Mean Female Sexual Function Index Research Articles

Sexual Dysfunction in Young Women with Type 1 Diabetes.

Introduction: Sexual dysfunctions (SD) are chronic complications that can develop due to vascular complications or autonomic neuropathy. Additionally, such complications can be of hormonal, infectious or psychogenic etiology. Objectives: The aim of study was to assess the sexual function and acceptance of the chronic disease in young sexually active women with type 1 diabetes (T1DM). Materials and methods: A total of 169 female patients with T1DM completed two standardized questionnaires, the Female Sexual Function Index (FSFI) and the Acceptance of Illness Scale (AIS). Other medical data were collected from medical history. Results: The mean FSFI score was 27.96 ± 5.00, and the mean AIS score was 29.67 ± 8.28. The score < 26 points in FSFI was obtained by 28.7% of patients. Analysis of correlation between the FSFI and the AIS showed that the higher the score on the FSFI, the higher the score on the AIS. Patients who underwent regular physical activity (55%) had a significantly higher acceptance of the disease (p = 0.0026) and reported painful intercourse significantly less frequently (p = 0.01). The value of HbA1c in the study group was 7.31 ± 1.25%. Patients with poorer glycemic control (HbA1c > 8%) obtained significantly lower scores on the FSFI (p = 0.03), whereas no differences were found on the AIS. Diabetes-related complications were observed in 25.5% of patients. The presence of chronic complications did not affect the results of the FSFI or the AIS. Patients with diabetes and hypertension had poorer functioning in the sexual sphere and had significantly lower scores on the FSFI. Past or present history of depression was reported by 36% of patients and also negatively affected acceptance of diabetes (p = 0.0015). Patients who reported recurrent urinary tract infections (17%) achieved significantly lower scores on the FSFI (p = 0.03) and showed that sex-related pain was significantly more prevalent (p = 0.02). In the case of the statement related to the embarrassment of people around the patient due to diabetes, patients with lower scores complained of SD significantly more often (p = 0.0033). Past deliveries, the type of labor, the use of contraceptives or the number of sexual partners had no influence on the overall assessment in both scales. However, in terms of desire, women who had delivered obtained higher scores (p = 0.0021). Conclusion: SD in women with T1DM may result from diabetes-related complications, hormonal disorders or recurrent genital or urinary tract infections. However, they usually have a psychological basis due to the lack of acceptance of the problems related to the treatment of diabetes.

Is psychosexual therapy a reliable alternative to bupropion extended-release to promote the sexual function in infertile women? An RCT.

BackgroundVarious treatment methods are used to deal with sexual problems.ObjectiveThis study was applied to answer the question of whether psychosexual therapy (PST) can be a reliable alternative to bupropion extended-release (BUP ER) to promote sexual function in infertile women.Materials and Methods In this randomized clinical trial, 105 infertile women with sexual dysfunction were randomly allocated to three groups: PST, BUP ER, and a control group. The PST group participated in a total of eight 2-hr group sessions. In BUP ER group, 150 mg/day Bupropion ER was administered for eight weeks. The control group did not receive any interventions. The female sexual function index (FSFI) and a clinical interview were used to assess their sexual dysfunction.ResultsThe mean pre-to-post treatment scores of FSFI and its subscales increased significantly in PST and BUP ER groups (except in the subscale of sexual pain) (p = 0.0001, p = 0.0001). The changes in the subjects were not significant in the control group. After adjusting for the baseline values, the results remained significant for the mean FSFI (p = 0.0001), and its subscales between the groups. Compared to the control group, a significant increase was observed in the mean FSFI (p = 0.0001, p = 0.002) and its subscales in the PST group and in the BUP ER group (except in the subscale of sexual pain). Comparison of two intervention methods showed that PST had the better effect on the sexual function improving (p = 0.0001) and its subscales (exempting the subscale of orgasm) than BUP ER.ConclusionPST can be considered not only a reliable alternative to pharmacotherapy; it also produces better results in terms of improving sexual function in infertile women.

