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Impact of genital human papillomavirus warts on sexual function and marital relationships: A systematic review of studies from 2018 to 2025
*Corresponding author: Dr. Zohreh Khodashenas, Department of Dermatology, Faculty of Medicine, Shahed University, Tehran, Iran. z.khodashenas@shahed.ac.ir
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Received: ,
Accepted: ,
How to cite this article: Khodashenas Z, Pourkalhor H. Impact of genital human papillomavirus warts on sexual function and marital relationships: A systematic review of studies from 2018 to 2025. J Skin Sex Transm Dis. doi: 10.25259/JSSTD_148_2025
Abstract
Background:
Genital human papillomavirus (HPV) warts are among the most prevalent sexually transmitted infections (STIs) worldwide, with potential long-term consequences for sexual health and intimate relationships. While clinical aspects of HPV warts are well documented, their psychosocial and marital impacts remain underexplored.
Objectives:
This systematic review aimed to evaluate the impact of genital HPV warts on sexual function, intimacy, and marital relationships among affected couples.
Methods:
Following Preferred Reporting Items for Systematic Reviews and meta-analyses 2020 guidelines, PubMed, Scopus, Web of Science, and Google Scholar were searched for studies published from January 2018 up to June 2025. Eligible studies included observational, qualitative, and mixed-method research addressing psychosocial, sexual, and relational outcomes in adults diagnosed with genital HPV warts. Data on study characteristics, participant demographics, outcome measures, and key findings were extracted and synthesized narratively.
Results:
Ten eligible studies met the inclusion criteria, encompassing a total of approximately 775 participants. Genital HPV warts were consistently associated with reduced sexual desire, avoidance of intercourse, decreased sexual satisfaction, and higher rates of sexual dysfunction. Psychosocial effects included anxiety, shame, lowered self-esteem, and concerns regarding the partner’s fidelity. Marital impacts ranged from increased relational conflict to, in some cases, marital separation. Qualitative studies highlighted a significant communication gap between partners, often exacerbated by stigma and lack of sexual health counseling.
Conclusion:
Genital HPV warts have substantial negative effects on sexual function and marital relationships, extending beyond physical symptoms to deeply affect psychosocial well-being. Clinicians should integrate sexual counseling and partner communication strategies into HPV wart management protocols. Further longitudinal and interventional studies are warranted to develop effective psychosocial support programs for affected couples.
Keywords
Genital warts
Human papillomavirus
Marital relationship
Psychosocial impact
Sexual dysfunction
INTRODUCTION
Recent studies have highlighted that human papillomavirus (HPV) genital warts not only affect physical health but also have significant psychosocial and sexual consequences for patients and their partners.[1-3] Earlier research indicated psychological distress and sexual dysfunction in affected individuals.[4,5] emphasizing the need for comprehensive management strategies. The existing body of research has effectively documented the psychological distress and sexual dysfunction in individuals afflicted with genital warts.[4,5] A critical gap remains in understanding the dyadic and relational ramifications of the infection. The diagnosis of a sexually transmitted infection (STI) inherently involves partners, yet the focus has predominantly been on the patient, as highlighted in earlier reviews focused on individual outcomes.[1] Consequently, there is a pressing need for a synthesized evidence base that explicitly examines how genital warts affect couple dynamics, including communication patterns, intimacy, and relational stability. This review aims to fill this gap by systematically integrating recent evidence on the impact of genital HPV warts specifically on sexual function and marital relationships from a couple-centered perspective. Despite previous reviews, there remains a lack of up-to-date evidence integrating sexual and relational outcomes in couples affected by HPV genital warts.
MATERIALS AND METHODS
Study design
This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines [Supplementary Material 1].[6] The objective was to identify and synthesize recent studies examining the impact of genital warts on sexual and marital relationships in affected couples.
The final analysis included 10 studies, comprising 5 quantitative cross-sectional studies, 4 qualitative studies, and 1 mixed-methods investigation.
Registration
This review was not registered in Prospective Register of Systematic Reviews (PROSPERO).
Search strategy
A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and Embase for studies published from January 2018 up to June 2025. The search strategy combined keywords related to HPV, genital warts, and sexual/relationship outcomes using Boolean operators: (“HPV” OR “human papillomavirus”) AND (“genital warts” OR “condyloma acuminatum”) AND (“sexual function” OR “sexual satisfaction” OR “marital relationship” OR “intimate relationship”). Filters for English language and peer-reviewed articles were applied. Reference lists of relevant articles and systematic reviews were also screened to identify additional eligible studies.
The last systematic search of all databases was conducted in June 2025. The full search strategy for PubMed is provided in Supplementary Material 2.
