Female Sexual Distress Scale Research Articles

Long-term Follow-up of Sexual Quality of Life after Laparoscopic Surgery in Patients with Deep Infiltrating Endometriosis

We performed a long-term follow-up to quantify the impairment of sexual quality of life (SQL) and health-related QL (HRQL) in sexually active women after laparoscopic excision of deep infiltrating endometriosis (DIE). Prospective case-control study. Hospital Clinic of Barcelona. A total of 193 patients (after dropout and exclusions) were divided into 2 groups: one hundred twenty-nine premenopausal women with DIE (DIE group) and 64 healthy women who underwent tubal ligation (C group). All patients underwent laparoscopic surgery: laparoscopic endometriosis surgery in the DIE group and laparoscopic tubal ligation in the C group. All women were followed for at least 36 months, and they completed the Medical Outcomes Study 36-item short form questionnaire to assess their HRQL and 3 self-administered questionnaires that evaluate different aspects of SQL: the generic Sexual Quality of Life-Female questionnaire, the Female Sexual Distress Scale to evaluate "sexually related distress," and the Brief Profile of Female Sexual Function to screen hypoactive sexual desire disorder. The patients with DIE as well as the controls completed the 4 questionnaires before surgery, and the patients with DIE also completed the questionnaires at 6 and 36 months after surgery. A comparison of the patients and controls before surgery showed a statistically significant impairment in SQL and HRQL among the patients with DIE. A statistically significant improvement in SQL and HRQL was observed in the DIE group 6 months after surgery, with scores being similar to those of the C group. An evaluation 36 months after surgery showed that SQL and HRQL were better than presurgical SQL and HRQL in the DIE group, with a slight reduction compared with the 6-month evaluation. SQL and HRQL improved in patients with DIE undergoing complete laparoscopic endometriosis resection and were comparable to those of healthy women at 6 months after surgery, showing a slight reduction at 36 months of follow-up.

Cognitive-behavioral couple therapy versus lidocaine for provoked vestibulodynia: A randomized clinical trial.

This randomized clinical trial compared a novel cognitive-behavioral couple therapy (CBCT) and topical lidocaine for provoked vestibulodynia. Participants were 108 women (M age = 27.06) and their partners randomized to one of two treatments and assessed at pre- and post-treatment and 6-month follow-up via questionnaires pertaining to the primary outcomes of women's pain (numerical rating scales of pain intensity and unpleasantness), and secondary outcomes of pain anxiety (Pain Anxiety Symptoms Scale), both partners' sexual function (Female Sexual Function Index; International Index of Erectile Function), sexual distress (Female Sexual Distress Scale Revised), pain-related psychological distress (Pain Catastrophizing Scale), treatment satisfaction, and global ratings of improvements in pain and sexuality. Intent-to-treat multilevel analyses showed that for women, CBCT yielded significantly more improvements than lidocaine in pain unpleasantness at 6-month follow-up, pain anxiety and pain catastrophizing at post-treatment and 6-month follow-up, and sexual distress at post-treatment, and resulted in better treatment satisfaction and global sexuality improvements at both time points. Partners significantly improved in their sexual function, sexual distress, and pain catastrophizing from pre- to post-treatment and pre-treatment to 6-month follow-up, with no significant group differences. Partners in the CBCT condition reported significantly greater treatment satisfaction at both time points, and greater sexuality improvements at post-treatment. CBCT yielded better outcomes on more dimensions of provoked vestibulodynia than lidocaine. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Exploring Relationships Between Genito-Pelvic Pain/Penetration Disorder, Sex Guilt, and Religiosity Among College Women in the U.S.

IntroductionDespite a growing body of research on psychosocial factors in Genito-Pelvic Pain/Penetration Disorder (GPPPD) during sexual intercourse, there are few studies examining adolescent and young adult women's experiences with painful sex and the effects of religiosity, sexual education, and sex guilt. AimThe purpose of the study was to examine the occurrence of GPPPD among sexually active female college students, including psychosocial factors of religiosity and religious practice, sexual education, sex guilt, and sexual distress. MethodsData were collected from 974 college women from a university in the Northeastern U.S. We limited our sample to sexually active women (n = 593, 60.9%; mean age: 18.96) who responded to the questionnaire item, “In general, do you feel pain with sexual intercourse?” Participants completed the Female Sexual Function Index (FSFI), Female Sexual Distress Scale (FSDS), Revised Mosher Sex Guilt Scale, Abbreviated Santa Clara Strength of Religious Faith Questionnaire, 10-item Gender Role Beliefs Scale, and measures on sexual wellness and practice and sexual education experiences. Data were analyzed using standard bivariate and regression analyses as well as path analysis. Main Outcome MeasuresWomen were asked, “In general, do you feel pain with sexual intercourse?” and categorized into one of three pain groups: occasional (10%–25% of the time), frequent (50% or more), and no pain (less than 10%). ResultsGPPPD with sex was prevalent among young college women, with 113 (19.1%) reporting frequent pain and 143 (24.1%) occasional pain (control n = 337, 56.8%). Numerous statistically significant factors were identified, including frequency of sex, ability to orgasm, sensations during intercourse, presence of a steady sexual partner, expectations of painful sex, sex guilt, and sexual distress. Sex guilt acted as full mediator between religiosity and painful sex. ImplicationsHealthcare providers should proactively initiate conversations with young female patients about painful intercourse to identify issues and normalize language on pain with sex. Educators are urged to teach evidence-based information on pain-free and guilt-free sexual experiences inside and outside religious contexts. ConclusionPainful sex affects adolescent and young adult women at a similar rate as non-college adult women and while religiosity does not directly impact young women's GPPPD, religiosity does lead to painful sex if it causes sex guilt. Further research is needed into the mechanisms of religion-based sexual shaming and among religiously conservative women who practice abstinence until marriage.Azim KA, Happel-Parkins A, Moses A, et al. Exploring Relationships Between Genito-Pelvic Pain/Penetration Disorder, Sex Guilt, and Religiosity Among College Women in the U.S. J Sex Med 2021;18:770–782.