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

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

Abstract P1-17-11: Sexual function in Mexican patients with breast cancer receiving active oncological treatment

Abstract Background: It is widely recognized that women's sexuality can be particularly complex during the treatment of breast cancer. This, in turn, has physical, emotional and psychological consequences throughout the life of these patients. However, there is limited information regarding sexual health in Hispanic women with breast cancer. The objective of this study was to evaluate sexual dysfunction in Mexican women with breast cancer who were receiving active treatment against cancer. Methods: We prospectively evaluated sexual dysfunction among Mexican patients with breast cancer receiving active oncological treatment at a single institution in Mexico City using the Spanish language version of the Female Sexual Function Index (FSFI). FSFI is graded as a continuous scale from 2-36, and is formed of 6 subscales (desire, arousal, lubrication, orgasm, satisfaction, and pain) with a maximal score of 6 each. Sexual dysfunction was defined as an FSFI &amp;lt;26.55 points. Demographic and clinical data were collected from the clinical record and analyzed using descriptive statistics. Fisher's exact tests were used for comparisons among groups. Results: 84 women with breast cancer undergoing active treatment completed the FSFI. Median age was 57 years (range 25-87), 59.2% were postmenopausal, and 46.4% were married. Median body mass index (BMI) was 25.2. 60% of patients had early stage breast cancer (Stage 0-II), 64% were receiving hormonal treatment (average duration of 28.3 months), and 25% were undergoing treatment with chemotherapy. 42% had undergone breast conserving surgery, while 28% had received a mastectomy. 51 patients (60.7%) reported absence of sexual activity during the previous four weeks. Patients who reported sexual activity in the previous four weeks had a mean FSFI score of 23 points (range 15.7-44) and 63.6% had sexual dysfunction. Subscale scores were as follows: desire 1.7 (range 1.2-2.4), arousal 2.9 (range 1.5-5.1), lubrication 3.1 (range 1.5-4), orgasm 3.6 (range 1.1-4.8), satisfaction 4.0 (range 1.2-5.6), and pain 2.5 (range 1.2-5.2). Premenopausal women were more likely than postmenopausal women to report sexual dysfunction (85% vs. 44%, p = 0.02) with a mean FSFI score of 20.9 and 17.3 respectively. Among postmenopausal women with sexual dysfunction, the lowest scores were found in the desire (1.72) and pain domains (2.5). Desire (3.2) and lubrication (3.27) were the domains with the lowest scores among premenopausal patients. Sexual dysfunction was not related to the type of breast surgery (mastectomy vs breast conserving, p = 0.26). Conclusions: Our study shows a significant proportion of Mexican women with breast cancer have sexual dysfunction and absence of sexual activity. Premenopausal patients were more frequently affected, particularly in the desire and lubrication domains, while postmenopausal women reported poor desire and pain. This provides valuable information to design innovative strategies aimed at improving the sexual health and quality of life of patients diagnosed with breast cancer undergoing active oncological treatments. Citation Format: Mónica Lily Cordón-Paz, Luis Lara-Mejía, Ana Olvera-Cruz, Lorelí Mejía-Fernández, Pilar Milke-Garcia, Yanin Chavarri-Guerra. Sexual function in Mexican patients with breast cancer receiving active oncological treatment [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-17-11.

Direct-acting antiviral drugs improve the female sexual burden associated with chronic HCV infection

ABSTRACTBackground: The impact of patient cure by direct-acting antiviral agents (DAAs) on female sexual dysfunction (FSD) associated with HCV hasn’t been studied.Aim: To study the impact of DAAs on associated FSD in patients with chronic HCV infection.Methods: In patients with chronic HCV infection who were eligible for DAAs, the self-administered female-sexual-function index (FSFI) questionnaire was completed by 300 sexually active females’ patients before treatment and compared to equal number of age and socioeconomically matched controls. FSFI questionnaire results after treatment were compared to patients’ baseline results.Results: The mean total score for the patients was significantly lower than that for controls (16.77 ± 1.36 versus 17.52 ± 0.99, P < 0.001). Patients after treatment with DAAs significantly scored better results than baseline results in the total score and all domains of the questionnaire and significantly less patients had FSD compared to baseline (2.7% versus 29.3% P < 0.05). Patients’ mean FSFI score significantly improved after cure (18.8 ± 0.27 vs. 16.77 ± 1.36, P < 0.001).Conclusion: Hepatitis C has negative impacts on FSF and affecting all domains of FSFI. The DAAS improve the sexual burden associated with hepatitis C in patients who achieved sustained virologic response.