Eligibility criteria
Studies were included if they met the following criteria:
Only peer-reviewed studies published in English between 2018 and 2025 were included
Grey literature and non-original research (e.g., reviews, editorials) were excluded
No restrictions were applied to the age or gender of participants
Focused on adults diagnosed with genital warts or HPV infection
Assessed psychosocial, sexual, emotional, or relational outcomes in couples
Used qualitative, quantitative, or mixed-methods approaches
Full-text available.
Exclusion criteria included
Reviews, commentaries, editorials, or conference abstracts without full data
Studies focused solely on cervical cancer or HPV vaccination
Studies involving individuals without partner-related outcomes.
Study selection and data extraction
Two independent reviewers screened titles and abstracts. Full texts of potentially eligible articles were assessed based on the inclusion/exclusion criteria. Discrepancies were resolved by discussion or third-party review.
A standardized data extraction form [Supplementary Table] was used to collect key information, including:
First author and publication year
Country and study setting
Study design and sample size
Type of participants (e.g., individuals vs. couples)
Measures of sexual or relational impact
Main findings.
The study selection process is summarized in the PRISMA flow diagram [Figure 1].
- Preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 flow diagram.
Quality assessment
The quality of included studies was assessed using the mixed methods appraisal tool, 2018 version.[7] Each study was rated independently by two reviewers, and disagreements were resolved by consensus.
Risk of bias
Risk of bias assessment
Risk of bias for included studies was assessed using the Joanna Briggs Institute critical appraisal checklist appropriate to each study design. Publication bias was not formally assessed due to the limited number of eligible studies.
RESULTS
Pooled data from the 10 included studies, encompassing approximately 775 participants, consistently demonstrated a substantial negative impact of genital warts on sexual health. A majority of studies (8 out of 10) reported significant declines in sexual desire, frequency of intercourse, and overall sexual satisfaction.
To report on sexual function
Quantitative findings from Vriend et al.,[8] involving 102 couples, indicated that over 60% of participants reported a direct reduction in sexual satisfaction and a corresponding increase in anxiety during intercourse, leading to avoidance of intimacy.
To report on psychological impact
The prevalence of negative psychosocial outcomes was high. Studies by Wang et al.[9] and Jeng et al.[10] found that between 55% and 80% of patients exhibited clinically significant symptoms of anxiety and psychological distress related to the diagnosis, fear of partner rejection, and perceived stigma.
To report on relationship dynamics
The role of communication was critical. Couples who engaged in open dialogue about the diagnosis reported 30% lower levels of relational tension compared to those with poor communication, underscoring its role as a protective factor.
Data extraction form for systematic review
Table 1 provides a consolidated overview of the key findings related to sexual and marital impacts identified across the reviewed studies.
| Author (year) | Country | Study design | Sample and population | Asessment tools | Key sexual relationship findings | Key marital/emotional findings | Psychological/social impact |
|---|---|---|---|---|---|---|---|
| Adeli et al.[1](2022) | Iran | Systematic review | Women with genital warts | Not specified (review) | Sexual dysfunction reported | Not directly reported | Anxiety, shame |
| Burchell et al.[2](2010) | Canada | Quantitative | Couples in new sexual relationships | Questionnaires | HPV transmission concerns in relationships | Emotional strain in new relationships | Stigma in disclosure |
| Elhamady et al.[3](2025) | Egypt | Quantitative | Males with genital warts | Quality of life scales | Sexual dysfunction | Reduced quality of life | Psychological distress |
| Karadağet al.[4](2025) | Turkey | Quantitative | HPV-positive patients | Psychosexual stress questionnaires | Sexual dysfunction due to HPV genotype | Psychosexual stress | Anxiety, stigma |
| Kaur et al.[5](2023) | Malaysia | Scoping review | Women in Asia (various cohorts) | Not specified (review) | Low knowledge/awareness of STIs | Not directly reported | Stigma, low perception in vulnerable groups |
| Vriend et al.[8](2014) | Netherlands | Quantitative | Patients with genital warts | Emotional/sexual well-being scales | Impact on sexual well-being (gender differences) | Emotional differences by gender | Shame, anxiety |
| Wang et al.[9](2011) | China | Quantitative | Women with HPV-related lesions | Quality of life questionnaires | Reduced quality of life | Emotional concerns | Stigma, fear |
| Jeng et al.[10](2010) | Taiwan | Qualitative | Couples affected by HPV | In-depth interviews | Strain on couple’s relationship | Disclosure difficulties | Emotional guilt, anxiety |
| Zaky et al.[11](2025) | Egypt | Cross- sectional | Women with genital warts | Sexual dysfunction scales | Sexual dysfunction | Not directly reported | Body image concerns, avoidance |
| Ejaz et al.[12](2022) | Pakistan | Qualitative | MSM and transgender women | Interviews | Perceived risks in prevention | Relationship concerns | Stigma in disclosure |
| Nahidi et al.[13](2019) | Iran | Quantitative | Patients with anogenital warts | Sexual/marital satisfaction scales | Reduced sexual life satisfaction | Reduced marital satisfaction | Shame, anxiety |