Impact of an Educational Program on Sexual Issues among Cervical Cancer Survivors' Women in Northern Upper Egypt

Background: Sexuality is an important part of normal human functioning. Gynecological cancer and its treatments can affect one or more phases of the sexual response cycle, through alterations of sexual function. Sexual dysfunction is one of the most distressful symptoms among cervical cancer survivors. Sexual distress is a broad term encompassing any sexual discomfort and dysfunction. Sexual difficulties following cervical cancer can be stressful for couples as it can feel like a core part of the relationship has disappeared. Aim: The study is conducted to evaluate the impact of an educational program on sexual issues (sexual dysfunction & sexual distress) among cervical cancer survivors' women in Northern Upper Egypt. Methods; Design: A quasi-experimental design. Setting: out-patient clinic in the oncology unit at Beni-Suef University Hospital. Subjects: A purposive sample of 70 women. Tools: structured interviewing questionnaire sheet, female sexual function index, and female sexual distress scale. Results: The results of the study revealed regression of all items of women’s sexual distress scores, and progression of all items of women’s sexual items post-program compared to pre-one. Conclusion: The teaching program was very effective in improving sexuality among cervical cancer survivors' women. Recommendations: Disseminate the educational booklet at health centers and oncology outpatients. Integrate psychologist, psychosexual specialist, and social worker in treatment and counseling program for women with cervical cancer in the early stage of their treatment.

Women's Sexual Distress Associated With Cervical Cancer

Background: Sexual distress impacts women’s mental well-being. Anger/aggression, separation, divorce, and depression may be results of sexual distress. It harms woman’s mental health, in turn, impact the relationship between spouses. Aim: The present study aimed to assess women’s sexual distress associated with cervical cancer. Methods; Design: A descriptive design was used for the current study. Setting: out-patient clinic in the oncology unit at Beni-Suef University Hospital. Subjects: A purposive sample of 70 women. Tools: Data was collected through a structured interviewing questionnaire sheet, female sexual distress scale. Results: The results of the study revealed that 35.7% of women were in the 1st degree when diagnosed, 88.6% of the studied women had sexual distress. There was a statistically significant relationship between the educational level of women, marriage age, and their total sexual distress scores, while there was no relationship between age and residence of women and their total sexual distress scores. Conclusion: Sexual distress was more prevalent among older, less educated, urban dwellers, and those whose age of marriage was less than 20 years old. Recommendations: Preparing health classes for cervical cancer women regarding sexual distress following cervical cancer.

Abstract OT-02-01: A longitudinal study assessing sexual dysfunction in postmenopausal women with breast cancer undergoing adjuvant treatment