Association Between Sexual Dysfunction, Sleep Impairment and Depression in Women with Fibromyalgia

We evaluated whether patients who meet the survey criteria for fibromyalgia suffer from a higher rate of sexual dysfunction and sleep disorders compared to those without fibromyalgia. While 54 of the participants were patients diagnosed with fibromyalgia, the remaining 41 made up the healthy control group of the study. The patients were given four different sets of questionnaires: the Pittsburgh Sleep Quality Index (PSQI), Revised Fibromyalgia Impact Questionnaire, Beck Depression Inventory (BDI) and Female Sexual Function Index (FSFI) in order to evaluate sleep function, fibromyalgia disease severity, depression status and sexual function. We found a mean FSFI score of 19.29 ± 3.35 in the women with FMS and 25.88 ± 2.47 in the control group. The participants with FMS suffered from higher depression rates compared to participants in the healthy group. With PSQI score > 5 indicating the presence of a sleep disorder, sleep disorders were detected in 66.6% of women with FMS and 39.3% without FMS. In the Spearman correlation analysis, weak negative correlation was found between the PSQI and FSFI values (r = − 0.213; p = 0.076). In contrast, a positive correlation was detected between the FSFI and RFIQ (r = 0.578; p = < 0.001). Finally, a negative correlation was detected between FSFI and BDI values (r = − 0.509; p < 0.001). Therefore, physicians who investigate the fibromyalgia syndrome in their routine practice to take the negative effects of sexual dysfunction on female patients into consideration.

Effects of Education About Rheumatoid Arthritis and Sexuality on the Sexual Problems of Women With Rheumatoid Arthritis.

The present quasi-experimental study was conducted to determine the effects of education about rheumatoid arthritis (RA) and sexuality on the sexual problems of women with RA. The study included 103 women with RA (51 in the experimental group, 52 in the control group). The study data were collected using the Personal Information Form and Female Sexual Function Index (FSFI). The women in the experimental group were provided education on sexuality, while those in the control group received no intervention. The aforementioned scales were administered twice: during the recruitment visit and then 1 month after the intervention. In the second measurement, the mean FSFI score increased in the experimental group, but was low in the control group, with the differences between the two groups being significant. Thus, providing sexual education to women with RA was effective in reducing sexual problems in women.

Examining sexual functions of women before and after menopause in Turkey.

Sexuality is an important factor that completes the lives of individuals and affects people in all age groups. To examine the sexual functions of women before and after menopause. This cross-sectional study was conducted at the Family Health Centers in Tunceli Turkey,\ between September 2014 and February 2015. The study data were obtained using a Questionnaire and the Female Sexual Function Index. The data were analyzed by number, percentage distribution, mean, standard deviation, t-test, and using binary logistic regression analysis. The mean Female Sexual Function Index score of the women was 23.8±8.0. The Female Sexual Function Index score of 59.7% of women was below the cut-off score (26.55) and was accepted indicative of sexual dysfunction. Low educational level (P < 0.01), low income (P < 0.01), and menopausal status (P < 0.0001) of the women were risk factors for sexual dysfunction. Prevalence of sexual dysfunction in the women was very high and they indicated no effort to seek medical care. Low educational and income level and menopausal status of the women were three factors increasing the risk of sexual dysfunction. Awareness of the society and the healthcare professionals about the issue should be increased.

Sexual Function, Quality of Life, and Mood After Radiation Therapy in Patients with Anal Cancer.

