Sexual Activity Research Articles

(027) HIGH PREVALENCE OF SYMPTOMATIC CLITORAL ADHESIONS IN PATIENTS WITH NEUROPROLIFERATIVE VESTIBULODYNIA UNDERGOING VESTIBULECTOMY

Abstract Introduction Clitoral adhesions occur when the epithelial skin surfaces of the prepuce and glans clitoris become adherent. The severity of clitoral adhesions is best documented during full prepucial retraction using vulvoscopy with photography; mild, moderate, and severe clitoral adhesions occur when there is >75%, 25-75%, and <25% visualization of the glans clitoris, respectively. Clitoral adhesions are associated with a closed compartment with inadequate clearance of keratinaceous sloughed material from the epithelial surfaces of the prepuce and glans clitoris. This trapped material may form keratin pearls resulting in local inflammation and glans hypersensitivity/pain. In one study of 614 evaluable individuals with vulvas who presented to a sexual medicine clinic for various sexual dysfunctions, 23% demonstrated clitoral adhesions based on vulvoscopy with photography (mild 44%, moderate 34%, and severe 22%) of which 14% complained of clitoral hypersensitivity/pain. We observe symptomatic and asymptomatic clitoral adhesions occurring in women presenting with entry dyspareunia, severe allodynia and hyperalgesia, who are clinical suspected and pathologically conformed to have neuroproliferative vestibulodynia (NPV). Surgical management of the NPV involves complete vestibulectomy with vaginal advancement flap. For those patients who also have clitoral adhesions, lysis of clitoral adhesions may be performed at the time of vestibulectomy. Objective To examine the association between clitoral adhesions and NPV. Methods A retrospective chart review of patients with NPV who underwent vestibulectomy and lysis of clitoral adhesions concomitantly between January 1, 2021 and October 31, 2023 was performed. History, physical examination, pre-op vulvoscopy with photographs, operative records and patient outcome data were collected. Results Sixty-three patients with NPV, (mean age 29, range 19 – 64 years), underwent vestibulectomy surgery. A total of 34 (54%) of these patients underwent concomitant lysis of (mild (38%), moderate (50%), or severe (12%) clitoral adhesions. Multiple keratin pearls were removed in 91% of cases. More than half (53%) of these patients with NPV and clitoral adhesions complained of glans hypersensitivity/pain during pre-op vulvoscopy. The majority (88%) of this cohort reported “somewhat better” or “very much better” on PGI-I after lysis of adhesions. No negative side effects following the lysis of clitoral adhesions were noted. Conclusions There is a high prevalence of symptomatic clitoral adhesions in patients with NPV (53%) compared to women who presented to a sexual medicine clinic for other sexual concerns (14%). While clitoral adhesions are not always symptomatic, we hypothesize the high prevalence in patients with NPV may be due any of the following: i) pain/stress resulting in peripheral nerves releasing neurotransmitters that stimulate proliferation/differentiation of prepucial sebaceous glands and upregulate prepucial sebaceous cell lipid synthesis, ii) infrequency of clitoral tissue engorgement from sexual activity, iii) limitation or aversion to touching or retracting clitoral prepucial tissue, iv) increased frequency of wearing menstrual pads rather than tampons, v) severe genital pain perceived as co-existing in both vestibule and clitoris and vi) the patient is already scheduled for surgery under anesthesia so the patient conveniently agrees to also undergo lysis of adhesions. Clinicians should be aware of this high association. Disclosure No.

(026) LOWER SEXUAL FUNCTIONING AND, IN PARTICULAR, SEXUAL PAIN IS ASSOCIATED WITH MORE FREQUENT USE OF ALCOHOL AND RECREATIONAL SUBSTANCES WITH SEXUAL ACTIVITY IN YOUNG WOMEN

