Middlesex Hospital Questionnaire Research Articles

Mental health, COVID-19 burden and quality of life of kidney transplant recipients two years after the COVID-19 pandemic.

Few studies have evaluated the psychological distress of COVID-19 in kidney transplantation and the psychological impact that the COVID-19 pandemic has had on kidney transplant recipients is not yet well understood. The present study aimed to investigate the change in symptom burden and health-related quality of life in the two years after initial assessment, by outlining the change over time of symptoms at 12 and 24 months of follow-up. This is a follow-up study. We performed a study published in 2021 (phase 1 of COVID-19); of the 89 kidney transplant recipients evaluated in this study, 60 completed the 12 months follow-up (March 2021 June 2021, phase 2 of COVID-19) and 57 completed the 24 months follow-up (March 2022 June 2022, post COVID-19). The same tools as in previous study were administered: the ad hoc questionnaire on emotional state and psychophysical well-being during COVID-19, the Middlesex Hospital Questionnaire (MHQ) to provide a simple and rapid quantification of the psychological and somatic symptoms and the Short Form Health Survey 36 (SF-36) was used to assess health-related quality of life. Compared to the first and second phase of COVID-19, the mean score of quality of life variables were higher in the post COVID-19 phase; thus the recipients physical health, mental health and their perception of their general health improved. Regarding the psychopathology variables the levels of Anxiety, Depression and Phobia in the Post COVID-19 phase decreased, while the Somatization score was higher. Lastly, burden of COVID-19 scores in the third phase, significantly decreased. Our study highlights a significant association between mental health and the burden of COVID-19 pandemic in kidney transplant recipients. This study showed, a significant worsening, over time, of some specific symptoms, such as somatization and phobias. However, the results showed that depressive symptoms improved during the study period. Long-term monitoring of kidney transplant recipients therefore remains fundamental. These results confirmed the need to provide integrated multidisciplinary services to adequately address the long-term effects of the COVID-19 pandemic on the mental health of the most vulnerable subjects.

Attachment and parental bond: impact on psychopathology, mental health and quality of life of hemodialysis patients: a cross-sectional study

BackgroundAttachment theory represents a reference model for understanding better how pre-existing personality factors can influence the coping with some chronic conditions. The onset of a chronic disease can represent a "threat" to the relationships between the subject and parental figures according to the type of bond that already exists. The aim of our study was to explore attachment styles in a sample of hemodialysis patients, hypothesizing that a secure attachment bond can constitute a protective factor for the quality of life and mental health in this type of patients.DesignWe used a cross-sectional design.MethodsFifty hemodialysis patients were given the following tests: Attachment Style Questionnaire (ASQ) to assess attachment styles, Parental Bonding Instrument (PBI) to assess parental bonding, Short Form Health Survey-36 (SF-36) for perceived quality of life and Middlesex Hospital Questionnaire (MHQ) to detect key psychological symptoms and relevant traits.ResultsThe results showed that secure attachment style correlated with good general health (r = 0.339; p < 0.05), good mental health (r = 0.547; p < 0.001) and mental component scale (r = 0.373; p < 0.05) of SF-36. Secure attachment was also significantly associated with mental health (B = 1.104; p = .002) of the SF-36.ConclusionsThe results confirmed the positive role of a secure attachment style for adequate psychological health. Early identification of patients with dysfunctional attachment styles will make it possible to offer them targeted interventions to improve their ability to accept, adapt and manage the disease and to maintain adequate psychological well-being.

(025) Inhibition and Excitation in the Sexual Brain: An Useful Tool for the Prediction of Therapeutic Outcomes in Women with Sexual Dysfunction

