Screening For Sexual Dysfunction Research Articles

Distribution of Serum Testosterone Concentrations in IBD Males and Associations With Inflammatory Bowel Disease Activity.

An inverse relationship exists between inflammation and testosterone concentrations in non-inflammatory bowel disease (IBD) immune conditions but has not been objectively explored in the IBD male population. We aimed to characterize the distribution of testosterone concentrations in a cohort of males with IBD and identify any relationship between testosterone levels and disease activity. We conducted a prospective cross-sectional study of male IBD patients. Demographics, disease characteristics, sex-hormone concentration, gonadotropins, C-reactive protein, fecal calprotectin, and patient-reported outcomes on quality of life and erectile function were collected. Relationships between disease activity, biomarkers, patient-reported outcome scores, and testosterone levels were analyzed using univariate and multivariate linear regression analyses. A total of 85 male IBD patients were included with a mean age 44±14.1 years, of which 49.4% had Crohn's disease. Mean testosterone concentration was 15.4±5.2 nmol/L and 17.6% had a serum testosterone <10.4 nmol/L. Active disease was associated with lower testosterone concentrations in univariate analysis (β ± SE = -0.25 ± -1.99, P = .02) but not in multivariate analysis (β -0.18±1.75, P = .06). Testosterone concentrations were independently associated with sex hormone-binding globulin levels (β ± SE = 0.45±0.04, P < .0001) and a younger age (β ± SE = -0.32±0.04, P <.0001). Erectile function scores (5-item International Index of Erectile Function) were lower in IBD patients with a longer duration of disease (β ± SE = -0.24±0.006, P = .04). Lower testosterone concentrations in men with IBD may reflect confounding from other factors and are not independently associated with disease activity. Greater awareness and screening for sexual dysfunction should occur in males with IBD, particularly in those with a longer disease duration.

Prevalence of Sexual Dysfunction among Psoriatic Male Patients

Abstract Background psoriasis is a recurring, cutaneous-articular, chronic inflammatory disease, resulting from immune and proliferative changes that affect the skin and mucosa. The worldwide incidence is 1-3% and the majority of the patients also have emotional difficulties like anxiety, depression, and sexual dysfunction. These issues along with the extent of body surface area affected have an impact on the quality of life, in particular, the sexual life, all aspects of sexual function were negatively affected by the disease process. Aim of the Work to evaluate the prevalence of sexual dysfunction among psoriatic male patients and the role of depression on sexual dysfunction. Patients and Methods the study included 60 male psoriatic patients (married sexually active with no genital abnormalities, malignancy, chronic diseases such as pulmonary, hepatic, renal, hematological, neurologic, psychosis, and similar psychiatric disorders, and not on medications that interfere with erectile function). All patients were subjected to the following: Full medical history taking, local examination of the genitalia, dermatological examination, sexual function evaluation using the Arabic version of IIEF (the international index of erectile function questionnaire) which is a validated questionnaire applied to all cases, and psychiatric evaluation using the Arabic version of Hence Hamilton Depression rating scale (HAM-D) to determine the patient’s level of depression. Results The study revealed a high prevalence of ED (86.7%) and depression (65%) among psoriatic male patients, the ED was statistically significantly affected by the severity, duration of the disease, and genital affection. Also, there was a significant correlation between ED, metabolic parameters, and depression with a significant P value. Conclusion there is a high prevalence of sexual dysfunction and depression among psoriatic male patients. Screening of sexual dysfunction among psoriatic male patients using the IIEF, depression using HAM-D, and metabolic risk factors is recommended for a better quality of life.

(077) WOMEN'S SEXUAL HEALTH: AN INTRODUCTION TO A BIOPSYCHOSOCIAL LECTURE FOR EARLY HEALTHCARE TRAINING

Abstract Introduction In 2009, The International Consultation in Sexual Medicine called for the implementation of a greatly expanded, national standard on sexual health education across the nation within medical schools (E Coleman et al. 2013). Yet, over half of medical students throughout the United States and Canada feel that their medical school education left them inadequately prepared to address their patients’ sexual health concerns (Shindel AW et al. 2010). A 2022 study illustrates that outside of basic female anatomy, over half of the Chicago area medical schools failed to address female sexual functioning in their curriculum (N Codispoti et al 2022). Furthermore, today's physicians share similar qualms, as they cite lack of education and training on sexual health as leading to barriers to care and a decrease in screening for sexual dysfunction (Parish SJ et al 2009). Our study delineates a proposed curriculum, analyzing for efficacy as well as the students perceived comfort with addressing this topic in clinic and their perspectives on its importance to their education. Objective Assess the need for curriculum supplementation based on student baseline knowledge and comfort with the topic of women's sexual health. Establish the supplemental curriculum, analyzing for efficacy of education and improved student comfort with addressed topics. Integration of supplemental curriculum into study location medical school curriculum and standardization to all area medical school curriculums. Methods This self controlled, cross-sectional, survey study investigates first year medical students' initial education level and perspectives on womens’ sexual function (WSF) and womens’ sexual dysfunction (WSD), and their post education knowledge level and perspective. The study team recruited 50 students for our study, approximately one third of the class. The study outcomes were assessed for the efficacy of each of the teaching materials through content based quiz questions, as well as the students perceived comfort with addressing this topic in clinic and their perspectives on its importance to their education as compared to the pre-education survey. Results The study resulted in statistically significant improvement from the pretest knowledge in subjects of postmenopausal atrophic vaginitis, perimenopausal risk factors and preventative care, and female HPG axis-based pubertal development. Notably within the demographic assessment, all medical specialties were selected as “of interest” by at least one participant. The participants also assessed that overall women’s sexual health should be taught in their preclinical curriculum and is valuable to their future career, despite the widely varied fields of medicine within interest. Conclusions With statistically significant improvement in knowledge of women’s sexual development and function through our proposed curriculum, we aim to advocate for implementation of a standardized preclinical women’s sexual health curriculum. Furthermore, our ongoing studies focus on the development of a curriculum directed at the pathology and treatments of female sexual dysfunction from a biopsychosocial perspective, resulting in a comprehensive curriculum. Disclosure No.

