Female Sexual Function Index Domains Research Articles

Impact of Genital and Non-Genital Psoriasis on Genital Self-Image, Quality of Life, and Sexual Dysfunction in Female Patients

Introduction: Psoriasis is a chronic systemic inflammatory disease that affects millions of people worldwide. While its physical manifestations are well-documented, the psychosocial impact of psoriasis, particularly on female patients, is an area of growing concern. Feelings of shame, inferiority, and stigma are common among individuals with psoriasis, and these emotional burdens can be especially pronounced in females, particularly when the genital area is affected. Objectives: We aimed to shed light on the significance of genital psoriasis on the overall well-being of female patients. Methods: We conducted a cross-sectional assessment of quality of life using the Dermatology Life Quality Index (DLQI), sexual function using Female Sexual Function Index (FSFI), genital self-image using Female Genital Self-Image Assessment (FGSIS), among Egyptian females with and without genital psoriasis. By comparing these aspects across different groups, Results: We found that females with genital lesions, experience a notable decline in sexual health with higher levels of sexual distress compared to healthy individuals. In terms of the six FSFI domains, the psoriatic group scored lower than the control group in all areas, except for pain, which showed a significant increase. Psoriatic females also exhibited a significantly more negative FGSIS compared to the control group, and there was a highly significant difference in FGSIS between females with and without genital psoriasis. Conclusion: Understanding the impact of genital psoriasis on female sexual health and overall quality of life is essential for comprehensive patient care This research is instrumental in addressing the psychosocial aspects of psoriasis and enhancing patient well-being.

Multifaceted Impact of CO2 Laser Therapy on Genitourinary Syndrome of Menopause, Vulvovaginal Atrophy and Sexual Function.

Genitourinary syndrome of menopause (GSM) encompasses a range of distressing symptoms in the vulvovaginal and/or bladder-urethral regions related to menopause changes, negatively influencing woman's quality of life and sexual activity. Fractional micro-ablative CO2 laser therapy has shown the potential to reinstate the vaginal epithelium to a condition akin to the premenopausal state, thereby ameliorating the subjective symptoms associated with GSM. We conducted a prospective, pilot study in 73 sexually active postmenopausal women treated with CO2 laser for their GSM symptoms, while assessing Vaginal Health Index Score (VHIS) and sexual function through the Female Sexual Function Index (FSFI) Questionnaire. The laser treatment resulted in a decrease in VHIS and patient-reported vulvovaginal atrophy (VVA) symptoms, with a significantly lower prevalence of vaginal itching, dryness, and burning (p < 0.001), as well as dyspareunia (p = 0.002). The occurrence of urinary incontinence, urgency, and vaginal heaviness significantly reduced, with an improvement in the staging of cystocele, either to Stage 1 or complete resolution (p < 0.001). FSFI total and domain scores were significantly higher after the treatment, indicating better sexual function, with a post-treatment score median of 25 (p < 0.001). Therefore, using a three-cycle fractional CO2 laser was an effective choice for reducing urogenital discomfort related to GSM in postmenopausal women.

Evaluation of Sexual Function of Transgender Individuals.

The current study sought to evaluate the sexual function of transgender men and women and to identify associated factors. Trans individuals who were outpatients at our gender incongruence (GI) center for follow-up of gender-affirming hormone therapy with age ranging 27 to 50 years were invited to participate in this cross-sectional study. Clinical data were collected from the medical records. Two scales, the Female Sexual Function Index (FSFI) and the Male Sexual Function Index (MSFI), were administered to all females (n = 50) and all males (n = 58). Each participant also responded to a semi-structured questionnaire that assessed feelings regarding being transgender and satisfaction with sexual life. Relative to trans women, trans men had a higher total FSFI score, and higher scores in the FSFI domains of arousal, lubrication, orgasm, and satisfaction (all p < 0.01), and in the total MSFI score, and higher scores in the MFSI domains of arousal, erection, orgasm, and satisfaction (all p < 0.01). A separate semi-structured evaluation indicated that more than half of the trans men and almost half of the trans women were satisfied or very satisfied with their sexual life. The total scores from the FSFI and MSFI indicated a high risk of sexual dysfunction in trans men and especially, in trans women. However, the semi-structured evaluation showed that more than half of the trans men and almost half of the trans women were satisfied with their sexual life.

Understanding the Benefits of CO2 Laser Treatment for Vulvovaginal Atrophy.

