Table 1.

Study characteristics for the included studies.

Author, year, country	Setting (population) Period of recruitment PCOS diagnostic criteria	Study design	Sample size per group	Outcomes	Summary of findings	Other notes	Risk of bias
Elsenbruch et al., 2003, Germany	Outpatient endocrine clinic, Website clinic (PCOS patients) Health screening program university (age-matched healthy controls, employees) Recruitment period not mentioned NIH criteria	Cross-sectional	PCOS 50 Controls 50	VAS sexual function	PCOS: less satisfied with sexual life, less attractive, sex life is as important as for controls, body hair impacts sexuality negatively	Elsenbruch, Tan, Hahn, and Caruso used the same control group	Moderate
Hahn et al., 2005, Germany	Outpatient endocrine Clinic, Website clinic (PCOS patients) Health screening program university (age-matched healthy controls Recruitment period not mentioned NIH criteria	Cross-sectional	PCOS 120 Controls 50	VAS sexual function	PCOS: less satisfied with sexual life, less attractive, sex life is as important as for controls, body hair impacts sexuality negatively	Elsenbruch, Tan, Hahn, and Caruso used the same control group	Moderate
Drosdzol et al., 2007, Poland	University Hospital (PCOS patients) Outpatient Gynecological Clinics (controls for routine checkup) Recruitment period not mentioned ESHRE criteria & Polish Endocrine Society	Cross-sectional	PCOS 50 Controls 40	ISS questionnaire sexual function	PCOS lower marital sexual function, more marital sexual dysfunction, hirsutism affects sexual function negatively than controls		Moderate
Tan et al., 2008, Germany	Outpatient endocrine clinic (PCOS patients) Health screening program university (age-matched healthy controls, employees) June 2005 to December 2006 NIH & Rotterdam	Cross-sectional	PCOS 115 Controls 50	VAS sexual function	PCOS reduced sexual satisfaction and sexual self-worth compared to controls	Elsenbruch, Tan, Hahn, and Caruso used the same control group We compared both the PCOS infertile and fertile group separately to the control group.	Moderate
Caruso et al., 2009, Italy	Family planning centre, University of Catania, Italy (PCOS patients) Health screening program university, Germany (age-matched control group, employees) April 2007 to March 2008 Rotterdam criteria	Prospective intervention	PCOS 94 Controls 50	VAS sexual function	Women with PCOS find themselves less sexual attractive. Body hair impacted sexual function and PCOS had an impact on social relations.	Elsenbruch, Tan, Hahn, and Caruso used the same control group Intervention study, we used baseline scores only for this meta-analysis	Moderate
Mansson et al., 2011, Sweden	Linne Infertility Clinic in Uppsale Department of Obstetrics & Gynecology and Medicine at Sahlgrenska University Hospital Gothenburg & support community website (PCOS patients) For each woman with PCOS a woman born on the same day, identified from the population registry served as a control (controls) 2002–2005 Rotterdam criteria	Case control	PCOS 49 Controls 49	McCoy-FSQ	Despite having the same number of partners and about the same frequency of sexual intercourse, women with PCOS were generally less satisfied with their sex lives compared to the population-based controls. PCOS women scored numerically lower than controls on the McCoy total score, but this difference was not statistically significant.	Not included in MA for outliers see Pastoor et al. 2018	NA
Gateva and Kamenov, 2012, Bulgaria	Hospitalized patients endocrine clinic (PCOS patients, lean, and obese) Other hospital population (controls, obese) Recruitment period not mentioned ESHRE & ASRM	Cross-sectional	PCOS 57 Controls 22	FSFI	PCOS lower sexual function scores then obese controls. Obese PCOS women score better in FSFI than lean PCOS women.	Intervention study, we used baseline scores only for this meta-analysis We only used data for obese women.	Moderate
Stovall et al., 2012, USA	Convenient, hospital (PCOS patients) Waiting rooms from three university gynaecological departments and a Family Medicine Clinic (controls) January 2006 to June 2009 NICHD	Cross-sectional	PCOS 92 Controls 82	CSFQ	PCOS lower orgasm score than controls, higher BMI related to worse orgasm scores, testosterone >1SD above mean better sexual function		Moderate
Ercan et al., 2013, Turkey	Two university hospital gynaecology departments (PCOS patients) University hospital outpatient unit, routine check-up (controls) Recruitment period not mentioned Rotterdam criteria	Cross-sectional	PCOS 32 Controls 32	FSFI	No differences in sexual function, higher testosterone associated with higher total FSFI score		Low
Ferraresi et al., 2013, Brazil	Consecutive sample, University Hospital Sao Paulo, Gynecologic Endocrinology (PCOS patients) Primary care same hospital, Regular menses (controls) September 2008 to July 2010 Rotterdam criteria	Cross-sectional	PCOS 48 Controls 35 rr83/87 total population	FSFI	PCOS 50% below cut off FSFI, no significant differences in FSFI total score between PCOS and control	We used both the lean and obese data.	Moderate
