Diagnosis Of Sexual Dysfunction Research Articles

(093) IMPACT OF ENROLLMENT DIAGNOSIS ON EFFICACY ENDPOINTS IN AN EXPLORATORY, PHASE 2B, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED CLINICAL TRIAL OF SILDENAFIL CREAM, 3.6% FOR THE TREATMENT OF FEMALE SEXUAL AROUSAL DISORDER

Abstract Introduction There are no FDA-approved treatments for female sexual arousal disorder (FSAD). Women with FSAD also often have co-existing secondary female sexual dysfunction (FSD) diagnoses. Objective Post-hoc subset analysis of the effect of enrollment FSD diagnoses on efficacy of Sildenafil Cream, 3.6% for treatment of FSAD. Methods Phase 2b, exploratory, randomized, placebo-controlled, double-blind study of Sildenafil Cream, 3.6% among premenopausal women with FSAD (NCT04948151). The change from baseline at week 12 in the arousal sensation (AS) domain (questions 6-9) of the 28-question sexual function questionnaire (SFQ28) was a co-primary efficacy endpoint. Changes from baseline in the mean number of satisfactory sexual experiences (SSEs) was a secondary endpoint. Exploratory efficacy endpoints included the Desire and Orgasm domains of the SFQ28. Enrollment FSD diagnoses were established during a clinical interview with independent experts. A retrospective review was performed of the clinical interviews for the intent-to-treat (ITT) population who completed the study (n=174) and enrollment diagnoses were categorized. Results Table 1 shows the breakdown of enrollment diagnoses by product group for the ITT population. Participants with FSAD and pain (n=6) were excluded. Although few women had FSAD as their sole diagnosis, when randomized to Sildenafil Cream, 3.6%, they had the largest mean increases in efficacy variables at week 12. Women with FSAD and secondary HSDD also experienced substantial benefit with Sildenafil Cream, 3.6% at week 12. Women with an enrollment diagnosis of FSAD with secondary FOD had the least benefit from Sildenafil Cream, 3.6% at week 12. Conclusions Data from this exploratory trial support the future target populations, including women with FSAD or FSAD with HSDD, will likely benefit the most from Sildenafil Cream, 3.6% treatment. Disclosure Yes, this is sponsored by industry/sponsor: Dare Bioscience and Strategic Science and Technologies LLC. Clarification: Industry initiated, executed and funded study. Any of the authors act as a consultant, employee or shareholder of an industry for: Dare Bioscience and Strategic Science and Technologies LLC.

Assessment of sexual function in postmenopausal breast cancer survivors.

Breast cancer (BC) is considered a risk factor for sexual dysfunction, which may be associated with the diagnosis itself or with oncological treatments. However, sexual dysfunction often remains underdiagnosed and unaddressed among BC survivors. The study sought to evaluate the sexual function of postmenopausal BC survivors compared with postmenopausal women without BC. This case-control study included 178 postmenopausal BC survivors (stages I-III), 45 to 70years of age, with amenorrhea for ≥12months and sexually active. They were compared with 178 women without BC, matched (±2years) for age and time since menopause in a 1:1 ratio. Sexual function was evaluated using the Female Sexual Function Index (FSFI), which consists of 6 domains (desire, arousal, lubrication, orgasm, satisfaction, and pain), with a total score ≤26.5 indicating risk of sexual dysfunction. Statistical analysis included Student's t test, chi-square test, and logistic regression (odds ratio [OR]). Evaluation of sexual function in postmenopausal women treated for BC. Postmenopausal BC survivors showed poorer sexual function in the desire domain (P = .002). No significant differences were observed between groups in the other FSFI domains and total score (P >.05). Postmenopausal BC survivors had a higher prevalence of risk of sexual dysfunction (64.6% with a total score ≤26.5) compared with the control group (51.6%) (P = .010). Adjusted risk analysis for age and time since menopause revealed a higher risk of sexual dysfunction in BC survivors compared with women without cancer (OR, 1.98; 95% confidence interval, 1.29-2.96; P = .007). Among BC survivors, the use of hormone therapy was associated with a higher risk of sexual dysfunction (OR, 3.46; 95% confidence interval, 1.59-7.51; P = .002). Postmenopausal BC survivors should be regularly assessed before and throughout treatment to enable the early detection and diagnosis of sexual dysfunction. The main strength is that this study might contribute to a better understanding of sexual function in postmenopausal BC survivors compared with women without BC. The main limitation is that while the FSFI is a valid and reliable tool for the evaluation of female sexual function, it does not allow a comprehensive diagnosis of sexual dysfunction, as it is not applicable to partners. Compared with postmenopausal women without BC, postmenopausal BC survivors face a higher risk of sexual dysfunction, especially when treated with adjuvant hormone therapy.

