Domains Of Sexual Function Research Articles

233P Sexual dysfunction among premenopausal breast cancer survivors

Breast cancer (BC) survivors report adverse sexual effects such as disrupted sexual function (SF) and sexual distress. Despite its high prevalence, sexual dysfunction (SD) is not effectively screened for or treated. Population-based study with premenopausal BC patients, aiming to assess the prevalence and predictors of SD. Sexually active (SA) women (W), stage I-III, that have finished and recovered from chemotherapy, radiotherapy, and surgery were included. SF was assessed using the Female Sexual Function Index (FSFI), a 19-item instrument assessing 6 domains of SF: Desire, Arousal, Lubrication, Orgasm, Satisfaction, and Pain. The total FSFI cutoff score for a diagnosis of SD was ≤ 26.5 FSFI acceptability and assessment of sexual health during follow-up appointments was measured with Likert scales (punctuated from 1-5). FSFI questionnaire was completed by 181 W, 36 were excluded after confirming they weren’t SA and 145 W were included with a median age at diagnosis of 40 years (22-57). Eighty-three qualified (57,2%) for SD based on FSFI. A statistically significant difference was found in lubrication difficulties between W under LHRH agonists plus endocrine therapy (ET) and W who were only under ET (3,92 ± 1,39 vs.4,38 ± 1,30 p=0,049). FSFI scores were compared between surgery modality: Mastectomy (M), Mastectomy with immediate breast reconstruction (MIR) and Tumorectomy (T). Statistically significant differences were found between the 3 groups: M (23,50 ± 5,70), MIR (27,27 ± 4,93), T (22,86 ± 7,34) p=0,004. Post hoc analysis revealed statistically significant differences between M and MIR (p=0,009), T and MIR (p=0,01), however not between M and T (p=1,00). Out of the 145 W, 66,9% were rarely or never asked about sexual health. Overall, W provided positive feedback about FSFI: they felt comfortable answering the questionnaire (Likert scale punctuation media (LS) = 4,44); it was easy to complete (LS = 4,5), relevant to their experiences (LS = 4,39), and had the right length (LS = 4,42). Our study suggest that SD is a greatly underestimated problem in this population. We report substantial sexual morbidity, especially after M and T, while LHRH agonists plus ET were associated with lubrication difficulties. FSFI questionnaire was suitable and well accepted.

Abstract LB-292: A randomized controlled trial of yoga in men with prostate cancer undergoing radical prostatectomy

Abstract Introduction and Objectives: New diagnosis of prostate cancer (PCa) may lead to anxiety, mental distress, fear and depression in up to 30% of men, which can contribute to poor quality of life (QOL). Recent research on Yoga in cancer patients has shown significant improvement in health related QOL, emotional health and fatigue. Given the lack of randomized clinical data regarding the effects of Yoga in PCa, we performed this study to evaluate the potential impact of Yoga on disease-specific QOL in men undergoing radical prostatectomy (RP) for PCa. Material and Method: We randomly assigned newly diagnosed men with localized prostate cancer to Yoga (n = 15) or standard of care (n= 15) prior to their RP. Yoga was given to the intervention group twice a week for 6 weeks for 60 minutes before the surgery and then re-initiated 3 to 6 weeks after the surgery for another six weeks. Self-report measures of QOL [ Expanded Prostate Index Composite (EPIC), Functional Assessment of Cancer Therapy-Prostate (FACT-P), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Functional Assessment of Cancer Therapy-General (FACT-G) and Five Facets of Mindfulness Questionnaire (FFMQ) primary outcomes], blood specimen (cytokine and immune markers; secondary outcome) were collected at baseline, prior to the surgery and 6 weeks after surgery. Results: Improvements in EPIC sexual domain (mean difference: 8.5 points), FACT-P (mean difference: 5.3 points), FACIT-F (mean difference: 5.4 points), and FACT-G (mean difference: 7.2 points) were seen at 6 weeks in the Yoga arm compared with controls. Greatest benefit of Yoga was seen in the subdomains of EPIC sexual function (mean difference: 8.9 points), EPIC sexual bother (mean difference: 7.6 points), FACT emotional wellbeing (mean difference: 5.4 points), FACT functional wellbeing (mean difference 8.3 points) and FACT social wellbeing (mean difference 14.1 points). We identified statistically significant reduction in the inflammatory cytokines- granulocyte colony-stimulating factor (G-CSF; 0.55 [0.05 - 1.05]; p-value = 0.03), Monocyte chemoattractant protein (MCP-1; 0.22 [0.01 - 0.43]; p-value = 0.04), FMS-like tyrosine kinase-3 ligand (FLT-3 L; 0.91 [-0.01 - 1.82]; p-value = 0.053) in the Yoga group during the same time period. Conclusions: A structured Yoga intervention in the preoperative setting improved QOL, especially in the domains of sexual function, social, emotional and functional well-being as well as fatigue. Yoga positively modulates chronic low-grade inflammation which may impact tumor microenvironment. Yoga is feasible and safe and has promising benefits to physical, mental and emotional well-being. Health care providers can utilize the preoperative period as a window of opportunity for an intervention and a teaching moment for the patient to enhance their overall health. Further integrated large-scale research into molecular impact of yoga on markers of inflammation and immune function are essential. Source of Funding: This project was supported by the ThriveWell Cancer Foundation grant to Dharam Kaushik. The content is solely the responsibility of the authors and does not necessarily represent the official views of the ThriveWell Cancer Foundation. Citation Format: Dharam Kaushik, Pankil Shah, Kumar A. Pratap, Ian M. Thompson, Robert S. Svatek, Javier Hernandez, Ian Thompson, Ahmed Mansour, Richapriya Jha, Yang Xiaoyu, Deepak K. Pruthi, Hanzhang Wang, J. Ricardo Rivero, Nydia Darby, Ronald Rodriguez, Michael A. Liss. A randomized controlled trial of yoga in men with prostate cancer undergoing radical prostatectomy [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr LB-292.

