Female Sexual Distress Scale-Revised Research Articles

Sexual health of women using combined oral contraceptive containing estetrol and drospirenone: A prospective observational study

Aim. To evaluate the effect of a combined oral contraceptive (COC) containing estetrol and drospirenone on the sexual function of women using it. Materials and methods. A total of 251 women aged 21–35 years (mean age, 25.30±2.82 years) referred for contraceptive fitting were included in the study (ICD-10: Z30.0 General contraceptive advice and counseling, Z30.4 Contraceptive drug monitoring). Women in the study cohort used the original formulation containing 15 mg estetrol and 3 mg drospirenone in a 24+4 regimen for contraceptive purposes, according to the current instructions. All female participants (n=251) were assessed for sexual function at baseline, 6 and 12 months using FSFI (The Female Sexual Function Index), FSDS-R (The Female Sexual Distress Scale-Revised) and SQoL-F (The Sexual Quality of Life-Female) scales. Study design. An open, independent, prospective observational study. Results. Women taking COC containing estetrol 15 mg and drospirenone 3 mg maintained a baseline high level of sexual satisfaction (p0.05) throughout the study, as assessed by FSFI, SQoL-F and FSDS-R scales. Conclusion. The results obtained indicate that there is no negative effect of COC containing 15 mg estetrol and 3 mg drospirenonone on the sexual function of women. High contraceptive efficacy of the drug was confirmed.

Effects of Dermal Fillers on Vaginal Laxity and Female Sexual Function: A Minimally Invasive Procedure for Vaginal Rejuvenation

Introduction: For improving vaginal rejuvenation and minimizing vaginal laxity, the increased demand for soft tissue fillers may give females seeking such therapies the chance to have better general health and sexual performance. To address a wider range of female health issues, and support a more all-encompassing approach to personal wellbeing as cosmetic treatments improve, it is crucial to research the possible repercussions of these minimally invasive operations. Methodology: The strength of pelvic floor muscles was measured using the Laborie Peritron 9300 (Portsmouth, New Hampshire, USA) perineometer. A 110 mm long conical vaginal probe with a 26 mm diameter, that may extend to 33 mm under pressure, is a characteristic of this device. The vaginal probe is connected to the perineometer’s main body by an 80 cm plastic tubing. When the probe is squeezed, the gadget has a pressure sensor that tracks vaginal pressure. A silicone rubber sensor loaded with air is included into the probe itself, to detect pressure in cmH2O. The Female Sexual Distress Scale-Revised (FSDS-R) was used to measure the participants’ degrees of sexual distress, and this method made it easier to gauge the participants’ pelvic floor muscle strength. Results: The participants’ mean age was 39.43±2.12 years, and further demographic characteristics provided evidence that 44% of the participants were married for 10 years and had children; 36% were married for 5 years with no children; and 20% had been married for less than 5 years. Conclusion: Soft tissue fillers, which have shown a rise in popularity, are a viable means of resolving issues with vaginal elasticity and rejuvenation.

Efficacy of in-office lysis of clitoral adhesions with excision of keratin pearls on clitoral pain and sexual function: a pre-post interventional study.

Keratin pearls are foci of central keratinization within concentric layers of squamous cells that can form under the clitoral prepuce and cause pain (clitorodynia); in-office removal of keratin pearls may reduce clitoral pain and improve sexual function. This study aims to investigate clitoral pain and sexual function in women with partial clitoral phimosis and keratin pearls before and after in-office lysis of clitoral adhesions with keratin pearl excision (LCA-KPE). A pre-post interventional study evaluated patients who underwent LCA-KPE between January 2017 and February 2023 in 2 metropolitan gynecology clinics specializing in vulvar pain. Patients presenting with keratin pearls and partial clitoral phimosis identified through retrospective chart review were asked to complete postprocedure questionnaires and provide subjective responses on clitoral discomfort, sexual function, sexual distress, and their experience with in-office LCA-KPE. Bivariate analyses with paired t tests were conducted to determine the effect of LCA-KPE. Qualitative data were analyzed with thematic coding. An 11-point pain visual analog scale was utilized to determine pre- and postprocedure clitoral discomfort and difficulty with orgasm. Female sexual dysfunction was measured with the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised. A total of 32 of 74 patients who met inclusion criteria completed postprocedure surveys (43% response rate). Mean clitoral pain for respondents was 6.91 at baseline and 2.50 after LCA-KPE (P < .001). Mean difficulty with orgasm was significantly decreased from 5.45 at baseline to 3.13 after LCA-KPE (P < .001). Participants had a mean FSFI total score of 17.68 after treatment compared with a mean total baseline FSFI of 12.12 (P = .017). The mean FSFI score for pain was 2.43 at follow-up compared with 1.37 at baseline (P = .049). There was no significant difference in the mean Female Sexual Distress Scale-Revised score before vs after the procedure (P = .27). Qualitative themes described the procedure as painful but worthwhile, with 77% of participants reporting the overall experience as positive. Recurrence rate overall was 28%, with a median of 2 repeat procedures. Recognizing keratin pearls as a structural cause of clitoral pain and offering in-office treatment is an important tool in addressing clitorodynia and improving sexual function. This is the largest study to date documenting the occurrence, identifying associated pain conditions, and evaluating procedural outcomes for clitoral keratin pearls. This study was limited by a relatively small sample size. In-office LCA-KPE significantly reduced clitoral discomfort and difficulty with orgasm.