(073) WOMEN'S SEXUAL DYSFUNCTION TRAINING MODULE INCREASES SCREENING COMFORT

Abstract Introduction Sexual dysfunction in women affects approximately 40% of patients, however, many providers fail to screen for it. The continual lack of screening presents limited opportunities for healthcare trainees to observe, learn and master this skill. Approximately half of medical students feel inadequately prepared to discuss these diagnoses with patients. For this reason, experts advocated a multidisciplinary, longitudinal sexual health education approach to address the exposure of women’s sexual health in the clinical setting. In order to address this issue, our institution created a module focusing on sexual dysfunction in women to educate healthcare students on screening, assessment and baseline treatment for the most common dysfunction, hypoactive sexual desire disorder or decreased libido. This module was created by a gynecologist and reviewed by professors in the psychology department and graduate nursing school. Additionally, it was approved by the medical school for use. It simulates a clinical rotation to emphasize screening for sexual dysfunction in women and baseline evaluation of decreased libido using a biopsychosocial model. Objective The primary aim of this study is to evaluate changes in students’ comfort level who screen for women’s sexual dysfunctions after completion of the Female Sexual Dysfunction Module. Additionally, we aim to assess the over baseline level of comfort in screening and determine if knowledge about when to screen is gained through the module. Methods This study was IRB approved. US medical students and graduate nursing students were approached via email to complete demographic information, a pre-survey, module, and post-survey. In the redcap survey, participants were asked to identify scenarios appropriate to broach the subject of a patient's sexual functioning. Additionally, they were asked to rate their comfort level asking patients about sexual desire, dyspareunia, and anorgasmia as well as general knowledge-based questions about sexual dysfunction in women. Results This study surveyed 425 medical students and nursing students from over 70 institutions across the US. Compared to their pre-module response, more respondents felt it was appropriate to query patients about their sexual functioning following the module (all p &amp;lt; .05). Respondents were also far more comfortable asking patients about their sexual health after the module compared to pre-module responses (all p &amp;lt; .05). Compared to their pre-module response, more respondents correctly identified the components of the linear female sexual response cycle created by Masters and Johnson (24.8% versus 61.6%; p &amp;lt; .001), and more respondents identified the components of the Plisst screening model (6.3% versus 53.7%; p &amp;lt; .001). Conclusions This nationwide study demonstrates our module provides statistical improvement in students’ comfort level when screening for female sexual dysfunction. It agrees with previous studies in terms of healthcare trainees’ overall lower baseline aptitude with this diagnosis and shows that this module statistically increases knowledge These results support using interactive modules in healthcare training curricula in order to standardize training. It can be especially helpful for schools where clinical exposure to this diagnosis is sparse. To further elucidate the most efficacious method of teaching, this study recommends future directions to assess the various models of sexual medicine education. Disclosure No.

(121) DISCREPANCY IN SEXUAL DYSFUNCTION, SEXUAL DESIRE, AND RELATIONSHIP SATISFACTION BETWEEN MALE AND FEMALE PARTNERS DURING THE POSTPARTUM PERIOD AND THE IMPACT OF POSTPARTUM DEPRESSION

