Female Sexuality in a University Population: An Observational Study

Material and methods

Study design and setting

This was an observational, cross-sectional, descriptive study conducted during March and April 2022 at the University of the Algarve, a public higher education institution located in southern Portugal. Recruitment occurred across multiple campus locations frequented by undergraduate and postgraduate students. It was approved by the Ethics Committee of the University of the Algarve (approval number: 07/2022).

All participants provided written informed consent. Participation was voluntary, and responses were fully anonymised.

The manuscript was written according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for cross-sectional studies [15]. A completed STROBE checklist is provided as supplementary material.

Participants

Eligible participants were female students aged 18–25 years enrolled at the University of the Algarve. The final sample consisted exclusively of participants who self-identified informally as cisgender during recruitment and participation procedures; however, gender identity was not formally assessed using structured questionnaire items. A convenience sample of 60 participants was recruited through random distribution of paper-based questionnaires across the campus. Students who did not meet the age criterion or who declined to provide informed consent were excluded.

Instruments

Data were collected using the following instruments:

1. Sociodemographic and gynecological history questionnaire — developed specifically for this study. Variables included: level of education, employment status, duration of current intimate relationship, area of residence, age at menarche, use of contraception (method and duration), and history of infertility.
2. Female Sexual Function Index (FSFI) — a validated Portuguese-language, 19-item questionnaire assessing six domains of sexual function: desire (items 1–2), subjective arousal (items 3–6), lubrication (items 7–10), orgasm (items 11–13), satisfaction (items 14–16), and sexual pain (items 17–19). Higher scores indicate better sexual function; a total score ≤26.55 is considered the clinical threshold for sexual dysfunction risk. The Portuguese-validated version demonstrated good psychometric properties, with high internal consistency (Cronbach’s alpha values ​​between 0.88 and 0.93), in addition to convergent and discriminant validity [16,17]. We should also point out that several FSFI items assess related but conceptually distinct dimensions of sexual functioning. To improve interpretability, the present study distinguished between behavioural frequency indicators and subjective appraisal measures when describing results. Specific FSFI items were selected a priori to operationalise prevalence estimates because they most directly reflected frequency-based symptom occurrence. Complementary items within the same domains were analysed descriptively to provide additional contextual information regarding subjective satisfaction, confidence, or perceived severity.
3. Female Sexual Distress Scale–Revised (FSDS-R) — a 13-item scale that quantifies distress arising from sexual difficulties. It consists of 13 items related to possible situations causing discomfort related to sex in women. For each item, one of the five possible answers must be selected related to the frequency with which each situation bothered the individual in the last 30 days: “Never” (0), “Rarely” (1), “Occasionally” (2), “Often” (3), and “Always” (4). The final score is obtained through the sum of the items, which can range from 0 to 52, where the higher the score, the higher the level of discomfort. A score above 11 corresponds to a high level of distress. The Portuguese-validated version demonstrated good psychometric indices, internal consistency with Cronbach’s alpha values ​​> 0.88, and discriminant validity. [18,19].
4. Sexual Satisfaction Scale for Women (SSS-W) — a 30-item questionnaire that aims to assess female sexual satisfaction and discomfort associated with sexual difficulties, evaluating five dimensions: contentment, communication, compatibility, relational concern, and personal concern. It is answered according to a five-point Likert scale (Strongly agree (1); Agree (2); Neither agree nor disagree (3); Disagree (4); Strongly disagree (5). The total score varies between 6 and 30 values ​​and is obtained by adding the items from each domain, with the relational and personal concern domains being added later, and this value is divided by 2. Higher scores reflect higher levels of sexual satisfaction. The validated Portuguese version demonstrated adequate psychometric properties and can be used as a valid and reliable measure for assessing sexual satisfaction in women: it had an overall Cronbach’s alpha of approximately 0.94, and Cronbach’s alpha values exceeding 0.80 for the individual domains [20,21]. Internal consistency reliability of the FSFI, FSDS-R, and SSS-W within the present sample was also assessed using Cronbach’s alpha coefficients.

Procedure

Questionnaires were administered in paper format in university common areas and classrooms during March–April 2022. Potential participants were approached in person by members of the research team and invited to participate voluntarily. Before questionnaire completion, participants received verbal and written information regarding the study objectives, confidentiality procedures, and anonymity of responses. Participants completed the questionnaires individually in a self-administered format without researcher interference. No identifying personal information was collected. Completed questionnaires were returned anonymously.

The total number of returned questionnaires confirmed the sample size. Following data collection, quantitative analysis was performed according to the following variable groups:

1. Sociodemographic: Academic degree, marital status, area and region of residence, existence of a current intimate relationship.
2. Gynecological History: Age at menarche; use of contraception, method and duration of use; presence of known infertility, type and etiology.
3. Sexual Difficulties: Lack of sexual desire/interest; Difficulties with sexual arousal; Difficulties in reaching orgasm; Genito-pelvic pain (dyspareunia); Lubrication deficit; Satisfaction with sex life (Figure 1).