Background and Objectives: Postmenopausal vaginal discomfort is often attributed to vulvovaginal atrophy (VVA). Women with VVA experience symptoms such as vaginal dryness, itching, burning, irritation, and dyspareunia. Materials and Methods: This pilot study was conducted to assess the effects of a micro-ablative fractional CO2 laser on the clinical symptoms of VVA, as well as concordant sexual function. The severity of VVA symptoms was evaluated by a visual analogue scale (VAS), while the condition of the vaginal mucosa was evaluated using the Vaginal Health Index Score (VHSI). Sexual function was evaluated using the Female Sexual Function Index (FSFI) Questionnaire. Results: Our cohort included 84 sexually active postmenopausal women with bothersome VVA, leading to sexual health complaints. The mean age of the participants in our study was 55.2 ± 5.4 years, with an average postmenopausal period of 6 ± 4.8 years. The age of our patients and the length of their postmenopausal period exhibited a significant negative correlation with VHSI scores, while a longer postmenopausal period was associated with increased severity of vaginal dryness and dyspareunia. Baseline VHSI values showed that 65% of patients had atrophic vaginitis with pronounced VVA symptoms (70.2% experienced vaginal itching, 73.8% reported vaginal burning, 95.3% had vaginal dryness, and 86.1% suffered from dyspareunia). Lower VHSI values significantly correlated with lower FSFI scores, while more severe VVA symptoms scores correlated with lower FSFI scores. VVA symptoms were significantly less severe after treatment. VHIS regained high non-atrophic values in 98.8% of patients post-treatment (p < 0.001). FSFI total and domain scores were significantly higher after treatment (p < 0.001). Conclusions: Our study revealed that fractional CO2 laser is a useful treatment option to alleviate VVA symptoms and improve vaginal health and sexual functioning in postmenopausal women.

(001) INHIBITION AND EXCITATION IN THE SEXUAL BRAIN: AN USEFUL TOOL FOR THE PREDICTION OF THE DIAGNOSIS AND TREATMENT OF HYPOACTIVE SEXUAL DESIRE IN WOMEN WITH SEXUAL DYSFUNCTION

Abstract Introduction HSDD (Hypoactive Sexual Desire Disorder) is one of the most common sex-related disorders among women. Despite its considerable prevalence, factors affecting sexual desire as well as therapeutic outcomes of treatment of HSDD in women have been scarcely studied. According to the Dual Control Model (DCM), for years female sexual desire has been identified as the result of two mainly centrally acting brain processes: excitation or inhibition towards sexual cues. In this context, the SIS (Sexual Inhibition Scale)/SES (Sexual Excitation Scale) validated questionnaire could represent an useful tool for the clinician to better characterize patients’ lack of desire. Objective This study was aimed at exploring both the inhibitory and excitatory components of sexual desire in women referring to our Clinic for sexual dysfunction, in order to find a cut-off value in the SIS/SES score predicting a diagnosis of HSDD. A secondary aim was also to identify clinical, relational and biochemical parameters significantly associated with these two dimensions of sexual desire. Methods We retrospectively recruited a consecutive series of 133 women consulting for Female Sexual Dysfunction (FSD). Patients underwent clinical and biochemical evaluation, a structured interview and completed several self-administered questionnaires, including SIS/SES, Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), Body Uneasiness Test (BUT), Emotional Eating Scale (EES) and Middlesex Hospital Questionnaire (MHQ). Results The ROC curve for SES score showed an accuracy of 0.687 ± 0.05 (p&amp;lt;0.0001) in identifying HSDD; considering a cut-off value of 47.5, the sensitivity and specificity for HSDD detection were 70.5% and 55.6%, respectively. In addition, the best cut-off value for SIS1 to diagnose HSDD was 32.5, with 0.664 ± 0.048 AUC (p=0.002), 68.2% sensitivity and 53.3% specificity. We next stratified FSD women according to these SES/SIS1 cut-off values, thus identifying patients with pathological (pSES, pSIS1) or non-pathological (npSES, npSIS1) scores and the following 4 different subgroups: group 1 npSES/npSIS1; group 2 npSES/pSIS1; group 3 pSES/npSIS1; group 4 pSES/pSIS1. Among the 4 groups we did not find any statistically significant difference concerning the main characteristics explored, including lifestyle, hormonal and metabolic factors, with the exception of age, which was associated with a progressive worsening of either SES and SIS1 scores (F=4.299, p=0.006). Concerning relational factors, we demonstrated that the longer the duration of the relationship, the more pathological the excitatory/inhibitory scores, even when adjusted for age (F=5.588, p=0.001). Noteworthy, with exception for FSFI orgasm (FSFI-O) and satisfaction (FSFI-S) domains, all others FSFI domains scores showed similar significant differences with the worst values observed in pSES subgroups, independently from the presence of pSIS1. In contrast, FSDS-R score showed a highly significant variation among subgroups, but with the pSIS1 subgroup displaying the worst distress score independently from the presence of pSES. Among endocrinological factors, only total testosterone levels showed significant variation among groups (F=5.952, p&amp;lt;0.001), with the lower level observed in FSD women with pSES or pSIS1, in whatever combination as compared to npSES/npSIS1, even after age-adjustment (F=3.176, p=0.027). Regarding psychopathological factors, in an age-adjusted model, we found a significantly different MHQ total score among the 4 groups, with the worst value associated with the pSIS1 group combined or not with pSES. We also explored eating disorder symptoms. The 4 groups reported significantly different values in the EES, with pSES/pSIS1 group showing the highest score, even after adjusting for age (F=3.316, p=0.023). We then investigated the relevance of stratifying HSDD patients according to SIS1 and SES np/p scores in predicting the beneficial effects of treatments for HSDD (improvement yes/no). Interestingly, we found that SES, but not SIS scores, could predict HSDD treatment outcome after 6 months; in particular, the lower the level of SES at baseline, the higher the improvement in FSFI-D domain during treatment is predictable. Finally, we explored which were the main determinants for SES/SIS1 scores in the study population. Noteworthy, a significantly stepwise increase of SES score was observed as a function of total testosterone levels (r=0.192, p=0.049). Conclusions In conclusion, the cutoffs of SIS1/SES found in this study could help characterizing HSDD women and identifying subgroups of patients with the highest probability to benefit from testosterone treatment. From a broader viewpoint, our study suggests that women diagnosed with HSDD should be evaluated by using more appropriate tools, including those not routinely employed in clinical practice, so that different “nuances” of this sexual disorder could be recognized and consequently adequately treated in a tailored therapy perspective. Disclosure No.

