Sexual Dysfunction in Females with Chronic Hepatitis B

Background: The average prevalence of hepatitis B surface antigen (HbsAg) positive in the general population is 3–4%, with a range of 1.1% to 12.2%. An estimated 40 million persons in India are thought to have a chronic Hepatitis B infection, according to certain regional level research. Chronic Hepatitis B (CHB) is highly associated with sexual dysfunction (SD), with a prevalence rate significantly higher than the general population. Women may experience reduced desire and arousal issues. SD often worsens with advanced liver fibrosis, cirrhosis, and related depression. Anxiety, depression, and stigma associated with a chronic, sexually transmissible illness are significant contributors to sexual dysfunction. Managing liver health through proper treatment, avoiding alcohol, and regular checkups can improve overall health and, in some cases, sexual function. The aim is to determine the prevalence of sexual dysfunction among female patients with chronic Hepatitis B at a Northern Indian tertiary care facility. Material and Methods: This study was carried out at PGIMS, Rohtak's Medical Gastroenterology Department. In a prospective study conducted over a one-year period, from May 1, 2025, to April 30, 2026, 300 individuals with diagnosed hepatitis B were asked if they had any sexual dysfunction. For better understanding 100 patients each of inactive carrier, chronic hepatitis on antiviral treatment and cirrhotic on antiviral treatment were enrolled in the study. All 300 HBV patients were females, in 20-50 yrs age group and were sexually active. Patient with past history of sexual dysfunction, anxiety, depression, diabetes mellitus, hypertension, hypothyroidism which can cause sexual dysfunction were not included in the study. All patients who were having HBV infection for at least three years were included in the study. Enzyme-linked immunosorbent assay (ELISA) testing for HbsAg and polymerase chain reaction (PCR) testing for HBV DNA were used to establish the presence of hepatitis B in every patient. Prior to study enrolment, written informed permission was obtained. Results: One of India's high flow facilities, our department is a Model Treatment Center (MTC) under the National Viral Hepatitis Control Program (NVHCP). Eight to ten new and forty follow-up HBV patients visit the program every day for consultations, and during the past twelve years, 12,000 HBV patients have been enrolled. A prospective investigation of 300 patients with diagnosed hepatitis B revealed that all of them were female. One hundred patients each of inactive carriers, patients with chronic hepatitis receiving antiviral therapy, and patients with cirrhosis receiving antiviral therapy were included from the 300 HBV patients in the entire pool. The sexual dysfunction was seen in 16% of cirrhotic, 10% of chronic hepatitis with significant fibrosis and 6% of Inactive carrier. Most common kind of sexual dysfunction was avoidance of sexual intercourse due to fear of HBV transmission to the sexual partner (27 patients, 84.37%), followed by loss of libido (3 patients, 9.375%) and failure to achieve sexual orgasm (2 patients, 6.25%). Out of 100 patients of HBV related cirrhotic patients, sexual dysfunction was seen in 16 patients (50%). Out of them 12 (75%) had avoidance of sexual intercourse due to fear of transmission to sexual partner, followed by loss of libido (2 patients, 12.50%) and lack of achievement of sexual orgasm (2 patients, 12.50%). In group of 100 patients of Chronic Hepatitis B with significant fibrosis- > F2 Fibrosis, total 10 patients (10%) had sexual dysfunction. Out of them 9 (90%) had avoidance of sexual intercourse due to fear of transmission to sexual partner, followed by loss of libido (1 patients, 10%) and none had lack of achievement of sexual orgasm. In group of 100 patients of chronic Hepatitis B-inactive carriers-F0-F1 Fibrosis, only 6 patients (6%) had sexual dysfunction and all of them (100%) had avoidance of sexual intercourse due to fear of transmission to sexual partner, and none had loss of libido or lack of achievement of sexual orgasm. Conclusion: A more comprehensive strategy is required for the management of hepatitis B patients, and each patient should be assessed not just from a hepatic perspective but also for any other hepatic effects, including sexual examination. The sexual aspect is often missed by treating team as well as not shared by patients. In India, masculinity is attached to core of heart of males and majority do not accept and share with health professionals. Hence, good repo of doctor with patients will help in healthy discussion among them on this sensitive issue.

Keywords: Hepatitis B, HbsAg, HBV DNA Quantitative, women, sexual arousal, infertility.