Abstract Introduction The “Dual control model” of sexual response postulates that sexual desire and associated behaviors depend on the balance between excitation and inhibition. These aspects have not been evaluated in women with sexual dysfunction (FSD). Objectives The aim of our study was to explore the psychosexual correlates of excitation and inhibition in women with FSD, according to their menopausal state. We also aimed at performing a pre-post analysis in a sub-sample of patients followed for 3-6 months, investigating the possible relationships between excitation and inhibition and the changes in questionnaires related to sexual function. Methods In an observational, retrospective study, we recruited a consecutive series of 66 women consulting for FSD. Patients underwent a clinical evaluation, a structured interview and completed several self-administered questionnaires, including Sexual Inhibition/Sexual Excitation Scale (SIS/SES), Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), Body Uneasiness Test (BUT) and Middlesex Hospital Questionnaire (MHQ). A subgroup of patients (n=28) was evaluated at 3-6 months follow-up, using the FSFI and FSDS-R questionnaires. Results Considering the whole sample, the SES scale was positively correlated with several psychosexual and relational parameters, including masturbation (p=0.005), number of lifetime partners (p=0.004) and histrionic personality traits (p=0.013), and negatively with the presence of a stable relationship (p=0.038) and its length (p=0.026). Sexual inhibition due to the fear of performance failure (SIS1 scale) positively correlated with conflicts within the couple (p=0.012), lack of privacy (p&amp;lt;0.0001), symptoms of general psychopathology (p=0.001; in particular, anxiety) and body image concerns (p=0.015). Regarding sexual parameters, the SES scale was associated with the total FSFI score (p=0.016), and the desire (p=0.011), arousal (p=0.030), lubrication (p=0.046) and orgasm domains (p=0.025), whereas the SIS1 scale was associated with the FSDS-R score (p=0.028). In premenopausal women, the SIS1 scale was associated with the diagnosis of Hypoactive Sexual Desire Disorder (HSDD), even after adjusting for confounders (p=0.047), whereas in postmenopausal women, we found an association between HSDD and the SES scale (p=0.039). Given these correlations, we developed two cut-off values for the SES and SIS1 scales, according to which a score &amp;lt; 49 on the SES (in postmenopausal women) and a score &amp;gt; 34 on the SIS1 (in premenopausal women) accurately identified patients diagnosed with HSDD. In postmenopausal women, the ROC curve for the SES scale showed an accuracy (AUC) of 0.734 +− 0.107, p=0.037, in identifying HSDD; considering a cut-off value of 49, the sensitivity and specificity for HSDD detection were 85.7% and 66.7%, respectively. In premenopausal women, the ROC curve for the SIS1 scale showed an AUC of 0.853 +− 0.081, p=0.007, in identifying HSDD; considering a cut-off value of 34, the sensitivity and specificity for HSDD detection were 78.6% and 75.0%, respectively. The mean change in FSFI total score was not correlated with the SES or SIS2 scales (p=0.214 and p=0.402, respectively), but only with the SIS1 scale (p=0.026). When comparing patients with low excitation (SES scale &amp;lt;49) and high inhibition (SIS1 scale &amp;gt;34) with the rest of the sample, they showed a significantly lower change in FSFI total score (p=0.018). Conclusions In women consulting for FSD, sexual excitation and inhibition, which may be easily assessed by the SIS/SES questionnaire, emerge as key aspects in both the diagnostic evaluation and planning of therapeutic outcomes, in the perspective of a personalized sexual medicine approach. Disclosure No.

(007) Physical activity and female sexual dysfunction: too much of a good thing?

Abstract Introduction Research on the relationship between physical activity (PA) and female sexual dysfunction (FSD) is lacking. Objectives To investigate the clinical, psychological, and sexual correlates of PA in women with FSD. Methods A non-selected series of n=322 pre- and post-menopausal patients consulting for FSD was retrospectively studied. Regular involvement in PA and its frequency (&amp;lt;1 hour/week: sedentary, 1-3 hours/week: active, 4-6 hours/week: very active, &amp;gt;6 hours/week: extremely active) were investigated with a specific question. FSDs, including HSDD (Hypoactive sexual desire disorder) and FGAD (Female genital arousal disorder), were diagnosed according to a structured and clinical interview. Participants underwent a physical examination and a clitoral Doppler ultrasound, and were asked to complete the Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), Body Uneasiness Test (BUT), and Middlesex Hospital Questionnaire (MHQ). Results At multivariate analysis, women engaging in PA (67.4%, n=217) scored significantly higher in several FSFI domains - including desire, arousal and lubrication - and showed lower sexual distress and lower resistance of clitoral arteries, as compared to sedentary women. A significant, inverse association between PA and HSDD was observed. Mediation analysis demonstrated that the negative association between PA and HSDD was partly mediated by body image concerns (BUT Global severity index), psychopathological symptoms (MHQ total score) and sexual distress (FSDS-R score). These latter two factors also partly mediated the association between PA and a reduced risk of FGAD, whilst a lower BMI was a full mediator in the relationship between PA and FGAD. Finally, extreme PA was associated with significantly worse scores in several psychosexual parameters (i.e. sexual satisfaction and histrionic/hysterical symptoms), even compared to a sedentary lifestyle. Conclusions In women with FSD, PA was associated with better sexual function and clitoral vascularization, lower sexual distress and reduced odds of HSDD and FGAD; the benefits of PA on sexuality were mediated by both psychological and organic determinants; excessive PA was related with a poor overall sexual function and with a low sexual satisfaction. Disclosure No.

