Psychosexual Distress Research Articles

Long-term psychosexual adjustment of adults born with classic bladder exstrophy

In literature studies exploring long-term psychosexual development and intimacy of adults living with the complex genitourinary conditions associated with classic bladder exstrophy (BE) are scarce, with small sample sizes and lacking in methodology. This study aims to examine areas of potential psychosexual distress in adults born with classic BE to develop targeted clinical interventions. The validated Sexrelation Evaluation Schedule Assessment Monitoring (SESAMO) questionnaire was administered to all BE patients aged ≥18 years operated on in our tertiary referral center during infancy. Z-scores were calculated for each area of interest, considering i) gender (female vs male); ii) committed partnership status (singles vs couples); iii) the voiding technique adopted to empty the bladder. A total of 33 (F:M 12:21; singles: couples 11:22) adults with BE were enrolled in the study at a median age of 39 (32-47) years. Overall, BE adults performed the worst regarding psychosexual identity (z-score:-1.282), pleasure (z-score:-0.915) and desire (z-score:-0.583); singles regarding relational attitude (z-score:-1.751) and imaginative eroticism (z-score:-0.806); couples regarding extramarital sexuality (z-score:-1.175) and sexual communication (z-score:-0.255). When it came to gender, females significantly performed worse than males regarding psychosexual identity (-1.645 vs -1.282; p-value:<0.0001) and areas of pleasure (-1.126 vs -0.359; p-value:<0.001). Single females performed worse than males regarding actual masturbation (-0.763 vs 0.583; p-value:<0.05) and better regarding relational attitude (-1.226 vs -1.751; p-value:<0.05). Females in stable relationships performed worse than males regarding actual masturbation (-1.645 vs 0.306; p-value:<0.05) and better regarding sexual intercourse (1.866 vs -0.565; p-value:<0.01). The voiding techniques used to empty the bladder did not show any influence on these results. Adults with BE have a greater likelihood of experiencing a wide range of psychosexual difficulties. Identifying the specific areas of psychological distress can help them cope with their medical experience and actual clinical condition and clinicians plan adequate psychological interventions.

Condyloma acuminata - the review of the treatment methods

Introduction and purpose:&#x0D; Condyloma acuminata, a benign manifestation of HPV infection, is a common sexually transmitted disease. Condyloma acuminata most commonly affects the anogenital area, but can also occur in the oral cavity. Macroscopically the lesions present as raised, fleshy papules, sometimes flat and broad, pedicled or cauliflower-like. Generally, the lesions are multiple, and as they grow, tend to coalesce into larger ones. Due to the lack of symptoms, condyloma acuminata are often found incidentally during routine medical appointments, e.g. in gynecologist’s offices. Additional symptoms and signs are pain, minor bleeding and pruritus. Patients suffering from condyloma acuminata are often in psychological and psychosexual distress. &#x0D; This work aims to provide a summary of the currently available treatment options based on scientific reports to date.&#x0D; A brief description of the state of knowledge:&#x0D; Among the factors that increase the risk of the HPV infection are age, lifestyle, promiscuity, smoking, HIV infection, a history of chlamydia or gonorrhea infections. To date, no treatment algorithm has been developed for condyloma acuminata. Two vaccines are on offer as primary prevention, Gardasil and Cervarix. The available treatment options are divided into two main groups: patient-administered and physician administered. Surgical methods have the highest therapeutic efficacy. Condyloma acuminata has a high recurrence rate. Usually, a multi-session combination treatment is needed to reach total remission.&#x0D; Summary (conclusions):&#x0D; The treatment of condyloma acuminata includes personalized targets due to their diverse clinical picture and the limitations of certain patient groups. The available treatment options do not exhaust the needs of patients suffering from condyloma acuminata. Further research into the effectiveness of specific treatments is advisable.

Sexual quality of life after gynaecological cancer: what young women want.