Vulvovaginal atrophy in women with and without a history of breast cancer: Baseline data from the PatiEnt satisfactiON studY (PEONY) in Italy

ObjectivesTo assess clinical characteristics of postmenopausal women with moderate/severe vulvovaginal atrophy, as well as its impact on sexual function, well-being, and quality of life, and to provide an overview of most used treatments. Study designOngoing longitudinal, observational study conducted in 17 Italian gynecology centers, involving women already treated or initiating a local vaginal estrogen therapy or ospemifene. We report baseline data for women with and without a history of breast cancer. Participants filled in self-reported questionnaires at study entry. Main outcome measuresSeverity of vulvovaginal atrophy; ongoing treatments; patient-reported outcomes, including severity of symptoms, Day-to-Day Impact of Vaginal Aging (DIVA), Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), and SF-12® Health Survey. ResultsOverall, 334 women (20.4 % with a history of breast cancer) started or continued local therapy (61.1 %) or ospemifene (38.8 %) at study entry. Vulvovaginal atrophy was severe in 28.6 %, and was responsible for severe symptoms, particularly vulvar dryness with burning or irritation and pain during sexual intercourse. Both sexual dysfunction (FSFI≤26) (81.5 %) and sexual distress (FSDS-R ≥ 11) (74.4 %) were common. A reduction in the SF-12 mental component score was documented. Women with breast cancer more often had severe vulvovaginal atrophy (41.2 %), had more severe symptoms, and the impact of vaginal symptoms on emotional well-being, sexual functioning and self-concept/body image was greater. The majority of them (83.8 %) received ospemifene as a treatment. ConclusionsModerate/severe vulvovaginal atrophy is a common, often neglected condition with an impact on QoL and sexuality, particularly in women with a history of breast cancer. It is important to alleviate the burden associated with the disease.

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.

Factors associated with fertility intention among women with systemic lupus erythematosus in China: A cross-sectional study.

This study aims to explore the status and influencing factors of fertility intention in women of childbearing age with systemic lupus erythematosus (SLE). A total of 158 SLE patients admitted to the Affiliated Hospital of Nantong University from February 2021 to February 2022 were selected for a cross-sectional study. The dependent variable in this study was the fertility intention of lupus women of childbearing age, so the questionnaire was selected: "In view of your disease, do you plan to have children? Yes/no" as the measurement statement. Lupus patients were divided into fertility intention groups and non-fertility intention groups. The questionnaire survey comprises following scales: Hospital Anxiety and Depression Scale (HADS), Multidimensional Fatigue Inventory (MFI-20), Female Sexual Distress Scale-Revised (FSDS-R), and others. Independent t-test, one-way ANOVA, Mann-Whitney U test, and binary logistic regression were used for analysis. The results showed that 20.9% of lupus patients in this study had a fertility intention. The fertility intention was associated with age, reproductive history, reproductive concerns, sexual distress, fatigue, family function, social support, depression, and sleep. Binary logistic regression showed that physical fatigue (OR 3.56, 95% CI 1.048-12.07) and personal health (OR 2.50, 95% CI 1.065-5.853) had significant predictors of fertility intention. Our study identified a lower fertility intention in SLE patients who had reproductive concerns, sexual distress, family dysfunction, and fatigue. We encourage healthcare institutions to provide counseling services to all the SLE patients who have fertility intention and focus more on those who have requirements for fertility.

The effect of emotional regulation difficulties on sexual and psychological distress using repetitive negative thinking as a mediator.

Sexual distress, a determinant factor in diagnosing sexual dysfunction, plays a significant role in individuals' sexual well-being, yet it has been overlooked in research. This exploratory study adopted a transdiagnostic approach to sexual distress and sought to examine the association between emotional regulation difficulties and sexual and psychological distress, with repetitive negative thinking as a potential mediator. We used a quantitative cross-sectional design with a sample of 509 partnered individuals. The survey included a sociodemographic questionnaire, the Difficulties in Emotion Regulation Scale-Short Form, the Kessler Psychological Distress Scale, the Persistent and Intrusive Negative Thoughts Scale, and the Female Sexual Distress Scale-Revised. Correlational analysis revealed significant associations among emotional regulation difficulties, repetitive negative thinking, psychological distress, and sexual distress. Furthermore, a mediation model demonstrated that repetitive negative thinking significantly mediated emotion dysregulation and psychological and sexual distress. These findings underscore the importance of considering emotion regulation difficulties and repetitive negative thinking as a maladaptive coping strategy when evaluating sexual distress and suggest that therapeutic interventions targeting such difficulties and thoughts may yield beneficial outcomes. These findings reinforce the importance of considering the role of emotional regulation difficulties and, consequently, repetitive negative thinking as a dysfunctional coping strategy, when studying and intervening in sexual distress. Future research with clinical samples should be developed to establish better the significance of considering these two dimensions in assessment and therapeutic intervention. Future research should corroborate and expand upon these findings to advance our understanding of sexual distress and optimize interventions in this domain.

