Female Sexual Distress Scale-Revised Research Articles

(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 (<1 hour/week: sedentary, 1-3 hours/week: active, 4-6 hours/week: very active, >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 ...

Sexual quality of life in young gynaecological cancer survivors: a qualitative study

PurposeThe impact of cancer diagnosis and treatment on sexual quality of life (SQoL) is a significant and often neglected issue in the treatment and survivorship period of young gynaecological cancer survivors (YGCS). This study sought to explore women’s lived experiences to understand how to protect and improve SQoL.MethodsA qualitative study with women aged 18–45 and pre- or perimenopausal at diagnosis (n = 15). A thematic analysis was performed in NVivo. Participants also completed a pre-interview questionnaire and The Female Sexual Distress Scale-Revised (FSDS-R).ResultsYGCS experienced high psychosexual distress. Notably, seven themes were identified: adjustment, confidence, fear, loss, shame, trauma, and communication. Gynaecological cancer (GC) treatment interfered with everyday life and had a long-term impact on mental, physical, and emotional health, with many reporting an altered sense of self, body image and sexual identity. Single women felt vulnerable in new relationships, while partnered women reported low sexual desire and guilt about sexual difficulties. Open communication, emotional intimacy, and an acceptance of the ‘new normal’ buffered the trauma of cancer and were vital to relationship satisfaction. Lastly, absent, or blunt patient-clinician communication contributed to psychosexual distress.ConclusionGC interferes with sexual function, partner relationships, psychosexual wellbeing, and quality of life. A better understanding of the lived experiences of YGCS can help healthcare providers to adopt a holistic, patient-centric, and multidisciplinary approach to SQoL. YGCS want psychosexual communication and support, across all stages of treatment and care. Healthcare providers should initiate and normalise conversations on the impact of treatment on SQoL.

Association of sexual attitudes with sexual dysfunction and sexual distress among Chinese breast cancer survivors: a cross-sectional study.

Little is known about sexual dysfunction and sexual distress in Chinese female breast cancer survivors (BCSs), and their associations with physical variables, psychological factors, body image, and sexual attitudes. A cross-sectional study of 341 BCSs was performed with the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised (FSDS-R). Associations between physical variables, psychological factors, body image, sexual attitudes, sexual dysfunction, and sexual distress were evaluated using logistic regression, adjusted for confounding factors. We found that 75.37% and 18.48% of BCSs reported sexual dysfunction and sexual distress during the past month, respectively. Attitudes toward sexual behavior such as "sexual activity may impede disease recovery," "sexual activity may cause cancer recurrence or metastasis," and "sexual activity may weaken treatment effects" were significantly associated with an increased likelihood of reporting sexual dysfunction and sexual distress. Body image disruption such as "felt physically less attractive as a result of your disease or treatment" was significantly associated with the experience of sexual distress. Sexual dysfunction and sexual distress are common issues in Chinese BCSs. Sexual misconception likely contributes to sexual dysfunction and sexual distress, and body image has a significantly negative association with sexual distress in BCSs. Interventions targeting sexual attitudes and body image might be important to address BCSs' sexual issues and improve their overall sexual health.

Sexual functioning in women with functional hypothalamic amenorrhea: exploring the relevance of an underlying polycystic ovary syndrome (PCOS)-phenotype

