Comparison of graft materials used in the McIndoe procedure in terms of anatomical and sexual function in a tertiary care hospital and a brief overview of vaginoplasty techniques.

BackgroundMenopause-related endocrinological shifts are linked to sexual dysfunction, and women with endometriosis exhibit lower Female Sexual Function Index (FSFI) scores, indicating impaired sexual well-being.AimTo assess the impact of menopause on sexual function in women with endometriosis.MethodsAn anonymous online survey was conducted among 1586 French women diagnosed with endometriosis. The FSFI questionnaire was used to evaluate sexual function, and menopause was defined as ≥12 months of amenorrhea. Multivariable logistic regression was performed to assess the relationship between FSFI scores and menopause status, adjusting for tobacco use, education, number of symptoms, and history of surgery. Logworth analyses were used to determine the strongest components of FSFI associated with menopause.OutcomesThe primary outcome was the FSFI total score and its six domains (desire, arousal, vaginal lubrication, orgasm, satisfaction, and dyspareunia) in menopausal and non-menopausal women with endometriosis.ResultsMenopausal women had significantly lower FSFI scores (15.3 vs. 16.9, P = 0.021). After adjustment, FSFI remained significantly lower (P = 0.026) in menopausal women but did not reach the established FSFI cutoff for sexual dysfunction (P = 0.451). Stratified analysis by age showed a steep decline in FSFI between 46 and 50 years, partial improvement at 51-55 years, and further decline after 55 years, particularly in arousal, orgasm, dyspareunia, and satisfaction. Arousal (logworth = 4.53, P < 0.001) was the most affected domain, followed by satisfaction (logworth = 1.81, P = 0.015).Clinical ImplicationsArousal appears to be the key determinant of sexual function decline in menopausal women with endometriosis, highlighting the need for targeted interventions such as hormone therapy, pain management, and sexual counseling.Strengths & LimitationsThe study benefits from a large sample size and validated FSFI assessment but is limited by selection bias from online recruitment, self-reported diagnosis of endometriosis, and lack of hormonal status confirmation. The cross-sectional design prevents causal inferences.ConclusionMenopause is associated with a decline in FSFI scores among women with endometriosis, with arousal being the most affected domain, underscoring the need for further research on personalized management strategies for sexual dysfunction in this population.

The effect of hysterectomy types on vaginal length, vaginal shortening rate and FSFI scores

Comparison of 2 Methods of Vaginal Cuff Closure at Laparoscopic Hysterectomy and Their Effect on Female Sexual Function and Vaginal Length: A Randomized Clinical Study

Objective. Sexual function remains a relatively unexplored field within urology, especially for female patients who have undergone radical cystectomy (RC). The aim of this study was to shed light on this area. Materials and methods. The Female Sexual Function Index (FSFI) questionnaire and other selective questions regarding sexual function were sent to 71 women who had undergone RC and were alive 1 year postsurgery. Forty-one completed questionnaires were returned and analysed using simple descriptive statistical analysis, owing to the small sample size. Results. The median age of the patients was 67 years (range 39–91 years). Seventy-eight per cent reported being sexually active before surgery and 37% post-surgery. The median FSFI score postsurgery was 4.8 (range 1.2–32). The highest FSFI score was seen in the category of satisfaction, which consists of questions regarding closeness with partner, sexual relationship and overall sex life. Lowest FSFI scores were seen for lubrication, orgasm and pain. Twenty-seven per cent of patients wanted more information on the impact RC would have on their sex lives and many asked for information for their partners. Conclusion. Despite being based on a limited number of patients, this study indicates a need for improvement within this field. Most patients scored below 26 on the FSFI questionnaire, the cut-off for sexual dysfunction. However, many reported being satisfied overall. Thus, the physician’s main goal is to identify patients in need of more information and guidance before and after surgery.

