Mean Female Sexual Function Index Research Articles

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

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

Coping styles for sexual dysfunction and stress among married women of reproductive age: a cross-sectional study from turkey

Objective: To identify sexual dysfunction in married women of reproductive age, and to examine its relationship with stress coping styles. Method: The cross-sectional, descriptive study was conducted between February and June 2019 at the obstetrics and gynaecology outpatient clinic of Gulhane Training and Research Hospital in Ankara, Turkey. The sample comprised married women aged 18-49 years who had an active sexual life over the preceding month, and were neither pregnant nor in the postpartum phase. Data was collected using the Female Sexual Function Index, and the Stress Coping Styles Scale. Data was analysed using SPSS 22. Results: There were 216 women with mean age 33.58±6.77 years. The mean Female Sexual Function Index score was 22.29±6.08. The mean Stress Coping Styles Scale subscale scores were: self-confident 20.71±3.53, helpless 18.07±4.27, submissive 12.13±3.00, optimistic 13.70±2.35, and seeking social support 11.89±2.01. The total Female Sexual Function Index score had a positive, significant correlation with self-confidence (r=0.15; p=0.03) and seeking social support subscales (r=0.18; p=0.01) and a negative, significant correlation with submissive subscale (r=-0.17; p=0.02) of the Stress Coping Styles Scale. Conclusion: Establishing awareness among women about sexual dysfunction and improving effective coping styles may contribute to improved sexual health among women. Key Words: Sexuality, Female, Sexual dysfunction, Coping strategies.

Genital self-image and sexual function in Iranian women from pregnancy to postpartum: a cohort study.

Genital self-image is among the factors affecting women's sexual function. The present study aimed to determine changes in the genital self-image and its relationship with women's sexual function in the third trimester of pregnancy and postpartum. The participants of this prospective cohort study included 301 eligible pregnant women chosen through stratified random sampling with proportional allocation from comprehensive health centers in Gorgan, Iran. The Persian version of the 7-item Female Genital Self-Image Scale, the 6-item Female Sexual Function Index, and Depression Anxiety and Stress Scale 21 were filled in a self-report manner on 2 occasions: (1) 30 to 37weeks of pregnancy and (2) 12 to 16weeks (± 2weeks) postpartum. Finally, the data were analyzed using SPSS 24 software. Outcomes included Female Genital Self-Image Scale and Female Sexual Function Index changes from pregnancy to postpartum according to the childbirth mode. The mean age of participants was 29.66 ± 5.27 years. These values for the genital self-image scores of women during pregnancy (19.18 ± 3.25) and postpartum (19.43 ± 3.57) were not significantly different (P = .30). Also, this difference was not statistically significant regarding the mode of delivery in 2 groups of women with vaginal birth (P = .62) and cesarean section (P = .14). The mean Female Sexual Function Index scores during pregnancy (15.15 ± 6.73) and postpartum (17.52 ± 6.46) were significantly different (P = .001). In addition, this difference was significant in women with vaginal birth (P = .004) and cesarean section (P = .001). Clinicians should inform women/couples about changes in female sexual function and address genital self-image as a factor involved in female sexual function during pregnancy and postpartum.Strengths and Limitations: Because the participants of this study were women in the third trimester of pregnancy, the obtained results may not be generalized to pregnant women in the first and second trimesters of pregnancy or even to different postpartum periods (ie, midterm and long term). The results showed that the female genital self-image is not significantly different during pregnancy and postpartum, or with the mode of delivery. However, the female sexual function score in postpartum is higher than in pregnancy, regardless of the mode of delivery.

(181) Female Sexuality During the Menopausal Transition: The Experience of Tunisian women

Abstract Introduction The menopausal transition is a gradual passage from pre-menopause to menopause. It is characterized by hormonal changes that affect a woman's reproductive and sexual health. Understanding the impact of the menopausal transition on sexual functioning is important for providing comprehensive care to these women. Objective Objective: In this study, we aimed to evaluate female sexuality in middle-aged Tunisian women using the female sexual function index (FSFI) Methods This was a descriptive and analytic transversal study, conducted at the Hammam-Lif sexual and reproductive health center over a period of 06 months from February 1st to July 31st, 2022. We included 162 women aged between 40 and 65 years old. We used a validated Arabic version of the Female Sexual Function Index to assess female sexual function. Results The average age of women included in our study was 48.27 years. The majority of questioned women were peri-menopausal, i.e. 40.74%, 35.8% were in pre-menopause and 23.6% were in post-menopause. Moreover, among postmenopausal women, only one patient took hormone replacement therapy. The mean gestity was 3.6 and mean parity was 2.5 in our study population. The majority of women had a gestation greater than or equal to three [0 to 8] and a parity greater than or equal to 2 [0 to 8], i.e. in 80.25% of cases. The mean FSFI score was 18.83 ±7.19, with extremes ranging from 2 to 30.4. The prevalence of sexual dysfunction in our study was as high as 88.9 %. The analysis of our results showed a degradation of the FSFI score from perimenopause to postmenopausal: it went from 21.21±6.4 in pre-menopause, to 18.56±7.33 in perimenopause and 15.65±7.11 in postmenopausal. The difference between the three periods was statistically significant (p=0.030). This decline was statistically significant for three domains namely desire (p=0.033), arousal (p=0.047), and orgasm (p&amp;lt;0.01). Conclusions The prevalence of female sexual dysfunction is quite high and tends to increase with age. The role of healthcare professionals is essential in caring for women and helping them overcome sexual health problems that arise during the menopausal transition period. Disclosure No.