Figure 1: Scheme of applicability of questionnaires to the variables under study.

The Sociodemographic Questionnaire used is available in Supplementary Material 2. Due to copyright restrictions associated with the validated psychometric instruments used in this study (FSFI, FSDS-R, and SSS-W), full questionnaires are not reproduced. However, operational definitions and questionnaire domains relevant to the present analyses are described above.

No sampling process was carried out. The number of responses confirmed the sample.

Outcome definitions

Frequency distribution tables were constructed. Selected individual FSFI items were used to estimate the prevalence of specific sexual difficulties rather than calculating formal FSFI domain dysfunction classifications. This approach was chosen because the primary objective was descriptive and exploratory, focusing on the frequency of self-reported difficulties in specific phases of the sexual response cycle within a young university population. Individual FSFI items were therefore used as symptom indicators rather than diagnostic measures. The present findings should be interpreted as reflecting self-reported sexual difficulties rather than clinically established sexual dysfunctions.

Sexual difficulty in each of the six domains was operationalised as follows: for desire/interest (item 1), arousal (item 3), lubrication (item 7), and orgasm (item 11), a difficulty was recorded when responses indicated the difficulty occurred in approximately half or more of sexual encounters. For dyspareunia (item 17), a difficulty was recorded when pain impeded penetration in approximately half or more of encounters. Although DSM-5 TR requires symptoms to be present in ≥75% of encounters for a clinical diagnosis, the present study adopted a 50% threshold to capture borderline or transient difficulties. Severity was classified as borderline/transient (approximately 50% of encounters) or moderate-to-severe (≥75% of encounters) (Table 1).

Sexual satisfaction was determined by item 6 of the SSS-W: “I feel satisfied with how my sex life is currently.” Responses of “reasonably satisfactory,” “very satisfactory,” or “completely satisfactory” were classified as satisfied with their sexual life, and those who answered “not at all satisfactory” or “not very satisfactory” were considered as dissatisfied.

Statistical analysis

Statistical analysis was performed using IBM SPSS Statistics® software, version 28 for Mac IOS®.

Associations between categorical variables were evaluated using Pearson’s chi-square test or Fisher’s exact test when expected cell frequencies were small. Statistical significance was defined as p < 0.05. Chi-square statistics are reported with corresponding degrees of freedom and p-values. Given the exploratory nature of the study and the limited sample size, inferential analyses were interpreted cautiously.

The study design and statistical approach were selected in accordance with recommendations for exploratory cross-sectional observational studies using self-report psychometric instruments and categorical prevalence outcomes.

Results

Sample characteristics

Sixty cisgender, heterosexual female students were enrolled. All participants reported being unmarried/single in terms of marital status, although 57% reported currently being in an intimate relationship. Sociodemographic and gynecological characteristics are presented in Table 2. The majority were pursuing higher education (73.3%), living in urban areas (74.6%), and residing in the Algarve Sotavento region (59.3%). More than half (56.7%) were in an intimate relationship, and 68.3% were using contraception — predominantly hormonal methods (86.8%).

Sexual function

The psychometric instruments demonstrated satisfactory internal consistency in the present sample. Cronbach’s alpha coefficients were 0.83 for the FSFI, 0.91 for the FSDS-R, and 0.81 for the SSS-W, indicating good-to-excellent reliability.

The mean total FSFI score was 28.14 (SD 6.92; maximum 36), indicating overall adequate sexual function, as scores ≤26.55 are considered to indicate dysfunction risk. At least one sexual difficulty was identified in 75% of participants; 33% reported two or more concurrent difficulties.

Prevalence of individual sexual difficulties

Sexual difficulty was defined as the presence of at least one of the five domains evaluated in this study: difficulty in desire/interest, difficulty in sexual arousal, difficulty in reaching orgasm, genito-pelvic pain, and difficulty in lubrication (Figure 2).

Figure 2: Prevalence of sexual difficulties in the study sample (N=60). Values represent the percentage of participants reporting each difficulty.
Data: Desire/Interest 42.4%, Orgasm 36.7%, Dyspareunia 21.7%, Lubrication 10.0%, Arousal 6.7%

The most prevalent difficulty was lack of sexual desire/interest, affecting 42% of participants (n = 25). Difficulty reaching orgasm ranked second, with a prevalence of 37% (n = 22). Genito-pelvic pain (dyspareunia) was present in 22% (n = 13), followed by lubrication difficulties (10%) and arousal difficulties (7%).

