Orgasmic Function Research Articles

Investigating the effect of mindfulness counselling on sexual functioning of women with premenstrual syndrome

Mindfulness exercises can improve a wide range of the psychological and interpersonal consequences of premenstrual syndrome. Nevertheless, there is sparse information about the effect of mindfulness counselling on sexual dysfunction in women with this condition. This study aimed to determine the effect of mindfulness counselling on the sexual functioning of women with premenstrual syndrome. In this controlled randomized study, 112 women diagnosed with premenstrual syndrome referred to selected urban healthcare centers in Isfahan, Iran, were randomly allocated to two groups (intervention and control), each with 56 participants. The intervention group underwent mindfulness counselling in eight 60-minute sessions online via Google Meet. The control group did not receive any kind of intervention. The principal measure was score on the Rosen Female Sexual Functioning Index (FSFI) before, immediately, and one month after the intervention. The data were analyzed by SPSS 23, through descriptive and analytical statistical tests (chi-square, Mann-Whitney, independent t-test, ANOVA, and repeated measure) with a significance level of 0.05. There was no statistically significant difference in the mean FSFI score (or the subscores) between the intervention and control groups (p greater than 0.05) at baseline. In the intervention group, there were significant increases (relative to both baseline and in comparison with the control group) in the mean subscores for sexual desire (P < 0.0001), orgasm (P = 0.01), satisfaction (P = 0.0001), sexual pain (P = 0.003), and general sexual functioning (P < 0.0001) immediately after and one month after the intervention, but the score for sexual arousal was significantly greater only at the one-month evaluation (P < 0.0001) and there were no differences in the scores for vaginal lubrication. On the other hand. Mindfulness counselling was effective in improving the sexual functioning of women suffering from premenstrual syndrome, and should be used for this purpose in healthcare centers.

Does Significant Weight Loss After Bariatric Surgery Affect Sexual Function and Urinary Symptoms? An Iranian Study.

For sexual dysfunction and lower urinary tract symptoms (LUTS), obesity is identified as an independent risk factor. The current study aimed to evaluate the effect of significant rapid weight loss by bariatric surgery on LUTS and sexual function among men and women with class III obesity. A group of patients who were planned to undergo bariatric surgery was enrolled in the study. Male patients were given the International Index of Erectile Function (IIEF) and the International Prostate Symptom Score (IPSS) questionnaires. In the female group, they filled in the female sexual function index (FSFI) and the International Consultation on Incontinence Questionnaire short form (ICIQ-SF) questionnaires. Patients were followed up 1year after their bariatric surgery. All questionnaires were completed by eighty-one patients. (mean age ± SD: 39.4 ± 9.2years; mean body mass index (BMI) ± SD: 47.15 ± 5.4kg/m2). The total score of the IPSS questionnaire decreased from 5.83 ± 3.01 preoperatively to 2.37 ± 1.66 postoperatively. The weight loss caused significant improvement in the storage phase of LUTS domains, but there were no considerable changes in the voiding phase. In the IIEF questionnaire, domains of sexual desire, overall satisfaction, and orgasmic function improved significantly. There was not a significant change in any FSFI domains after bariatric surgery. Mean ICIQ-SF decreased, but it was not substantial. Bariatric surgery can significantly improve the storage phase in men, but not the voiding phase. Sexual desire, orgasmic function, and overall satisfaction were significantly improved in men. No significant improvement in sexual function and UI in women was observed.

Use of Phytotherapy in the Treatment of Patients with Erectile Dysfunction

Erectile dysfunction (ED) is one of the most common sexual disorders. In men with a mild stage of ED, it is possible to achieve a therapeutic effect from the use of phytotherapy. The objective: analysis of the effectiveness of the combination of natural compounds in patients with mild ED. Materials and methods. 28 patients (average age – 35±5.3 years) with mild ED participated in the study of the effectiveness of the dietary supplement. All patients were examined before and 1 month after the use of the combination of natural compounds, namely: collection of a detailed medical and sexual history, ultrasound dopplerography of the vessels of the penis, lipidogram, blood glucose level and total testosterone level were measured in the laboratory. The patients received the dietary supplement, which includes zinc citrate, L-arginine, an extract of the fruits of slanky anchovies, an extract of epimedium leaves, an extract of the root of Tongkat Ali, an extract of the root of Korean red ginseng, 1 capsule 2 times a day. Results. During the study, a psychogenic form of ED was found in 12 (42.9%) men, an organic cause of ED in 3 (10.7%), and a mixed form in 13 (46.4%) men. 1 month after the end of the use of the complex, it was established that all indicators of the «International Index of Erectile Function-15» (MIEF-15) questionnaire improved in ED patients. Conclusions. The results of the study showed that the use of the complex significantly improved sexual satisfaction, sexual desire, orgasmic function and quality of life in men with mild ED.