Abstract Introduction Studies suggest that changes in sexual health and relationship satisfaction are common in women during pregnancy and postpartum, however these are often overlooked during postpartum care. Furthermore, one in seven women experience additional challenges of postpartum depression within the first postnatal yea. Studies have recognized depression as a major predictor for reduced sexual desire and satisfaction. There is little empirical data on the impact of postpartum depression on the sexual health of both male and female partners and relationship satisfaction. Objective This study assesses the relationship between postpartum depression, relationship satisfaction, and sexual satisfaction at three postpartum time points: immediate, six weeks, and twelve weeks postpartum, in postpartum patients and their partners. Methods This longitudinal study was conducted on heterosexual couples recruited from the postpartum unit, excluding patients with pregnancy complications. Each partner was consented immediately postpartum and individually surveyed to evaluate their sexual desire, relationship satisfaction, and sexual dysfunction immediately, 6 weeks, and 12 weeks postpartum. The Sexual Desire Inventory-2, Sexual Dysfunction Questionnaire, and Couples Satisfaction Index were utilized. Mothers were additionally screened for postpartum depression using the Edinburgh Postnatal Depression Scale at the three time points. We then conducted a retrospective chart review from 6 and 12 week postpartum visits to investigate delivery details and sexual dysfunction screening as reported in clinic documentation. Results This sample consisted of 89 female (54.60%), and 74 male (45.40%). 5 had postpartum depression at least 1 timepoint (8.20%). Sexual desire differed significantly between female and male partners over the entire postpartum period (p &amp;lt; 0.01), and relationship satisfaction differed significantly over time throughout the postpartum period across both female and male partners (p &amp;lt; 0.01). Across the entire postpartum period, female partner sexual desire scores were, on average, 7.02 units lower than male partner sexual desire scores (Mean Difference; 95% CI: -7.02; -11.02, -3.02), meaning that female partner sexual desire was significantly lower than male partner sexual desire throughout the postpartum period. For both female and male partners, relationship satisfaction scores were significantly lower at 12 weeks postpartum (p &amp;lt; 0.01) and at 6 weeks postpartum (p &amp;lt; 0.01) as compared to immediately postpartum, meaning that both female and male partners were significantly less satisfied with their relationships at 6 weeks postpartum and at 12 weeks postpartum as compared to immediately postpartum. 82% females were not screened for sexual dysfunction at 6 weeks postpartum and 2% were screened. Conclusions Discrepancy in relationship satisfaction and sexual desire between male and female partners was found throughout the postpartum period. Yet, a majority of patients are not screened for sexual dysfunction at their 6 week postpartum visit. These findings elucidate the need to normalize and address sexual health during the postpartum period as standard of care, including screening and treatment, in both male and female partners. Disclosure No.

(062) IMPLEMENTING A VALIDATED SEXUAL DYSFUNCTION SCREENING TOOL AT AN INNER-CITY WOMEN’S HEALTH CLINIC

Abstract Introduction The American College of Obstetricians and Gynecologists (ACOG) reports 43% of American women experience sexual health problems, including Female Sexual Interest and Arousal Disorder, Female Orgasmic Disorder, Genito–Pelvic Pain and Penetration Disorder, and Substance or Medication-Induced Sexual Dysfunction. Objective At Women’s Ambulatory Health Services (WAHS), an inner-city clinic associated with Hartford HealthCare, at which UConn Health ObGyn residents work, there is no routine screening in place for sexual dysfunction. This project aimed to implement the Female Sexual Function Index (FSFI) for screening for sexual dysfunction at this clinic to identify patients who may benefit from treatment. Methods We implemented the FSFI-short version, a six-question screening tool for sexual dysfunction that has been validated in English and Spanish and utilized in many countries on July 1st, 2022. Patients presenting for a new gynecologic visit or an annual gynecologic exam were asked to complete the screening tool. Patients who scored equal to or less than 18 on the FSFI-short version were identified as at risk for female sexual dysfunction and were offered referral to a health psychologist specializing in sexual dysfunction. We utilized the RE-AIM framework for implementation science to guide the implementation evaluation. We collected data on patients from July 1 through December 1, 2022. We collected patient demographics and implementation outcomes, including rate of survey completion, candidacy for referral and referral completion. Results 196 surveys were reviewed between July 1st and December 1st of 2022. 44 surveys were excluded for various reasons, including not meeting study inclusion criteria or invalid responses. 152 screening forms were included and 45 patients screened positive. Subjective patient barriers were gathered from comments written directly onto the paper survey as well as quotes documented by their providers in the visit note. These subjective barriers included hesitancy to discuss sexual health and lacking knowledge that the gynecologist provider offers assessment and management for these disorders. Conclusions The introduction of the FSFI-sv at WAHS has both expanded the resources offered to patients, enhanced the environment surrounding topics of women’s health both between staff members as well as within the patient-provider relationship, and has unearthed multiple opportunities for improving the screening process, referral selection and work flow for sexual dysfunction amongst the patient population. Disclosure No.

Testing effectiveness and implementation of a standardized approach to sexual dysfunction screening among adolescent and young adult-aged survivors of childhood cancer: A type I hybrid, mixed methods trial protocol: Effectiveness of sexual dysfunction screening among AYA cancer survivors: a study protocol.

Approximately 20-50% of adolescent and young adult-aged childhood cancer survivors (AYA-CCS) experience sexual dysfunction (SD), although this healthcare need is widely underrecognized. Previous research from both AYA-CCS patients and their providers report that SD needs are unaddressed despite patient desires for SD discussions to be incorporated as part of their care. Patients and providers agree that standardized use of a patient-reported outcome measure may facilitate SD discussions; an SD screening approach was developed with patient and provider input. This study will measure the effectiveness of a standardized SD screening intervention and assess implementation outcomes and multilevel barriers and facilitators to guide future research. This multi-site, mixed methods, type 1 effectiveness-implementation hybrid trial will be evaluated using a pre-post design (NCT05524610). The trial will enroll 86 AYA-CCS (ages 15-39) from two cancer centers in the United States. The SD intervention consists of core fundamental functions with a "menu" of intervention options to allow for flexibility in delivery and tailoring in variable contexts. Effectiveness of the intervention on facilitating SD communication will be measured through patient surveys and clinical data; multivariable logistic regression will be used for the binary outcome of self-reported SD screening, controlling for patient-level predictors. Implementation outcomes will be assessed using mixed methods (electronic health record abstraction, patient and provider surveys, and provider interviews. Quantitative and qualitative findings will be merged using a joint display to understand factors affecting intervention success. Identification and treatment of SD in AYA-CCS is an important and challenging quality of life concern. The type 1 hybrid design will facilitate rapid translation from research to practice by testing the effects of the intervention while simultaneously identifying multilevel barriers and facilitators to real-world implementation. This approach will inform future testing and dissemination of the SD screening intervention.