(055) Application of a Very Low Calorie Ketogenic Diet (VLCKD) Protocol in Women's Endocrinology: Psychosexual Correlates of Weight Loss

Abstract Introduction The role of obesity in female sexuality is controversial and there are no intervention studies aimed at evaluating the effect of the Very Low Calories Ketogenic Diet (VLCKD) on female sexual function, in particular on arousal. Objective To evaluate the psychosexual correlates of obesity and Metabolic Syndrome (MetS) in a sample of women consulting for sexual symptoms; to investigate the change in measures of arousal after weight loss obtained with VLCKD. Methods In a retrospective study, n=322 women consulting for sexual symptoms were enrolled. The patients underwent a clinical, laboratory, sexual and psychological examination and were studied by color-Doppler ultrasound for the evaluation of genital vascularization, with measurement of the Pulsatility Index (PI) of the clitoral artery. They completed the Female Sexual Function Index (FSFI), Female Sexual Distress Scale - Revised (FSDS-R), Body Uneasiness Test, Eating Disorder Examination Questionnaire (EDE Q), and Middlesex Hospital Questionnaire, for psychiatric symptoms. Twelve patients underwent a nutritional intervention aimed at weight loss, based on a VLCKD protocol. These cases were compared with patients treated with different strategies for sexual symptoms, in a 1:1 case-control study (matched for BMI, age and menopausal status). Results In the total sample, clitoral PI was significantly higher in obese women (p = 0.018) and in those diagnosed with MetS (p=0.043). A statistically significant inverse correlation emerged between WC ≥ 88 cm and FSFI Arousal score (p=0.028). In patients undergoing a nutritional intervention with VCLKD protocol (n=12), after a mean follow-up of 20+-2 weeks, BMI showed a reduction of 6.7+-2.8 kg/m2 (p&amp;lt;0.001) and WC of 14.3+-5.2 cm (p&amp;lt;0.001), with fat mass loss of 14.6+-5.4 kg (-37.1%; p&amp;lt;0.001). At follow-up, the total FSFI and FSDS-R scores significantly improved (17.0+-13.6 vs. 11.2+-7.9, p=0.016, and 7.4+-8.3 vs. 13.3+-10.6, p=0.039, respectively). Among the FSFI subdomains, Arousal showed a significant increase (p=0.035). We also observed an improvement in EDE total score (p=0.032), Shape (p=0.008) and Weight subscales (p=0.011), BUT-B Positive Symptoms Distress Index (p=0.009) and BUT-A Body Image Concerns (p=0.043), and MHQ total score (p&amp;lt;0.001). The clitoral artery PI at follow-up showed a non-significant reduction. At multivariate analysis, the change in the Total FSFI was correlated with the BUT-B PSDI score change (p=0.031) and the EDE Shape change (p=0.043), when including DeltaMHQ and DeltaWC as further covariates. Finally, in a 1:1 case-control study, a significant difference emerged in the improvement of FSFI total score, which was more relevant in cases than in controls (p=0.046); on the other hand, there was no difference in the change in FSDS-R score between cases and controls. Conclusions Our data suggest that weight loss obtained by VLCKD is associated with an improvement in sexual function, and in particular in Arousal, whose change could be mediated by improved body image parameters. The effect of weight loss on cardiometabolic risk factors related to sexual dysfunction requires dedicated longitudinal studies, with the use of objective methods. Disclosure No

(008) Psychosexual, Relational and Clinical Correlates of Orgasmic Function and Female Orgasm Disorder in Women Consulting for Sexual Symptoms

Abstract Introduction Female Orgasm Disorder and its risk factors are still under-investigated. Objective To describe the psychological, relational and clinical correlates of orgasmic function during partnered sexual activity in women consulting for sexual symptoms. Methods In an observational retrospective study, we collected data from a consecutive sample of 430 heterosexual, sexually active women (mean age 46±12.9 years) consulting for sexual symptoms. All patients underwent a structured interview and a physical, gynecologic and laboratory examination; they completed a series of validated questionnaires, including the Female Sexual Function Index (FSFI), the Female Sexual Distress Scale-Revised (FSDS-R), the Middlesex Hospital Questionnaire (MHQ), the Body Uneasiness Test (BUT-A and BUT-B), the Sexual Inhibition/Excitation Scale (SIS/SES), and the Dyadic Adjustment Scale (DAS). Results 268 subjects (62%) reported a persistent distressing decrease of the frequency of orgasm for at least six months. Among them, 93 (22% of the whole sample) reported a mild decrease, 91 (21%) a severe decrease, and 19% reported anorgasmia. Nine women described Anorgasmia as lifelong. The severe decrease of orgasm frequency during partnered sexual activity was associated with the inability to reach orgasm with masturbation (p=0.009). After adjusting for age and menopausal status, the FSFI Orgasm (FSFI-O) domain was negatively associated with MHQ total score (p=0.001), an index of general psychopathology, and with body image concerns, explored through both BUT-A and BUT-B global measures. The stronger correlation emerged with the BUT-A Avoidance subscale (p=0.005). Among other psychological parameters, significant, negative correlations were observed between FSFI-O and a reported diagnosis of psychiatric disease, including mood disorders (p=0.001), use of antidepressants (p=0.001), chronic stress (p=0.002), and familiar conflicts (p=0.008). Noteworthy, no correlation was observed between FSFI-O and Inhibition/Excitation measures. When exploring sexual and relational parameters, we found that women displaying higher FSFI-O scores were more likely to be engaged in a stable sexual relationship (p=0.003), to report at least three sexual encounters per month (p&amp;lt;0.001) and lack of marital conflict (p=0.004). Among sexual dysfunctions in the male partner, as perceived by the woman, only low desire showed a clear negative correlation with FSFI-O (p=0.002). FSFI-O was also positively correlated with the Dyadic Satisfaction (p&amp;lt;0.001) and the Dyadic Cohesion subscales (p=0.032). Finally, when considering clinical parameters, women with a history of endometriosis (p=0.008), genitourinary disorders (i.e., recurrent vulvovaginitis or urinary tract infections; p=0.027), urinary incontinence (0.017) and pelvic surgery (i.e. hysterectomy; p=0.017) reported significantly lower FSFI-O scores. FSFI-O was not correlated with metabolic or hormonal laboratory parameters, including estradiol, prolactin or testosterone levels. When considering the diagnosis of severe FOD, the main clinical risk factors were psychiatric diseases (OR 1.566, CI 1.034;2.370), past Unwanted sexual experiences (OR 1.679, CI 1.109;2.541), urinary incontinence (OR 1.644, CI 1.132;1.387) and past pelvic surgery (OR 1.710, CI 1.129;2.591). Conclusions Orgasmic function was correlated with anxiety and depressive symptoms, use of antidepressants, body image concerns, marital conflicts and low partner’s desire, independently of age and menopausal status. Risk factors for severe FOD were psychiatric diseases, abuse history, urinary incontinence and past pelvic surgery. Disclosure No