(095) Vaginal Lubrication Improves Sexual Desire among Menopausal Women

Abstract Introduction Female sexual dysfunction (FSD) can be a direct result of hormonal changes in a woman’s lifetime, including the use of birth control, postpartum, or menopausal. The FSFI (Female Sexual Function Index) measures sexual function based on six domains: desire, arousal, lubrication, orgasm, satisfaction and pain. Studies have shown that vaginal lubrication can be affected by hormonal changes; however, it is unclear how lubrication relates to sexual desire among women with hormonal changes of varied etiology. Objective The objective of this study is to evaluate the relationship between vaginal lubrication and sexual desire among women who are on birth control, postpartum, or menopausal. Methods A post-market analysis was performed of all women who had utilized the sexual wellness application Rosy between February 2022 and November 2022. Application users had previously filled out the FSFI short form (6-item) and the desire and lubrication domain results were analyzed. We utilized multivariable linear regression models to determine significant effects between lubrication score and desire score controlling for whether the patient was on birth control, postpartum, or menopausal. Results A total of 11,407 women met the study criteria. 2,599 were menopausal, 3,394 were postpartum, and 8,013 were on birth control. The median age was 34.2 (range 17–80) years old. The mean FSFI short form scores for lubrication were as follows based on category: birth control = 3.03, postpartum = 2.0, and menopausal = 1.94. Mean FSFI short scores for desire were birth control = 2.44, postpartum = 2.23, and menopausal = 1.80. Regression modeling revealed a significant association between lubrication score and desire score (mean of 0.36 increase in desire score per point increase in lubrication score, 95% CI 0.35, 0.36, p&amp;lt;0.001). With women on birth control as a baseline, a menopausal status was associated with an increased desire (estimate 0.33, p&amp;lt;0.001). The interaction term between lubrication score and menopausal status was positive (0.06, p&amp;lt;0.001). Conclusions Iatrogenic or physiologic hormonal changes such as birth control, postpartum, or menopause can alter vaginal lubrication scores. Among these women, those with better vaginal lubrication have an associated increase in sexual desire. Improvements in lubrication can positively affect sexual desire in menopausal women. Our findings of a significant positive interaction between lubrication scores and menopausal status is interpreted as the magnified effect that increase lubrication has on sexual desire in this population. Furthermore, these findings reinforce that among this cohort, menopausal women are most effected by hormonal changes that can alter lubrication and ultimately sexual desire. While this data demonstrates interesting findings, potential confounders include users of Rosy who may have underlying sexual dysfunction, which may alter these results. Further studies are needed on this topic among the general population. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Rosy.

(179) Sexual Dysfunctions in Infertile Tunisian Women

Abstract Introduction Once perceived as a source of pleasure and enjoyment, sexuality has evolved for infertile couples, focusing primarily on a purely procreative objective. Infertility has a direct impact on a woman's sex life, calling into question her femininity and causing significant alterations in the components of her sexual response. Objective The aims of our study were to assess the frequency of sexual dysfunction in Tunisian women facing infertility and to identify the aspects of their sexuality most affected. Methods This was a prospective, cross-sectional, and descriptive study, including a sample of 200 Tunisian infertile women, followed up in a Tunisian Assisted reproduction center over a three-month period, from November 24, 2022 to February 24, 2023. To assess the different dimensions of sexuality in infertile women, we used the Arabic version of the FSFI (female sexual function index) Results The mean age of our women was 30 ± 4 years. The majority had a university educational level (80%), an urban origin (87%), an average socio-economic level (63%), and no medical or gynecological surgery history (62%). Most partners (67%) had no sexual dysfunction (SD). The most frequent male SD was premature ejaculation, observed in 14% of cases. As regards the etiology of infertility, most cases were classified as unexplained (28%), while the remainder were linked to female causes, dominated by PCOS (40%). The majority of women had initially discussed the subject of sexuality (72%) with their partners. In our sample, the mean FSFI score was 20.74, with extremes ranging from 2 to 35.4. The prevalence of female sexual dysfunction (FSD) was 82%. The areas most affected were sexual satisfaction (50%), reaching orgasm (45%), as well as lubrication (44%) and arousal (44%). Lower educational level, secondary infertility, contraceptive use, and a long history of fertility treatment as well as the presence of sexual dysfunction in the male partner, were found to be associated with sexual dysfunction in women suffering from infertility, yet no significant correlation was established. Conclusions Infertility is associated with high rates of sexual dysfunction. Thorough counseling and continuing support of infertile women is therefore indicated. Disclosure No.