(018) Is Female Sexual Dysfunction an Important Factor in Physician Process of Care and Decision-Making for Common Gynecologic Procedures: An Interview Study

Abstract Introduction The mid-urethral sling (MUS) and cervical conization are two common gynecologic procedures performed to correct symptoms of stress urinary incontinence, and to treat cervical dysplasia respectively. There is limited literature surrounding the decision-making process, and process of care physicians follow when performing these procedures. Additionally, current evidence suggests that sexual dysfunction (SD) can result in some women following the MUS procedure and cervical conization, specifically the loop electrosurgical excision procedure (LEEP). Despite this, it is unclear in the literature how physicians performing these procedures perceive this evidence, and if it has an influence on their process of care and decision-making. Objectives The objective of this study was to understand the factors that impact physician decision-making surrounding MUS and cervical conization procedures. A specific interest of this research was determining if and how the recent evidence regarding the potential for post-operative complications of SD is incorporated into the decision-making process and process of care of physicians performing MUS/LEEP. Methods A qualitative semi-structured interview protocol was developed that explored three general areas: pre- and post-operative patient counseling, physicians’ decision making intra-operatively, and physicians’ approach to and perceptions of SD and sexual health counseling. Six Canadian staff physicians with specializations in relevant fields were recruited and interviewed as a pilot study. Thematic content analysis of the recorded and transcribed interviews was completed using NVivo 12. Results All participants indicated a preferred surgical approach (transobturator; LEEP). Factors that influenced this choice included reported risk data, procedure efficacy, and training. A commonly identified theme was the importance of minimizing damage to surrounding tissues (MUS) and minimizing the amount of tissue excised (conization) to mitigate post-operative complications. Most participants acknowledged that these procedures could have a negative impact on female sexual functioning (FSF). However, individual definitions of SD and the perceived type, degree, and potential of impact on these procedures on FSF were highly variable. Most of the participants indicated that they assessed some aspect of their patient’s sexual functioning post-operatively, however none specified a compete assessment of FSF or the use of a validated instrument or questionnaire. None of the MUS physicians reported discussing the evidence-based risk of the possible negative impact of the MUS procedure on orgasm function with their patients. Conclusions The results from this pilot study provide emerging evidence that physicians’ definitions of SD, and the perceived impact of LEEP and MUS on FSF are highly variable and do not fully reflect current evidence. The degree to which the physicians incorporated the reported post-operative risk of SD as a part of their process of care within the context of these procedures was also inconsistent. These results suggest the need for a standardized process of care with regard to counseling patients of the risk of post-operative SD, in addition to the assessment of female sexual health within the context of these two procedures. Further validation of these results is needed in a larger cohort, with an extension of this study that includes American physicians currently underway. Disclosure No.

An Evaluation of Psychogenic Predictors of Non-Organic Erectile Dysfunction.

Background and Objectives: Erectile dysfunction is a significant problem, which diminishes the quality of life. The aim of this study was to investigate the relationship of childhood trauma and attachment styles in the aetiology of psychogenic erectile dysfunction. Materials and Methods: The study included 80 participants (40 patients who presented with the complaint of erectile dysfunction, were not determined with an organic pathology, and were diagnosed with erectile dysfunction according to the DSM-5 criteria; and a control group of 40 healthy subjects.) The structured clinical interview form for DSM-5 (SCID-5) was applied to all the participants, together with the International Erectile Function Index (IIEF), the Childhood Trauma Questionnaire (CTQ), the Relationship Scale Questionnaire (RSQ), and the Beck Depression Inventory (BDI). Results: The emotional abuse (p = 0.002), physical abuse (p = 0.049), emotional neglect (p = 0.004), physical neglect (p = 0.002), and total scale points of the CTQ were determined to be significantly higher in the patient group than in the control group. Secure (p = 0.022) and dismissive (p = 0.009) attachment styles were found to be higher in the control group. As the time together with the current sexual partner increased, so the severity of erectile dysfunction increased, and sexual function, orgasmic function, sexual satisfaction, and general satisfaction decreased. As emotional abuse, sexual abuse, and physical neglect increased, the severity of erectile dysfunction increased. Childhood trauma (β = -0.275, t (73) = -2.704, p = 0.009) and the duration together with the partner (β = -0.249, t (73) = -2.512, p = 0.014) were found to be predictive of erectile dysfunction. Conclusions: The results of this study demonstrated that childhood trauma and the time elapsed without treatment are predictors of psychogenic erectile dysfunction severity, and secure attachment style and self-esteem play an important role in the aetiology of psychogenic erectile dysfunction.