(137) Telemedicine for Sexual Health Issues: A Descriptive Cross-Sectional Study

Abstract Introduction Telemedicine has revolutionized healthcare by enabling remote consultations. In the realm of sexual health, it offers a discreet and convenient platform for couples to seek expert advice, receive counseling, and access personalized treatments from the comfort and privacy of their own homes. Objective The objective of this study is to examine the predominant sexual health issues in telemedicine consultations and analyze the socio-demographic profiles of the subjects accessing the service. Methods The study received ethical clearance from the Institutional Review Committee of the Medical College. A sexual wellness clinic was established within the psychiatry department, operating on specific days. Patients visiting the clinic were provided with a WhatsApp number for teleconsultation. This number was also shared on various social media platforms to reach a wider audience. During the study period, 88 individuals sought telemedicine consultation, of whom 51 presented with one or more sexual health issues and were included in the study after providing informed verbal consent. The subjects' sociodemographic profiles and relevant clinical data were recorded. Diagnosis of sexual dysfunction followed the DSM5 criteria, while other sexual health issues were categorized separately. Data were analyzed using descriptive statistics. Results Among 51 subjects 48 were male while 3 were female. Fourty six subjects had some sexual dysfunction while 5 subjects presented with other sexual health issues. Majority of the patients were young. Among sexual dysfunction, premature ejaculation was the most common sexual dysfunction while among sexual health issues, dhat syndrome was the most common one. Conclusions In regions with limited access to sexual health services, telemedicine offers a promising alternative, providing accessible and private consultations. This study emphasizes its significance in addressing sexual health concerns and advocates for further integration into mainstream healthcare. Disclosure No.

(279) Quantitative Analyze of Psycho Diagnostic Data in the Diagnosis of Female Sexual Dysfunctions

Abstract Introduction Sexual activity is an important aspect of quality of life. It's a fact that mental disorders caused by sexual trauma in past, bullying, strict up bringing, stigmatization, low level of sexual education, playing important role in development of female sexual dysfunctions. Objective The aim of our study was to detect how effective is psycho diagnostic examination for timely diagnosis and adequately treatment of women with sexual dysfunctions. Methods In our research that was conducted from October 2022 to July 2023, at the Z.Marshania’s sexual medicine center participated 75 women with different sexual dysfunctions. The study was quantitative. We used a correlational analysis to assess the association between dependent and independent variables. Independent variables with a p-value < 0.05 were taken as statistically significant with sexual dysfunction. To evaluate psychological characteristics, we took MMPI-1, SSTAI, and Beck Depression Questionnaire. Results All our patients had different sexual difficulties. 55% among 75 had psychological problems that were identified before the sexual dysfunction was discovered. The largest correlation (53%) was found between anxiety disorders and Female Orgasmic Disorder (FOD), as well as between depression and Female Hypoactive Sexual Desire Disorder (FHSDD) which was 34%. It is also worth emphasizing the style of life caused by strict traditional family education, due to which some of the patients had an inadequate perception of sexual life (63%). Conclusions The prevalence of sexual dysfunction among women with mental disorders is quite high, therefore, along with the treatment of sexual dysfunctions, it is important to properly evaluate the psychological state that can be performed effectively by psycho-diagnostic examination. Without it, the treatment of sexual dysfunctions among women will not be managed adequately. Disclosure No.

Provider perspectives and recommendations on standardized sexual function screening intervention in adolescent/young adult oncology patients.

Sexual function (SF) concerns are common among adolescent and young adult (AYA) cancer survivors, are underrecognized and undertreated. This study sought AYA oncology provider input on the implementation of an SF screening tool to address this unmet need. Semi-structured interviews were completed with oncology providers (n=25) who care for AYAs at a single institution. Interviews sought to understand barriers to addressing SF, elicit perspectives on use of an established screening tool, and obtain recommendations for SF screening intervention development and implementation. Interviews were developed using the Consolidated Framework for Implementation Research (CFIR); thematic analysis-guided interpretation. AYA oncology providers were in favor of using an SF screening tool, but confirmed previously identified barriers and implementation considerations within multiple CFIR domains, including concerns about privacy, patient comfort, provider buy-in, provider knowledge, resource needs, and workflow/capacity constraints. They identified numerous strategies to address barriers through screening intervention design and implementation approaches. For example, provider buy-in could be optimized through education, availability of clinical resources, creation of a dedicated sexual healthcare team, provider engagement in intervention development, and leadership involvement. Development and implementation of an effective SF screening intervention is necessary to improve diagnosis and treatment of sexual dysfunction, with the ultimate goal of improving sexual health-related quality of life in AYA cancer survivors. AYA oncology providers identified numerous intervention and implementation design strategies for the development and implementation of an SF screening intervention, which must be integrated with patient recommendations.