Definitive chemoradiation (CRT) results in high cure rates of anal cancer, with advanced radiation (RT) techniques improving toxicity. However, there is limited data regarding these patients' sexual function (SF), quality of life (QOL), and mood. We hypothesized that anal cancer treatment would result in detrimental effects on SF, QOL, and mood. We prospectively surveyed patients with anal cancer treated with definitive CRT. We assessed SF for women with the Female Sexual Function Index (FSFI) and for men with the International Index of Erectile Function (IIEF). For all patients, we assessed QOL using EORTC QLQ-C30 and CR29 and mood using the Hospital Anxiety and Depression Scale (HADS). We reported descriptive statistics for SF, QOL, and mood and used univariate analysis to evaluate predictors of SF for women. Of 50 eligible patients, 84% completed the surveys. Median time from RT until survey was 36months (1-97months). Women (n = 34) reported poor SF overall (mean FSFI score = 15, scale 2-36, standard deviation (SD) 10.4). Most women reported poor SF related to satisfaction, desire, orgasm, arousal, pain, and lubrication. Men (n = 8) also had poor overall satisfaction (mean IIEF score = 6.1, scale 2-10, SD 3.6). Men reported poor erectile function and lower satisfaction with intercourse. Mean QLQ-C30 QOL score was 86.5 (SD 16.3). Results from EORTC QLQ-CR-20 demonstrated patients experienced poor sexual interest. Per HADS, 2.5% reported depression and 18% anxiety. Patients with anal cancer experience sexual dysfunction after RT, with QOL and mood symptoms similar to patients with other cancers. Our data support the need for ongoing efforts to understand and address issues with SF, QOL, and mood following RT for these patients.

A Longitudinal Study of Sexual Function in Women With Newly Diagnosed Inflammatory Bowel Disease.

The literature provides conflicting data on sexual function in women with inflammatory bowel disease (IBD). We aim to describe sexual function at baseline and over time in a prospective inception cohort of adult women with IBD. Women age 18 years or older enrolled in the Ocean State Crohn's & Colitis Area Registry (OSCCAR) with 2 years of prospective follow-up were included in the study. All subjects were enrolled within 1 year of IBD diagnosis. Female sexual function was assessed using the Female Sexual Function Index (FSFI). Linear mixed effects models were used to assess changes in FSFI by various demographic and clinical factors. One hundred sixteen of 130 eligible women (89%) were included in the study. Ninety-seven percent of women had sexual dysfunction, defined as an FSFI score of <26.55, with a baseline mean FSFI score (SD) of 16.4 (8.4) overall (15.5 [8.6] in Crohn's disease, 17.4 [8.1] in UC, P = 0.22). Despite improvement in overall disease activity, there was no significant change in the FSFI score or individual domain scores over the entire 2-year study period. Among all women with IBD, older age, nonsingle marital status, lower Short Form Health Survey (SF-36) Physical Component Summary score, and the use of biologics were independent risk factors for sexual dysfunction. Almost all women experienced sexual dysfunction that did not improve over time despite improvement in overall disease activity. Future studies are warranted to identify underlying mechanisms that explain the associations between demographic and clinical factors and sexual dysfunction among newly diagnosed women.

Sexual dysfunction in in-vitro fertilization (IVF) patients and the effect of ovarian reserve on sexual dysfunction

Aim: In this prospective study, we aimed to compare the patients scheduled for in vitro fertilization (IVF) with poor ovarian reserve to patients with unexplained infertility in the same age group in terms of sexual dysfunction.Material and Methods: In this prospective study, a total of 146 patients admitted to the IVF center of Ondokuz Mayis University between June 2018 and December 2018 were included in the study. Fourty-eight of these patients had poor ovarian reserve and 98 were scheduled for IVF due to unexplained infertility. In these patients, the female sexual function index (FSFI) scores were calculated for the diagnosis of sexual dysfunction prior to treatment. In addition, ovarian reserve tests such as cyclic follicle stimulating hormone (FSH) and anti mullerian hormone (AMH) at the beginning of the menstrual cycle were recorded.Results: The mean age of the female patients in the study was 30.2+-5 years. The mean FSFI score was 22.36 +-3.31 and 22.44+-3.53 in the group with poor ovarian reserve and with unexplained infertility, respectively. The prevalence of sexual dysfunction (FSFI score 26.55) in the poor ovarian reserve group was 89.6% (n=48) compared to the unexplained infertility group, which was 93.9% (n=98). The analysis of domains revealed no statistically significant difference between the two groups (p=0,356).Conclusion: Sexual dysfunction is frequently observed in patients scheduled for IVF. Our study showed that there was no difference in sexual dysfunction between the two groups. Interestingly, it was revealed that there was a correlation between FSH levels and satisfaction and pain.It was also interesting that the rate of sexual dysfunction was extremely high in both groups.Keywords: Decreased ovarian reserve; sexual dysfunction; unexplained infertility; ovarian reserve.