AYURVEDIC MANAGEMENT OF KLAIBYA (IMPOTENCE) WITH TERATOZOO-SPERMIA: 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 mill who reported symptoms of Ling-Shaithilyata (loss of pe-nile erection), Mlana-Shishnata (loss of erection during intercourse), and Alpaharsha (desire for intercourse) along with a history of 3-5 years without a child. The patient was diagnosed as Klaibya, a condition character-ised by male sexual dysfunction, with teratozoospermia, a condition involving abnormal sperm morphology. Ayurvedic therapy, specifically Vajikarna chikitsa, was administered to the patient following an internal Sho-dhana (bio-cleansing) procedure. The treatment protocol included Koshtha-Shuddhi (purgation), a decoction of herbal medicines, and Yogbasti. Additionally, the patient received Vasti-Bastand Vrushya Basti for two months and oral intake of specific Ayur-vedic formulations for three months. The patient was assessed 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 and 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 disor-ders.

Impact of female stress urinary incontinence and related treatments on the sexual function of male partners: a systematic review and meta-analysis.

No conclusions have been reached on whether female stress urinary incontinence (SUI) and related treatments affect male partners' sexual function. To assess the effects of female SUI and related treatments on male partners' sexual function. A comprehensive search of the PubMed, Embase, Web of Science, Cochrane, and Scopus databases was performed up to September 6, 2022. Studies were included that investigated the effect of female SUI and related treatments on male partners' sexual function. Male partners' sexual function. Of the 2294 citations identified, 18 studies with 1350 participants were included. Two studies assessed the effect of female SUI without treatment on male partners' sexual function, finding that partners had more erectile dysfunction, more sexual dissatisfaction, and less sexual frequency than partners of women without urinary incontinence. Seven studies directly assessed the effect of female SUI treatments on male partners' sexual function by surveying the male partners. Among these, 4 assessed transobturator suburethral tape (TOT) surgery; 1 assessed TOT and tension-free vaginal tape obturator surgery; and the remaining 2 assessed pulsed magnetic stimulation and laser treatment. Among the 4 TOT studies, 3 used the International Index of Erectile Function (IIEF). TOT surgery significantly improved the total IIEF score (mean difference [MD] = 9.74, P< .00001), along with erectile function (MD = 1.49, P< .00001), orgasmic function (MD = 0.35, P= .001), sexual desire (MD = 2.08, P< .00001), intercourse satisfaction (MD = 2.36, P< .00001), and overall satisfaction (MD = 3.46, P< .00001). However, the improvements in IIEF items may be of unclear clinical significance, as 4 points in the erectile function domain of the IIEF are typically defined as the minimal clinically important difference. In addition, 9 studies indirectly assessed the effect of female SUI surgery on male partners' sexual function by surveying patients with the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire. The results demonstrated no significant differences in erectile function (MD = 0.08, P= .40) or premature ejaculation (MD = 0.07, P= .54). The effects of female SUI and related treatments on male partners' sexual function were summarized for the first time, providing a reference for future clinical practice and scientific research. A limited number of studies that used various scales met the standardized eligibility criteria. Female SUI may affect male partners' sexual function, and female patients' anti-incontinence surgery does not appear to have a clinically significant improvement on the sexual function of their partners.

Hyperestrogenism is associated with sexual function impairment in men-findings from a cross-sectional, real-life study.

Hyperestrogenism is believed to be harmful to male sexuality. We aimed to investigate the prevalence of and the impact of hyperestrogenism on sexual functioning in a cohort of men seeking medical attention for new-onset erectile dysfunction. Data from 547 men seeking first medical help for new-onset erectile dysfunction at a single andrology center were analyzed. Patients were assessed with a thorough medical and sexual history. Comorbidities were scored with the Charlson comorbidity index. All patients completed the International index of erectile function; the International index of erectile function-erectile function domain was categorized according to Cappelleri's criteria. Circulating hormones were measured in every patient. Hyperestrogenism was defined as estradiol levels >42.6 pg/mL (Tan etal., 2015). Descriptive statistics and logistic/linear regression models tested the association between hyperestrogenism and International index of erectile function domains score. Overall, 96 (17.6%) participants had serum estrogen levels suggestive of hyperestrogenism. Men with hyperestrogenism were older (median [interquartile range]: 46 [35-59] vs. 44 [31-56] years; p<0.001), had a higher rate of comorbidities (Charlson comorbidity index ≥1: 26.0% vs. 7.4%; p<0.001), and higher serum total testosterone values (5.4 [5.2-8.0] vs. 4.3 [4.1-5.7] ng/mL; p=0.01) than those with normal estradiol values. A higher prevalence of severe erectile dysfunction (135 [29.9%] vs. 47 [48.9%] men; p=0.01) and of hypogonadism (22 [4.8%] vs. 6 [6.3%] men; p=0.004) were found in men with hyperestrogenism. Serum estradiol levels were positively correlated with total testosterone levels (β = 0.26, p<0.001) but negatively correlated with International index of erectile function-orgasmic function (β = -0.24, p=0.002) and International index of erectile function-erectile function scores (β = -0.03, p<0.001). When International index of erectile function scores was used to stratify erectile dysfunction patients, hyperestrogenism (odds ratio 2.44, p=0.02) was associated with severe erectile dysfunction. One out of five men seeking first medical help for erectile dysfunction showed elevated serum estradiol values suggestive of hyperestrogenism. Hyperestrogenism was associated with health-significant comorbidities, orgasmic function impairment, and erectile dysfunction severity.