Difficulty with Sexual Desire/Interest and Arousal

The most prevalent difficulty was lack of sexual desire/interest, present in 42% of participants. Of those, 36% reported this occurring in approximately half of sexual encounters (borderline/transient), and 7% in a few or no encounters (moderate-to-severe) (Figure 3).

Figure 3: Desire/Interest difficulty frequencies.

Of the 60 respondents, 48% (29) described their sexual desire as moderate, while a cumulative percentage of 3% (2) described it as low, very low, or absent in the last four weeks. Additionally, 19% (11) reported feeling troubled at least frequently by having little sexual desire: 7% (4) often and 12% (7) sometimes (Table 3).

Difficulty with arousal was the least common finding, reported by 7% of participants; 85% percent reported becoming sexually aroused at least most of the time during sexual activity (Figure 4).

Figure 4: Frequencies of Sexual Arousal Difficulty.

Among all respondents, 68% (41) still report feeling satisfied with their arousal at least more than half of the time, while 25% (15) reported satisfaction only half of the time or less. Regarding the degree of arousal, the majority, 75% (45), rated their arousal as high to very high, with 17% (10) rating it as moderate or low. Additionally, 62% (37) reported high or very high confidence in their ability to become aroused, while 33% (n = 20) described their confidence as moderate or lower (Table 4).

Difficulty in reaching orgasm

Difficulty achieving orgasm was the second most prevalent difficulty (37%). A total of 57% (34) of participants reported having reached orgasm at least more than half of the time during sexual stimulation, while 15% (9) did so only about half of the time. More than a fifth of respondents, 22% (13), reported reaching orgasm less than half the time or never (Figure 5).

Figure 5: Frequencies of Orgasm Difficulty.

Most women, 80% (47), considered themselves at least moderately satisfied with their ability to reach orgasm during sexual activity (Table 5).

Dyspareunia

Dyspareunia was reported by 22% of participants. Of those, 60% reported pain occurring infrequently, and 20% reported pain in approximately half of their encounters. Pain severity was rated as moderate by 17% and low-to-very-low by 72% (Table 6).

Difficulty in lubrication

Lubrication difficulties were reported by 10% of participants. The majority (85%) reported adequate lubrication during sexual activity in most encounters, and 72% reported maintaining lubrication until the end of sexual activity. Approximately one-fifth of women (22%, n = 13) reported maintaining lubrication only half the time or less (Figure 6).

Figure 6: Frequencies of Lubrication Dysfunction.

Regarding difficulty maintaining lubrication during sexual activity, 38% (n = 23) reported some degree of difficulty, with the majority of these (32%, n = 19, approximately one third of the total sample) classifying it as slightly difficult. A similar pattern was observed regarding difficulty maintaining lubrication until the end of sexual activity, with 46% (n = 27) reporting some difficulty; notably, 15% (n = 9) described it as at least difficult to remain lubricated (Table 7).

Comorbidity of sexual difficulties

One-third of participants (33%) reported two or more concurrent sexual difficulties. Notable co-occurrences included: 44% of women with desire/interest difficulties also reported orgasmic difficulties. Arousal dysfunction, though less common (n=4), showed the highest comorbidity rates, with 50–75% of affected women reporting dysfunction across every other domain. Orgasmic dysfunction (n = 33) co-occurred most notably with desire problems (33%). Dyspareunia (n = 13) showed a particularly strong association with orgasmic dysfunction (60%), suggesting that pain during intercourse frequently compromises the ability to reach orgasm. Overall, the pattern indicates that sexual difficulties rarely occur in isolation; comorbidity across domains was the rule rather than the exception, with orgasmic and arousal difficulties emerging as the most consistently overlapping problems (Table 8).

Sexual satisfaction

Most participants (73%) reported satisfaction with their current sex life. Among those who were dissatisfied (27%), 15% rated their sex life as slightly unsatisfactory and 12% as not at all satisfactory. No statistically significant associations were found between current sexual satisfaction and the presence of at least one sexual difficulty (p=1.0), or between being in an intimate relationship and sexual satisfaction (p=1.0). Sexual distress, as assessed by the FSDS-R, was reported by 7% of participants (Figure 7).

Figure 7: Frequencies of Satisfaction with current sex life.

Discussion

This epidemiological study conducted in Portugal specifically examined the prevalence of sexual difficulties among female university students aged 18–25 years.

The study was conducted within a single university population; no formal a priori sample size calculation was performed. It was primarily designed to provide preliminary descriptive data regarding the prevalence and comorbidity of sexual difficulties among young Portuguese university women, a population for which limited national data are available. Consequently, the findings should be interpreted as exploratory and hypothesis-generating rather than confirmatory, particularly given the modest convenience sample size (N = 60).