Female sexual dysfunction-knowledge, attitude, practices, and barriers encountered by medical fraternity across the country: A web-based cross-sectional study.

Sexual dysfunction in women is common yet often remains underdiagnosed due to the lack of adequate training and experience of the doctors to manage female sexual dysfunctions. This study was done to assess the knowledge and attitude of medical professionals toward female sexual dysfunction and the various practices and barriers they encounter while managing women with sexual dysfunction. A web-based cross-sectional study was done using the snowball sampling method. A well-structured, self-administered, and pre-validated questionnaire containing 27 items was administered through social media. Data was collected and evaluated to assess their knowledge, practices they follow, and barriers encountered while managing female sexual dysfunction. A total of 513 doctors participated in the study. Out of all, only 11.1% of the doctors were often seeing patients with sexual dysfunction. Loss of desire (44%), painful intercourse (33%), lack of lubrication (18%), and anorgasmia (5%) are common symptoms with which women present. The majority of doctors (78.9%) were comfortable in starting a conversation, over half (52.6%) were confident in making a diagnosis, and 51.3% were confident in providing sexual counseling. Yet, only 11.1% were routinely screening women for sexual dysfunctions, and 33.8% were providing counseling regarding sexual issues. Lack of time (31.6%), lack of adequate training (57.3%), unavailability of effective treatment (11.9%), patient discomfort (60.62%), and patient's reluctance to seek treatment (15.8%) were the barriers encountered by doctors. When assessed for knowledge, around 30.9% had excellent knowledge (≥75th percentile) about female sexual dysfunction. Sexual dysfunction among women is an important health issue that significantly affects the social, mental, and physical well-being of those suffering from it. Screening for sexual dysfunction should be done routinely in day-to-day clinical practice to improve the overall quality of life of a couple.

(010) Provider Habits on Screening Sexual Dysfunction in Pregnancy: A Novel Mixed Methods Study

Abstract Introduction The prevalence of sexual dysfunction increases throughout pregnancy. The American College of Obstetricians and Gynecologists (ACOG) recommends screening for sexual dysfunction in pregnancy, however, there is little information on when or how this is occurring. Objective To evaluate provider opinions and screening habits regarding sexual dysfunction in pregnancy. Methods This is a mixed methods study conducted with an opinion/practice survey completed by 31 perinatal care providers in Illinois and a randomized, retrospective chart review of obstetric clinic visits of 113 patients at a tertiary medical center in the Chicago metro area. Results 85% of providers believe that sexual dysfunction is either somewhat (n=17) or very important (n=9) as compared to other conditions in pregnancy. Approximately one third (n=11) of providers indicate that they regularly screen for sexual dysfunction in pregnancy. 19% of patients (n=21) charts contained evidence of screening for sexual dysfunction during the perinatal period. Less than half of those with evidence of screening were screened antepartum (n=8). No patients had evidence of screening in the third trimester. Of those patients denoted as screened, 76% (n=16) reported symptoms of sexual dysfunction. Conclusions The findings from the survey pilot study demonstrate that while most providers agree sexual dysfunction in pregnancy is somewhat to very important, there is significant variability in their approach to addressing it, with a majority not addressing it at all. Providers reported multiple barriers to screening including a lack of time and appropriate training. Minimal evidence of sexual dysfunction screening or education during prenatal care was seen on chart review. Given the known high prevalence of sexual dysfunction in the perinatal period, these findings elucidate a need for the development of uniform, screening and education standards for pregnancy. Disclosure No.

Sexual function index adaptation for breast cancer patients (FSFI-BC)- translation and psychometric properties of Persian version

BackgroundEffective interventions to improve sexual dysfunction in breast cancer survivors need screening of these dysfunctions with a suitable instrument. The aim of present study was translation and identifying psychometric properties of Female Sexual Function Index – Adapted for Breast Cancer (FSFI-BC) which has been specifically developed for breast cancer survivors.MethodThis methodological study was performed between February 2017 and October 2018. 200 breast cancer survivors in stage 1 or 2 who were selected through convenience sampling method, completed the questionnaire. Reliability was assessed by Cronbach’s alfa and test re-test analysis and construct validity was performed through confirmatory (CFA) and exploratory factor analysis( EFA).ResultsSix factors were extracted in exploratory factor analysis (EFA). These factors explained 74.6% of the total variance in in NSA group and 0.821 in SA group. Reliability evaluation indicated high internal consistency and good test re-test reliability. Cronbach’s alpha coefficient in all areas of the tool was above 0.7 (the lowest and the highest measures were 0.885 and 0.945, respectively), which is a good indicator for reliability of an instrument. Confirmatory factor analysis showed an acceptable fitness for seven factors of FSFI-BC questionnaire (Normed Fit Index or NFI = 0.9 for both groups, Comparative of Fit Index or CFI = 0.93 and 0.92, χ 2/df = 1.68 and 1.71 for SA(Sexually Active) and NSA(No Sexually Active) individuals, respectively) .ConclusionStudy findings suggest that Persian version of FSFI-BC is a suitable instrument for sexual dysfunction screening in breast cancer survivors.