Recreation use of phosphodiesterase type 5 inhibitors, the other side of erectile dysfunction.

To the Editor, In 1998 Sildenafil was approved by the Food and Drug Administration as first line therapy for erectile dysfunction. Since then, phosphodiesterase type 5 inhibitors (PDE5i) represent the first-line treatment of erectile dysfunction (ED), improving physiological erectile function, sexual orgasmic function, psychological self-esteem, couples' relationship, and quality of life. [...].

(069) Vaginal Lubrication: Equally Important for Orgasm in Premenopausal and Postmenopausal 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: Abbvie, Coloplast, Rosy.

(099) A Systematic Review Investigating the Involvement of the Pelvic Floor Muscles in Sexual Function and Sexual Response

Abstract Introduction The pelvic floor muscles (PFM) have been suggested to play a key role in sexual function and sexual response in women. However, current syntheses of the evidence have been limited to interventional studies investigating the effect of modalities targeting the PFM on sexual function in women with pelvic pain and pelvic floor disorders. The literature has therefore never been critically appraised while excluding these potential confounders, which prevents to fully capture and understand the involvement of the PFM in sexual function and sexual response. Objective To examine and synthesize the available evidence on: i) the effects of PFM training on sexual function in women without pelvic pain or pelvic disorders, ii) the association between PFM function and sexual function/response and iii) the differences in the PFM function between women with and without sexual dysfunctions. Methods Electronic databases including Medline, Cochrane, CENTRAL, CINAHL, Psycinfo, Sportdiscuss, AMED, Scopus and EMBASE were searched using a peer-reviewed search strategy. We also performed a hand search of the references of all relevant articles and a grey literature search. Main outcomes included sexual function (self-reported questionnaire), sexual response (physiological test) and PFM function (strength and tone assessed with various assessment tools). We included interventional studies (randomized controlled trials and non-randomized studies) investigating the effects of PFM training on sexual outcomes as well as observational studies examining the association between PFM function (strength and tone) and sexual outcomes or the differences in PFM function in women with and without sexual dysfunctions. Quality of selected studies was assessed using the Mixed Methods Appraisal Tool by a team of two reviewers and disagreements were resolved by consensus or involvement of a third-party. Results The literature search resulted in 33 eligible studies including 14 interventional studies and 19 observational studies. Most studies (31/33) were of moderate quality or higher. Overall, 10 of the 14 interventional studies reported that PFM training had a significant effect on sexual function. Of the 11 observational studies investigating the association between PFM function and sexual function, 8 showed significant correlations (ranging from weak to strong) with sexual satisfaction, lubrication, arousal, orgasm or overall sexual function. Of the observational studies, 7 supported the involvement of the PFM as part of the sexual response (i.e. in the arousal and orgasm phases). Regarding the 3 studies evaluating the differences in the PFM function of women with and without sexual dysfunctions, the results were conflicting. Conclusions Findings of this review support the involvement of the PFM in sexual function and in sexual response in women without pain and pelvic dysfunctions. This review supports the need to further investigate modalities targeting the PFM as part of the management for sexual dysfunctions. 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

(200) Anatomic Maps of Erogenous Sensation &amp; Pleasure in the Penis: Do Circumcised Men Report These Differently Than Uncircumcised Men?

