Associations between female sexual distress, genitourinary diagnoses, and mental health in a sexual health clinic population: a single-center retrospective review

Background Female sexual distress is multifactorial, with barriers to care arising from limited research and sociocultural stigmas. While studies examine individual impacts of depression, anxiety, dyspareunia, and hypoactive sexual desire disorder (HSDD) on distress, few explore comorbid intersections. This project evaluates how common psychiatric and genitourinary diagnoses are associated with female sexual distress. Methods A retrospective chart review with cross-sectional analytic component was conducted of 515 patients seen in a single clinic between January 2019 and July 2025. Data included demographics, menopausal status, and scores on the Female Sexual Distress Survey Revised (FSDS-R), Female Sexual Function Index (FSFI), and Sexual Experience Survey. Psychiatric and genitourinary diagnoses were documented. Thirty-one charts were excluded due to missing or incorrect scores. Data analysis included Mann–Whitney U, chi-squared testing, and multiple linear regression, with P ≤ .05 as significant. Results Among 484 patients, 97.3% were White with mean age 45.8 years (SD 13.7). Menopausal status was not associated with increased distress (P = .068), but women ≤40 years had significantly higher distress scores (P = .0086). Univariate analysis showed higher FSDS-R scores with diagnoses of HSDD (P < .001), anxiety (P < .001), depression (P < .001), post-traumatic stress disorder (PTSD; P < .001), and history of sexual (P = .0045) or emotional/physical/verbal abuse (P = .0053). Dyspareunia was not significant univariately (P = .37). Multiple linear regression identified HSDD (β = 6.03, P = <.001) as the strongest predictor with a 6 point increase, dyspareunia (β = 2.65, P = .009), and history of sexual abuse (β = 4.1, P = .03), as independent predictors of elevated distress. PTSD exhibited a borderline relationship (β = 5.3, P = .051). Female Sexual Function Index was also an independent predictor, with each point decrease indicating a 0.31 point increase in FSDS-R score (P = <.001). Older age was a minor protective factor (β = 0.086, P = .044). Anxiety and depression symptoms lost independent significance in the adjusted model. Conclusions Trauma history, decreased desire, and somatic pain significantly impact distress and should be screened for. Dyspareunia independently predicts distress but may be masked by other factors. The attenuation of depression and anxiety after multivariable adjustment may reflect shared clinical variance rather than independent drivers of distress. Overall, multidisciplinary teams including mental health, physical therapy, and social support should be included in treating sexual distress. Future research should validate these findings in multicenter studies and explore interventions targeting comorbid conditions.