Abstract According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), Female Sexual Dysfunction is defined as a sexual problem associated with personal distress. It can be caused by any of the following: lack of sexual desire, impaired arousal, inability to achieve orgasm, or pain with sexual activity. Several studies have demonstrated the negative impact chemotherapy has on sexual functioning, short term and long term in women undergoing breast cancer treatment. Most of the research that has been done in this area only evaluated this problem in premenopausal women. The limited studies investigating this in postmenopausal women have found similar effects in this population group. The goal of this study is to assess sexual dysfunction in high risk postmenopausal women with breast cancer undergoing adjuvant therapy. We want to define this problem in this poorly studied subgroup, and to assess the degree of dysfunction, time course over which it occurs, and the particular sexual domains this occurs in. T This longitudinal study will assess sexual functioning utilizing two survey tools- the Female Sexual Function Index (FSFI), and the Female Sexual Distress Scale (FSDS-R). The FSFI is a 19- item questionnaire that assesses six domains of sexual functioning: desire, arousal, lubrication, orgasm, satisfaction, and pain The FSFI has been proven to have excellent validity and reliability in determining sexual dysfunction in healthy women, as well as women with various cancers including breast cancer. It was designed to be easy to use, and can be used in heterosexual, as well as homosexual women. To be consistent with the DSM 5’s definition of sexual dysfunction regarding personal distress, which is not evaluated in the FSFI, the FSDS-R will be utilized. This is a 13-item questionnaire, which has demonstrated excellent validity and reliability in determining sexual distress associated with sexual dysfunction. Participants will serve as their own control while assessing any change in sexual functioning over the course of the administration of 2-3 survey sets. The 1st set of surveys will be administered prior to receiving any treatments, this will serve as a baseline assessment for future comparison. The last 1-2 survey sets will be administered 6 months to 1 year after the initiation of adjuvant therapy. Data will be analyzed with a Repeated Measures ANOVA if statistical assumptions are met. If statistical assumptions are not met the Friedman ANOVA will be used. Post-Hoc testing will be conducted if significant main effects are found. At this time, 13 patients are currently enrolled in this trial. The number of participants for this study to achieve statistical power was calculated to be n=42. This calculation was based on one treatment group, with three observations across time, a correlation amount of repeated measures of 0.5, and a non-sphericity correction of 1.0. The assumed effect size was small to moderate with an F=0.20, an alpha of 0.05, and a beta of 0.20. Eligibility Criteria for this trial: •Must be a postmenopausal female •Diagnosed with Stage I, II, or III breast cancer •Not currently receiving endocrine therapy or chemotherapy•Plans with their physician to receive adjuvant therapy For more information please contact: Heidi Worth, MD PGY2 Internal Medicine Resident University of Tennessee Medical Center, Knoxville 904-540-1286 hworth@utmck.edu Citation Format: Heidi Worth, Timothy Panella, Clayton Bell, Mark Rasnake, Patricia Roberson, Lauren Lewis. A longitudinal study assessing sexual dysfunction in postmenopausal women with breast cancer undergoing adjuvant treatment [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr OT-02-01.

Patient-reported sexual function of breast cancer survivors with genitourinary syndrome of menopause after fractional CO2 laser therapy.

The objective of this pilot study was to evaluate the change in sexual function following treatment with fractional CO2 laser therapy in breast cancer (BC) survivors with genitourinary syndrome of menopause (GSM). A single-arm feasibility study of BC survivors with symptoms of GSM, including dyspareunia and/or vaginal dryness, was conducted. Participants who received three treatments with fractional CO2 laser and 4-week follow-up were contacted for patient-reported outcomes and adverse events at 12 months. Sexual function was measured using the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale Revised (FSDS-R). Descriptive statistics were calculated for patient demographics and disease characteristics for the set of participants who agreed to long-term follow-up and those who were lost to follow-up. FSFI and FSDS-R scores were summarized at baseline, 4 weeks and 12 months, as well as the change from baseline, and were compared using a Wilcoxon signed rank test. A total of 67 BC survivors enrolled, 59 completed treatments and 4-week follow-up; 39 participated in the 12 month follow-up. The overall FSFI score improved from baseline to 4-week follow-up (median Δ 8.8 [Q1, Q3] (QS) (2.2, 16.7)], P < 0.001). There were improvements at 4 weeks in all domains of the FSFI (P < 0.001 for each) including desire (median Δ 1.2; QS [0.6, 1.8]), arousal (median Δ 1.2; QS [0.3, 2.7]), lubrication (median Δ 1.8 (0, 3.3), orgasm (median Δ 1.2; QS [0, 3.6]), satisfaction (median Δ 1.6 (0.4, 3.2)), and pain (median Δ 1.6 (0, 3.6). The FSDS-R score also improved from baseline to 4-week follow-up (median Δ -10.0; QS [-16, -5] P < 0.001) indicating less sexually related distress. The scores of the FSFI and FSDS-R remained improved at 12 months and there were no serious adverse events reported. In BC survivors with GSM, the total and individual domain scores of the FSFI and the FSDS-R improved after fractional CO2 laser therapy.

Vulvovaginal atrophy of menopause and its impact on sexual function in an Italian clinical cohort of post-menopausal women