Assessing Sexual Function of Women after 12 Months of IUD Usage

The Intrauterine Device (IUD) is a well-accepted method of contraception. Most women are currently using it because of its effectiveness, longevity, and affordability. Moreover, users need no strict routine instructions for IUD. However, many women in the absence of any pre-existing conditions that may impair sexual functions discontinue the method due to poor sexual satisfaction. This paper aims to assess and measure the effects of IUDs on sexual function in women with no underlying condition over a period of 12 months. This study employed a longitudinal approach. To be eligible to participate, the study enrolled 260 women who have chosen to use IUDs willingly on their own at these selected centers during this period and are aged 20 years and above. It collected data at baseline and at 12 months of use. Measurements at these two timelines were done using the Female Sexual Function Index (FSFI). The prevalence of female sexual dysfunction among participants after 12 months was 47.7% (124). In the analysis of Mean scores, FSFI at baseline and at 12 months was 31.31 and 24.76 respectively (p<0.05). Significantly reduced scores (p=0.001), for all the six domains (desire, arousal, lubrication, orgasm, satisfaction, and pain) of sexual function were noted. Desire and pain were the most affected areas of sexual function with very low scores. Without any underlying and related triggers of sexual health, the study discovered that IUDs have the potentials to cause female sexual dysfunction in almost half of its users.

Association Between Body Mass Index and Female Sexual Dysfunction: A Cross-sectional Study from the Data Registry on Experiences of Aging, Menopause, and Sexuality

BackgroundObesity and female sexual dysfunction (FSD) are prevalent conditions, and both are associated with significant adverse effects on health and well-being. AimTo investigate the association between body mass index and FSD, as well as potential moderators. MethodsThis cross-sectional study was performed by analyzing medical records of 6,688 women seeking consultation for menopause-related or sexual health–related concerns at women’s health clinics at Mayo Clinic Rochester, MN, and Scottsdale, AZ, between May 1, 2015, and September 15, 2019. OutcomesFemale sexual function was assessed by the Female Sexual Function Index, and sexual distress was assessed by the Female Sexual Distress Scale-Revised. ResultsBeing overweight or obese was associated with a lack of sexual activity. Among sexually active women, those who were overweight or obese had lower Female Sexual Function Index total scores and sexual function domain scores (indicating worse sexual function), including sexual arousal, lubrication, satisfaction, orgasm, and pain, and higher levels of sexual distress than those with normal weight. However, on multivariable analysis, these associations were found to be mediated by other factors, including age, level of education, reproductive stage, medication use, and mood disturbances, which are known to impact body weight and sexual function in women. Clinical ImplicationsOverweight and obesity were associated with sexual inactivity and greater odds of having FSD, which should prompt proactive assessment of sexual function. Strengths and LimitationsThe strengths of this study include the large cohort size and assessment of sexual problems in addition to sexual distress, a key component of the definition of sexual dysfunction. This study also took into account multiple potential moderating factors. Limitations include the cross-sectional design, which precludes determination of causality as well as lack of diversity in the cohort, potentially limiting generalizability of results. In addition, sexual function was not assessed in women reporting no recent sexual activity, which may confound results. ConclusionOverweight/obesity and FSD are highly prevalent conditions, which appear to be indirectly associated. These results highlight the need to identify and address FSD in all overweight and obese women, with particular attention to potential contributing factors.Faubion SS, Fairbanks F, Kuhle CL, et al. Association Between Body Mass Index and Female Sexual Dysfunction: A Cross-sectional Study from the Data Registry on Experiences of Aging, Menopause, and Sexuality. J Sex Med 2020;17:1971–1980.

Radiotherapy after radical prostatectomy: Effect of timing of postprostatectomy radiation on functional outcomes

Introduction and objectiveThe timing of radiotherapy (RT) after prostatectomy is controversial, and its effect on sexual, urinary, and bowel function is unknown. This study seeks to compare patient-reported functional outcomes after radical prostatectomy (RP) and postprostatectomy radiation as well as elucidate the timing of radiation to allow optimal recovery of function. MethodsThe Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study is a prospective, population-based, observational study of men with localized prostate cancer. Patient-reported sexual, urinary, and bowel functional outcomes were measured using the 26-item Expanded Prostate Index Composite at baseline and at 6, 12, 36, and 60 months after enrollment. Functional outcomes were compared among men undergoing RP alone, post-RP adjuvant radiation (RP + aRT), and post-RP salvage radiation (RP + sRT) using multivariable models controlling for baseline clinical, demographic, and functional characteristics. ResultsAmong 1,482 CEASAR participants initially treated with RP for clinically localized prostate cancer, 11.5% (N = 170) received adjuvant (aRT, N = 57) or salvage (sRT, N = 113) radiation. Men who received post-RP RT had worse scores in all domains (sexual function [−9.0, 95% confidence interval {−14.5, −3.6}, P < 0.001], incontinence [−8.8, {−14.0, −3.6}, P < 0.001], irritative voiding [−5.9, {−9.0, −2.8}, P < 0.001], bowel irritative [−3.5, {-5.8, −1.2}, P = 0.002], and hormonal function [−4.5, {−7.2, −1.7}, P = 0.001]) compared to RP alone at 5 years of follow-up. Compared to men treated with RP alone in an adjusted linear model, sRT was associated with significantly worse scores in all functional domains. aRT was associated with significantly worse incontinence, urinary irritation, and hormonal function domain scores compared to RP alone at 5 years of follow-up. On multivariable modeling, RT administered approximately 24 months after RP was associated with the smallest decline in sexual domain score, with an adjusted mean decrease of 8.85 points (95% confidence interval [−19.8, 2.1]) from post-RP, pre-RT baseline. ConclusionsIn men with localized prostate cancer, post-RP RT was associated with significantly worse sexual, urinary, and bowel function domain scores at 5 years compared to RP alone. Radiation delayed for approximately 24 months after RP may be optimal for preserving erectile function compared to radiation administered closer to the time of RP.

