Self-reported Sexual Function Research Articles

(002) PER- AND POLYFLUOROALKYL SUBSTANCES (PFAS) AND FEMALE SEXUAL FUNCTION IN A PRECONCEPTION COHORT

Abstract Introduction Per- and polyfluoroalkyl substances (PFAS) are prevalent environmental chemicals used extensively in consumer and industrial products. Distressing disruptions to sexual function are prevalent in reproductive-aged women, yet its etiology is incompletely characterized. PFAS could plausibly affect sexual function because they interfere with the production, metabolism, and secretion of reproductive hormones and have known neurotoxic properties. To our knowledge, however, no research to date has evaluated associations between PFAS exposure and female sexual function. Objective To evaluate associations between PFAS biomarker concentrations and female sexual function. Methods We used cross-sectional data from the Pregnancy Study Online (PRESTO; n=82), a preconception cohort study of female-identified pregnancy planners living in the United States or Canada, to estimate associations between PFAS biomarker concentrations and female sexual function, measured using 6 select items from the Female Sexual Function Index (FSFI). We summed scores from the FSFI items to create a sexual function score (range=0-30; median in PRESTO=22). Lower scores were indicative of worse sexual function. We measured concentrations of four PFAS (specifically PFOS, PFOA, PFNA, and PFHxS) in serum using isotope-dilution tandem mass spectrometry. We used multivariable linear regression to estimate mean differences in sexual function scores per interquartile range (IQR) increase in PFAS concentrations with 95% confidence intervals (CIs), adjusting for potential confounders. We stratified results by parity (parous vs. nulliparous) to evaluate the potential for effect modification by prior pregnancy, as placental transfer, menstruation, and lactation are known routes of PFAS elimination. Results Median serum PFAS concentrations (ng/mL) were 1.3, 1.1, 0.3, and 0.7 for PFOS, PFOA, PFNA, and PFHxS, respectively. An IQR increase in PFHxS was associated with a 1.4-point decrease (95% CI -2.1, -0.6) in sexual function scores, reflecting a ~5% change. Among parous participants, there was a consistent trend of decreased sexual function scores per IQR increase in PFAS concentrations. The strongest association was observed for PFOS, where an IQR increase in serum concentration was associated with a 4.9-point decrease in sexual function scores (95% CI -9.1, -0.6). Conclusions These preliminary findings indicate that higher serum PFAS concentrations are associated with decreased self-reported female sexual function. Prior research evaluating the relationship between environmental chemical exposures and sexual function have historically focused on male outcomes (e.g., semen quality). These fundings suggest value in expanding research focused on the sexual health consequences of endocrine disrupting chemicals to include female sexual function. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: LAW serves as a consultant to AbbVie, Inc.

(116) SUBJECTIVE AND GENITAL SEXUAL RESPONSE IN FEMALE BREAST CANCER SURVIVORS: RESULTS FROM A PSYCHOPHYSIOLOGY STUDY

Abstract Introduction Sexual dysfunction is a prevalent concern affecting more than 70% of female breast cancer survivors, casting a substantial shadow on their quality of life. Beyond the physical impact of cancer and its treatments, the emotional and psychological toll of sexual dysfunction introduces additional challenges, amplifying stress levels and undermining overall well-being. Acknowledging the profound implications of sexual dysfunction in this group and the absence of therapies, there is an urgent need to delve deeper into the intricacies of its manifestations. Objective This study aimed to gather preliminary data on psychophysiological aspects of sexual function in premenopausal breast cancer patients undergoing antihormonal therapy and compare them with a healthy control group. Exploring sexual arousal in breast cancer patients may unveil potential targets for innovative treatment strategies to address sexual dysfunction in this population. Methods Participants were prescreened during a telephone interview. We included 40 premenopausal breast cancer survivors with an age range of 29 to 57 years (M = 43.5, SD = 6.36) on current hormonal treatment and 20 healthy controls with an age range of 22 to 35 (M = 27.55, SD = 3.19). Physiological measures (VPA and HRV), subjective sexual arousal (SSA) and self-reported orgasm were assessed in response to audiovisual stimuli and vibrotactile clitoral stimulation sexual stimuli in breast cancer survivors and healthy controls. Self-reported measures like the Female Sexual Function Index (FSFI), the Sexual Self-Esteem Inventory (SSEI) und the PROMIS29 were incorporated. Data were analyzed using 2-level mixed effect models. Results No significant differences in VPA scores were observed between healthy controls and breast cancer survivors. Both groups exhibited a greater genital response to clitoral vibrator use than to visual stimuli. Group differences emerged in SSA and HRV, with higher SSA and lower HRV being detected. Breast cancer survivors climaxed less frequently than healthy controls and had significantly lower self-reported sexual function. Conclusions Physiological measures of arousal in breast cancer survivors were comparable to healthy controls and only subjective arousal differed. This finding indicates that subjective arousal should be further explored as the focus of intervention and treatment methods for breast cancer patients experiencing sexual dysfunction. Our findings underscore the importance of tailored strategies that resonate with individual narratives, acknowledging the emotional intricacies of post-cancer sexual well-being. This study not only contributes to scientific knowledge but also calls for a compassionate and personalized treatment paradigm, enriching the landscape of survivorship care. Disclosure Yes, this is sponsored by industry/sponsor: WOW Tech GmbH Clarification: No industry support in study design or execution.

