Sexual Dysfunction in Females with Chronic Hepatitis C

Background: Female sexual dysfunction (FSD) in patients with Hepatitis C (HCV) is highly prevalent, affecting up to 50% of female patients. Primary complaints include diminished sexual drive, arousal difficulties, orgasmic disorders, and pain during intercourse. These issues are driven by a complex mix of physiological and psychological factors. Fatigue is one of the most common HCV symptoms, draining the energy required for intimacy. Chronic illness, fear of transmission, and the stigma associated with HCV often lead to mental health challenges that directly lower libido. Severe liver disease or advanced cirrhosis alters sex hormone metabolism, which can impact vaginal lubrication and desire. Certain antiviral treatments or medications prescribed to manage HCV-related conditions can cause side effects that impair sexual function. The aim is to determine the prevalence of sexual dysfunction among female patients with chronic Hepatitis C at a Northern Indian tertiary care facility. Material and Methods: This study was carried out at PGIMS, Rohtak's Medical Gastroenterology Department. In this one-year prospective trial, which ran from April 1, 2025, to March 31, 2026, 200 individuals with diagnosed hepatitis C were asked if they had any form of sexual dysfunction. For better understanding 100 patients each of F0-F3 fibrosis and F4 (cirrhosis) on antiviral treatment were enrolled in the study. All 200 HCV patients were females, in 20-50 yrs age group and were sexually active. The sexual history was taken by female doctor or female nursing officer only, thereby removing the inhibition of sharing personal history with male health care worker. Patient with past history of sexual dysfunction, anxiety, depression, diabetes mellitus, hypertension, hypothyroidism which can cause sexual dysfunction were not included in the study. Enzyme linked immunosorbent assay (ELISA) testing for anti-HCV antibodies and polymerase chain reaction (PCR) testing for quantitative HCV RNA were used to establish the presence of hepatitis C in every patient. Results: As a Model Treatment Center (MTC) under the National Viral Hepatitis Control Program (NVHCP), our department is among India's high flow facilities. On daily basis, 5-6 new and 20 follow up patients of HCV come for consultation and till date 12,500 HCV patients have been enrolled in last twelve years in this program. A prospective investigation of 200 patients with diagnosed hepatitis C revealed that none of them smoked, drank alcohol, or used intravenous drugs. All of the patients were female. Out of total pool of 200 HCV patients, 100 patients each of F0-F3 fibrosis and F4 (cirrhosis), on antiviral treatment were enrolled in the study. The sexual dysfunction was seen 10% (20 patients). Out of them 13 (65%) were cirrhotic and 7 (35%%) belonged to F0-F3 group. Most common kind of sexual dysfunction was avoidance of sexual intercourse due to fear of HCV transmission to the sexual partner (16 patients, 80%), followed by loss of libido (3 patients, 15%) and failure to achieve sexual orgasm (1 patient, 5%). Out of 100 patients of HCV related cirrhotic patients, sexual dysfunction was seen in 13 patients (13%). Out of them 10 (76.92 %) had avoidance of sexual intercourse due to fear of transmission to sexual partner, followed by loss of libido (2 patients, 15.38%) and lack of achievement of sexual orgasm (1 patients, 7.69%). In group of 100 patients of Chronic Hepatitis C with F0-F3 fibrosis, total 7 patients (7%) had sexual dysfunction. Out of them 6 (85.71%) had avoidance of sexual intercourse due to fear of transmission to sexual partner, followed by loss of libido (1 patients, 14.29%) and none had lack of achievement of sexual orgasm. Conclusion: Patients with hepatitis C require a more comprehensive approach to treatment, and each patient should be assessed not just from a hepatic perspective but also for any other hepatic effects, including sexual examination. Females have less sexual dysfunction in respect to males due to non-intake of alcohol and smoking in our geographical location. It can be due to good counselling leading to decrease of fear about illness. Some elements of underreporting due to sexuality being a personal and sensitive issue cannot be ruled out.

Keywords: Hepatitis C, Anti-HCV antibody, HCV RNA Quantitative, women, sexual arousal, infertility.