Objective: To compare the long-term outcomes of cervicovaginal reconstruction between using small intestinal submucosa (SIS) grafts and using autologous lateral femoral split-thickness skin substitutes (STS) grafts. Methods: This was a prospective cohort study, involving 81 patients with obstructive cervical dysplasia who underwent cervicovaginal reconstruction using either SIS or STS grafts from January 2012 to August 2024. Data were collected, including demographic characteristics, operative duration, hospitalization costs, postoperative menstrual recovery, pregnancy outcomes, reoperation rates, vaginal length, and other relevant clinical parameters. Cosmetic satisfaction was assessed via questionnaire at 6th month post-surgery. Sexual function was evaluated using the Female Sexual Function Index (FSFI) questionnaire after resumption of sexual activity. Differences between the two groups were analyzed. Results: The mean age of overall patients at diagnosis was (16±5) years, with no significant difference between the SIS group [(16±6) years] and the STS group [(16±4) years]. The average operative time was (170.9±76.2) minutes, significantly shorter in the SIS group compared to the STS group [(158.0±67.9) vs (252.6±78.4) min; P<0.001)]. Total hospitalization costs were significantly higher in the SIS group than in the STS group [(4.2±1.4) vs (2.0±0.6) ten thousand yuan; P<0.001]. At a median follow-up of 67 months, all patients resumed menstruation postoperatively. Twelve patients (14.8%) experienced vaginal or cervical restenosis or atresia within 30 months after surgery, and 28 patients (34.6%) required secondary surgery. Specifically, 12 cases (14.8%) underwent repeat vaginal or cervical recanalization, 22 cases (27.2%) experienced intrauterine catheter loss, and 2 cases (2.5%) had failed in conservation due to hysterectomy. The mean postoperative vaginal length was (7.3±1.2) cm, with the SIS group showing significantly shorter vaginal length compared to the STS group [(7.2±1.2) vs (7.9±0.6) cm; P<0.05]. Patients in the SIS group reported higher body image scores and cosmetic satisfaction scores than those in the STS group [(15.9±1.4) vs (14.2±1.5) points, P<0.001; (18.6±2.1) vs (16.8±2.0) points, P=0.009]. Twenty-one patients (25.9%) resumed sexual activity postoperatively, with no statistically significant difference in FSFI scores between the two groups (P>0.05). Eleven patients (13.6%) expressed an intention to conceive, and one patient in the SIS group successfully became pregnant and delivered via assisted reproductive technology. Conclusions: Conservation reconstruction surgery for patients with obstructive cervical dysplasia is safe and effective, allowing patients to resume menstruation, achieve satisfactory sexual life, and achieve pregnancy and childbirth. The method of SIS grafts results in shorter operation times and better aesthetics but at a higher cost.

Introduction: Post episiotomy mother often experience variable sexual function disturbance, and the outcomes are potentially disadvantaged. Sexual function disturbance can be measured by using female sexual function index (FSFI) questionnaire. To determine the sexual function of post-episiotomy mother measured by using FSFI. Methods: Post episiotomy mother fill the FSFI questionnaire. The study had been done at H. Adam Malik Hospital and networking hospital in October 2014. This is a cross-sectional study, using descriptive method. Chi-square test and Fisher exact were used to analyze the data. Results: From 100 cases, the majority are 19-25 years old (43%), 26-30 years old (25%), 31-35 years old (23%), and 36-40 years old (9%). Based on the period of episiotomy, the study objects &gt;9 months ago (65%), 6-9 months ago (14%), and 3-5 months ago (11%). Average scoring of the FFSI domain is lubrication (FSFI score=10.24±3.83), arousal (FSFI score=9.61±3.54), pain (FSFI score=8.91±4.39), satisfaction (FSFI score=8.74±3.66), orgasm (FSFI score=8.63±3.66), and desire (FSFI score=4.72±1.86). The above of cut off point was 26,55 (68%) and below it was (32%). Conclusion: The average score of FSFI based on domain respectively started from the highest to the lowest score are lubrication, arousal, pain, satisfaction, orgasm, and desire. It is important for a woman to understand that sexual dysfunction they experienced after episiotomy is temporary.

HIGHLIGHTS Testosterone level correlates with FSFI score, showing that sexual function correlates with hormonal physiology. FSFI is a valid and useful tool in measuring sexual function. ABSTRACT Objective: This research aimed to analyze the correlation between testosterone levels and sexual function in postmenopausal women. Materials and Methods: This research was a descriptive observational study with a case series approach conducted at Aras Kabu Health Center Outpatient Polyclinic from May to August 2022. The normality test was carried out using the Shapiro-Wilk test. If the data were not normally distributed, data would be analyzed using the Spearman correlation test. If the data were normally distributed, the data analysis would use the Pearson correlation test. Results: There was a significant relationship between Female Sexual Function Index (FSFI) score with testosterone levels and duration of menopause with p&lt;0.05. The degree of correlation found was 0.619 between testosterone levels and FSFI scores, indicating a moderate and significant positive correlation. A correlation degree of 0.482 was found between FSFI and length of menopause which indicated a significant moderate positive correlation, while the degree of correlation between testosterone levels and length of menopause was found to be 0.711, showing a strong and significant positive correlation. Conclusion: There is a significant relationship between FSFI scores with testosterone levels and duration of menopause as well. There was also a significant relationship between testosterone levels and the duration of menopause.