Associations between gynecologic clinician type and routine female sexual dysfunction screening.

Female sexual dysfunction (FSD) is a common problem in the United States; however, only 14% to 40% of women are screened by their health care clinicians. There are few data on how differences in clinician type affects screening rates. This study aimed to assess differences in FSD screening rates among gynecology clinician types, identify factors associated with screening, and compare screening rates of FSD against conditions with established screening recommendations. Data were collected by retrospective chart review of annual visits at an urban tertiary care center. Screening rates for FSD, depression, cervical cancer, and breast cancer were calculated and compared. Multivariable logistic regression modeling was utilized to assess the correlation between various patient characteristics and FSD screening rates. Study outcome measures included percentages of women who were screened for FSD, depression, cervical cancer, and breast cancer. FSD screening rate was significantly higher among resident-level clinicians vs nonresident clinicians (59% vs 31%; P < .001). When the nonresident clinicians were subanalyzed, certified nursing midwives were the second most likely to screen for FSD (odds ratio [OR], 0.41), followed by nurse practitioners (OR, 0.29) and attending physicians (OR, 0.22). According to multivariable logistic regression techniques, 5 factors were associated with an increased likelihood of a patient being screened for FSD at an annual examination: patient seen by a resident physician rather than an attending physician, patient history of FSD, patient age ≥40 years, patient report of being sexually active at the time of visit, and patient history of cervical procedures. There is an opportunity to improve FSD screening rates by clinicians. Future research may assess what factors, such as increased sexual function education or greater incentives to document FSD screening, may result in higher screening rates. From this, targeted and effective interventions might be crafted to improve future screening rates. This study is one of the first to compare FSD screening rates among clinician types in the same specialty. Study limitations include the inherent limitations of a retrospective design, including selection biases. Residents were more likely to screen for FSD at annual well-woman visits than attending clinicians, nurse practitioners, and certified nurse midwives. Understanding the reasons for varied FSD screening rates among clinician types may aid in the development of strategies to improve screening for this important aspect of women's health.

P17 Feasibility and uptake of guideline-adherent sexual dysfunction screening in a gynecologic cancer survivor population

P17 Feasibility and uptake of guideline-adherent sexual dysfunction screening in a gynecologic cancer survivor population

(057) Retrospective Cohort Study: Associations Between Gynecology Provider Level and Female Sexual Dysfunction Screening Rates during Annual Exams

Abstract Introduction Female sexual dysfunction (FSD) is a broad term that encompasses personal distress from various aspects of intercourse including desire, arousal, orgasm, or pain. Various studies report a high prevalence of 10-20% in women, FSD screening rates are low in the United States. Objectives The objectives of this study are to determine if provider type or provider level of training affect rate of FSD screening at annual well-woman visits, and to compare rates of FSD screening compared to other screening including depression, cervical cancer, and breast cancer. Methods We performed a retrospective cohort study chart review of patients from our outpatient gynecology office who underwent a well-woman annual visit. Women were eligible if at least 18 years of age, new patients, sexually active now or in the past, were seen by a provider in our gynecology department (attending, resident, midwife, or nurse practitioner), and used English as a primary language. Charts were identified within the gynecology department between 11/1/2017 and 1/31/2020 by looking up visits with CPT codes 99385, 99386, and 99387, as well as GC modifiers to identify resident-level providers. The attending-level physician, nurse practitioner, and certified nursing midwife visits were matched to resident-level visits by CPT code and similar date of service. The primary outcome is comparative rates of FSD screening by resident-level providers versus attending-level providers. Secondary outcomes including comparative rates of FSD screening amongst other provider types, and comparison of FSD screening versus depression, cervical cancer, and breast cancer screening. Outcomes will be analyzed using Chi-square testing (if more than 5 patients are screened for FSD from each provider-type) or Fisher’s exact test (if no more than 5 patients are screened for FSD from any provider-type). Multivariable logistic regression modeling will be used to identified any associations between patient or provider demographics that may affect screening rates (patient age, race, insurance type, sex of provider, etc.) Results We have approximately 400 total charts identified for review, which is ongoing and approximately 20% complete. We anticipate reporting results and conclusions after completion of chart review. Conclusions We have approximately 400 total charts identified for review, which is ongoing and approximately 20% complete. We anticipate reporting results and conclusions after completion of chart review. Disclosure No.