The aim of current study was to estimate the impact of vulvovaginal atrophy (VVA) on sexual function in a clinical population of Italian postmenopausal women. Women aged 45–75 years with at least one VVA symptom completed three questionnaires: Day-to-Day Impact of Vaginal Aging (DIVA), Female Sexual Function Index (FSFI) and Female Sexual Distress Scale revised (FSDS-R). A gynaecological examination was performed for VVA confirmation. Among the 1,066 evaluable patients, VVA was confirmed in around 90% of the sample. Sexual function impairment was significantly higher in patients with confirmed VVA as observed by significant differences in the sexual function component of the DIVA questionnaire (p = .014), the FSDS-R (p < .0005), and the FSFI (p < .0005), as well as for all the FSFI subdomains: desire (p < .0005), arousal (p < .0005), lubrication (p < .0005), orgasm (p < .0005), satisfaction (p < .0005) and pain (p < .0005). Significant impairment of sexual function was demonstrated in Italian postmenopausal women who were clinically confirmed with signs of VVA through gynaecological examination. IMPACT STATEMENT What is already known on this subject: At least half of postmenopausal women report VVA associated symptoms with significant impact on sexual function and ultimately on sexual activity. What the results of this study add: As compared with patients without confirmed VVA, the negative impact on sexual function was significantly higher in patients with confirmed VVA. This difference was observed for the sexual function component (DIVA-C) of the DIVA questionnaire, for the overall FSDS-R result, and for the overall FSFI score, as well as for all the FSFI subdomains (desire, arousal, lubrication, orgasm, satisfaction and pain). What the implications are of these findings for clinical practice and/or further research: An impairment of sexual function is significantly associated with VVA diagnosis in Italian post-menopausal women, especially when diagnosis was objectively confirmed by clinical signs of VVA visible in the gynaecological examination. In addition, this study demonstrates that inquiring about VVA using a structured questionnaire may increase the diagnosis of VVA related changes in sexual function.

Целевая терапия тазовой боли, ассоциированной с эндометриозом. Оценка качества жизни и сексуальной функции

Objective. To study the efficacy of dienogest 2 mg in the treatment of female patients with pelvic pain associated with endometriosis in terms of improving the quality of life and sexual function. Patients and methods. The study group included 54 female patients with confirmed diagnosis of genital endometriosis (adenomyosis, infiltrating endometriosis, ovarian endometrial cysts). Dienogest 2 mg once daily was prescribed to all patients; 38 patients received non-steroidal anti-inflammatory drugs and constituted the comparison group. The visual analogue scale was used to assess pelvic pain, dysmenorrhea, and dyspareunia in patients with endometriosis. The 36-Item Short Form Survey (SF-36), the Female Sexual Function Index (FSFI), and the Female Sexual Distress Scale (FSDS) were used to assess the quality of life, sexual function, and sexual distress, respectively. The study contained two consecutive follow-ups after 3 and 6 months. All patients included in the study refused the proposed surgical treatment. Results. A slight decrease in chronic pelvic pain, dysmenorrhea, and dyspareunia was observed in the study group after 3 months (p &lt; 0.05) with a progressive decrease in pain intensity by 6 months of dienogest administration (p &lt; 0.001). The qualityof-life assessment showed a similar tendency: improvements were significant in several categories after 3 months (p &lt; 0.05) and in all categories by 6 months (p &lt; 0.001). The FSFI score had no changes after 3 months of follow-up (p with no statistical significance) but improved between 3 and 6 months (p &lt; 0.001). The same was observed regarding the FSDS scale (p &lt; 0.001). No changes were seen in the comparison group. Conclusion. Administration of dienogest 2 mg once daily in women with endometriosis-associated pelvic pain significantly reduces pain syndrome while positively affecting the quality of life and sexual function. Key words: dyspareunia, endometriosis, chronic pelvic pain, dienogest, quality of life, sexual activity

Partner Responses to Low Desire: Associations With Sexual, Relational, and Psychological Well-Being Among Couples Coping With Female Sexual Interest/Arousal Disorder

BackgroundThe experience of distressing low sexual interest/arousal—female sexual interest/arousal disorder (FSIAD)—is prevalent in women of all ages and is associated with poorer sexual, relationship, and psychological well-being than women without this difficulty. Women who are partnered are almost 5 times more likely to be distressed by low desire and to receive a diagnosis of FSIAD than unpartnered women, indicating that interpersonal factors are highly relevant, although largely neglected in past research. AimIn a dyadic cross-sectional and longitudinal study, we examined whether partner responses to FSIAD were associated with the sexual, relationship, and psychological well-being of couples, and whether any effects persisted 1 year later. MethodsWomen diagnosed with FSIAD (N = 89) completed a validated measure of perceived partner positive vs negative responses to their low sexual interest/arousal and their partners reported on their own responses, as well as measures of sexual desire, sexual satisfaction, relationship satisfaction, sexual distress, and anxiety. 1 year later, couples (N = 66) completed the outcome measures again. Data were analyzed according to the Actor-Partner Interdependence Model. OutcomesOutcomes included were the Sexual Desire Inventory–Solitary and Partner-Focused Subscales; Global Measure of Sexual Satisfaction; Female Sexual Distress Scale; Couple Satisfaction Index; and State-Trait Anxiety Inventory–Short-Form. ResultsWhen women with FSIAD perceived more positive partner responses (eg, warm, supportive, compassionate) than negative responses (eg, hostile, unsupportive, indifferent), they were more satisfied with the relationship and they and their partners reported lower anxiety. When partners reported more positive than negative responses, they had greater relationship and sexual satisfaction and lower sexual distress and anxiety. Exploratory analyses revealed that women's perceptions of their partners' responses accounted for the link between partners' own responses and women's relationship satisfaction and anxiety. Partner responses did not predict any change in outcomes over time. Clinical ImplicationsFindings support interpersonal conceptualizations of FSIAD and may inform the development of future couple-based interventions. Strengths & LimitationsThis study is one of the few dyadic investigations of FSIAD, as diagnosed via a clinical interview. Significant associations were only observed cross-sectionally, limiting causal conclusions. There was limited power to detect longitudinal effects. ConclusionMore positive responses to women's low sexual interest/arousal by partners is linked to better adjustment among couples affected by FSIAD.Rosen NO, Corsini-Munt S, Dubé JP, et al. Partner Responses to Low Desire: Associations With Sexual, Relational, and Psychological Well-Being Among Couples Coping With Female Sexual Interest/Arousal Disorder. J Sex Med 2020;17:2168–2180.