Comparative cross-sectional study on sexual function of couples during pregnancy: Assisted reproductive techniques versus spontaneous conceptions.

This study aims to compare the sexual functions of couples undergoing assisted reproductive techniques (ART) with those conceiving spontaneously during pregnancy. A total of 102 couples participated in this cross-sectional study, with 68 couples in the spontaneous conception group and 34 couples in the ART group. Data collection was conducted face-to-face in the antenatal clinic using separate "Descriptive Information Form" for women and men, "Female Sexual Function Index (FSFI)" for women, and "Libido Scoring System (LSS)" for men. Descriptive statistical methods, Chi-square and Fisher exact tests, t-test, and Pearson correlation test were used for data analysis. It was observed that the mean FSFI total scores of women who conceived spontaneously and through ART during pregnancy were at a good level (≥30), while the mean LSS scores of their partners were at a moderate level (5-7). No statistically significant distinction existed among the groups. Further research is advisable by adjusting the sample selection criteria, such as gravida, duration of ART treatment, and gestational age.

(004) Correlations Between Immunohistochemical Staining and Pain-Related Assessments in Patients with Neuroproliferative Vestibulodynia

Abstract Introduction A clinically suspected diagnosis of neuroproliferative vestibulodynia (NPV) can be confirmed by examining immunohistochemical (IHC) staining of excised vestibular specimens. Compared to controls, specimens from NPV patients have been found to contain &amp;gt;8 mast cells per high-power field (HPF) and increased density of nerves. Objective To assess for correlations between patient reported pain-related measures and computer-assisted histometry of excised vestibulectomy specimen IHC staining with CD117 (marker for mast cells) and PGP9.5 (marker for nerves) in a cohort of histopathologically confirmed NPV patients. Methods Patients (n=65) with lifelong or acquired NPV undergoing vestibulectomy had IHC-staining of the vestibular tissue. Tissue sections from the 1:00-11:00 and/or 12:00 regions of the vestibule were examined and high-resolution images were captured using a microscope at 100x and 200x magnification. A minimum of 2 photomicrographs per magnification were taken for each tissue section that included epithelial basement membrane and adjacent subepithelium representative of the majority of immunostained tissue. Fractional area of positive immunostaining of all photomicrographs was determined using computer-assisted histometry by ImageJ. Mean fractional area was determined from 3 separate measurements of each photomicrograph. Correlations were made between density of IHC staining and the following assessments: pain domain of the Female Sexual Function Index (FSFI), the Short Form McGill Pain Questionnaire (SF-MPQ), and cotton-tipped swab testing. We also examined correlations with the Patient Global Impression of Improvement (PGI-I), a treatment response index and indirect assessment of pain. Data were analyzed using Spearman correlations and the Mann-Whitney test. Results While all patients reported high levels of pain, there were no correlations between CD117- or PGP9.5-immunopositive mean fractional area and FSFI pain domain or SF-MPQ scores. There was no difference in immunopositive mean fractional area between lifelong and acquired NPV. A positive correlation between fractional area of CD117 immunostaining in the 1:00-11:00 region of the vestibule and cotton-tipped swab test pain score approached but did not reach statistical significance (r = 0.24, p = 0.063). Fractional area of PGP9.5 immunostaining was negatively correlated with PGI-I scores (r = -0.50, p = 0.006) in the 1:00-11:00 region of the vestibule. Lower PGI-I scores are indicative of greater improvement after surgical intervention. No other correlations were observed between immunostaining and PGI-I or cotton-tipped swab testing scores. Likewise, SF-MPQ domain scores had no correlation to PGI-I or cotton-tipped swab testing. Median cotton-tipped swab testing pain scores were significantly higher (p &amp;lt; 0.001) in patients with lifelong NPV (7.6) compared to those with acquired NPV (5.7). Conclusions The lack of correlations between immunopositive staining and multiple pain-related assessment scores suggests a non-linear threshold for mast cell accumulation and nerve proliferation that produces pain symptoms for all NPV patients. Cotton-tipped swab pain scores were more closely associated with density of CD117 immunostaining, while clinical improvement in pain symptoms was significantly correlated with density of PGP9.5 immunostaining. The fact that patients with lifelong NPV had significantly more pain on cotton-tipped swab testing than the acquired NPV subgroup may be related to duration of the condition. Disclosure No.