Psychosexual distress is known to be a common complication of treatment for gynaecological cancer (GC), affecting the sexual quality of life (SQoL) for an increasing number of young gynaecological cancer survivors (YGCS). The SQoL in YGCS study aimed to identify strategies that are acceptable and helpful to YGCS in protecting and improving SQoL, using a salutogenic approach. A qualitative study was undertaken with young women aged 18-45 and pre- or perimenopausal at diagnosis. Semi-structured interviews were conducted on Zoom and a thematic analysis of transcripts was completed in NVivo. Fifteen interviews with YGCS revealed three themes for strategy development: psychosexual education, psychosocial support, and healthcare policy and strategy to establish SQoL as standard care in gynaecologic oncology. The strategies put forward by YGCS showed the need for a holistic, patient-centric, and multidisciplinary approach to SQoL. A better understanding of the strategies acceptable to YGCS, including the importance of using a trauma-informed approach to communication and care, can help healthcare providers play a vital role in protecting and improving SQoL.

(019) Longitudinal Observation on the Prevalence and Impact of Psychological Distress Among Patients Treated for Erectile Dysfunction During the COVID Pandemic

Abstract Introduction The COVID global pandemic has significantly affected the delivery of the healthcare system with valued resources diverted to cope with more urgent clinical services. Erectile dysfunction (ED) is considered a non-urgent medical condition and hence, males with ED were not prioritised and invariably faced long delays in clinical management including postponement in surgical waitlist during this pandemic. Objective To assess the prevalence and impact of psychological distress among males with ED during the COVID pandemic based on changes in the outcomes of validated questionnaires such as the International Index of Erectile Function (IIEF), Depression and Anxiety Stress Scales (DASS-21), Sexual Distress Scale (SDS) and Decisional Engagement Scale (DES-10), as well as perceived availability of medical support. Methods Following ethics approval, this prospective longitudinal study tracked males with ED at a tertiary medical centre between June 2020 and June 2022. Inclusion criteria included males aged 20 to 70 years, who have pre-existing ED (greater than 6 months), receiving medical therapies for ED, and had enrolled in the prospective database at the time of the study. Exclusion criteria were those who have undergone penile prosthesis implantation or received major abdominopelvic surgery during the study period that may preclude sexual activity. All patients completed validated questionnaires at 0, 6, 12, 18 and 24 months with additional data collected during the peak periods of local COVID social measure lockdown. Results A total of 80 patients were identified during the 24 months and 20 patients dropped out due to surgery (15 patients) and incomplete follow-up (5 patients). The mean age of males was 46.8 (21-69) years, and the duration of ED was 14.5 (6-33) months. Almost one-third of the patients showed increased DASS scores on depression (38 patients) and anxiety (42 patients) subscales and one-quarter on stress (29 patients) subscales, with worse DASS scores during the peak periods of social measures. On the SDS questionnaire, higher concerns were registered across all domains apart from the question on regrets about your sexuality. The analyses showed a worsening of the IIEF scores (p&amp;lt;0.021), anxiety and stress (DASS score with p=0.045 and p=0.038, respectively) as well as SDS score (p=0.048) during this pandemic. However, the DES-10 scores were more positive with most patients reporting a score above 7 out of 10 in terms of items on accepting current arrangement (75%) and confidence in clinician decision-making about the treatment (80%) although most patients (92%) indicated the desire to be kept updated and provided with more detailed information on their clinical care. Conclusions The COVID pandemic has caused an adverse psychosexual impact on many patients’ erectile function and mental well-being, and social measures lockdown invariably heightened patient psychosexual distress. Our study showed regular clinical contact and medical reassurance coupled with an explanation of reasons for clinical delays in the non-urgent medical condition resulted in a high level of confidence in clinicians and potentially minimised emotional adjustment in the patients. Disclosure No

Sexual quality of life in young gynaecological cancer survivors: a qualitative study