A Study of Sexual Dysfunction and Quality of Life in Female Patients on Selective Serotonin Reuptake Inhibitor (SSRI)

Context: Sexual dysfunction is one of the most common and disconcerting side effect during treatment with Selective serotonin reuptake inhibitors (SSRIs). Sexual side effects from these medications have significant impact on self esteem, quality of life and can lead to non compliance and relapse in long term treatment. Aims: To study prevalence, severity of sexual dysfunction and its possible association with quality of life in female patients on treatment with SSRI for depression and anxiety. Materials and Methods: This was an observational, cross sectional, single-centre study. Hundred consecutive female patients who were sexually active, on SSRIs for six weeks or more were recruited. Diagnosis of Major depressive disorder (MDD), Anxiety disorders and female sexual dysfunction was done by clinician administered interview as per Diagnostic and Statistical Manual of mental disorders (DSM 5). The patients were further assessed for demographic details, CSFQ-F-C, HAM-D, HAM-A and WHOQOL-BREF scales for sexual dysfunction, depression, anxiety and quality of life respectively. p value of <0.05 was considered to be statistically significant. Results: Prevalence of sexual dysfunction was 84%. Patients with sexual dysfunction scored significantly lower value in social relationships (p= 0.0002) and environment (p= 0.033) domains of quality of life. Frequency of sexual dysfunction among patients on fluoxetine was 86.20%, on escitalopram was 86.76% and on sertraline was 66.6%. Frequency of sexual dysfunction was more with higher dose of SSRIs. Conclusions: Patients on various SSRIs experienced sexual dysfunction and had poor quality of life. Frequency of sexual dysfunction was more with higher doses of SSRIs. Keywords: Sexual dysfunction, Selective serotonin reuptake inhibitors, Depression, Anxiety, quality of life.

Chinese expert consensus on diagnosis and treatment of female sexual dysfunction (2023 version)

Chinese expert consensus on diagnosis and treatment of female sexual dysfunction (2023 version)

Association of sexual dysfunction according to DSM-5 diagnostic criteria with avoidance of and discomfort during sex in a population-based sample.

Sexual dysfunction frequencies and diagnostic indicators among older populations are relevant for public health measures, but evidence from large population-based studies is still scarce. To determine sexual dysfunction frequencies for women and men according to the Diagnostic and Statistical Manual of Mental Disorders (fifth edition; DSM-5) among 45- to 74-year-old participants of the population-based Hamburg City Health Study and the factors associated with sexual dysfunction diagnoses. We determined sexual dysfunction frequencies according to the DSM-5 and the factors associated with sexual dysfunction diagnoses (quality/avoidance of and discomfort during sex) among 45- to 74-year-olds from 7786 participants of the population-based Hamburg City Health Study. We analyzed cross-sectional self-report questionnaire data collected between 2016 and 2019 using descriptive statistics, comparative tests (Fisher test, Mann-Whitney U test), and logistic regression. Outcomes included sexual dysfunction frequencies - specifically, sexual difficulties experienced frequently or more often, over at least six months in the last year, causing severe or very severe distress, and not associated with physical health or relationship problems - and items on quality/avoidance of and discomfort during sex. Participants' median age was 62.0 years (IQR,14) and 51.1% were women. The frequency of sexual dysfunction according to the DSM-5 was 9.3% (95% CI, 8.3%-10.4%) in women and 6.2% (95% CI, 5.4%-7.1%) in men, with women's sexual interest/arousal and men's erectile disorder being most common. Sexual dysfunction rates increased with age: whereas complaints were more frequent among women than men in the younger groups, participants aged ≥65 years with a sexual dysfunction were more often men. Quality/avoidance of and discomfort during sex were significantly associated with a diagnosis of sexual dysfunction. Results suggest that sexual dysfunction caused by other than physical health or relationship factors is important to consider in this population. In addition, the avoidance of, perceived quality of, and discomfort during sex serve as valuable diagnostic indicators for the presence of sexual dysfunction. This study draws on robust data from a large sample to give valuable insight on the frequency of sexual difficulties and dysfunctions as defined by DSM-5 criteria. Limitations represent the restriction to self-report questionnaire data, the focus on participants living in a metropolitan area, and the lack of experience of sexual difficulties due to a lack of sexual activity not being taken into account. The study provides estimates for DSM-5 sexual dysfunction frequencies among Germans from a metropolitan area and points to the diagnostic value of age-related changes as well as the quality/avoidance of and discomfort during sex.