Radical Cystectomy and Perioperative Sexual Function: A Cross-Sectional Analysis

BackgroundCancer-related changes in sexual function (SF) negatively impact quality of life and intimate partner relationships. There is a lack of data regarding SF among patients who underwent radical cystectomy (RC). AimTo comparatively evaluate perioperative SF among patients who underwent RC. MethodsA prospective cohort of 150 patients undergoing RC for bladder cancer and participating in an internal validation study at a single institution from 2016 to 2019 were eligible for analysis. The European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire–Bladder Cancer Muscle Invasive (EORTC QLQ–BLM 30) and Functional Assessment of Cancer Therapy–Bladder were administered; those completing the SF subscale of the EORTC QLQ–BLM 30 were included in final analysis. Analysis was performed using descriptive statistics and generalized linear modeling. OutcomesThe primary outcome was interest or engagement in sexual activity within 4 weeks of survey completion, whereas the secondary outcome was a mean score on the EORTC QLQ–BLM 30 SF subscale. ResultsOverall, 132 of 150 (88%) of patients were eligible, of whom 82% were male, and the median age was 68.5 years. 53% reported at least a little interest in sexual activity, and 40% endorsed sexual activity within the last 4 weeks. The mean SF subscale score was 61.5 ± 25.2. Women had significantly worse mean scores of 72.9 ± 27.1 versus 59.1 ± 24.2 for men (P = .02). On multivariate analysis, both age and female gender were independently associated with higher SF domain scores. Clinical ImplicationsA substantial portion of patients who underwent RC endorse being sexually active or express interest in sexually activity in the perioperative period. Given the recent increase in attention given to SF outcomes and quality of life, this work supports further efforts to explore this area and develop novel interventions to improve outcomes. Strengths and LimitationsStrengths include rigorously collected, cross-sectional data using standardized methodology. Limitations include a relatively small sample size of female patients and unknown meaningful clinical difference. ConclusionsA substantial portion of patients report sexual interest and activity in the perioperative period; however, female gender is associated with worse SF domain scores. These findings support further inquiry into this topic.Westerman ME, Kokorovic A, Wang XS, et al. Radical Cystectomy and Perioperative Sexual Function: A Cross-Sectional Analysis. J Sex Med 2020;17:1995–2004.

Associations between androgens and sexual function in premenopausal women: a cross-sectional study

Although clinicians often measure the serum concentration of androgens in premenopausal women presenting with sexual dysfunction, with some women given testosterone or dehydroepiandrosterone as treatment if their concentrations are low, whether androgens are determinants of sexual function in women of reproductive age is uncertain. We aimed to clarify the associations between androgens and sexual function in a community-based sample of non-health-care-seeking women. This is a substudy of the Grollo-Ruzzene cross-sectional study, which recruited women aged 18-39 years from eastern states in Australia (QLD, NSW, VIC). After providing consent, women completed an online survey that included the Profile of Female Secual Function (PFSF) questionnaire, and those who were who were not pregnant, breastfeeding, or using systemic steroids were asked to provide a blood sample. At sampling, women were asked the dates of their last menstrual bleed. Serum androgens was measured by liquid chromatography and tandem mass spectrometry and sex hormone binding globulin (SHBG) by immunoassay. Associations between androgens and domains of sexual function, assessed by the PFSF, were examined in participants with regular menstrual cycles. After univariable linear regression (model 1), age, BMI, stage of menstrual cycle, and smoking status were added to the model (model 2), and then parity, partner status, and psychotropic medication use (model 3). Of 6986 women who completed the online survey (surveys completed between Nov 11, 2016, and July 21, 2017), 3698 were eligible and 761 (20·6%) provided blood samples by Sept 30, 2017. Of those who provided a blood sample, 588 (77·3%) had regular menstrual cycles and were included in the analysis. Adjusting for age, BMI, cycle stage, smoking, parity, partner status, and psychoactive medication, sexual desire was positively associated with serum dehydroepiandrosterone (β-coefficient 3·39, 95% CI 0·65 to 6·03) and androstenedione (4·81, 0·16 to 9·12), and negatively with SHBG (-5.74, -9.54 to -1·90), each model explaining less than 4% of the variation in desire. Testosterone (6·00, 1·29 to 10·94) and androstenedione (6·05, 0·70 to 11·51) were significantly associated with orgasm, with the final models explaining less than 1% of the variation in orgasm. Significant associations were found between androstenedione (7·32, 0·93 to 13·08) and dehydroepiandrosterone (4·44, 0·86 to 7·95) and pleasure, and between testosterone and sexual self-image 5·87 (1·27 to 10·61), with inclusion of parity, partners status, and psychotropic drug use increasing the proportion of variation explained by each model to approximately 10%. There were no statistically significant associations between 11-oxygenated steroids and any PFSF domain, or between arousal or responsiveness and any hormone. No associations were seen between 11-oxygenated steroids and any sexual domain, or between arousal or responsiveness and any hormone. Associations between androgens and sexual function in premenopausal women are small, and their measurement offers no diagnostic use in this context. Further research to determine whether 11-ketoandrostenedione or 11-ketotestosterone are of clinical significance is warranted. The Grollo-Ruzzene Foundation.