PurposeTo study sexual function and distress in women with functional hypothalamic amenorrhea (FHA) compared to women with FHA and an underlying polycystic ovary syndrome (PCOS)-phenotype, considering also their psychometric variables. As a secondary aim, we explored the relationship between sexual functioning and hormonal milieu in these women.MethodsThis is a retrospective cross-sectional study conducted on 36 women with typical FHA and 43 women with FHA + PCOS-phenotype. The following validated psychometric questionnaires were administered: Female Sexual Functional Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), Body Attitude Test (BAT), Bulimia Investigation Test (BITE), State Anxiety Inventory (STAI), Beck Depression Inventory (BDI), Multidimensional Perfectionism Scale (MPS). Available hormones to formulate FHA diagnosis in the standard routine were considered.ResultsWomen with typical FHA reported a significantly lower FSFI total score than women with FHA + PCOS-phenotype (95% CI for median 16–21.3 vs. 21.1–24.1, p = 0.002), whereas the FSDS-R score was similar in the two groups (95% CI for median 6–16 vs. 6–16.3). No statistically significant differences were evident in body attitude, state and trait anxiety, depression, bulimic risk, and perfectionism between the two groups, confirming the two FHA groups were superimposable from a psychometric perspective. State anxiety correlated negatively with the FSFI total score in both typical FHA (rho: − 0.33, p = 0.05) and FHA + PCOS-phenotype (rho: − 0.40, p = 0.009). In the entire study population, a positive correlation was found between luteinizing hormone, androstenedione, and 17ß-estradiol and the total FSFI score (rho: 0.28, p = 0.01; rho: 0.27, p = 0.01, rho: 0.27, p = 0.01, respectively).ConclusionWomen with FHA showed a very high rate of sexual symptoms as part of their condition, but those with a typical diagnosis displayed a more severe sexual impairment as compared with the FHA + PCOS-phenotype, in spite of a similar psychometric profile. Sexual distress was equally present in both groups (approximately 4 out of 10 women). Further studies should be designed to investigate the potential role of sex hormones, mainly LH-driven androstenedione, in influencing women’s sexual functioning.

Gebelikte cinsel sıkıntı ve öznel mutluluk arasındaki ilişki

OBJECTIVE: The aim of the study was to determine the relationship between sexual distress and subjective happiness during pregnancy. MATERIAL and METHODS: The cross-sectional study was conducted with 420 women who met the inclusion criteria (pregnant women aged 18 years and older, without any health risk) and agreed to participate in the study. Healthy pregnant women who applied to outpatient clinics and met the inclusion criteria were included in the sample of the study by random sampling method. Data were collected with the Descriptive Characteristics Form, the Female Sexual Distress Scale–Revised (FSDS-R), and the Subjective Happiness Scale (SHS). One-Way ANOVA test was used in groups of more than two, and t-test was used in pairs and independent groups to compare the mean scores of the scale. In addition, Pearson Product Moments Correlation Coefficient was used to determine the relationship between dependent and independent variables. RESULTS: In the study, the total score of SHS was 19.59±4.99; The total score of FSDS-R was determined as 24.33±6.39. It was determined that there was a negative significant relationship between the subjective happiness and sexual distress of the pregnant women, while the subjective happiness levels of the pregnant women increased, the mean scores of sexual distress decreased significantly and there was a weak relationship between them (r=-0.378, p&lt;0.001). CONCLUSION: In the study, it was determined that while the subjective happiness levels of the pregnant women increased, their mean sexual distress score decreased. According to these results, identifying the pregnant women who have sexual difficulties and directing them to appropriate resources may help to minimize the sexual problems experienced during pregnancy. Keywords: pregnancy, sexual distress, subjective happiness

The Impacts of Alexithymia and Sexual Distress on Sexual Functioning Among Portuguese Women

Introduction: Recognizing own’s emotions seems to have an important role regarding not only our overall well-being, but also our sexual functioning. Aims: The aim of this study is to analyze the association or impact of alexithymia on female sexual functioning. Methods: 459 Portuguese women, with a mean age of 34.57 years (SD = 10.27), ranging from 18 to 65 years, completed the Toronto Alexithymia Scale (TAS-20), the Female Sexual Distress Scale – Revised (FSDS-R) and, additionally, completed the Female Sexual Function Index (FSFI), indicating if and when a sexual relationship occurred in the last month. Results: The results showed that higher levels of alexithymia were associated with worse sexual functioning and higher levels of sexual distress. Higher levels of sexual distress were associated with worse sexual functioning. It was possible to establish a significant linear regression model between dimensions of alexithymia (difficulties in identifying feelings and difficulties in describing feelings) and sexual distress in sexual functioning; the variables together explained about 45.2% of sexual functioning in these women. Conclusions: The results emphasize the relevance of alexithymia’s dimensions in sexual functioning concerning women with or without sexual dysfunction, since they present themselves as significant predictors. Professionals working in women’s sexual health should take this into account for more effective assessment and intervention in matters concerning sexual health.

