Effect of radiotherapy for rectal cancer on female sexual function: a prospective cohort study.

BackgroundWomen treated for rectal cancer are at risk of sexual dysfunction and impaired ovarian androgen production. AimTo investigate a possible association between serum levels of endogenous androgens and sexual function in women with rectal cancer. MethodsWomen diagnosed with stage I–III rectal cancer were consecutively included and prospectively followed with the Female Sexual Function Index (FSFI) questionnaire from baseline to 2 years postoperatively and blood samples for hormone analyses, baseline to 1 year. Androgens were measured with liquid chromatography−mass spectrometry and electrochemiluminescence. The associations between the 4 measured androgens (testosterone, free testosterone, androstenedione, and dehydroepiandrosterone sulphate) and sexual function were assessed with generalized least squares random effects regression analysis in sexually active women. OutcomesThe primary outcome measure was the mean change observed in the FSFI total score when the serum androgen levels changed with one unit. Secondary outcomes were the corresponding mean changes in the FSFI domain scores: sexual desire, arousal, lubrication, orgasm, satisfaction, and pain/discomfort. ResultsIn the 99 participants, the median FSFI total score decreased from 21.9 (range 2.0 – 36.0) to 16.4 (3.5 – 34.5) and 11.5 (2.0 to 34.8) at 1 and 2-years follow-up. After adjustment for age, partner, psychological well-being, preoperative (chemo)radiotherapy, and surgery, total testosterone and androstenedione were significantly associated with FSFI total score (β-coefficients 3.45 (95% CI 0.92 – 5.97) and 1.39 (0.46 – 2.33) respectively). Testosterone was significantly associated with the FSFI-domains lubrication and orgasm, free testosterone with lubrication, androstenedione with all domains except desire and satisfaction, and dehydroepiandrosterone sulphate with none of the domains. Strengths and LimitationsThis is the first study investigating whether androgen levels are of importance for the impaired sexual function seen in women following rectal cancer treatment. The prospective design allows for repeated measures and the use of the FSFI for comparisons across studies. No laboratory data were collected at the 2-year follow-up, and the missing data could have further clarified the studied associations. Conclusion and Clinical ImplicationTestosterone and androstenedione were associated with sexual function in female rectal cancer patients. The results are of interest for future intervention studies and contribute to the understanding of sexual problems, which is an essential component of the rehabilitation process in pelvic cancer survivors.Svanström Röjvall A, Buchli C, Flöter Rådestad A, et al. Impact of Androgens on Sexual Function in Women With Rectal Cancer – A Prospective Cohort Study. J Sex Med 2021;18:1374–1382.

Arriving at the diagnosis of female sexual dysfunction

Preoperative sexual function in women with rectal cancer

Comparison of the Effect of Intermittent and Continuous Aerobic Physical Training on Sexual Function of Women With Polycystic Ovary Syndrome: Randomized Controlled Trial

In patients with systemic sclerosis (SSc), sexual function is somewhat impaired. Our aim was to evaluate sexual function in women with SSc in comparison to controls, and to investigate the association with sociodemographic and disease characteristics, and physical and psychological variables. Forty-six women with SSc and 46 healthy women were assessed for sociodemographic characteristics and gynecological development and administered the Female Sexual Function Index (FSFI), Medical Outcomes Study Short Form-36 (SF-36), Health Assessment Questionnaire (HAQ), Hospital Anxiety and Depression Scale (HADS), Rosenberg Self-Esteem Scale, Coping Orientation to Problems Experienced-New Italian Version, and Functional Assessment of Chronic Illness Therapy-Fatigue Scale. Patients were also assessed for disease duration and subset, Female Sexual Function in SSc, Hand Mobility in Scleroderma test (HAMIS), Cochin Hand Functional Disability Scale, Mouth Handicap in Systemic Sclerosis Scale (MHISS), Disability Sexual and Body Esteem Scale (PDSBE); and fist closure, hand opening, and mouth opening. In patients with SSc, only FSFI desire subscale score was significantly lower (p = 0.035) versus controls. Total FSFI score, similar to controls, was related with Medical Outcomes Study Short Form-36 mental component, HAQ (p = 0.022), MHISS (p = 0.038), and HAMIS (p = 0.037). In SSc, the main factors independently associated with sexual functioning were vaginal dryness [regression coefficient (B) = -0.72; p < 0.001], PDSBE (B = 0.42; p = 0.001), and HADS depression scale (B = -0.23; p = 0.035). Together, these variables explained 70% of the variance in the FSFI total score. In SSc, sexual function, although not different from controls, is influenced by specific disease-related and psychological concerns. Thus it should be included in patient evaluations and assessed in daily clinical practice.