Abstract Introduction Research on the relationship between alcohol use and women’s sexual functioning has varied, with some studies showing that alcohol use increases self-reported sexual arousal and others showing alcohol-induced decreases in genital arousal (George, 2019). As such, expectancies tend to be self-fulfilling for subjective effects of alcohol, regardless of the physiological effects (Lee et al., 2014). Most research on sexual functioning and alcohol use has failed to look at the intentional use of alcohol to enhance sexual activity, despite the common use of recreation substances with sexual activity (sex-linked substance use, SLSU) in college age populations (Willis et al., 2021; Herbenick et al., 2018). One study found that while drinking was related to fewer problems with sexual function, SLSU was associated with lower sexual functioning for arousal, lubrication, orgasm, and satisfaction but not sexual pain (Witting et al., 2008). It has been proposed that women may engage in SLSU for different reasons such as to overcome inhibitions or to increase pleasure; however, it is unclear how these intentions are related to sexual dysfunction and relationship status. Objective To investigate how patterns of SLSU for different purposes are related to different dimensions of women’s sexual function. Methods We surveyed 701 women (mean age 20.42, SD = 2.55) in the Midwestern US. Participants reported their frequency of SLSU within the last month to “feel less sexually inhibited”, “increase your sexual desire or arousal” and “increase your sexual pleasure, or to make it easier to have an orgasm”. SLSU was measured as a total factor across the three intentions and as individual subfactors. Participants also completed the Female Sexual Function Index (FSFI; Rosen et al., 2000) and demographic measures including relationship status. Using independent multivariate general linear models, we examined how subfactors of the FSFI, particularly pain, were related to frequency of SLSU. Results Our results indicate that among young adult women, higher use of SLSU broadly was associated with FSD as measured by the FSFI. Specifically, lower sexual functioning was associated with more frequent SLSU to feel less sexually inhibited and to increase sexual desire/arousal, but not SLSU to increase sexual pleasure/have an orgasm. Additionally, when considering relationship status, there was an interaction between SLSU and FSD such that women in a relationship without FSD reported the lowest SLSU compared to women in a relationship with FSD and compared to single women without FSD. Single women who did not meet criteria for FSD reported the highest levels of SLSU. When investigating subfactors of the FSFI and SLSU intentions, contrary to prior findings, women with more sexual pain reported more frequent SLSU to feel less sexually inhibited and to increase sexual pleasure/have an orgasm, but not to increase sexual desire/arousal. Conclusions Our results indicate that sexual functioning and in particular, sexual pain functioning, are related to frequency of SLSU. Further, our results suggest that both sexual function and relationship status interact in relation to SLSU. Clinically, these findings reinforce the value of discussing sexual pain and dysfunction alongside substance use intentions, particularly among young college aged women. Disclosure No.

(008) VAGINAL TESTOSTERONE ABSORBANCE AFTER SEXUAL AROUSAL

Abstract Introduction While topical (exogenous) estrogens have been a focus of treatment for vaginal pain, recent work has shown testosterone may also revitalize weakened vaginal tissue. This research has documented that vaginal tissue responds well to exogenous testosterone treatment, supporting the hypothesis that endogenous testosterone may play a significant role in vaginal health. However, is it not known how the dynamics of vaginal arousal may contribute to activity of endogenous testosterone within the vaginal environment. Specifically, there is reason to expect that vaginal sexual arousal may activate mechanisms within the vaginal tissue that increase absorption of testosterone from the mucosal layer into the tissue beneath. Objective This project aims to characterize the influence of vaginal arousal on the presence of testosterone in the vaginal mucosa both pre- and post-arousal, and the within-person stability of these effects over time (3 weeks). Methods Analyses are drawn from an ongoing clinical trial in which participants complete 3 in-lab sessions spaced 3 weeks apart, in which they provided samples of cervicovaginal fluid before and after watching an erotic video (~7 minutes). For each fluid sample, participants insert a disposable menstrual cup, which sits loosely around the cervix, for about 10 minutes. After the post-arousal menstrual cup is removed, participants complete a survey battery that includes demographics and measures of sexual function and sexual desire. Results For the present analysis, data were drawn from 68 participants that had pre- and post-arousal samples for at least one study session. Preliminary tests revealed that, controlling for changes in fluid volume, testosterone in the vaginal mucosa decreased significantly between pre- and post-vaginal sexual arousal (F(1, 197.26) = 67.29, p < .0001). Additional data regarding the association between absorption of testosterone during arousal and self-reported sexual functioning will also be presented. Conclusions Though further work is needed to confirm testosterone is absorbed into the surrounding vaginal tissue, our findings suggest a significant movement of testosterone out of cervicovaginal fluid during sexual arousal. Likely, the increased blood flow that accompanies vaginal sexual arousal allows for greater absorption of testosterone originally present in the mucosa into the vaginal tissue. If vaginal sexual arousal allows for greater testosterone absorption, it may provide a unique window of time during which application of exogenous testosterone may be most advantageous. Further, if endogenous testosterone absorption happens during masturbation or sexual activity, this may function over the longer term as a protective factor for tissue integrity. Disclosure No.