The Effect of Foot Massage Applied to Turkish Women Living in Rural Areas on Sexual Distress and Sexual Self-Confidence: A Randomized Controlled Study

Introduction: This study was conducted to determine the effect of foot massage applied to women with sexual distress in rural areas on sexual distress and sexual self-confidence. Material and Methods: This randomized controlled study was conducted with women who applied to a family health center located in a rural area in northern Turkey and who had sexual distress. The research sample consisted of 84 women, 42 of whom were in the experimental group and 42 in the control group. While foot massage consisting of eight sessions and lasting 4 weeks was applied to the women in the experimental group, no such intervention was applied to the control group. Research data were collected by Female Sexual Distress Scale-Revised (FSDS-R) and Sexual Self-Confidence Scale (SSS). Results: It was determined that the pre-intervention sexual distress and sexual self-confidence levels of the women in the experimental and control groups were similar and that the difference between the groups was not statistically significant (p > 0.05). After the intervention, it was determined that the mean FSDS-R scores of the women in the experimental group decreased significantly, while the mean SSS score increased significantly, and the difference between the groups was found to be statistically significant (p < 0.001). Conclusion: Foot massage can be used to reduce the level of sexual distress and increase sexual self-confidence in women with sexual distress. Health professionals who provide health services can use foot massage to positively improve sexuality in women.

The effect of cervical conization on women’s sexual function and psychological health (341)

Objectives: Diagnosis of cervical dysplasia and subsequent conization of the uterine cervix might affect women’s sexual health. The study objective was to assess the effect of cervical conization on women’s sexual function and psychological wellbeing using structured questionnaires. Methods: Patients undergoing conization of the cervix completed questionnaires before and 6-12 months after conization. Assessment of sexual distress and function was done using the female sexual distress scale-revised (FSDS-r) and the female sexual function inventory (FSFI), respectively. Risk for anxiety and depression was assessed using the Hospital Anxiety and Depression Scale (HADS). Results: From October 2018 to March 2021, 55 patients undergoing cervical conization were recruited. No significant differences were found in FSDS-r scores before and after conization. An equal number of patients indicated having sexual distress (29 patients, 53%, before and after conization, p=1.0). No significant changes were noticed on any FSDS domains or the total FSDS score before and after conization (26.8 vs 26.0, p=0.461). The percent of patients that indicated an overall sexual dysfunction, increased from 49 percent before conization, to 59 percent after conization (p=0.388). A high percentage of patients indicated signs of anxiety on the HADS questionnaire, both before and after conization (49% and 47%, respectively). The median anxiety and depression scores did not change after conization (p=1.0). Conclusions: A high percentage of patients undergoing conization suffer from sexual distress, sexual dysfunction, and general anxiety, both before and after conization. The conization procedure itself did not seem to affect questionnaire scores. Gynecologists should be aware of the psychological and sexual effects of the diagnosis and treatment of cervical pre-cancerous lesions; patients should be counseled accordingly. Objectives: Diagnosis of cervical dysplasia and subsequent conization of the uterine cervix might affect women’s sexual health. The study objective was to assess the effect of cervical conization on women’s sexual function and psychological wellbeing using structured questionnaires. Methods: Patients undergoing conization of the cervix completed questionnaires before and 6-12 months after conization. Assessment of sexual distress and function was done using the female sexual distress scale-revised (FSDS-r) and the female sexual function inventory (FSFI), respectively. Risk for anxiety and depression was assessed using the Hospital Anxiety and Depression Scale (HADS). Results: From October 2018 to March 2021, 55 patients undergoing cervical conization were recruited. No significant differences were found in FSDS-r scores before and after conization. An equal number of patients indicated having sexual distress (29 patients, 53%, before and after conization, p=1.0). No significant changes were noticed on any FSDS domains or the total FSDS score before and after conization (26.8 vs 26.0, p=0.461). The percent of patients that indicated an overall sexual dysfunction, increased from 49 percent before conization, to 59 percent after conization (p=0.388). A high percentage of patients indicated signs of anxiety on the HADS questionnaire, both before and after conization (49% and 47%, respectively). The median anxiety and depression scores did not change after conization (p=1.0). Conclusions: A high percentage of patients undergoing conization suffer from sexual distress, sexual dysfunction, and general anxiety, both before and after conization. The conization procedure itself did not seem to affect questionnaire scores. Gynecologists should be aware of the psychological and sexual effects of the diagnosis and treatment of cervical pre-cancerous lesions; patients should be counseled accordingly.