(119) Provider Habits Regarding Screening for Sexual Dysfunction in Pregnancy at a Tertiary Medical Center in Chicago, IL

Abstract Introduction A national survey of Ob/Gyns illustrates the majority do not routinely inquire about sexual dysfunction, pleasure, or satisfaction despite female sexual dysfunction (FSD) being an issue affecting an estimated 43% of women throughout their lifetime. Moreover, many studies have shown an increase in sexual dysfunction in pregnancy, including a Brazilian study showing 73.3% of women experience sexual dysfunction in their third trimester. No specific guidance exists for providers regarding the timing of screening nor the proper methods of education for sexual dysfunction in pregnancy. The International Society for the Study of Women’s Sexual Health (ISSWSH) detailed that certain sexual dysfunction disorders have numerous publications, yet lack of concise screening resources to aid the clinician in detection and management. Objective This study evaluated screening and education practices for sexual dysfunction in pregnancy at a tertiary medical center in a low-risk population. Methods From 2018 to 2021, an average of 1284 women received prenatal care at our institution annually. This study randomly reviewed 113 charts from patients receiving prenatal care with our low-risk providers. We conducted a retrospective chart review, collecting data including: pre-existing conditions, Edinburgh Postpartum Depression Screen (EPDS) scores, and characteristics of both the provider and the type of sexual dysfunction present. Results Of 113 pregnant women in our sample, 19% (N=21) were screened for sexual dysfunction throughout the course of their pregnancy and postpartum visits. There were no notable differences in screening habits based on patient age, Gravida, Para, BMI, marital status, or pregnancy complications. At any time, the median EPDS score for those screened for FSD was consistently greater compared to those who were not screened. Patients were more commonly screened by attendings (71%, N=15) rather than residents (29%, N=6) or APNs (10%, N=2). Patients were most commonly screened postpartum (N=13). No women were screened in the third trimester. Of the 21 who were screened, 76% (N=16) screened positive for sexual dysfunction. The majority of those with FSD had myofascial pain (N=9). A quarter had dyspareunia (N=4). Of those with FSD, 19% (N=3) were educated on sexual dysfunction postpartum. Conclusions Our chart review revealed that less than 20% of patients were screened for sexual dysfunction over the course of their pregnancy, including the postpartum period. We found no evidence of education provided on sexual dysfunction in pregnancy. Of those screened, the prevalence of sexual dysfunction was 76%. There were no notable changes in screening habits based on the specific patient characteristics studied or demographics, however screening tended to be more prevalent in patients with increased EPDS scores. At our institution, attending physicians more frequently screen for FSD over resident physicians or APNs in our practice. Postpartum was the most popular time to screen. Prenatal sexual dysfunction occurs most prominently in the third trimester, but we found no evidence of screening being performed during this time. Disclosure No

(062) Identifying the Comfort Level and Understanding of Female Anorgasmia in Medical Students Following an Interactive Online Medical Educational Module in Female Anorgasmia

Abstract Introduction Sexuality is an important aspect of a woman's health; however, in the United States, it is estimated that 10 to 42% of women suffer from female anorgasmia [1]. Despite the high prevalence of female orgasmic disorders, many women are reluctant to discuss it with their providers due to anxiety or embarrassment. They will only voice this issue after direct clinical inquiry. Healthcare professionals frequently under screen for anorgasmia in patients [2]. There is good evidence that sexual health education increases providers’ confidence in screening for sexual dysfunction and ultimately improves the quality of life for their patients. Yet, historically, there has been a lack of medical student education and training on female sexual dysfunction [3]. To address this gap, we created a medical student online training module focused on female anorgasmia. Objective Our primary goals are to obtain preliminary data on: the baseline medical student knowledge of female anorgasmia, the effectiveness of our female anorgasmia module, and the feasibility of assessing the module in an academic setting. We hypothesize that our female anorgasmia module will increase students' knowledge and comfort in addressing and screening for anorgasmia in a clinical setting. Methods We obtained IRB approval. A REDcap database was created to collect and record results. Students were recruited through email and class-based group messaging services. Through pre and post-surveys, we assessed participants’ baseline comfort in screening for anorgasmia and evaluated changes in their comfort after completion of the module. Results Of 24 participants in the study, 11 completed all components and were used to assess the pre and post-responses. Our baseline responses showed 54% of medical students were slightly or not comfortable screening for anorgasmia. 27% were slightly comfortable screening for decreased desire. Our post module responses showed statical improvement in both comfort in screening for desire (p = .03) and orgasm (p = .01). An increase in medical knowledge surrounding anorgasmia was seen but not statically significant. Conclusions Our pilot study revealed over half of medical student participants at baseline had no or little comfort in screening for anorgasmia. Our module improved participants’ comfort in screening for anorgasmia. It also showed an increase in medical knowledge surrounding anorgasmia. Additionally, participants gained statically significant comfort in screening for desire. While our initial results are promising, we cannot attribute them to our entire population due to the small sample size. Of the 24, 11 participants completed all components needed to assess the module (demographics, the pre-module survey, the module, and the post-module survey. We plan to reevaluate our REDcap survey, assessment instructions and hope to provide incentives to our participants to maximize our completion rate. An additional study with a larger sample size is necessary to better assess the effectiveness of the module. Disclosure No

(118) Pilot Survey Study Evaluating Sexual Healthcare Delivery and Provider Habits for Pregnant Patients