(050) Low Prolactin Level Identifies Hypoactive Sexual Desire Disorder Women With a Reduced Inhibition Profile

Abstract Introduction Data on the role of prolactin (PRL) in the physiologic range in the female sexual response are scanty. Objective To investigate the association between PRL and sexual function as assessed by the Female Sexual Function Index (FSFI). We explored the presence of a cut-off level of PRL able to identify Hypoactive Sexual Desire Disorder (HSDD). Methods N=264 pre- and post-menopausal women consulting for FSD and sexually active were included in this observational, retrospective study. A clinical, biochemical and psychosexual evaluation was performed. Main Outcome measures: FSFI, Female Sexual Distress Scale-Revised, Middlesex Hospital Questionnaire and Sexual excitation/sexual inhibition scale (SIS/SES). HSDD was diagnosed through a clinical interview. Results In a multivariate model, PRL showed a significant, positive correlation with FSFI Desire (p=0.009) and Satisfaction (p=0.011). Women with PRL in the V quintile (14.58-24.59 μg/L) reported significantly higher FSFI Desire scores than those with PRL in the I quintile (5.12-6.53 μg/L). Women with HSDD presented a significantly lower PRL level than those without (p=0.032). A ROC curve analysis for PRL showed an accuracy of 0.610+-0.044 (p=0.014) in predicting HSDD. With a threshold of 9.83 μg/L, sensitivity and specificity for HSDD were 63% and 56%, respectively. Subjects with PRL =9.83 μg/L. The difference in SIS1 score was independent of cortisol. Conclusions Among FSD women with normo-PRL levels, those with the lowest levels demonstrated a poorer sexual desire than those with the highest levels. PRL &amp;lt;9.83 μg/L could predict HSDD and a lower sexual inhibitory trait. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: LV received scientific research grants, advisory board attendance and speaker honoraria from Therascience, Theramex, Bayer Schering Pharma, Intercept, Lipocine, Ibsa.

Low prolactin level identifies hypoactive sexual desire disorder women with a reduced inhibition profile

PurposeData on the role of prolactin (PRL) in the physiologic range in the female sexual response are scanty. We aimed at investigating the association between PRL and sexual function as assessed by the Female Sexual Function Index (FSFI). We explored the presence of a cut-off level of PRL able to identify Hypoactive Sexual Desire Disorder (HSDD).Methods277 pre- and post-menopausal women consulting for Female Sexual Dysfunction (FSD) and sexually active were enrolled in an observational, retrospective study. 42 women were used as no-FSD controls. A clinical, biochemical and psychosexual evaluation was performed. The main outcome measures were: FSFI, Female Sexual Distress Scale-Revised, Middlesex Hospital Questionnaire and Sexual excitation/sexual inhibition scale (SIS/SES).ResultsNormo-PRL FSD women (n = 264) showed lower FSFI Desire score than controls (n = 42), and higher than hyper-PRL FSD women (n = 13). These differences emerged both in pre-menopausal and post-menopausal subjects. In the normo-PRL FSD group, those with PRL in the higher quintile reported higher FSFI Desire scores than those with PRL in the lowest quintile. Women with HSDD presented a lower PRL level than those without (p = 0.032). A ROC curve analysis for PRL showed an accuracy of 0.610 ± 0.044 (p = 0.014) in predicting HSDD. With a threshold of < 9.83 μg/L, sensitivity and specificity for HSDD were 63% and 56%, respectively. Subjects with PRL < 9.83 μg/L also reported lower sexual inhibition (p = 0.006) and lower cortisol levels (p = 0.003) than those with PRL > = 9.83 μg/L.ConclusionsHyper-PRL is associated with low desire; however, among normo-PRL FSD women, those with the lowest levels demonstrated a poorer desire than those with the highest levels. PRL < 9.83 μg/L predicted HSDD and a lower sexual inhibitory trait.