Clinical Presentation of Clitorodynia associated with Clitoral Adhesions and Keratin Pearls

ABSTRACT Introduction Clitoral adhesions occur when the clitoral prepuce adheres to the glans clitoris. This can lead to 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 pain (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 Explore the clinical presentation of clitoral pain associated with clitoral adhesions and keratin pearls related to concomitant genitopelvic pain conditions and sexual dysfunction. Methods A retrospective chart review was conducted in two metropolitan gynecology clinics specializing in vulvar pain between January 2018 and September 2021. Patients presenting with clitoral pain (clitorodynia) were identified in the electronic medical record through a search of physician-entered diagnoses and confirmed by 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. FSD was measured with the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised (FSDS-R). Data was presented in means and percentages. Results Forty-one patients met inclusion criteria. Average age at presentation was 35 years (range 19-73 years). Self-reported ethnicity of the study population was 73% White, 5% Hispanic, 5% Asian, 2% Black, with no response from 15% of participants. Vulvar lichen sclerosus was noted in 17% (7/41) of patients, with an average age of 46 years (range 24-73 years). Seventy-six percent (31/41) of patients also had the diagnosis of overactive (hypertonic) pelvic floor muscle dysfunction (PFD), 25% (8/31) had pudendal neuralgia and 10% (3/31) had interstitial cystitis/painful bladder syndrome. Forty-six percent (19/41) of patients had provoked vestibulodynia (PVD) associated with a hormonal factor (hormonal contraceptive use, postpartum/breastfeeding, perimenopause, or menopause). Recurrent vulvar candidiasis or tinea cruris was noted in 5% of patients. Four patients (10%) presented with clitoral pain alone and were not found to have other identified genitopelvic pain conditions. Baseline FSFI and FSDS-R data were available in 35 patients. Mean FSFI score was 13.25, with 91% of patients meeting criteria for FSD (total FSFI score &amp;lt; 26.55). Mean scores for FSFI domains were: desire (2.4), arousal (2.1), lubrication (2.5), orgasm (2.0), satisfaction (2.5), and pain (1.6). Mean FSDS-R score was 29.42, with 89% of patients meeting criteria for FSD (FSDS-R score ³11). Conclusions Clitoral pain associated with clitoral adhesions and keratin pearls occurs in women of all ages. Clitoral adhesions are not confined to patients with vulvar lichen sclerosus. A vast majority of patients with clitoral adhesions and keratin pearls have additional chronic vulvar pain conditions, most commonly overactive PFD, pudendal neuralgia, or hormonally-associated PVD. Clitoral pain with clitoral adhesions and keratin pearls is associated with FSD and sexual distress. Clitorodynia and clitoral phimosis should be identified in the clinical evaluation of genitopelvic pain. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Consultant for Good Clean Love and Mahana Therapeutics; part-time employee of Dare Bioscience. Received research funding from Dare Science, SST, Endoceutics, The Cellular Medicine Association, and Ipsen for other projects. He is a consultant for Ipsen, SST, and AMAG

Eating Disorder Symptoms as a Risk Factor for Hypoactive Sexual Desire Disorder in Women: A Pilot-study