Understanding Sexual Help-Seeking for Women With Breast Cancer: What Distinguishes Women Who Seek Help From Those Who Do Not?

BackgroundSexual problems are extremely common for women after breast cancer (BC). AimTo determine, in a sample of BC outpatients, how commonly women sought help for sexual concerns, from a health care provider (HCP), from other individuals, or from alternate sources; and to examine whether help-seeking was associated with women's sexual function/activity, self-efficacy for clinical communication about sexual health, or sociodemographic/medical characteristics. MethodsBC patients participating in a sexual/menopausal health communication intervention trial completed web-based baseline self-report surveys. One-way analysis of variances compared effects of the level of sexual help-seeking (none; 1 outlet; 2–3 outlets) on sexual function domains. Chi-square or t-tests compared women seeking help with those not seeking help on other study variables. Main Outcome MeasuresPatient-reported outcome instruments assessed sexual help-seeking (past month), sexual function and activity (PROMIS Sexual Function and Satisfaction Brief Profile Version 2.0), and self-efficacy (confidence) for communicating with their BC clinician about sexual health. Results144 women (mean age = 56.0 years; 62% partnered; 67% white; 27% black/African American; 4% Hispanic/Latina; 15% stage IV) participated in this study. 49% of women sought help for sexual concerns, most often from intimate partners, family and/or friends (42%), followed by HCPs (24%), or online/print materials (19%); very few women (n = 4; 3%) sought help only from a HCP. Women seeking help were younger and more likely to be partnered and sexually active than those not seeking help. Sexual function was impaired for all domains but was most impaired for sexual interest. Among sexually active women, those seeking help from 2 to 3 sources reported worse sexual function in certain domains (sexual interest, lubrication, vaginal discomfort, vulvar discomfort–labial, satisfaction). Women seeking help from outlets other than HCPs had significantly lower self-efficacy than those who did not. Clinical ImplicationsBC patients with access to a partner and who are sexually active but find sex unsatisfying, uncomfortable, or lack interest may be in particular need of sexual help. Further, women may turn to outlets other than HCPs for sexual help partly because they lack the confidence to do so with a HCP. Sexual health information should be made available to women's partners, family, and friends, so they may effectively discuss such issues if needed. Strengths & LimitationsStrengths of the study included examination of a range of sexual function domains and a theoretical construct in relation to BC patients' sexual help-seeking and a medically diverse sample. Limitations include a cross-sectional design. ConclusionWomen treated for BC should receive accurate and timely sexual health information.Reese JB, Sorice KA, Pollard W, et al. Understanding Sexual Help-Seeking for Women With Breast Cancer: What Distinguishes Women Who Seek Help From Those Who Do Not? J Sex Med 2020;17:1729–1739.

Sexual Functioning and Satisfaction Among College Survivors of Sexual Violence: Examining PTSD Symptoms and Sexual Schemas.

Decreased sexual functioning is prevalent among female survivors of sexual violence yet psychological factors that contribute to sexual impairments in this population are understudied. To extend research in this area, the current study examined two psychological factors as they relate to sexual functioning concerns among 148 female survivors of sexual violence: severity of posttraumatic stress symptoms (PTSSs) and sexual self-schemas. Four domains of sexual functioning were examined: sexual desire, sexual arousal, sexual satisfaction, and orgasm functioning. It was predicted that PTSSs would be associated with a more negative sexual schema, which in turn, would be associated with decreased sexual functioning across the four domains. Using path analysis, PTSSs were found to be indirectly associated with decreased sexual satisfaction (b = -.08, SEb = .04, p = .035), sexual arousal (b = -.01, SEb = .001, p = .02), and reduced orgasm functioning (b = -.01, SEb = .001, p = .002). Results also supported significant direct paths from PTSS to all sexual functioning variables. These results support that negative sexual self-schemas may be relevant to the co-association of PTSSs and reductions in sexual functioning and satisfaction.

A Pilot Study Assessing Aspects of Sexual Function Predicted to Be Important After Treatment for Prostate Cancer in Gay Men: An Underserved Domain Highlighted.

Purpose: Existing questionnaires assessing sexual function after prostate cancer (PCa) were developed in predominantly heterosexual male cohorts and may measure function incompletely in gay men. We sought to determine if there are sexual function domains relevant to gay men that are not captured by the Expanded Prostate Cancer Index Composite (EPIC) sexual function assessment. Methods: Fifty-three gay men with PCa responded to an online survey regarding the applicability of the sexual function domain in the validated EPIC questionnaire. They were then queried about whether the prostate is a source of sexual pleasure and the importance of measuring sexual satisfaction as it relates to receptive anal intercourse. Results: A majority of gay men with PCa found the EPIC sexual function tool to be applicable when measuring erectile function (76.5%). Of the men queried, 64.2% felt that the prostate is a source of sexual pleasure and 52.8% felt it important to measure sexual satisfaction associated with receptive anal intercourse. A larger proportion of gay men who engaged in receptive anal intercourse, compared with those who did not engage in receptive anal intercourse, felt that the prostate is a source of sexual pleasure (100% vs. 57.1%), and thought it important to measure sexual satisfaction as it relates to receptive anal intercourse after PCa treatment (90.0% vs. 45.2%). Conclusions: Our findings highlight the need to create a validated questionnaire to measure sexual satisfaction from receptive anal intercourse to help care for men engaging in receptive anal intercourse after PCa treatment.

