Orgasmic Function Research Articles

Shorter prostatic urethral length in preoperative Magnetic Resonance Imaging is associated with higher risk of climacturia following robot-assisted laparoscopic radical prostatectomy.

Climacturia is defined as the leakage of urine during orgasm and it is an adverse effect of radical prostatectomy. Our goal was to determine if various preoperative MRI pelvic floor measurements were associated with the risk of climacturia following robot-assisted laparoscopic radical prostatectomy. For this purpose, we conducted a prospective study involving 57 patients who underwent robot-assisted laparoscopic radical prostatectomy. MRI measurements were analysed by 2 urologists and 2 radiologists. Follow-up was carried out at 3, 6, and 12 months using the Parra orgasmic function questionnaire. We analysed all measurements, along with other patient, surgery, and tumour characteristics, classifying patients into two groups based on the presence or absence of climacturia. A logistic regression model was applied among statistically significant variables. STROBE recommendations were taken into consideration. Shorter prostatic urethral length was associated with higher risk of climacturia at 3 months, OR = 0.83 (95%CI 0.688-0.98) (p = 0.024). Patients with climacturia at 6 months had greater median urethral width [12.66 mm, interquartile range (IQR): 11.77-13.55 vs 12.13 mm, IQR 11.08-13.18] (p = 0.02). Patients with climacturia at 12 months had a higher proportion of preoperative lower urinary tract symptoms (57.14% vs. 20%) (p = 0.026). In the logistic regression, the history of lower urinary tract symptoms was associated with a higher risk of climacturia, OR = 6.07 (95% CI 1.342-26.03) (p = 0.023). In conclusion, shorter prostatic urethral length in preoperative MRI and a history of lower urinary tract symptoms were associated with a higher risk of climacturia following robot-assisted laparoscopic radical prostatectomy.

Liver transplantation improves erectile function in patients with end-stage liver disease: a systematic review and meta-analysis.

Liver transplantation (LT) has been recognized as the most effective therapy for end-stage liver disease (ESLD). However, the question of whether LT can improve erectile function in patients with ESLD remains controversial. Therefore, we conducted this meta-analysis to evaluate the association between LT and erectile dysfunction (ED). According to the PRISMA guidelines, studies were included after conducting searches in four databases from March 2024 onwards. These databases included PubMed, Cochrane Library, Web of Science, and Embase. The primary outcome of interest was to compare the International Index of Erectile Function (IIEF) scores between patients after and before LT. Standardized mean differences (SMDs) and their corresponding 95% confidence intervals (CIs) were utilized to assess the relationship between LT and ED. The results showed that the LT group had higher IIEF-5 domain scores for erectile function compared to the control group (SMD =-0.31, 95% CI: -0.53 to -0.09), P=0.007). No heterogeneity or publication bias was detected in the results. Additionally, the IIEF-15 domain score was also found to be improved after LT. Specifically, the LT group had higher domain scores for erectile function (SMD =-0.77, 95% CI: -1.07 to -0.48, P<0.001), orgasmic function (SMD =-0.82, 95% CI: -1.12 to -0.52, P<0.001), sexual desire (SMD =-0.89, 95% CI: -1.19 to -0.59, P<0.001), intercourse satisfaction (SMD =-0.92, 95% CI: -1.22 to -0.62, P<0.001), and overall satisfaction (SMD =-0.87, 95% CI: -1.17 to -0.57, P<0.001). It is suggested by our meta-analysis that LT may contribute to improvements in erectile function among men with ESLD. This improvement may be related to the remarkable improvement in endocrine hormone disorders observed after LT. However, future studies with better designs and larger sample sizes are still needed to confirm our conclusions. Additionally, attention to erectile function before and after surgery in patients with liver failure is crucial.

Impact of Telemedicine on Women's Sexual Dysfunction: A Systematic Review and Meta-Analysis

Context: Sexual satisfaction is crucial for women's overall well-being; however, traditional interventions often face challenges such as high costs, limited access, inadequate specialized care, and discomfort during counseling sessions. Telemedicine presents a promising solution to these issues. Objectives: This systematic review and meta-analysis evaluate the efficacy of telemedicine interventions in improving sexual function and satisfaction among women. Evidence Acquisition: We searched SCOPUS, Web of Science, and PubMed for relevant articles published up to January 2024. The search strategy and keywords were crafted using the PICO approach to align with the study's objectives and ensure a comprehensive and structured review. The quality of the included studies was assessed using the Jadad scale. The primary outcome measures were sexual desire, arousal, lubrication, orgasm, pain, satisfaction, and overall Female Sexual Function Index (FSFI) scores. A random-effects model was employed for the meta-analysis, and the I-square index was used to assess heterogeneity. Results: The systematic review identified six studies from an initial pool of 4,174 that demonstrated a positive effect of telemedicine interventions on all domains of the FSFI questionnaire, except for the pain domain and overall sexual function scores in women. The effects of telemedicine on sexual desire [standardized mean difference (SMD) = 0.92, 95% CI = 0.51, 1.32], sexual arousal (SMD = 0.97, 95% CI = 0.42, 1.53), vaginal lubrication (SMD = 0.41, 95% CI = 0.23, 0.59), orgasm (SMD = 0.40, 95% CI = 0.21, 0.58), sexual satisfaction (SMD = 0.74, 95% CI = 0.48, 1), and total FSFI (SMD = 1.03, 95% CI = 0.49, 1.58) were found to be significant. However, the effect on pain was not statistically significant (SMD = 0.15, 95% CI = -0.10, 0.40). Conclusions: This study supports the effectiveness of telemedicine in improving women's sexual satisfaction and function. However, due to limitations in the included studies, such as small sample sizes, lack of randomization, and lack of blinding in some cases, more comprehensive studies are recommended. Future research should address these methodological limitations to provide stronger evidence on the effectiveness of telemedicine interventions for women's sexual health.