(190) Prescription Patterns in Women with Vulvar Lichen Sclerosus With and Without a Diagnosis of Sexual Dysfunction - A Claims Database Cohort Analysis

Abstract Introduction Vulvar lichen sclerosus (VLS) often presents with intense pruritus and recurrent painful lesions, negatively impacting quality of life and, potentially, the ability to engage in sexual penetration. VLS treatment ranges from topical steroids to systemic antipruritic agents. No studies have yet characterized how concurrent sexual dysfunction impacts VLS treatment. Objective The objective of our study is to assess prescribing patterns in women with VLS with sexual dysfunction compared to women without a diagnosis of sexual dysfunction. Methods A US claims database network (TriNetX Research Network) was queried from 2009 to 2022. We compared women aged ≥18 with VLS (ICD-10: N90.4) and sexual dysfunction (R37 or F52) with women aged ≥18 with VLS but no diagnosis of sexual dysfunction. Outcomes of interest were prescription of opioids (N02A), topical steroids (DE200), vaginal estrogen (GU500), prednisone (8640) or intramuscular (IM) triamcinolone (10759), benzodiazepines (CN302), antifungals (D01) or oral fluconazole (4450), or antipruritic agents including hydroxyzine (5553), amitriptyline (704), gabapentin (25480), or citalopram (2556) within 6 months of the initial diagnosis of VLS. Propensity-matching between the cohorts age, ethnicity, race, type 1 diabetes (E10), vitiligo (L80), autoimmune thyroiditis (E06.3), alopecia areata (L63), pernicious anemia (D51.0), overweight and obesity (E66), type 2 diabetes (E11), hyperlipidemia (E78), essential hypertension (I10), and alcohol abuse (F10.10) was conducted. Results We identified 32,241 women with VLS that did not have concurrent sexual dysfunction (average age 59.5) and 416 women with VLS that had concurrent sexual dysfunction (average age 58.9). After propensity-score matching, the average age of women in each cohort was between 58 and 59 years old (Table 1). Women diagnosed with concurrent sexual dysfunction (n=416) were significantly more likely to receive vaginal estrogen prescriptions (Risk Ratio (RR) 2.00, 95% Confidence Interval (CI) 1.47-2.73), benzodiazepines (RR 1.39, 95% CI 1.00-1.942), and topical anti-inflammatory agents (RR 1.26, 95% CI 1.08-1.47) compared to an equivalent number of propensity-score matched women without a diagnosis of concurrent sexual dysfunction (Table 2). Prescription rates for systemic VLS treatments including oral prednisone or intramuscular triamcinolone (RR 1.06, 95% CI 0.56-1.98), opioids (RR 0.96, 95% CI 0.66-1.40), antifungals (RR 1.35, 95% CI 0.97-1.89), antipruritic agents hydroxyzine, amitriptyline, gabapentin, or citalopram (RR 1.35, 95% CI 0.94-1.93) did not significantly differ between women with or without concurrent sexual dysfunction. Conclusions Our results demonstrate that VLS treatment patterns differ with concurrent sexual dysfunction, with vaginal estrogen, benzodiazepines, and topical anti-inflammatory agents prescribed at higher rates to those with concurrent sexual dysfunction. Rates of prescriptions of opioids, antifungals, oral prednisone, intramuscular triamcinolone, hydroxyzine, amitriptyline, gabapentin, and citalopram were similar between the groups. Given the pruritic vulvar lesions associated with VLS, the low percentage (1.29%) of women with VLS and concurrent sexual dysfunction highlights a potential pattern of underdiagnosis; further study is required to investigate the relationship between VLS and sexual dysfunction. Disclosure No

(355) Sexually Speaking: How are Medical School Clinical Curricula Preparing Future Physicians?