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

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

Inhibition and excitation in the sexual brain: An useful tool for the prediction of therapeutic outcomes in women with sexual dysfunction

ABSTRACT Introduction The “Dual control model” of sexual response postulates that sexual desire and associated behaviors depend on the balance between excitation and inhibition. These aspects have not been evaluated in women with sexual dysfunction (FSD). Objective To explore the psychosexual correlates of excitation and inhibition in women with FSD, according to their menopausal state. We also aimed at performing a pre-post analysis in a sub-sample of patients followed for 3-6 months, investigating the possible relationships between excitation and inhibition and the changes in questionnaires related to sexual function. Methods In an observational, retrospective study, we recruited a consecutive series of 66 women consulting for FSD. Patients underwent a clinical evaluation, a structured interview and completed several self-administered questionnaires, including Sexual Inhibition/Sexual Excitation Scale (SIS/SES), Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), Body Uneasiness Test (BUT) and Middlesex Hospital Questionnaire (MHQ). A subgroup of patients (n=28) was evaluated at 3-6 months follow-up, using the FSFI and FSDS-R questionnaires. Results In pre-menopausal women, the SIS1 scale (Sexual inhibition due to the fear of performance failure) was associated with the diagnosis of Hypoactive Sexual Desire Disorder (HSDD), even after adjusting for confounders (p=0.047), whereas in post-menopausal women, we found an association between HSDD and the SES scale (total sexual excitation) (p=0.039; see also Figure 1). Given these correlations, we developed two cut-off values for the SES and SIS1 scales, according to which a score &amp;lt; 49 on the SES (in postmenopausal women) and a score &amp;gt; 34 on the SIS1 (in premenopausal women) accurately identified patients diagnosed with HSDD. In post-menopausal women, the ROC curve for the SES scale showed an accuracy (AUC) of 0.734 +- 0.107, p=0.037, in identifying HSDD; considering a cut-off value of 49, the sensitivity and specificity for HSDD detection were 85.7% and 66.7%, respectively (Fig. 2). In premenopausal women, the ROC curve for the SIS1 scale showed an AUC of 0.853 +- 0.081, p=0.007, in identifying HSDD; considering a cut-off value of 34, the sensitivity and specificity for HSDD detection were 78.6% and 75.0%, respectively (Fig. 3). At follow-up, the mean change in FSFI total score was not correlated with the SES or SIS2 scales (p=0.214 and p=0.402, respectively), but only with the SIS1 scale (p=0.026). When comparing patients with low excitation (SES scale &amp;lt;49) and high inhibition (SIS1 scale &amp;gt;34) with the rest of the sample, they showed a significantly lower change in FSFI total score (p=0.018). Conclusions In women consulting for FSD, sexual excitation and inhibition, which may be easily assessed by the SIS/SES questionnaire, emerge as key aspects in both the diagnostic evaluation and planning of therapeutic outcomes, in the perspective of a personalized sexual medicine approach. Disclosure Work supported by industry: no.