Abstract Introduction For thousands of years male circumcision (MC) has been performed for cultural, religious, aesthetic, and public health reasons, and it continues to be among the most common surgical procedure performed worldwide. The effects of MC on sexual function remains controversial, despite recent systematic reviews demonstrating no adverse effects. A key area of debate regarding MC has been the impact of MC on penile sensation. Existing literature evaluating changes in penile sensitivity and pleasure following MC have primarily focused on the penis glans and the frenulum-area of the shaft. Additionally, studies describing the effects of MC on orgasm have focused on the changes in ease of reaching orgasm/ejaculatory latency. In truth, although patients rely on providers to counsel them about what results they might expect to occur with MC, the effects of MC on erogenous sensation and other orgasm-related domains of sexual function are still not well understood. Objective We sought to expand on the existing literature by assessing erogenous sensation throughout the entire penis surface area, and to evaluate differences in reported orgasm function among circumcised and uncircumcised men. Methods Adult male subjects recruited from a paid anonymous online survey platform (QualtricsTM, USA) were shown anatomic illustrations of a penis whose entire surface area was divided into 12 different regions. Subjects were instructed to identify regions they found pleasurable when touched during sex, and to rate each on a 1-10 scale. Subjects were also asked to characterize their typical orgasm across the following six domains: 1. Lead-time, 2. Orgasm duration, 3. Perceived body-location(s) of orgasm-sensation, 4. Classification of orgasm experience as a single or multiple-peak event, 5. Refractory period duration, and 6. Overall satisfaction. Comparisons between circumcised and uncircumcised men were performed with a 2-tailed T-test. The Benjamini-Hochberg Procedure with FDR=0.05 was applied to control for multiple comparisons. Results The survey was completed by 227 circumcised (mean age ± SD, 46.6 ± 17.7y) and 175 uncircumcised men (47.8 ± 18.1y). There were no significant differences in ratings across all twelve regions among circumcised and uncircumcised cohorts. However, when subjects were asked to identify which regions gave pleasure when touched during sex, significantly more circumcised (vs. uncircumcised) men reported a preference for the penis-tip (38% vs 17%, p=0.024) and the middle third of their ventral shaft (63% vs 48%, p=0.036). There were no significant differences in reported experience with orgasm quality and function across all six queried domains among circumcised and uncircumcised cohorts. Conclusions Our findings suggest that both circumcised and uncircumcised men experience pleasure in their penis and experiences with orgasm function similarly. Although we often think of the tip of the penis as being the “most erogenous” location for men, we found that scored erogeneity was generally similar across the entire length of the penis. Although overall erogeneity ratings did not differ, we found that circumcised men reported more areas of their penis as “pleasurable when touched during sex”, as compared to their uncircumcised counterparts. These findings will be important to share with patients and their families considering MC. Disclosure No

(256) Sexual Function and Andrology Parameters in Men after Treatment of Anterior Urethral Strictures with the Optilume Drug Coated Balloon

Abstract Introduction The Optilume Urethral Drug Coated Balloon (DCB) is a novel endoscopic treatment for recurrent male anterior urethral strictures. An important topic of discussion with patients during counseling on treatment options includes the potential affect of treatment on sexual function and fertility. The ROBUST III study was a prospective, randomized study comparing standard of care endoscopic therapy against treatment with the Optilume DCB. Assessments included evaluation of sexual function and andrology parameters. Objective The objective was to study the potential affect of treatment with the Optilume DCB on sexual function and, for younger patients, fertility. Methods A total of 79 men were randomized to receive treatment with the Optilume DCB. Sexual function was assessed via the 15 item International Index of Erectile Function (IIEF) questionnaire. Erectile function, orgasmic function, and overall satisfaction sub-domains were assessed at 3, 6, and 12 months after treatment in patients that were sexually active at baseline. Fifteen additional subjects were enrolled in a non-randomized pharmacokinetic sub-study that included assessments of paclitaxel concentration in semen and sperm quality parameters through 6 months post-treatment. Results Average erectile function and overall satisfaction scores improved from baseline to 12 months post-treatment, while orgasmic function was not changed (Figure). The improvement in satisfaction was statistically significant at 12 months (p=0.003). No adverse events of de novo erectile or ejaculatory dysfunction were reported. Average ejaculate sperm concentration did not change from baseline to 6 months (49 million/mL vs 46.6 million/mL, p=0.88), nor did total spermatozoa per ejaculate (107.2 million vs 104.0 million, p=0.94). Paclitaxel concentration in semen after treatment was maximal at 30 days (2.99 ng/mL) and was reduced near the limit of quantitation of the analytical method by 6 months (0.12 ng/mL). Conclusions Treatment of male anterior urethral strictures with the Optilume DCB did not appear to have an impact on sexual function as measured by the IIEF and adverse event assessments. Average sperm quality parameters did not differ from baseline to 6 months post-treatment. Low levels of paclitaxel were detected in semen after treatment but were nearly undetectable by 6 months. Disclosure Yes, this is sponsored by industry/sponsor: Urotronic Inc. Clarification Industry funding only - investigator initiated and executed study. Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Sci, Coloplast, Medtronic USA Inc., PROCEPT BioRobotic Corporation, NeoTract Inc., Janssen Biotech Inc., Endo Pharmaceuticals Inc., Tolmar Pharmaceuticals, Inc., 180 Medical Inc., AbbVie Inc., Pfizer Inc., Bluewind Medical, Astellas Pharma US Inc., Antares Pharma Inc., Axonic Modulation Technologies Inc., Allergan Inc., Terumo Medical Corporation, Dendreon Pharmaceuticals llc, Blue Earth Diagnostics Limited, Ferring Pharmaceuticals Inc., Olympus America Inc., Karl Storz Endoscopy-America, Clovis Oncology Inc., Dornier MedTech America Inc., Travere Therapeutics Inc., Valeant Pharmaceuticals North America LLC