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.

Association of hirsutism and anthropometric profiles with sexual dysfunction and anxiety levels in infertile Indonesian women with polycystic ovarian syndrome

BackgroundHyperandrogenism is frequently found in polycystic ovary syndrome (PCOS) and contributes to physical manifestations like hirsutism and obesity, along with infertility. This condition can result in anxiety, depression, and body image disorders, potentially leading to sexual dysfunction. The objective of this investigation was to assess the correlation among hirsutism, anthropometric characteristics, sexual dysfunction, and anxiety levels among infertile Indonesian women diagnosed with PCOS.MethodsFrom December 2021 to December 2022, a cross-sectional study was undertaken involving 71 infertile women diagnosed with PCOS at Yasmin Clinic, Dr. Cipto Mangunkusumo General Hospital in Jakarta, Indonesia. Hirsutism was assessed using the modified Ferriman-Gallwey (mFG) score; the anthropometric profile was assessed using BMI and waist-to-hip ratio. The assessment of sexual dysfunction was conducted using the Female Sexual Function Index (FSFI) questionnaire, while the evaluation of anxiety levels utilized the HAM-A questionnaires.ResultsIn this study, it was discovered that 53.3% of subjects experienced sexual dysfunction. However, there was no statistically significant relationship between hirsutism, anthropometric profile, and sexual dysfunction score in infertile women with PCOS (p > 0.05). Analysis of the overall FSFI domain score revealed that lubrication and satisfaction were lower in obese patients (p = 0.02 and p = 0.03), but this did not contribute to an overall sexual dysfunction score. Also, we found that subjects who experienced sexual dysfunction had a higher anxiety score (p < 0.005), with correlation analysis showing that Ferriman-Gallwey (FG) scores have a significant positive correlation with anxiety.ConclusionThere is no correlation between hirsutism, anthropometric profile, and sexual dysfunction in infertile Indonesian women diagnosed with PCOS. However, hirsutism could play a role in causing anxiety in Indonesian PCOS women. Additional investigation is required, as female sexual function is an intricate subject.

Enhancing Quality of Life and Sexual Functioning in Female Androgenetic Alopecia: Therapeutic Potential of Hair Follicle-Derived Stem Cells.

The study aimed to examine the impact of stem cell treatment on quality of life (QoL) and sexual functioning in women with androgenetic alopecia (AGA). Twenty-three women underwent a single session of autologous cellular micrografts (ACMs). The World Health Organization Quality of Life Brief Version (WHOQOL-BREF) and Female Sexual Function Index (FSFI) were used before and after 6 months. The AGA severity decreased by an average of 1 point on the Ludwig scale (p = 0.004) after treatment. FSFI scores indicated sexual dysfunction in over half of the women at baseline, but they improved significantly post-treatment for arousal [median (IQR): 4.8 (1.5) vs. 5.10 (0.9); p = 0.035] and satisfaction [4.4 (1.4) vs. 4.8 (1.8); p = 0.025]. QoL scores improved after treatment in psychological health (57.96 ± 19.0 vs. 69.35 ± 14.0; p = 0.031) and environment (72.96 ± 13.4 vs. 81.09 ± 12.6; p = 0.007), but not in physical health and social relationships. No associations were found between the WHOQOL-BREF or FSFI domains versus age and AGA severity. AGA reduces QoL and impacts sexual functioning in women with AGA. The high treatment burden arises from the chronic and progressive nature of AGA, coupled with limited treatment effectiveness. Effective treatments for AGA, like ACM, are urgently needed to enhance patient-reported outcomes along with clinical results.