(048) PERI-ORGASMIC PHENOMENON IN WOMEN: VARIABILITY AND CIRCUMSTANCES

Abstract Introduction Introduction: Peri-orgasmic phenomena are rare physical or psychological responses experienced by some individuals in association with orgasm. By definition, a peri-orgasmic response to orgasm is not related to the physiology of orgasm and does not include psychological, whole body, or genito-pelvic sensations commonly experienced during sexual activity. While many women may experience coital incontinence, uterine contractions, female ejaculation from peri-urethral glands or pelvic pain simultaneous with orgasm, these are not considered to be peri-orgasmic phenomena. The literature on peri-orgasmic phenomena is sparse and comprised almost exclusively of case reports and reviews. Examples of reported physical symptoms include cataplexy, facial pain, ear pain, foot pain, and sneezing. Emotional symptoms include crying, dysphoria, laughter, hallucinations, and panic attacks. While a number of mechanisms to explain physical phenomena have been proposed, the etiology of these symptoms is not understood. Objective Objective: To survey a population of women that experience peri-orgasmic phenomena to determine 1) the relative frequency of various symptoms, 2) the consistency in which symptoms occur, and 3) if the symptoms are more likely to occur in partnered sexual activity as opposed to masturbation. Methods Methods: A short video explaining peri-orgasmic phenomena was posted on social media for the purposes of recruiting women who experienced physical or psychological peri-orgasmic phenomena. They were then directed to a six-question anonymous survey. Results Results: 3800 women viewed the video. 72 women, ages 18 to over 65 who self-identified as experiencing peri-orgasmic phenomena responded to the online survey. 62% of women reported physical symptoms: Headache- 33%, Muscle weakness 24%, foot pain or tingling 20.56%, facial pain or itching 3.25 %, sneezing 2.22%, yawning 1%. 87.5% of women reported psychological symptoms: 60.32% crying, 42.86% sadness or urge to cry (with a positive sexual experience), 38% laughing, 4.76% hallucinations. 14% of women experienced symptomatology consistently with orgasm. 74.65% only experienced symptoms “sometimes”. The majority of respondents (50.7%) experienced symptoms exclusively with partnered sexual activity, 9.86% during masturbation, and 14.08% with the use of a vibrator. Many respondents experienced more than one symptom. Over 30% experienced both physical and psychological symptoms. Conclusions Conclusions: Peri-orgasmic phenomena, while rarely reported, appear to occur more frequently than generally appreciated. Most women who report peri-orgasmic phenomena experience psychological symptoms such as crying or laughing. Physical symptoms occurred less often, and in most cases were headache, muscle weakness, or foot pain. While some symptoms are more common, there is a wide range of both physical and psychological symptoms reported in this survey. These phenomena do not occur consistently with orgasm and are more likely to occur with a partner than during masturbation, suggesting that there may be an emotional component to both physical and psychological symptoms. Vibrator use was not preferentially associated with peri-orgasmic phenomena indicating that it is unlikely that the intensity of the orgasm determines the likelihood of symptomatology. More research is needed to determine the etiology of these psychological and physical responses to orgasm. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Sermonix.

(115) SEXUAL SELF-ESTEEM IN TWO SAMPLES OF ADOLESCENT AND YOUNG ADULT CANCER SURVIVORS: A QUALITATIVE INVESTIGATION

Abstract Introduction As rates of survival from cancer continue to increase in adolescents and young adults, long term physical and psychological impacts are likely to rise. For those diagnosed with cancer during childhood or adolescence, one such late effect may be delayed sexual development. Delayed sexual development may manifest as issues of sexual functioning (i.e., the ability to successfully complete the sexual response cycle) as well as issues of sexual self-concept (i.e., how one navigates the world as a sexual being). These issues may, in turn, impact survivors’ self-esteem. These concerns are likely to be exponentially exacerbated when survivors identify as a member of a sexual and/or gender minority (SGM) group. Objective Based on empirical research and two studies from our team, we examine variables that impact the sexual self-esteem of AYA cancer survivors, particularly those that identify as members of an SGM group. Methods In our small pilot project, we conducted cognitive interviews to assess whether a novel model, adapted from sexual health frameworks established by Woods (1995) and Evan et al. (2006), applied to AYA cancer survivors. Following analysis of these interviews, we refined our model, and received funding for a larger qualitative study (n = 30) tailored to AYA cancer survivors who identify as members of an SGM group. Results Four cisgender female cancer survivors participated in this small qualitative study, which provided preliminary validation that variables such as body image, amount of sexual education, quality of interpersonal relationships, and sexual functioning, were all tied into one’s perception of their sexual self-esteem. Several additional potential variables were identified from these interviews, including amount of sexual equity (how much participants felt that their sexual activity was balanced between them and a partner), religiosity, negative self-evaluative emotions (e.g., guilt and shame), and SGM identity, that could influence sexual self-esteem. Preliminary analyses of our SGM-focused qualitative study have revealed high levels of asexuality and mental health comorbidities that may be affecting sexual self-esteem. Recruitment and analysis for this study is ongoing. Conclusions Results from these two studies will provide some of the first empirical research on sexual self-esteem in a population for which sexual health is vastly under researched. We anticipate that this work will lay the foundation for novel measurements and interventions for these individuals. By providing a voice to those who are underrepresented in research, we hope that this research may have high-impact in informing future interventions to become more holistic and culturally-informed to allow for studies to ensure they are reflecting all identities of cancer survivors. Finally, we anticipate that this research may be of significant benefit to oncology providers and clinicians to overhaul and adapt sexual education for patients in treatment, as well as inform areas of concern and assessment for these providers and clinicians, particularly among their SGM patients and survivors. Disclosure No.

