Prevalence of female sexual dysfunction and associated factors among women in Ethiopia: a systematic review and meta- analysis.

BACKGROUND: Female sexual dysfunction (FSD) is a common yet under-recognized component of women’s reproductive health, particularly in low-income settings where sexual health is rarely addressed in routine care. It is associated with adverse physical, psychological, and social consequences that negatively affect women’s quality of life and intimate relationships. In Ethiopia, existing studies are limited in number and methodologically heterogeneous, with widely varying prevalence estimates and inconsistent reporting of associated factors. Therefore, a comprehensive synthesis of the available evidence is needed to inform clinical practice, support integration of sexual health into reproductive services, and guide evidence-based policy and programming. METHODS: We searched PubMed, Embase, Scopus, Web of Science, CINAHL, the Cochrane Library, African Journals Online (AJOL), and Google Scholar for observational studies published between January 2015 and August 2025. Eleven observational studies involving 5,982 participants that screened for FSD using validated instruments, namely the Female Sexual Function Index (FSFI) or the Changes in Sexual Functioning Questionnaire (CSFQ), met the inclusion criteria. Study quality was evaluated using the Joanna Briggs Institute checklist. Pooled prevalence was estimated using a random-effects meta-analysis, heterogeneity was assessed using the I² statistic, publication bias was evaluated, and subgroup and meta-regression analyses were conducted to explore sources of heterogeneity. RESULTS: The pooled prevalence of women who screened positive for FSD was 53.8% (95% CI: 46.38–61.22%; I² = 96.39%), with a wide prediction interval indicating substantial variability across study populations. Subgroup pooled prevalence estimates were 61.1% among women with medical conditions, 61.7% among women with mental illness, and 45.4% among general/reproductive-age women. Depression (AOR = 3.06; 95% CI: 1.82–5.15) and older age (AOR = 3.61; 95% CI: 1.71–7.61) were significantly associated with increased odds of FSD, However, the pooled adjusted effect estimate for substance use was not statistically significant. CONCLUSION AND RECOMMENDATIONS: This systematic review and meta-analysis found that over half of Ethiopian women screened positive for FSD, exceeding global and low- and middle-income estimates, particularly among those with chronic medical and mental health conditions. Older age and depression were consistently associated with increased odds of FSD. Integrating routine FSD screening into reproductive and mental health services, strengthening provider training in sexual health assessment and counseling, and promoting community awareness to reduce stigma are essential steps to improve women’s sexual well-being. PROSPERO REGISTRATION NUMBER: CRD420251136497