Total and bioavailable 25-hydroxyvitamin D is not associated with improved sexual dysfunction following vitamin D supplementation in women with polycystic ovarian syndrome: a pilot study.

Vitamin D (Vit D) deficiency has been linked to symptoms of polycystic ovary syndrome (PCOS), yet little is known about Vit D supplementation as a treatment for sexual dysfunction (SDy) in women with PCOS. To explore the implications of serum total 25-hydroxyvitamin D (25[OH]D) and bioavailable 25[OH]D (bio-25[OH]D) status and replacement on women with PCOS and SDy. Reproductive-age women with PCOS who were not desiring fertility were eligible provided that they also had SDy, as assessed by the Female Sexual Function Index (FSFI), and were without severe depression, as evaluated by the Beck Depression Inventory II (BDI-II). Participants were given the recommended dietary allowance of Vit D (600IU daily) plus hormonal contraception (HC; cyclic ethinyl estradiol/drospirenone) or no HC for 6months. Comparisons between groups were analyzed by chi-square test and t-test, and Pearson's correlation coefficient analyzed correlations between FSFI with demographics, BDI-II, androgen levels, and total and bio-25[OH]D. The outcomes included SDy (FSFI <26.55), total and serum bio-25[OH]D levels, and total and free testosterone. A total of 42 women without severe depression completed the FSFI, with 28 (66.7%) having SDy. All FSFI domains, including arousal, lubrication, orgasm, and pain, were significantly lower as compared with women without SDy, with no associations with respect to demographics, total and free testosterone, or total and bio-25[OH]D. Vit D replacement was initiated with HC (n = 18) or no HC (n = 10), and for those completing the study, FSFI improved (score >26.55) in 61% (11/18) regardless of the treatment group. A time-treatment effect showed a significant change for the domain of orgasm, suggesting that HC had more of an impact than Vit D replacement. Improvement in sexual function as a dichotomous variable was not associated with age, body mass index, other demographics, total and free testosterone, total and bio-25[OH]D, or HC use. Due to the prevalence of SDy in women with PCOS, efficacious treatment options are necessary. This study is the first to analyze the effect of Vit D supplementation on SDy in women with PCOS. Limitations included the small number of participants who completed the study, thus limiting meaningful conclusions and generalizability. Vit D status was not associated with SDy and BDI-II. While HC may have played a role, standard Vit D supplementation could not account for the noted improvement in FSFI in women with PCOS.

Safety and efficacy of non-ablative CO2 laser treatment of vulvo-vaginal atrophy in women with history of breast cancer.

Breast cancer survivors (BCS) suffer severe vulvo-vaginal atrophy (VVA) and some of the most effective therapies are contraindicated. In literature we have no data about the non-ablative CO2 laser on these women. The aim of this study was to examine its efficacy, safety and acceptability in BCS. The enrolled women underwent 3 sessions of laser therapy (t0, t1, t2) and a one-month follow up examination (t3). At each time point we measured objective signs of VVA via VHI (Vaginal Health Index) and VuHI (Vulvar Health Index) and subjective parameters (Dryness, Burning, Itching, Dysuria) via visual analog scales (VAS). In sexually active women we evaluated the sexual function with FSFI (Female Sexual Function Index), FSDS (Female Sexual Distress Score) scores and MENQOL (menopause quality of life questionnaire). We enrolled 26 BCS. The mean VHI, VuVHI, dryness and burning VAS scores improved significantly and this improvement was not influenced by the initial VVA grade. MENQOL sexual domain, Lubrication, Orgasm and Pain domains and FSFI total score improved significantly, while Desire, Arousal and Satisfaction domains of FSFI and FSDS did not. At t0 women using Aromatase Inhibitors suffered more severe vaginal dryness than women using Tamoxifen or no therapy, but the three subgroups improved without differences. No adverse event and minimum discomfortwere reported. The non-ablative CO2 laser is a safe and effective treatment of VVA and has positive effects on sexual function in BCS regardless the use of adjuvant therapies and the initial grade of VVA.

Adjuvant administration of probiotic effects on sexual function in depressant women undergoing SSRIs treatment: a double-blinded randomized controlled trial