(010) ERECTION FUNCTION AND BOTHER IN TRANSGENDER WOMEN TAKING GENDER AFFIRMING HORMONE THERAPY AND AFTER PRE-VAGINOPLASTY BILATERAL ORCHIECTOMY

Abstract Introduction Gender-affirming (GA) hormone therapy (GAHT) and bilateral orchiectomy (GABO) significantly reduce gender dysphoria in transgender women (TW). A key source of dysphoria is penile erection. To date, no studies have described erectile function (EF) among TW taking GAHT and after GABO. Objective We aimed to: 1) Evaluate EF among two cohorts of TW before vaginoplasty: One taking only GAHT >6mo., and the other taking GAHT & >6 months post-GABO). 2) Determine the incidence of erections among these cohorts based on whether they do or do not use their penis for sexual activity 3) Query subjects’ interest for any treatment that could eliminate penile erections before vaginoplasty. Methods Pre-vaginoplasty TW on GAHT were surveyed anonymously. Participants were grouped based on GABO status. We queried EF using the Sexual Health Inventory for Men (SHIM) questionnaire at three points (pre-GAHT, >6 months after starting GAHT, and >6 months post-GABO). We also queried the incidence of any erections in these three states, and, whether patients would undergo a procedure that promised to reduce or eliminate erections. Results 31 participants participated (16 GAHT-only; 15 GAHT+GABO). Median age was 37 years (IQR 25.3 Y) and median years on GAHT was 5.5 years (IQR 7.3 Y). 21/31 (68%) reported they do not use their penis for sexual activity. TW on GAHT and GAHT+GABO showed reduced SHIM score, with lowest scores in TW who did not use their penis during sex (Figure 1a). Spontaneous erections were reduced for women who did not use their penis during sex in the GAHT+GABO group, vs. the GAHT-only group, but both groups reported high incidence of erections with arousal and during sex (b). Most TW showed a high interest in any procedure that promised to completely eliminate their erections (c). Conclusions Our study is the first to show that GAHT reduces SHIM scores, but the greatest reduction is in TW who do not use their penis for sexual activity. While GABO significantly reduces spontaneous erections vs. GAHT alone, neither appears to have much effect on erections with sexual arousal or sexual activity. The majority of women reported significant dislike & dysphoria from their erections, and would choose to undergo any reasonable procedure that completely eliminated, or at least reduced, their erections. Further study with larger numbers is warranted. Disclosure No.

Penile microbiome: decoding its impact on HIV risk.

The penile microbiome has been linked to local inflammation and increased risk for sexually transmitted infections, including HIV. This review explores recent studies of this emerging area of HIV research. The male urogenital tract supports multiple distinct niches, where their associated microbiome are shaped by abiotic (e.g., oxygen, moisture) and biotic (e.g., host immunity) environmental factors and host behaviors, particularly sexual activity. In addition, male circumcision is a significant drivers of male genital microbiome in both children and adults. Recent sexual partner studies provide new insight into the exchange of genital bacteria and concurrent local immune changes that may impact HIV risk. The male genital microbiome is shaped by the local microenvironment and host behaviors including sexual activity. Improving our understanding of the connection between the male genital microbiome, local inflammation, and HIV susceptibility, as well as how pro-inflammatory genital bacteria are transmitted between sexual partners may inform new strategies to prevent HIV transmission.