The impact of pharmacotherapy on sexual function in female patients being treated for idiopathic overactive bladder: a systematic review

BackgroundOveractive bladder (OAB) is a condition defined by urgency with or without incontinence which disproportionately affects female patients and has a negative impact on sexual enjoyment and avoidance behaviour. Pharmacotherapy can be considered one of the main options for treating OAB. This research set out to determine the impact of pharmacotherapy on sexual function in females with OAB.MethodsThis research used the robust methodology of a systematic review. The clinical question was formulated using the PICO (population, intervention, control, and outcomes) format to include females being treated with pharmacotherapy (anticholinergics or beta-3 adrenergic agonists) for idiopathic OAB with the use of a validated questionnaire assessing self-reported sexual function at baseline and post-treatment. The review incorporated the MEDLINE, PubMed and EMBASE databases. The AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews) appraisal tool was used to guide the review process. Two reviewers worked independently in screening abstracts, deciding on the inclusion of full-texts, data extraction and risk of bias assessment.ResultsIn female patients with OAB, pharmacotherapy does seem to offer at least partial improvement in self-reported sexual function outcomes after 12 weeks of therapy. Still, the value of this finding is limited by an overall poor quality of evidence. Patients with a higher degree of bother at baseline stand to benefit the most from treatment when an improvement within this health-related quality of life domain is sought.ConclusionThis research should form the basis for a well-conducted randomized controlled study to accurately assess sexual function improvements in females being treated with pharmacotherapy for OAB.

Impact of neoadjuvant relugolix on patient-reported sexual function and bother.

Sexual function following local treatment for prostate cancer is an important quality of life concern. Relugolix is a novel oral GnRH receptor antagonist used in combination with radiation therapy in the treatment of unfavorable prostate cancer. It has been shown to achieve rapid and profound testosterone suppression. As a result, these very low testosterone levels may impact both sexual functioning and perceptions. This prospective study sought to assess neoadjuvant relugolix-induced sexual dysfunction prior to stereotactic body radiation therapy (SBRT). Between March 2021 and September 2023, 87 patients with localized prostate cancer were treated with neoadjuvant relugolix followed by SBRT per an institutional protocol. Sexual function and bother were assessed via the sexual domain of the validated Expanded Prostate Index Composite (EPIC-26) survey. Responses were collected for each patient at pre-treatment baseline and after several months of relugolix. A Utilization of Sexual Medications/Devices questionnaire was administered at the same time points to assess erectile aid usage. The median age was 72 years and 43% of patients were non-white. The median baseline Sexual Health Inventory for Men (SHIM) score was 13 and 41.7% of patients utilized sexual aids prior to relugolix. Patients initiated relugolix at a median of 4.5 months (2-14 months) prior to SBRT. 95% and 87% of patients achieved effective castration (≤ 50 ng/dL) and profound castration (< 20 ng/dl) at SBRT initiation, respectively. Ability to have an erection, ability to reach orgasm, quality of erections, frequency of erections, and overall sexual function significantly declined following relugolix. There was a non- significant increase in sexual bother. In concordance with known side effects of androgen deprivation therapy (ADT), neoadjuvant relugolix was associated with a significant decline in self-reported sexual function. However, patients indicated only a minimal and non-significant increase in bother. Future investigations should compare outcomes while on relugolix directly to GnRH agonist-induced sexual dysfunction.

(290) Impact of Neoadjuvant Relugolix on Patient-Reported Sexual Function and Bother