Prevalence and Predictors of Female Sexual Dysfunction in Migraine.

Background:Migraine is a common cause of primary headache, with women being affected thrice as common as men. Very few studies are available on sexual dysfunction in female migraineurs. There are no published studies done on the same in India till now. This study was done to look for the prevalence and predictors of sexual dysfunction disorder in females suffering from migraine.Materials and Methods:This is a cross-sectional study done to look for the prevalence and predictors of female sexual dysfunction in migraine. Sixty female patients with migraine were studied. The International Headache Society's International Classification of Headache Disorders, 3rd Edition, was followed to diagnose migraine with or without aura. Migraine disability assessment scale was used to assess migraine-related disability, and Female Sexual Function Index (FSFI) score was used to assess female sexual function.Results:Sexual dysfunction was found in 78.3% migraineurs. The mean FSFI score was 23.1 ± 4.76. The FSFI scores in all the domains were lower in the individuals studied. Acute headaches resulted in loss of sexual desire among all the migraineurs.Conclusion:Sexual dysfunction is common in migraine with all domains of sexual function being affected. There is a significant negative correlation of sexual function with duration of acute episodes of headache and increasing frequency of migraine attacks per month.

The effect of overactive bladder treatment with anticholinergics on female sexual function in women: a prospective observational study.

The aim of the study was to determine the effect of anticholinergics used for overactive bladder treatment on the sexual function of women. Between January 2016 and August 2018, over 18years old, 216 sexual active women with OAB and 165 healthy women as control group were prospectively enrolled in the study. Five different anticholinergics were used for the treatment. Female Sexual Function Index (FSFI), eight-item overactive bladder awareness tool (OAB-V8), and Beck Depression Inventory form were completed before and after 3months. Baseline and post-treatment scores were compared with a control group of age-matched healthy women. Patients with OAB reported at baseline significantly worse sexual function in all FSFI domains compared to healthy control group (21.47 ± 3.22 vs. 26.79 ± 5.56, p < 0.01). Three months after treatment, over 85% of participants reported clinically relevant improvements in sexual function, with statistically significant changes in mean FSFI scores. Treatment of OAB with anticholinergics can improve sexual function of sexual active women with OAB. Patients may be informed about this potential benefit of anticholinergic treatment, to improve their sexual function.

The influence of partnership quality and breastfeeding on postpartum female sexual function.

Female sexual dysfunction is known to have a huge impact on quality of life and is highly prevalent during the peripartum period. Several influencing variables were found to be associated with impaired sexual function postpartum, among them breastfeeding and partnership quality. However, little is known about the predictive value of these variables. Therefore, this longitudinal cohort study aimed to examine prospectively the influence of the two variables on sexual function 4-month postpartum. Questionnaires were administered to 330 women prenatally (TI, third trimester) and postpartum (TII, 1week; TIII, 4months). Medical data were collected from the respondents' hospital records. The Female Sexual Function Index (FSFI) was used to determine overall sexual function, desire, arousal, lubrication, orgasm, satisfaction, and pain perinatally. At all timepoints, mean FSFI scores were below the critical FSFI-score of 26.55. Partnership quality, breastfeeding, high maternal education, and maternal depressive symptoms correlated significantly with FSFI scores postpartum. Further analyses confirmed antenatal partnership quality and breastfeeding behavior as strong predictors of sexual function 4-month postpartum, explaining 24.3% of variance. Women who stopped breastfeeding or never breastfed at all showed the highest FSFI scores. Our findings indicate that exclusively breastfeeding women and those who report low partnership quality have an increased likelihood of sexual functioning problems 4-month postpartum. Health-care providers need to be encouraged to counsel on postpartum sexuality and influencing factors during prenatal classes to de-pathologize those changes and to foster a positive approach to peripartum sexuality.