(288) Risk Factors and Real-World Short-Term Outcomes of a Failed Trial of Void After Rezum in a Multiethnic Population

Abstract Introduction A failed trial of void (TOV) following surgery for benign prostatic hyperplasia (BPH) predisposes patients to have trouble voiding, increases hospital stays and office visits, and increases detrusor muscle injury due to bladder over-distention. Rezum is a minimally invasive surgical therapy that utilizes convective radiofrequency water vapor thermal energy to ablate obstructive lobes of the prostate, resulting in improvement in lower urinary tract symptoms (LUTS) secondary to BPH. Identifying risk factors for a failed Rezum TOV can help identify a group of BPH patients who may need to be counseled preoperatively for an increased risk of postoperative urinary retention and therefore have their period of postoperative catheterization extended. Objective The purpose of the study was to identify risk factors for a TOV following Rezum and assess the impact of a failed TOV on real-world short-term outcomes. Methods A single office, retrospective study was conducted on patients treated with Rezum between December 2017 and October 2019. Patients were included if they had a follow-up for catheter removal after Rezum. Patients were excluded if they were in urinary retention requiring catheterization on the day of the procedure. A urinary catheter was placed in all patients following treatment. Demographic data and outcome measures, including International Prostate Symptom Score (IPSS), quality of life (QoL), International Index of Erectile Function (IIEF)-Erectile and -Orgasmic function, maximum urinary flow rate (Qmax), postvoid residual (PVR), and adverse events were analyzed at baseline, 1-, 3-, and/or 6-months postoperatively. Risk factors were identified through multivariate logistic regression analyses. Results A total of 289 patients were included, with the majority being Asian (36.0%), followed by non-Hispanic Black (28.7%), Hispanic (22.5%), and non-Hispanic White (12.8%). Thirty-five patients (12.1%) failed their TOV while 254 (87.9%) had a successful TOV. All patients were given a TOV after a median of 5 days (4-5). Those who failed their TOV spent a mean of 13.7 days (SD: 13.3) with a catheter. Patients who failed their TOV were more likely to get a urinary tract infection (20.0% vs. 4.7%, p 200 ml failed their TOV (40.0%) when compared to patients with a baseline PVR &amp;lt;200 ml (10.9%, p=0.008). Conclusions Following Rezum, approximately 1 in 8 patients were not able to pass their initial TOV. Baseline PVR was the only independent risk factor for a failed TOV. Nevertheless, all patients experienced significant relief in LUTS with preservation of sexual function. Patients with large baseline PVR, particularly &amp;gt;200 ml, should be counseled on possibly failing their TOV and requiring a catheter for an extended period. These patients should also be counseled on alternative BPH treatment options for which they may be a better candidate for. Disclosure No

(340) Sexual Dysfunction in Women with Sickle Cell Disease

Abstract Introduction Sickle cell disease (SCD) is a genetic hemoglobinopathy with clinical and epidemiological relevance. Its clinical manifestations directly affect the quality of life of affected individuals. There is a gap in the literature regarding the approach to aspects related to the sexual and reproductive health of people with sickle cell disease, especially in the female population, given that most of the available studies evaluated men. The aim of this study was to assess the sexual health of adult women with SCD. Objective The aim of this study was to assess the sexual health of adult women with SCD. Methods We prospectively evaluated 29 women with SCD with a median age 34 (26.5 - 40). Nineteen women had HbSS and 10 HbSC hemoglobinopathies. Quantitative data on sociodemographic, biological, and clinical characteristics were collected. Sexual dysfunction was assessed using the Female Sexual Function Index (FSFI). Results The median age at diagnosis was 9(1-22) years old, the median age at menarche was 14(13-15) years, and the onset of sexual life occurred on average at 19(16-20) years. Sexual activity was reported by 75.8%. Of the sexually active patients, 40.9% had impaired sexual function (the FSFI total score &amp;lt; 26.55). The Median, FSFI score was 23.5 (1-32.5). The median scores of each domain are detailed in fig 1.The most prevalent sexual dysfunction was hypoactive desire, reported by 72.7% of women. Conclusions Sexual function is tremendously affected by SCD in most women. They present a significant decrease in overall satisfaction with sexual life and markedly reduced sexual desire and orgasmic function. Disclosure No

(276) Sexual Health of Transfeminine Individuals: A Chance to Educate Medical Providers