(135) DYSORGASMIA IN A FEMALE PATIENT FOLLOWING TRAM RECONSTRUCTIVE SURGERY

Abstract Introduction Many women struggle with sexual dysfunction, either in desire, arousal, orgasm, and/or pain. Despite the incidence of dysorgasmia in the general population, there is a paucity of literature focusing on its causes and treatment, especially when attributed to medical conditions and surgery. Objective This case report describes an unusual presentation of post-orgasmic pain following breast reconstruction surgery using abdominal tissue. Methods A 73-year old woman presented with chronic orgasmic pain in the deep pelvic area following transverse rectus abdominal muscle (TRAM) flap reconstruction for a mastectomy in the setting of breast cancer treatment. The patient was diagnosed with ductal carcinoma breast cancer in 2011, where she received a lumpectomy with radiation. After 2 years, in 2013, she was diagnosed with a recurrence of breast cancer. She underwent a mastectomy with no complications, with a transverse rectus abdominal muscle flap reconstruction surgery conducted five days later. Following the TRAM reconstruction, the patient consistently began to observe pain with orgasm. Results Prior to this surgery, the patient had experienced normal sexual intercourse and orgasm throughout her life. The patient describes pain with orgasm associated with self-stimulation, manual stimulation, oral stimulation, and vaginal penetration. The patient describes the pain associated with orgasm as a “deep, dull pain” causing nausea and is often associated with abdominal spasms. The pain lasts 2-3 minutes following orgasm and is rated as a 5-6/10 on the pain scale. The pain is not associated with urinary incontinence, urinary fullness, or bowel dysfunction. Physical exam revealed a tense abdominal wall consistent with TRAM reconstruction, well healed incisions, a normal clitoris in terms of appearance and sensation and normal pelvic floor muscles. Conclusions An orgasm is a complex process which involves interplays between the clitoris, the glans pubis, and the sympathetic activation system. A four-phase model for orgasm has been explored, which separates the orgasm response into: desire (the urge to participate in sexual activities), arousal (increased genital blood flow and clitorial erection), orgasm (after the threshold for stimulation has been reached), and resolution. Dysorgasmia can be multifactorial, and while still unclear, etiologies include pelvic floor dysfunction and/or spasm. While the pathophysiology of how the pelvic floor is connected to orgasm is not exactly understood, it is theorized to be due to dysregulated coordination of pelvic floor muscles. A transverse rectus abdominis muscle (TRAM) flap is a common breast reconstructive procedure following mastectomy. The most common complications of a TRAM flap surgery are hernias/abdominal bulges, fat necrosis, and loco-regional occurance. Interestingly, TRAM surgeries have previously been associated with pelvic floor dysfunction in women due to an increase in abdominal pressure. Since the pelvic floor is tightly connected to the mechanism of an orgasm, it is possible that disruptions to the pelvic floor may lead to painful spasms during orgasms. This is also consistent with the patient’s sensation of abdominal “spasms” during/after orgasm. While not all TRAM surgeries cause dysorgasmia, this patient’s dysorgasmia may be postulated to be secondary to pelvic floor dysfunction. Disclosure No.

(079) ENCOURAGING A GREATER AWARENESS OF ALL RELEVANT FACTORS WHEN SEXUAL MEDICINE AND SEX THERAPY CLINICIANS APPLY THE BIOPSYCHOSOCIAL MODEL