Abstract Introduction Relugolix is an oral GnRH receptor antagonist used in combination with radiation therapy in the treatment of unfavorable prostate cancer. It has been shown to achieve rapid and profound testosterone suppression (total testosterone &amp;lt;20 ng/dL) without the need for bothersome injections. Such low testosterone levels may impact sexual functioning and perceptions. Objective Given the potential benefits of Relugolix over other androgen deprivation therapies (ADTs), this prospective study sought to assess neoadjuvant Relugolix-induced sexual dysfunction prior to the initiation of stereotactic body radiation therapy (SBRT). Methods Prospective, patient-reported data was collected from a male cohort diagnosed with localized prostate cancer and subsequently treated with neoadjuvant Relugolix and SBRT. Relugolix was initiated at least 2 months prior to SBRT. Sexual function and bother were assessed via the sexual domain of the validated Expanded Prostate Index Composite (EPIC-26) survey which includes five function questions (erections and orgasm) and one overall bother question. Individual scores ranged from 0-100 with higher scores reflecting improved function/less bother. EPIC-26 was collected for each patient at pre-Relugolix baseline and one hour prior to SBRT initiation. Individual items were evaluated for statistical significance (paired t-test, p &amp;lt; 0.05) and clinical significance by minimally important difference (MID, +/- 0.5 SD from baseline score). Results Between July 2021 and January 2023, 49 patients with localized prostate cancer were treated with neoadjuvant Relugolix (4-6 months) and SBRT (36.25-40 Gy in 5 fractions) at Georgetown University Hospital per institutional protocol IRB 12-1775. The median age was 73 years. 27% of patients were black and 26.1% were obese (BMI ≥30 kg/m2). Patients initiated Relugolix at a median of 3.6 months prior to SBRT. 82% of patients had intermediate risk disease. All individual EPIC sexual function scores declined in a similar manner following neoadjuvant Relugolix therapy. These declines were both statistically and clinically significant. There was no statistically or clinically significant change in the EPIC sexual overall bother score. Conclusions In concordance with known side effects of ADT, neoadjuvant Relugolix was associated with a significant decline in self-reported sexual function. However, patients indicated only a minimal and non-significant increase in bother. Relugolix was well-tolerated as patients on Relugolix did not subjectively find their sexual dysfunction troublesome. Future investigations should compare outcomes while on Relugolix directly to GnRH agonist-induced sexual dysfunction. Disclosure No.

Adverse outcomes (AOs) in patients (pts) with metastatic castration-sensitive prostate cancer (mCSPC) treated with intensified androgen deprivation therapy (ADT+).

113 Background: mCSPC pts experience adverse outcomes (AOs) with intensified androgen deprivation, resulting in treatment discontinuation; however, there is limited data to identify those at risk. The IRONMAN registry is a global initiative to enroll advanced prostate cancer patients worldwide, and survey data on AOs, patient-reported outcomes (PROs), and clinico-epidemiologic (demographic, cancer, and treatment) details. We report the prevalence and predictors of AOs from baseline demographic, clinical, and PRO information with the onset of AOs and present a risk prediction model for clinical use. Methods: We analyzed data from 553 mCSPC patients in the IRONMAN registry from inception to March 2023 who received ADT+ alone (Abiraterone 47.6%, Enzalutamide 26.9%, Apalutamide 22.6%, Darolutamide 2.9%) and had completed baseline PROs. We defined AOs, reported by 60 global sites, as non-progression-related clinically significant serious adverse events (csSAE), treatment discontinuation, and dose reductions (DR/DC), delineated as a composite outcome based on first event. We processed baseline variable groups: Demographics (race, ethnicity, marital status, study site), Clinical Factors (age, ECOG score, metastatic sites, ADT+, concurrent medications, labs [ALP, Hb, LDH, and PSA]), Concurrent therapies (steroid use within 30 days [d] &amp; steroid dose, radiation/surgery prior or planned in 6months) and PROs (EORTC QLQ-C30 and EPIC-23). We developed a multifactorial logistic regression model to predict adverse outcomes (AOs) within two years of initiating ADT+ therapy. All variables with less than 25-30% missing data were included. Variable selection was conducted in two layers: intra-group stepwise selection followed by an inter-group selection of variables retained from the first layer. The model's discriminatory ability was evaluated using the area under curve (AUC). Results: 553 pts met inclusion (51.6% North America, 72% White, mean age: 71 years [range, 40 to 96 years], and 62.9% confirmed bone-metastatic mCSPC). 119 pts (21.5%) developed AOs (61 csSAEs [18 dead; Median: 140 d; IQR 81-360 d], 58 DR/DC [Median: 122 d; IQR 43-262 d]). &lt;5% went off study. The multifactorial model (n=314 pts) performed well at predicting AOs (AUC 0.77 [0.70-0.84]), with significant factors being more self-reported pain, greater urinary frequency, prednisone&gt;5mg within 30d, more self-reported weakness and poor sexual function within 3 months of ADT+ initiation. Conclusions: 1 in 5 mCSPC patients on ADT+ experienced non-progression-related AOs at 2 years. Significant, easily assessed predictive factors are identified and may be utilized in their clinical management. A novel multifactorial model is presented to predict AOs at 2 years. Further validation, assessment of missingness bias, and imputation are planned.

Validity of self-reported male sexual function scales in a young Chinese population: a comparative study with clinician-assisted evaluation.