PurposeThe impact of cancer diagnosis and treatment on sexual quality of life (SQoL) is a significant and often neglected issue in the treatment and survivorship period of young gynaecological cancer survivors (YGCS). This study sought to explore women’s lived experiences to understand how to protect and improve SQoL.MethodsA qualitative study with women aged 18–45 and pre- or perimenopausal at diagnosis (n = 15). A thematic analysis was performed in NVivo. Participants also completed a pre-interview questionnaire and The Female Sexual Distress Scale-Revised (FSDS-R).ResultsYGCS experienced high psychosexual distress. Notably, seven themes were identified: adjustment, confidence, fear, loss, shame, trauma, and communication. Gynaecological cancer (GC) treatment interfered with everyday life and had a long-term impact on mental, physical, and emotional health, with many reporting an altered sense of self, body image and sexual identity. Single women felt vulnerable in new relationships, while partnered women reported low sexual desire and guilt about sexual difficulties. Open communication, emotional intimacy, and an acceptance of the ‘new normal’ buffered the trauma of cancer and were vital to relationship satisfaction. Lastly, absent, or blunt patient-clinician communication contributed to psychosexual distress.ConclusionGC interferes with sexual function, partner relationships, psychosexual wellbeing, and quality of life. A better understanding of the lived experiences of YGCS can help healthcare providers to adopt a holistic, patient-centric, and multidisciplinary approach to SQoL. YGCS want psychosexual communication and support, across all stages of treatment and care. Healthcare providers should initiate and normalise conversations on the impact of treatment on SQoL.

Psychosexual distress following routine primary human papillomavirus testing: a longitudinal evaluation within the English Cervical Screening Programme

ObjectiveTo assess psychosexual distress over a 12‐month period among women receiving different human papillomavirus (HPV) and cytology results in the context of the English HPV primary screening pilot.DesignLongitudinal, between‐group study.SettingFive sites in England where primary HPV testing was piloted.PopulationWomen aged 24–65 years (n = 1133) who had taken part in the NHS Cervical Screening Programme.MethodsWomen were sent a postal questionnaire soon after receiving their screening results (baseline) and 6 and 12 months later. Data were analysed using linear regression models to compare psychosexual outcomes between groups receiving six possible combinations of HPV and cytology screening results, including a control group with normal cytology and no HPV test.Main outcome measuresPsychosexual distress, assessed using six items from the Psychosocial Effects of Abnormal Pap Smears Questionnaire (PEAPS‐Q).ResultsAt all time points, there was an association between screening result group and psychosexual distress (all P < 0.001). At baseline, mean psychosexual distress score (possible range: 1–5) was significantly higher among women with HPV and normal cytology (B = 1.15, 95% CI 0.96–1.34), HPV and abnormal cytology (B = 1.02, 95% CI: 0.78–1.27) and persistent HPV (B = 0.90, 95% CI 0.70–1.10) compared with the control group (all P < 0.001). At the 6 and 12 month follow ups the pattern of results were similar, but coefficients were smaller.ConclusionsOur findings suggest receiving an HPV‐positive result can cause psychosexual distress, particularly in the short‐term. Developing interventions to minimise the psychosexual burden of testing HPV‐positive will be essential to avoid unnecessary harm to the millions of women taking part in cervical screening.Tweetable abstractReceiving an HPV‐positive result following primary HPV testing can cause psychosexual distress, particularly in the short‐term.

Feasibility and acceptability of i-Restoring Body Image after Cancer (i-ReBIC): A pilot trial for female cancer survivors.

This pilot study aimed to evaluate the feasibility, acceptability, and psychosocial outcomes of a text-based online group therapy intervention, i-Restoring Body Image after Cancer (i-ReBIC). i-ReBIC was developed to reduce body image distress and psychosexual dysfunction among women diagnosed and treated for breast or gynecological cancer. i-ReBIC was adapted from an empirically tested face-to-face group therapy intervention, ReBIC. Over the 8-week intervention, participants engaged in 90-minute weekly text-based online discussions. Each week, a new topic associated with reconnecting to the body, adjusting to a postcancer identity, and improving psychosexual functioning was addressed. Homework assignments included readings, guided imagery exercises, and journaling. Sixty women with cancer enrolled in the pilot study. Among them, 47 completed the intervention, and 44 filled out all prestudy and poststudy questionnaires. Ninety-three percent of participants (n = 41) were satisfied and reported that it met their expectations. Eighty percent of participants (n = 35) reported no technical difficulties during the intervention. Preoutcome and postoutcome measures on body image distress and experience of embodiment showed statistically significant improvements. Psychosexual distress and quality of life also showed improvements but were not statistically significant. This study suggests that i-ReBIC is feasible, well accepted, and effective in addressing persistent body image concerns experienced by women treated for breast or gynecological cancer. As an online group therapy, i-ReBIC can expand the reach of its original face-to-face intervention by mitigating barriers and improving access to care in a cost-effective manner.