Zueff et al., 2015, Brazil	Outpatient Clinic Human Reproduction Sector, University of Sao Paulo, (PCOS patients and controls) April 2009 to July 2010 Rotterdam criteria	Case control	PCOS 43 Controls 44	SQ-F	No significant differences in total SQ-F scores		Moderate
Benetti-Pinto et al., 2014, Brazil	Gynaecology department university hospital, University of Campinas, Sao Paulo (PCOS patients and controls) Recruitment period not mentioned Rotterdam criteria	Cross-sectional	PCOS 56 Controls 102 rr 100%	FSFI	PCOS lower score on FSFI scales except for desire and orgasm		Low
Elkhiat et al., 2015, Egypt	Gynecology & Obstetrics Clinic, Kasr El Aini hospital, Cairo University (PCOS patients and controls) Recruitment period not mentioned Rotterdam criteria	Cross-sectional	PCOS 85 Controls 63	FSDQ	PCOS lower scores on FSDQ scales except for solitary desire. Normal testosterone levels in PCOS associated with better sexual function.		Moderate
Kowalczyk et al., 2015, Poland	University hospital University of Silesia: department of Gynecologic Endocrinology (PCOS patients) Gynaecological outpatient clinics of Women’s Health Diagnostic Center, Katowice (controls) March 2009 to September 2009 Rotterdam criteria	Cross-sectional	PCOS 73 Controls 45	MSQ	Both groups find sexuality equally important. PCOS rates themselves negatively as sexual partner.		Low
Lara et al., 2015, Brazil	Endocrine gynaecology outpatient clinic, University of Sao Paulo (PCOS patients and controls) December 2010 to December 2013 Rotterdam criteria	Case control	PCOS 43 Controls 51	FSFI	PCOS more sexual dysfunction at baseline, other scales similar scores between PCOS and controls	Intervention study, we used baseline scores only for this meta-analysis	Moderate
Noroozzadeh et al., 2016, Iran	Stratified-cluster sampling method in four provinces of various geographic regions of Iran (PCOS patients and controls) Recruitment period not mentioned Rotterdam criteria	Cross-sectional population based	PCOS 63 Controls 216	FSFI	No significant differences between controls and PCOS on FSFI scores.		Low
Shafti and Shahbazi, 2016, Iran	Shahid Rajaee Hospital and selected women infertility clinics in Tonekabon, convenient sampling (PCOS patients) Clinics employees and patients companions, convenient sampling (controls) November 2013 to June 2014 Rotterdam criteria	Casual comparative study	PCOS 129 Controls 125	FSFI	No significant differences on FSFI scores between PCOS and controls		Moderate to high
Diamond et al., 2017, USA	Trial PCOS II (PCOS patients) Trial AMIGOS (infertile controls) Women seeking infertility care Recruitment period not mentioned Rotterdam criteria	Cross-sectional secondary data analysis with data from clinical trial	PCOS 733 Controls 865	FSFI	Sexual function scores, as assessed by the Female Sexual Function Inventory, were nearly identical. The Female Sexual Distress Scale total score was higher in women with polycystic ovary syndrome. The mean Female Sexual Function Inventory total score increased slightly as the free androgen index increased, mainly as a result of the desire subscore. This association was more pronounced in the women with unexplained infertility	We only used baseline data for this study. Excluded from MA for being an outlier (see Pastoor et al. 2018)	NA
Basirat et al., 2019, Iran	Infertility clinic Fatemeh Azahra Infertility and Reproductive Health Research Center, Babol, Iran (PCOS patients and controls) May 2016 to December 2017 Rotterdam criteria	Case control	PCOS 120 Controls 120	FSFI	No significant differences on FSFI scores between PCOS and controls		Low
Glowinska et al., 2020, Poland	Gynecology Clinic at Posnan University Of Medical Sciences (women with PCOS) Internet advertisements (control group) December 2012 to March 2015 Rotterdam criteria	Cross-sectional case control study	PCOS 94 Controls 47	SSS	No significant difference on this scale between PCOS and controls	We only used scores on the Physical satisfactions scale since we thought these were most comparable with FSFI satisfaction	Moderate
Deniz and Kehribar, 2020, Turkey	Private Manavgat Obstettrics and Gynecology Center, Antalya, Turkey (PCOS patients and controls) January 2019 to November 2019 ESHRE & ASRM	Case control	PCOS 50 Controls 50	FSFI	Controls have a significantly higher FSFI total score than women with PCOS	We only used data from PCOS fertile group	Low
Aydogan Kirmizi et al., 2020, Turkey	A tertiary centre (PCOS patients and controls) February 2019 to October 2019 Rotterdam criteria	Case control	PCOS 20 Controls 30	FSFI	FSFI lubrication score was significantly higher in the PCOS group. Other scores were not significantly different.	We only used data from PCOS fertile group	Moderate
Akbari Sene et al., 2021, Iran	Two infertility centres in Tehran, Iran (PCOS patients and controls) February 2018 to March 2018 ESHRE	Case control	PCOS 116 Controls 93	FSFI	No significant differences were found between PCOS and controls		Low