Psychometric scales, commonly used to gauge sexual function, can sometimes be influenced by response biases. In our research from June 2020 to April 2021, we examined the accuracy of self-reported sexual function scales. We invited patients from the Department of Infertility and Sexual Medicine at the Third Affiliated Hospital of Sun Yat-sen University (Guangzhou, China), who have male sexual dysfunction, to participate by filling out a self-reported version of a specific questionnaire. In addition, they went through a clinician-assisted version of this questionnaire, encompassing tools such as the Premature Ejaculation Diagnostic Tool (PEDT), the 6-item International Index of Erectile Function (IIEF-6), the Erection Hardness Scale (EHS), and the Masturbation Erection Index (MEI). Using the clinician-assisted version as a reference, we categorized patients and applied various statistical methods, such as the Chi-square test, intraclass correlation coefficient (ICC), logistic regression, and the Bland-Altman plot, to gauge reliability. In our study with 322 participants, we found that while there were no notable discrepancies in error rates based on our categorization, certain scales showed significant differences in terms of overestimation and underestimation, with the exception of the PEDT. The positive diagnosis rate consistency between the self-reported and clinician-assisted versions was observed. High ICC values between the two versions across the scales were indicative of remarkable reliability. Our findings show that the self-reported versions of tools such as EHS, IIEF-6, MEI, and PEDT are credible and hold clinical reliability. However, employing a dual-diagnosis approach might be more prudent to circumvent potential misdiagnoses.

Treatment of Vulvovaginal Laxity by Electroporation: The Jett Plasma Medical for Her II Study.

Vaginal laxity is a widespread and undertreated medical condition associated especially with vaginal parity. To evaluate the efficacy and safety of electroporation therapy treatment of vulvovaginal laxity by the Jett Plasma for Her II device. The Jett Plasma for Her II Study is a multicentric, prospective, randomized, single-blinded, and controlled study. Women presenting with vaginal laxity were randomized to receive electroporation therapy delivered to the vaginal tissue (active-82 patients) vs. therapy with zero intensity (placebo-9 patients). A total of 91 subjects whose average age was 48.69 ± 10.89 were included. Due to the results of a one-way analysis of variance, it may be concluded that in the case of the vaginal laxity questionnaire (VLQ), there is a statistically significant difference between actively treated patients and the placebo group (F1,574 = 46.91; p < 0.001). In the case of the female sexual function index (FSFI), a one-way ANOVA test also showed a statistically significant difference between the actively treated patients and the placebo group (F1,278 = 7.97; p = 0.005). In the case of the incontinence impact questionnaire-7 (IIQ-7), a one-way ANOVA test showed a statistically significant difference between the actively treated patients and the placebo group (F1,384 = 15.51; p < 0.001). It confirms that improvement of vaginal laxity is conjoined with benefits in symptoms of urinary incontinence. Biopsy performed after the end of the treatment shows an increase in the vaginal mucosa thickness by an average of 100.04% in the active group. The treatment was well tolerated with no adverse events. No topical anesthetics were required. Treatments of vulvovaginal laxity by electroporation therapy achieved significant and sustainable 12-month effectiveness. Responses to the questionnaires also suggest subjective improvement in self-reported sexual function, incontinence, sexual satisfaction, and urogenital distress.

Sexual health and serotonin 4 receptor brain binding in unmedicated patients with depression—a NeuroPharm study

Sexual dysfunction is prominent in Major Depressive Disorder (MDD) and affects women with depression more than men. Patients with MDD relative to healthy controls have lower brain levels of the serotonin 4 receptor (5-HT4R), which is expressed with high density in the striatum, i.e. a key hub of the reward system. Reduced sexual desire is putatively related to disturbed reward processing and may index anhedonia in MDD. Here, we aim to illuminate plausible underlying neurobiology of sexual dysfunction in unmedicated patients with MDD. We map associations between 5-HT4R binding, as imaged with [11C]SB207145 PET, in the striatum, and self-reported sexual function. We also evaluate if pre-treatment sexual desire score predicts 8-week treatment outcome in women. From the NeuroPharm study, we include 85 untreated MDD patients (71% women) who underwent eight weeks of antidepressant drug treatment. In the mixed sex group, we find no difference in 5-HT4R binding between patients with sexual dysfunction vs normal sexual function. However, in women we find lower 5-HT4R binding in the sexual dysfunctional group compared to women with normal sexual function (β = −0.36, 95%CI[−0.62:−0.09], p = 0.009) as well as a positive association between sexual desire and 5-HT4R binding (β = 0.07, 95%CI [0.02:0.13], p = 0.012). Sexual desire at baseline do not predict treatment outcome (ROC curve AUC = 52%[36%:67%]) in women. Taken together, we find evidence for a positive association between sexual desire and striatal 5-HT4R availability in women with depression. Interestingly, this raises the question if direct 5-HT4R agonism can target reduced sexual desire or anhedonia in MDD.