Prevalence and predictors of sexual distress in married reproductive-age women: A cross-sectional study from Iran.

Although various surveys have been conducted for sexual problems, there is a lack of population-based studies on sexual distress in Iran. Thus, we sought to determine the prevalence and predictive factors of sexual distress in this population. Overall, 1000 married women aged 16-49 years were enrolled in this study using the two-stage cluster sampling method. To identify sexual distress, the female sexual distress scale-revised (FSDS-R) was completed. The predictive factors were assessed using a checklist. A total of 318 women (31.8%) suffered from sexual distress. Among socio-demographic factors, satisfaction with marriage (p = 0.001), among personal factors history of infertility and fear of contracting sexually transmitted infections (p < 0.01), and among sexual and interpersonal factors satisfaction with the level of sexual desire (p = 0.01), pain during sexual intercourse (p < 0.01), premature ejaculation disorders in the partner (p < 0.05), and sexual satisfaction (p < 0.001) were significantly associated with sexual distress. Clinicians should evaluate sexual distress comprehensively and consider all the related dimensions. The high overall prevalence of sexual distress, with or without an identifiable dysfunction, signals the importance of health professionals being adequately prepared to discuss sexual health concerns.

Long-term consequences of juvenile vulvar lichen sclerosus: Acohort study of adults with a histologically confirmed diagnosis in childhood or adolescence.

Vulvar lichen sclerosus (VLS) occurs in at least one in 900 girls. There is limited knowledge as to what extent the disease persists in adulthood and what the repercussions in adulthood may be. The aim of this study is to evaluate the long-term consequences of VLS diagnosed in childhood or adolescence. The population of females histologically diagnosed with VLS in childhood or adolescence in the Netherlands between 1991 and 2015 was identified through the national pathology database. Histological specimens were retrieved and re-evaluated. Potential participants for whom the diagnosis was reconfirmed and who are now adults, were then traced and surveyed. Descriptive statistics were calculated and compared with the literature. Main outcome measures are the demographics of the cohort, their scores on standardized quality of life (QoL) and sexuality questionnaires and answers to additional questions regarding patients' experience with the disease. The questionnaires used were the Dermatology Life Quality Index (DLQI), the Skindex-29, the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale-Revised (FSDS-R). Secondary outcome measures include obstetric history and histological features found in the original tissue specimens. A total of 81 women participated, median age 29.0 years, median follow-up from childhood diagnosis 19.5 years. Both QoL and sexuality were somewhat affected in 51.9% of cases. Less than half (45%) reported having regular check-ups. Forty-five (56%) reported symptoms within the past year; of those with symptoms, 14 (31%) were not under surveillance. Cesarean section rate (14.5%) was comparable to the general population, and there were more high-grade obstetric anal sphincter injuries with vaginal deliveries than expected. Sixteen respondents (20%) were not aware of the childhood diagnosis prior to this study. Symptoms due to VLS are reported by most adults diagnosed as juveniles. QoL and sexuality are affected and correlate to recent symptoms. VLS as a juvenile does not preclude a vaginal delivery. Women diagnosed with VLS in childhood or adolescence are often lost to follow-up.

Prospective study of safety and objective improvement in sysmptoms of GSM (Genitourinary syndrome of menopause) withEr:YAG vaginal /urethral laser treatment

: Genitourinary Syndrome of Menopause (GSM) is the condition which combines the conditions of vulvovaginal atrophy (VVA) and urinary tract dysfunction which are associated with oestrogen deficiency. GSM is treated using vaginal laser therapy by using non-ablative Er: YAG laser therapy to evaluate the effectiveness and safety of this therapy. The present study was planned to evaluate the safety and objective improvement in symptoms of GSM with Er:yag vaginal / urethral laser treatment in sextual and urinary symptoms of post / peri menopausal women on long term basis. A prospective study was conducted at V care laser centre from 2020 on words to till date. Total sample population enrolled was 74 among them 53 completed 1 follow up and 29 had completed 2 follow up. Data were collected before and subsequent 2 follow ups over next 12 months on parameters like dryness, dyspareunia, itching/ burning and lower urinary tract symptoms, data were collected using VLQ (vaginal laxity questionnaire), VHIS (vaginal health index score), FSDS-R (The female sexual distress scale – revised)and Satisfaction questionnaire (0-3) assessed on FSFI. : The study showed symptomatic improvement among patients with GSM like no pain or mild pain among 79.31% and 20.39% respectively, no itching (72.41%) at the end of 2 follow up. There was an improvement in vaginal condition (normal – 93.10%) at the end of 2 follow up. Majority of patients reported no sexual distress (82.7%). : The non-ablative Er: YAG laser therapy is efficacious and safe modality for treatment of symptoms in cases of genitourinary syndrome of menopause. It also offers a promising, minimally invasive safe treatment for SUI.