Female sexual dysfunction (FSD) has an impact on the lives of many women, and it is inadequately investigated by medical professionals in women living with HIV (WLWH). In the present study, the aim was to investigate the prevalence and risk factors of sexual dysfunction (SD) in a cohort of WLWH using the Female Sexual Function Index (FSFI) questionnaire. This monocentric cross-sectional study was conducted at the ASST Spedali Civili of Brescia, Italy, between April 2023 and August 2023. To assess SD, the FSFI questionnaire was administered in accordance with current European AIDS Clinical Society guidelines to all consecutive cisgender adult WLWH who presented to our unit of Infectious Diseases. We used FSFI < 26.55 to identify participants at risk of SD. Participants were divided into two groups based on the pathological cut-off of FSFI score. Comparison of demographic characteristics, menopausal status, and comorbidities among the two different groups of WLWH. The questionnaire was offered to 371 women and 179 (48.2%) completed it. Of the 192 (51,8%) excluded, there were 129 women who declined to participate and 63 who were unable to do so due to a language barrier. Two-thirds (117/179) of individuals declared sexual intercourse in the previous month and were considered. Among those who completed the questionnaire, 36% scored below the FSFI total cut-off, indicating increased risk of SD. The most frequently impaired domains were desire (56.4%) and lubrication (52.1%). The correlation between age and total FSFI score was significant (P= .008), as well as menopausal women obtained lower FSFI scores (P= .0004). Age and menopausal status are substantial factors influencing sexual functionality. This study is limited by its reliance on self-reported data and a sample size that may be insufficient for detecting subtle effects. However, it leverages the well-validated FSFI tool and benefits from trusted questionnaire administration by HIV healthcare providers. Sexual dysfunction in menopausal WLWH has a high prevalence (36%). Interestingly, around 67% of women declined to investigate and deal with sexual issues.

BackgroundThis cross-sectional, nested cohort study assessed Female Sexual Function Index (FSFI) scores in postmenopausal women with breast cancer receiving primary chemotherapy.MethodsThe FSFI questionnaire was administered to 24 postmenopausal women one month after diagnosis of breast cancer (post-diagnosis group) and one month after completion of the first cycle of primary anthracyclin-based chemotherapy (post-chemotherapy group). Scores were compared to those of 24 healthy postmenopausal women seeking routine gynecological care (control group). All patients were sexually active at the time of enrollment. Mean age was 57.29 ± 11.82 years in the breast cancer group and 52.58 ± 7.19 years in the control group.ResultsScores in all domains of the FSFI instrument were significantly lower in the post-diagnosis group than in controls (−41.3%, p < 0.001). A further major reduction in FSFI scores was evident on completion of one cycle of primary chemotherapy (down 46.7% from post-diagnosis scores, p < 0.003), again in all domains. Six patients (25%) ceased all sexual relations, in a significant change from baseline (p < 0.001). After one chemotherapy cycle, a further five patients ceased sexual activity, for a total of 11 (45.8%) participants – a borderline significant difference (p = 0.063).ConclusionThe present study shows that female sexual function as assessed by the FSFI declines significantly at two distinct points in time: upon diagnosis of breast cancer and after administration of systemic chemotherapy.

Hysterectomy ranks among the most frequently performed gynecological surgical procedures. At the time of operation, the majority of patients are premenopausal and sexually active. Hence, detailed counseling about the effects of hysterectomy on postoperative sexuality and quality of life can be regarded as an integral part of preoperative counseling. However, available data on these subjects are limited and contradictory. The aim of this study was to assess quality of life and sexuality following three common hysterectomy procedures-total laparoscopic hysterectomy (TLH), supracervical laparoscopic hysterectomy (SLH), and vaginal hysterectomy (VH)-in premenopausal patients using the European Quality of Life Five-Dimension Scale (EQ-5D) and Female Sexual Function Index (FSFI). Preoperative and postoperative EQ-5D and FSFI scores were compared using the Wilcoxon signed-rank test. Kruskal-Wallis analysis and Mann-Whitney U-test with post hoc Bonferroni correction were used to assess differences among the three subgroups. All premenopausal patients who underwent TLH, SLH, or VH without adnexectomy due to benign uterine disorders between April 2011 and June 2013 at the Department of Gynaecology and Obstetrics of Saarland University Hospital were enrolled in this observational cohort study. Sexuality and quality of life status were assessed preoperatively and 6 months postoperatively using two standardized validated questionnaires: the FSFI, a multidimensional, self-reported instrument for the assessment of female sexual function, and the EQ-5D, a standardized, validated instrument to measure an individual's health status. Of 402 eligible patients, 237 completed the study. Patient characteristics and preoperative FSFI and EQ-5D scores did not differ among the three hysterectomy subgroups. Postoperative FSFI and EQ-5D scores were significantly higher (P ≤ 0.01) than preoperative scores for all procedures but did not differ among the groups. In this cohort of premenopausal women, hysterectomy without adnexectomy performed due to benign uterine pathologies had significant positive effects on postoperative sexual function and quality of life, regardless of the surgical technique used.