Sexual Function and Contraception Use in Women With Inflammatory Bowel Disease

Introduction: IBD likely influences sexual function in women. Prior studies show impaired sexual function in female IBD patients, pain during sexual intercourse, low desire, and difficulty attaining orgasm[1,2]. The aim of our study was to evaluate sexual function and contraceptive methods in IBD patients vs. controls. Methods: A prospective, cross-sectional study was conducted at Women & Infants Hospital of RI, Center for Women's Gastrointestinal Health. Women aged 18-45 with and without IBD completed a questionnaire that assessed 6 subdomains of the Female Sexual Function Index (FSFI), similar to a study by Bel et al.1,3 Contraception and age at diagnosis were assessed, which have been previously studied in varying cohorts2,4. Results: Surveys were completed by 32 IBD patients and 45 controls. Total FSFI score did not vary significantly between IBD and control groups, but IBD patients scored lower than controls in all subdomains. Within the IBD group, a statistically significant correlation was found between age at diagnosis and sexual function. Patients diagnosed at age 16 or younger (N=4) scored lower than patients diagnosed at age 17 or older (N=20) in total FSFI score and in four subdomains (Table 1). Although no differences were found in contraception rates between IBD and control groups, IBD patients were more likely to have received a tubal ligation (Table 2). Conclusion: This study suggests that age at IBD diagnosis may be a determinant of future sexual function. Women with IBD were more likely to have a tubal ligation, suggesting that voluntary childlessness, found to be higher in IBD patients5, may have a role in decisions regarding contraception. A limitation of this study was sample size. The results of this study suggest that gastroenterologists can improve the sexual function and reproductive health of their female IBD patients through history and referral for psychological or sexual-therapeutic interventions.721_A Figure 1. Independent samples test for mean FSFI scores between IBD patients diagnosed at age 16 or younger vs. those diagnosed at age 17 or older721_B Figure 2. Chi-square test for differences in rates of tubal ligation in IBD Group vs. Control Group

1766P - Sexual functioning and depression among Egyptian breast cancer patients following surgery and neoadjuvant/adjuvant chemotherapy

Background: Breast cancer and its treatment may have a negative impact of the sexual wellbeing of patients and psychological morbidity may further add to this impact. Little is known about the sexuality of Egyptian patients with breast cancer. This may be due to barriers related to health care professionals, patients and their families and the culture. Aim: To evaluate sexual functioning among Egyptian breast cancer patients following treatment and to determine the relation between their sexual wellbeing and anxiety and depression and other possible factors. Methods: This prospective cross-sectional observational study included married breast cancer patient from 20 to 50 years of age who underwent surgery and received neoadjuvant/adjuvant chemotherapy. The Female Sexual Function Index (FSFI) was used to assess their sexual wellbeing. FSFI total score cutoff value of 26.55 was used to determine sexual dysfunction. The Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression. In addition, demographic and clinical data were collected. Results: Thirty-six out of 38 patients (94.7%) invited to participate in the study signed an informed consent and completed the FSFI questionnaire. The mean FSFI total score was 23.1±7.4 and 61% of patients had sexual dysfunction. The HADS depression scale was >7 (borderline-abnormal/abnormal) in 12 (33%) patients and the HADS anxiety scale was >7 in 25 (69%). Patients with borderline-abnormal/abnormal HADS depression score had a significantly lower FSFI total score compared to those with normal HADS depression score (20 vs. 25, respectively; p = 0.029). The HADS anxiety score did not correlate significantly with the FSFI scores. Conclusions: Unlike the common belief, the majority of Egyptian female breast cancer patients included in this study was willing to discuss their sexual wellbeing. The results suggest that a significant proportion of Egyptian patients who completed treatment for breast cancer experience sexual dysfunction and psychological morbidity and that sexual dysfunction correlate significantly with depression among them. Legal entity responsible for the study: Clinical Oncology Department, Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