A survey of patient tolerance and satisfaction with capsaicin for neuroproliferative vestibulodynia.

Topical capsaicin has been used to treat vulvodynia but has been poorly studied for use in neuroproliferative provoked vestibulodynia (PVD); capsaicin decreases allodynia by blocking vanilloid receptors (TRPV1) on C-afferent nociceptors, but the therapy causes discomfort to the point of intolerance in some patients. The present study evaluated tolerability and efficacy of topical capsaicin to treat neuroproliferative PVD. Patients with neuroproliferative PVD prescribed 0.025% capsaicin compounded in VersaBase cream were identified through prescription records. Outcome measures included the Female Sexual Function Index (FSFI), the Female Sexual Distress Scale-Revised, and a 22-question questionnaire assessing patient experience and treatment tolerability. Among tolerant patients, capsaicin significantly decreased vestibular pain, but tolerance was highly variable. Twenty-five patients responded to the follow-up questionnaire. The average age at presentation was 30years (range, 18-52years). Eighty percent of patients tolerated capsaicin application for the full 20minutes within a median time of 1 to 2weeks. Of the 16 patients reporting tolerance to 20-minute application, 12 (60%) experienced improvement in vestibular pain. On an 11-point numeric rating scale, the mean pain score was 8.96 and the median score was 10 with first application. Among all participants, 16 (64%) had reduction in pain during treatment. Fifty-six percent of patients would recommend capsaicin as a treatment for vulvar pain. Qualitative content analysis focused on categories of efficacy, value, and feasibility, which indicated that those able to tolerate the treatment experienced improvement while using the medication. The mean Female Sexual Distress Scale-Revised score was 35.96 at baseline compared with 25.09 at follow-up (P< .0001). On a numeric rating scale, the mean self-reported vulvar pain score was 8.2 at baseline compared with 5.35 when using capsaicin consistently (P< .0001). The mean FSFI pain domain score was 2.45 at baseline compared with 0.98 at follow-up (P= .005). While not statistically significant, the mean total FSFI score was 15.44 at baseline compared with 17.84 at follow-up (P= .3730). Capsaicin is helpful for some patients with PVD, but thorough counseling is important because of highly variable tolerance. Strengths include examination of a poorly studied therapy and inclusion of narrative responses from patients to inform counseling. Limitations include small sample size, retrospective design, and low survey response rate. Patients should be appropriately selected and thoroughly counseled given high levels of intolerance, but capsaicin therapy may be considered for patients with neuroproliferative PVD who have failed conservative treatments and wish to avoid surgery.

Prevalence and associated factors of sexual dysfunction in female hemodialysis patients: first report from Somalia

BackgroundSexual dysfunction is frequent in female hemodialysis patients and is related to poorer quality of life. It is often a neglected topic associated with marked distress and interpersonal difficulties.ObjectiveFew studies are reported from Sub-Saharan African Countries (SSA) regarding female sexual dysfunction (FSD) in (HD) patients. The study aims to explore the prevalence and associated factors of FSD in female HD at a sole dialysis centre in Somalia.MethodOver a one-month period, a cross-sectional study was conducted among women with end-stage renal disease aged 18–50 years who were undergoing a dialysis program for at least three months at the dialysis center of our hospital. The participants were married, and they were living with their partners. Data regarding the sociodemographic features, clinical characteristics, frequency of sexual intercourse per week, and the Female Sexual Function Index (FSFI) scores were collected using a standard face-to-face interview questionnaire.ResultsDuring the study period, a total of 115 participants were eligible for the study’s inclusion criteria. The mean patient age was 38.5 ± 9.3 years. The most common cause of ESRD was diabetes, which accounted for 53%, followed by hypertension (26.1%) and glomerulonephritis (9.6%). The mean duration of dialysis was 2.9 ± 1.4 years, and approximately two-thirds of the participants (62.5%) were in the program for more than three years. Regarding the frequency of sexual intercourse, 61.7% of female participants performed sexual intercourse less than once time/a week. The prevalence of FSD was 92.2% (n = 106) of all participants. The mean FSFI score of the participants was 16.05 ± 4.48. Longer duration of dialysis program (i.e., more than four years), increasing age (i.e., > 35 years), those with diabetes had scored lower overall FSFI scores.ConclusionThe prevalence of female sexual dysfunction among Somali female hemodialysis patients was very high, representing a significant problem in end-stage renal disease (ESRD). Our study findings revealed that increasing age, diabetes, and duration of dialysis negatively impact female sexual function and are significantly associated with FSD.