Polycystic ovary syndrome (PCOS) appears to be related to sexual dysfunction, especially if associated with obesity. However, it is not clear whether obesity per se is an independent factor for sexual dysfunction. We hypothesized that obese polycystic ovary syndrome (OPCOS) patients have poorer sexual function than controls and nonobese polycystic ovary syndrome (NOPCOS) women. To assess the sexual function of women (either obese or nonobese) with PCOS compared to women with regular cycles. The main outcome measures were the Female Sexual Function Index (FSFI) and Free Androgen Index (FAI) values. We used a cross-sectional study design to evaluate 83 women, including 19 nonobese women without PCOS, 24 nonobese women with PCOS, 16 obese women without PCOS, and 24 obese women with PCOS. The FSFI questionnaire was used to gather data from all women, and free testosterone levels were determined and employed to calculate FAI values. Higher androgen concentrations were evident in the PCOS groups compared to controls (NOC [nonobese control] 2.3 ± 0.7; OC [obese control] 2.1 ± 0.5; NOPCOS 3.1 ± 0.8; OPCOS 3.5 ± 1.2; P < 0.0001). This was also true for FAI, with the exception of obese controls and nonobese women with PCOS, in whom the levels were similar (NOC 4.9 ± 1.6; OC 6.5 ± 3.1; NOPCOS 7.5 ± 3.9; OPCOS 12.8 ± 5.2; P < 0.05). Evaluation of the total FSFI scores revealed that obese women without PCOS had below-normal sexual function scores, whereas both obese and nonobese women with PCOS had borderline scores compared to controls, who had normal FSFI findings. No association was observed between body mass index, the presence of PCOS, testosterone level, and FSFI score. The obese women in our sample were at a higher risk for sexual dysfunction and lower FSFI scores, and women with PCOS had borderline FSFI values, regardless of their obesity status. Based on this result, larger studies using the methods described in this pilot study are warranted to elucidate if obesity can impair sexual function in PCOS women.

We aimed to analyse the relationship between sperm parameters and International Index of Erectile Function (IIEF) score, the Female Sexual Function Index (FSFI) score, the testosterone (T) level in infertile men and between FSFI score and partners' fertility. Patients were divided into three groups; (group 1: azoospermia [n=57], group 2: sperm count <15million [n=41], group 3: sperm count >15million [n=81]). Patients and their partners filled the IIEF and FSFI forms. The normality of the tests was analysed with Kolmogorov-Smirnov and Shapiro-Wilk tests. Spearman's rho test, a nonparametric test, was used to correlate the data. A value of p<.05 was considered statistically significant. There was a positive correlation between the sperm count, other sperm parameters, morphology and motility and IIEF score, FSFI score and T (p=.037, .028 and .041 respectively). We found a positive correlation between IIEF score and FSFI score (p=.182). Infertile partners' FSFI score was lower than fertile partners' scores (p=.023). Male infertility causes severe sexual dysfunction in couples, and female sexual dysfunction increases in parallel to that of men. Male sexual function also tends to decrease with low sperm count. While the clinician evaluates infertile couples, psychological and sexual functions should also be evaluated and patients should not be deprived of appropriate treatment.

233P Sexual dysfunction among premenopausal breast cancer survivors

To investigate the effects of dehydroepiandrosterone (DHEA) supplementation on female sexual function in premenopausal infertile women of advanced ages. This observational study was conducted in an academically affiliated private fertility center. Patients included 87 premenopausal infertile women, 50 of whom completed the study including the Female Sexual Function Index (FSFI) questionnaires and comprehensive endocrine evaluation before and 4-8 weeks after initiating 25 mg of oral micronized DHEA TID. Age of patients was 41.1 ± 4.2 years, BMI 24.4 ± 6.1 kg/m2, 86% were married, and 42% were parous. Following supplementation with DHEA, all serum androgen levels increased (each P < 0.0001), while FSH levels decreased by 2.6 ± 4.4 from a baseline of 10.3 ± 5.4 mIU/mL (P = 0.009). The FSFI score for the whole study group increased by 7% (from 27.2 ± 6.9 to 29.2 ± 5.6; P = 0.0166). Domain scores for desire increased by 17% (P = 0.0004) and by 12% for arousal (P = 0.0122); lubrication demonstrated an 8% trend towards improvement (P = 0.0551), while no changes in domain scores for orgasm, satisfaction, or pain were observed. Women in the lowest starting FSFI score quartile (<25.7), experienced a 6.1 ± 8.0 (34%) increase in total FSFI score following DHEA supplementation. Among these women, improvements in domain categories were noted for desire (40%), arousal (46%), lubrication (33%), orgasm (54%), satisfaction (24%), and pain (25%). This uncontrolled observational study implies that supplementation with DHEA improves sexual function in older premenopausal women with low baseline FSFI scores.

Impact of Sacral Neuromodulation on Female Sexual Function and His Correlation with Clinical Outcome and Quality of Life Indexes: A Monocentric Experience