Physical activity and female sexual dysfunction: A lot helps, but not too much

ABSTRACT Introduction Research on the relationship between physical activity (PA) and female sexual dysfunction (FSD) is lacking. Objective To investigate the clinical, psychological, and sexual correlates of PA in women with FSD. Methods A non-selected series of n=322 pre- and post-menopausal patients consulting for FSD was retrospectively studied. Regular involvement in PA and its frequency (&amp;lt;1 hour/week: sedentary, 1-3 hours/week: active, 4-6 hours/week: very active, &amp;gt;6 hours/week: extremely active) were investigated with a specific question. FSDs, including HSDD (Hypoactive sexual desire disorder) and FGAD (Female genital arousal disorder), were diagnosed according to a structured and clinical interview. Participants underwent a physical examination and a clitoral Doppler ultrasound, and were asked to complete the Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), Body Uneasiness Test (BUT), and Middlesex Hospital Questionnaire (MHQ). Results Mean age was 45.1±12.9, mean body mass index was 25.24±6.34 kg/m2 and 46.3% (n=149) of women were post-menopausal. At multivariate analysis, women engaging in PA (67.4%, n = 217) scored significantly higher in several FSFI domains - including desire, arousal and lubrication (see Table 1) - and showed lower sexual distress and lower resistance of clitoral arteries, as compared to sedentary women. A significant, inverse association between PA and HSDD was observed (see Table 1). In the same adjusted model, the association between PA and the vascular resistance of clitoral arteries, expressed by clitoral PI, retained statistical significance. Mediation analysis demonstrated that the negative association between PA and HSDD was partly mediated by body image concerns (BUT Global severity index), psychopathological symptoms (MHQ total score) and sexual distress (FSDS-R score). These latter two factors also partly mediated the association between PA and a reduced risk of FGAD, whilst a lower BMI was a full mediator in the relationship between PA and FGAD. Finally, extreme PA was associated with significantly worse scores in several psychosexual parameters (i,e, sexual satisfaction – see Figure 1) and histrionic/hysterical symptoms), even compared to a sedentary lifestyle. Conclusions In women with FSD, PA was associated with better sexual function and clitoral vascularization, lower sexual distress and reduced odds of HSDD and FGAD; the benefits of PA on sexuality were mediated by both psychological and organic determinants; excessive PA was related with a poor overall sexual function and with a low sexual satisfaction. Women consulting for FSD may gain benefits from regular PA; however, physicians should remain alert to the downsides of excessive exercise. Disclosure Work supported by industry: no.

Cardiometabolic risk is unraveled by color Doppler ultrasound of the clitoral and uterine arteries in women consulting for sexual symptoms

Female sexual dysfunction (FSD) may be a mirror of a poor cardiometabolic state. In a small pilot study enrolling 71 women with FSD, we previously demonstrated that clitoral Pulsatility Index (PI) evaluated by using color Doppler ultrasound (CDU), reflecting vascular resistance, was associated with cardiometabolic risk factors. Data on uterine CDU in this context are lacking. First, to confirm previously reported data on the direct association between clitoral PI and cardiometabolic risk factors on a larger study population of women consulting for sexual symptoms; second, to investigate eventual similar correlations between cardiometabolic risk factors and CDU parameters of the uterine artery. We also ascertained whether uterine artery PI, similarly to what had previously been observed for clitoral artery PI, was directly related to body image uneasiness and psychopathological symptoms, assessed by validated questionnaires. N = 230 women consulting our clinic for sexual symptoms were examined with clitoral CDU and blood sampling and were asked to fill out the Female Sexual Function Index, the Middlesex Hospital Questionnaire (MHQ) and the Body Uneasiness Test (BUT). In a subgroup of women (n = 164), we also performed transvaginal CDU with measurement of uterine artery parameters. At multivariate analysis, we found a direct association between clitoral PI and body mass index (BMI) (p = 0.004), waist circumference (WC) (p = 0.004), triglycerides (p = 0.006), insulin (p = 0.029) and HOMA-IR (p = 0.009). Furthermore, a correlation between obesity and Metabolic Syndrome (MetS) and a higher clitoral PI was observed (p = 0.003 and p = 0.012, respectively). Clitoral PI was also correlated with MHQ-S (p = 0.010), a scale exploring somatized anxiety symptoms, and BUT-B Positive Symptom Distress Index (p = 0.010), a measure of body image concerns. Similarly, when investigating the uterine artery, we were able to demonstrate an association between its PI and BMI (p < 0.0001), WC (p = 0.001), insulin (p = 0.006), glycated haemoglobin (p = < 0.0001), and HOMA-IR (p = 0.009). Women diagnosed with obesity and MetS showed significantly higher uterine PI values vs. those without obesity or MetS (p = 0.001 and p = 0.004, respectively). Finally, uterine PI was associated with BUT-A Global Severity Index (p < 0.0001) and with several other BUT-A subdomains. Vascular resistance of clitoral and uterine arteries is associated with cardiometabolic risk factors and body image concerns in women consulting for sexual symptoms. If further confirmed in different populations, our data could suggest CDU, a common examination method, as a useful tool for an identification—and possible correction—of cardiometabolic risk factors.

Quality of Life and Mental Health in Kidney Transplant Recipients During the COVID-19 Pandemic.