Four years of real-world sexual function outcomes after Rezum therapy in men with and without baseline erectile dysfunction.

Rezum alleviates lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH) while preserving sexual function, but long-term sexual function outcomes are lacking in patients with baseline erectile dysfunction (ED). The study sought to analyze 4years of real-world sexual function outcomes of Rezum using the International Index of Erectile Function (IIEF) questionnaire, stratified by baseline ED status. Participants included multiethnic Rezum-treated patients from a single outpatient office. IIEF domains and BPH medication usage were compared at baseline and 6, 12, and 48months using t tests, Mann-Whitney U tests, chi-square tests, and Wilcoxon signed rank tests. Primary outcomes over 4years included the IIEF functional domains (erectile function [EF], orgasmic function [OF], sexual desire [SD], intercourse satisfaction [IS], overall satisfaction [OS]) and BPH medication usage. A total of 91 patients were included: 40 (44%) in the ED cohort and 51 (56%) in the no ED cohort. History of diabetes was more prevalent in the ED cohort (35% vs 15.7%; P = .048). Baseline scores in the EF, OF, IS, and OS domains were lower in the ED cohort. Compared with baseline, there were no significant changes in any IIEF domains in either cohort at 6months. At 12months, the ED cohort had significant percent decreases in OF (-25%; P = .02), SD (-22.2%; P = .04), and OS (-33.3%; P = .004); the no ED cohort had a significant percent increase in EF (5%; P = .04). At 48months, the no ED cohort had no significant changes in any IIEF domains, while the ED cohort had significant percent increases in EF (30%; P = .01), SD (22.5%; P = .02), IS (20%; P = .01), and OS (58.3%; P = .008). Both cohorts significantly discontinued BPH medications at all follow-ups. At 48months, there were no cases of de novo ED in the no ED cohort. As modern BPH therapies continue to demonstrate efficacy in alleviating lower urinary tract symptoms, the preservation or improvement of sexual function emerges as an increasingly important consideration for patients, with our study suggesting Rezum as a compelling option. Our study has the strength of long-term Rezum outcomes in an ethnically diverse patient population, stratified by the presence of baseline ED, but is limited by retrospective design, single-center nature, and small sample sizes at long-term follow-ups. Rezum preserved long-term sexual function in patients without baseline ED and improved sexual function in those with baseline ED; however, individuals with ED may experience temporary decreases in sexual function at 12months.

Sexual function in patients with testicular neoplasm before specialized treatment methods. Clinical trial

Introduction. Testicular neoplasms (TN) are one of the most common oncological diseases among young men. Currently the sexual function of such patients remains understudied. The aim of the study was to assess the state of sexual function in men with testicular neoplasms before treatment.Material and methods. The cross-sectional continuous single-center study included 35 men with TN. The average age of patients was 34.2–8.2 years (95% CI: 31.4-37.1). The comparison group included 28 healthy volunteers, average age 30.5–4.9 years (95% CI: 28.6-32.4). Some social characteristics of the patient (marriage and children), the state of sexual function (using the IIEF-15 and ICF questionnaires), the level of anxiety and depression (according to the HADS scale), the levels of total and free testosterone, globulin-binding sex hormone (SHBG), follicle-stimulating hormone (FSH), luteinizing hormone (LH) and prolactin were evaluated.Results. Patients in the main group showed a decrease in erection in 10 (28.6%), satisfaction with sexual intercourse in 12 (34.3%), impaired orgasmic function in 2 (5.7%), decreased libido and overall satisfaction in 9 (25.7%). Nonparametric analysis revealed a statistically significant decrease in libido (p &lt; 0.05), satisfaction with sexual intercourse (p &lt; 0.05) and overall satisfaction (p = 0.007) in patients of the main group compared with the control group. Patients with testicular neoplasms had disorders of the mental component – in 12 (34.3%), erection – in 20 (57.1%), neurohumoral – in 25 (71.4%), ejaculatory – in 10 (28.6%) patients. Subclinical depression was observed in 13 (37.1%) and clinically pronounced depression in 11 (31.4%) patients of the main group. Anxiety and depression were statistically significantly more common in the main group (p = 0.0013). The level of anxiety and depression was more pronounced in unmarried (p = 0.013) children-free patients (p = 0.025). Low levels of total testosterone were detected in 13 (39.4%), free testosterone in 12 (38.7%), LH in 11 (33.3%), FSH in 6 (18.7%) patients from the main group. Elevated levels of LH were recorded in 4 (12.1%), FSH in 4 (12.5%), prolactin in 2 (6.9%) and SHBG in 1 (5%).Conclusion. Patients with TN have a deterioration in sexual function compared to a healthy population of the same age group. The further studies are needed to access the influence of tumor histology and treatment of sexual function.

