Improvement In Sexual Function Research Articles

Sexual well-being and fertility in male renal transplant recipients: A study in a tertiary care centre.

Sexual dysfunction is a common problem among chronic kidney disease (CKD) patients. The uraemia, comorbid conditions, hormonal disturbances, autonomic neuropathy, side effects of medication and psycho-social factors contribute to sexual dysfunction. These factors also affect fertility of CKD patients. It starts early in CKD and gradually deteriorates with time. Renal transplant corrects most of the issues and leads to improvement of sexual function which ultimately leads to improved fertility outcomes. It was a cross sectional study performed in a single institution including 135 male renal transplant recipients. A questionnaire was used to evaluate the socio-economic status, fertility and developmental condition of the off-springs. The International index of erectile dysfunction (IIEF) was used for assessment of sexual well-being of the patient. The data were statistically analysed by SPSS 25.0 version. The mean age at transplant was 40.9 ± 9.9 years and the duration of haemodialysis received 13.6 ± 7.43 months. Among 135 recipients 63 (46.67%) desired but only 49 were successful to father a child. Upper middle class being the largest group to receive renal transplant also had the highest fertility rate in our study. The children born had no development anomaly. Sexual function improved in 85 patients, worsened in 15 and remain unchanged among 35 patients after renal transplant. Overall there was significant improvement in all five parameters of IIEF. Renal transplant corrects most of the metabolic abnormality as well gives a psychological boost to the CKD patients. These lead to improvement of sexual functions which in turn improves the fertility in renal transplant recipients. But the overall fertility rate among the male renal transplant recipients was comparable to the general population.

Patient Satisfaction of the Non-Surgical Lysis Procedure for Clitoral Adhesions in Patients with and without Lichen Sclerosuas

ABSTRACT Introduction Lichen sclerosus (LS) is a chronic, inflammatory skin disorder in the anogenital region typically found in prepubertal or postmenopausal women that causes skin thinning, whitening, wrinkling, itching, and pain. LS is an established risk factor for the development of clitoral adhesions (CA). CA occur when the prepuce adheres to the glans clitoris leading to discomfort, hypersensitivity/hyposensitivity, difficulty reaching orgasm, and chronic vulvodynia. However, CA can also occur in the absence of LS. Two lysis of CA treatment modalities exist - one surgical procedure and one non-surgical, office-based procedure that stretches the preputial tissue open. Previous studies explored LS patient satisfaction with surgical lysis or dorsal-slit surgery but not with the non-surgical approach. The non-surgical office-based procedure has also never been studied in patients without LS. Objective The aim of this study is two-fold: to evaluate patient satisfaction and outcomes of the non-surgical lysis of CA procedure in women with LS and to compare the efficacy of the procedure in patients with and without LS. Methods 61 women who have been treated for CA using the non-surgical lysis procedure at one sexual medicine practice from 2017-2021 were identified using a retrospective chart review. An online survey was sent to these patients to evaluate the efficacy of the procedure in improving pain and sexual functioning, as well as patient satisfaction with the procedure. Results 41 women participated in the study (67% response rate) and 5 had a diagnosis of LS that was optimally treated with high-potent steroids. In terms of procedure satisfaction, there was no significant difference in patient satisfaction (80% vs 83%) or the likelihood of recommending the procedure to a friend who also had CA (80% vs. 94%) among women with and without LS. In regards to improving sexual functioning, there was no significant difference in the procedure's ability to improve sexual arousal (80% vs. 60%), ability to orgasm (80% vs. 62%), and sexual satisfaction (60 vs. 72%) between women with and without LS. Finally, there was no significant difference in reporting the procedure was painful (40% vs. 25%) or the incidence of recurrence of adhesions (40% vs. 51%). Conclusions This study demonstrates high patient satisfaction and improvement in sexual functioning associated with the non-surgical lysis procedure for CA in women with and without LS. CA should not be considered as an adjunct side-effect of LS but as an independent pathology. Physicians should examine the clitoris in women with and without LS in order to determine if a patient has CA. Once diagnosed, the non-surgical lysis procedure has similar efficacy and patient satisfaction in women with and without LS and could be considered as a treatment option for improving sexual function in women. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Sprout (Raleigh, NC), Absorption Pharmaceuticals

A Retrospective Case Series on Patient Satisfaction and Efficacy of Non-Surgical Lysis of Clitoral Adhesions