Abstract Introduction Sexual health is an essential component of overall health and wellness. It has been demonstrated that roughly one-third of patients in the United States have sexual dysfunction defined as persistent, recurrent problems with sexual response, desire, orgasm, or pain that cause distress. Currently, only half of United States medical schools require formal sexual health instruction, which contributes to the under-preparedness physicians experience in addressing essential issues related to female sexual medicine (FSM). Previous work from our group revealed a need for restructuring pre-clinical medical school curricula as they pertain to FSM and female sexual dysfunction. Thus, a comprehensive education in medical schools’ clinical curricula covering FSM, including standardized screening for sexual dysfunction, assumes an important role. Objective This study focuses on educational content within the obstetrics and gynecology (OBGYN) core clerkships of medical schools to determine if and how FSM is taught to third-year medical students as they interact with patients. Methods OBGYN clerkship syllabi, synchronous lecture materials, and supplemental resources were collected from four medical schools, including three allopathic and one osteopathic institution, in the surrounding Chicago, Illinois area. To standardize our clinical curriculum needs assessment, we limited content review to lectures and resources provided directly from the institution to students during their OBGYN rotation. Upon review of each institution’s clerkship materials, we assessed the goals set forth in each syllabus in terms of lecture or online learning content required for completion by rotating students. Results Clerkship curriculum materials were collected from four (n=4) medical schools. Three of the four institutions dedicate 6 weeks to the core OBGYN clerkship, while one dedicates only 4 weeks. When comparing the specific aims and course content outlines in the rotation syllabi, 3 out of 4 institutions included topics on FSM or female sexual dysfunction. Of these, only one institution had corresponding synchronous clerkship time dedicated to these topics as a one-hour-long required lecture for students. Furthermore, only one program offered training to third-year clinical students in comprehensive sexual history-taking practices, including screening for female sexual dysfunction. The format in which this was fulfilled was through a recommended online module for interested students to complete independently. Conclusions Our focused needs assessment of both allopathic and osteopathic medical schools in the Chicagoland area reveals inconsistencies in the outlined institution-specific goals of their OBGYN clinical rotation and the content that was available and required for students to complete. A single one-hour lecture was included at only one institution specifically dedicated to the screening, diagnosis, and treatment of female sexual dysfunction. This same school was the only of the four to offer any training in screening for female sexual dysfunction, and this was not required, only recommended. Future work includes emphasizing FSM as crucial a domain for medical students to gain proficiency and confidence during clerkships, particularly in a didactic setting that can be utilized clinically on the wards. Disclosure No

(315) The Association of Sexual Dysfunction with Race in Men and Women: A Comparative Review

Abstract Introduction Numerous studies have shown that, regardless of age, men with sexual dysfunction have a lower quality of life than men without sexual dysfunction. Sexual difficulties are also common among women and can cause significant distress and impact on mental health and quality of life. Female sexual dysfunction (FSD) is a multifaceted problem that is continuously under diagnosed and under treated. Historically in medicine, the sexual health of racial minorities who are underrepresented in medicine has been compromised due to multiple racism and discriminatory healthcare practices. These historical factors offer an unexplored context for interpreting the epidemiology of sexual health inequities among underrepresented populations today, despite significant advancements in ensuring equitable healthcare. Objective To assess the prevalence and risk of experiencing sexual dysfunction across various racial groups and examine the determinants and consequences to quality of life to women in comparison to men of the same racial group. Methods The methods for this systematic literature search have been developed according to the recommendations from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements. PubMed as well as 7 key electronic databases (including MEDLINE, Ovid, and ScienceDirect), and up-to-date editions of pertinent journals and organizational websites were searched. Criteria for including studies consisted of randomized control trials, cohort studies, and studies that had relevance to criteria for erectile dysfunction, female sexual disfunction, male sexual dysfunction, healthcare inequities, and hypoactive sexual desire disorder. The studies were assessed for value, author, and how data from the included studies were obtained, investigated, evaluated, and synthesized. Results It can be concluded that there is a higher reported incidence of sexual dysfunction in women overall when compared to men (43% among adult women and 31% among adult men). Women are also at a greater risk of sexual function difficulties due to higher rates of anxiety, depression, pelvic floor pain and pain with sexual intercourse. Out of the racial groups studied, black women are least likely to seek treatment for the diagnosis of sexual dysfunction and dyspareunia. However, when screened, black women can have up to a three times as high incidence of reporting symptoms associated with FSD. Conclusions The results indicate that sexual dysfunction is an important public health concern in reference to men’s and women’s sexual health. Providing healthcare professionals with information concerning sex-related behaviors may overcome racial and ethnic barriers to treatment and improve patient management. Sexual well-being should be appreciated as one of the most important aspects of one's wellbeing and quality of life. Further research should focus on the evaluation of different interventions that would address sexual satisfaction and treatment of sexual dysfunction in patient populations that are under-diagnosed and under-treated. Disclosure No

Breast cancer survivorship and sexual dysfunction: a population-based cohort study.