Effect of TAMSULOSIN on Sexual Dysfunction in Patients Complaining of Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia

Abstract Background Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) and Erectile Dysfunction are common disorders of advancing age. Aim and Objectives The aim of the study was to assess the effect of Tamsulosin on sexual function in patients complaining of LUTS suggestive of BPH. Subjects and Methods We evaluated the sexual function, erectile &amp; ejaculatory, of patients enrolled in the study using validated questionnaires. This evaluation was done before treatment with Tamsulosin and 3 months later, comparing the Pre &amp; Post-Treatment scores. Results There was a statistically significant deterioration of orgasmic function domain of IIEF between Pre &amp; Post-Treatment. However, no significant changes were noticed with the other IIEF domains. Also according to the MSHQ-EjD-SF, there was a significant deterioration in the ejaculation domain and ejaculation bother domain. Conclusion Tamsulosin was found to be with higher risk for decreasing the orgasmic frequencies and the ejaculation for patients suffering from BPH.

Effects of Abstinence from Opioid on Sexual Functioning in Men with Opioid Use Disorder: An Observational Study

Objective: Sexual dysfunction amongst persons with opioid use disorder (OUD) is quite prevalent. Research about the effects of abstinence from opioids on sexual functioning is scarce. The aim of this study is to assess the sexual functioning among men with OUD and examine the effects of abstinence from opioids on sexual functioning. Methods: An observational study was conducted at a tertiary-level multi-specialty public-funded hospital in northern India. A total of 50 men with OUD underwent a self-report–based assessment of sexual functioning using the International Index of Erectile Function (IIEF-15). Five sub-domains of IIEF-15 (i.e., erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction) were assessed at baseline, two weeks and eight weeks of abstinence from opioids. Results: A total of 44 participants out of 50 reported significant dysfunction. Most of them reported dysfunction in the domains of overall satisfaction (88%, n = 44) and sexual desire (72%, n = 36). After eight weeks of abstinence from opioids, 10 participants out of 44 reported improvement on mean assessment scores. The improvement was noted as follows: erectile function (8%), orgasmic function (2%), sexual desire (8%), intercourse satisfaction (8%) and overall satisfaction (16%) as compared to baseline. There was significant improvement in the subdomain of sexual desire ( p value .05) over the course of eight weeks of abstinence compared to baseline. Conclusion: Abstinence from opioids leads to improvement in sexual functioning over a period of eight weeks of abstinence in men with OUD.

(072) ASSOCIATIONS BETWEEN MASTURBATORY ORGASM FUNCTION AND PARTNERED SEXUAL SATISFACTION IN CISGENDER WOMEN

Abstract Introduction Masturbation has been associated with a number of health and quality of life benefits, including improved self-esteem, sexual agency, and stress relief. While prior studies have asserted an association between solo masturbation and satisfaction with partnered sex, there is a paucity of literature that assesses specific parameters of masturbatory orgasm function and their potential association with sexual satisfaction. Objective This study aims to explore the association between satisfaction with partnered sex and six parameters of masturbatory orgasm function/satisfaction. Methods Respondents were recruited via Qualtrics and completed an anonymous, online questionnaire that assessed sexual satisfaction, based on the New Sexual Satisfaction Scale (NSSS)–a validated, 20-item survey. NSSS scores were calculated by summing the possible 5-point Likert scale ratings across all 20 questions, with a higher NSSS score indicating greater satisfaction with partnered sex. Respondents also completed questions that queried frequency of masturbation and partnered-sexual activity, as well as six parameters of orgasm function measured under the condition of solo-masturbation: lead time to orgasm, duration of orgasm, refractory period between orgasms, location of orgasm experience, experience of orgasm, and satisfaction with orgasm. Statistical analyses were completed using Qualtrics Stats iQ software to assess for an association between NSSS score and the aforementioned variables. Results A sample of n=178 sexually active cisgender women (mean age = 43.6±14.9 years) completed the study survey. Cisgender women who reported higher NSSS scores were significantly more likely to endorse engaging in partnered sexual activities on a more frequent basis (p&amp;lt;0.05), but there was no statistically significant relationship between NSSS score and frequency of solo-masturbation (p=0.2). A statistically significant relationship existed between NSSS score and 2/6 of the masturbatory orgasm parameters assessed (Figure 1). Cisgender women with higher partnered sexual satisfaction scores reported significantly longer duration of masturbatory orgasm and higher satisfaction with orgasm during masturbation (both p&amp;lt;0.01). There were otherwise no significant associations between NSSS score and lead-time to orgasm, refractory period between orgasms, experience of orgasm as single vs. multiple peaks, or bodily location of orgasm experience under the condition of masturbation. Conclusions Cisgender women who reported more frequent partnered sexual activity, as well as a longer duration of masturbatory orgasm time and higher satisfaction with orgasm from masturbation, reported significantly greater partnered sexual satisfaction. This association between satisfaction with solo masturbation and satisfaction with partnered sexual activity supports leading theories of masturbation improving body knowledge, self-confidence, and sexual agency. Findings also highlight how variability in orgasm function does not always result in differences in sexual satisfaction, which is more so associated with self-perceived orgasm satisfaction. Disclosure No.

(100) MASTURBATION: AN UNDERUTILIZED TREATMENT?