Pilot study of radiofrequency thermal therapy performed twice on the entire vaginal wall for vaginal laxity

ObjectiveRadiofrequency thermal (RFT) therapy is commonly performed to treat vaginal laxity (VL), but the optimal technique of RFT therapy is unclear. We aimed to evaluate the efficacy and safety of RFT therapy performed twice on the whole vaginal wall in women with VL. MethodsThis was a single-arm, open-label clinical trial conducted in a tertiary hospital in the Republic of Korea from July 2018 to January 2019. Non-pregnant, adult women with VL, defined as a score ≤3 on a vaginal laxity questionnaire (VLQ), were recruited. RFT therapy consisted of 2 office procedures performed 3 weeks apart. Starting from the upper vaginal wall at the 12 o’clock position, the whole vaginal wall was slowly rubbed with a heated vaginal probe for 20 minutes. After the 2nd RFT therapy session, patients had follow-up visits at 4 and 12 weeks, and changes in the VLQ score, Female Sexual Function Index (FSFI) score, Female Sexual Distress Scale (FSDS) score, and vaginal pressure at rest and during the Valsalva maneuver and treatment-emergent adverse events (TEAEs) were examined. ResultsThirty subjects were enrolled, but 28 were evaluated for efficacy measurements. RFT therapy improved the VLQ score (means at baseline, 4 weeks, and 12 weeks were 2.5, 4.9, and 4.8, respectively; p < 0.0001), FSFI score (means at baseline, 4 weeks, and 12 weeks were 21.9, 27.0, and 27.2, respectively; p < 0.0001), and FSDS score (means at baseline, 4 weeks, and 12 weeks were 33.8, 21.1, and 18.6, respectively; p < 0.0001); however, vaginal pressure did not increase. The effect of RFT therapy peaked at the 4-week follow-up and plateaued at week 12. No TEAE was observed, except transient grade 1 vaginal pain. ConclusionRFT therapy performed twice on the whole vaginal wall showed promising efficacy and safety profiles and has merit for further investigation.

Multimodal physical therapy versus topical lidocaine for provoked vestibulodynia: a multicenter, randomized trial

Provoked vestibulodynia is the most common subtype of chronic vulvar pain. This highly prevalent and debilitating condition is characterized by acute recurrent pain located at the entry of the vagina in response to pressure application or attempted vaginal penetration. Although physical therapy is advocated as a first-line treatment for provoked vestibulodynia, evidence supporting its efficacy is scarce. The purpose of this study was to establish the efficacy of multimodal physical therapy compared with topical lidocaine, a frequently used first-line treatment. We conducted a multicenter, parallel-group, randomized clinical trial in women diagnosed as having provoked vestibulodynia recruited from the community and 4 Canadian university hospitals. Women were randomly assigned (1:1) to receive either weekly sessions of physical therapy or overnight topical lidocaine (5% ointment) for 10 weeks. Randomization was stratified by center using random permuted blocks from a computer-generated list managed by an independent individual. Physical therapy entailed education, pelvic floor muscle exercises with biofeedback, manual therapy, and dilation. Assessments were conducted at baseline, posttreatment, and 6-month follow-up. Outcome assessors, investigators, and data analysts were masked to allocation. The primary outcome was pain intensity during intercourse evaluated with the numeric rating scale (0-10). Secondary outcomes included pain quality (McGill-Melzack Pain Questionnaire), sexual function (Female Sexual Function Index), sexual distress (Female Sexual Distress Scale), satisfaction (numeric rating scale of 0-10), andparticipants' impression of change (Patient Global Impression of Change). Intention-to-treat analyses were conducted using piecewise linear-growth models. Among 212 women who were recruited and randomized, 201 (95%) completed the posttreatment assessment and 195 (92%) completed the 6-month follow-up. Multimodal physical therapy was more effective than lidocaine for reducing pain intensity during intercourse (between-group pre-post slope difference, P<.001; mean group postdifference, 1.8; 95% confidence interval, 1.2-2.3), and results were maintained at 6-month follow-up (mean group difference, 1.8; 95% confidence interval, 1.2-2.5). The physical therapy group also performed better than the lidocaine group in all secondary outcomes (pain quality, sexual function, sexual distress, satisfaction, and participants' impression of change) at posttreatment and 6-month follow-up. Moreover, the changes observed after physical therapy were shown to be clinically meaningful. Regarding participants' impression of change, 79% of women in the physical therapy group reported being very much or much improved compared with 39% in the lidocaine group (P<.001). The findings provide strong evidence that physical therapy is effective for pain, sexual function, and sexual distress and support its recommendation as the first-line treatment of choice for provoked vestibulodynia.