(025) Inhibition and Excitation in the Sexual Brain: An Useful Tool for the Prediction of Therapeutic Outcomes in Women with Sexual Dysfunction

Abstract Introduction The “Dual control model” of sexual response postulates that sexual desire and associated behaviors depend on the balance between excitation and inhibition. These aspects have not been evaluated in women with sexual dysfunction (FSD). Objectives The aim of our study was to explore the psychosexual correlates of excitation and inhibition in women with FSD, according to their menopausal state. We also aimed at performing a pre-post analysis in a sub-sample of patients followed for 3-6 months, investigating the possible relationships between excitation and inhibition and the changes in questionnaires related to sexual function. Methods In an observational, retrospective study, we recruited a consecutive series of 66 women consulting for FSD. Patients underwent a clinical evaluation, a structured interview and completed several self-administered questionnaires, including Sexual Inhibition/Sexual Excitation Scale (SIS/SES), Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), Body Uneasiness Test (BUT) and Middlesex Hospital Questionnaire (MHQ). A subgroup of patients (n=28) was evaluated at 3-6 months follow-up, using the FSFI and FSDS-R questionnaires. Results Considering the whole sample, the SES scale was positively correlated with several psychosexual and relational parameters, including masturbation (p=0.005), number of lifetime partners (p=0.004) and histrionic personality traits (p=0.013), and negatively with the presence of a stable relationship (p=0.038) and its length (p=0.026). Sexual inhibition due to the fear of performance failure (SIS1 scale) positively correlated with conflicts within the couple (p=0.012), lack of privacy (p&amp;lt;0.0001), symptoms of general psychopathology (p=0.001; in particular, anxiety) and body image concerns (p=0.015). Regarding sexual parameters, the SES scale was associated with the total FSFI score (p=0.016), and the desire (p=0.011), arousal (p=0.030), lubrication (p=0.046) and orgasm domains (p=0.025), whereas the SIS1 scale was associated with the FSDS-R score (p=0.028). In premenopausal women, the SIS1 scale was associated with the diagnosis of Hypoactive Sexual Desire Disorder (HSDD), even after adjusting for confounders (p=0.047), whereas in postmenopausal women, we found an association between HSDD and the SES scale (p=0.039). Given these correlations, we developed two cut-off values for the SES and SIS1 scales, according to which a score &amp;lt; 49 on the SES (in postmenopausal women) and a score &amp;gt; 34 on the SIS1 (in premenopausal women) accurately identified patients diagnosed with HSDD. In postmenopausal women, the ROC curve for the SES scale showed an accuracy (AUC) of 0.734 +− 0.107, p=0.037, in identifying HSDD; considering a cut-off value of 49, the sensitivity and specificity for HSDD detection were 85.7% and 66.7%, respectively. In premenopausal women, the ROC curve for the SIS1 scale showed an AUC of 0.853 +− 0.081, p=0.007, in identifying HSDD; considering a cut-off value of 34, the sensitivity and specificity for HSDD detection were 78.6% and 75.0%, respectively. The mean change in FSFI total score was not correlated with the SES or SIS2 scales (p=0.214 and p=0.402, respectively), but only with the SIS1 scale (p=0.026). When comparing patients with low excitation (SES scale &amp;lt;49) and high inhibition (SIS1 scale &amp;gt;34) with the rest of the sample, they showed a significantly lower change in FSFI total score (p=0.018). Conclusions In women consulting for FSD, sexual excitation and inhibition, which may be easily assessed by the SIS/SES questionnaire, emerge as key aspects in both the diagnostic evaluation and planning of therapeutic outcomes, in the perspective of a personalized sexual medicine approach. Disclosure No.

(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.

The Effect of Mindfulness-Based Sexual Counseling on Sexual Distress, Attitude Toward Sexuality, and Body Image Concerns in Pregnant Women: A Randomized Controlled Trial.

Sexual distress during pregnancy can cause a negative attitude toward sexuality during pregnancy, and this can be seen especially in conjunction with body image concerns. This study was conducted to determine the effects of mindfulness-based sexual counseling (MBSC) on sexual distress, attitudes toward sexuality, and body image concerns in pregnant women. A randomized controlled trial was conducted in a sample of women who experienced sexual distress presenting to a Healthy Living Center in eastern Turkey. Women (N = 134) were randomly assigned to receive a 4-week, 8-session counseling program based on mindfulness (experimental group; n = 67) or treatment as usual (control group; n = 67). The primary outcome of the study, sexual distress, was assessed using the Female Sexual Distress Scale-Revised. Secondary outcomes included attitude toward sexuality, assessed using the Attitude Scale toward Sexuality during Pregnancy, and body image concerns, using the Body Image Concerns during Pregnancy Scale. Outcomes were compared postintervention, correcting for baseline using analysis of covariance. The study was registered with ClinicalTrials.gov (NCT04900194). Mean scores for sexual distress (7.69 vs 17.36; P < .001) and body image concerns (57.76 vs 73.88; P < .001) decreased significantly in the mindfulness group compared with the control group. Similarly, mean scores for attitudes toward sexuality significantly improved in the mindfulness group compared with the control group (133.52 vs 105.78; P < .05). MBSC is a promising strategy to help women experiencing sexual distress during pregnancy to reduce their levels of sexual distress, raise their positive attitudes toward sexuality, and lower their body image concerns. Larger clinical trials of MBSC are recommended to support introduction of MBSC into clinical practice.