Abstract Introduction Certain types of masturbation have been shown to affect genital and genitourinary health. However, the full range of health benefits associated with masturbation and its various forms remains inadequately studied. Objective This study aimed to investigate the literature addressing utilization of masturbation for various health conditions among females. Methods We conducted a systematic literature review of PubMed, Embase, and Medline from January 1980 to November 2023, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search incorporated keywords such as “masturbation,” “sexual pleasure,” “benefits of masturbation,” “sexual self-stimulation,” “solo sex,” “onanism,” and “self-pleasure.” Inclusion criteria for the analysis were clinical trials, cohort studies, and reviews with cisgender women over 18 years old as participants, and masturbation utilized as an intervention. Exclusion criteria were case reports, surveys, studies involving men, or those with a history of gender dysphoria. Results A total of 176 studies were initially identified. Only five studies met all inclusion and exclusion criteria. Among these, four were clinical trials, and one was a systematic review. All but one study investigated the role of masturbation in the ability to orgasm with or without a partner. Orgasmic function was noted to be improved among participants in these four studies. One study investigated the endocrine changes associated with orgasm and found a significant elevation in post-orgasmic prolactin, similar to men. Participants in all the studies were cisgender women aged 18 to 55, predominantly heterosexual. The intervention duration ranged from 10 minutes per session to multiple sessions over the course of five weeks, with only one study specifying the mode of masturbation (vibrators). Four of the studies used erotica and pornography as augmentation to masturbation, and a partner was involved in the intervention in two of the studies. Only one study employed formal quantitative methods for outcome assessment. Conclusions Masturbation has primarily been investigated as an intervention for orgasmic dysfunction. There is a significant need for studies examining different types of masturbation and their effects on general and genitourinary health. Disclosure No.

(036) BASELINE CHARACTERISTICS OF PATIENTS UNDERGOING GENDER AFFIRMING HYSTERECTOMIES

Abstract Introduction Gender affirming hysterectomies (GAH) are one of the many interventions offered to people with uteruses who are seeking gender affirming care. Gender affirming care, especially hormones, has been shown to improve sexual satisfaction outcomes, but no research currently exists on sexual function or orgasm experience after gender affirming hysterectomy in particular. Post-hysterectomy sexual function has only been examined in cisgender populations, and has found mixed results on sexual health, wellness, and function. Research on sexual function and orgasm experience after GAH is needed to inform evidence-based recommendations and advance our understanding of sexual pleasure in a population that has historically been under-researched. Objective To achieve a better understanding of how gender affirming hysterectomies impact the experience of sex through a standardized analysis of orgasms and sexual function. Methods This project is a prospective study of patients receiving gender affirming hysterectomies at a single tertiary care center (November 2023-ongoing). Baseline characteristics (pre-hysterectomy) have been collected and analyzed via surveys asking about demographics, sexual practices, medical history, orgasm satisfaction (Orgasm Rating Scale) and sexual function (Transmasculine Sexual Functioning Index). Results We currently have 5 patients enrolled and anticipate a sample size of 30 participants by mid-February 2024. We plan to present pre-hysterectomy data describing participants’ overall sexual function and satisfaction. We anticipate a diversity of sexual practices and wellbeing. Conclusions There is a dearth in the current literature describing sexual function of individuals pursuing GAH. Further characterizing this population's pre-operative sexual practices and satisfaction will improve our ability to counsel patients considering GAH. Comparing this baseline data to sexual function post-GAH will provide insight into how GAH impacts ability to perform sexually and its influence on overall sexual satisfaction. This data will allow us to provide evidence-based recommendations regarding the impact of hysterectomy on orgasm and sexual function in patients seeking GAH. Disclosure No.

(063) ORGASM FUNCTION AND SEXUAL SATISFACTION: A COMPARISON BETWEEN PRE- VERSUS POSTMENOPAUSAL CISGENDER WOMEN

Abstract Introduction Despite the prevalence, relevance, and impact of menopause on people with ovaries, there is a paucity of research on its impact on sexual function and satisfaction. While an association between menopause and sexual dysfunction has been found, no studies assessed objective parameters of orgasm function and many utilized sexual satisfaction surveys that did not include participants’ perceptions of their sexual partner(s). Objective This study aimed to assess differences between pre- versus postmenopausal cisgender women using a six-parameter inventory of orgasm function and a validated sexual satisfaction psychometric scale, using both ego-centered and partner-centered measures. Methods Respondents were recruited and administered an anonymous, online questionnaire via Qualtrics as part of a larger study on sexual function and erogenous sensation. The questionnaire queried demographic information, menopause status, and six parameters of orgasm function under the controlled scenario of solo masturbation. Satisfaction with sexual activity with a partner was measured by the validated New Sexual Satisfaction Scale (NSSS), a 20-item psychometric survey that measures sexual satisfaction in the past six months across two subscales: the ego-centered and partner-/activity-centered subscale. The 5-point Likert scales for all 20 questions were summated, for a total possible score of 20 (minimum sexual satisfaction) to 100 (maximum sexual satisfaction). Statistical analyses were completed using Qualtrics Stats iQ, utilizing ANOVA and chi-square tests. Results A total of 283 cisgender women completed the study questionnaire. Premenopausal women were significantly more likely to report a higher average frequency of engaging in sexual activities with a partner and solo masturbation (Table 1). Of the six orgasm parameters (Table 2), the only statistically significant difference existed in the experience of orgasm as peaks, with more postmenopausal women reporting a multi-peaked orgasm versus a single-peak orgasm. The average NSSS score amongst all cisgender women in our sample was 68±20, and there was no statistically significant difference (p&amp;lt;0.8) between pre- versus postmenopausal cisgender women. Of the 20 questions within the NSSS, there was no statistically significant difference in 10/10 and 9/10 of the partner-centered NSSS subscale questions between the two groups. The only statistically significant difference between groups was premenopausal women reported higher satisfaction with the partner-centered measure of “The way I sexually react to my partner” (p&amp;lt;0.05). Conclusions Contrary to the medical literature, we found no significant difference in total sexual satisfaction between pre- versus postmenopausal cisgender women, as measured by the validated NSSS. Moreover, there was no significant difference in 5/6 of the orgasm parameter measurements. While sexual satisfaction is intrinsically linked to sexual function, it is important to note that self-perception of partner and activities may also play an important role in shaping an individual’s pleasure during sex. These findings highlight the importance of considering these nuances when assessing sexual satisfaction and may help to better inform the sexual function/satisfaction expectations of cisgender women as they approach menopause. Disclosure No.