Quality of life of women using the etonogestrel long-acting reversible contraceptive implant after abortion for unplanned pregnancy

Objectives The aims of the study were to investigate the effect of a subcutaneous etonogestrel-containing contraceptive implant on the quality of life (QoL) and sexual function of women who had undergone termination of an unplanned pregnancy. Methods At pregnancy termination 140 women received contraceptive counselling on the etonogestrel implant. The Short Form-36 questionnaire, the Female Sexual Function Index and the Female Sexual Distress Scale were used to investigate, respectively, the QoL, sexual function and sexual distress of the women at baseline and at 6, 12, 24 and 36 months of follow-up. Results The study group comprised 86 (61.4%) women who chose to use the contraceptive implant. The control group comprised 28 (20.0%) women who chose to use short-acting reversible contraception (SARC) and 26 (18.6%) women who chose not to use hormonal contraception. In the women not using hormonal contraception there were 23 (88.5%) unintended pregnancies before the end of the 3 year study period. QoL, sexual function and sexual distress improved in the study group from the 6 months follow-up until the end of the study (p < 0.001). QoL (p < 0.02) and sexuality (p < 0.001) gradually improved in the control group after 24 and 12 months of follow-up, respectively. None of the women using the etonogestrel implant became pregnant during the study. Inter-group analysis showed better improvement in QoL, sexual function and sexual distress in the study group than in the control group from 6 months (p < 0.004) until the end of the study (p < 0.001). Conclusion Compared with SARC and non-hormonal contraception, the contraceptive implant promoted better QoL and sexuality in users and reduced the incidence of unplanned pregnancy. However, the women who opted for SARC or non-hormonal contraception did so because of the lower cost compared with that of the contraceptive implant.

Laparoscopic sacrocolpopexy plus ventral rectopexy as combined treatment for multicompartment pelvic organ prolapse.

Pelvic organ prolapse (POP) is a dynamic disorder that affects the entire pelvic diaphragm. POP may often involve multiple organs. Abdominal sacrocolpopexy is considered the gold standard to treat female anterior and apical prolapse. Abdominal ventral mesh rectopexy has gained increasing acceptance as an effective treatment for rectal prolapse. The aim of the present study was to assess the safety, feasibility and 1-year outcomes of laparoscopic sacrocolpopexy plus ventral rectopexy as a combined treatment of multicompartment POP. All female patients at our institution with anterior and apical prolapse with symptoms of obstructed defecation were examined by an urogynecologist and a colorectal surgeon, and were judged suitable for the study. Patients with Pelvic Organ Prolapse Quantification (POP-Q) system stage III and IV and concomitant rectal prolapse were treated by laparoscopic sacrocolpopexy plus ventral rectopexy. After surgery, 1- and 12-month follow-up was performed and the data were retrospectively analyzed. Patients' symptoms were evaluated using the Female Sexual Distress Scale (FSDS), Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12), and Wexner-Agachan constipation score. A total of 98 patients underwent surgery. No intraoperative or postoperative morbidity occurred. At the time of follow-up, all women expressed great satisfaction with the surgical treatment: all the patients had at most POP-Q Stage 1 and 78.8% had a Patient Global Impression of Improvement (PGI-I) score < 3. Significant improvement of symptoms related to POP and to obstructed defecation syndrome, as shown by the FSDS, PISQ-12, and Wexner-Agachan constipation score, was observed in all patients at follow-up CONCLUSIONS: Laparoscopic sacrocolpopexy with ventral rectopexy is a feasible and safe procedure for the combined surgical management of anterior, apical, and posterior prolapse, and provides excellent objective and subjective outcomes.

The European Vulvovaginal Epidemiological Survey (EVES): impact on sexual function of vulvovaginal atrophy of menopause.