Clitoral adhesions are characterized by adherence of preputial tissue to the glans clitoris and can be managed using a non-surgical approach in order to relieve symptoms of sexual dysfunction. To evaluate efficacy and patient satisfaction associated with the non-surgical lysis procedure in order to determine if it is an appropriate treatment for symptomatic clitoral adhesions. The non-surgical lysis procedure is performed by using a fine Jacobsen mosquito forceps to separate the plane between the prepuce and the glans of the clitoris, removing smegma and/or keratin pearls from underneath the adhesions and allowing for visualization of the entire glans. A chart review of 61 women that were treated for clitoral adhesions using the non-surgical lysis procedure at 1 sexual medicine practice was performed and an online survey was sent to these patients. Encrypted survey responses were used to evaluate patient satisfaction as well as self-reported improvement in sexual functioning and pain before and after the procedure. 41 survey responses were received out of 61 eligible (67% response rate). A large majority reported improvement in pain (76%), sexual arousal (63%), and ability to achieve orgasm (64%) and no participants reported worsening in these symptoms. Of the 16 women that reported the inability to orgasm from external clitoral stimulation prior to the procedure, 6 (38%) were able to do so afterwards. Seventy-one percent of respondents reported improvement in their satisfaction with sex and 83% reported being satisfied with their decision to have the procedure. Ninety-three percent of participants reported that they would recommend this procedure to a friend with clitoral adhesions. The results of this study will help clinicians to recognize the non-surgical lysis procedure as a treatment option for clitoral adhesions. This study is the first of its kind assessing a cohort of patients undergoing the non-surgical lysis procedure for clitoral adhesions. Its limitations include a small sample size from 1 clinic and lack of validated instrument to evaluate sexual function and pain before and after the procedure. Providers should regularly examine the clitoris of patients with symptoms of sexual dysfunction in order to determine if they have clitoral adhesions. The non-surgical lysis procedure may be a viable therapeutic option for these patients that has demonstrated both satisfaction and symptom relief. Myers MC, Romanello JP, Nico E, et al. A Retrospective Case Series on Patient Satisfaction and Efficacy of Non-Surgical Lysis of Clitoral Adhesions. J Sex Med 2022;19:1412-1420.

The Lived Experience of Patients with Adult Acquired Buried Penis.

We describe the lived experience of adults with acquired buried penis (AABP) through thematic analysis of patient interviews. We examine the challenges that patients face and the impacts of surgery. This mixed-methods study utilized validated instruments and semi-structured interviews to capture pre- and postsurgical outcomes. Semi-structured interviews were conducted with open-ended questions to elicit the impact of AABP on a patient's quality of life in several domains including urinary function, sexual function, interpersonal relationships and mental health. Recruitment was completed once we achieved thematic saturation. Twenty patients participated in the study; 11 underwent surgical treatment for AABP. Semi-structured interviewee responses were coded into 12 different themes and 39 subthemes. The most common themes were problems with urinary (19/20, 95%) and sexual function (19/20, 95%). Most participants (16/20, 80%) reported negative impacts of AABP on social life. Interviewees struggled with relationships (8/20, 40%) and mental health (11/20, 55%), often avoiding romantic relationships and reporting fear of rejection with concomitant depression and/or anxiety. The majority (70%, 14/20) experienced difficulties accessing care. Among patients who underwent surgery, the majority discussed improvement in urinary and sexual function (82% [9/11] and 73% [8/11], respectively). Though weight gain was a precipitating factor, weight loss did not result in symptom improvement. Rather, in 4/20 (20%), weight loss made their condition worse. Patients living with AABP experience profound negative impacts on quality of life including their urinary and sexual function, social life and mental health. Many patients face issues with access to care.

Abstract 5940: Impact of obesity on sexual functioning in women with gynecologic cancer pre-and post-radiotherapy

Abstract Background: As the prevalence of obesity in women increases in the US, a better understanding of the effect of obesity on women with gynecologic cancer (GynCa) is imperative. However, whether obesity impacts sexual functioning (SF) in GynCa patients has been understudied. Limited studies have used body mass index (BMI) as the only obesity indicator, which may result in a misunderstanding of the effect of obesity on SF in GynCa patients with different body compositions. This study aimed to explore the role of obesity via two different measures in determining SF in GynCa patients pre-and post-radiotherapy (RT). Methods: In this secondary analysis, obesity was measured pre-RT by both BMI and body fat percentage (BFP). BFP was calculated by using the Clinica Universidad de Navarra-Body Adiposity Estimator. SF, physical and emotional well-being were assessed pre-RT by the Female Sexual Function Index and the Functional Assessment of Cancer Therapy-General. At 6 months post-RT, SF was reassessed. Generalized linear models (GLM) and generalized linear mixed models (GLMM) with a log-link were implemented to identify the effect of obesity (using BMI and BFP) on SF pre-and post-RT. Regression-based mediation analysis was used to identify mediating effects of physical and emotional well-being between obesity and SF. Results: Among 54 (24 cervical and 30 endometrial) patients, 48% were Black, 52% were married or in a domestic partnership, and 59% were treated with surgery and/or chemotherapy pre-RT (i.e. prior treatment). Less patients were classified as being obese when obesity was measured by BMI (48%) compared to BFP (61%). Patients with endometrial cancer and prior treatment history were more likely to be obese and reported better SF. Unadjusted GLM showed that patients with obesity had better SF than those without obesity pre-RT regardless of obesity measures (BMI p = .018; BFP p = .016). However, we found no association between obesity (both BMI-and BFP-based obesity) and SF pre-RT after adjusting for cancer type and prior treatment history. GLMM showed that BFP-based obesity had a negative effect on the improvement in SF from pre-RT to post-RT (p = .013) after adjusting for cancer type and prior treatment history. Patients without BFP-based obesity showed a significant improvement post-RT (p = .019), but those with obesity (per BFP) showed no changes in SF post-RT (p = .949) compared to pre-RT. BMI-based obesity did not affect the changes in SF post-RT. We found no mediation effects of physical and emotional well-being between obesity and SF. Conclusions: Obesity may play a negative role in SF improvement in GynCa patients post-RT. More rigorous research and clinical attention to obesity measurement are necessary to determine the association between obesity and SF in GynCa patients and thus lead to the discovery of new interventions for this long-neglected topic of SF in GynCa patients, particularly for those who are obese. Citation Format: Haerim Lee, Deborah W. Bruner, Yi-Juan Hu, Jinbing Bai, Tony Y. Eng, Joseph W. Shelton, Pretesh R. Patel, Namita Khanna, Isabelle Scott, Katherine A. Yeager. Impact of obesity on sexual functioning in women with gynecologic cancer pre-and post-radiotherapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5940.