A New Approach to the Assessment of Erectile Dysfunction Based on Vasomotion Monitored by the Flow-Mediated Skin Fluorescence (FMSF) Technique-A Preliminary Study.

Background: Erectile dysfunction (ED) most often has vascular etiology and usually is the earliest symptom of vascular dysfunction. The aim of this study was to evaluate vascular dysfunction with the use of the Flow-Mediated Skin Fluorescence (FMSF) technique in men with and without ED. Methods: Included were 39 men (median age 53) with ED and 40 men (median age 41.5) without ED. Medical interview, physical examination, and anthropometrical measurements were performed for all participants. The serum total testosterone, LH, and SHBG determinations were performed in patients with ED, and the Free Testosterone Index (FTI) was calculated. The FMSF technique was used to measure the microcirculatory oscillations at the baseline and to determine the flowmotion (FM) and vasomotion (VM) parameters. The Normoxia Oscillatory Index (NOI) was calculated, which represents the contribution of the endothelial (ENDO) and neurogenic (NEURO) oscillations relative to all oscillations detected at low-frequency intervals (<0.15 Hz): NOI = (ENDO + NEURO)/(ENDO + NEURO + VM). Results: In men with ED were found significantly lower FM and VM parameters, but the NOI was significantly higher in comparison to men without ED. VM and FM correlated significantly positively with erectile function, orgasmic function, and general sexual satisfaction in the whole group and the FTI in the ED group. The thresholds of 53.5 FM (AUC = 0.7) and 8.4 VM (AUC = 0.7) were predictive values for discriminating men with ED. Conclusions: It was shown that the FMSF diagnostic technique may be helpful in the early diagnosis of microcirculation dysfunction due to impaired vasomotion caused by decreased testosterone activity.

Does Near Miss Compromise Sexual Function in Reproductive-Aged Women? A Comparative Cross-Sectional Study in Ahvaz, Iran

Background: Maternal near miss (MNM) is defined as any life-threatening event during pregnancy, delivery, or within six weeks after the termination of pregnancy. Objectives: This cross-sectional study aimed to assess sexual function in women with (n = 140) and without MNM (n = 246). Methods: Eligible participants were women with MNM and basic literacy who had given birth at least 8 - 12 weeks prior to the study. Participants were recruited from Imam Khomeini and Taleghani hospitals, while women without MNM were recruited from two public health centers in Ahvaz. Data collection commenced in December 2020 and concluded in March 2021. A demographic questionnaire and the Female Sexual Function Index were used to collect the data. Data were analyzed using independent t-tests, chi-square tests, and multiple linear regression. Results: The predominant mode of delivery among MNM women was cesarean section (70%, P &lt; 0.05). The most common causes of MNM were preeclampsia (41.43%) and placenta accreta (24.29%), followed by hypertension and diabetes (17.86%). Women without MNM reported significantly higher scores in sexual satisfaction (β = 0.355, 95% CI: 0.019, 0.690, P = 0.035), lubrication (β = 0.707, 95% CI: 0.435, 0.980, P &lt; 0.0001), sexual arousal (β = 0.394, 95% CI: 0.116, 0.522, P = 0.007), sexual desire (β = 0.319, 95% CI: 0.116, 0.522, p = 0.002), and total sexual function score (β = 1.768, 95% CI: 0.306, 3.230, P = 0.018). Women who had undergone cesarean section reported lower scores in sexual satisfaction (β = -0.646, 95% CI: -0.983, -0.309, P &lt; 0.0001), orgasm (β = -0.620, 95% CI: -0.965, -0.275, P &lt; 0.0001), sexual arousal (β = -0.473, 95% CI: 0.159, 0.439, P = 0.001), and total sexual function score (β = -3.181, 95% CI: -4.655, -1.707, P &lt; 0.0001). Older women scored significantly lower in all components of sexual function except for pain. Conclusions: The study results indicated that all components of sexual function, except pain, were lower in women with MNM. A significantly higher number of women who had undergone cesarean section experienced MNM and sexual dysfunction. Health policymakers should focus not only on the causes of MNM, particularly cesarean sections, but also on assessing the sexual function of women affected by MNM.

Sexual Dysfunction in Postural Orthostatic Tachycardia Syndrome (POTS): A Cross-Sectional, Case-Control Study.