Abstract Introduction The biopsychosocial model is generally considered the current gold standard for the diagnosis and treatment of sexual disorders (Rullo et al, 2016). Shortcomings in how clinicians apply it remain. Given the model’s importance to our field, we must periodically re-examine ways to optimize its strengths and minimize misapplication. This presentation encourages all to examine our understanding and application of the model so it remains adequately inclusive and robust for diagnosis and treatment. Doing so will remind clinicians of how they already use it productively but will also alert them to potential “blind spots” resulting from their specialized training and practice cultivated within their professions of origin. The biopsychosocial model must be a “stand-in” for all the predisposing, precipitating, and maintaining biological, medical/surgical, cognitive, behavioral, emotional, social, and cultural factors involved in the etiology and treatment of sexual disorders. The relevant aspects of those factors are best understood at a granular detail level that recognizes their proportional contribution to a given individual’s sexual response. Most clinicians pay lip service to using a biopsychosocial approach, but too frequently, there is an overly exclusive focus on one or two aspects of the model, with insufficient awareness of other contributing factors. How many sex therapists offering diagnosis and treatment worldwide (typically aware of psychosocial nuances) are conversant with the impact of the biomedical diagnostic and treatment advances for cancers and chronic diseases, which may extend life but often result in diminished sexual function and satisfaction? How many know the latest benchwork discoveries and investigative techniques that improve understanding of drug interactions and mechanisms illuminating etiology? Reciprocally, do most physicians attend to the many cognitive, emotional, behavioral, and cultural factors contributing to or exacerbating a sexual disorder? How many physicians, when prescribing, inquire of the patient (or their partner) if the patient’s goals for sexual activity are aligned with those of their partner? Physicians who prefer broader assessment find time limitations negating the potential for multilayered engagement. Finally, how many of us provide competent cultural awareness and sensitivity when evaluating and treating our patients? Telehealth is accelerating global access to patients, which creates an ever-increasing need for practitioner sensitivity to patient population differences. Many subscribe to a multidisciplinary model, whether working alone or in a team setting, but siloed thinking is still reinforced. There is increasing collegial respect, but perspectives remain separated. Therefore, it becomes incumbent upon all to mindfully seek continuing education opportunities (offered by our professional societies, etc.) to fill in the gaps we must recognize in our expertise. In applying our model, we must aspire to include recognition of all relevant factors, in effect leading to more comprehensive care while retaining the ease of use of the term “biopsychosocial.” Objective Given the biopsychosocial model’s importance to our field, we must periodically re-examine ways to optimize its strengths and minimize misapplication. Methods Expert opinion commentary. Results There are shortcomings in how clinicians apply the biopsychosocial model. Conclusions We must aspire to recognize and appreciate all relevant etiologic and treatment factors when applying our model, leading to more comprehensive care and greater patient and clinician satisfaction. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Palatin, Sprout, Pfizer, Roman, Mediflix, Kanna.

(112) SEXUAL HEALTH AFTER RISK REDUCING SALPINGO-OOPHERECTOMY FOR BRCA PATIENTS

Abstract Introduction There is no study assessing the changes in sexual health after risk reducing oopherectomy in premenopausal women. Objective Objective: To evaluate the effect of risk-reducing salpingo-oophorectomy (RRSO) on change in sexual function in women aged 34-50 years with pathogenic variants in BRCA1 or BRCA2 (BRCA1/2). Methods Methods: The PROSper (Prospective Research of Outcomes after Salpingo-oophorectomy) study is a prospective cohort of women aged 34-50 years with BRCA1 or two germline pathogenic variants that compares health outcomes after RRSO to a non-RRSO control group with ovarian conservation. Women aged 34-50 years, who were planning either RRSO or ovarian conservation, were enrolled for 3 years of follow-up. Sexual Function was measured using the Sexual Health Outcomes in Women (SHOW-Q) a validated survey tool that measures sexual desire, frequency, satisfaction, orgasm, and discomfort specifically in patients with a history of a pelvic condition, including oophorectomy. Differences in sexual function between the RRSO and non-RRSO groups, were determined by using mixed effects multivariable linear regression models. Results Results: Of 100 PROSper participants, all completed SHOW Q. At baseline patients who had undergone RRSO before enrollment had lower SHOW-Q scores (71 vs 64). Across all 60 months of the study the SHOW-Q scores remained persistently lower in those undergoing RRSO raging from 6-13 points across the time studied (p <0.05) controlling for age, depression, partner, menopausal symptoms and hormone therapy Conclusions Conclusion: Women with pathogenic variants in BRCA1/2 who undergo RRSO before the age of 50 years have greater effects on sexual function than those that do not. The detrimental effect of rRRSO is not otherwise explained by hormone therapy, depression or menopausal symptoms. This information should be incorporated into counseling and post op management to consider options to improve sexual health post surgery Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: sprout pharma.

Representation of social actors in The Straits Times and The Independent Singapore: A comparative critical discourse analysis of the repeal of Section 377A in Singapore

Section 377A was a decades-old law introduced in Singapore in 1938, which had made sexual intimacy between gay men, even when consensual, punishable by a maximum sentence of two years in prison. In Aug 2022, in what many considered as a historic moment in Singapore, the Prime Minister announced its repeal. Following the announcement, several related news articles were published by the news outlets The Straits Times and The Independent Singapore. This study, therefore, sets out to undertake a critical discourse analysis of these news articles, focusing on the representation of two groups of social actors, namely the Singapore government and gay people. Guided by a framework that constitutes the theoretical approach of Critical Discourse Analysis (CDA), Fairclough, Van Dijk and Wodak’s perspectives on power relations as discursive, as well as Van Leeuwen's theories on discourse construction and representations of social actors, the analysis of the textual data reveals distinct patterns in how the Singapore government and gay people are represented. In an area where there is little comparative critical discourse research on how more powerful groups and less powerful groups are represented in news coverage following significant legal and sociopolitical changes in a society, this article aims to deepen readers’ understanding of such discursive patterns and foster media literacy, thereby attaining the practical result of pointing readers in the direction of change – a desired outcome that CDA seeks through its research.