Abstract Introduction Providers may be unfamiliar with the sexual health needs of transgender patients. This hinders chances to provide comprehensive care, as many patients require prompting to discuss sensitive sexual issues. To increase awareness of these issues, we developed a questionnaire which assessed the sexual health of transfeminine individuals. Objective We sought to describe the sexual experiences and preferences of transfeminine individuals, and to categorize sexual health needs in this population. Methods IRB approval was obtained to develop (with transgender community feedback) a questionnaire assessing urinary and sexual health. Sexual preferences, symptoms, and quality of life (QOL) responses were compared among vaginoplasty (VP) and non-vaginoplasty (NVP) groups. NVP respondents were evaluated based on the International Index of Erectile Function (IIEF) categories: erectile function (EF), orgasmic function (OF), and sexual desire (SD). Results 53 transfeminine individuals (11 vaginoplasty, 10 orchiectomy, 32 no procedure) with mean age of 40 years (range 21-80) participated. Sexual QOL was similar for both groups (Table 1). There was an association between self-reported sexual activity and VP/NVP status, where a higher proportion of NVP respondents reported sexual activity with others and penetrative anal sex (p&amp;lt;0.05). Among NVP respondents, 38 (90.4%) of whom were undergoing hormone therapy, 23 (55%) indicated penile function was important to them. NVP IIEF EF, OF, and SD categories mean scores were 13.3, 5.8, and 5.6, respectively, compared to 25.8, 9.8, and 7.0 from the cis-gender controls in the initial IIEF study. 5 (11.9%) individuals used oral medications for erectile assistance, while 1 (2.3%) had a prosthesis. Conclusions When comparing VP and NVP respondents, we found similarities in sexual QOL while noticing differences in sexual preference, highlighting the diversity of this population. While many NVP respondents reported importance of penile function and presence of erectile dysfunction, only a minority were on treatment. This highlights an opportunity for providers to discuss sexual health with transfeminine patients and offer appropriate treatments. Disclosure No

(201) Young Adult Males Report Reluctance in Disclosing Sexual Health Concerns to Physicians: A Cross-Sectional Study

Abstract Introduction The reported prevalence of sexual dysfunction in young adult males has recently increased, but estimates are highly variable, ranging from 1% to 30%. Sexual dysfunction can have organic, psychogenic, and multidimensional causes, and sexual concerns warrant medical assessment. However, both clinical management and epidemiologic research depend upon the willingness of patients to disclose symptoms. Despite this issue, there is limited research on the comfort level of young adult males in discussing sexual health or sexual dysfunction with physicians. Objective To assess the comfort level of young adult males in discussing their sexual health, including sexual side effects caused by medications, with doctors. Methods A cross-sectional, paid survey was designed in collaboration with our institution’s biostatistics core using Qualtrics XM. Biological males ages 18 to 35 were recruited using social media. The survey included demographic characteristics and contained several 5-point Likert scale questions to query perceptions of personal health. Additionally, respondents ranked the top three of seven subjects that they felt most difficult to talk about with their doctor (mental health, physical health, school/job achievement, maintaining body weight, ability to orgasm, libido, and erectile function). Participants also ranked the three items that were most important to them according to their current personal values. These ranked variables were subsequently transformed to calculate an “impact score” for analysis (3 points = ranked 1st; 2 points = ranked 2nd; 1 point = ranked 3rd; 0 points = unranked). Results 505 out of 665 electronically delivered surveys were returned (76% response rate), and 486 had complete and evaluable responses. Age was normally distributed with a mean of 27.4 years (SD: 3.6). Participants were 40% non-white, 21% LGBTQ+, and 89% sexually active. 37% reported a history of major depressive disorder (MDD) and 34% reported a history of generalized anxiety disorder (GAD). 51% of respondents agreed or strongly agreed with the statement, “I am embarrassed to talk about sexual problems with my doctor.” As illustrated by Figure 1A, respondents ranked all sexual health topics as uniformly and significantly more difficult to discuss with their physicians compared to all other aspects of personal health assessed (p=0.0000-0.02). As displayed in Figure 1B, respondents indicated that sexual health subjects were of lower importance relative to the other areas of personal health. Grossly, there were no significant correlations between impact scores and age. Conclusions Our results suggest that young adult males display high rates of embarrassment and reluctance in sharing sexual concerns with physicians. Though young adult males place less value on sexual health, it is closely interconnected with mental and physical well-being. Our findings reinforce the crucial need for physicians to actively combat stigma around sexual health conversations, normalize these discussions with their young adult male patients, and directly inquire about sexual concerns in patients with medical conditions or medications with known sexual side effects. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Dadi, Teleflex, Lina.