BackgroundAccording to the Institute of Health Metrics and Evaluation’s Global Health Data Exchange (2023) it is estimated that 5% of all adults will experience depressive disorder. Amongst the general loss of pleasure and interest in everyday activities that are symptoms of low mood, reduced sexual desire and sexual dysfunction can be particularly overlooked. Human sexuality is complex, but finding solutions based on scientific evidence to limit the symptoms of depressive disorder and the iatrogenic impact of antidepressant treatment to improve this outcome is an important step in promoting psychological health and general wellbeing.ObjectiveThe present study aimed is to provide scientific evidence to assess the effect of oral probiotic on sexual function in women with depressive disorder treated with Selective Serotonin Reuptake Inhibitors (SSRIs) in an Iranian population.DesignThis study was a double-blind randomized clinical trial. Eligible women were assigned to lactofem plus SSRIs (n = 58) or SSRIs alone (n = 54). In group A, SSRI antidepressants were prescribed together with Lactofem, and in group B, SSRI antidepressants were prescribed alone. Lactofem including Lactobacillus acidophilus 2 × 109 cfu/g, Bifidobacterium bifidus 2 × 109 cfu/g, Lactobacillus rutri 2 × 109 cfu/g, Lactobacillus fermentum 2 × 109 cfu/g; capsule weight of 500 mg bio-capsule administered orally and daily. The duration of intervention in two groups was two months. All questionnaires were completed by the patients before and after the intervention. The Female Sexual Function Index (FSFI), Hamilton Depression Rating Scale and Larson's Sexual Satisfaction Questionnaire were used to evaluate sexual function, severity of depressive disorder and sexual satisfaction, respectively.ResultsBased on the results of the present study, there was a statistically significant difference in sexual satisfaction and severity of depressive disorder between the groups before and after the intervention (P < 0.05). Also, our findings showed that after eight weeks, the Lactofem plus SSRIs group showed significant improvement in FSFI domains and total scores compared to SSRIs alone group (P < 0.05).ConclusionsThe results of the present study show that taking probiotics for eight weeks may improve the severity of depressive disorder, sexual function and sexual satisfaction in depressed women treated with SSRIs.Trial registrationClinicalTrials.govidentifier: IRCT20160524028038N14 (19/12/2022)

Supervised Pelvic Floor Muscle Training Improves Sexual Function and Diminishes Sexual Distress in Women with Relapsing-Remitting Multiple Sclerosis: A Randomised Controlled Study.

This study investigates the impact of pelvic floor muscle training (PFMT) on sexual function and distress in women with multiple sclerosis (MS), a prevalent chronic nervous system disorder associated with sexual dysfunction. This study's primary aim was to assess the effectiveness of PFMT at improving sexual function and alleviating sexual distress in this population. In a randomised controlled trial, 82 women with MS were divided into two groups: Group A (41 women) underwent 12 weeks of PFMT, while Group B (41 women) served as a control group with no intervention. Both groups were assessed at the beginning and end of this study using the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised (FSDS-R). Statistical analysis, including Chi-square tests, was employed to compare the outcomes between the two groups, with a p-value of less than 0.05 considered significant. The results revealed no significant differences in baseline sexual function and distress between the groups. However, at the conclusion of the 12-week period, Group A exhibited statistically significant improvements in nearly all domains of FSFI and FSDS-R compared to Group B, except in the pain domain. This study concludes that PFMT can effectively enhance sexual function and reduce sexual distress in women suffering from MS. These findings underscore the potential of PFMT as a therapeutic intervention in managing sexual dysfunction associated with MS.

Hybrid cooperative complexes to decrease VAS score and enhance sexual function in women with vulvar lichen sclerosus.

Lichen sclerosus is a chronic, inflammatory, progressive skin disease predominantly affecting anogenital areas. Vulvar lichen sclerosus (VLS) is one of the most common conditions treated in vulvar clinics; most patients report distressing symptoms of itching, burning, stinging, and pain (particularly during or after sexual intercourse). A preliminary, prospective, single-center study was performed to investigate the efficacy of hyaluronan hybrid cooperative complex (HCC) comprising high and low molecular weight hyaluronic acid to treat menopausal women with VLS. Patients (N = 30) received two HCC injections at 32 mg/ml (one month apart). At baseline and one and six months after treatment, patients completed validated psychometric questionnaires to assess their self-reported pain, itching, and dryness using the Visual Analogue Scale (VAS) and sexual function by the Female Sexual Function Index (FSFI). After treatment with HCC, no side effects or complications were reported. VAS scores showed a trend towards reduced pain and itching intensity, and there was a statistically significant reduction in median VAS score for dryness at follow-up vs. baseline (p=0.038). For sexual function, there was a statistically significant improvement in lubrication (p=0.001) and orgasm (p=0.001) FSFI domains. Overall, this preliminary study demonstrated the promising efficacy of HCC in menopausal women with VLS without side effects.