Background: We aimed to determine whether patients with postural orthostatic tachycardia syndrome (POTS) have sexual dysfunction compared to age-matched healthy controls. Methods: Utilizing online COMPASS-31 to evaluate dysautonomia symptom severity, Beck's Depression Inventory Second Edition (BDII), Female Sexual Function (FSF), and International Index of Erection Function (IIEF) questionnaires, we compared sexual function scores in patients with POTS to scores obtained from sex- and age-matched healthy controls via a cross-sectional case-control study. Results: A total of 160 women with POTS, mean age 30.2 ± 7.9 (range 21-50 years), had lower FSF scores than 62 healthy age-matched female controls. IIEF scores in 29 male patients with POTS with a mean age of 30.1 ± 6.0 (range 21-47) were significantly lower than in 27 healthy age-matched male controls. Female POTS patients had significantly lower scores in the sub-domains of desire, arousal, and satisfaction, while male POTS patients had significantly lower scores in erectile and orgasmic function, desire, and satisfaction than healthy controls. Predictive factors of sexual dysfunction were depression in women and age in men. The severity of autonomic symptoms correlated with sexual dysfunction in women, but this effect disappeared after controlling for depression. Conclusions: Compared to healthy controls, women and men with POTS have significant sexual dysfunction, which needs to be considered in the diagnostic and therapeutic approaches as part of comprehensive patient care.

(055) Vaginal Lubrication: Equally Important for Orgasm in Premenopausal, Postmenopausal, and Post-Partum Women?

Abstract Introduction The female sexual response cycle is complex with interconnected domains. Studies have shown that vaginal lubrication is affected by age and hormonal changes; however, the relationship between lubrication and orgasm has not been well described in premenopausal women, women who are postpartum, and postmenopausal women. Objective The objective of this study is to evaluate the relationship between vaginal lubrication and orgasm among premenopausal, postpartum, and postmenopausal women 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 complete the Female Sexual Function Index (FSFI) short form (6-item) upon initial use of the application. We utilized multivariable linear regression models to determine significant effects between lubrication score and orgasm scores score controlling for whether the patient was on birth control, postpartum, or menopausal Results We reviewed a large database of 30,358 women from across the United States. Among these, 2,599 women were menopausal, 2, 011 were premenopausal women, and 795 were postpartum. The mean lubrication scores on FSFI -6 were: menopausal = 1.93, premenopausal = 2.68, postpartum = 2.73. Mean scores for orgasm were 2.2, 2.62, 2.31 respectively. Premenopausal women had higher overall scores on FSFI- 6, with orgasm scores improving with age. Higher scores in lubrication domain had less impact on orgasm domain in pre-menopausal women compared to post-menopausal women (p=0.04). No correlation between improvement in lubrication and orgasm noted among post-partum women when compared to post-menopausal women (p=0.87) Conclusions Lubrication has a higher impact on orgasm among post-menopausal women compared to pre-menopausal women and not correlated with orgasmic function among women in the post-partum period. These findings enhance our knowledge and refine current management of anorgasmia. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Rosy.

AYURVEDIC MANAGEMENT OF TERATOZOOSPERMIA: A SINGLE CASE STUDY

Male infertility is a significant factor in over 40% of infertility cases. This research paper presents a case study of a 35-year-old Indian labourer working in a steel factory who reported symptoms of Mlan-Shishnata (loss of erection during intercourse), Alpaharsha (reduced sexual desire) along with a history of 4 years without a child. The patient was diagnosed as Klaibya, a condition characterised by male sexual dysfunction, with teratozoospermia, a condition involving abnormal sperm morphology. Ayurvedic therapy, specifically Vajikaran chikitsa, was administered to the patient following an Abhyantar Shodhana (bio-cleansing) procedure. The treatment protocol included Koshtha-Shuddhi (purgation) with the decoction of herbal medicines and Yogbasti. Additionally, the patient received Bastand Vrushya Basti for two months and oral intake of specific Ayurvedic formulations for three months. The patient's progress was evaluated using the International Index of Erectile Function and semen analysis before and after three months of treatment. Semen analysis after treatment revealed that 63% of the patient's sperm exhibited normal morphology, indicating a substantial enhancement compared to the initial Teratozoospermia condition, along with significant improvement in erectile function, orgasmic function, Sexual desire, Intercourse satisfaction and Overall satisfaction of the individual demonstrating the successful use of Ayurvedic formulations in treating Klaibya w.s.r.t. teratozoospermia without any reported adverse side effects. This case study underscores the diverse range of Ayurvedic therapy options available for addressing male infertility disorders.

(126) Application of HIFEM Therapy Improves Orgasmic, Urinary and Erectile Function by Stimulation of Pelvic Floor Muscles