New Innovations for the Treatment of Vulvovaginal Atrophy: An Up-to-Date Review

Vulvovaginal atrophy (VVA) is a chronic progressive disease involving the female genital apparatus and lower urinary tract. This condition is related to hypoestrogenism consequent to menopause onset but is also due to the hormonal decrease after adjuvant therapy for patients affected by breast cancer. Considering the high prevalence of VVA and the expected growth of this condition due to the increase in the average age of the female population, it is easy to understand its significant social impact. VVA causes uncomfortable disorders, such as vaginal dryness, itching, burning, and dyspareunia, and requires constant treatment, on cessation of which symptoms tend to reappear. The currently available therapies include vaginal lubricants and moisturizers, vaginal estrogens and dehydroepiandrosterone (DHEA), systemic hormone therapy, and Ospemifene. Considering, however, that such therapies have some problems that include contraindications, ineffectiveness, and low compliance, finding an innovative, effective, and safe treatment is crucial. The present data suggest great efficacy and safety of a vaginal laser in the treatment of genital symptoms and improvement in sexual function in patients affected by VVA. The beneficial effect tends to be sustained over the long-term, and no serious adverse events have been identified. The aim of this review is to report up-to-date efficacy and safety data of laser energy devices, in particular the microablative fractional carbon dioxide laser and the non-ablative photothermal Erbium-YAG laser.

A quantitative study to explore functional outcomes following laparoscopic ventral mesh rectopexy for rectal prolapse.

Rectal prolapse is a life-altering problem and laparoscopic ventral mesh rectopexy (LVMR) is emerging as the surgical intervention of choice. However, the literature is ambiguous on its effect on bowel function and sparse as regards bladder and sexual function. This study assesses short-term functional outcomes following LVMR. This quantitative retrospective study with a pretest-post-test design included 130 adults who had undergone LVMR from October 2010 to December 2018 in a tertiary centre. Analysis with paired-samples t-test and Wilcoxon matched pairs test was done using SPSS (v26). The median age was 58 years (interquartile range, 48-74 years); 123 (94.6%) were female. The median length of stay was two days (interquartile range, 1-2 days). A total of 104 (80%) sets of medical notes were reviewed. One patient had recurrence of rectal prolapse. Synthetic mesh was used in 24 patients (23.1%) and biological mesh in 80 (76.9%). One patient had extrusion of a synthetic mesh and required surgery; 31(23.8%) completed the Electronic Patient Assessment Questionnaire for Pelvic Floor. Overall, the improvement in bladder function was not statistically significant (p = 0.670). A statistically significant improvement was seen for all bowel symptoms (p = 0.002) excluding constipation (p = 0.295). Irritable bowel symptoms associated with rectal prolapse improved significantly following LVMR (p = 0.001). Vaginal prolapse (p < 0.0005), dyspareunia (p = 0.001) and bowel symptoms affecting sexual intercourse (p = 0.01) improved, but improvement in overall sexual function was not statistically significant (p = 0.081). LVMR improves bowel function overall, although it can worsen constipation. It has the potential to improve sexual function but makes negligible difference to bladder function.

Effects of Aromatherapy With Citrus Aurantium Lavender on Sexual Function of Postmenopausal Women: A Randomized Controlled Trial.

Objective: The purpose of this study was to explore the effectiveness of aromatherapy with Citrus aurantium Lavender on the sexual function of postmenopausal women. Materials and methods : A randomized controlled trial with single-blind design was conducted on eighty postmenopausal women in Ahvaz, Iran from January to December 2019. The women were randomly assigned to the Citrus aurantium group (n=40) and placebo group (n=40). The intervention group received two drops of Citrus aurantium essential oil twice a day, for four consecutive days a week, for four weeks as inhalation. Similarly, placebo was received by the control group. Results: The results of this study revealed that in the intervention group, the FSFI total score and all of its dimensions were significantly improved compared to the control group. Conclusion: Aromatherapy using Citrus aurantium can be used as an alternative or complementary method for improvement of sexual function in postmenopausal women. It is recommended that the postmenopausal women suffering from sexual dysfunction be informed on the aromatherapy by Citrus aurantium essential oil.

Effectiveness of Kegel exercise and lubricant gel for improving sexual function in menopausal women: A randomized trial