The impact of COVID-19 and long COVID on sexual function in cisgender women.

Research suggests that COVID-19 impairs sexual function in men, but little is known about the impact of COVID-19 (or long COVID) on sexual function in women. We sought to compare the sexual function of cisgender women who had never had COVID-19, who had COVID-19 but not long COVID, and who had long COVID, and assessed whether long COVID symptoms and/or emotional distress mediate the relationship between COVID-19 history and sexual function. In total, 2329 adult cisgender women were recruited online as study participants. Half of these women reported having had COVID-19, and the other half reported never having had COVID-19. Of those who had COVID-19, 25% (n= 170) reported having long COVID. We compared the mean Female Sexual Function Index (FSFI) scores by using t-tests for each of the primary comparison categories (never COVID vs COVID and only COVID vs long COVID). Four path models were used to test the hypotheses that (1) long COVID symptoms or (2) depression, anxiety, and/or stress assessed with the subscales of the 21-item Depression, Anxiety, and Stress Scale (DASS-21) mediated the relationship between COVID-19 and sexual function. Sexual function was measured with the FSFI, long COVID symptoms were assessed using the Centers for Disease Control working symptom set, and emotional distress was measured with the DASS-21. In total, 1313 participants provided data suitable for analysis. The never-COVID group (n= 645, 49.1%) had higher scores on the Desire, Arousal, Lubrication, and Satisfaction subscales of the FSFI (mean [M] [SD] FSFI total Mnever COVID = 27.98[4.84] vs MCOVID = 27.05[5.21]) than the combined only-COVID (n= 498, 37.9%) and long-COVID (n= 170, 12.9%) groups. The FSFI subscale scores were significantly higher in the only-COVID group than in the long-COVID group for the Arousal, Lubrication, and Orgasm and lower for the Pain subscales and higher for overall sexual function (FSFI total Monly COVID = 27.49[5.00] vs Mlong COVID = 25.77[5.61]. None of the proposed mediation models had adequate model fit. Clinicians treating cisgender women who have COVID-19 should consider proactively discussing sexual function with their patients and offering available resources. In this study we used a large and diverse sample, but this sample did not include transgender or gender-diverse persons. This study was also correlational; as such, causal conclusions cannot be drawn. Further, the mechanism of action remains unexplained. The study findings suggest the following: (1) COVID-19 infection is associated with impaired sexual function in cisgender women, and (2) that women with long COVID experienced incrementally more impaired sexual function than women with COVID-19 who did not develop long COVID.

Endometriosis and sexual disorders: the effect of surgical and medical treatment, a multicentre cross-sectional study

Background Sexual health is a major concern in women with endometriosis, however only a few controlled studies have examined this with validated instruments. The effect of hormonal treatments on sexual function in endometriosis is also an underrated topic. The aim of this study was to investigate sexual function of patients with endometriosis by a specific tool to better evaluate their sexual function (including different domains), and the influence of hormonal treatment or surgery on these parameters. Methods An observational, cross-sectional, multicentre study was conducted in a group (n=194) of sexually active, women aged 25–45 years old, with surgical or ultrasonographic diagnosis of endometriosis, referred to the Endometriosis Center of Careggi University Hospital or Negrar di Valpolicella. Sexual function was assessed by administering the Female Sexual Function Index (FSFI), which assesses the domains of desire, arousal, lubrication, orgasm, satisfaction and pain. FSFI scores were compared to those of a control group (n=58) and according to the treatment received by patients with endometriosis. Results Ovarian endometriosis was present in 50 patients (25.8%), deep infiltrating endometriosis in 65 patients (33.5%) and both in 79 patients (40.7%). Adenomyosis coexisted in 102 patients (52.6%). Women with endometriosis reported a mean total FSFI score of 18.3 [4.2-25.8] (&lt; 26.55), indicating female sexual dysfunction (FSD) in all patients. At multivariate analysis, after adjusting for confounders (BMI and hormonal therapy), women with endometriosis presented significantly lower scores than controls in all the FSFI (p&lt;0.001). Patients with endometriosis under hormonal treatments (n=124; 64%), regardless of the type, had significantly lower scores in all FSFI subscales and total score, even after adjusting for confounders—age, BMI and history of surgery. Conclusions Patients with endometriosis are at risk for FSD, encompassing not only dyspareunia, but all domains of sexual function. Hormonal treatments do not result in improvement in sexual symptoms.