(059) THE EFFECTIVENESS OF SYSTEMIC TREATMENT ON SEXUAL RELUCTANCE IN WOMEN

Abstract Introduction Diminished sexual desire among women is a prevalent issue that transcends various age, cultural, social, and economic contexts. This condition significantly impacts quality of life, mental well-being, and marital satisfaction, leading to considerable psychological and emotional distress for those affected. In light of these consequences, the current study was undertaken to examine the efficacy of systemic treatment in addressing sexual reluctance in women. Employing a quasi-experimental design with a pre-test-post-test structure, the study incorporated a control group and included a two-month follow-up period Objective Lack of desire for sexual activity among women is a widespread issue that transcends various age groups, cultural contexts, and socio-economic conditions. This condition significantly impacts the overall quality of life, mental well-being, and marital satisfaction, inflicting numerous psychological and emotional challenges on those affected. Recognizing the substantial consequences associated with this problem, the present study was undertaken to explore the effectiveness of systemic treatment in addressing sexual reluctance in women. Methods The research employed a quasi-experimental design with a pre-test-post-test structure, incorporating a control group and a two-month follow-up period. The statistical population comprised women experiencing hypoactive sexual desire in Tehran in 2019. Twenty-four participants were selected through a voluntary sampling method and randomly assigned to experimental and control groups, each consisting of 12 women. The experimental group underwent systemic treatment over eight sessions during two months, with one 90-minute session per week. The Sexual Desire Questionnaire (Halbert, 1992) was utilized for data collection. Analysis of the collected data was conducted using repeated measurement ANOVA through SPSS 23 statistical software Results The data obtained from the study were analyzed through repeated measurement ANOVA via SPSS 23 statistical software. The results showed that systematic therapy has significant effect on the women’s hypoactive sexual desire (p<0.001) in a way that this therapy could lead to the decrease of women’s hypoactive sexual desire. Conclusions The current study suggests that systematic therapy is a viable method to alleviate hypoactive sexual desire in women. This approach involves various techniques, including correcting unrealistic expectations, addressing communication challenges, exploring doubts about treatment, promoting accountability for sexual intimacy, rectifying misconceptions about love and sexual behavior, analyzing conflict resolution styles, training in punctuation techniques, attending to emotional expression, revisiting the familial environment, scrutinizing parental messages, incorporating positive themes, addressing fear of intimacy and power dynamics, and identifying and expressing anger in a healthy manner. Overall, this comprehensive approach is considered effective in reducing low sexual desire in women. Disclosure No.