Abstract Introduction Female sexual dysfunction affects many women throughout their lives and is associated with medical, psychological, and quality-of-life issues. Studies show an increased prevalence of sexual dysfunction in pregnancy, particularly in the third trimester. However, limited empirical data on sexual dysfunction in American pregnant women exist, and there is a lack of recommendations for intrapartum sexual healthcare screening. It is difficult to find concise screening resources to aid in detection and management. Studies have found that healthcare providers may not inquire about a patient’s difficulty due to known barriers, including a lack of knowledge and training. Objective This pilot survey study aims to assess current provider patterns and modalities surrounding screening patients for sexual dysfunction in pregnancy through a direct questionnaire. Methods This pilot study is an IRB-approved, observational cross-sectional survey conducted via REDCAP. The anonymous questionnaire contains approximately 20 items, including questions regarding provider demographics and screening practices. We identified perinatal care providers, including Physicians, Advanced Practice Nurses (APNs), and Certified Nurse Midwives (CNMs), through Doximity. The data is largely quantitative and includes some qualitative responses to open-ended questions that are not powered. Descriptive summary statistics are reported overall and stratified by provider background. Results 25 perinatal care providers completed the survey; 15 (60%) physicians and 10 (40%) APNs and CNMs. Male providers represented 8% (n=2) of responses. 16 (64%) providers reported that they regularly screen for sexual dysfunction in pregnant patients. Of those 16 providers, the age range most represented was the 41-50 age range (n=7, 43.75%), and they consisted of 10 (62.5%) physicians and 6 (37.5%) APNs or CNMs. Of the providers who regularly screen, 7 (43.75%) selected that the most important time to screen was in the postpartum period and 4 (25%) selected the initial obstetric visit. Physicians reported asking both patients and their partners about sexual dysfunction in pregnancy “almost always” (n=1, 6.25%), “sometimes” (n=4, 25%), “almost never” (n=6, 37.5%), or “never” (n=4, 25%). APNs and CNMs reported asking both partners about sexual dysfunction in pregnancy “sometimes” (n=3, 33.3%), “almost never” (n=3, 33.3%), or “never” (n=4, 44%). Qualitative data revealed these barriers to regularly screening for sexual dysfunction in pregnancy: a lack of time, other screening prioritizations, lack of training, and lack of knowledge surrounding screening in partners. Conclusions Approximately two-thirds (64%) of providers support screening for sexual dysfunction in pregnancy. A similar proportion of physicians (66%) and APNs/CNMs (60%) reported that they regularly screen for sexual dysfunction in pregnancy. Of the providers who regularly screen, providers selected that the most important time to screen is postpartum (43.75%) followed by the initial obstetric visit (25%). In general, providers report screening via open-ended questions or questionnaires. Some providers who support, but do not regularly screen detailed these specific barriers to screening: lack of time, other screening prioritizations, lack of training, and lack of knowledge surrounding screening in partners. Disclosure No

(355) Sexually Speaking: How are Medical School Clinical Curricula Preparing Future Physicians?

Abstract Introduction Sexual health is an essential component of overall health and wellness. It has been demonstrated that roughly one-third of patients in the United States have sexual dysfunction defined as persistent, recurrent problems with sexual response, desire, orgasm, or pain that cause distress. Currently, only half of United States medical schools require formal sexual health instruction, which contributes to the under-preparedness physicians experience in addressing essential issues related to female sexual medicine (FSM). Previous work from our group revealed a need for restructuring pre-clinical medical school curricula as they pertain to FSM and female sexual dysfunction. Thus, a comprehensive education in medical schools’ clinical curricula covering FSM, including standardized screening for sexual dysfunction, assumes an important role. Objective This study focuses on educational content within the obstetrics and gynecology (OBGYN) core clerkships of medical schools to determine if and how FSM is taught to third-year medical students as they interact with patients. Methods OBGYN clerkship syllabi, synchronous lecture materials, and supplemental resources were collected from four medical schools, including three allopathic and one osteopathic institution, in the surrounding Chicago, Illinois area. To standardize our clinical curriculum needs assessment, we limited content review to lectures and resources provided directly from the institution to students during their OBGYN rotation. Upon review of each institution’s clerkship materials, we assessed the goals set forth in each syllabus in terms of lecture or online learning content required for completion by rotating students. Results Clerkship curriculum materials were collected from four (n=4) medical schools. Three of the four institutions dedicate 6 weeks to the core OBGYN clerkship, while one dedicates only 4 weeks. When comparing the specific aims and course content outlines in the rotation syllabi, 3 out of 4 institutions included topics on FSM or female sexual dysfunction. Of these, only one institution had corresponding synchronous clerkship time dedicated to these topics as a one-hour-long required lecture for students. Furthermore, only one program offered training to third-year clinical students in comprehensive sexual history-taking practices, including screening for female sexual dysfunction. The format in which this was fulfilled was through a recommended online module for interested students to complete independently. Conclusions Our focused needs assessment of both allopathic and osteopathic medical schools in the Chicagoland area reveals inconsistencies in the outlined institution-specific goals of their OBGYN clinical rotation and the content that was available and required for students to complete. A single one-hour lecture was included at only one institution specifically dedicated to the screening, diagnosis, and treatment of female sexual dysfunction. This same school was the only of the four to offer any training in screening for female sexual dysfunction, and this was not required, only recommended. Future work includes emphasizing FSM as crucial a domain for medical students to gain proficiency and confidence during clerkships, particularly in a didactic setting that can be utilized clinically on the wards. Disclosure No