DISFUNÇÃO SEXUAL EM MULHERES QUE FAZEM SEXO COM MULHERES

OBJETIVO: verificar se existe diferença na prevalência de disfunção sexual entre mulheres que fazem sexo com mulheres e mulheres que fazem sexo apenas com homens, e se as percepções interna e externa do estigma acerca da orientação sexual se relacionam com a disfunção sexual. METODOLOGIA: estudo transversal com 105 mulheres com idade superior a 18 anos e sexualmente ativas, sendo 35 do grupo mulheres que fazem sexo com mulheres e 70 do grupo mulheres que fazem sexo apenas com homens. Avaliou-se aspectos sociodemográficos e aplicou-se o Índice de Função Sexual Feminina para todas as participantes e a Escala de Avaliação de Homofobia Internalizada apenas para mulheres que fazem sexo com mulheres. Para avaliar variáveis categóricas foram utilizados os testes Qui-Quadrado de Pearson, teste Exato de Fisher ou teste Qui-Quadrado de Pearson com simulações de Monte-Carlo. O nível de significância adotado foi de 5% e software utilizado foi o R Core Team 2019. RESULTADOS: a prevalência global de disfunção sexual foi de 17,1%. Não houve diferença significativa na média do escore do Índice de Função Sexual Feminina entre os grupos (30,2±3,5x29,8±3,3, p=0,518). Verificou-se melhor escore de desejo nas mulheres que fazem sexo com mulheres (4,8±0,9x4,3±0,9, p=0,003). As percepções externa e interna do estigma acerca da orientação sexual não se relacionaram com a dinsfunção sexual. CONCLUSÕES: a prevalência de disfunção sexual foi relativamente baixa, não houve relação entre orientação sexual e disfunção sexual e as percepções interna e externa do estigma acerca da orientação sexual não se associaram à disfunção sexual.

Prospective cohort study comparing quality of life and sexual health outcomes between women undergoing robotic, laparoscopic and open surgery for endometrial cancer

ObjectiveTo evaluate patient-reported outcomes (PROs) between women treated by laparoscopic, robotic and open approaches for endometrial cancer. MethodsProspective cohort study comparing PRO at baseline, short- (1 and 3 weeks) and long-term (12 and 24 weeks) follow-up postoperatively. Quality of life (QOL) measures were the Functional Assessment of Cancer Therapy (FACT-G), EuroQol Five Dimensions (EQ-5D), and Brief Pain Inventory (BPI). Sexual health measures were the Female Sexual Function Index (FSFI) and the Sexual Adjustment and Body Image Scale for Gynecologic Cancer (SABIS-G). Results468 eligible patients (laparotomy = 92, laparoscopy = 152, robotic = 224) were recruited. There were no significant differences between the laparoscopy and robotic groups for any PRO (P > 0.05). At short-term follow-up, patients who underwent minimally invasive surgery (robotic or laparoscopy) had significantly higher FACT-G (P < 0.0001) and EQ-5D (P < 0.0001) scores, with less pain (P = 0.02) and improved pain interference (P = 0.0008), than patients undergoing laparotomy. At long-term follow-up, there were sustained improvements in the FACT-G (P = 0.035) and the health state EQ-5D visual analogue scale (P = 0.022). Surgical approach had no impact on sexual health (P > 0.05); however the mean FSFI score for the entire cohort met clinical cut-offs for sexual dysfunction. ConclusionMinimally invasive approaches result in improved QOL beyond the short-term postoperative period, with benefits noted up to 12 weeks after surgery. This prolonged QOL advantage provides further evidence that MIS should be the standard surgical approach for women with early stage endometrial cancer.

Efficacy of Vaginal Estradiol or Vaginal Moisturizer vs Placebo for Treating Postmenopausal Vulvovaginal Symptoms