Do different treatment strategies influence women’s level of psychosexual distress? Observational cohort study of women with premalignant HPV-associated genital lesions

ObjectiveTo examine the impact of different treatment strategies - surgical treatment or watchful waiting- on sexual activity, psychosocial distress, and fear of progression in women with Human Papillomavirus (HPV)-associated premalignant genital lesions. Study designObservational cohort study of women diagnosed with HPV-associated premalignant lesions of the cervix, vagina or vulva. Patients were stratified into two groups depending on the severity of their premalignancy: surgical treatment or watchful waiting. Validated patient administered questionnaires, i.e. Fear of Progression questionnaire (FoP-Q), Cervical Dysplasia Distress Questionnaire (CDDQ), and Sexual Activity Questionnaire (SAQ) were completed after clinical evaluation (baseline), at 6- and 12-months follow-ups. Results209 women treated with surgery (N = 125) were compared with women who were monitored in regular intervals (N = 82). During an observational period of 12 months there were no significant differences in fear of progression, psychosocial distress, and sexual activity (p > 0.05). The level of concerns and anxiety about the future, and fear of progression were present, mostly at baseline. While there was a small increase of tension from visit to visit in both groups, patients generally were able to cope with their clinical situation quite well. ConclusionsFear of progression, psychosocial distress and sexual activity in women with precancerous HPV- associated premalignant genital lesions seem to be independent from type of treatment. Both treatment strategies may be applied without major psychological sequelae, as long as adequate information is provided.

The Risk and Associated Factors of Female Sexual Dysfunction (FSD) in Women with Psoriasis

Introduction: Psoriasis is a chronic, immune mediated, hyperproliferative skin disease that has substantial impact on the sexual functions. This study aimed to determine the prevalence and associated factors of female sexual dysfunction (FSD) in patients with psoriasis. Methods: A cross-sectional study involving 79 women with psoriasis attending two Dermatology Outpatient Clinics were interviewed and assessed for female sexual dysfunction and severity of psoriasis. The socio-demographic and clinical characteristics of the subjects were compared between the women with and without sexual dysfunction. The subjects were interviewed using Mini International Neuropsychiatric Interview (M.I.N.I.) to exclude any existing psychiatric illness. Sexual dysfunction was assessed using a validated questionnaire on sexual function and the severity of psoriasis was assessed using Psoriasis Area and Severity Index (PASI). Results: The prevalence of FSD in the patients with psoriasis was 20.3%, with hypoactive sexual desire being the most prevalent problem (44.3%). Sexual dysfunction was associated with older age, menopause, low body mass index, longer duration of marriage and presence of psoriasis in the genital area. Female sexual dysfunction was highly prevalent in patients with psoriasis. Conclusion: Management of psoriasis should include assessment in patients’ sexual health. Genital area involvement with psoriasis should not be overlooked as it can cause significant psychosexual distress.

Sexual Activity, Psychosexual Distress, and Fear of Progression in Women With Human Papillomavirus-Related Premalignant Genital Lesions.

Genital human papillomavirus (HPV) infections are very common in women 18 to 30 years old and substantially affect women's sexual health. To examine sexual activity, psychosexual distress, and fear of progression in women diagnosed with HPV-related precancerous genital lesions. In this observational study, women diagnosed with premalignant lesions of the cervix, vagina, or vulva were recruited from a university hospital-based colposcopy clinic. Quantitative data from three validated patient-administered questionnaires (Sexual Activity Questionnaire, German version of the Cervical Dysplasia Distress Questionnaire, and Fear of Progression Questionnaire) were compared within the study population, according to the location of the genital lesion, and with relevant reference populations. Qualitative data from two written open-ended questions about women's thoughts regarding diagnosis and information were analyzed. Two-hundred nine women completed the questionnaires. Seventy-eight percent of women (n= 162) were referred for evaluation of suspect lesions of the cervix, 8% (n= 17) of the vagina, and 14% (n= 30) of the vulva. There were no significant differences in questionnaire results among the three patient groups, except for sexual consequences (Cervical Dysplasia Distress Questionnaire) and recent sexual activity (Sexual Activity Questionnaire). Women with vulvar lesions were most likely to worry about sexual consequences (ie, being unable to have children, being sexually less attractive, or infecting a sexual partner; P= .04). The Sexual Activity Questionnaire subscales sexual pleasure (P= .15) and sexual habits (P= 1.00) were similar to those in a healthy control population, whereas sexual discomfort (P= .51) was comparable to that in a reference population of women who survived cervical cancer. The subscale partner-specific concerns (Fear of Progression Questionnaire) was similar to that in a reference population of patients with cancer (P= .28). HPV-related precancerous genital lesions, especially of the vulva, are likely to cause concerns about sexual health. Effective information and communication are important to lessen negative sexual consequences and anxiety.