BackgroundThere are different approaches to improving sexual function among menopausal women including Kegel exercise and using lubricant gel. However, it is not clear which of these methods could be more effective. This study aimed to compare the effectiveness of these two methods on sexual function in menopausal women. MethodsThe present randomized trial was conducted on 150 menopausal women in Dezful, Iran. Eligible women were randomly assigned to two interventions (Kegel exercise and lubricating gel) and one control groups. The Kegel exercise group received training on the exercise method; the lubricant gel group was given the lubricating gel and taught how it should be used, while the control group received no intervention. The interventions continued for 12 weeks, and sexual function was assessed at four times: baseline, one month, two months, and three-months follow-up. Chi-square test, one-way analysis of variance, repeated measures, analysis of covariance, and logistic regression analyses were applied. ResultsNo significant difference was found between groups regarding demographic and obstetrics variables. After adjusting for the baseline sexual function score, covariate analysis showed a significant improvement in sexual function in Kegel and gel groups as compared to the control group. Similarly, within-group comparison using repeated measures analysis showed that sexual function in both Kegel and gel groups improved during the study follow-up periods while women in the control group showed no changes in their sexual function. Finally, logistic regression analysis indicated a significantly higher odds ratio for better sexual function in both Kegel and gel groups. However, the odds of better sexual function for the Kegel group (OR = 4.19, 95% CI: 1.81–9.72, P = 0.001) was higher than the gel group (OR = 3.7, 95% CI: 1.42–7.52, P = 0.005). ConclusionBoth Kegel exercise and gel were effectively improved sexual function in menopausal women. However, the findings indicated that sexual function was more likely to be improved after using Kegel exercise than using lubricant gel. Trial registrationIRCT20150128020854N7. Registered 30 September 2019, https://fa.irct.ir/user/trial/40878/view.

Relationship between sexual function improvement and treatment satisfaction by TRT in LOH patients

ABSTRACT Introduction In the treatment of LOH (late-onset hypogonadism) syndrome, TRT (testosterone replacement therapy) is effective for various LOH related symptoms including sexual function. However, among Japanese population, sexual desire is not always strong in elderly men. Even if the patients do not have opportunities of sexual intercourse, TRT may still be beneficial for other symptoms derived from LOH syndrome. Objectives To examine patients’ satisfaction by TRT, we examined the relationship between TRT effect on sexual function and whole treatment satisfaction in our patient cohort. Methods Patients who have LOH symptoms and low serum free-testosterone (FT) levels were diagnosed as LOH syndrome. FT was diagnosed as “low” when &amp;lt;8.5pg/ml, while diagnosed as “borderline” when 8.5-11.8pg/ml. For TRT, testosterone enanthate 250mg/2-4weeks was given for more than 6 months. SHIM (Sexual Health Inventory for Men) score and our original questionnaire asking whether they are satisfied with the treatment were examined. Results Median patients’ age was 54 years (n=95). Before treatment, total testosterone was 4.5±1.8ng/ml and free testosterone was 6.2±2.3pg/ml. The majority of chief complaint before treatment were psychological or somatic symptoms. After treatment, SHIM score showed significant improvement in all questions of 1 to 5, and total SHIM score increased from 6.4 to 9.4. The number of patients who have few opportunities for sexual intercourse (0 point for SHIM Q3.4.5) decreased from 66% to 48% after treatment. Using the questionnaire for patients’ satisfaction, 71% were classified into the effective group. The number of patients who still had few opportunities of sexual intercourse after treatment was 39% in the effective group and 71% in the ineffective group. Conclusions From the point of patient satisfaction, TRT for LOH syndrome was effective in 71% of patients. Almost 40 percent of the patients who were satisfied with the treatment answered that there were few opportunities of sexual intercourse even after treatment. The improvement in sexual function may not be always required in a cohort of our patient population. Disclosure Work supported by industry: no.

Redo surgery improves sexual function in patients with sequelae of failed hypospadias repair

ABSTRACT Introduction Despite major improvements in management of congenital abnormalities of male external genitalia, non-pediatric urologists still encounter late complications of failed hypospadias repair. Such patients represent a complex group burdened with lower urinary tract symptoms, subfertility and sexual dysfunction. Psychological problems related to appearance of external genitalia are also common. It is currently unknown whether redo surgery improves sexual well-being in adults with sequelae of failed hypospadias repair. Objective To evaluate improvement in sexual function in patients with late complications of hypospadias repair. Methods We performed an analysis of symptoms related to sexual dysfunction in 112 patients with late complications of hypospadias repair who were admitted to our department for redo surgery. Average age of patients at admission was 32.1 years (min-max: 18-62). All patients consented to interview, completion of questionnaires, endocrine evaluation and penile doppler ultrasound when indicated. We compared prevalence of specific sexual symptoms before and after redo surgery using McNemar's test. Results Prevalence of erectile dysfunction following redo surgery decreased from 40.2% to 23.2% (p &amp;lt; 0.0001). Prevalence of low libido decreased from 59.8% to 30.3% (p &amp;lt; 0.0001). Asthenic ejaculation also became less frequent; initially it was present in 63.4% patients, and after surgery it was present only in 24.1% (p &amp;lt; 0.0001). Incidence of painful ejaculation decreased from 10.7% to 0.9% (p = 0.0026). Redo surgery didn't have positive or negative impact on premature ejaculation, delayed ejaculation, anejaculation and orgasmic dysfunction. Conclusion Redo surgery for complications of hypospadias repair seems to positively impact libido and erectile function, probably through improvement of body image and alleviation of psychogenic factors for erectile dysfunction. However, most ejaculation-related disorders, except asthenic ejaculation and painful ejaculation, remain unaffected. Disclosure Work supported by industry: no.