Comparing long-term sexual dysfunction across different uterine cancer treatment modalities

The objective of this study was to assess differences in long-term sexual and menopausal side effects after uterine cancer treatment among treatment modalities. This is a cross-sectional study that examined women treated for uterine cancer from 2006-2018. Eligible women included those who underwent a hysterectomy/bilateral salpino-oophorectemy alone (HS), with brachytherapy (BT), or with external beam radiation therapy (EBRT). A noncancer cohort of women who underwent a hysterectomy/BSO for benign indications were also identified (non-CA). To compare outcomes, we utilized a shortened form of the female sexual function index (FSFI) and the menopause survey, which consists of 3 subscales: hot flashes, vaginal symptoms, and urinary symptoms. Demographic, comorbidity, and other treatment variables were collected. Survey totals were compared across cohorts using ANOVA tests and logistic regression. A total of 284 women completed the Menopause Survey (Non-CA 64, HS 60, BT 69, EBRT 91); 116 women reported sexual activity in the last 4 weeks and completed the FSFI (NC 32, HS 21, BT 31, EBRT 32). The mean FSFI score for the entire cohort was 11.4 (SD 4.16), which indicates poor sexual function. There was no significant difference between any cohort in the overall FSFI score (p = 0.708) or in any of the FSFI subscales (all p > 0.05). On univariate analysis, BT was associated with fewer menopausal hot flashes and vaginal symptoms compared to the non-CA cohort (p < 0.05), which did not persist on multivariable analysis. There was no significant difference in sexual dysfunction or menopausal symptoms in those treated for uterine cancer with or without adjuvant radiation. Most patients reported poor sexual function.

Determination of Sexual Functioning and Factors Affecting Sexual Functions of Women Following Abdominal and Vaginal Hysterectomy

Objective: The study was designed as an analytic and descriptive study to determine sexual functioning and the factors affecting sexual functions in women undergoing abdominal and vaginal hysterectomy. Materials and Methods: Based on the power calculation, 120 women (Abdominal hysterectomy=60; Vaginal hysterectomy=60) were included in the study. The study data were collected using “Demographic and Individual Information Form”, “Female Sexual Function Index (FSFI)”, and “Beck Depression Inventory (BDI)”. Results: The mean FSFI scores were similar in women who underwent abdominal hysterectomy (22.73±6.94) and vaginal hysterectomy (20.84±8.22) (p&gt;0.05). There was a significant relationship between the mean FSFI score and age, menopausal status, and changes in sexual life after hysterectomy in women in both groups (p

Long term sexual outcomes of Mayer Rokitansky Küster Hauser Syndrome patients after Uncu-modified Davydov procedure.

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome has an incidence of 1 in 4000. The absence of the vagina and uterus results in sexual dysfunction and infertility. The first-line treatment is vaginal dilatation. There exists a number of second-line surgical options including the Uncu-modified Davydov procedure. To determine the complication rate, anatomical outcomes, and long-term sexual outcomes of MRKH syndrome patients after Uncu-modified Davydov procedure. Patients with MRKH syndrome who underwent paramesonephric remnant-supported laparoscopic double-layer peritoneal pull-down vaginoplasty (aka Uncu-modified Davydov procedure) between January 2008 and December 2021. The procedure involves laparoscopic circular dissection of the pelvic peritoneum followed by pulling down, through the opened vaginal orifice, and suturing the vaginal cuff with the support of uterine remnants. The long-term complication rate, anatomical outcomes, and sexual function outcomes (as measured by Female Sexual Function Index (FSFI)) were ascertained. Main Outcome Measures: The long-term complication rate, anatomical outcomes and FSFI survey results. A total of 50 patients with MRKH syndrome underwent the Uncu-modified Davydov procedure between Jan 2008- Dec 2021. There were four perioperative complications: three bladder injuries (6%) and one rectal serosa injury (2%). Four long-term postoperative complications were identified: one vesicovaginal fistula (2%), one recto-vaginal fistula (2%), and two vaginal stenoses (4%). All patients were physically examined at least one year after surgery. The mean vaginal length was 8.4 + 1.9 cm. The mean FSFI score was 31.5 + 3.9 (minimum score of 24, maximum score of 36). Conclusion: The Uncu-modified Davydov procedure has been demonstrated to be a safe and effective treatment option with high female sexual function index scores for patients with MRKH syndrome. The long-term complication rate, anatomical and sexual outcomes of Uncu-modified laparoscopic peritoneal pull-down vaginoplasty were reported in this study. The results indicated that the surgical approach could be used in selective MRKH patients who failed first-line self-dilatation therapy.

The relationship between sleep problems and sexual dysfunction among pregnant women in Turkey.