Response and Rebuttal to Editorial Comment on “Sexual Activity, Psychosexual Distress and Fear of Progression in Women with HPV-Related Premalignant Genital Lesions”

Response and Rebuttal to Editorial Comment on “Sexual Activity, Psychosexual Distress and Fear of Progression in Women with HPV-Related Premalignant Genital Lesions”

Neourethral meatus reconstruction for vulvectomies requiring resection of the distal part of the urethra

ObjectiveVulvar cancer is a relatively rare tumour accounting for just 5% of all gynaecological malignancies. Radical excision can sometimes involve the distal one-third to one-half of the urethra leading to postoperative problems with micturition, asymmetries and psychosexual distress. Although this topic has been largely addressed, no specific method for distal urethra reconstruction has been described. The aim of this paper is to assess the safety and reliability of our reconstructive technique. MethodsWe conducted a retrospective study of 47 consecutive patients who underwent neourethral meatus reconstruction with vaginal mucosa flap. The surgical technique is described step-by-step. We reviewed the patients' demographics, operative characteristics, as well as immediate complications and long-term outcomes. ResultsNeo-meatal reconstruction was combined to direct vulvar closure in 2 patients, rhomboid flaps in 3 cases, 1 bilateral lotus flap and 36 V-Y fasciocutaneous flaps, 4 rectus abdominis and 1 gracilis flap. Wound dehiscence at the site of the neourethral reconstruction occurred in only 4.3%, partial necrosis of the vaginal mucosa flap in 2.1%. Totally post-operative early complication rate including the whole procedures was 29.8% with a re-operation rate of 4.3%. Long-term outcomes were evaluated in 68.1% patients, including 18.7% of urinary incontinence, no urethral stenosis and 25% of narrowed vaginal introitus. ConclusionNeourethral meatus reconstruction using the vaginal mucosa flap is a simple, safe and reliable technique with a very low early complication rate. We suggest that this flap could be a good option to preserve and restore urinary function in case of distal urethral amputation.

Protocol of a Randomized Controlled Trial of an Online Support Group for Sexual Distress Due to Gynecologic Cancer

Objective: To demonstrate the efficacy of a 12-week, professionally-facilitated, Internet-based support group for women who are sexually distressed due to gynaecologic cancer and its treatment. Methods: The participants are women who received treatment for gynaecologic cancer, were diagnosed within the previous five years and who currently have no evidence of disease. They must meet a minimum cut-off score on the Revised Female Sexual Distress Scale (FSDS-R). Enrolled participants are randomized to the immediate treatment condition or to the waitlist control condition. The intervention is delivered in an asynchronous format (i.e., bulletin board), and also includes two scheduled synchronous (i.e., live chat) sessions. Each week, a new topic relating to sexuality and gynaecologic cancer is introduced, and group members are given access to psych educational materials on that topic. Assessments are completed at baseline, month 5, and month 9. The primary outcome is sexual distress, and the secondary outcomes include sexual function, body image, depression and anxiety, relationship satisfaction, and perceived social support. Results: To date, 234 of the planned 520 participants have been enrolled and 7 groups (4 immediate treatments and 3 waitlist) have been conducted. Conclusion: Women treated for gynaecologic cancer often experience psychosexual distress. Demonstrating the efficacy of an online intervention that targets those concerns is an important step towards meeting the needs of survivors of gynaecologic cancer.