Abstract Introduction The weak pelvic floor in men contributes to various urological disorders. Treatment can be accomplished by strengthening the pelvic floor muscles (PFM) through pelvic floor muscle training. Nevertheless, such development of PFM is time-consuming and heavily dependent on the subject's ability to perform selective muscle contractions. An advantageous approach is the targeted stimulation of PFM which can be accomplished via electromagnetic stimulation. Particularly, the pelvic floor muscles can be non-invasively and selectively stimulated via the HIFEM field. This results in the natural development and rehabilitation of PFM, which, among other functions, plays a vital role in facilitating orgasmic, urinary and erectile function. Objective The aim of this study is to assess the safety and efficacy of the HIFEM pelvic procedure for the treatment of erectile dysfunction. Methods In this study, 28 males with a median age of 56 (30-72 years) were enrolled. The treatment was composed of ten weekly 28-minute sessions. Outcome measurements were collected via questionnaires and ultrasound imaging prior to and after the last treatment. To assess changes in erectile and sexual function, and prostate-related symptoms, the International Index of Erectile Function (IIEF) and International Prostate Symptom Score (IPSS) were used. Transverse B-Mode ultrasound video scans were recorded along the long axis of the penile shaft from the tip to the base with the penis in a flaccid state. A linear transducer was used, the depth was set at 2 cm, and the frame rate was approximately 30 frames per second. Separate video recordings of the left and right cavernosum were taken. The ultrasound scans were processed by the Morphometrix cloud-based algorithm. Adverse events were monitored during the study. Results All evaluation methods proved the efficiency of treatment on a statistically significant level. A significant improvement was detected in the majority (4 of 5) of the domains of IIEF, with the overall score improvement from a baseline value of 45.14±2.42 to 48.75±2.86 (+3.61 points). The most exceptional improvement was found in Sexual desire (+18.78%; p=1.06x10-3), Erectile dysfunction (+13.03%; p=5.7x10-4), and Orgasmic function (+10.69%; p=7.04x10-5) domains. The mean difference in the total score of the IPSS questionnaire reached -3.04 points (p=5.1x10-6), exceeding the corresponding minimal clinical difference (MIC=3 points). Overall, subjects, on average, shifted from moderately symptomatic (9.57±1.37 points) to mildly symptomatic (6.54±0.91 points). An increase in vascularity of both cavernosal was measured within 57% of patients who underwent ultrasound examination; specifically, a significant improvement was recorded in tissue segment count (TSC; +104%; p=1.17x10-4) and density (TSD; +81% p=2.20x10-3), pointing to better blood flow and delivery in examined tissues. No adverse event was observed. Conclusions The therapy administering HIFEM technology of the pelvic floor for selective PFM stimulation demonstrated significant improvement of erectile and orgasmic function and urinary symptoms. The questionnaire results corresponded with ultrasound measurements using a novel algorithm, identifying positive changes in the penile vascular system. Overall, the treatment may be considered a safe and a possible first-line solution for male patients suffering from dysfunctions linked to weakened pelvic floor muscles. Further investigation is needed. Disclosure Yes, this is sponsored by industry/sponsor: BTL. Clarification: Industry funding only - investigator initiated and executed study. Any of the authors act as a consultant, employee or shareholder of an industry for: AFFIRM Science.

(209) Four-Year Real-world Sexual Function Outcomes of Rezum Therapy in Patients With and Without Erectile Dysfunction

Abstract Introduction Multiple studies have demonstrated Rezum therapy to effectively alleviate lower urinary tract symptoms secondary to benign prostatic hyperplasia while preserving sexual function. However, long-term real-world outcomes on sexual function are lacking in patients with baseline erectile dysfunction (ED) following Rezum treatment. Objective To compare four-year sexual function outcomes after Rezum between patients with and without baseline ED. Methods A retrospective study was conducted on patients from a multiethnic population treated with Rezum between 2017-2019. Patients were stratified into one of two cohorts based on presence or absence of ED at baseline. Sexual function was assessed with the validated 15-question International Index of Erectile Function (IIEF) questionnaire. Those who completed the IIEF questionnaire at baseline and 6-, 12-, and/or 48-months postoperatively were included. Function domains were calculated based on IIEF guidelines on clinical application of the questionnaire, and included erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction. Results Ninety-one patients were included: 44% (40) with baseline ED and 56% (51) without baseline ED. At baseline, 50% of the ED cohort were taking ED medications. No significant differences were found in age, prostate volume, and past medical history of hypertension or dyslipidemia between the cohorts. The ED cohort had a significantly greater proportion of patients with diabetes mellitus when compared to non-ED cohort (35 vs 15.7%, p=0.048). At baseline, the ED cohort had significantly lower scores for the IIEF domains of erectile function (p=0.007), orgasmic function (p=0.034), intercourse satisfaction (p=0.033), and overall satisfaction (p=0.002) when compared to the no ED cohort. Between the cohorts, no significant differences in the number of injections utilized during treatment in the lateral or medial prostatic lobes were observed. Compared to baseline, there was no significance in any IIEF domains in either cohort at 6-months. At 12-months, the ED cohort had significant percent decreases in orgasmic function (-25%, p=0.018), sexual desire (-22.2%, p=0.039), and overall satisfaction (-33.3%, p=0.004), while the non-ED cohort had a significant percent increase in erectile function (5%, p=0.04) when compared to baseline. At 48-months, the non-ED cohort had no significant changes in any IIEF domains, while the ED cohort had significant percent increases in erectile function (30%, p=0.013), sexual desire (22.5%, p=0.023), intercourse satisfaction (20%, p=0.011), and overall satisfaction (58.3%, p=0.008). At 48-months, there were no cases of de novo ED in the non-ED cohort and no significant changes in ED medications in the ED cohort when compared to baseline (53.3 vs 46.7%, p=0.72). Conclusions At long-term, Rezum preserved sexual function in patients with no baseline ED and improved sexual function in patients with baseline ED. However, patients with baseline ED may experience temporary decreases in sexual function at 12-months postoperatively. Additional larger studies are warranted to further evaluate these real-world results. Disclosure No.