Effects of testosterone treatment on clitoral haemodynamics in women with sexual dysfunction

ABSTRACT Introduction Preclinical studies show that, in the clitoris, testosterone (T) is necessary to maintain a functional contractile and relaxant machinery, which represents the underlying mechanism of the peripheral arousal response. Although there is clinical evidence suggesting that T treatment significantly improves multiple domains of sexual functioning, the vascularization of clitoral tissue and its regulation by sex steroids are still under-investigated. Objective To explore the effects of 6-month systemic T administration on clitoral color Doppler ultrasound (CDU) parameters in women with female sexual dysfunction (FSD). Methods 81 women with FSD were retrospectively recruited. Data on CDU parameters at baseline and after 6 months with four different treatments were available and thus further longitudinally analyzed: local non-hormonal moisturizers (NH group), n=37; transdermal 2% T gel 300 mcg/day (T group), n=23; local estrogens (E group), n=12; combined therapy (T+E group), n=9. Patients underwent physical, laboratory, and genital CDU examinations at both visits and completed different validated questionnaires, including the Female Sexual Function Index (FSFI). Results At 6-month visit, T therapy significantly increased clitoral artery peak systolic velocity (PSV) when compared to both NH (p &amp;lt; 0.0001) and E (p &amp;lt; 0.0001) groups. A similar increase was found in the T + E group (p = 0.039 vs. E) (Fig.1). In addition, T treatment was associated with significantly higher FSFI desire, pain, arousal, lubrication, orgasm and total scores at 6-month visit vs. baseline. Similar findings were observed in the T + E group. No significant differences in the variations of total and high-density lipoprotein-cholesterol, triglycerides, fasting glycemia, insulin and glycated hemoglobin levels were found among the four groups. No adverse events were observed. Conclusions In women complaining for FSD, systemic T administration, either alone or combined with local estrogens, was associated with a positive effect on clitoral blood flow and a clinical improvement in sexual function, showing a good safety profile. Disclosure Work supported by industry: no.

MP15-01 LONGITUDINAL PATIENT-REPORTED OUTCOMES MEASURES DEMONSTRATE CONTINUED IMPROVEMENTS IN URINARY AND ERECTILE FUNCTION AFTER RADICAL PROSTATECTOMY THROUGH 30 MONTHS

You have accessJournal of UrologyCME1 May 2022MP15-01 LONGITUDINAL PATIENT-REPORTED OUTCOMES MEASURES DEMONSTRATE CONTINUED IMPROVEMENTS IN URINARY AND ERECTILE FUNCTION AFTER RADICAL PROSTATECTOMY THROUGH 30 MONTHS Daniel Frendl, Wesley Chou, Matthew Wszolek, Francis McGovern, Adam Feldman, Michael Blute, Jeffrey Twum-Ampofo, Marcela del Carmen, Marilyn Heng, Rachel Sisodia, and Douglas Dahl Daniel FrendlDaniel Frendl More articles by this author , Wesley ChouWesley Chou More articles by this author , Matthew WszolekMatthew Wszolek More articles by this author , Francis McGovernFrancis McGovern More articles by this author , Adam FeldmanAdam Feldman More articles by this author , Michael BluteMichael Blute More articles by this author , Jeffrey Twum-AmpofoJeffrey Twum-Ampofo More articles by this author , Marcela del CarmenMarcela del Carmen More articles by this author , Marilyn HengMarilyn Heng More articles by this author , Rachel SisodiaRachel Sisodia More articles by this author , and Douglas DahlDouglas Dahl More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002544.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patient-reported outcomes measures (PROMs) are critical for tracking quality of life and functional outcomes. Urinary incontinence and sexual dysfunction are common adverse effects experienced after radical prostatectomy (RP). PROMs may help inform patients about expected recovery after RP. We assess long-term patient-reported return of urinary and sexual function after RP in routine practice. METHODS: The Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) questionnaire was administered to all patients who underwent RP at our institution in 2016-2017. Questionnaires were administered preoperatively and up to 30 months postoperatively. Primary outcomes of interest were postoperative return of urinary and sexual function, respectively defined as either no urinary pads or use of one pad per day without overall urinary bother, and either erections sufficient for intercourse or erections sufficient for masturbation/foreplay without overall sexual bother. We used Kaplan-Meier estimators to evaluate time to return of these outcomes. RESULTS: Of 634 patients who underwent RP, we included 392 who completed ≥1 questionnaire; 184/392 (47%) had preoperative and postoperative responses. The mean age was 62.4 years (SD 6.5), with 93% of patients having a nerve-sparing surgery and 38% having pathologic extracapsular (≥T3a) disease (Table 1). At 12 months, unadjusted Kaplan-Meier estimates for cumulative likelihood of return of urinary function was 55%, improving to 98% by 30 months (Fig. 1A). For patients with good baseline sexual function who underwent nerve-sparing surgery, 24% reported return of sexual function by 12 months, improving to 71% at 30 months (Fig. 1B). CONCLUSIONS: Routine electronic solicitation of PROMs in our practice showed continued improvements in continence and sexual function up to 30 months postoperatively. These findings may help inform patients regarding typical functional recovery trajectories after RP. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e241 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Frendl More articles by this author Wesley Chou More articles by this author Matthew Wszolek More articles by this author Francis McGovern More articles by this author Adam Feldman More articles by this author Michael Blute More articles by this author Jeffrey Twum-Ampofo More articles by this author Marcela del Carmen More articles by this author Marilyn Heng More articles by this author Rachel Sisodia More articles by this author Douglas Dahl More articles by this author Expand All Advertisement PDF DownloadLoading ...