(550) Sexual Arousal in Premenopausal Breast Cancer Patients on Antihormonal Treatment

Abstract Introduction Breast Cancer is the most common cancer in women and is associated with a severe impairment of general life quality, body-related self-esteem and sexual function and satisfaction. Sexual satisfaction has been shown to have a significant impact on general health and well-being. Nevertheless, research aiming at understanding sexual function in breast cancer patients is very scarce, no vaginal plethysmography data measuring vaginal blood flow on breast cancer patients currently exists. A better understanding of the interplay of the physiological sexual response and subjective sexual arousal in breast cancer survivors could help develop new strategies for treating this specific target group and contributing to improve their health and life quality. Objective The aim of this study is to collect preliminary data on psychophysiological aspects of the sex.al function of premenopausal breast cancer patients on antihormonal therapy and compare them with healthy controls. Specifically, we hypothesized that (1) genital arousal following visual stimuli is less in breast cancer patients than in healthy controls, (2) genital arousal following tactile stimuli is the same in breast cancer patients and healthy controls, (3) genital arousal following tactile stimuli is greater than following visual stimuli in both breast cancer patients and healthy controls. Serum sex hormone levels and self-reported sexual function are analyzed as moderators. Methods Breast cancer survivors (n=60) treated with antihormonal therapy for breast cancer, who are in complete remission for at least one year and healthy controls (n=20), undergo vaginal plethysmography while sexual stimuli (visual, tactile, visual + tactile) are presented. Subjective arousal and genital arousal are recorded continuously. Hormone serum levels, self-reported sexual function, sexual self-esteem, and quality of life measures are analyzed as potential moderators. Results Intraindividual differences (subjective and genital arousal) and interindividual differences (breast cancer patients, healthy controls) are analyzed based on a 2-level mixed effect models for each outcome variable. Pearson correlations are calculated to assess the relationships between subjective arousal and genital arousal for each group. Conclusions This study is the first to provide data on genital and subjective arousal in premenopausal women with breast cancer on antihormonal treatment compared to healthy controls and explore the data in connection with serum hormone levels. Overall, it will give a further insight in sexual function of breast cancer survivors to reveal targets to improve sexual function in this target group. Disclosure Yes, this is sponsored by industry/sponsor: WOW Tech™ Group. Clarification Industry funding only - investigator initiated and executed study.

Implementation of individually tailored treatment plans in a group-based intervention for women with mixed vulvo-vaginal and sexual health concerns following cancer treatment: A feasibility study.

This study evaluated a professionally-led, group-based vulvo-vaginal and sexual health (VSH) workshop for women diagnosed with cancer. The study goals were to: (1) implement and assess a novel group intervention for diverse VSH concerns; (2) explore post-workshop changes in symptom bother, motivation to use VSH treatments, and frequency of VSH treatment use; (3) examine post-workshop changes in sexual well-being. A group-based educational workshop to address a variety of VSH concerns was developed and implemented. During the workshop, participants created an individualized treatment plan by selecting from various VSH treatment options presented. Treatment plan follow-ups were administered online at one-, two-, and three-months post-workshop. At baseline and three-month follow-up, participants completed online questionnaires to assess self-reported vulvo-vaginal symptoms, sexual function, sexual distress, and use of VSH strategies. 195 participants (age 20-81) attended workshops over a 2.5-year period. Individualized treatment plans were effectively completed by most participants (92%). Preliminary results show decreases in bother severity associated with VSH concerns post-workshop, stabilizing after 2 months. At three-month follow-up, participants reported increased use of VSH treatment strategies. Sexual satisfaction, sexual distress, and emotional impact of vulvovaginal symptoms also improved. Workshop attendance was associated with increased uptake of VSH treatment strategies and improvements in several parameters of sexual well-being. Findings indicate that individualized treatment plans can be implemented effectively in a group setting and that a one-time, group-based educational workshop can meaningfully impact VSH-related behavior change, reduce vulvo-vaginal symptom bother and promote sexual well-being in patients with diverse VSH concerns.

Psychometric evaluation of the Swedish version of the PROMIS Sexual Function and Satisfaction Measures in clinical and nonclinical young adult populations.

The Patient-Reported Outcomes Measurement Information System (PROMIS®) Sexual Function and Satisfaction (SexFS) version 2.0 measurement tool was developed to assess sexual functioning and satisfaction in the general population regardless of health condition and sexual orientation. The study aimed to evaluate the psychometric properties of the Swedish version of the PROMIS SexFS measure in clinical and nonclinical populations of young adults (aged <40years). The SexFS was answered by a clinical population of young adult women (n = 180) and men (n = 110) with breast cancer and testicular cancer, respectively, and a nonclinical population of young adult women (n = 511) and men (n = 324) from the general population. Psychometric properties were evaluated by examining data quality (score distribution, floor and ceiling effects, proportion of missing data), construct validity (corrected item, total correlation, scaling success), and reliability (Cronbach α). The following domains of the SexFS 2.0 were investigated: Vaginal Lubrication, Vaginal Discomfort, Vulvar Discomfort- Clitoral, Vulvar Discomfort- Labial, Erectile Function, Interest in Sexual Activity, Satisfaction With Sex Life, Orgasm- Ability, and Orgasm- Pleasure. The Swedish version of the SexFS 2.0 generated data of acceptable quality. Some noteworthy floor or ceiling effects were identified across domains and respondent groups. Corrected item totals were used to express the coherence between an item and the other items in the domain. The correlation coefficients were above 0.40 for all items, except for 1 of the items within the Vaginal Discomfort domain and for the items in the Erectile Function domain in the nonclinical group of men. High proportions of scaling success were noted across domains (96%-100%). Reliability was satisfactory (α = 0.74-0.92) for all domains, expect for Erectile Function of the nonclinical group (α = 0.53), due to low variability in item responses, which was improved somewhat (α = 0.65) when combined with the clinical group. A flexible tool to measure self-reported sexual function and satisfaction in young men and women is available for researchers and clinicians in Sweden. The nationwide population-based sample of patients with cancer, identified from national quality registers, minimized selection bias. However, men in the general population had a lower response rate (34%) compared to the other groups, which introduced a risk of bias in estimates. The psychometric evaluation was limited to young adults (aged 19-40years). The results provide evidence for the validity and reliability of the Swedish version of the SexFS measure for the assessment of sexual functioning and satisfaction in young adults from both clinical and nonclinical populations.