Breast cancer is the most common non-skin cancer in women and an increasing number of people are living as breast cancer survivors. While the prognosis of breast cancer continues to improve, the rates of sexual dysfunction and the risk related to cancer treatments have not been well characterized in a population-based study. We identified a cohort of 19,709 breast cancer survivors diagnosed between 1997 and 2017 from the Utah Cancer Registry, and 93,389 cancer-free women who were matched by age and birth state from the Utah Population Database. Sexual dysfunction diagnoses were identified through ICD-9 and ICD-10 codes from electronic medical records and statewide healthcare facilities data. Cox proportional hazard models were used to estimate hazard ratios for risk of sexual dysfunction. Breast cancer survivors were at higher risk of sexual dysfunction diagnosis (9.1% versus 6.9%, HR 1.60, 95% CI 1.51-1.70) compared to the general population. This risk increased 2.05-fold within 1 to 5years after cancer diagnosis (95% CI 1.89-2.22) and 3.05-fold in individuals diagnosed with cancer at < 50years of age (95% CI 2.65-3.51). Cancer treatments including endocrine therapy, chemotherapy and radiation therapy were associated with an increased risk of sexual dysfunction among breast cancer survivors. Risk of sexual dysfunction in breast cancer survivors is higher than in the general population, but may be underdiagnosed in the clinical setting. Health care professionals should be encouraged to address the topic of sexual health early on in the treatment of breast cancer, and routinely screen patients for symptoms of sexual dysfunction.

Sexual function history taking in medicine.

Sexual history taking is important for the proper diagnosis and treatment of sexual dysfunction. It is often neglected in a clinical setting and it is also underreported by patients due to stigma and hesitation. Here we have described how we should take sexual function history taking during any sexual dysfunction.

Гинекологические аспекты сексуальной дисфункции в постменопаузальном периоде

Sexuality is defined as a physical, emotional, psychological, and social welfare state associated with sexual desires. The prevalence of sexual dysfunction among postmenopausal women is estimated to be 68% to 87%. The most significant causes of sexual disorders in this period are physiological changes of female body, psychological problems, lack of special knowledge, and male health status. Sexual function is linked to the complex neurotransmitter-hormone interaction both at the central and peripheral levels. The major cause of sexual dysfunction in postmenopausal women is genitourinary menopausal syndrome. Most commonly, gynecologist becomes a first contact physician dealing with female sexual disorders. Sexual dysfunction diagnosis in postmenopause includes the use of validated questionnaires, the assessment of the type and severity of menopausal disorders, the impact of somatic diseases and psychological issues, as well as a thorough physical examination. As sexual dysfunction in postmenopausal women is caused by multiple factors and has a complex pathogenesis, it is necessary to set up a multidisciplinary approach to problem solving. According to the biopsychosocial model, gynecologist has a wide range of therapeutic options for dealing with sexual disorders — pharmacotherapy (hormonal and non-hormonal agents), rational psychotherapy, and multimodal treatment methods. KEYWORDS: sexual dysfunction, postmenopause, sexual hormones, estrogens, androgens, genitourinary menopausal syndrome, biopsychosocial model of healthcare. FOR CITATION: Sandakova E.A., Zhukovskaya I.G. Gynecological aspects of sexual dysfunction in the postmenopausal women. Russian Journal of Woman and Child Health. 2023;6(1):26–30 (in Russ.). DOI: 10.32364/2618-8430-2023-6-1-26-30.

Summary of the most important changes in sexual dysfunction and sexual health introduced in the latest revision of the International Classification of Diseases and Related Health Problems ICD-11

Aim&#x0D; The aim of this publication is to review the changes introduced by the latest revision of the International Classification of Diseases and Health Problems, within sexual health and to compare them to the previously valid ICD-10.&#x0D; Method&#x0D; This paper reviews both classifications and compares them with each other, presents diagnostic criteria for the most important changes within sexual dysfunctions, paraphilic disorders, gender non-conformity, sexual orientation and compulsive sexual disorders. The changes introduced in ICD-11 were proposed based on advances in research and clinical practice, as well as significant changes in social attitudes and human rights. This article describes and compares the main changes that have occurred in this area.&#x0D; Results&#x0D; The World Health Organization has introduced far-reaching changes in the area of understanding and diagnosis of sexual dysfunctions by combining its psychological and physiological components, creating a bio-psycho-social model of sexual disorders. Another revolutionary change is the depathologisation and de-medicalisation of gender identity by introducing the term gender non-conformity and regrouping it from the previous category of personality and behavioural disorders to the newly created category of sexual health. ICD-11 also uses less oppressive and empowering terms. ICD-11 removed the category ‘Mental and behavioural disorders related to sexual development and orientation’, deeming it outdated and clinically irrelevant, and made significant changes to paraphilic disorders by excluding normative but atypical sexual behaviours such as fetishism, sadomasochism, fetishistic transvestism, and introducing diagnoses of dripping and compulsive sexual sadism. In the area of paraphilic disorders, a clear distinction is made between clinically significant and public health-relevant conditions and those that merely reflect private atypical sexual behaviour. The last significant change is the introduction of the category of compulsive sexual behaviour in the group of impulse control disorders.