The main finding is a high prevalence (75%) of at least one sexual difficulty in this cohort of young, highly educated women — consistent with figures reported in prior Portuguese studies [7,8] — despite an overall mean FSFI score within the functional range. Only 7% of participants reported sexual distress, indicating that most difficulties were not perceived as causing significant personal distress, at least at this stage of life.

Low sexual desire/interest was the most prevalent difficulty (42%), consistent with patterns documented in other Portuguese studies and international research [4,5,7,8]. Most desire difficulties were borderline or transient in nature (occurring in approximately half of sexual encounters). Orgasmic difficulties were the second most common finding (37%), a rate slightly higher than observed in comparable samples [22,23]. These two difficulties also showed substantial comorbidity: 44% of women reporting desire difficulties also reported orgasmic difficulties.

Dyspareunia (22%) was more prevalent than the estimates reported for the general female population (8–21%) [24,25].

Lubrication difficulties (10%) were among the least prevalent findings and were slightly below the approximately 13% reported for the general Portuguese female population [3]. Arousal difficulties (7%) were also notably below the approximately 15% estimated for Portuguese women in general [3]. This difference may reflect the age of the sample, as androgenic hormones, which modulate arousal and lubrication, peak during the primary reproductive years [26,27].

The finding that 73% of participants reported sexual satisfaction despite the high prevalence of specific difficulties is noteworthy and parallels findings from a 2019 Brazilian study of 100 university students [28]. This apparent dissociation between the presence of specific difficulties and overall satisfaction may reflect the complexity and multidimensionality of sexual satisfaction, which extends beyond isolated functional difficulties to encompass relational, emotional, and contextual factors.

Limitations

The primary limitations of this study include the relatively small, convenience sample of single women from a single institution. This reduces statistical power and limits the precision and generalisability of prevalence estimates. Small subgroup sizes may also have constrained the reliability of inferential analyses, particularly chi-square comparisons involving low expected cell frequencies. Consequently, these findings should be considered preliminary and hypothesis-generating.

Gender identity and sexual orientation were not assessed as well, limiting the ability to characterise the sample more precisely and restricting the interpretation and generalisability of findings across gender- and sexually-diverse populations.

An additional limitation relates to the use of individual FSFI items to operationalise sexual difficulties rather than validated FSFI domain scores. Although this strategy allowed the identification of specific symptom patterns and facilitated exploratory prevalence analyses, single-item measures are less metrically robust than multidimensional domain scoring approaches and may not fully capture the complexity, severity, or persistence of sexual dysfunction.

Suggested revision

The exclusive reliance on self-report measures, the cross-sectional design precluding causal inference, and the lack of clinical diagnostic confirmation of reported difficulties are additional constraints. Furthermore, the absence of a comparison group and the sample’s limited demographic variability (all single; predominantly hormonal contraceptive users) restricts the scope of associative analyses.

Conclusions

This study identifies a high prevalence of sexual difficulties in a cohort of young, highly educated Portuguese women, particularly in the domains of sexual desire/interest and orgasm, thereby supporting the initial study hypothesis. However, only a minority reported associated sexual distress, suggesting that many reported difficulties may reflect transient or context-dependent sexual experiences rather than clinically established dysfunction. Entry into higher education represents a transitional life period with unique psychosocial demands that may influence sexual health. These findings reinforce the subjective nature of female sexuality and highlight the importance of distinguishing between sexual difficulties and distress-associated sexual dysfunction.

Consequently, sexual health promotion strategies targeting young women in higher education settings should incorporate accessible information, non-stigmatising discussion of sexuality, and broader psychosocial perspectives on sexual wellbeing.

Future research should employ larger, more diverse samples and longitudinal designs to better characterise the determinants and trajectories of sexual difficulties in this population.

Author contributions

EC: study conception and design; development of data collection instruments; manuscript drafting, revision, and final approval. AL: study conception and design; data collection and analysis; manuscript drafting and final approval. AM: data analysis; statistical review; final approval. MP: manuscript review and final approval. AMA: data analysis; statistical review; manuscript revision and final approval.

Ethics approval and consent to participate

All procedures were conducted in accordance with the ethical standards of the responsible committee on human experimentation (Ethics Committee of the University of the Algarve) and with the Helsinki Declaration as revised in 2013. Written informed consent was obtained from all participants.

Data availability

The authors confirm compliance with the University of the Algarve’s protocols regarding data publication. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Disclosure statement

No potential conflict of interest was reported by the authors in relation to the present work.

Funding

This research received no specific funding from any public, commercial, or not-for-profit funding agency.

Previous presentations

A preliminary version of this work was presented as a digital poster at the XV Portuguese Congress of Gynaecology, June 2022, Estoril Congress Centre, Estoril, Portugal.

Supplementary-Materials