(292) Impact of Urinary Incontinence on Sexual Function in Patients Presenting for Lower Urinary Tract Symptoms

Abstract Introduction Patients with low urinary tract symptoms (LUTS) frequently complain some sexual dysfunction and sometimes even episodes of bothersome urinary incontinence (UI). Objective We aimed to assess the relationship between UI (as measured with the ICIQ-UI-SF), and sexual disfunction (as measured with the IIEF), in men presenting with LUTS at a tertiary-referral centre. Methods In this cross-sectional study, data were retrospectively retrieved from 938 consecutive patients aged &amp;gt;18 years seeking first medical help for self-reported LUTS (i.e., all patients had IPSS≥1). All patients had a complete clinical assessment and completed the IPSS, the ICIQ-UI-SF, the OAB-q and the IIEF questionnaires. Patients were stratified into “no UI” (ICIQ-UI-SF=0), “mild UI” (ICIQ-UI-SF=1-7), “moderate UI” (ICIQ-UI-SF=8-13) or “severe UI” (ICIQ-UI-SF=14-21). ANOVA test assessed differences in baseline characteristics among these groups. Spearman correlation test was applied to evaluate the correlation between ICIQ-UI-SF and IIEF domain scores. A linear regression analyses tested putative risk factors associated with increased ICIQ-UI-SF scores. Results Of 938, 589 (63%) patients had no UI, 237 (25%) had mild UI, 76 (8%) moderate UI and 36 (4%) severe UI. There were no substantial differences in total PSA levels and uroflowmetry parameters among UI groups, whereas prostate volume, IPSS and OAB-q scores were higher as UI symptoms increased (all p≤ 0.03). A negative correlation was found between IIEF-total, IIEF-Erectile Function, IIEF-Intercourse Satisfaction and IIEF-Overall Satisfaction scores and ICIQ-UI-SF scores (i.e., the worse UI symptoms, the worse the overall sexual function (rho= -0.12; p&amp;lt;0.001), IIEF-EF (rho= -0.15; p&amp;lt;0.001), IIEF-IS (rho = -0.1; p=0.004) and IIEF-OS (rho = -0.12; p&amp;lt;0.001). Sexual desire and orgasmic function domains were not correlated with ICIQ-UI-SF. Finally, higher BMI (Coeff 0.12; 95% CI 0.03-0.32; p=0.011), diabetes (Coeff 1.76; 0.35-3.18; p=0.015) and presence of comorbidities (Coeff: 0.9; 0.06-0.1.74; p=0.035) were associated with higher ICIQ-UI-SF scores. Main limitations of the study were that ICIQ-UI-SF does not discriminate between urge or stress UI. Conclusions In patients presenting with LUTS, the presence of urinary incontinence was associated with worsening of overall sexual function (i.e., erectile function, intercourse satisfaction and overall satisfaction). Disclosure No

Neoclitoral location may affect sexual function in transgender women: a preliminary pelvic MRI study.

Assigned female at birth with anorgasmia possess a smaller clitoral glans and clitoral components farther from the vagina lumen than women with normal orgasmic function. There are no studies evaluating this correlation in operated transgender women. We evaluated whether differences in MRI measurements of neoclitoris volume and distance between the neoclitoris and the neovagina were correlated with differences in sexual function. We recruited for a prospective survey study 40 operated male to female patients (oMtF) who had undergone genital gender affirming surgery and postoperative pelvic MRI. Individual pelvic MRIs were reviewed by two blinded investigators, the three axes of the neoclitoris were measured and the volume was calculated using the ellipsoid formula. The distance between the neoclitoris and the neovagina was also measured. Sexual functioning was assessed using the Female Sexual Function Index (FSFI) and the operated Male to Female Sexual Function Index (oMtFSFI). Mean scores differences in FSFI, oMtFSFI were examined; associations with clitoral size, location, sexual functioning and demographical variables were investigated as well. The response rate was 55%, 11 MtFs operated with pubic neoclitoris technique (PNT) and 11 with neo-urethroclitoroplasty according to Petrović (NCP). The NCP group presented a neoclitoris mean volume of 1.04 (SD 0.39) cc vs 1.31 (SD 0.78) cc of the other group (p = 0.55). The mean distance between neoclitoris and neovagina was 4.20 (SD 0.57) cm in the PNT group and 2.55 (SD 0.45) in the NCP group (p < 0.001). Patients who had undergone NCP achieved a higher FSFI and oMtFSFI mean Total Score than those operated with the previous technique (FSFI 25.81 SD 3.02 vs 18.62 SD 9.92 p = 0.08; oMtFSFI 37.63 SD 8.28 vs 43.36 SD 13.02 p = 0.23). According to pelvic MRI measurements, this study suggests a correlation between neoclitoral location and oMtF sexual satisfaction.