How Prostate Cancer Patients are Surveyed may Influence Self-Reported Sexual Function Responses

BackgroundThe side effects of prostate cancer treatment include decreases in sexual function, hence, the way patient reported outcomes are collected may affect the quantity and quality of responses. AimTo determine the effect that different survey modes (email, telephone, or mail) had on the quantity of missing data and self-reported function following treatment. MethodsMen newly diagnosed with prostate cancer and enrolled in the Victorian Prostate Cancer Outcomes Registry formed the study population. The Expanded Prostate Cancer Index Composite (EPIC-26) survey instrument was administered approximately 1 year after their initial treatment. EPIC-26 measures self-reported function in the sexual, urinary, bowel, and hormonal domains. Multivariable regression models were used to examine effects of survey mode, adjusting for age, residence, socioeconomic status, diagnosing institute type, risk group and primary treatment modality. OutcomesThe percentage of patients for whom a domain score could not be calculated due to missing responses and the functional score within each domain. ResultsRegistry staff attempted to reach 8,586 men eligible to complete the EPIC-26. Of these, 4,301 (50%) returned the survey via email, 1,882 (22%) completed by telephone, and 197 (2.3%) by mail. 2,206 (26%) were uncontactable or did not respond. Email responders had the highest proportion answering all 26 questions (95% vs 87% by phone and 67% by mail). The sexual function score was unable to be calculated due to missing responses for 1.3% of email responders, 8.8% by phone, and 8.1% by mail. After adjustment for patient and disease factors, phone responders were almost 6 times more likely than email responders to have a missing score in this domain, odds ratio = 5.84 (95% confidence interval: 4.06–8.40). The adjusted mean functional score (out of 100) was higher for those responding by phone than email or mail across all domains. The largest adjusted difference between phone and email was observed in the hormonal domain (mean difference 4.5, 95% confidence interval: 3.5–5.4), exceeding the published minimally important difference for this score. Clinical ImplicationsStudies that ask questions regarding sexual health and use multi-modal data collection methods should be aware that this potentially affects their data and consider adjusting for this factor in their analyses. Strengths and limitationsA large study sample utilizing a widely available survey instrument. Patient specific reasons for non-response were not explored. ConclusionCompletion mode effects should be considered when analyzing responses to sexual function questions in an older, male population.Papa N, Bensley JG, Perera M, et al. How Prostate Cancer Patients are Surveyed may Influence Self-Reported Sexual Function Responses. J Sex Med 2022;19:1442–1450.

Sexual Activity, Function and Dysfunction After a Diagnosis of Bladder Cancer

Sexual dysfunction is common in those affected by cancer and local and radical treatments for Bladder Cancer (BC) can affect sexual function directly. To evaluate sexual function following a bladder cancer (BC) diagnosis. Self-reported sexual function was collected 10 years after a diagnosis of BC as part of a cross-sectional patient reported outcome measure (PROM) survey exploring life after BC diagnosis and treatment. Participants completed a combined EORTC QLQ-BLM30 and QLQ-NMIBC24 questionnaire, including questions on sexual activity, intimacy, erectile/ejaculatory function and vaginal dryness. A total of 1796 participants returned a completed survey out of 3279 eligible participants (55%). Of the participants who returned a completed survey, a total of 1530 (85%) participants answered sexual function questions. The median (IQR) age was 75 (70-81). Participants were predominantly men (78%) and married/in civil partnerships (66%). In total, 31% were sexually active. Vaginal dryness was common (66%) in women. Erectile and ejaculatory dysfunction (80% and 58% respectively) were common in men. Compared to TURBT +/- intravesical treatments, those who had radical treatment were less likely to be sexually active (adjusted OR 0.56, 95% CI: 0.44-0.72, P<0.001) and had worse mean scores for intimacy problems (29.1 [radical treatment] vs 12.1, P<0.001), male sexual problems (72.2 [radical treatment] vs 45.7, P<0.001) and overall sexual function (17.1 [radical treatment] vs 20.3, P=0.01). These findings highlight the magnitude of sexual dysfunction in the BC patient cohort and can help inform patients during the pre-op counselling process and shared decision making prior to BC treatments. This study provides the largest in-depth analysis of sexual activity and function after BC diagnosis and treatment, to date. Limitations include the lack of data on participants' sexual function prior to BC treatment and the heterogeneity with respect to time passed since last BC treatment. Sexual dysfunction in BC patients is common and rates appear higher following radical treatments compared to endoscopic. It is important to elicit these problems in clinics to enable counselling and treatment. Jubber I, Rogers Z, Catto JWF, et al. Sexual Activity, Function and Dysfunction After a Diagnosis of Bladder Cancer. J Sex Med 2022;19:1431-1441.