Sexual dysfunction and sleep problems are common in women. Nevertheless, the relationship between sleep problems and sexual dysfunction during pregnancy has yet to be fully clarified. The aim of this study was to evaluate the relationship between sleep problems and sexual dysfunction in pregnant women. The study had a cross-sectional design and the sample was determined by employing the G*Power program on the basis of the findings of a related study. Taking the correlation value between the Female Sexual Function Index (FSFI) and the Insomnia Severity Index (ISI) into account, it was found that the minimum sample size was 219 pregnant women. Healthy pregnant women who were literate, did not have a diagnosed psychiatric disease, did not have a mental disability or communication problems, were in the gestation period, were not restricted by their doctors in terms of engaging in sexual activity, and who were willing to participate were included. The study included those pregnant women who consecutively attended the NST polyclinic in a maternity hospital in a province in the Black Sea region of Turkey between January 2022 and August 2022. The Sociodemographic Information Form, the Pittsburgh Sleep Quality Index (PSQI), the ISI, and the FSFI were used to collect data. A total of 220 pregnant women took part. The women had a mean age of 27.4 ± 6.3. Of the pregnant women, all had poor sleep quality: 61% had insomnia problems; 30% had sexual dysfunction. When the relationships between the PSQI, ISI and FSFI were examined, there was a statistically significant positive correlation between the mean PSQI and ISI scores (p = 0.000). A statistically significant negative correlation was determined between the mean ISI and FSFI scores (p = 0.044). According to the multiple regression analysis, age did not significantly predict sexual function (β = -0.112; t = -1.639; p = 0.103); insomnia severity predicted sexual function negatively (β = -0.146; t = -2.136; p = 0.034). The explained variance was 2.6%. The findings suggest that sleep quality as measured by the PSQIdoes not correlate with female sexual dysfunctionin pregnant women. However, severity of insomnia does correlate with sexual dysfunction.

Comparison of sexual function of people with colorectal cancer with and without colostomy bag in Iran: a comparative cross-sectional study

The aim of this study was to investigate and compare sexual function in individuals with colorectal cancer, with and without a colostomy bag. A quantitative, descriptive-comparative design was employed, and a cluster random sampling method was used to recruit 252 patients with colorectal cancer. Data collection tools included a participants characteristics form, the International Index of Erectile Function (IIEF) for men, and the Female Sexual Function Index (FSFI) for women. The mean IIEF total score for men with a colostomy was 26.17 ± 15.30, and for men without a colostomy, it was 29.05 ± 17.14. The mean FSFI total score for women with a colostomy was 6.40 ± 7.21, and for women without a colostomy, it was 9.10 ± 14.67. There was no statistically difference in IIEF scores between men with and without colostomy bags (p > 0.05). However, women with colostomy bags had significantly lower FSFI scores compared to women without colostomy bags (p < 0.05). Addressing sexual concerns in individuals with colorectal cancer is crucial for enhancing their sexual well-being and overall quality of life. Comprehensive support, timely interventions, and targeted services are essential to help patients navigate the challenges and improve their overall well-being.

(013) More Than Just “Vaginal Dryness”: Addressing an Unmet Need for Sexual Health Intervention in Female Cancer Survivors

Abstract Introduction Female sexual dysfunction (FSD) in cancer survivors is underreported and therefore undertreated. While the impact of cancer treatment on sexual health has been investigated through validated patient-reported outcomes, little work has been done to describe genitourinary anatomical changes in women in this population and how these changes relate to sexual function. Objective This study aims to 1) describe the population of female cancer survivors seeking treatment for sexual dysfunction through a novel sexual health after cancer program and 2) correlate disruptions in genitourinary exam findings to patient-reported sexual function. Methods A retrospective analysis included patients presenting to a sexual health after cancer program at a cancer center in South Florida. Patients received a baseline Female Sexual Function Index (FSFI) and underwent a physical, including abdominopelvic, exam. The FSFI is a validated 19-item survey that assesses desire, arousal, lubrication, orgasm, satisfaction, and pain domains. A total FSFI≤26.55 indicates sexual dysfunction. Genitourinary exam changes were characterized using a novel Adapted Vulvovaginal Exam Score (AVES) which assesses vaginal rugae, vascularity, epithelial integrity, elasticity, and dryness. A high AVES (&amp;gt;3) corresponds to more severe exam disruptions. Mean FSFI total and domain scores were compared between AVES groups (0-3 vs. &amp;gt;3) using t-test. A multivariate binary logistic regression model was fit to identify significant patient factors, treatment characteristics, and FSFI responses associated with high AVES score. Adjusted odds ratios (aOR) and corresponding 95% confidence intervals (95%CI) were calculated. Results Between 2020-2021, 139 female cis-gender women with a median age of 46 (range 19-70) at diagnosis were seen in the MUSIC Program that 56.8% identified as Hispanic/Latinx. Most were treated for breast (79.1%) or gynecologic (9.4%) cancer. Common presenting symptoms included vaginal dryness (55%), painful sex (45%), low desire (36%) and hot flashes (22%). Patients who disclosed details about pain (n=62) reported penetration was possible but uncomfortable (14%), possible but painful (58%) or impossible due to pain (11%). Those who disclosed changes with orgasm (n=43, 31%) reported it was more difficult (26%), or impossible (23%). Of those completing the FSFI (n=108, 78%), median Desire Domain score was 1.8 (IQR 1.2), and median Total Score was 9.85 (IQR 13.3), with 97% of patients meeting criteria for FSD. Mean total FSFI score, as well as lubrication, orgasm, satisfaction, and pain domain scores were significantly lower in high AVES. Multivariate analyses revealed that women with poor FSFI satisfaction domain score (&amp;lt;3.6) was significantly more likely to have high AVES (aOR 2.81; 95%CI 1.03-7.65; p=0.044). Conclusions The present study characterizes the range of anatomic changes associated with sexual dysfunction in a diverse cohort of female cancer patients. Future work will describe treatment strategies employed and their effectiveness at symptom resolution and quality-of-life improvement to meet the needs of this growing population. Disclosure No