Introduction: The COVID-19 pandemic has led to an increase in mental distress such as phobic anxieties, depressive reactions, hypochondriac concerns, and insomnia. Among the causes are risk of infection and prolonged isolation. This study aimed to analyze psychopathological variables and dysfunctional lifestyles related to adequate therapeutic compliance in kidney transplant recipients.Methods: Eighty-nine kidney transplant recipients were evaluated using an online protocol including a questionnaire concerning habits, lifestyle and psychophysical well-being in the COVID-19 period, the Middlesex Hospital Questionnaire (MHQ) and the SF-36 Health Survey to evaluate the perception of their physical and emotional health.Results: Of these recipients, 28.6% reported changes in their emotional state. Sleep quality deteriorated for 16.1%. Anxiety (M = 5.57, r = 0.33; p < 0.05) and phobia (M = 6.28, r = 0.26; p < 0.05) correlated with concerns related to physical health. There was no negative impact on relational and socialization aspects, which were likely well compensated by the use of remote technologies such as video phone calls, Zoom meetings and use of computers (r = 0.99; r = 0.80; p < 0.05).Conclusions: It would be interesting to maintain this remote visit and interview mode to monitor, on a clinical and psychological level, kidney transplant recipients in subsequent follow-ups (12–18 months), to check for any psychopathological disorders and/or changes in their resilience capacity in the Coronavirus emergency.

Physical Activity and Female Sexual Dysfunction: A Lot Helps, But Not Too Much

Research on the relationship between physical activity (PA) and female sexual dysfunction (FSD) is lacking. To investigate the clinical, psychological, and sexual correlates of PA in women with FSD. A non-selected series of n = 322 pre- and post-menopausal patients consulting for FSD was retrospectively studied. Regular involvement in PA and its frequency (<1 hour/week: sedentary, 1-3 hours/week: active, 4-6 hours/week: very active, >6 hours/week: extremely active) were investigated with a specific question. FSDs, including HSDD (Hypoactive sexual desire disorder) and FGAD (Female genital arousal disorder), were diagnosed according to a structured and clinical interview. Participants underwent a physical examination and a clitoral Doppler ultrasound, and were asked to complete the Female Sexual Function Index, Female Sexual Distress Scale-Revised, Body Uneasiness Test, and Middlesex Hospital Questionnaire. At multivariate analysis, women engaging in PA (67.4%, n = 217) scored significantly higher in several Female Sexual Function Index domains - including desire, arousal and lubrication - and showed lower sexual distress and lower resistance of clitoral arteries, as compared to sedentary women. A significant, inverse association between PA and HSDD was observed. Mediation analysis demonstrated that the negative association between PA and HSDD was partly mediated by body image concerns (Body Uneasiness Test Global severity index), psychopathological symptoms (Middlesex Hospital Questionnaire total score) and sexual distress (Female Sexual Distress Scale-Revised score). These latter 2 factors also partly mediated the association between PA and a reduced risk of FGAD, whilst a lower BMI was a full mediator in the relationship between PA and FGAD. Finally, extreme PA was associated with significantly worse scores in several psychosexual parameters (i,e, sexual satisfaction and histrionic/hysterical symptoms), even compared to a sedentary lifestyle. Women consulting for FSD may gain benefits on desire, arousal, lubrication and sex-related distress from regular PA; however, physicians should remain alert to the downsides of excessive exercise. The main strength lies in the novelty of the findings. The main limitations are the cross-sectional nature, the clinical setting, the small sample size of the different PA groups, and the use of self-reported instruments for the evaluation of PA. In women with FSD, PA was associated with better sexual function and clitoral vascularization, lower sexual distress and reduced odds of HSDD and FGAD; the benefits of PA on sexuality were mediated by both psychological and organic determinants; excessive PA was related with a poor overall sexual function and with a low sexual satisfaction.

Indoor tanning early in life is associated with increased risk of anxiety and depression later in life

Indoor tanning early in life is associated with increased risk of anxiety and depression later in life

Depression, anxiety, and quality of life in patients undergoing hemodialysis and renal transplantation

Background End-stage renal disease (ESRD) is a severe and debilitating disease. Insignificant data exist on depression, anxiety, quality of life (QoL), and life satisfaction in patients on hemodialysis (HD) in comparison with patients with renal transplantation (RT).Aim The aim of this study was to compare the presence and severity of depression and accompanying anxiety symptoms between HD patients and RT recipients and to correlate both depression and anxiety with the QoL and life satisfaction affection in both groups of patients.Patients and methods A comparative cross-sectional study was conducted on 64 patients with ESRD who were recruited consecutively from the nephrology outpatient clinic of Kasr Al Ainy, Cairo University Hospitals, over a period of 1 year. Patients were applied the Physical, Cognitive, Affective, Social, Economic and Ego Questionnaire to assess QoL, Beck Depression Inventory to assess depression, Middlesex Hospital Questionnaire to assess anxiety, and Life Satisfaction Scale for life satisfaction.Results The study results showed that depression, anxiety, and somatization in the HD group showed significant higher scores than the RT group. Patients on HD were significantly less satisfied with their life and showed lower scores on the physical domain, whereas patients with RT had significant lower scores on the economic domain of QoL. Life satisfaction and most domains of QoL were negatively correlated with depression, anxiety, and somatization in the HD group.Conclusion Depression accompanied with a variety of anxiety symptoms constituted determinants of poor QoL in the setting of ESRD and consequently, less life satisfaction. HD patients showed higher levels of depression, anxiety, and somatization along with poorer QoL and less life satisfaction than patients with RT.

