Polycystic ovary syndrome (PCOS) is an endocrine disorder frequently identified in women of reproductive age, and it encompasses diverse clinical implications. Three essential characteristics in establishing a diagnosis of PCOS are the presence of anovulatory cycles, hyperandrogenism (clinical and biochemical), and the appearance of polycystic ovaries (Rotterdam criteria). PCOS has various clinical implications, including the risk of cardiovascular disease, insulin resistance, dyslipidemia, obesity, acne, male pattern baldness, hirsutism, and infertility. The changes in female morphologic features have been reported to affect other aspects, including mood disorders, anxiety, body image disorders, eating disorders, sleep disorders, bipolar disorder, sexual dysfunction, and depression [17].

In this study, the mean age of the participants was 27 years, with 42 subjects (59.2%) having a bachelor’s degree and 35 subjects (49.3%) employed in the private sector. According to Quinn et al., a significant proportion of PCOS patients fall within the reproductive age range, and Pangastuti et al. noted the highest incidence of PCOS in Indonesia among those aged 26–30 years (45.7%) [4, 18]. We chose our sample from Yasmin Infertility Clinic to enroll a homogeneous urban sample, given its private clinic status. In a systematic review conducted by McCool-Myers et al. [19], which involved 135 studies from 41 countries, notable demographic factors influencing female sexual function were identified. These factors encompassed unemployment, low socioeconomic status, lack of education, and economic difficulties [19].

Research examining the occurrence of sexual dysfunctions in women with PCOS has reported prevalence rates varying from 27.2 to 62.5% [15, 20, 21]. Sexual function is complex, involving many factors spanning biology, psychology, medicine, cultural and religious influences, and socioeconomic status. A survey conducted randomly in South and East Asian nations revealed that over 30% of women between the ages of 40 and 80 reported experiencing sexual dysfunction [22]. Efekhtar et al. reported that 57.7% of PCOS women had sexual dysfunction [15]. In a study conducted by Dashti et al., it was reported that sexual dysfunction affected 62.5% of Malaysian women with PCOS, with the domains of arousal and lubrication being notably impacted at rates of 93.8% and 87.5%, respectively [21]. In our study, we found 53.5% of subjects had a sexual dysfunction. The results in this study do not differ significantly between the two groups; however, they align closely with findings from some previous studies.

The findings of this study were that the mean BMI was 23.7 kg/m2(considered overweight), while the mean waist-hip circumference ratio was 0.82 (within the normal range), based on the WHO Asia–Pacific Region criteria [23]. A study by Wiweko et al. at Dr. Cipto Mangunkusumo General Hospital 2008 reported that a body mass index (BMI) of ≧ 25 kg/m2was observed in 73% of women with PCOS [24]. Additional research has observed that individuals with PCOS and hyperandrogenism exhibit a greater prevalence of visceral fat in comparison to subcutaneous fat, as indicated by a waist-hip circumference ratio surpassing 0.85 [25, 26]. However, women diagnosed with PCOS may demonstrate a slender physique despite adhering to a diet characterized by elevated fat and sugar intake and low fiber content. This dietary pattern can result in alterations in microbiota balance, leading to conditions of insulin resistance and hyperandrogenism [27].

Hyperandrogenism in PCOS contributes to alterations in physical appearance, manifesting as hirsutism, alopecia, acne, and obesity. While hyperandrogenism is associated with an increase in sexual desire, hirsutism in women may trigger a lack of self-confidence and anxiety related to a perceived deficiency in feminine identity, potentially leading to sexual dysfunction [28, 29]. In our study, 67.65% exhibited hirsutism, but no significant relationship was found with the FSFI score. This contrasts with a previous study by Bazarganipour et al., involving 300 PCOS subjects in Iran, which reported a negative correlation between hirsutism and self-confidence scores (ß =  − 0.124, p= 0.032) [30]. This discrepancy could be attributed to differences in the Ferriman-Galwey cut point (mFG ≥ 5 for the Indonesian population), which might not significantly contribute to sexual dysfunction in Indonesian women due to less prominent hair growth patterns that do not interfere significantly with the appearance of the study subjects.

Hirsutism has different cut points depending on genetics, race, and ethnicity. European and Central Asian women have different cut points from Southeast Asian women; even on the Asian continent, the Ferriman-Gallwey score cut point is different. An extensive population-based study encompassing 3,000 women in China established an mFG score of ≥ 5 as a correlation with PCOS. Similarly, in Thailand, the 97.5th percentile for the mFG score was determined to be ≥ 3 [31, 32]. Nonetheless, a cross-sectional study conducted in Boston in the USA, which included 170 Caucasian and 20 Asian PCOS women, demonstrated a similar prevalence of hirsutism, defined by mFG score of ≥ 9 [33].

It had been reported that obese women with PCOS had anxiety disorders, which can also affect their sexual function [28, 30, 34]. In this study, there was no statistically significant between the sexual dysfunction score and anthropometric profile on PCOS. Still, there is a lower mean score in the lubrication domain (4.72 ± 0.64 vs. 5.15 ± 0.69) and pleasure domain (3.45 ± 0, 53 vs. 3.65 ± 0.47), which is statistically significant (p = 0.02 vs. p = 0.13). These findings are not in line with other studies, which may be caused by the mean of our subject being categorized as overweight. It has been reported that obesity contributes to sexual dysfunction in women. In a cross-sectional study in Iran conducted by Mozafari et al., 120 women with sexual dysfunction had a BMI of more than 25 and had lower FSFI total scores (16.2 ± 2.8 vs. 20.45 ± 9.4; p≤ 0.05) [35]. In a comparable investigation conducted by Esposito et al., the obese group exhibited lower FSFI scores, involving 52 women [36]. Elsenbruch et al. tried to analyze the quality of life, social well-being, and sexual pleasure for 100 subjects, and it was found that the group of PCOS with obesity had a lower sense of pleasure in their sexual life and felt less sexually attractive than the control group (41.3 ± 33.4 vs. 73.8 ± 27.4; p< 0.001) [37].

Subjects with sexual dysfunction exhibited a higher mean anxiety score compared to those without sexual dysfunction. We examine additional factors (age, duration of marriage, BMI, waist-to-hip ratio, FG score) that could influence anxiety in this study. It has been observed that as age and duration of marriage increased, there was a higher prevalence of various forms of Female Sexual Dysfunction (FSD), such as pain and issues related to desire, arousal, lubrication, orgasm, and satisfaction. Additionally, aging influences the sexual response cycle and the physiology of marital intimacy, leading to hormonal changes. Consequently, there is a decline in sexual desire and frequency, ultimately resulting in decreased marital satisfaction [38].

Our analysis revealed a statistically significant negative correlation between age and anxiety in the group with sexual dysfunction, whereas the FG score showed a weak positive correlation with anxiety. The feature of hirsutism might cause anxiety in Indonesian women but does not have a significant correlation with the sexual dysfunction score, as mentioned above. This can occur because of cultural, religious, political, historical, and socioeconomic differences that underlie sexual attitudes. Laumann et al. conducted a cross-national study across 29 countries. They found that women residing in male-centered or patriarchal societies, including Indonesia, exhibited the lowest levels of sexual well-being. These studies reinforce the notion that companionate relationships typically emphasize the importance of sexual function and performance in intimate partnerships. In essence, within companionate relationships, sexual activity serves not only reproductive functions but also reflects the overall quality of the relationship. Moreover, in male-centric societies, there is often an oversight regarding the relational significance of sexual experiences and the significance of sexual pleasure for women [39].