Prospective, cross-sectional, comparative study. To evaluate sexual function in women with spinal cord injury (SCI) using Female Sexual Function Index (FSFI) and to compare results with healthy controls. Secondary objectives were to determine prevalence of sexual dysfunction and to examine associations between sexual function and neurological level, functional independence, bladder and bowel function, and medical complications. Ankara Bilkent City Hospital, Türkiye. Twenty-six women with SCI and 23 age-matched healthy controls were included. Demographic and obstetric characteristics (age, marital status, educational level, employment status, pregnancy history, number of deliveries, mode of delivery, menstrual status, and contraceptive use) were recorded. Sexual function was assessed using the Female Sexual Function Index (FSFI). Functional independence was evaluated with the Spinal Cord Independence Measure III (SCIM III), and bowel dysfunction was assessed using the Neurogenic Bowel Dysfunction (NBD) score. Group comparisons were performed using non-parametric tests and correlations were analyzed using Spearman correlation analysis. Women with SCI had significantly lower FSFI total and domain scores than healthy controls (p < 0.001). Sexual dysfunction (FSFI < 26.55) was highly prevalent in SCI group. FSFI total scores were not significantly associated with neurological level or ASIA classification. FSFI scores showed a strong positive correlation with SCIM III (r = 0.77, p < 0.001) and a moderate negative correlation with NBD scores (r = -0.44, p = 0.024). Urinary incontinence was associated with significantly lower FSFI scores (p = 0.008). FSFI scores differed significantly according to bladder management method with highest scores in spontaneous voiding and lowest in indwelling catheter users (p < 0.001). Sexual function is markedly impaired in women with SCI and is strongly related to functional independence, bladder and bowel function and urinary management than to neurological injury level, highlighting need for a multidisciplinary approach in SCI rehabilitation.

Research suggests that COVID-19 impairs sexual function in men, but little is known about the impact of COVID-19 (or long COVID) on sexual function in women. We sought to compare the sexual function of cisgender women who had never had COVID-19, who had COVID-19 but not long COVID, and who had long COVID, and assessed whether long COVID symptoms and/or emotional distress mediate the relationship between COVID-19 history and sexual function. In total, 2329 adult cisgender women were recruited online as study participants. Half of these women reported having had COVID-19, and the other half reported never having had COVID-19. Of those who had COVID-19, 25% (n= 170) reported having long COVID. We compared the mean Female Sexual Function Index (FSFI) scores by using t-tests for each of the primary comparison categories (never COVID vs COVID and only COVID vs long COVID). Four path models were used to test the hypotheses that (1) long COVID symptoms or (2) depression, anxiety, and/or stress assessed with the subscales of the 21-item Depression, Anxiety, and Stress Scale (DASS-21) mediated the relationship between COVID-19 and sexual function. Sexual function was measured with the FSFI, long COVID symptoms were assessed using the Centers for Disease Control working symptom set, and emotional distress was measured with the DASS-21. In total, 1313 participants provided data suitable for analysis. The never-COVID group (n= 645, 49.1%) had higher scores on the Desire, Arousal, Lubrication, and Satisfaction subscales of the FSFI (mean [M] [SD] FSFI total Mnever COVID = 27.98[4.84] vs MCOVID = 27.05[5.21]) than the combined only-COVID (n= 498, 37.9%) and long-COVID (n= 170, 12.9%) groups. The FSFI subscale scores were significantly higher in the only-COVID group than in the long-COVID group for the Arousal, Lubrication, and Orgasm and lower for the Pain subscales and higher for overall sexual function (FSFI total Monly COVID = 27.49[5.00] vs Mlong COVID = 25.77[5.61]. None of the proposed mediation models had adequate model fit. Clinicians treating cisgender women who have COVID-19 should consider proactively discussing sexual function with their patients and offering available resources. In this study we used a large and diverse sample, but this sample did not include transgender or gender-diverse persons. This study was also correlational; as such, causal conclusions cannot be drawn. Further, the mechanism of action remains unexplained. The study findings suggest the following: (1) COVID-19 infection is associated with impaired sexual function in cisgender women, and (2) that women with long COVID experienced incrementally more impaired sexual function than women with COVID-19 who did not develop long COVID.