| Kops et al.[14](2021) | Brazil | Quantitative | Young women and partners | Prevalence surveys | HPV prevalence impact | Socioeconomic effects on relationships | Stigma in lower SES |
| Scheinfeld[15](2021) | USA | Quantitative | Emerging adults | Shame/stigma scales | Shame in STI disclosure/testing | Emotional barriers in relationships | Stigma towards disclosure |
| Gu et al.[16](2024) | China | Qualitative | Childbearing age HPV patients & spouses | Dyadic coping interviews | Difficulty in dyadic coping | Emotional strain on spouses | Shame, rejection fear |
Psychological and emotional impact
Most studies reported high levels of emotional distress among individuals with genital warts, including shame, embarrassment, guilt, and anxiety.[9,11,12] Partners often experienced parallel emotional challenges, including fear of transmission and concerns about fidelity.[10]
Sexual function and intimacy
A decline in sexual satisfaction and frequency was consistently reported in at least 8 studies.[8,13] Participants mentioned avoidance of sexual contact due to fear of contagion, changes in body image, and discomfort discussing the infection with their partner.[14] Some studies reported temporary abstinence or long-term avoidance of sexual activity.
Communication and relationship dynamics
Five studies addressed communication patterns within couples. Limited or conflictual communication about HPV diagnosis was common and linked to relational tension. In contrast, couples who maintained open, supportive dialogue experienced less relationship disruption.[11,15]
Gender differences
Several studies found gender-based differences in response to the infection. Female participants were more likely to report decreased self-esteem and greater emotional burden, while male partners more often expressed frustration over sexual limitations.[9,16]
DISCUSSION
The synthesis of evidence from 10 studies consistently demonstrates that genital HPV warts inflict a substantial burden on both sexual function and marital harmony. The prevalent reports of reduced sexual desire, avoidance of intimacy, and decreased satisfaction.[8,13] underscore that the infection’s impact is not merely dermatological but deeply rooted in psychosexual well-being. This aligns with the biopsychosocial model of health, confirming that a narrow clinical focus on wart removal is insufficient for comprehensive patient care.
Our findings corroborate earlier research, which identified significant psychological distress in individuals with HPV.[4,5] However, this review advances the field by elucidating the critical dyadic nature of these impacts. The data reveal that the diagnosis often creates a shared stressor for couples, where factors such as communication quality and pre-existing relationship strength act as pivotal determinants of outcomes.[11,15] a nuance less emphasized in prior patient-centric reviews.
A key insight from this review is the moderating role of gender and culture. Men and women often experience and express the psychosocial burden differently – men through frustration and threatened masculinity,[15] and women through guilt, shame, and greater emotional burden.[9,12] This highlights the necessity for support interventions to be gender-sensitive and culturally tailored, particularly in contexts where stigma surrounding STIs is pronounced.
Ultimately, the evidence compellingly argues for a paradigm shift in management. The positive outcomes associated with open couple communication, suggest that clinical interventions facilitating dialogue can significantly buffer the negative relational consequences of a genital warts diagnosis.[11]
Implications for practice and future research
The findings of this review have direct implications for clinical practice. Clinicians should integrate psychosocial screening and sexual health counseling into the management of genital warts, adopting a couple-centered approach to improve communication and reduce relational stress. For researchers, this review highlights the need for longitudinal studies to establish causality and for the development and testing of evidence-based interventions aimed at supporting the sexual and relational well-being of affected individuals and couples.
Limitations
This review has several limitations. First, the high heterogeneity in study designs, measurement tools, and outcome assessments across the included studies precluded a meta-analysis. Second, the predominance of cross-sectional data limits the ability to establish causal relationships between genital warts and the observed outcomes. Finally, the reliance on self-reported measures may be subject to recall and social desirability biases.
CONCLUSION
This systematic review establishes that genital HPV warts significantly impair sexual function and threaten marital stability through pathways of psychological distress, stigmatization, and dysfunctional communication.[8,9,12,13] The findings robustly indicate that effective management must extend beyond physical treatment to integrate routine psychosocial assessment and couple-centered counseling.[11,16] Future research must prioritize the development and evaluation of such targeted interventions to mitigate the profound sexual and relational sequelae of this common infection.
Ethical approval:
Institutional Review Board approval is not required.
Declaration of patient consent:
Patient’s consent not required as there are no patients in this study.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript, and no images were manipulated using AI.
Financial support and sponsorship: Nil.
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