To estimate the impact of vulvovaginal atrophy (VVA) on sexual function in a clinical population of postmenopausal women. Women 45 to 75 years old and more than 12 months after the last menstruation, who attended menopausal/gynecological centers in Italy and Spain, were included. Women with at least one VVA symptom completed the following questionnaires: Day-to-Day Impact of Vaginal Aging (DIVA), Female Sexual Function Index (FSFI), and Female Sexual Distress Scale revised (FSDS-R). A physical gynecological examination was performed to confirm the VVA diagnosis. Data were analyzed by chi-square and Student's t tests. In all, 2,160 evaluable women were included in the study. VVA was confirmed in 90% of the included participants. The negative impact on sexual function was significantly higher in women with than in women without confirmed VVA, as evaluated with the sexual function component (DIVA-C) of the DIVA questionnaire (P = 0.013). Statistically significant differences (P < 0.0005) were also detected in the scores of overall FSDS-R, the overall FSFI, and of all the FSFI subdomains (desire, arousal, lubrication, orgasm, satisfaction, and pain). For postmenopausal women with at least one VVA symptom, the presence of physician-confirmed VVA is associated with significant impaired sexual function, as shown by unadjusted analyses. Given the impact on quality of life and the prevalence of VVA, further research to improve and reduce VVA is warranted.

Fat Grafting Improves Fibrosis and Scarring in Vulvar Lichen Sclerosus: Results From a Prospective Cohort Study.

The aim of the study was to evaluate the effect of lipotransfer in women presenting with fibrosis and scarring due to lichen sclerosus. This prospective cohort study included 33 women attending the vulvar clinic of a public hospital. Patients received one lipotransfer treatment. Validated measures were used prospectively to assess the sexual function (Female Sexual Function Index, Female Sexual Distress Scale); symptoms (visual analog scale for itching, burning, soreness), pain (Pain Anxiety Symptoms Scale 20); psychological status and quality of life (Hospital Anxiety and Depression Scale, Relationship Assessment Scale, Wound Management Questionnaire Revised); physician-based disease signs (Vulvar Architecture Severity Scale). Data were analyzed using paired t test with nonparametric Wilcoxon matched-pairs signed rank test and unpaired t test with nonparametric Mann-Whitney test (Prism6 Software). The mean (SD) follow-up was 12.9 (3.5) months. Sexual function improved after treatment (p < .001), as well as the distress associated with sexuality (p < .0001). A significant improvement was reported in itching (p < .001), burning (p < .05), soreness (p < .001), and pain (p < .0001). Patients reported a significant improvement in romantic relationship (p < .05), anxiety (p < .0001), and depression (p < .0001). Improvement was not significant in the self-care associated with self-disgust assessment (p = .42). The clinical physician-based score showed an overall improvement in all the treated areas to lesser or greater extent. The use of fat grafting in lichen sclerosus is promising. Further studies are required to rule out a potential placebo effect and to better understand the underlying molecular mechanism of action.

New medical device containing verbascoside, carrageenan and glycerophosphoinositol for the treatment of dyspareunia in reproductive age women: A prospective observational study

IntroductionDyspareunia, especially in reproductive age, often has a negative impact on women’s sexual life, with great psychological impact. Our aim was to assess the effect of a device containing verbascoside, glycerophosphoinositol (GPI), hyaluronic acid sodium salt (HANa) and carrageenan (CG) for the treatment of idiopathic dyspareunia and its impact on sexual function in reproductive age women. MethodsWe recruited 43 sexually active women of reproductive age who had been suffering from superficial idiopathic dyspareunia in the last 6 months. The therapy with a device containing verbascoside, GPI, HANa and CG was applied in the vulvar and vaginal area twice a day for 12 weeks. Quality of Life (QoL) and the sexual function were assessed with Female Sexual Function Index (FSFI) and Female Sexual Distress Scale (FSDS) questionnaires before and after 12 weeks of treatment. ResultsAfter treatment, the mean FSFI total score was 27.87 ± 1.86, significantly higher than before treatment (p < 0.0001). Improvement in distress about sex life was shown after treatment. The mean FSDS total score decreased significantly after 12 weeks (p < 0.0001). A reduction in dyspareunia measured with a VAS scale was observed. ConclusionsLocal application of a combination of verbascoside, GPI, HANa and CG effectively reduced dyspareunia and pain without any important adverse effects.

Instruments for Screening, Diagnosis, and Management of Patients with Generalized Acquired Hypoactive Sexual Desire Disorder.

Screening, diagnosis, and management of hypoactive sexual desire disorder (HSDD) and research into the condition have been challenging due to its biopsychosocial complexity and lack of consensus on relevant measures. Although physician interviews yield much clinically valid information, self-reported questionnaires appear more acceptable to patients and physicians. Consequently, validated patient-reported outcome (PRO) tools are essential for evaluation and management of HSDD, including any therapeutic intervention. The US Food and Drug Administration (FDA) has issued guidance on the use of appropriate endpoints and associated measures for female sexual dysfunction, including HSDD. Although many of the available measures were not designed specifically for HSDD assessment, as per FDA guidelines, most clinical studies have used individual domains or items from established tools, such as the Female Sexual Function Index-desire domain and Item 13 of the revised Female Sexual Distress Scale. For clinical practice, several professional societies recommend the Decreased Sexual Desire Screener and/or a sexual history as tools to diagnose HSDD. This review discusses frequently used PRO tools as well as the newly developed and validated Elements of Desire Questionnaire, which may be appropriate for clinical trials or clinical practice.