Sexual dysfunction among gynecologic cancer survivors in a population-based cohort study.

Treatment for gynecologic cancer is associated with sexual dysfunction, which may present during and/or after treatment. The aim of this study was to investigate the risk of sexual dysfunction among gynecologic cancer survivors compared to cancer-free women in a population-based cohort study. We identified a cohort of 4863 endometrial, ovarian, and cervical cancer survivors diagnosed between 1997 and 2012 in the Utah Cancer Registry. Up to five cancer-free women were matched to cancer survivors (N = 22,693). We used ICD-9 codes to identify sexual dysfunction. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for sexual dysfunction with adjustment for potential confounders. Approximately 6.6% of gynecologic cancer survivors had sexual dysfunction diagnoses 1-5years after cancer diagnosis. Gynecologic cancer survivors had higher risks of overall sexual dysfunction (HR: 2.51, 95% CI: 2.16, 2.93), dyspareunia (HR: 3.27, 95% CI: 2.63, 4.06), and vaginal dryness (HR: 2.63, 95% CI: 2.21, 3.12) compared to a general population of women, 1-5years after cancer diagnosis. Sexual dysfunction was associated with advance cancer stage (HRRegional vs. Localized: 1.61, 95% CI: 1.19, 2.31), radiation therapy (HR: 1.73, 95% CI: 1.29, 2.31), and chemotherapy (HR: 1.80, 95% CI: 1.30, 2.50). This large cohort study confirms that there is an increased risk of sexual dysfunction among gynecologic cancer survivors when compared to the general population. Further investigation is needed to address the risk factors for sexual dysfunction and to improve patient-provider communication, diagnosis, documentation, and treatment of sexual dysfunction among gynecologic cancer survivors.

Evaluation of sexual functional status and consistency of scales in patients with hypogonadotropic hypogonadism before and after testosterone replacement therapy: a single-center experience.

This study aimed to investigate the frequency of sexual dysfunction and the effect of short-term testosterone replacement therapy on sexual functions in congenital hypogonadism patients. Furthermore, we sought to reveal the consistency of the self-report scales used for the diagnosis of sexual dysfunction and the relationship between biochemical parameters. The study was conducted on 47 young male patients aged above 18 years who were diagnosed with hypogonadotropic hypogonadism. Short (IIEF-5) and long (IIEF-15) forms of the International Index of Erectile Function and Arizona Sexual Experiences Scale (ASEX) were applied before treatment under the supervision of a physician. The patients' blood pressure, height, and weight were measured, and their luteinizing hormone (LH), FSH, and total testosterone levels were recorded. Patients who started their treatments were called for a follow-up checkup after 6 months. Their blood pressure, height, and weight were measured by reapplying the ASEX, IIEF-5, and IIEF-15. In addition, their LH, FSH, and total testosterone levels in the biochemical tests were rerecorded. In this study, the sexual dysfunction status of patients diagnosed with hypogonadotropic hypogonadism before and after treatment was evaluated using the ASEX, IIEF-15, and IIEF-5 scales. A decrease in sexual dysfunction was observed in all three scales after treatment compared with that before treatment. The IIEF-5 and IIEF-15 scales were found to be uncorrelated in terms of the pretreatment values but were correlated in terms of the post-treatment values. Although a correlation was observed between ASEX and IIEF- 5 before treatment, no correlation was detected between ASEX and IIEF-15. After the treatment, ASEX was found to be correlated with both IIEF-5 and IIEF-15. The results of the scales indicated the correlation in all categories, except the pretreatment results of the IIEF-15 scale. The results of the current study demonstrated a significant improvement in the sexual function of hypogonadism patients undergoing short-term testosterone therapy. The ASEX, IIEF-5, and IIEF-15 scales used in the diagnosis and follow-up of sexual dysfunction were useful for evaluating sexual functions in hypogonadotropic hypogonadism patients.

The Arizona Sexual Experiences Scale-the Thai Translation (ASEX-Thai): Reliability and validity in Thai patients with mental disorders.