P-02-71 Clinical and Psychological Characteristics of Men With Primary and Secondary Couple Infertility

To assess clinical and psychological parameters, and their associations, in men with primary and secondary infertility and fertile men. 580 males of infertile couples (38.0±5.8years) and 115 fertile men (36.6±5.3years) were studied. All subjects underwent, during the same day, clinical evaluation and psychological assessment with Middlesex Hospital Questionnaire (MHQ) (total and subdomains score(ss)). Patients had already undergone at least one semen analysis before and were aware of their sperm quality. Among males of infertile couples, 494 (85.2%) reported primary infertility (group#1) and 86 (14.8%) secondary infertility (group#2). Group#3 (control group) was made up of 115 fertile men. Group#1and#2 showed higher cryptorchidism frequency and gonadotrophins and lower mean testicular volume than group#3, while group#1 higher FSH levels and lower mean testicular volume than group#2. Group#3 showed better semen parameters than group#1and#2, while group#1 lower total sperm count and higher azoospermia prevalence than group#2. Infertility duration was not different between group#1and#2. However, group#2-with-miscarriages showed higher female partner's age and infertility duration than group#1. In group#1, infertility duration was positively associated with male age (particularly≥42years).

Approval Motive as an Interactive Predictor of Mental Health

The desire to be socially approved is a very common desire found in every individual and drives the individual to behave in socially approved manner and to be health. In present study, Approval Motive Scale (AMS; Tripathy and Tripathy, 1988) and Middlesex Hospital Questionnaire (MHQ; Shrivastava and Bhat, 1981) were administered on a sample which consisted of 100 adolescents (50 boys and 50 girls) of 15 to 21 years of age range. Results indicated statistically significant difference in adolescents on approval motives, free floating anxiety, phobia, somatic complaints, depression and overall M. H. Q. The findings of the study also show that approval motives is negatively related with overall M. H. Q. and its dimension viz. free floating anxiety, obsession- compulsion, phobia, somatic complaints, depression and hysteria.

Masturbation is associated with psychopathological and reproduction health conditions: an online survey among campus male students

In order to investigate the association between masturbation and psychopathological and reproduction relative conditions, an online survey was conducted among campus male students of Zhejiang University, which comprised of basic personal information, and questions for reproduction related health, masturbation frequency, and psychological well-being. Psychological status was evaluated with Middlesex Hospital Questionnaire (MHQ). The psychological and reproduction health related parameters were compared among the groups divided according to masturbation frequency. Finally 143 students were included in analysis. Floating anxiety, somatic, and hysteric scores were significantly associated with masturbation, with higher scores in group with highest masturbation frequency; masturbation is significantly associated with fatigue, soreness and weakness of the lumbar region, memory decline, immunity decline, insomnia dreaminess and gradual increase of frequency of masturbation, and the rates of most of the reproduction related symptoms increased accompanying the increase of the masturbation frequency. MQH scores of obsession, phobic anxiety, and depression were not associated with masturbation. It was concluded that masturbation may adversely affect psychological health as well as reproductive well-being.

PS-06-004 Psychosexual correlates of unwanted sexual experiences in women consulting for female sexual dysfunction according to their timing across the life span

Our aim was to investigate the prevalence of unwanted sexual experiences (USEs) in a setting of female sexual dysfunction (FSD) and to examine whether they are associated with different psychosexual parameters depending on the timing of occurrence. A consecutive series of 200 heterosexual women attending our clinic for FSD was consecutively recruited. Patients underwent a structured interview and completed the Female Sexual Function Index (FSFI), the Middlesex Hospital Questionnaire (MHQ), the Female Sexual Distress Scale Revised (FSDS-R), the Body Uneasiness Test (BUT), and the Childhood Experience of Care and Abuse Questionnaire (CECA-Q). 47 women (23.5%) reported USEs, occurring in childhood (<14 years), adolescence (<17 and ≥14), and adult life (≥17) in 38.3% (n=18), 31.9% (n=15), and 29.8% (n=14) of cases, respectively. We observed an association between history of lifetime USEs and indexes of psychopathology, specifically diagnosis of psychiatric diseases, use of psychiatric medications, and anxiety symptoms (MHQ free-floating anxiety score, MHQ-A). USEs were associated with lower orgasm ability (FSFI orgasm domain), higher sexually related distress levels (FSDS-R total score), and higher body image concerns (BUT) including depersonalization symptoms. Notably, women exposed to USEs in adolescence reported a stronger impairment of arousal, orgasm, and satisfaction domains and higher sexual distress when compared to women without a history of USEs or reporting USEs in childhood. Women exposed to USEs in childhood exhibited higher body image concerns and depersonalization symptoms when compared to those not reporting USEs.