P.0401 Self-reported sexual function in depressed patients and serotonin 4 receptor brain binding – a Positron Emission Tomography study

P.0401 Self-reported sexual function in depressed patients and serotonin 4 receptor brain binding – a Positron Emission Tomography study

Androgens and estrogens predict sexual function after autologous hematopoietic stem cell transplant in men.

Autologous hematopoietic stem cell transplantation (AHSCT) is associated with sexual dysfunction and hypogonadism. Androgens are associated with sexual function in healthy men, but the role of estrogens is less well-known, and the association of these sex steroids with sexual function during AHSCT has not been characterized. The purpose of this study was to determine the predictive value of sex hormones before and acutely after AHSCT on sexual function recovery. We examined sex hormones and self-reported sexual function before (PRE) and 1-month post-AHSCT (MONTH1; n=19), and sexual function again 1-year post-AHSCT in men (YEAR1; n=15). Sexual function decreased from PRE to MONTH1 (p ≤ 0.05) with no differences between PRE and YEAR1. Erectile dysfunction was prevalent at PRE (68.4%) and increased at MONTH1 (100%; p ≤ 0.05) but was not different between PRE and YEAR1 (60.0%). From PRE to MONTH1, total testosterone (TT), dihydrotestosterone (DHT), follicle-stimulating hormone, and sex-hormone-binding globulin (SHBG) increased (p ≤ 0.02) while estradiol (p ≤ 0.026) and estrone decreased (p ≤ 0.001). MONTH1 TT and DHT were associated with sexual function at MONTH1, while PRE SHBG, MONTH1 estradiol, and change in estrone predicted sexual function at YEAR1. Sexual dysfunction is very prevalent prior to AHSCT and is transiently and severely worsened acutely after. AHSCT induces acute decreases in total and free estrogens, with SHBG increases leading to increases in total androgens, without changes in free androgens. Androgens and estrogens are both adversely affected by AHSCT but may predict sexual dysfunction in this population. This supports the premise that estrogen impacts sexual function independent from androgens and that steroid hormones are associated with acute changes in sexual function in this setting. Larger, controlled trials with long-term sex hormone assessment will need to confirm the association between early changes in estrogens and long-term sexual function recovery.

D-Chiro-Inositol improves testosterone levels in older hypogonadal men with low-normal testosterone: a pilot study

BackgroundSeveral recent journal articles report that d-chiro-inositol (DCI), primarily known as insulin second messenger, influences steroidogenesis. In particular, new evidence is arising on DCI ability to regulate aromatase expression and testosterone biosynthesis. In this regard, DCI administration could represent a good therapeutic opportunity in case of reduced levels of testosterone.Older men generally have lower testosterone concentrations than younger men, and recent randomized controlled trials have examined whether testosterone treatment might improve health outcomes in this age group. There is limited information about the safety of testosterone replacement therapy in these men, hence DCI could represent an interesting alternative for future trials. Therefore, this study aims to evaluate the effect of DCI treatment on testosterone levels in older male patient.ResultsTen older men with basal low testosterone levels were enrolled in this study. Patients took 600 mg of DCI, two-times per day, for 30 days. We evaluated hormonal and glycaemic parameters, weight, waist circumference, and Body-Mass Index at baseline (T0) and after 30 days (T1). Finally, all patients also filled in the standardized International Index of Erectile Function questionnaire and performed the Handgrip test at T0 and T1. Men receiving DCI showed increased androgen and reduced oestrogen concentrations, and improved glycaemic profiles. DCI was also associated with reduced weight, Body-Mass Index, waist circumference, and improved grip strength and self-reported sexual function. All these effects led to the improvement of sexual function and physical strength.ConclusionsIn this pilot study, DCI treatment improved the levels of testosterone and androstenedione at the expense of oestrogens in elder men with low basal levels of these hormones without adverse effects.Trial registrationClinicaltrials.gov: D-chiroinositol Administration in Hypogonadal Males, NCT04708249

Satisfying curiosities through “sextech”: Who is accessing non-traditional sexual education?