Background: Sexual dysfunction is common among patients with mental disorders but receives less clinical attention, especially in Thailand and other Asian countries. The Arizona Sexual Experiences Scale-the Thai Translation (ASEX-Thai), a self-rated, brief, questionnaire is a potential tool for screening for sexual dysfunction in this population. Our study aimed to assess the reliability and validity of ASEX-Thai in Thai patients with mental disorders. Methods: We enrolled 202 patients from an outpatient psychiatric department at atertiary hospital in Bangkok, Thailand. Demographic data, clinical data, and diagnosis of sexual dysfunction were assessed. ASEX-Thai was done, and we analyzed the test's psychometric properties. Results:Most participants were diagnosed with major depressive disorder (48%). There was a positive correlation between the ASEX-Thai and sexual dysfunction diagnosis (r = 0.402, p < 0.001). The KMO coefficient was 0.77 and Barlett's sphericity test was significant (χ 2= 409.76, p<0.001). A score of ≥ 17 points of the ASEX-Thai was the most suitable for sexual dysfunction screening (sensitivity 77.23 %, and specificity 58.42 %). For reliability, the Cronbach's alpha coefficient (0.831) showed good internal consistency. Conclusions: The ASEX-Thai is a valid and reliable self-rated questionnaire for screening for sexual dysfunction among Thai patients with mental disorders. The test could help clinicians to evaluate this undetected condition and deliver proper interventions.

The Arizona Sexual Experiences Scale-the Thai Translation (ASEX-Thai): Reliability and validity in Thai patients with mental disorders

Background: Sexual dysfunction is common among patients with mental disorders but receives less clinical attention, especially in Thailand and other Asian countries. The Arizona Sexual Experiences Scale-the Thai Translation (ASEX-Thai), a self-rated, brief, questionnaire is a potential tool for screening for sexual dysfunction in this population. Our study aimed to assess the reliability and validity of ASEX-Thai in Thai patients with mental disorders. Methods: We enrolled 202 patients from an outpatient psychiatric department at a tertiary hospital in Bangkok, Thailand. Demographic data, clinical data, and diagnosis of sexual dysfunction were assessed. ASEX-Thai was done, and we analyzed the test’s psychometric properties. Results: Most participants were diagnosed with major depressive disorder (48%). There was a positive correlation between the ASEX-Thai and sexual dysfunction diagnosis (r = 0.402, p < 0.001). The KMO coefficient was 0.77 and Barlett’s sphericity test was significant (χ 2 = 409.76, p<0.001). A score of ≥ 17 points of the ASEX-Thai was the most suitable for sexual dysfunction screening (sensitivity 77.23 %, and specificity 58.42 %). For reliability, the Cronbach’s alpha coefficient (0.831) showed good internal consistency. Conclusions: The ASEX-Thai is a valid and reliable self-rated questionnaire for screening for sexual dysfunction among Thai patients with mental disorders. The test could help clinicians to evaluate this undetected condition and deliver proper interventions.

Assessment of sexual dysfunction in patients with multiple sclerosis: a perspective from neurologist

BackgroundSexual dysfunction (SD) is a common comorbidity in people with multiple sclerosis (pwMS). It affects the quality of life and remains an overlooked condition. The objective of this study was to describe how Colombian neurologists assess and treat SD and explore the barriers during sexual function evaluation.MethodsIn this observational cross-sectional study we developed a questionnaire for neurologists with 4 sections (demographic data, evaluation and treatment of SD, and possible reasons for not discussing sexual dysfunction.) It was sent via email to 326 Colombian neurologists. We grouped the answers according to the type of consultation (neurologists from a MS program or no MS program). We described through absolute frequencies and proportions.ResultsFifty neurologists answered the survey. 64% stated that they usually study sexual dysfunction in neurological disorders. The main methods employed were private reading (86%) and attending conferences (14%). 5/50 participants have never attend pwMS; the Sect. 2–4 was not answered by them. 29% work in a MS program, all of them asked their patients about sexual function, but 18.75% of physicians working outside an MS program have never asked about it. Main reasons for not talking about sexual dysfunction were lack of knowledge (65.1%), presence of a companion (65.1%) and lack of time (55.8%). 91% of the neurologists reported that their patients usually and frequently ask about sexual function. Neurologists use informal questions to assess sexual function (80%), although 64.4% said that they are aware of SD questionnaires. When sexual dysfunction is detected, 91% of neurologists refer patients to another specialist and 87% do not start any treatment.ConclusionsColombian neurologists are concerned with sexual function in pwMS, however it remains an underdiagnosed an undertreated condition. It is necessary to strengthen knowledge about the diagnosis and treatment of sexual dysfunction in pwMS, for neurologists and patients. It is also imperative to eliminate barriers around the topic and include sexual function evaluation and treatment as the routine care of pwMS.