ABSTRACT Introduction Eating and sexual behavior are driven by neurological mechanisms that are extremely intertwined; emerging evidence indicates that their deep relationship can be mediated by the presence of specific psychopathologies. Objective To investigate the relationship between female sexual dysfunction (FSD) and eating disorders (EDs). Methods 123 retrospectively recruited women consulting for FSD underwent physical examination and completed the following validated questionnaires: Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), Eating Disorder Examination Questionnaire (EDE-Q), Binge Eating Scale (BES), Emotional Eating Scale (EES), Barrat Impulsiveness Scale-11 (BIS-11), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory Y (STAI Y), Symptom Checklist 90-Revised (SCL-90-R), Body Uneasiness Test (BUT), Dyadic Adjustment Scale (DAS) and Sexual Inhibition/Sexual Excitation Scales (SIS/SES). Moreover, demographic, medical and psycho-sexuological data were obtained through a structured interview. Results In relation to menopausal status, we did not observe any significant difference in all the investigated questionnaires in pre- vs. postmenopausal women. When stratifying patients for BMI (&amp;lt;25, 25-30, &amp;gt;30 kg/m2) we found that all the scores related to EDE-Q subscales were significantly different among the three subgroups (all p&amp;lt;0.001). Furthermore, patients with a history of Unwanted Sexual Experience (USE) had significantly higher BES (p=0.034) and EES (p=0.027) total scores compared with those without. Moreover, when we stratified our patients according to the clinical diagnosis of Hypoactive Sexual Desire Disorder (HSDD), we found that those with HSDD showed a worst psychological profile than those without, in particular a higher score at EDE-Q and BDI (all p&amp;lt;0.05). In contrast, when stratifying patients for the other two main FSD diagnosis, Female Genital Arousal Disorder (FGAD) and Female Orgasm Disorder (FOD), no significant differences among all the investigated questionnaires were observed. To further verify the impact of the different psychopathological aspects on the risk of having HSDD, we found that the only questionnaires scores that contributed to this dysfunction were EDE-Q (OR 1.678, IC [1.164-2.421]; p=0.006), total BDI (OR 1.055, IC [1.006-1.107]; p=0.027) and SIS1 (OR 1.101, IC [1.109-1.190]; p=0.015), after adjustment for age. After simultaneous analysis in a multivariate model of the three questionnaires, we found that both a higher EDE-Q score and a higher SIS1 score were significant risk factors for HSDD (p=0.007 and p=0.034, respectively). Finally, we subdivided our patients into three groups: no Binge Eating (BE), sporadic BE and frequent BE, observing a significant positive association between frequency of BE and sexual distress, as assessed by FSDS-R total score. Conclusions In a population of women affected by FSD, ED traits could negatively affect sexual desire, representing a relevant risk factor for the clinical diagnosis of HSDD. Among all the investigated psychopathological aspects, the psychological alterations related to EDs seem to play a more pronounced effect on HSDD than other commonly accepted risk factors for sexual desire disorders, such as depression and increased inhibitory trait. In a clinical perspective, it would worth to investigate the relative change in FSD and ED after treatment for ED and vice versa. Disclosure No

Low Prolactin Levels Identify HSDD and a Low Inhibition Profile in Women with Sexual Symptoms

ABSTRACT Introduction Data on the role of prolactin (PRL) in the physiologic range in the female sexual response are scanty. Objective We aimed at investigating the association between PRL levels and sexual function, and specifically, with the desire domain as assessed by the Female Sexual Function Index. We also explored the presence of a cut-off level of PRL able to identify women with a diagnosis of Hypoactive Sexual Desire Disorder (HSDD). Methods N=234 pre- and post-menopausal women (mean age 45.2+-12.4 years) consulting for female sexual dysfunction (FSD), and sexually active in the previous 4 weeks, were retrospectively analysed. A clinical, biochemical and pharmacological evaluation was performed. All patients completed the FSFI, the Female Sexual Distress Scale-Revised (FSDS-R), the Middlesex Hospital Questionnaire (MHQ) for the screening of psychopathological symptoms and the Sexual excitation/sexual inhibition scale (SIS/SES). Biochemical assessment included PRL (by luminescent oxygen channeling immunoassay). Results Only few patients (n=9) had hyperPRL (PRL&amp;gt; 483.0 mU/L) and showed a significantly higher MHQ total score (p=0.043), lower Total (p=0.037), Desire (p=0.002), Arousal (p=0.024) and Satisfaction (p=0.026) FSFI scores and a higher FSDS-R score (p=0.006) compared with women with normoPRL women. At univariate linear regression analysis, we did not find a significant correlation between FSFI total score and PRL levels. Hypothesizing the non-linearity of the association between these 2 variables, we tested different fitting models and found that the quadratic relationship was the best fitting (R2=0.11).When stratifying normoPRL women into tertiles (T1: PRL &amp;lt; 163.55 mU/L; T2= PRL &amp;gt; 163.55 and &amp;lt; 262.0 mU/L; T3: PRL &amp;gt; 262.0 and &amp;lt; 483.0 mU/L), a significant difference emerged in FSFI Desire (p=0.001), Arousal (p=0.033) and Satisfaction (p=0.019) among the 4 groups; however, only the difference in Desire was confirmed (p=0.034) in a multivariate model. A post-hoc analysis showed that only women in the T3 PRL tertile had significantly higher scores in FSFI Desire (p=0.011) and Satisfaction (0.045) vs. women with hyperPRL.After excluding hyperPRL women, we compared PRL between women with (n=35) and without HSDD (n=190) and observed that those with HSDD showed significantly lower PRL levels (p=0.002). ROC curve analysis for PRL levels showed an accuracy of 0.615 +- 0.022, p = 0.040, in predicting HSDD, and when a threshold of PRL&amp;lt;190 mU/L was chosen, sensitivity and specificity for HSDD were both 64.7%. Finally, we compared women with PRL levels &amp;gt; and &amp;lt; 190 mU/L. At multivariate analysis, women with PRL &amp;lt;190 mU/L showed a significantly lower cortisol (p=0.017) and SIS1 score (p=0.049), a scale of sexual inhibition, than women with PRL &amp;gt;190 mU/L (bit still in the normal range). Conclusions FSD women with hyperPRL showed a worse sexual function than those with normal PRL levels. However, when stratifying normoPRL women based on PRL tertiles, those included in the highest group had the best FSFI profile. Measuring PRL level in women with FSD is important, not only in order to ascertain the presence of a hyperPRL condition, but also to potentially predict the presence of HSDD or of a lower sexual inhibitory trait. Disclosure No