Study of sexual dysfunction among females with COC versus Intrauterine Hormonal device

Background: Sexuality in females is a multidimensional issue of psychological, physiological and cultural components. Evaluation of sexual partner, intimate relationships, and past abusive relationships or sexual trauma is crucial in female sexual dysfunction (FSD). Aim of the work: The present study was designed to evaluate the sexual dysfunction among female using combined oral contraception and a hormone releasing intra-uterine device [IUD] as a method of contraception. Patients and Methods:This was observational study which was conducted on 80 women to show the effect of contraception on sexual dysfunctions from February 2019 to last of August 2019. This study includes two groups; Group I: 40 women on combined oral contraceptives [COC] and group II: 40 women on hormonal intrauterine device. All females had been assessed for different domains of sexual function by Female Sexual Function Index [FSFI] questionnaire. Results: Age, parity and body mass index were comparable between both groups; group I [COC] and group II [IDU]. On the other side, females on COC had lower sexual function index (49.4±4.15) than women with hormonal IUD (67.27±6.88). These results confirmed on nearly all domains of FSFI. Thus, sexual dysfunction is significantly higher among COC group. Conclusion: Intrauterine hormonal device contraception is better than combined oral contraception (COC) which has little side effect and has better results on sexual desire, arousal, lubrication and satisfaction in addition to little effect on sexual pain than combined oral contraception.

S234. DEPRESSION AND SEXUAL FUNCTIONING: TWO NEGLECTED AND PREVALENT DOMAINS IN PEOPLE WITH SCHIZOPHRENIA

BackgroundSexual function is highly neglected in individuals with schizophrenia (SZ). Clinicians usually underestimate the rates of sexual dysfunctions in these patients, and this group does not spontaneously complain about it.Sexual dysfunction in this population could reach up to 80% and its known to affect all domains of sexual function. Moreover, it may be linked to stigma and discrimination factors.Medication side effects on sexuality concern more than any other side effects, and it is known to be a major cause of poor quality of life and non-adherence to medication.Furthermore, the relationship between sexual dysfunction and other psychiatric symptoms in SZ is still unclear.Our aim was to describe the sexual dysfunction in chronic patients with SZ and its relation to negative, positive and depressive symptoms.MethodsA convenience and exploratory sample of 57 patients (age 43.75±10.38, 69% men, 86,2% single) were recruited from an university outpatient schizophrenia clinic, in Porto Alegre – Brazil. Participants were assessed using Arizona Sexual Experience Scale (ASEX), Medication Adherence Rating Scale (MARS), Positive and Negative Syndrome Scale (PANSS), Calgary Depression Inventory and demographic information.Sexual dysfunction was considered following the ASEX scoring criteria.ResultsSexual dysfunction was present in 51,8% of the patients, assessed by ASEX. Women showed increased sexual dysfunction than men (χ2=22,727, p < .001). There were no differences between patients that reported sexual dysfunction and the ones who did not regarding age, duration of illness and medication adherence assessed by MARS (p > .05). Additionally, there were no differences between groups on positive and negative symptoms assessed by PANSS.Interestingly, patients with sexual dysfunction had increased depressive symptoms compared to patients with a good perceived sexual function (t(54) = -3.326, p = .002). Calgary total scores were positively correlated with ASEX total scores (r = .369, p = .005).Nevertheless, we did not find significant correlations between ASEX total scores and other scales. Scores found on MARS (8.07±1.5) suggest that this sample is highly adherent to prescribed treatment.DiscussionThis is an exploratory and preliminary study that shows and reinforces the idea that sexual dysfunction is importantly prevalent and remains as a neglected issue in individuals with schizophrenia, as are the depressive symptoms. We showed that there is an association between these two domains, which might indicate a need for change of perspective for the pharmacological and psychosocial approaches currently used.In addition to the dopaminergic blockage by antipsychotics that lead to reduction in positive symptoms, we believe there is a need to look for depression symptoms to access, prevent and treat sexual dysfunction. Inattention to this event may result in abrupt treatment discontinuation and relapse.Curiously, the fact that we did not find any correlations between sexual evaluations and PANSS scores would suggest that sexual dysfunction in chronic patients could differ from others stages of the disease. The size of our sample and the fact that we did not access hormones and prolactin levels are important limitations of this study. However this is an exploratory study that provided clues on the subject, allowing to address further investigation taking into account the limitations.

PCN33 HEALTH RELATED QUALITY OF LIFE AMONG BREAST CANCER PATIENTS UNDERGOING ADJUVANT CHEMOTHERAPY AT A TERTIARY HEALTH FACILITY: A CROSS SECTIONAL STUDY

Breast cancer is the second most prevalent, cause for mortality and third most incident cancer among women in Zimbabwe. The clinical effects of breast cancer and its treatment are clearly reported as clinical outcomes. However, the disease condition and its treatment have an impact on the quality of life of an individual. This study therefore aimed to estimate the health-related quality of life (HRQoL) scores among breast cancer patients. The other objective of the study was to explore the determinants of health-related quality of life. A cross-sectional study was carried out at Parirenyatwa Hospital, to assess HRQoL and its correlates. The English and Shona versions of the European Organization for Research and Treatment of Cancer QLQ-C30 (version 3) and its disease specific complementary BR-23 tool were used. Multivariable linear regression was applied to identify the demographic and clinical predictors of HRQoL. A total of 63 participants, with a mean age of 45 consented to take part in the study. The overall global quality of life score (GQoL) was 52.51±11.93. Participants reported high functional scores in physical functioning (65.4±17.9), emotional functioning (73.4±11.6) and cognitive functioning (60.1±24.7) and very low scores in role functioning (33.0±19.5), social functioning (40.6±29.8) and sexual functioning (24.6±25.5). Participants also reported challenges with pain and fatigue on the symptom scale. The participants reported moderate GQol scores which indicate moderate success in the breast cancer management programs. However more effort is needed in the role, social and sexual functioning domains.

