Breaking the silence on female sexual dysfunction in Saudi Arabia: a narrative review of barriers to women’s health services in primary care

Background: Female sexual dysfunction (FSD) is a prevalent and underreported women’s health condition that significantly impacts the quality of life. Objective: To explore the epidemiology of FSD in Saudi Arabia and determine barriers from patients, providers, and the system’s perspectives with screening, diagnosing, and treating cases in primary healthcare. Methods: A narrative review of literature was conducted using electronic databases (CINAHL, PsycINFO, and MEDLINE Ovid), supplemented with manual searches of Ministry of Health reports and reference lists. Search terms included “female sexual dysfunction,” “epidemiology,” “sexual health,” “Saudi Arabia,” “primary healthcare,” “barriers,” “general practitioners,” “family physicians,” and “women’s health services.” Barriers were categorized at three levels: patient, provider, and system. Results and discussion: FSD is prevalent in Saudi Arabia, as concluded by limited available studies. Sociocultural stigma, lack of sexual health awareness, and fear of judgment and consequences of consultation affect help-seeking behavior from the patient’s side. Primary care providers often lack awareness, training, confidence, and clinical guidance to screen, diagnose, and manage FSD. At the system level, barriers include underdevelopment of national pathways and guidelines on approaching FSD, especially in the context of primary healthcare. Comparatively, neighboring Middle Eastern countries share similar socio-cultural barriers. On the other hand, Western systems show greater implementation of guidelines. Conclusion and recommendations: Addressing FSD in Saudi Arabia requires a system-based and socio-culturally acceptable response. Key barriers exist at the patient level (e.g., stigma and lack of awareness), provider level (e.g., limited training and confidence), and system level (e.g., absence of national guidelines). Strategic actions should include training primary healthcare providers, establishing clinical pathways and national guidelines, and promoting community awareness to support the Saudi Vision 2030 goals of women’s health empowerment and healthcare transformation. Additionally, conducting a large population-based epidemiological study is essential to accurately estimate the national burden of FSD.