Influence of Antipsychotic Agents on the Sexuality of Patients Diagnosed with Schizophrenia

Sexuality is a natural component of human behavior. The general population has been extensively studied since the first half of the 20th century. On the other hand, regarding patients treated for schizophrenia, discussing sexual disorders was initially considered inappropriate because it was believed they should not be sexually active. Given these findings, this work proposes to study the sexuality of patients with schizophrenia. Our objectives were to assess the sexuality of patients with schizophrenia, to identify factors associated with sexual dysfunction among these patients, and to determine practitioners' attitudes toward the sexuality of our study population. This is a cross-sectional study carried out in the Psychiatry Department of Kairouan (outpatient department), including 46 patients diagnosed with schizophrenia. A pre-established information sheet was completed for each patient recruited, including sociodemographic and clinical data; on the other hand, 3 scales ensured a sexual psychometric evaluation: Psychotropic-Related Sexual Dysfunction Questionnaire, Arizona Sexual Experiences Scale, and Changes in Sexual Functioning Questionnaire-Male Clinical Version. Concerning the evaluation of sexuality according to the scales used, sexual dysfunction according to Psychotropic-Related Sexual Dysfunction Questionnaire scores was observed in 31 patients (67.4%). According to Arizona Sexual Experiences Scale scores, 24 patients (52%) had a sexual dysfunction, and for the total score of the Changes in Sexual Functioning Questionnaire-Male Clinical Version, 27 patients (58.7%) had a sexual dysfunction. We cannot confirm the existence of a relationship between the dose of the current treatment (in chlorpromazine equivalent) used and the results of the test assessing sexuality. In addition to these results, we can deduce the existence of a statistically significant association between the antipsychotic agent used and the results of the Psychotropic-Related Sexual Dysfunction Questionnaire only. We recommend that screening for sexual dysfunction in patients followed for schizophrenia should be systematic, regardless of the antipsychotic molecule type and dosage. In this regard, we recommend the establishment of a better therapeutic relationship between caregivers and patients with schizophrenia, based on empathy and trust, so that the latter feel comfortable enough to address the sexual dimension in general and sexual dysfunction in particular.

The Arizona Sexual Experiences Scale-the Thai Translation (ASEX-Thai): Reliability and validity in Thai patients with mental disorders.

Background: Sexual dysfunction is common among patients with mental disorders but receives less clinical attention, especially in Thailand and other Asian countries. The Arizona Sexual Experiences Scale-the Thai Translation (ASEX-Thai), a self-rated, brief, questionnaire is a potential tool for screening for sexual dysfunction in this population. Our study aimed to assess the reliability and validity of ASEX-Thai in Thai patients with mental disorders. Methods: We enrolled 202 patients from an outpatient psychiatric department at atertiary hospital in Bangkok, Thailand. Demographic data, clinical data, and diagnosis of sexual dysfunction were assessed. ASEX-Thai was done, and we analyzed the test's psychometric properties. Results:Most participants were diagnosed with major depressive disorder (48%). There was a positive correlation between the ASEX-Thai and sexual dysfunction diagnosis (r = 0.402, p < 0.001). The KMO coefficient was 0.77 and Barlett's sphericity test was significant (χ 2= 409.76, p<0.001). A score of ≥ 17 points of the ASEX-Thai was the most suitable for sexual dysfunction screening (sensitivity 77.23 %, and specificity 58.42 %). For reliability, the Cronbach's alpha coefficient (0.831) showed good internal consistency. Conclusions: The ASEX-Thai is a valid and reliable self-rated questionnaire for screening for sexual dysfunction among Thai patients with mental disorders. The test could help clinicians to evaluate this undetected condition and deliver proper interventions.

The Arizona Sexual Experiences Scale-the Thai Translation (ASEX-Thai): Reliability and validity in Thai patients with mental disorders

Background: Sexual dysfunction is common among patients with mental disorders but receives less clinical attention, especially in Thailand and other Asian countries. The Arizona Sexual Experiences Scale-the Thai Translation (ASEX-Thai), a self-rated, brief, questionnaire is a potential tool for screening for sexual dysfunction in this population. Our study aimed to assess the reliability and validity of ASEX-Thai in Thai patients with mental disorders. Methods: We enrolled 202 patients from an outpatient psychiatric department at a tertiary hospital in Bangkok, Thailand. Demographic data, clinical data, and diagnosis of sexual dysfunction were assessed. ASEX-Thai was done, and we analyzed the test’s psychometric properties. Results: Most participants were diagnosed with major depressive disorder (48%). There was a positive correlation between the ASEX-Thai and sexual dysfunction diagnosis (r = 0.402, p < 0.001). The KMO coefficient was 0.77 and Barlett’s sphericity test was significant (χ 2 = 409.76, p<0.001). A score of ≥ 17 points of the ASEX-Thai was the most suitable for sexual dysfunction screening (sensitivity 77.23 %, and specificity 58.42 %). For reliability, the Cronbach’s alpha coefficient (0.831) showed good internal consistency. Conclusions: The ASEX-Thai is a valid and reliable self-rated questionnaire for screening for sexual dysfunction among Thai patients with mental disorders. The test could help clinicians to evaluate this undetected condition and deliver proper interventions.