Effect of tibolone versus hormone replacement therapy on lower urinary tract symptoms and sexual function

BackgroundFew studies have compared the effects of tibolone versus hormone replacement therapy (HRT) on lower urinary tract symptoms and female sexual function. The current study aimed to compare these treatments. MethodsWomen with climacteric symptoms were recruited consecutively and allocated to receive tibolone (2.5 mg) or estradiol valerate (1 mg) and medroxyprogesterone acetate (2.5 mg). Patients were followed up at 4 weeks and 12 weeks after treatment. ResultsOverall, there were no significance of improvement in the International Prostate Symptoms Score (IPSS) scores in the HRT group. However, nocturia and the IPSS storage score improved after tibolone treatment. In addition, orgasm, satisfaction and pain improved after HRT. However, desire, lubrication, and Female Sexual Function Index (FSFI) total scores improved after tibolone treatment. There was a between-group difference in the change from baseline in the nocturia score after 4 weeks of treatment (0.1 ± 0.9 for HRT vs. −0.4 ± 1.2 for tibolone, p = 0.02). Nonetheless, there were no significant differences of the changes from baseline in the other IPSS and FSFI domains between the tibolone and HRT groups. ConclusionDespite the limited effect, tibolone seems to have more benefit in nocturia than HRT. In addition, tibolone seems to have benefits on overall low urinary tract storage symptoms; and both tibolone and HRT seem to have beneficial effects on female sexual function, despite there were no significant differences between tibolone and HRT.

Sexual dysfunction in women with breast cancer of Northeast Brazil: a retrospective longitudinal study

Breast cancer treatment leads to physical and psychological changes. The aim of this study was to analyze the incidence of sexual dysfunction and its risk factors in women diagnosed with breast cancer. This retrospective cohort study included women diagnosed and treated for breast cancer (exposed group, n = 90) and healthy women (non-exposed group, n = 93). Data were collected from February 2019 to October 2021 in the state of Rio Grande do Norte (Northeast Brazil), from medical records and using the Female Sexual Function Index (FSFI) questionnaire. Data were collected from medical records and using the Female Sexual Function Index (FSFI) questionnaire. Primary outcomes were analyzed using binary logistic regression. The Mann–Whitney test was used to analyze FSFI domains between groups. The exposed group had a 74% incidence of sexual dysfunction and 3.9 times increased chances of having sexual dysfunction compared with the non-exposed group (OR 3.9, CI 1.8 to 8.2, p < 0.001). Presence of comorbidities increased the chances of sexual dysfunction by 2.5 times (OR 2.5, CI 1.2 to 4.9, p = 0.009). Women diagnosed and treated for breast cancer had a higher incidence of sexual dysfunction than healthy women. Furthermore, comorbidities also increased the chances of sexual dysfunction regardless of exposure to breast cancer.

Does Significant Weight Loss After Bariatric Surgery Affect Sexual Function and Urinary Symptoms? An Iranian Study.

For sexual dysfunction and lower urinary tract symptoms (LUTS), obesity is identified as an independent risk factor. The current study aimed to evaluate the effect of significant rapid weight loss by bariatric surgery on LUTS and sexual function among men and women with class III obesity. A group of patients who were planned to undergo bariatric surgery was enrolled in the study. Male patients were given the International Index of Erectile Function (IIEF) and the International Prostate Symptom Score (IPSS) questionnaires. In the female group, they filled in the female sexual function index (FSFI) and the International Consultation on Incontinence Questionnaire short form (ICIQ-SF) questionnaires. Patients were followed up 1year after their bariatric surgery. All questionnaires were completed by eighty-one patients. (mean age ± SD: 39.4 ± 9.2years; mean body mass index (BMI) ± SD: 47.15 ± 5.4kg/m2). The total score of the IPSS questionnaire decreased from 5.83 ± 3.01 preoperatively to 2.37 ± 1.66 postoperatively. The weight loss caused significant improvement in the storage phase of LUTS domains, but there were no considerable changes in the voiding phase. In the IIEF questionnaire, domains of sexual desire, overall satisfaction, and orgasmic function improved significantly. There was not a significant change in any FSFI domains after bariatric surgery. Mean ICIQ-SF decreased, but it was not substantial. Bariatric surgery can significantly improve the storage phase in men, but not the voiding phase. Sexual desire, orgasmic function, and overall satisfaction were significantly improved in men. No significant improvement in sexual function and UI in women was observed.

(007) Physical activity and female sexual dysfunction: too much of a good thing?