To compare sexual functioning and distress in women with systemic sclerosis (SSc) with that in healthy controls and determine the association between disease characteristics and sexual function. We conducted a cross-sectional study of 69 women with SSc (ages 18-60 years) and 58 healthy, age-matched controls. Assessment included the Female Sexual Function Index (FSFI), Female Sexual Distress Scale (FSDS), Hospital Anxiety and Depression Scale, Short Form 36 health survey, sociodemographic characteristics, and in patients only, the Health Assessment Questionnaire. Of 69 eligible patients with SSc, 37 (54%) responded, in addition to 37 (64%) of 58 controls. The FSFI total score and the subscale scores for lubrication, orgasm, arousal, and pain were significantly lower and the FSDS scores were significantly higher in patients with SSc. Longer disease duration and higher levels of marital dissatisfaction were significantly associated with low sexual function in patients with SSc. Longer disease duration, more depressive symptoms, and the use of antidepressants were significantly associated with sexual distress. Multivariate analyses indicated that marital distress was the only variable significantly associated with low sexual function in patients with SSc (beta = 0.40, P < 0.05), whereas depression was the only variable significantly associated with sexual distress (beta = 0.32, P < 0.05). The same pattern of associations was found in the healthy control group. Women with SSc reported significantly impaired sexual functioning and more sexual distress then healthy controls. Impaired sexual functioning and sexual distress were associated with marital distress and depressive symptoms. These results indicate that in daily practice, inquiring about sexuality and screening for depressive symptoms is indicated in every patient with SSc, irrespective of their clinical characteristics.

The objectives of this paper are to compare sexual function and distress in women with systemic lupus erythematosus (SLE) and in healthy controls; to determine the association between disease characteristics, quality of life, psychopathology and sexual function; and to compare sexual function and distress of women according to age (reproductive and nonreproductive-age women). We conducted a cross-sectional study of 120 participants; 65 women had SLE (aged 18-65), and 55 were healthy, age-matched controls. The assessment included the Female Sexual Function Index (FSFI), Symptom Checklist-90-Revised (SCL-90-R), Short Form 36 health survey (SF-36), socio-demographic characteristics and the Systemic Lupus International Collaborating Clinics (SLICC) and SLE Disease Activity Index (SLEDAI) in SLE patients only. Of 65 eligible patients with SLE, 61 (94%) responded; of 55 control subjects, 53 (96%) responded. The FSFI total score and subscale scores for desire, arousal, lubrication, orgasm and pain were significantly lower in patients with SLE. More somatization, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, hostility, phobia, paranoid ideation, psychoticism, the Positive Symptom Total (PST), Positive Score Discomfort Index (PSDI), the use of psychotropic drugs, general health, vitality, social function, emotional role and mental health were significantly associated with changes in the patient group's sexuality. Multivariate analysis indicated that depression, PSDI and vitality were the variables significantly associated with low sexual function in patients with SLE. Women with SLE reported significantly impaired sexual function compared with healthy controls. Impaired sexual function was associated with somatization, obsessive-compulsive behavior, interpersonal sensitivity, depression, hostility, paranoid ideation, psychoticism, PST, higher scores in the PSDI subscale, vitality, social functioning and mental health. These results indicate that, in daily practice, inquiring about sexuality and quality of life and screening for psychopathology are important for every patient with SLE, irrespective of their clinical characteristics.

Percutaneous Tibial Nerve Stimulation Improves Female Sexual Function in Women with Overactive Bladder Syndrome

OnabotulinumtoxinA detrusor injection improves female sexual function in women with overactive bladder wet syndrome