"What Motivates Her": Motivations for Considering Labial Reduction Surgery as Recounted on Women's Online Communities and Surgeons' Websites.

IntroductionIncreasing numbers of women are seeking labial reduction surgery. We studied the motivations for considering labial reduction surgery as recounted on women's online communities and surgery provider's websites.AimsThe study analyzed motivations for considering labial reduction surgery expressed by women on online communities, looked at the role of the women's age and nationality, compared findings with motivations indicated on the websites of an international sample of surgery providers, and identified similarities to and differences from what is known from extant studies.MethodsQuantitative content analysis of the posts of 78 American, British, and Dutch women on online communities, and 40 international surgery providers' websites about labial reduction surgery was conducted.Main Outcome MeasuresMain outcome measures concerned the incidence and prominence of different motivational categories (functional/emotional and discomfort/enhancement related). Differences in motivations as a function of age, national background, and women's vs. surgeons' stated motivations were tested.ResultsEmotional discomfort regarding self-appearance and social and sexual relationships was found to be the most frequent and most prominent motivation for considering labial reduction surgery on women's online communities, regardless of age and national background. Functional discomfort and desired emotional enhancement ranked second. Very few age or national differences were found. The surgeons' websites recognized functional discomfort more and elaborated upon emotional issues in sexual relationships less than members of the online communities.ConclusionsFeelings of emotional and psychosexual distress in addition to functional distress are a highly prevalent motivation among women considering labial reduction surgery. Emotional distress appears to be greater and more freely emphasized when women communicate on online communities, while functional issues appear to receive greater notice on surgery provider's websites. Zwier S. “What motivates her”: Motivations for considering labial reduction surgery as recounted on women's online communities and surgeons' websites. Sex Med 2014;2:16–23.

Psychosexual distress in women with gynecologic cancer: a feasibility study of an online support group

The psychosexual concerns of gynecologic cancer patients are often unaddressed and there are limited resources available for women to deal with this highly sensitive topic. This feasibility study examines the participation rates and preliminary outcomes for an online support group designed specifically for women who are sexually distressed subsequent to gynecologic cancer treatment A 12-week online intervention was developed to address the psychosexual impact of gynecologic cancer. This intervention included a professionally moderated, asynchronous discussion forum as well as the provision of psycho-educational materials addressing the psychosexual impact of gynecologic cancer. Each week, a new topic was introduced and relevant material was posted on the website. Women were encouraged to share their experiences related to the topic. Twenty-seven, sexually distressed, remitted gynecologic cancer patients were randomly assigned to immediate treatment or a waitlist control condition. Participants completed questionnaires at baseline, 4-month and 8-month follow-ups assessing sexual distress as the primary outcome as well as anxiety, depression, and illness intrusiveness. Participation rates differed between the two groups, with greater participation occurring in the second group. Exit interviews indicated that the majority of the participants were satisfied with the intervention. Intent-to-treat analyses suggest a small effect for reduction in sexual distress This feasibility study suggests that women find this intervention acceptable. Further research is required to determine efficacy.

A Qualitative Study of an Internet-Based Support Group for Women with Sexual Distress Due to Gynecologic Cancer

Internet-based support groups for cancer patients have been studied extensively; very few have focused on gynecologic cancer. We pilot-tested a web-based support group for gynecologic cancer patients and assessed women's perceptions of the intervention. Twenty-seven gynecologic cancer patients were randomized to an immediate intervention or a waitlist control group. Women participated in a 12-week, web-based support group focusing on sexuality-related topics. Semi-structured interviews were conducted to investigate the feasibility and efficacy of the intervention. Women reported benefits to participating in the intervention, including receiving support from group members and moderators, increased emotional well-being, improved feelings of body image and sexuality, and comfort in discussing sexuality online. Web-based support groups are both feasible and accepted by gynecologic cancer patients with psychosexual distress. The online format provided women with easy access to the support group and anonymity in discussing psychosexual concerns. Women with gynecologic cancer may benefit from participating in online support groups which provide an environment of relative anonymity to discuss psychosexual concerns.