Genital Pain and Sexual Functioning: Effects on Sexual Experience, Psychological Health, and Quality of Life

BackgroundGenital pain (GP) is a common symptom in women of reproductive age. The prevalence of GP is difficult to gauge as it has been underreported by both patients and clinicians and neglected in clinical studies despite wide recognition of the adverse effects to women's health. AimThe purpose of the present study was 3-fold: (i) to explore the self-reported presence and perception of GP and its association with sexual functioning, sexual distress, emotions, psychopathology, and quality of life (QoL); (ii) to explore if, controlling for the pain effect, women with Female Sexual Function Index (FSFI) scores indicating sexual dysfunction also reported worse outcomes regarding sexual distress, emotions, psychological health, and QoL than GP women with higher FSFI scores; and (iii) to evaluate the effects of GP duration, comparing women with GP with shorter (<6 months) duration of symptoms with women with longer (≥6 months) duration of symptom of GP on sexual functioning, distress, emotions, psychopathology and QoL. MethodsA total of 1,034 women (age ranges between 18 and 40 years) from the Italian general population completed a web survey on sexual health. Outcomes6 self-report questionnaires exploring different biopsychosocial factors were assessed: the FSFI, the Female Sexual Distress Scale, the Positive and Negative Affect Schedule, the Short Form McGill Pain Questionnaire adapted for GP, the Short Form 36, and the Symptom Check List-90-Revised. ResultsWomen who reported GP (n = 319) indicated generally lower sexual function than women without GP (n = 648; P = .036). They reported a higher level of sexual distress (P < .001), more negative emotions related to sexual experiences (P = .001), lower scores in all QoL domains (P < .001), and higher levels of psychopathological symptoms (P < .001). Controlling for pain effects, women whose FSFI scores indicated sexual dysfunction (n = 150) reported higher rates of sexual distress than women whose FSFI scores indicated normal sexual function (n = 169; P < .001).The scores also indicated fewer positive (P < .001) and more negative emotions (P < .001) related to sexuality, lower QoL (P < .001) and significantly higher psychological burden (P < .001). Moreover, women experiencing GP for ≥6 months reported significantly lower means on the FSFI total score (P < .05; especially in the desire, satisfaction, and pain domains), distress (P < .001), and emotions (P < .05) than women experiencing GP duration <6 months. No significant differences were found on the QoL and the psychopathological symptoms. Clinical ImplicationsGP is significantly pervasive, but a high percentage of sexual problems and related emotional suffering is overlooked. Raising awareness about this issue is critical, both among clinicians and the general public. Strengths & LimitationsThe present study highlighted important characteristics of GP from a community sample; the results indicate problems related to pain experiences and their repercussions on sexual, psychological, affective health, and QoL. Major limitations are related to the use of self-report measures via a web-based study. ConclusionThe results provide evidence of a lack of awareness regarding pain experiences as they relate to sexual functioning in women; clinicians would be advised to more fully investigate sexual functioning and psychosocial variables associated with GP during routine consultation beginning with the first onset of the symptoms.Nimbi FM, Rossi V, Tripodi F, et al. Genital Pain and Sexual Functioning: Effects on Sexual Experience, Psychological Health, and Quality of Life. J Sex Med 2020; 17:771–783.

193 Bremelanotide for Hypoactive Sexual Desire Disorder: Contraceptive Subgroups Efficacy Analysis

Hypoactive sexual desire disorder (HSDD) is the most common sexual dysfunction associated with personal distress in women, and is characterized by an absence or deficiency of sexual desire accompanied by distress. HSDD affects approximately 10% of women, with a similar prevalence regardless of age. Bremelanotide, a melanocortin receptor agonist and an analog of the endogenous neuropeptide α-melanocortin stimulating hormone, has been approved for the treatment of acquired, generalized HSDD in premenopausal women. The RECONNECT studies, which comprised two double-blind, randomized, placebo-controlled studies, demonstrated that subcutaneous self-administration of bremelanotide significantly improved sexual desire and decreased personal distress in premenopausal women with HSDD. To investigate the efficacy of bremelanotide across hormonal contraceptive subgroups in the RECONNECT studies. Patients self-administered bremelanotide 1.75 mg or placebo subcutaneously for 24 weeks, using an autoinjector pen as needed prior to sexual activity. Patients were evaluated (“yes” and “no” subgroups) based on concurrent use of hormonal contraceptives (including oral contraceptives and other estrogen-containing products). Efficacy was assessed using RECONNECT co-primary endpoints: change from baseline to end-of-study (EOS) for Female Sexual Function Index–desire domain (FSFI-D) and Female Sexual Distress Scale–Desire/Arousal/Orgasm (FSDS-DAO) Item 13 scores.