Study question What factors are associated with sexual function in women with endometriosis? Summary answer In this study, the most important variables associated with sexual function were dyspareunia (especially deep and introital dyspareunia combined), infertility, fatigue, and psychological comorbidities. What is known already Endometriosis is a chronic gynaecologic disease that affects women of reproductive age, with negative consequences on multiple life domains, including sexuality. Although it has been demonstrated that endometriosis-related sexual issues may negatively affect women’s intimate relationships, their subjective experience remains overlooked, either in research or clinical practice. In this regard, the impact of dyspareunia (especially deep dyspareunia) has been highlighted in several studies, but the role of symptoms other than pain, such as fatigue, infertility, and psychological comorbidities, has not been yet clarified. Moreover, little is known about how women deal with dyspareunia and the quality of doctor-patient communication. Study design, size, duration This observational study was conducted between 8 November and 21 December 2021 in collaboration with the largest Italian patient association, Associazione Progetto Endometriosi (APE [Endometriosis Project Association]). Data were collected through a self-administered online survey hosted on Qualtrics (Qualtrics Ltd.). Women were invited to participate in the study via APE’s Facebook page and newsletters. The online survey was anonymous, and women were allowed to complete it only after providing their electronic consent. Participants/materials, setting, methods Participants were 612 women (age: 36.41 ± 6.72 years) with a surgical or clinical diagnosis of endometriosis and a sexual partner. They completed the Female Sexual Function Index (FSFI), the Hospital Anxiety and Depression Scale (HADS), and the Rosenberg Self-Esteem Scale (RSES). Demographic and gynaecologic data – including endometriosis stage, type of lesions, symptoms (e.g., pelvic pain, fatigue, infertility), treatment –, and information regarding women’s subjective experience of dyspareunia were collected using a researcher-made questionnaire. Main results and the role of chance Dyspareunia was experienced by 524 (86%) women. Sexual dysfunction (FSFI total score &amp;lt; 26.55) was reported by 479 (78%) participants. Multiple regression analyses revealed that sexual function (FSFI total score) was associated with dyspareunia (β = −.108, P = .008), infertility (β = −.082, P = .040), fatigue (β = −.108, P = .021), and symptoms of anxiety and depression (HADS total score; β = −.127, P = .021). Women with sexual dysfunction were more likely to report rectovaginal endometriotic lesions (59% vs. 47%, P = .016) and stage 4 endometriosis (43% vs. 32%, P = .002), to experience deep and introital dyspareunia combined (50% vs. 21%, P &amp;lt; .001), with greater symptoms of anxiety and depression (F [2,595] = 21.812, P &amp;lt; .001, Wilk’s Λ = .932, η2p = .068) and lower self-esteem (t [589] = 5.111, P &amp;lt; .001). Women with dyspareunia and sexual dysfunction reported greater fear of pain and consequent inability to relax during intercourse, avoidance of sex, worries about their sexual life, sexual dissatisfaction, and feelings of guilt towards the partner (Ps &amp;lt; .001), along with poorer support and understanding from doctors (P = .006) than women with dyspareunia who did not report sexual dysfunction. Limitations, reasons for caution This is one of the largest studies on sexual function in women with endometriosis. However, there are reasons for caution when interpreting our results due to the self-reported nature of all the data (including medical information) and the risk of selection bias due to our recruitment strategy. Wider implications of the findings Our results clearly indicate that the majority of women with endometriosis experience sexual problems that are mostly (but not solely) due to dyspareunia. The assessment of sexual function should be included in routine clinical practice with these patients, also considering its association with psychological symptoms and self-esteem. Trial registration number Not applicable

Impaired Sexual Function in Young Women With PCOS: The Detrimental Effect of Anovulation

The Impact of Systemic Lupus Erythematosus on Women's Sexual Functioning

A growing body of evidence has suggested a significant impact of mode of delivery on female sexual function. In the present study, we aimed to investigate the effect of mode of delivery on postpartum sexual function. We conducted a cross-sectional study on 684 women during their first year after their first delivery. The sexual function of the included women was assessed using the Arabic version of the Female Sexual Function Index (FSFI). Data analysis was carried out using SPSS version 22 for Microsoft Windows. The present study included 684 primiparous women, in which 320 women had a history of vaginal delivery (VD0 and 364 women had a history of Cesarean section (CS). In terms of FSFI items, women with a history of CS had statistically significant higher FSFI total score than women with VD (31.34 ± 3.8 vs 30.23 ± 3.6, respectively; P < 0.001). Moreover, patients with more than 6 months since birth had a statistically significant higher total FSFI score than patients with less than 6 months since birth (30.97 ± 3.5 vs 29.97 ± 3.5, respectively; P < 0.001). However, the difference was clinically subtle. In addition, women who breastfed their babies had statistically significant lower total FSFI score than women who used artificial methods of lactation (29.61 ± 4.2 vs 30.27 ± 3.3, respectively; P < 0.001). In conclusion, the present study showed that the mode of delivery was not clinically associated with clinical impairment in sexual function within 1 year after delivery, despite the statistically significant difference. It is recommended that the decision to perform CS should not rely on the fear of the risk of postpartum sexual dysfunction.