Nearly half of postmenopausal women report bothersome vulvovaginal symptoms, but few data support the efficacy of 2 commonly recommended treatments. To compare the efficacy of a low-dose vaginal estradiol tablet and a vaginal moisturizer, each vs placebo, for treatment of moderate-to-severe postmenopausal vulvovaginal symptoms. This 12-week multicenter randomized clinical trial enrolled postmenopausal women with moderate to severe symptoms of vulvovaginal itching, pain, dryness, irritation, or pain with penetration. Vaginal 10-μg estradiol tablet (daily for 2 weeks, then twice weekly) plus placebo gel (3 times a week) (n = 102) vs placebo tablet plus vaginal moisturizer (n = 100) vs dual placebo (n = 100). The main outcome was decrease in severity (0-3) of most bothersome symptom (MBS) between enrollment and 12 weeks. Additional measures included a composite vaginal symptom score, Female Sexual Function Index (FSFI) score (2-36), modified Female Sexual Distress Score-Revised item 1, treatment satisfaction and meaningful benefit, Vaginal Maturation Index, and vaginal pH. The 302 women had a mean (SD) age of 61 (4) years and were primarily white (267 [88%]), college educated (200 [66%]), and sexually active (245 [81%]). Most women (294 [97%]) provided data for the primary analysis. The most commonly reported MBS was pain with vaginal penetration (182 [60%]), followed by vulvovaginal dryness (63 [21%]). Mean baseline MBS severity was similar between treatment groups: estradiol, 2.4 (95% CI, 2.3 to 2.6); moisturizer, 2.5 (95% CI, 2.3 to 2.6); placebo, 2.5 (95% CI, 2.4 to 2.6). All treatment groups had similar mean reductions in MBS severity over 12 weeks: estradiol, -1.4 (95% CI, -1.6 to -1.2); moisturizer, -1.2 (95% CI, -1.4 to -1.0); and placebo, -1.3 (95% CI, -1.5 to -1.1). No significant differences were seen between estradiol (P = .25) or moisturizer (P = .31) compared with placebo. Mean total FSFI improvement was similar between estradiol (5.4; 95% CI, 4.0 to 6.9) and placebo (4.5; 95% CI, 2.8 to 6.1) (P = .64), and between moisturizer (3.1; 95% CI, 1.7 to 4.5) and placebo (P = .17). Our results suggest that neither prescribed vaginal estradiol tablet nor over-the-counter vaginal moisturizer provides additional benefit over placebo vaginal tablet and gel in reducing postmenopausal vulvovaginal symptoms. clinicaltrials.gov Identifier: NCT02516202.

Flibanserin for Hypoactive Sexual Desire Disorder: An Open-Label Safety Study

BackgroundTo evaluate the safety of flibanserin in premenopausal and naturally postmenopausal women with hypoactive sexual desire disorder (HSDD) in an open-label extension (OLE) study. AimTo examine the safety and tolerability of flibanserin 100 mg once daily at bedtime in the treatment of premenopausal and naturally postmenopausal women with HSDD in a multicenter 28-week OLE study. MethodsPatients entering this study received flibanserin or placebo in the double-blinded, placebo-controlled trials of premenopausal and postmenopausal women and in a pharmacokinetic study of postmenopausal women. OutcomesThe primary end point of this OLE study was the incidence of adverse events (AEs). Secondary exploratory efficacy measures included the Female Sexual Distress Scale–Revised (FSDS-R) total score and FSDS-R item 13 (distress owing to low desire) score and the Female Sexual Function Index (FSFI) total score. Because the sponsor terminated the study early at discontinuation of the development of flibanserin, only descriptive statistics were calculated. ResultsOf the 595 patients receiving study medication, 346 and 249 patients were premenopausal and postmenopausal, respectively. The mean number of days of exposure to flibanserin was 72.8 (SD = 41.6). AEs were reported by 352 patients (59.2%), and most AEs (93.8%) were mild or moderate. The most common AEs (≥5%) were dizziness (9.6%), somnolence (8.6%), insomnia (6.2%), and nausea (5.7%). There were no flibanserin-related serious AEs and no instances of suicidal ideation. The safety profile of flibanserin was similar for premenopausal and postmenopausal women. The FSDS-R total scores and FSDS-R item 13 scores were numerically lower at weeks 4, 12, and 20 than at baseline (decrease in distress owing to low desire) for premenopausal and postmenopausal women. Mean FSFI total scores were numerically higher at weeks 4, 12, and 20 than at baseline, irrespective of menopausal status of the patients. Clinical ImplicationsThe results of this study support the safety and tolerability of flibanserin for the treatment of HSDD in premenopausal and naturally postmenopausal women. Strengths and LimitationsAlthough this open-label study was designed to be 28 weeks long, it was discontinued early by the sponsor, and patients’ maximum duration of exposure to flibanserin was 23.9 weeks. The open-label design and lack of a placebo-controlled arm are other study limitations. ConclusionIn this open-label study, flibanserin 100 mg once daily at bedtime was generally safe and well tolerated by premenopausal and naturally postmenopausal women with HSDD.Simon JA, Derogatis L, Portman D, et al. Flibanserin for Hypoactive Sexual Desire Disorder: An Open-Label Safety Study. J Sex Med 2018;15:387–395.