Abstract Introduction Research on the relationship between physical activity (PA) and female sexual dysfunction (FSD) is lacking. Objectives To investigate the clinical, psychological, and sexual correlates of PA in women with FSD. Methods A non-selected series of n=322 pre- and post-menopausal patients consulting for FSD was retrospectively studied. Regular involvement in PA and its frequency (&amp;lt;1 hour/week: sedentary, 1-3 hours/week: active, 4-6 hours/week: very active, &amp;gt;6 hours/week: extremely active) were investigated with a specific question. FSDs, including HSDD (Hypoactive sexual desire disorder) and FGAD (Female genital arousal disorder), were diagnosed according to a structured and clinical interview. Participants underwent a physical examination and a clitoral Doppler ultrasound, and were asked to complete the Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), Body Uneasiness Test (BUT), and Middlesex Hospital Questionnaire (MHQ). Results At multivariate analysis, women engaging in PA (67.4%, n=217) scored significantly higher in several FSFI domains - including desire, arousal and lubrication - and showed lower sexual distress and lower resistance of clitoral arteries, as compared to sedentary women. A significant, inverse association between PA and HSDD was observed. Mediation analysis demonstrated that the negative association between PA and HSDD was partly mediated by body image concerns (BUT Global severity index), psychopathological symptoms (MHQ total score) and sexual distress (FSDS-R score). These latter two factors also partly mediated the association between PA and a reduced risk of FGAD, whilst a lower BMI was a full mediator in the relationship between PA and FGAD. Finally, extreme PA was associated with significantly worse scores in several psychosexual parameters (i.e. sexual satisfaction and histrionic/hysterical symptoms), even compared to a sedentary lifestyle. Conclusions In women with FSD, PA was associated with better sexual function and clitoral vascularization, lower sexual distress and reduced odds of HSDD and FGAD; the benefits of PA on sexuality were mediated by both psychological and organic determinants; excessive PA was related with a poor overall sexual function and with a low sexual satisfaction. Disclosure No.

(013) More Than Just “Vaginal Dryness”: Addressing an Unmet Need for Sexual Health Intervention in Female Cancer Survivors

Abstract Introduction Female sexual dysfunction (FSD) in cancer survivors is underreported and therefore undertreated. While the impact of cancer treatment on sexual health has been investigated through validated patient-reported outcomes, little work has been done to describe genitourinary anatomical changes in women in this population and how these changes relate to sexual function. Objective This study aims to 1) describe the population of female cancer survivors seeking treatment for sexual dysfunction through a novel sexual health after cancer program and 2) correlate disruptions in genitourinary exam findings to patient-reported sexual function. Methods A retrospective analysis included patients presenting to a sexual health after cancer program at a cancer center in South Florida. Patients received a baseline Female Sexual Function Index (FSFI) and underwent a physical, including abdominopelvic, exam. The FSFI is a validated 19-item survey that assesses desire, arousal, lubrication, orgasm, satisfaction, and pain domains. A total FSFI≤26.55 indicates sexual dysfunction. Genitourinary exam changes were characterized using a novel Adapted Vulvovaginal Exam Score (AVES) which assesses vaginal rugae, vascularity, epithelial integrity, elasticity, and dryness. A high AVES (&amp;gt;3) corresponds to more severe exam disruptions. Mean FSFI total and domain scores were compared between AVES groups (0-3 vs. &amp;gt;3) using t-test. A multivariate binary logistic regression model was fit to identify significant patient factors, treatment characteristics, and FSFI responses associated with high AVES score. Adjusted odds ratios (aOR) and corresponding 95% confidence intervals (95%CI) were calculated. Results Between 2020-2021, 139 female cis-gender women with a median age of 46 (range 19-70) at diagnosis were seen in the MUSIC Program that 56.8% identified as Hispanic/Latinx. Most were treated for breast (79.1%) or gynecologic (9.4%) cancer. Common presenting symptoms included vaginal dryness (55%), painful sex (45%), low desire (36%) and hot flashes (22%). Patients who disclosed details about pain (n=62) reported penetration was possible but uncomfortable (14%), possible but painful (58%) or impossible due to pain (11%). Those who disclosed changes with orgasm (n=43, 31%) reported it was more difficult (26%), or impossible (23%). Of those completing the FSFI (n=108, 78%), median Desire Domain score was 1.8 (IQR 1.2), and median Total Score was 9.85 (IQR 13.3), with 97% of patients meeting criteria for FSD. Mean total FSFI score, as well as lubrication, orgasm, satisfaction, and pain domain scores were significantly lower in high AVES. Multivariate analyses revealed that women with poor FSFI satisfaction domain score (&amp;lt;3.6) was significantly more likely to have high AVES (aOR 2.81; 95%CI 1.03-7.65; p=0.044). Conclusions The present study characterizes the range of anatomic changes associated with sexual dysfunction in a diverse cohort of female cancer patients. Future work will describe treatment strategies employed and their effectiveness at symptom resolution and quality-of-life improvement to meet the needs of this growing population. Disclosure No

(003) New Treatment Approach for Female Sexual Dysfunction by Transvaginal Shockwave Therapy (TVST)