Quality of life of patients with locally advanced rectal cancer after neoadjuvant therapy and sphincter-preserving surgery

Objective: To investigate quality of life (QoL) of patients with locally advanced rectal cancer (LARC) who underwent low anterior resection with protective stoma under neoadjuvant therapy mode, and to explore the changes of QoL of patients from before neoadjuvant therapy to 12 months after stoma reversal. Methods: A descriptive case series study was carried out. A retrospective study was performed on patients with mid and low LARC who received complete neoadjuvant long course radiotherapy and chemotherapy, followed by radical low anterior resection (LAR) combined with protective stoma at Peking Union Medical College Hospital from December 2017 to January 2020. Inclusion criteria: (1) patients with rectal MRI assessment of mT3-4b or mN1-2 without distant metastasis (M0) before neoadjuvant therapy; (2) distance from tumor lower margin to the anal verge <12 cm; (3) rectal adenocarcinoma confirmed by biopsy before neoadjuvant therapy; (4) complete cycle of neoadjuvant therapy; (5) patients undergoing radical LAR with sphincter preservation and protective ostomy; (6) patients receiving follow-up for more than 12 months after stoma reversal. Exclusion criteria: (1) patients as grade Ⅳ to Ⅴclassified by the American Society of Anesthesiologists (ASA); (2) patients with multiple primary colorectal cancer; (3) patients with history of other malignant tumors in the past 5 years; (4) patients of emergency surgery; (5) pregnant or lactating women; (6) patients with history of severe mental illness; (7) patients with contraindication of MRI, radiotherapy, chemotherapy, or surgical treatment. A total of 83 patients were enrolled, including 51 males and 28 females with median age of 59 years and mean BMI of (24.4±3.1) kg/m(2). EORTC QLQ-CR29, international erectile function index (IIEF), Wexner constipation score and low anterior resection syndrome (LARS) score were applied to investigate the QoL of the patients before neoadjuvant therapy, 3 and 12 months after ostomy reversal, including rectal anal function and sexual function. M (P25, P75) was used for the scores of the scale. Results: (1) EORTC QLQ-CR29 score showed that before neoadjuvant therapy, before surgery, 3 months and 12 months after ostomy reversal, anxiety [64.4 (52, 0, 82.5), 75.3 (66.0, 89.5), 82.6 (78.5, 90.0), 83.6 (78.0, 91.0)] and concern about body image [76.8 (66.0, 92.0), 81.1 (76.5, 91.5), 85.5 (82.5, 94.0), 86.1 (82.0, 92.0)] were improved (all P<0.01); pelvic pain [5.4 (2.0, 8.0), 5, 0 (2.0, 7.8), 3.9 (1.0, 5.0), 3.0 (1.0, 5.0)], urinary incontinence [15.7 (7.0, 22.0), 11.1 (0, 17.5), 10.0 (0, 17.0), 9.9 (0, 16.0)], impotence [14.3 (4.2, 19.0), 12.2 (0, 16.8), 5.6 (0, 10.0), 5.2 (0.2, 8.0)], urinate [26.4 (13.0, 38.5), 13.9 (0, 20.0), 13.4 (2.5, 21.5), 13.2 (2.0, 20.0)] and mucous bloody stool [4.7 (3.0, 6.0), 2.6 (0, 5.0), 2.2 (0, 5.0), 1.9 (0, 4.0)] were improved as well (all P<0.01). The scores fluctuated in the improvement of male sexual function, abdominal pain, dry mouth, worry about body mass change, skin pain and dyspareunia, but the symptoms were significantly improved after ostomy reversal compared with before neoadjuvant therapy (all P<0.05). There were no significant changes in female sexual function, dysuria, dysgeusia and fecal incontinence after ostomy reversal compared with before neoadjuvant therapy (all P>0.05). (2) IIEF scale showed that all scores were similar before and after neoadjuvant therapy (all P>0.05). (3) Rectal and anal function scale revealed that before neoadjuvant therapy, before operation, 3 months and 12 months after stoma reversal, gas incontinence [3.1 (0, 4.0), 2.3 (0, 4.0), 1.8 (0, 4.0), 1.2 (0, 3.0)] and urgent defecation [7.2 (0, 11.0), 5.2 (0, 11.0), 2.9 (0, 9.0), 1.7 (0, 0)] were improved (all P<0.001). In terms of improving incomplete emptying sensation, the symptoms fluctuated, but the symptoms improved significantly after ostomy reversal compared with before neoadjuvant therapy (all P<0.05). While the symptoms of assistance with defecation [0 (0, 0), 0.7 (0, 1.0), 0.6 (0, 1.0), 0.7 (0, 1.0)] and defecation failure [0.2 (0, 0), 1.0 (0, 2.0), 0.8 (0, 1.5), 0.8 (0, 1.0)] showed a worsening trend (all P<0.001). Stratified analysis was performed on patients with different efficacy of neoadjuvant therapy to compare the changes in QoL before and after neoadjuvant therapy. Patients with less sensitive and more sensitive neoadjuvant therapy showed similar changes in function and symptoms. Patients with less sensitive therapy showed significant improvement in dysuria, urinary incontinence, skin pain and dyspareunia (all P<0.05), and the symptom of defecation frequency in more sensitive patients was significantly improved (P<0.05). Conclusions: For patients with LARC, neoadjuvant radiochemotherapy combined with radical LAR and protective stoma can improve QoL in many aspects. It is noted that patients show a worsening trend in the need for assistance with defecation and in defecation failure.