A Comparative Study on Sexual Function and Sexual Distress of Women With and Without Breast Cancer in Zanjan, Iran

Background &amp; Aims Breast cancer (BC) is one of the important challenges of the health system due to its impact on marital relationships. This study aims to compare sexual function and sexual distress of women with and without BC. Materials &amp; Methods In this case-control study, 75 women with BC and 75 healthy women from Zanjan, Iran participated. Data were collected using a demographic form, the female sexual distress scale-revised (FSDS-R), and the female sexual function index (FSFI). Data analysis was done in SPSS software, version 20 using the Mann-Whitney test and multivariate analysis of covariance. Results The mean age of patients was 36.49±6.53 years and the mean age of controls was 36±0.72 years. There was no statistically significant difference between the two groups in terms of some demographic variables such as age, educational level of women and their husbands, occupation of women and their husbands, place of residence, and number of children (P&gt;0.05). The mean score of FSFI in all subscales in the patient group was lower than in the control group. This difference was statistically significant only in the dimension of desire (P=0.003). regarding the sexual distress variable, the mean FSDS-R score of healthy women was lower than that of women with breast cancer, but this difference was not statistically significant (P&gt;0.05). Conclusion The difference between women with and without breast cancer is significant only in the desire domain of sexual function. There is no statistically significant difference between the two groups in sexual distress and in other domains of sexual function. The sexual problems of women with BC require consideration and support, and provding counseling in terms of sexual function.

(055) Application of a Very Low Calorie Ketogenic Diet (VLCKD) Protocol in Women's Endocrinology: Psychosexual Correlates of Weight Loss

Abstract Introduction The role of obesity in female sexuality is controversial and there are no intervention studies aimed at evaluating the effect of the Very Low Calories Ketogenic Diet (VLCKD) on female sexual function, in particular on arousal. Objective To evaluate the psychosexual correlates of obesity and Metabolic Syndrome (MetS) in a sample of women consulting for sexual symptoms; to investigate the change in measures of arousal after weight loss obtained with VLCKD. Methods In a retrospective study, n=322 women consulting for sexual symptoms were enrolled. The patients underwent a clinical, laboratory, sexual and psychological examination and were studied by color-Doppler ultrasound for the evaluation of genital vascularization, with measurement of the Pulsatility Index (PI) of the clitoral artery. They completed the Female Sexual Function Index (FSFI), Female Sexual Distress Scale - Revised (FSDS-R), Body Uneasiness Test, Eating Disorder Examination Questionnaire (EDE Q), and Middlesex Hospital Questionnaire, for psychiatric symptoms. Twelve patients underwent a nutritional intervention aimed at weight loss, based on a VLCKD protocol. These cases were compared with patients treated with different strategies for sexual symptoms, in a 1:1 case-control study (matched for BMI, age and menopausal status). Results In the total sample, clitoral PI was significantly higher in obese women (p = 0.018) and in those diagnosed with MetS (p=0.043). A statistically significant inverse correlation emerged between WC ≥ 88 cm and FSFI Arousal score (p=0.028). In patients undergoing a nutritional intervention with VCLKD protocol (n=12), after a mean follow-up of 20+-2 weeks, BMI showed a reduction of 6.7+-2.8 kg/m2 (p&amp;lt;0.001) and WC of 14.3+-5.2 cm (p&amp;lt;0.001), with fat mass loss of 14.6+-5.4 kg (-37.1%; p&amp;lt;0.001). At follow-up, the total FSFI and FSDS-R scores significantly improved (17.0+-13.6 vs. 11.2+-7.9, p=0.016, and 7.4+-8.3 vs. 13.3+-10.6, p=0.039, respectively). Among the FSFI subdomains, Arousal showed a significant increase (p=0.035). We also observed an improvement in EDE total score (p=0.032), Shape (p=0.008) and Weight subscales (p=0.011), BUT-B Positive Symptoms Distress Index (p=0.009) and BUT-A Body Image Concerns (p=0.043), and MHQ total score (p&amp;lt;0.001). The clitoral artery PI at follow-up showed a non-significant reduction. At multivariate analysis, the change in the Total FSFI was correlated with the BUT-B PSDI score change (p=0.031) and the EDE Shape change (p=0.043), when including DeltaMHQ and DeltaWC as further covariates. Finally, in a 1:1 case-control study, a significant difference emerged in the improvement of FSFI total score, which was more relevant in cases than in controls (p=0.046); on the other hand, there was no difference in the change in FSDS-R score between cases and controls. Conclusions Our data suggest that weight loss obtained by VLCKD is associated with an improvement in sexual function, and in particular in Arousal, whose change could be mediated by improved body image parameters. The effect of weight loss on cardiometabolic risk factors related to sexual dysfunction requires dedicated longitudinal studies, with the use of objective methods. Disclosure No