Abstract Introduction Female Sexual Dysfunction (FSD) is a common condition of women especially following menopause. In recent years, energy-based devices (EBD), such as lasers and radio-frequencies, have been marketed for vaginal rejuvenation and FSD. Low-intensity shockwave therapy (LIST) has been introduced as a treatment for male erectile dysfunction and may hold promise for FSD. In women energy has to be delivered to the vaginal wall to manifest its tissue regenerative potential. In this pilot study, we evaluated a specially designed transvaginal probe, which is able to deliver shockwave energy to the vaginal wall and the external genitalia. Objective To evaluate the safety and therapeutic efficacy of LIST, when applied transvaginally for the treatment of FSD and incontinence. We call this approach transvaginal shockwave therapy (TVST). Methods The study was a single-arm, pilot study conducted between February-August 2021. Fifteen female patients aged 45-61 years (mean age: 52.7 years) were recruited and 78.6% of them were post-menopausal. All women presented with sexual dysfunction and 7 of them (46.7%) also reported urinary incontinence. Treatment was performed with the MoreNova system (Hikkonu Ltd., Israel), an electromagnetic low-intensity shockwave generator, using a novel transvaginal probe. Energy flow density was 0.09 mJoule/mm2 and intensity was gradually increased to the maximal tolerable level (1.6-1.8). Each session delivered 400 shockwaves to 6 predefined anatomical areas: the frontal vaginal wall (11 and 1 o' clock positions), the labia minora and majora (left, right). Patients underwent a total of 6 treatment sessions over the course of three weeks (2 per week). Statistical analysis was performed using student’s t-test (paired, one-tail, significance at p&amp;lt;0.05). Results Sexual dysfunction was assessed with the Female Sexual Function Index (FSFI) and incontinence with the ICIQ-UI Short-Form. Evaluations were performed at baseline and at 1 and 3 month post treatment. One patient aborted (for reasons unrelated to treatment) and was excluded from analysis. No patient complained of pain or discomfort during or after treatment and no side-effects were reported. Mean total FSFI score at baseline was 13.93, increased significantly to 22.66 at 1 month and slightly decreased to 20.88 at 3 months post treatment. All domains of the FSFI were significantly improved both at 1 and 3 month follow-ups compared to baseline. Percentage of patients achieving minimally clinically important differences (MCID) of the FSFI domains (Krychman et al, 2018) was also estimated. It was found that at 1 month follow-up more than 70% of patients achieved improvements exceeding the MCID in the pain, orgasm and lubrication FSFI domains. At 3 months, this significant improvement was sustained in the pain and orgasm domains. Mean ICIQ-UI was 3,53 at baseline and decreased to 3 at 3 months and 2.28 at 3 months post treatment. Conclusions There is a great need for new, effective and safe therapies for FSD. Quite often FSD is not reported by the patients and disregarded by physicians who are not involved in sexual medicine. Robust scientific evidence as to the efficacy of EBDs is also lacking. In our study, we found that TVST is safe and very well-tolerated by the patients. It improved FSD up to 3 months post treatment and this improvement was evident in all domains of the FSFI. There was also improvement in incontinence, as documented by the ICIQ-UI index. This observation surely warrants further investigation. Our data, although limited, underline the need for large scale, controlled studies ideally targeting different genito-urinary conditions. Disclosure Yes, this is sponsored by industry/sponsor: Direx Clarification Industry funding only - investigator initiated and executed study.

Sexual Function in Pregnancy in a Nigerian Population: A Prospective Longitudinal Study.

Studies are abound from low- and middle-income countries (LMICs) on postpartum sexual dysfunction but very limited in pregnancy. The data will help clinicians in providing women with evidence-based information and counseling in these regards. To determine the effects of different trimesters of pregnancy on sexual functions and the possible risk factors for sexual dysfunction in pregnancy. The study was longitudinal in design, and study population consisted of 270 pregnant women attending antenatal care at the two largest tertiary hospitals in Enugu, Nigeria. The recruitment was in the first trimester, and each recruited participant served as her own control. Interviews were conducted at specific times in the three trimesters, and data regarding sexual functions were obtained using validated questionnaires. Analysis of variance (ANOVA) was performed to compare the mean total and domain female sexual function index (FSFI) scores between the three trimesters, and Bonferroni's test for significant association between any two trimesters as may be applicable. The risk factors were determined via multivariate logistic regression analysis. A P value ≤0.05 was considered statistically significant. The FSFI means total score decreased as pregnancy advanced. It was significantly lower in second trimester (T2) than in first trimester (T1) (P < 0.001), and significantly lower in third trimester (T3) than T1 (P < 0.001), but no difference between T3 and T2 (P = 0.759). Similarly, the mean frequency of coitus per week declined across the trimesters; lower in T2 than T1 (2.2 ± 0.7 vs. 2.4 ± 0.6; P < 0.01), and lower in T3 than T1, but no difference between T3 and T2. The overall rate of sexual dysfunction was 50.7% and the risk factors age ≥35 years (AdjOR: 1.4; 95%CI: 1.1-1.9; P: 0.01), multiparity (AdjOR: 1.7; 95%CI: 1.2-2.5; P: 0.013) and a previous history of cesarean section (AdjOR: 2.1; 95%CI: 1.7-2.6; P: 0.004). Sexual function declines as pregnancy advances and the rate of sexual dysfunction is high in Enugu, Nigeria. Obstetricians are encouraged to discuss sexual health issues during antenatal care services and make more efforts towards reducing the modifying obstetric risk factors.