Interferential current: a new option for the treatment of sexual complaints in women with premature ovarian insufficiency using systemic hormone therapy: a randomized clinical trial

The aim of the study was to evaluate the efficacy of interferential current (IC) in the sexual function of women with premature ovarian insufficiency (POI) using systemic hormone therapy (HT), compared to topical estriol. A randomized clinical trial with 40 women with POI using systemic HT, who were sexually active and referred for dyspareunia and reduction of lubrication. The women were divided into two treatment groups for 4 weeks: IC group (eight electrotherapy sessions twice a week); or E group (estriol vaginal cream, daily application, 0.5 mg/d). The Female Sexual Function Index was used to evaluate pre-/posttreatment sexual function. Mean age was 37.13 ± 7.27 years and mean treatment time with HT was 8.20 ± 8.73 years, similar data for both groups. There was an improvement in global sexual function, lubrication, and pain domains for both treatments. The differences between the pre-/posttreatment lubrication scores were respectively 0.75 ± 3.31 (P = 0.014) for IC and 1.16 ± 1.22 (P < 0.001) for estriol, whereas for dyspareunia the differences were 1.00 ± 1.47 (P = 0.005) for IC, and 0.68 ± 1.30 (P = 0.006) for estriol. There was no pre-/posttreatment difference for the desire and arousal domains. Only in the IC group did orgasm (difference 0.90 ± 1.42, P = 0.010) and satisfaction improve (difference 0.70 ± 1.28, P = 0.021). The use of perineal IC seems to be a new option for women with POI using systemic HT and presenting with sexual complaints, leading to an improvement in pain, lubrication, satisfaction, and orgasm.

Sexual function after voluntary medical male circumcision for human immunodeficiency virus prevention: Results from a programmatic delivery setting in Botswana

BackgroundUptake of voluntary medical male circumcision (VMMC) remains modest in Botswana in spite of the government’s commitment and service provision availability. Data on sexual function post-VMMC in programmatic settings could help guide messaging tailored to Botswana.ObjectivesAt 3-month post-VMMC, we evaluated changes in sexual function and satisfaction with the VMMC procedure amongst a cohort of HIV-negative, sexually active men aged 18–49 years who underwent VMMC in a public-sector clinic in Botswana.MethodsWe assessed whether each of the following domains of sexual function had improved, stayed the same or worsened since VMMC: sexual desire, ability to use condoms, ease of vaginal penetration, ease of ejaculation, ability to achieve and maintain an erection and hygiene or cleanliness.ResultsData on sexual function were available for 378 men at 3-month post-VMMC. Median age was 27 years – 54% had a higher than secondary education, 72% were employed and 27% were married. Nearly all (96%) the men reported improvement in at least one domain of sexual function, while 19% reported improvement in all six domains. One-fourth (91/378, 24%) of the men reported that at least one domain of sexual function worsened post-VMMC. The most frequently reported domain that worsened was sexual desire (11%); in all other domains, < 10% of the men reported worsening. Men who reported any worsening sexual function were 2.3-fold as likely to be less than ‘very satisfied’ with the VMMC procedure (risk ratio 2.36, 95% confidence interval [CI] 1.66–3.34, p < 0.001).ConclusionEmphasising improved sexual function experienced after VMMC in demand-creation efforts could potentially increase VMMC uptake in Botswana.

The Non-Motor Symptom Profile of Progressive Supranuclear Palsy.

ObjectiveNon-motor symptoms (NMSs) significantly contribute to increased morbidity and poor quality of life in patients with parkinsonian disorders. This study aims to explore the profile of NMSs in patients with progressive supranuclear palsy (PSP) using the validated Non-Motor Symptom Scale (NMSS).MethodsSeventy-six patients with PSP were evaluated in this study. Motor symptoms and NMSs were evaluated using the PSP Rating Scale (PSPRS), Unified Parkinson’s Disease Rating Scale-III, Montreal Cognitive Assessment, Hamilton Depression (HAM-D) and Anxiety Rating Scales, Parkinson’s Disease Sleep Scale (PDSS) and NMSS. NMS severity and prevalence were also compared between patients with PSP-Richardson syndrome (PSP-RS) and those with PSP-parkinsonism.ResultsAll subjects in this cohort reported at least 2 NMSs. The most prevalent NMSs in patients with PSP were in the domains of sleep/fatigue, mood/cognition, and sexual function. The least prevalent NMSs were in the domains of cardiovascular including falls, and perceptual problems/hallucinations. Significant correlations were observed between the NMSS scores and HAM-D, PDSS, PSPRS scores and PSPRS sub-scores. The severity of NMSs was unrelated to the duration of illness. Patients with PSP-RS reported a higher severity of drooling, altered smell/taste, depression and altered interest in sex and a higher prevalence of sexual dysfunction.ConclusionNMSs are commonly observed in patients with PSP, and the domains of sleep, mood and sexual function are most commonly affected. These symptoms contribute significantly to disease morbidity, and clinicians should pay adequate attention to identifying and addressing these symptoms.