(085) Topical Capsaicin for Provoked Vestibulodynia

Abstract Introduction Provoked vestibulodynia (PVD), occurs when pain is localized in the vulvar vestibule and triggered by any vestibular contact (sexual or otherwise). PVD is the most common form of vulvodynia and there is currently no approved treatment. Capsaicin cream is hypothesized to improve vestibular allodynia in patients with neuroproliferative PVD by binding to the vanilloid receptor (TRPV1) on the C- afferent nociceptors and thereby causing defunctionalization of the TRPV1. Although capsaicin has been utilized as a treatment for vulvodynia, very little is known about its effectiveness in improving vestibular pain and sexual function. Objective Investigate the therapeutic potential of capsaicin cream as treatment for PVD. Methods Patients who were prescribed 0.025% capsaicin compounded in VersaBase cream were identified in the electronic medical record through a search of physician-entered diagnoses and confirmed with a prescription list from a compounding pharmacy. Adult patients with documented vulvodynia were included. Female Sexual Dysfunction (FSD) was measured before and after treatment with the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised (FSDS-R). Results Twenty-five patients responded to the follow-up questionnaire. Average age at presentation was 30 years (range 18-52 years). Self-reported ethnicity of the study population was 76% White, 4% Latina, 4% Asian, 4% Mixed, and 4% Middle Eastern, with no response from 8% of participants. After consistent daily usage, 80% of patients were able to tolerate capsaicin application for the full 20 minutes. Washing the cream off with cold water was helpful for tolerating capsaicin application for 72% of patients, and 8% of patients found applying a topical anesthetic such as lidocaine helpful. The median amount of time required to increase tolerance to the full 20 minutes was 1-2 weeks. On a VAS scale, the mean pain score while initially applying capsaicin was 8.96, and the median was 10. While 48% of patients found capsaicin improved their vulvar pain, 56% of patients would recommend capsaicin as a treatment for vulvar pain. The mean FSDS score was 35.96 at baseline compared to 25.09 at follow-up (p &amp;lt; 0.0001). On a VAS scale, the mean self-reported vulvar pain score was 8.2 at baseline compared to 5.35 when using capsaicin consistently (p &amp;lt; 0.0001). The mean FSFI pain domain score was 0.98 at follow-up compared to 2.45 at baseline (p = 0.005). While not statistically significant, the mean total FSFI score was 15.44 at baseline compared to 17.84 at follow-up. Conclusions Capsaicin cream is a promising treatment for PVD. Among patients who are able to tolerate consistent daily usage, capsaicin cream significantly decreases vulvar pain. Patients should be counseled that topical capsaicin is initially severely painful, even with the use of topical anesthetics such as lidocaine. Emotional distress and trauma were reported among patients who were not able to tolerate capsaicin application. However, patients who were able to tolerate capsaicin reported feeling “grateful” and “satisfied” with the treatment. Capsaicin cream should be considered for patients who have failed more conservative treatments and proper counseling regarding application should be reviewed. Disclosure No

(008) Psychosexual, Relational and Clinical Correlates of Orgasmic Function and Female Orgasm Disorder in Women Consulting for Sexual Symptoms

Abstract Introduction Female Orgasm Disorder and its risk factors are still under-investigated. Objective To describe the psychological, relational and clinical correlates of orgasmic function during partnered sexual activity in women consulting for sexual symptoms. Methods In an observational retrospective study, we collected data from a consecutive sample of 430 heterosexual, sexually active women (mean age 46±12.9 years) consulting for sexual symptoms. All patients underwent a structured interview and a physical, gynecologic and laboratory examination; they completed a series of validated questionnaires, including the Female Sexual Function Index (FSFI), the Female Sexual Distress Scale-Revised (FSDS-R), the Middlesex Hospital Questionnaire (MHQ), the Body Uneasiness Test (BUT-A and BUT-B), the Sexual Inhibition/Excitation Scale (SIS/SES), and the Dyadic Adjustment Scale (DAS). Results 268 subjects (62%) reported a persistent distressing decrease of the frequency of orgasm for at least six months. Among them, 93 (22% of the whole sample) reported a mild decrease, 91 (21%) a severe decrease, and 19% reported anorgasmia. Nine women described Anorgasmia as lifelong. The severe decrease of orgasm frequency during partnered sexual activity was associated with the inability to reach orgasm with masturbation (p=0.009). After adjusting for age and menopausal status, the FSFI Orgasm (FSFI-O) domain was negatively associated with MHQ total score (p=0.001), an index of general psychopathology, and with body image concerns, explored through both BUT-A and BUT-B global measures. The stronger correlation emerged with the BUT-A Avoidance subscale (p=0.005). Among other psychological parameters, significant, negative correlations were observed between FSFI-O and a reported diagnosis of psychiatric disease, including mood disorders (p=0.001), use of antidepressants (p=0.001), chronic stress (p=0.002), and familiar conflicts (p=0.008). Noteworthy, no correlation was observed between FSFI-O and Inhibition/Excitation measures. When exploring sexual and relational parameters, we found that women displaying higher FSFI-O scores were more likely to be engaged in a stable sexual relationship (p=0.003), to report at least three sexual encounters per month (p&amp;lt;0.001) and lack of marital conflict (p=0.004). Among sexual dysfunctions in the male partner, as perceived by the woman, only low desire showed a clear negative correlation with FSFI-O (p=0.002). FSFI-O was also positively correlated with the Dyadic Satisfaction (p&amp;lt;0.001) and the Dyadic Cohesion subscales (p=0.032). Finally, when considering clinical parameters, women with a history of endometriosis (p=0.008), genitourinary disorders (i.e., recurrent vulvovaginitis or urinary tract infections; p=0.027), urinary incontinence (0.017) and pelvic surgery (i.e. hysterectomy; p=0.017) reported significantly lower FSFI-O scores. FSFI-O was not correlated with metabolic or hormonal laboratory parameters, including estradiol, prolactin or testosterone levels. When considering the diagnosis of severe FOD, the main clinical risk factors were psychiatric diseases (OR 1.566, CI 1.034;2.370), past Unwanted sexual experiences (OR 1.679, CI 1.109;2.541), urinary incontinence (OR 1.644, CI 1.132;1.387) and past pelvic surgery (OR 1.710, CI 1.129;2.591). Conclusions Orgasmic function was correlated with anxiety and depressive symptoms, use of antidepressants, body image concerns, marital conflicts and low partner’s desire, independently of age and menopausal status. Risk factors for severe FOD were psychiatric diseases, abuse history, urinary incontinence and past pelvic surgery. Disclosure No

