Psychosexual function and dysfunction in women with anorexia nervosa: a systematic scoping review

Student thesis: Doctoral ThesisDoctor of Philosophy


Background: Research suggests that various physiological and psychosocial factors are associated with the sexual health of women with anorexia nervosa. However, to date, this evidence-base has not been reviewed and summarised. This project systematically reviewed evidence on psychosexual development, function and dysfunction in women diagnosed with anorexia nervosa.
Methods: A systematic scoping review was conducted. Three databases (PsychINFO, PubMed, Embase), and several grey information sources, were searched for studies published since database inception until April 2020. All designs were considered, providing they incorporated a relevant measure of sexual function and/or dysfunction in women with anorexia nervosa. Studies focussing only on sexuality or gender identity were excluded. Narrative synthesis was used to summarise relevant data.
Results: Twenty-eight studies (n = 1,484 women with anorexia nervosa) were included. All were conducted in Western countries, with the majority employing cross-sectional research design. Limited longitudinal data were available. Measures of sexual function and dysfunction varied significantly, though most adopted a biopsychosocial framework. Although the current evidence-base is seriously limited, broad consensus across included studies suggests that women with anorexia nervosa experience higher levels of sexual problems than women without eating disorders. Whether women with anorexia nervosa experience more sexual difficulties than women with other eating disorders is, however, much less clear and warrants further investigation. Sex drive may be linked to body mass index, while other aspects of sexual functioning might not be specifically linked to the weight status of women with anorexia nervosa.
Conclusions: Sexual problems in women with anorexia nervosa are common. Although some of the variance is explained by low weight status, and associated physiological sequelae, other psychosocial factors are also involved. Psychosocial correlates of sexual dysfunction in women with anorexia are, however, poorly understood at present and further research is required. Sexual problems are relevant clinical outcomes for people with eating disorders, which should be explored and addressed within specialised eating disorder assessments and interventions. Future research is required to better understand causal pathways between the biological and psychosocial correlates of anorexia nervosa and sexual problems.
Date of Award1 Oct 2021
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorGerome Breen (Supervisor), Christopher Huebel (Supervisor) & Janet Treasure (Supervisor)

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