Unexpected Therapeutic Responses in Sexual Function in Women Prescribed Flibanserin for Hypoactive Sexual Desire Disorder

ABSTRACT Introduction Flibanserin is a multifunctional serotonin agonist and antagonist for the treatment of acquired, generalized hypoactive sexual desire disorder (HSDD). Flibanserin is approved for use in premenopausal women in the US and in both premenopausal and postmenopausal women ≤60 years old in Canada. A post-hoc analysis of Female Sexual Function Index (FSFI) scores from pivotal trials in premenopausal women with HSDD indicated significant improvements in total and individual domain scores after treatment initiation with flibanserin compared to placebo. Objective The purpose of this case report study is to examine the postmarketing database to determine whether improvements in other aspects of sexual function have also been reported by women who were prescribed flibanserin in real world use outside of clinical trials. Methods A search was performed in the global safety database to identify postmarketing case reports from August 2015 to March 2021. “Therapeutic response unexpected” was the Medical Dictionary for Regulatory Affairs (MedDRA 23.1) preferred term used in this search strategy. Study results include only case reports with narratives containing verbatim terms relevant to the domains on the FSFI (arousal, lubrication, orgasm, pain, satisfaction), excluding desire as this is an expected response. Results Thirty-two postmarketing case reports, including 13 patient testimonials of “therapeutic response unexpected”, were identified during this period. Of these 32 case reports, 12 (38%) contained terms related to unexpected improvements in sexual function. Among the 12 reports of improved sexual function, 10 (83%) included terms related to increases in frequency, intensity, or duration of orgasms, one of which also mentioned improvement in arousal. The remaining 2 cases included 1 report of improvement in lubrication and 1 report of improvement in pain. Conclusions These postmarketing case reports are consistent with the post-hoc analyses of the data from the flibanserin clinical trials and provide further support that flibanserin therapy can lead to improvement in multiple aspects of sexual function in addition to sexual desire. Disclosure Yes, this is sponsored by industry/sponsor: Sprout Pharmaceuticals Clarification Industry initiated, executed and funded study Any of the authors act as a consultant, employee or shareholder of an industry for: Sprout Pharmaceuticals

Pain Characteristics, Fear-avoidance Variables, and Pelvic Floor Function as Predictors of Treatment Response to Physical Therapy in Women With Provoked Vestibulodynia.

The aim was to investigate whether pretreatment pain characteristics, psychological variables, and pelvic floor muscle (PFM) function predict the response to physical therapy (PT) in women with provoked vestibulodynia (PVD). One hundred-five women diagnosed with PVD underwent 10 weekly sessions of individual PT comprising education, PFM exercises with biofeedback, manual therapy, and dilators. Treatment outcomes were evaluated at pretreatment, post-treatment, and 6-month follow-up and included pain intensity (numerical rating scale 0 to 10) and sexual function (Female Sexual Function Scale). Multilevel analyses were used to examine the potential predictors of response over time including pain characteristics (PVD subtype, pain duration), psychological variables (fear of pain, pain catastrophizing), and PFM function assessed with a dynamometric speculum (tone, flexibility, and strength). PVD subtype and PFM tone were significant predictors of greater treatment response for pain intensity reduction. Secondary PVD (ie, pain developed after a period of pain-free intercourse) and lower PFM tone at baseline were both associated with greater reduction in pain intensity after PT and at follow-up. Among the psychological variables, fear of pain was the only significant predictor of better treatment response when assessed through improvement in sexual function, where higher fear of pain at baseline was associated with greater improvement after PT. This study identified PVD secondary subtype, lower PFM tone, and higher fear of pain as significant predictors of better treatment response to PT in women with PVD.

The impact of smoking on sexual function.

To evaluate the hypothesis that there is an improvement in sexual function following smoking cessation (as smoking is a well-established risk factor for sexual dysfunction), we analysed the association between cigarette smoking and smoking cessation with sexual function among participants of the REduction by DUtasteride of prostate Cancer Events (REDUCE) study. We analysed baseline data of 6754 men, aged 50-75 years divided into: lifelong non-smokers, former smokers, and current smokers. We examined total testosterone (TT, normal range ≥10 nmol/L) and sexual function variables: self-reported sexual activity, low libido, and erectile dysfunction (ED). Differences between current vs non-smokers and former vs current smokers were analysed using the chi-square test, linear and logistic regressions. A total of 3069 (45.4%) men were non-smokers, 2673 (39.6%) former smokers, and 1012 (15%) current smokers. Current smokers were significantly younger than former and non-smokers (mean age 61.6, 63.2, and 62.7 years, respectively), leaner (mean body mass index 27.0, 27.7, and 27.2 kg/m2 , respectively), and had less hypertension (32.4%, 41.6%, and 36.8%, respectively; all P < 0.01). In uni- and multivariable analysis, current smokers had higher mean TT than non-smokers (485.4 vs 451.2 nmol/L, P < 0.001), higher prevalence of low libido (25.6% vs 21.0%, P = 0.002) and ED (31.6% vs 26.0%, P < 0.001) with comparable sexual activity (81.7% vs 82.8%, P = 0.420). In multivariable analysis, former smokers had statistically significantly less prevalence of low libido (odds ratio [OR] 0.8, P = 0.013) and ED (OR 0.8, P = 0.006) compared to current smokers. Cigarette smoking was associated with worse sexual health compared to non-smokers, while former smokers had better erectile function and libido than current smokers. Smoking cessation may improve male sexual health and counselling on smoking cessation may be considered at the time of sexual health evaluations.