(213) Sexual Dysfunction in Young Women with Recurrent Urinary Tract Infections

Abstract Introduction Sexual intercourse is the risk factor most commonly associated with recurrent UTI in young women. Few studies have analyzed how rUTIs subsequently impact women’s sexual health and function Objective To investigate whether young women with rUTIs experience sexual dysfunction. Methods This is a prospective study with preliminary data collection from May – June 2022. A survey was posted on five subreddits, r/Healthyhooha, r/Interstitialcystitis, r/CUTI, r/WomensHealth and r/badwomensanatomy, which included questions on demographics, rUTI history and the 13-question Female Sexual Distress Scale-Revised (FSDS-R). Women were asked to answer the questionnaire in terms of their rUTI frequency and severity, with a scale from 0 (never) to 4 (always). Women between 18 – 35 years, not currently pregnant, and had UTIs at least every 3-4 months were included in the analysis. A score ≥ 11 indicated female sexual dysfunction (FSD). Severity of FSD was categorized as: mild (11 – 20), mild-moderate (21 – 30), moderate (31 – 40) and severe (≥41). Results One hundred fifty-one women completed the survey with 120 included in the analysis (79.5%). The average age was 27±4.9 years, majority self-identified as white (85.7%), and over half had a comorbidity (57.5%), with the most common being irritable bowel syndrome (33.3%) and autoimmune illnesses (23.2%). Half of women (50%) experienced UTIs every 3-4 months, 36.7% every month, and 13.3% every week. Women had rUTIs for an average of 9.2±8.4 years. Over half of women (59.2%) had a complication from their rUTIs, with 43% having pyelonephritis and 26.6% urosepsis. In the FSDS-r, frustration about sexual problems received the highest average score (2.9), with 42.5% of women reporting frequently and 30% reporting always feeling frustrated. Guilt over sexual problems had the second highest average score (2.7), with 35% of women frequently and 29.2% always feeling guilty. More than a third of women (40.8%) responded that they frequently avoid sex due to sexual distress. We found 111 (92.5%) participants qualified as having FSD, with an average FSDS-r score of 31.9±12.3. In terms of FSD severity, 10.8% had mild, 28% mild-moderate, 33.2% moderate and 28% severe. There was no significant difference between ethnicity, comorbidities, complications, and UTI frequency with worsening FSD score. Conclusions Many young women experience rUTIs. In our study, over 90% of young women with rUTIs qualified as having FSD measured by the FSDS-R. Our findings highlight the importance of screening women who experience rUTIs for sexual dysfunction to potentially improve their sexual health and quality of life. Disclosure No