There is a growing field of apps/websites designed to address user concerns about sex using valid information (e.g., OMGYes.com). Young people may turn to this educational sexuality-related technology ("sextech") to address perceived shortcomings of traditional sex education. The current study investigated the prevalence, motivations, and outcomes associated with educational sextech use and examined links between sextech use and self-reported sexual function in a sample of 1029 young adults (18-24 years; 57% women). Those who reported past sextech use (n = 236; 32%) completed an anonymous survey assessing patterns of sextech use, perceptions of associated outcomes, and current sexual function. They reported use of one site/app on average. Sextech users had worse sexual function than a comparison group of non-users (n = 440; 18-24 years, 58% women) but reported perceiving sextech as helpful. Most users reported approach (vs avoidance) motives. This study is the first to our knowledge to investigate sextech use among young people and has implications for better reaching this group for sexual education.

Using the Movember Foundation's GAP3 cohort to measure the effect of active surveillance on patient-reported urinary and sexual function-a retrospective study in low-risk prostate cancer patients.

BackgroundActive surveillance (AS) for low-risk prostate cancer (PCa) is intended to overcome potential side-effects of definitive treatment. Frequent prostate biopsies during AS may, however, impact erectile (EF) and urinary function (UF). The objective of this study was to test the influence of prostate biopsies on patient-reported EF and UF using multicenter data from the largest to-date AS-database.MethodsIn this retrospective study, data analyses were performed using the Movember GAP3 database (v3.2), containing data from 21,169 AS participants from 27 AS-cohorts worldwide. Participants were included in the study if they had at least one follow-up prostate biopsy and completed at least one patient reported outcome measure (PROM) related to EF [Sexual Health Inventory for Men (SHIM)/five item International Index of Erectile Function (IIEF-5)] or UF [International Prostate Symptom Score (IPSS)] during follow-up. The longitudinal effect of the number of biopsies on either SHIM/IIEF-5 or IPSS were analyzed using linear mixed models to adjust for clustering at patient-level. Analyses were stratified by center; covariates included age and Gleason Grade group at diagnosis, and time on AS.ResultsA total of 696 participants completed the SHIM/IIEF-5 3,175 times, with a median follow-up of 36 months [interquartile range (IQR) 20–55 months]. A total of 845 participants completed the IPSS 4,061 times, with a median follow-up of 35 months (IQR 19–56 months). The intraclass correlation (ICC) was 0.74 for the SHIM/IIEF-5 and 0.68 for the IPSS, indicating substantial differences between participants’ PROMs. Limited heterogeneity between cohorts in the estimated effect of the number of biopsies on either PROM were observed. A significant association was observed between the number of biopsies and the SHIM/IIEF-5 score, but not for the IPSS score. Every biopsy was associated with a decrease in the SHIM/IIEF-5 score of an average 0.67 (95% CI, 0.47–0.88) points.ConclusionsRepeated prostate biopsy as part of an AS protocol for men with low-risk PCa does not have a significant association with self-reported UF but does impact self-reported sexual function. Further research is, however, needed to understand whether the effect on sexual function implies a negative clinical impact on their quality of life and is meaningful from a patient’s perspective. In the meantime, clinicians and patients should anticipate a potential decline in erectile function and hence consider incorporating the risk of this harm into their discussion about opting for AS and also when deciding on the stringency of follow-up biopsy schedules with long-term AS.

Sexual Function and Depressive Symptoms in Middle-Aged Women with LongLasting Type 1 Diabetes – A Cross-Sectional Study

Background &amp; aim: Women and men with diabetes, type 1 (T1D) and type 2 (T2D) develop complications in small and large blood vessels as well as in nerve pathways over time. In men, erectile dysfunction is a well-documented complication. However, sexual dysfunction in women with different types of diabetes is less studied. Sexual dysfunction is associated with lowered health-related quality of life and depression. The aim of the study was to investigate self-reported sexual function and signs of depression in middle-aged women with long-lasting T1D. Methods: A cross-sectional questionnaire study including the Female Sexual Function Index (FSFI) and the Patient Health Questionnaire (PHQ-9) together with background questions was designed. The sample was women aged 45-66 with T1D for at least 15 years, identified from clinical medical records at four hospitals in southern Sweden. Descriptive statistical analysis of background factors, depression, and self-reported sexual dysfunction, as well as correlation and regression analysis, are presented. Results: A total of 212 women completed the questionnaire, mean age 54.1 (SD: 5.83), mean years with T1D 36.2 (SD: 11.42). Almost half of the women had sexual dysfunction (45.2%; FSFI &lt; 26.55, max 36) and the mean full score was 23.73 (SD: 10.57). The FSFI domains are desire, arousal, lubrication, orgasm, satisfaction and pain. Symptoms of depression measured by PHQ-9 were reported by 39.8%. A low FSFI was significantly associated with severe depression (p&lt;0.001). Conclusions: Problems with sexual dysfunction and depression in middle-aged women with long-lasting T1D are common and may be unreported unless addressed in clinical care. Nurses could start asking women about problems with lubrication and vaginal pain in relation to sexual activity. Lubricants or local estrogen therapy could prevent those problems. Routinely assessing depressive status is equally important in improving quality of life for women with T1D.