Changes in sexual function and vaginal topography using transperineal ultrasound after vaginal laser treatment for women with stress urinary incontinence

We aim to assess the changes in sexual function and vaginal topography using 3-D transperineal ultrasound in stress-incontinent women treated with Er:YAG vaginal laser. Two hundred and twenty women with stress urinary incontinence (SUI) treated with Er:YAG laser were recruited. Assessment before and 6 months after the treatment included vaginal topography using 3-D transperineal ultrasound and sexual function using female sexual function index questionnaire (FSFI). A total of 50 women with complete data showed that the symptomatic improvement was noted in 37 (74%) women. After Er:YAG vaginal laser treatment, significantly decreased width and cross-sectional area in proximal, middle, and distal vagina were found in women with SUI. Nearly all of the domains of FSFI improved significantly after the vaginal laser treatment, except sexual desire. In conclusion, 3-D transperineal ultrasound can be used to conduct vaginal topography. After Er:YAG vaginal laser treatment, the anatomical changes of vaginal shrinkage and the improvement of female sexual function were both noted. The favorable outcome of sexual function partly related to the tightening of vagina, as evidenced by the measurements of the 3-D transperineal ultrasound.

Does omalizumab use in chronic spontaneous urticaria results in improvement in sexual functions?

Chronic spontaneous urticaria (CSU) is a disease that can affect the patient's quality of life (QoL), sexual functions, and mood. We planned a retrospective study to investigate the effects of omalizumab use in CSU patients on sexual function. We also aimed to evaluate the sexual function, quality of life (QoL), and mood of CSU patients compared to the control group consisting of idiopathic pruritus patients. A review of patients' records with CSU attending the dermatology outpatient clinic from January 2020 to June 2020 was done. Urticaria activation score (UAS7), Beck depression inventory (BDI), Dermatology life quality index (DLQI), female sexual function index (FSFI) to female participants, and the international index of erectile function (IIEF) to male participants were used to assess the impact of the disease on patients' life. The obtained data were analyzed by using SPSS software. Each one of the mean UAS, BDI, and DLQI score values decreased significantly in weeks in omalizumab group patients. IIEF score in male patients and FSFI score in female patients also increased in weeks in omalizumab group patients. Omalizumab can play an effective role in enhancing the sexual function of CSU patients in addition to improving their DLQI.

Abstract P4-10-05: Safety and efficacy of low dose topical testosterone for sexual function improvement in women with breast cancer under treatment with ovarian suppression and aromatase inhibitor

Abstract Background: Premenopausal, high-risk, hormone receptor-positive breast cancer patients areoften treated with ovarian suppression in combination with aromatase inhibitors (AI). Thiscombination results in important adverse effects, particularly in sexual function, such as vaginaldryness and loss of libido. Vaginal estrogen is effective but may elevate serum estradiol levelsand, theoretically, may increase recurrence risk. Vaginal testosterone is also commonlyprescribed to ameliorate symptoms, though its safety remains uncertain, with limited availabledata. In our study, we aimed to determine the safety and efficacy, particularly regarding sexualfunction, of a low-dose, topical testosterone gel administration.Methods: This is a pilot, single-center study, designed to evaluate the efficacy of topicaltestosterone gel (3 mg/ml/per day) in improving sexual function in 30 premenopausal patientson ovarian suppression in combination with an AI. The primary safety endpoint was todetermine serum estradiol, measured by liquid chromatography mass spectrometry (E2) on amonthly a basis for 3 consecutive months. The primary efficacy endpoint was assessed by meansof the Female Sexual Function Index (FSFI) questionnaire, that include various domains of sexualfunction such as libido, sexual satisfaction and vaginal lubrication. The score can range from 2to 36, being 2 the lowest and 36 the highest sexual satisfaction. Patients had to have a baselineE2 of less than 2.7 pg/ml prior to study entry.Results: Herein, we report the preliminary results on the first 20 patients. The mean age was39.3 years, 85% had early or locally advanced disease and 15% had metastatic disease. Tenpatients completed the 3-month treatment, while five are still on therapy. Four of the 20discontinued treatment, mainly due to logistical difficulties during the follow-up visits. Onepatient had a localized allergic reaction and, also, discontinued treatment. A total of 15 patientsmaintained the value of E2 of less than 2,7 pg/ml during the 3-month treatment in all 3measurements. We observed an improvement in FSFI measures over the visits, with an increasefrom a mean of 10.2 at baseline to 19.4 at the third month (P&amp;lt;0.001), with the greatestimprovement observed between the second and third months.Conclusion: Our preliminary findings suggest that topical testosterone appears safe andeffective in improving sexual function in patients on ovarian suppression and aromataseinhibitor. Further studies are clearly warranted. Citation Format: Patrícia Taranto, Diogo de Brito Sales, Luciano de Melo Pompei, Alessandro Leal, Gustavo Schvartsman, Antonio Carlos Buzaid. Safety and efficacy of low dose topical testosterone for sexual function improvement in women with breast cancer under treatment with ovarian suppression and aromatase inhibitor [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-10-05.