Understanding female sexual function: Flo’s latest research

Female sexual response has historically been understudied. Using the Female Sexual Function Index (FSFI-6), this Flo–Yale collaboration estimated female sexual response and its associations with sociodemographic characteristics, self-reported health conditions, and frequency of logged sex events.

In a survey-based study with 2,392 of our app users in the United States, we found that women who were using our Trying to Conceive Mode and logging sexual activity more frequently had higher FSFI-6 scores. Age, body weight, and certain health conditions were also associated with variations in sexual response.

We conducted this study in collaboration with Dr. Lubna Pal, a professor of obstetrics, gynecology, and reproductive sciences at Yale School of Medicine, US, and member of Flo’s scientific advisory board. The results are published in the journal npj Women’s Health.

Study overview 

Female sexual function concerns represent a multifactorial domain influenced by biological, psychological, and behavioural determinants. Large-scale real-world datasets in this area remain limited.

In this study, we aimed to understand whether the following factors influence sexual response:

• Frequency of different sexual activities
• Reproductive health conditions
• Sociodemographic factors like age and weight
  
  

Sexual activity frequency correlated with higher sexual-response scores 

Participants who logged vaginal sex events more frequently than average had higher FSFI-6 scores (mean=23 logs per year). Higher levels of logged orgasms, high sex drive, and sensual touch were also associated with higher scores. Oral sex, masturbation, and use of sex toys were also positively correlated. 

“These findings based on real-world data offer novel insights into sexual responses and experiences of reproductive-age females,” Dr. Pal commented. “At this point, it is unclear if the mere act of having sex more often means that someone has a higher level of sexual response or if it’s the other way around — i.e., that people with higher sexual response tend to have sex more often. These findings clearly identify a need for future research,” Dr. Pal added. 

Trying to Conceive mode linked with higher scores

The Flo app has several modes that users can select, including Track, Trying to Conceive, Pregnancy, and Perimenopause. Participants using Flo’s Trying to Conceive Mode rather than our Track Mode had higher FSFI-6 scores. 

“We were a little bit surprised about this result. Other studies have shown that when couples are actively trying to conceive, the increased focus on timing sex around ovulation can be very stressful and linked with lower levels of sexual functioning. However, much of this research included women with fertility problems,” commented Liudmila Zhaunova, PhD, director of research at Flo. 

“Since we didn’t ask about fertility in our survey, our participants likely include women with and without fertility issues, which could explain the differences, and it’s possible that our app users in this mode are highly motivated to have sex as they are trying to get pregnant,” she continued. 

Age and health conditions

When it came to the impact of age on sexual response, the picture was mixed. Our participants who were 35 and older had higher scores for orgasms and reported less pain during sex than their counterparts who were under 35. Additionally, the scores for satisfaction were lower among those 35 and older. Yet, there was no difference in the overall FSFI-6 scores between the groups.   

“A decline in sexual function and deterioration in sexual satisfaction with advancing age is a common perception. Existing studies suggest that a decline in sexual function may be evident in some as early as late 30s,” Dr. Pal said. “The positive associations that we noted in this real-world study of sexually active females who are neither ‘patients’ nor seeking ‘care for a problem’ with being over 35 and aspects of sexual response are therefore highly reassuring. Aging is NOT necessarily all bad after all!” 

Having one of the included reproductive health conditions was linked with lower FSFI-6 scores, which was driven by experiencing more pain during sex. This finding was most pronounced among women with uterine fibroids, whereas there was no link between sexual response and those reporting other conditions, including endometriosis and polycystic ovary syndrome. 

“Thanks to our app users who so generously used their time to complete this survey, we’ve been able to explore female sexual response and some of the factors that can influence it,” Liudmila concluded. “In our study, we saw that over 4 in 10 women get their information about sexual health from mobile apps or the internet. This highlights the potential of apps like Flo in helping women better understand their bodies and providing them with medically accurate health information.”  

Clinical perspective

These findings offer a valuable snapshot of real-world sexual-health patterns among reproductive-age women. For clinicians, these insights can help contextualise patient experiences that may not always be discussed during consultations, supporting more informed, evidence-based conversations around sexual satisfaction, discomfort, and reproductive goals.

It is expected that more people will utilize menstrual-tracking applications given their ease of use, anonymity, and availability. In this study, 41.6% of participants reported obtaining their primary reproductive-health information from web-or mobile-based applications. This highlights how digital tools are becoming an integral part of women's health education, helping women understand their bodies and normalising conversations about sensitive topics. 

Conversely, digital tools can help address such topics by helping clinicians understand patterns in real-world data to support patient care. 

Free Resources for your practice 

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• Educational patient leaflets about reproductive health 
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Learn more about the scientific foundation of Flo and how our research drives innovation in female health tracking. Visit Flo Science and Research.