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

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

(003) New Treatment Approach for Female Sexual Dysfunction by Transvaginal Shockwave Therapy (TVST)

Abstract Introduction Female Sexual Dysfunction (FSD) is a common condition of women especially following menopause. In recent years, energy-based devices (EBD), such as lasers and radio-frequencies, have been marketed for vaginal rejuvenation and FSD. Low-intensity shockwave therapy (LIST) has been introduced as a treatment for male erectile dysfunction and may hold promise for FSD. In women energy has to be delivered to the vaginal wall to manifest its tissue regenerative potential. In this pilot study, we evaluated a specially designed transvaginal probe, which is able to deliver shockwave energy to the vaginal wall and the external genitalia. Objective To evaluate the safety and therapeutic efficacy of LIST, when applied transvaginally for the treatment of FSD and incontinence. We call this approach transvaginal shockwave therapy (TVST). Methods The study was a single-arm, pilot study conducted between February-August 2021. Fifteen female patients aged 45-61 years (mean age: 52.7 years) were recruited and 78.6% of them were post-menopausal. All women presented with sexual dysfunction and 7 of them (46.7%) also reported urinary incontinence. Treatment was performed with the MoreNova system (Hikkonu Ltd., Israel), an electromagnetic low-intensity shockwave generator, using a novel transvaginal probe. Energy flow density was 0.09 mJoule/mm2 and intensity was gradually increased to the maximal tolerable level (1.6-1.8). Each session delivered 400 shockwaves to 6 predefined anatomical areas: the frontal vaginal wall (11 and 1 o' clock positions), the labia minora and majora (left, right). Patients underwent a total of 6 treatment sessions over the course of three weeks (2 per week). Statistical analysis was performed using student’s t-test (paired, one-tail, significance at p&amp;lt;0.05). Results Sexual dysfunction was assessed with the Female Sexual Function Index (FSFI) and incontinence with the ICIQ-UI Short-Form. Evaluations were performed at baseline and at 1 and 3 month post treatment. One patient aborted (for reasons unrelated to treatment) and was excluded from analysis. No patient complained of pain or discomfort during or after treatment and no side-effects were reported. Mean total FSFI score at baseline was 13.93, increased significantly to 22.66 at 1 month and slightly decreased to 20.88 at 3 months post treatment. All domains of the FSFI were significantly improved both at 1 and 3 month follow-ups compared to baseline. Percentage of patients achieving minimally clinically important differences (MCID) of the FSFI domains (Krychman et al, 2018) was also estimated. It was found that at 1 month follow-up more than 70% of patients achieved improvements exceeding the MCID in the pain, orgasm and lubrication FSFI domains. At 3 months, this significant improvement was sustained in the pain and orgasm domains. Mean ICIQ-UI was 3,53 at baseline and decreased to 3 at 3 months and 2.28 at 3 months post treatment. Conclusions There is a great need for new, effective and safe therapies for FSD. Quite often FSD is not reported by the patients and disregarded by physicians who are not involved in sexual medicine. Robust scientific evidence as to the efficacy of EBDs is also lacking. In our study, we found that TVST is safe and very well-tolerated by the patients. It improved FSD up to 3 months post treatment and this improvement was evident in all domains of the FSFI. There was also improvement in incontinence, as documented by the ICIQ-UI index. This observation surely warrants further investigation. Our data, although limited, underline the need for large scale, controlled studies ideally targeting different genito-urinary conditions. Disclosure Yes, this is sponsored by industry/sponsor: Direx Clarification Industry funding only - investigator initiated and executed study.