MP59-02 THE EFFECT OF RENAL TRANSPLANTATION ON FEMALE SEXUAL FUNCTION

INTRODUCTION AND OBJECTIVE: Chronic renal failure (CRF) and renal replacement therapy have a negative impact on female sexual function (FSF). The available data on FSF after renal transplantation (RTx) is limited with no clear evidence of the real impact of RTx on sexual function. The objective is to evaluate FSF after RTx and compare the data to age-matched normal females (control). METHODS: The study was conducted between January 2018 and June 2019. We assessed FSF in RTx married, sexually active in child-bearing period (20-45 years) females and passed at least six months of follow-up post RTx and had normally functioning graft. Sexual function was evaluated with a detailed 19-item questionnaire (The Female Sexual Function Index, FSFI). The questionnaire consists of six domains assessing sexual desire, arousal, lubrication, orgasm, satisfaction and pain. All domains are summed to give total score. The higher the score, the better the sexual function domain. We compared the mean scores of all domains of FSFI to an age-matched sexually active married normal females using independent sample t test. In female transplant recipients married before RTx, we compared the current FSFI to the pre-transplant values using paired sample t test. RESULTS: The study included 100 RTx females (54 were married before RTx) with a mean ±SD age of 32.8±7.9 years with a median (range) follow-up of 102 (12-312) months. The causes of CRF were unknown, glomerulonephritis, lupus nephritis, toxemia of pregnancy, stone disease and neuropathic bladder in 58, 18, 4, 8, 6 and 6, respectively. Eighty three were maintained on hemodialysis for a median (range) of 16 (93-84) months before RTx. They compared to a 37 age-matched normal females with a mean± SD age of 34±6.6 years (p=0.4). RTx females showed statistically significant lower sexual desire (p <0.001), arousal ( p=0.01) and total score (p=0.03) in comparison to control with no statistically significant difference in other domains (p>0.05). In comparison to pre-RTx values, all showed statistically significant improvement of total FSFI (20.7±5.5 vs. 27.8±3.1, P<0.001) and all domains except pain. (Figure 1)Figure 1: comparison of FSFI domains before and post renal transplantation span> CONCLUSIONS: Successful RTx may improve female sexual function. Yet, FSF after RTx remains lower compared to healthy control.Source of Funding: no funding

MP53-06 RADIOTHERAPY AFTER RADICAL PROSTATECTOMY: EFFECT OF TIMING OF POST-PROSTATECTOMY RADIATION ON FUNCTIONAL OUTCOMES

You have accessJournal of UrologyProstate Cancer: Localized: Radiation Therapy (MP53)1 Apr 2020MP53-06 RADIOTHERAPY AFTER RADICAL PROSTATECTOMY: EFFECT OF TIMING OF POST-PROSTATECTOMY RADIATION ON FUNCTIONAL OUTCOMES Heather Huelster*, Aaron Laviana, Daniel Joyce, Tatsuki Koyama, Zhiguo Zhao, Li-Ching Huang, Karen Hoffman, Ralph Conwill, David Penson, and Daniel Barocas Heather Huelster*Heather Huelster* More articles by this author , Aaron LavianaAaron Laviana More articles by this author , Daniel JoyceDaniel Joyce More articles by this author , Tatsuki KoyamaTatsuki Koyama More articles by this author , Zhiguo ZhaoZhiguo Zhao More articles by this author , Li-Ching HuangLi-Ching Huang More articles by this author , Karen HoffmanKaren Hoffman More articles by this author , Ralph ConwillRalph Conwill More articles by this author , David PensonDavid Penson More articles by this author , and Daniel BarocasDaniel Barocas More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000915.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The timing of radiation after prostatectomy is controversial, and its effect on patient-reported sexual, urinary, and bowel function is unknown. This study seeks to compare outcomes after radical prostatectomy (RP) and post-prostatectomy radiation as well as elucidate the timing of radiation to allow optimal recovery of function. METHODS: The Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study is a prospective, population-based study of men with localized prostate cancer. Patient-reported functional outcomes were measured using the 26-item Expanded Prostate Index Composite (EPIC-26) at baseline and 6, 12, 36, and 60 months after enrollment. Functional outcomes were compared using multivariable models controlling for baseline demographic and clinical characteristics. RESULTS: Among 1482 CEASAR participants initially treated with RP for clinically localized prostate cancer, 11.5% (N=170) received adjuvant (N=57) or salvage (N=113) external beam radiotherapy. Men who received post-RP radiotherapy had worse scores in all domains compared to RP alone at 5 years of follow up. Compared to men treated with RP alone in an adjusted linear model, salvage radiation was associated with significantly worse domain scores for sexual function (-11.1, 95%CI [-17.0, - 5.3], p<0.001), incontinence (-7.6, [-13.6, -1.6], p=0.014), urinary irritation (-6.1, [-9.7, -2.4], p=0.001), bowel function (-4.5, [-7.4, -1.7], p=0.002), and hormonal function (-3.3, [-6.0, -0.6], p=0.017). Adjuvant radiation was associated with significantly worse incontinence (-11.9, [-20.7, -3.1], p=0.008), urinary irritation (-5.9, [-11.2, -0.6], p=0.030), and hormonal function (-7.3, [-13.6, -1.0], p=0.023) domain scores compared to RP alone at 5 years of follow up. On multivariable regression analysis, radiotherapy administered at 24 months after RP was associated with the smallest decline in sexual domain score, with an adjusted mean difference of -5.3 points (p=0.016) from post-RP baseline. CONCLUSIONS: In men with localized prostate cancer, post-prostatectomy radiation was associated with significantly worse EPIC-26 sexual, urinary, and bowel function domain scores at 5 years compared to RP alone. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e783-e784 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Heather Huelster* More articles by this author Aaron Laviana More articles by this author Daniel Joyce More articles by this author Tatsuki Koyama More articles by this author Zhiguo Zhao More articles by this author Li-Ching Huang More articles by this author Karen Hoffman More articles by this author Ralph Conwill More articles by this author David Penson More articles by this author Daniel Barocas More articles by this author Expand All Advertisement PDF downloadLoading ...

