 (0.0%) 20 (100.0%) Other 2 (11.8%) 9 (52.9%) 6 (35.3%) 0 (0.0%) 17 (100.0%) Total 15 (11.6%) 40 (31.0%) 40 (31.0%) 34 (26.4%) 129 (100.0%)

Pearson Chi-square test is used for comparison

partners to perform better sexual intercourses in which women have great benefits. Sexual dysfunction in USA is 43% and is associated with various demographic characteristics, including age and educational attainment. The low sexual desire category was (22%), a category for arousal problems (14%), and a group with sexual pain (7%), [7]. A study in Brazil of which 1212 women who provided information, 49% reported at least one sexual dysfunction [8]. Based on total sexual function score, 84 (46.9%) out of 179 Turkish women had sexual dysfunction. No significant differences were detected in smoking history but sexual dysfunction was significantly higher in the presence of older age [9]. In a study in Iran 31.5% of the women interviewed, reported


group (73.3%) [11]. A Chinese study determined the prevalence for FSD, low desire, arousal disorder, lubrication disorder, orgasm disorder, and sexual pain to be 37.6%, 23.6%, 25.4%, 36.8%, 30.6%, and 21.8% in urban Chinese women, respectively [12]. Some 42 (25.8%) out of 163 Malaysian women had sexual dysfunction. Prevalence of sexual dysfunction increased significantly with age. Sexual dysfunctions were detected as desire problem (39.3%), arousal problem (25.8%), lubrication problem (21.5%), orgasm problem (16.6%), satisfaction problem (21.5%) and pain problems (16.6%) [13]. Our findings are almost similar with the other aforementioned studies in the way of the problem listing. An Indian study recently reported FSD in 73.2% subject of the sample [14]. FSD in a total of 504 Korean women was 43.1%. FSD was detected as a desire problem in 44.0% of women, an arousal problem in 49.0%, a lubrication problem in 37.0%, an orgasm problem in 32.0%, a satisfaction problem in 37.0%, and a pain problem in 34.6% [15].


This was the first study of its kind in the field of sexology in Kosovo which may serve as a starting point for future surveys with wider-ranging samples of women. The present data show us that our women have almost similar sexual problems with the women from other countries. Female sexual dysfunction correlates with age. Apart from age, smoking is a major risk factor for FSD. The impressive fact is that women are willing to talk about their sexual problems with a doctor in a country where sex is still a taboo.

Based on this research we strongly recommend to health and educational policy makers in Kosovo to see the possibility to involve sexuality education into school syllabus.


It is not applicable.


It is not applicable.


Authors have declared that no competing interests exist.


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_________________________________________________________________________________ © 2017 Fejza et al.; This is an Open Access article distributed under the terms of the Creative Commons Attribution License [http://creativecommons.org/licenses/by/4.0], which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Table 1. General characteristic of the participants and findings

Table 1.

General characteristic of the participants and findings p.3
Table 3. Correlation between sexual problems and participants age

Table 3.

Correlation between sexual problems and participants age p.4
Table 2. Potential risk factors for FSD

Table 2.

Potential risk factors for FSD p.4