(135) Keratin Pearl Excision for Clitorodynia and Female Sexual Dysfunction

Abstract Introduction Clitoral adhesions occur when the clitoral prepuce adheres to the glans clitoris. This can cause accumulation of desquamated epithelial cells under the prepuce, resulting in the formation of smegmatic pseudocysts and keratin pearls. A keratin pearl is a focus of central keratinization within concentric layers of squamous cells. Presence of these firm, millimeter-sized masses can lead to clitoral irritation and hypersensitivity (similar to a grain of sand in the eye). Although keratin pearls have been described in the literature, there is little known about their clinical presentation or association with female sexual dysfunction (FSD). Objective Investigate the effectiveness of keratin pearl excision as a treatment for clitoral pain and female sexual dysfunction. Methods A retrospective chart review was conducted in two metropolitan gynecology clinics specializing in vulvar pain between January 2017 and December 2021. Patients presenting with clitoral pain (clitorodynia) were identified in the electronic medical record through a search of physician-entered diagnoses and confirmed via review of the clinical notes. Adult patients with documented clitoral pain as well as clitoral adhesions (clitoral phimosis) and keratin pearls noted on exam were included in the study. Female Sexual Dysfunction (FSD) was measured with the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised (FSDS-R). Prospective data was collected via an electronic follow-up survey. Data were presented in means and percentages. Results Fifty-eight patients met inclusion criteria. Average age at presentation was 35 years (range 19-73 years). Self-reported ethnicity of the study population was 81% White, 7% Hispanic, 5% Asian, 2% Black, with no response from 5% of participants. Preliminary results show that patients reported a 66% decrease in mean clitoral discomfort (p &amp;lt; 0.0001) and a 52% reduction in mean difficulty with orgasm (p = 0.019) after excision of keratin pearls. Patients who completed the follow-up questionnaire (n = 18) had a mean FSFI total score of 18.3 compared to mean total baseline FSFI of 13.11 (p = 0.03). The mean FSFI score for pain was 2.85 at follow up compared to 1.52 at baseline (p = 0.01). The mean FSFI score for orgasm was 3.36 at follow up compared to 2.16 at baseline (p = 0.03). Although not statistically significant, most likely because of a small sample size, the mean FSFI score was higher at follow-up than at baseline for lubrication (45%), arousal (42%), satisfaction (19%), and desire (17%). Patients had no change in mean FSD-R score from baseline to follow up. Conclusions Clitorodynia associated with clitoral adhesions and keratin pearls occurs in women of all ages. Excising keratin pearls may reduce female sexual dysfunction. These preliminary results suggest that excising keratin pearls may improve clitoral discomfort and reduce difficulty with orgasm. Excising keratin pearls may also lead to an improvement in overall female sexual function. Disclosure No

MP45-12 SEXUAL DYSFUNCTION IN YOUNG WOMEN WITH RECURRENT URINARY TRACT INFECTIONS

You have accessJournal of UrologyCME1 Apr 2023MP45-12 SEXUAL DYSFUNCTION IN YOUNG WOMEN WITH RECURRENT URINARY TRACT INFECTIONS Alison Schulz, Justin Loloi, Eden Axler, and Nitya Abraham Alison SchulzAlison Schulz More articles by this author , Justin LoloiJustin Loloi More articles by this author , Eden AxlerEden Axler More articles by this author , and Nitya AbrahamNitya Abraham More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003291.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In young women, the risk factor most commonly associated with recurrent UTIs (rUTIs) is sexual intercourse. However, few studies have subsequently analyzed the effect of rUTIs on women’s sexual health. Thus, we investigated whether young women with rUTIs experience sexual dysfunction. METHODS: Between May – Sept 2022, a survey was posted on 5 subreddits (r/Healthyhooha, r/Interstitialcystitis, r/CUTI, r/WomensHealth and r/badwomensanatomy) with questions pertaining to demographics, rUTI history and the Female Sexual Distress Scale-Revised (FSDS-r). Women answered statements in terms of rUTI frequency and severity, with a scale from 0 (never) to 4 (always). A score ≥11 indicated female sexual dysfunction (FSD), categorized as mild (11 – 20), mild-moderate (21 – 30), moderate (31 – 40) and severe (≥41). Women between 18 – 35 years, not currently pregnant, and who had UTIs at least every 3-4 months were included. Statistical analysis was performed by Kruskal–Wallis, Chi-square or Fisher’s exact tests. RESULTS: One hundred sixty-six women completed the survey and 135 (81.3%) met inclusion criteria. Average age±SD was 26.8±5 years, a majority self-identified as white (84.2%), and over half had a comorbidity (59.3%). Approximately 50% of women experienced UTIs every 3-4 months, 36% every month, and 14% every week. Women had rUTIs for an average±SD of 8.6±8.2 years. Over half (60%) experienced a UTI-related complication requiring hospitalization. In the FSDS-r portion, frustration about sexual problems received the highest average score (2.86/4) and low sexual desire had the lowest score (1.84/4). More than a third of women responded that they frequently avoid sex due to sexual distress (40.7%) and are frequently worried about sex (43.7%). We found that 124 (91.9%) participants qualified as having FSD, with an average score of 31.3±12.5. In terms of FSD severity, 12.1% had mild, 27.4% mild-moderate, 33.9% moderate and 26.6% severe. We found a significant difference between the number of UTI years and FSD severity (p = 0.032). CONCLUSIONS: In our study, over 90% of young women with rUTIs qualified as having FSD measured by FSDS-r. Our findings highlight the importance of screening women who experience rUTIs for sexual dysfunction, and providing them with tools to prevent future UTIs, hopefully avoiding long-term consequences and improving overall sexual health. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e625 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alison Schulz More articles by this author Justin Loloi More articles by this author Eden Axler More articles by this author Nitya Abraham More articles by this author Expand All Advertisement PDF downloadLoading ...