P-504 Quality of life and Sexual Dysfunction in Bologna poor ovarian responders (POR)

Abstract Study question Is quality of life (QoL) and sexual function of poor ovarian responders affected by patients’ age and ovarian reserve? Summary answer QoL and sexual function in POR are only affected by infertility duration and number of previous IVF attempts; not by patients’ age and ovarian reserve. What is known already Diagnosis of infertility is a common cause of sexual health disorders. Couples undergoing Assisted Reproductive Technology (ART) can face emotional stress and feelings of inadequacy or guilt that may interfere in their quality life and sexual function, Poor ovarian responders may represent a group of patients with compromised sexual function and quality of life, owing to either their advanced age or the decline in the serum androgen levels observed in this population. Nonetheless, up to date evidence is scarce concerning clinical factors that may affect quality of life and sexual function of women with poor ovarian response. Study design, size, duration In a prospective study conducted between 2015 and 2021 we collected questionnaires from poor ovarian responders fulfilling the Bologna criteria concerning their quality of life and sexual function. Participants/materials, setting, methods Overall 70 women undergoing IVF treatment who fulfilled Bologna’s criteria for poor ovarian responders were interviewed at their first visit. Sexual distress was evaluated using the Female Sexual Distress Scale-Revised (FSDSR) and Quality of life was measured by a fertility questionnaire (FertiQOL). Bivariate statistical analysis was conducted in order to evaluate clinical factors (patients’ age, duration of infertility, previous IVF attempts and ovarian reserve) that could potentially negatively affect sexual distress and quality of life. Main results and the role of chance Patients’ mean age was 38.6 years old (with 20.6% of the patients being under 35, 33.8% between 35-39 and 45.6% were above 40 years). Infertility duration was less than a year for 22.1% of patients and over one year for 77.9% of patients. Most of patients (80.9%) had at least one previous IVF/ICSI treatment. Quality of life and sexual function, as defined by FertiQol and FSDS-R scores, were comparable among different age groups, and older patients had similar QoL and sexual function with younger patients. Similarly, ovarian reserve did not affect any of the primary outcomes and no association has been found with AFC and FertiQol and FSDS-R scores. The only variables affecting FertiQol and FSDS-R scores were the duration of infertility and the number of previous IVF attempts. Quality of life was significantly lower (75.4 vs 85.9, p &amp;lt; 0.001) among poor responders with previous IVF attempts (&amp;gt; or = 1), whereas sexual distress was higher (10.6 vs 2.54, p &amp;lt; 0.001) in women with previous IVF/ICSI treatment (&amp;gt;0 or = 1) and women with longer duration of infertility (&amp;gt;1 year vs ≤ 1 year) (10.2 vs 4.9, p = 0.049). Limitations, reasons for caution The results are only applicable to women who fulfil the Bologna criteria for poor ovarian response and cannot be generalized to all infertile women. Wider implications of the findings Low ovarian reserve and patients’ age have limited effect on quality of life and sexual distress of poor ovarian responders. Social and sexual concerns should be taken in consideration in Bologna poor responders, especially in those with longer duration of infertility and previous failed IVF attempts independent of their age. Trial registration number Not applicable