(210) Four-Year Surgical and Sexual Function Outcomes of Rezum Therapy Across a Broad Range of Prostate Volumes

Abstract Introduction Benign prostatic hyperplasia (BPH) often leads to the development of lower urinary tract symptoms (LUTS), which can result in significant deterioration in quality of life (QoL). Rezum therapy has demonstrated efficacy in alleviating LUTS secondary to BPH across a broad range of prostate volumes (PVs). However, there is a scarcity of long-term real-world data on Rezum outcomes across a wide range of PVs. Objective To evaluate surgical and sexual function Rezum outcomes over a 4-year period in patients with PVs &amp;lt;30cc, 30-80cc, or &amp;gt;80cc. Methods A retrospective study was conducted on patients from a multiethnic population treated with Rezum between 2017 and 2019. Patients were stratified into three cohorts based on PV: &amp;lt;30cc, 30-80cc, or &amp;gt;80cc. Outcome measures, including International Prostate Symptom Score (IPSS), QoL, International Index of Erectile Function (IIEF)-Erectile and Orgasmic function, maximum urinary flow rate (Qmax), BPH medication usage, adverse events (AEs), and decisional regret scores were collected and compared at baseline and 1-, 3-, 6-, 12-, and/or 48-months follow-up. Results A total of 252 patients were analyzed, with 35 (13.9%), 196 (77.8%), and 21 (8.3%) patients in the 30cc, 30-80cc, and &amp;gt;80cc cohorts, respectively. The &amp;gt;80cc cohort was significantly older (66.9 years [8.1]) than the &amp;lt;30cc cohort (63.4 years [8.5], p = 0.02). The &amp;lt;30cc cohort had a significantly higher baseline IPSS (21 [15-28]) and QoL (5 [4-6]) than the 30-80cc (IPSS 17 [10-23], p = 0.003; QoL 4 [3-5], p=0.02) and &amp;gt;80cc (IPSS 16 [6.5-22.5], p = 0.01; QoL 4 [3-5], p = 0.006) cohorts. The number of injections utilized per lateral prostatic lobe significantly increased with PV (&amp;lt;30cc: 1 injection [0-1] vs 30-80cc: 2 injections [1-2] vs &amp;gt;80cc: 3 injections [2-3.5], p &amp;lt; 0.001). When compared to baseline, the combined cohort saw significant percent changes at 48-months in IPSS (-70.6%, p &amp;lt; .001), QoL (-80%, p &amp;lt; .001), and Qmax (52%, p = 0.003). Within each PV cohort, significant improvements in IPSS and QoL were found at all follow-ups when compared to baseline. Qmax improvements were significant only in the 30-80cc cohort at all follow-ups. There were no significant differences in percent changes in IPSS, QoL, or Qmax between cohorts at 3-, 6-, 12-, or 48-months when compared to baseline. The &amp;lt;30cc and 30-80cc cohorts had significant decreases in BPH medication usage as early as 3-months that remained durable through 48-months (all p &amp;lt; 0.05). The &amp;gt;80cc cohort experienced a significant decrease in BPH medication usage at 3-months but it did not remain durable to 12- or 48-months. No significant differences in postoperative AEs or decision regret scores were observed between cohorts. There were no significant changes in erectile function and orgasmic function at 12-months within cohorts. No significant differences were found in 48-months reoperation rates between the &amp;lt;30cc, 30-80cc, and &amp;gt;80cc cohorts (0% vs 4.9% vs 5%, p = 0.49). Conclusions Rezum effectively improved LUTS secondary to BPH irrespective of PV, with improvements being durable over 4 years. However, patients with PVs &amp;gt;80cc should be counseled on the possibility of continuing their BPH medications following treatment. Disclosure No.

(341) First-time Orgasm in a Man with Flibanserin Use: A Case Report

Abstract Introduction Anorgasmia is a poorly understood phenomenon defined as either a lifelong or an acquired consistent inability to achieve ejaculation. Despite the prevalence of anorgasmia, there is currently no established treatment. Objective In this abstract, we present the unique case of a patient with lifelong anorgasmia who was able to achieve his first orgasm with off-label use of flibanserin. Methods A 28-year-old male presented to our office with complaints of lifelong anejaculation and anorgasmia, without any signs of erectile dysfunction. He reported good libido and energy levels and denied any urinary symptoms or history of depression. Physical examination revealed normal genital anatomy without lesions. Testicular size was within normal limits, and a palpable varicocele was noted. Hormonal evaluations revealed total testosterone levels of 590 ng/dl and prolactin levels of 12 ng/ml. The baseline International Index of Erectile Function (IIEF) score was 41, with an orgasmic function sub-domain (IIEF-OF) score of 2. The patient had no history of major surgeries. He denied any neurological, infectious, or endocrine cause of anejaculation or anorgasmia. He was not taking medications that could cause these symptoms, except for over-the-counter allergy medications. Upon further questioning, the patient equated orgasm with ejaculation and reported having never experienced any previous orgasms. Results The patient was prescribed 150 mg of bupropion daily, which was increased to 300 mg daily after two weeks, in combination with sex therapy. Despite having received four–five sex therapy sessions over three months, the patient reported that this treatment approach was not effective. Subsequently, bupropion was tapered and discontinued. The patient was then started on bremelanotide, administered at a dose of 10 mg/mL, injecting 0.2mL (2 mg) before sexual activity. Although various forms of stimulation were attempted, the patient was unable to achieve orgasm with bremelanotide, and experienced penile pain. Flibanserin was then initiated, and after 28-32 doses over four weeks, the patient achieved his first orgasm. Notably, the patient also experienced nocturia and insomnia after initiating this medication. The follow-up IIEF score marginally improved by two points without any improvement in IIEF-OF. Conclusions This case highlights the challenges in managing anorgasmia and anejaculation in a young male patient. A stepwise approach, involving pharmacotherapy and sex therapy, was unsuccessful. However, off-label use of flibanserin ultimately resulted in the patient achieving his first orgasm, albeit with some side effects. Further studies are required to evaluate the efficacy and safety of flibanserin for this indication. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Consultant for AbbVie, Marius, Tolmar, Endo, Petros, Boston Scientific, Coloplast Investor: Sprout.