MP53-17 PATIENT-REPORTED OUTCOMES AFTER PROSTATE ONLY VS PROSTATE AND PELVIC LYMPH NODE RADIATION THERAPY

You have accessJournal of UrologyProstate Cancer: Localized: Radiation Therapy (MP53)1 Apr 2020MP53-17 PATIENT-REPORTED OUTCOMES AFTER PROSTATE ONLY VS PROSTATE AND PELVIC LYMPH NODE RADIATION THERAPY Matthew Parry*, Julie Nossiter, Thomas Cowling, Arunan Sujenthiran, Brendan Berry, Paul Cathcart, Noel Clarke, Heather Payne, Jan van der Meulen, and Ajay Aggarwal Matthew Parry*Matthew Parry* More articles by this author , Julie NossiterJulie Nossiter More articles by this author , Thomas CowlingThomas Cowling More articles by this author , Arunan SujenthiranArunan Sujenthiran More articles by this author , Brendan BerryBrendan Berry More articles by this author , Paul CathcartPaul Cathcart More articles by this author , Noel ClarkeNoel Clarke More articles by this author , Heather PayneHeather Payne More articles by this author , Jan van der MeulenJan van der Meulen More articles by this author , and Ajay AggarwalAjay Aggarwal More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000915.017AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Little is known about the toxicity of pelvic lymph node (PLN) irradiation following intensity-modulated radiation therapy (IMRT) for the treatment of men with high-risk prostate cancer. We aimed to compare patient-reported outcomes of IMRT to the prostate and the pelvic lymph nodes (PPLN-IMRT) compared to prostate only IMRT (PO-IMRT). METHODS: Patients diagnosed with high-risk or locally advanced prostate cancer in the English National Health Service, between April 2014 and September 2016, and treated with IMRT were identified from the National Prostate Cancer Audit. Men were mailed a questionnaire 18 months after diagnosis. Patient-reported sexual, urinary, bowel and hormonal function domains using the EPIC-26, and generic health-related quality of life (HRQoL) using EQ-5D-5L, were collected from patient surveys. Comparator groups (PPLN-IMRT versus PO-IMRT) were compared using linear regression, adjusting for baseline patient, tumour and treatment characteristics. RESULTS: Of the 5468 men (78%) who responded to the patient survey, 4196 (77%) received PO-IMRT and 1272 (23%) received PPLN-IMRT. Adjusted mean scores for urinary, bowel, and hormonal EPIC-26 domains, and HRQoL were similar irrespective of the treatment region. Patients receiving PPLN-IMRT reported worse sexual function than those receiving PO-IMRT (-2.26 adjusted mean difference on a 0-100 scale; 95% CI: -3.66 to -0.86, P =0.002) but this was not a clinically meaningful difference. CONCLUSIONS: PPLN-IMRT is not associated with clinically important differences in patient-reported toxicity for men with high-risk or locally advanced prostate cancer. Results from ongoing trials will provide further insight into the anti-cancer effectiveness of PLN irradiation. Source of Funding: M.G.P. was supported by a Doctoral Research Fellowship from the NHS National Institute for Health Research (DRF-2018-11-ST2-036). T.E.C. was supported by the Medical Research Council (MR/S020470/1). B.B. was partly supported by the NHS National Institute for Health Research through an Academic Clinical Fellowship. H.P. was supported by the University College London Hospitals/University College London Comprehensive Biomedical Research Centre. J.v.d.M. was partly supported by the NIHR Collaboration for Leadership in Applied Health Research and Care North Thames at Bart’s Health NHS Trust. The views expressed in this article are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e789-e789 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Parry* More articles by this author Julie Nossiter More articles by this author Thomas Cowling More articles by this author Arunan Sujenthiran More articles by this author Brendan Berry More articles by this author Paul Cathcart More articles by this author Noel Clarke More articles by this author Heather Payne More articles by this author Jan van der Meulen More articles by this author Ajay Aggarwal More articles by this author Expand All Advertisement PDF downloadLoading ...

The Impact of Oxytocin Vaginal Gel on Sexual Function in Postmenopausal Women: A Randomized Controlled Trial

Many postmenopausal women suffer from sexual dysfunction mostly due to the vulvovaginal atrophy. The aim of this study was to assess the effect of vaginal oxytocin gel on sexual function of postmenopausal women. This study was conducted on 96 postmenopausal women with symptoms of vaginal atrophy and sexual dysfunction who were randomly recruited into two groups of oxytocin vaginal gel (400 IU, n = 48) or placebo (n = 48). The PH, vaginal maturation index, and sexual function (using Female Sexual Function Index) of the participants were measured at the beginning of the study and eight weeks later. The vaginal maturation index and the PH of the vagina improved in the oxytocin group compared to those of the placebo. All domains of sexual function including desire, arousal, lubrication, pain, sexual satisfaction, and total score of sexual function improved significantly in the oxytocin gel compared to the control group (p < 0.0001). The results of this study showed that the administration of oxytocin vaginal gel could significantly improve vaginal atrophy as well as sexual function in postmenopausal women. Therefore, using vaginal oxytocin gel for sexual dysfunction in postmenopausal women who are not interested in hormone therapy is recommended.