Mantzou et al., 2021, Greece	Division of endocrinology of the University Hospital of Patras, Greece (PCOS patients) Two workshops on female sexuality conducted in the Universities of Athens and Patras, Greece (controls) Recruitment period not mentioned AE-PCOS criteria	Case control	PCOS 76 Controls 133	FSFI	Women with PCOS scored significantly lower on FSFI domains arousal, lubrication, orgasm, and satisfaction and on the FSFI total score		Low
Taghavi et al., 2021, Iran	Infertility clinic in Omelila Hospital in Hormozgan province Iran (PCOS patients) Convenience sampling, patients companions (controls) April 2015 to April 2016 Rotterdam criteria	Case control	PCOS 90 Controls 90	FSFI	Women with PCOS scored significantly lower on all FSFI domains and the FSFI total score		Moderate
Kałużna et al., 2021, Poland	Not reported, most likely Poznan University of Medical Sciences (PCOS patients, eumenorrheic healthy women) Recruitment period not mentioned Rotterdam & ESHRE	Case control	PCOS 190 Controls 197	SSQ	No significant difference between the groups in SSQ total score	PCOS infertile, control fertile	Moderate to high
Naumova et al., 2021, Spain	Reproductive medicine unit of the Hospital Clinic, Barcelona, Spain (PCOS patients and controls) December 2017 to June 2019 Rotterdam criteria	Case control	PCOS 37 Controls 31 (male factor infertility)	FSFI	Women with PCOS scored significantly lower compared to the MFI control group on all FSFI domains except pain and on the FSFI total score	We only used data from the male factor infertility control group and the PCOS infertile group	Low
Karsten et al., 2021, The Netherlands	Follow up of an RCT (women with obesity and infertility randomized to lifestyle intervention followed by infertility treatment or to prompt infertility treatment), outpatients fertility clinics (PCOS patients and controls) June 2009 to June 2012 Rotterdam criteria	Cross-sectional analysis of data from a follow up study after a multicentre RCT	PCOS 64 (orgasm, lubrication, total) PCOS 73 (sexual interest) PCOS 70 (sexual satisfaction) Controls 79 (orgasm, lubrication, total) Controls 100 (sexual interest) Controls 97 (sexual satisfaction)	MFSQ	No significant differences between PCOS and controls were found on MFSQ scores.		Low
Ashrafi et al., 2022, Iran	Royal Institute and health care centres in Tehran, Iran (PCOS patients and controls) May 2016 to June 2017 Rotterdam criteria	Cross-sectional	PCOS 80 Controls 80 (male factor infertility)	FSFI	Infertile women with PCOS showed lower scores on all FSFI domains and the FSFI total score compared to women with male factor infertility.	We only used data from the male factor infertility control group	Moderate
Aba and Aytek Şik, 2022, Turkey	Sisli Kolan Hospital Reproductive Health and Family Planning Center in Istanbul, Turkey (POCS patients and controls) January 2019 to June 2019. Rotterdam criteria	Case control	PCOS 97 Controls 95	FSFI	Sex drive, arousal, lubrication, orgasm, and averages of pain subscales and female sexual function index total score were significantly lower in the PCOS group than in the control group.		Moderate
Çetinkaya Altuntaş et al., 2022, Turkey	Recep Tayyip Erdogan University endocrinology outpatient clinic, Turkey 2020–2021 Rotterdam criteria	Cross-sectional	PCOS 167 Controls 73	FSFI	No significant differences on the FSFI were found between the PCOS group and the control group.	We only used data from the complete PCOS group. PCOS group overweight, control group normal BMI.	Low
Daneshfar et al., 2022, Iran	Arash hospital clinic at Tehran in Iran October 2018 to December 2019 Rotterdam criteria	Cross-sectional	PCOS 210 Controls 210	FSFI	Women with PCOS reported a significantly lower total FSFI mean score then control women.	We only used data from the PCOS group and the control group. PCOS group infertile, control group fertile. Both groups overweight.	High
Mojahed et al., 2023, Iran	Arash hospital clinic at Tehran in Iran October 2018 to December 2019 PCOS criteria used: not reported	Cross-sectional	PCOS 106 Controls 106	FSFI	PCOS Group scored significantly lower on all FSFI subdomains (except arousal) and the FSFI total score compared to the control group.		High
Yildiz et al., 2017, Turkey	Sisli Etfal Research Hospital and Van Ercis State Hospital January 2013 to December 2013 Rotterdam criteria	Cross-sectional	PCOS 90 (27 with normal BMI) Controls 80	FSFI	In the normal BMI groups, the PCOS group scored significantly lower on all FSFI domains (except desire) and FSFI total score compared to the control group.	We only used the scores of the PCOS group with a normal BMI.	High

BMI, body mass index; CSFQ, Changes in Sexual Function Questionnaire; FSFI, Female Sexual Function Index; FSDQ, Female Sexual Desire Questionnaire; FSDQ, Female Sexual Desire Questionnaire; ISS, Index of Sexual Satisfaction; McCoy-FSQ, McCoy Female Sexuality Questionnaire; MSQ, Multidimensional Sexuality Questionnaire; PCOS, polycystic ovary syndrome; SSS, Sexual Satisfaction Scales; SSQ, Sexual Satisfaction Questionnaire; SQ-F, Sexual Quotient-Female; VAS, visual analogue scale.