(058) HAVING SEX OUT OF A SENSE OF DUTY: THE INFLUENCE OF NONCONSENSUAL SEXUAL EXPERIENCES AND SEXUAL FUNCTIONING

Abstract Introduction Pleasure and emotional bonding are two motives for why women have sex that are commonly discussed in the literature. Less commonly reported, but frequently endorsed by women, is the motive “duty sex,” in which an individual engages in sex out of a sense of obligation to maintain a relationship or their partner’s feelings towards them, to ensure their partner will not leave them, or to avoid conflict. Engaging in duty sex can yield negative outcomes such as emotional discomfort and lower relationship satisfaction, although there have been some reports of positive outcomes, including feelings of closeness (O’Sullivan & Allgeier, 1998). Women with a history of nonconsensual sexual experiences (NSEs) show high rates of sexual dysfunction (Pulverman et al., 2018), and sexual dysfunction in women has been linked to a higher tendency to engage in duty sex (Meston & Stanton, 2017). Objective This study aimed to investigate the potential connections between sexual dysfunction and the frequency of duty sex in women with NSE histories. Methods Women (N = 820; mean age = 35.36, SD = 11.32) completed the Nonconsensual Sexual Experiences Inventory (NSEI; Kilimnik & Meston, 2017), the Female Sexual Function Index (FSFI; Rosen et al., 2000), items indicative of duty sex from the Sexual Motivations Scale (Cooper et al., 1998), as well as other measures not reported here. Results Women were categorized as either having NSE history (n = 465) or not (n = 355) based on the NSEI. FSFI total scores predicted duty sex such that women with lower sexual functioning reported engaging in more duty sex, R2 = .18, F(1, 654) = 147.30, p < .01, and higher levels of duty sex predicted lower sexual satisfaction, R2 = .057, F(1, 807) = 50.13, p < .01. Results from a multiple linear regression revealed that NSE history significantly predicted engagement in duty sex after controlling for sexual function, R2 = .19, F(2, 653) = 77.06, p < .01. Conclusions The results suggest that women with NSE histories endorse a higher frequency of duty sex motives compared to women without NSE histories that cannot be explained by variability in sexual functioning. That is, women with NSE histories were more likely to engage in sex out of fear that their partner would love them less, be angry with them, or leave them if they refused to engage in sex, and this effect was over and above the relationship of these motives with sexual dysfunction. As engaging in these duty sex motives was linked to overall sexual dissatisfaction, future research that examines the cognitive mechanisms by which having a history of NSE leads women to feel obligated to have sex out of a sense of duty would help enhance the sex lives of women with NSE histories. Disclosure No.

(066) EXPLORING THE IMPACT OF ALCOHOL ON SEXUAL FUNCTION IN PERIMENOPAUSAL WOMEN

Abstract Introduction Sexual well-being is an important quality of life component to women throughout life, and during menopausal transition and beyond. Female sexual response cycle includes desire, arousal, orgasm, and resolution phases. Female sexual dysfunction (FSD) encompasses all phases of sexual response cycle and can lead to distress for both the woman and her partner and warrant further investigation. Research has indicated both positive and negative associations between alcohol consumption and sexual health, our review goal is to further explore the relationship between alcohol consumption and sexual function in perimenopausal women. Objective We aim to review the current literature regarding the influence of alcohol use on sexual health during the menopausal transition and beyond. Methods The examination of alcohol consumption and its effects on sexual health in menopausal women was performed through reviewing existing literature. The literature search was completed in the Ovid MEDLINE database (1946- Present) in August 2023. 16 articles were identified in the initial search. 12 articles met our inclusion criteria and were independently reviewed by the authors. Results from these articles were summarized. The search was limited to the English language and the last 20 years (2003-current). Keywords included: menopause, pre-menopause, post menopause, perimenopause, alcohol use, alcohol related disorder, and sexual function. Results Seven out of 16 articles reviewed linked a negative association between alcohol consumption and female sexual function. Seven indicated a positive association between alcohol use and sexual function and 2 articles did not reveal an association. The findings of our review indicate a complex relationship of alcohol on women's sexual function. Studies indicating a positive association between mild alcohol consumption (equal or less than 0.21 FL oz. alcohol/day) and improved sexual function. This effect was theorized due to alcohol increasing endogenous estrogen or due to behavioral changes such as disinhibition, influencing sexual activities influenced by alcohol or subjective arousal due to drinking. Additionally, a positive association was seen between increased alcohol consumption and Female Sexual Function Index (FSFI) scores. However no significant influence on Female Sexual Distress Scale scoring was identified which is a key component to FSD. Other studies showed that excessive or prolonged alcohol consumption (more than 1.00 FL oz. alcohol per day) found to be associated with worsening sexual function and can impact all 6 domains on the FSFI (which include: desire, arousal, lubrication, orgasm, satisfaction, and pain) even after abstinence. These findings were reflected in another study that showed women (however not exclusively menopausal) who were seeking treatment for alcohol dependency diagnosis experienced low sexual desire, inability to achieve orgasm and less satisfaction. Initiating alcohol consumption at a younger age, along with an extended and more intense period of dependency, was correlated with a higher likelihood of experiencing increased sexual dysfunction. A meta-Analysis of 7 studies showed increased odds of sexual dysfunction with alcohol consumption. Another study showed that moderate alcohol consumption was found to be an independent risk factor for FSD and Genitourinary syndrome of menopause (GSM) which can lead to FSD. Conclusions The impact of alcohol on sexual health in postmenopausal women is multifaceted, based on varying levels of consumption influencing various aspects of sexual function. This relationship can also be influenced by other factors such as pre-existing sexual problems and the utilization of alcohol as a coping mechanism to reduce anxiety, release stress or to increase sexual behavior through enhancing arousal. A study indicated that menopausal symptoms may trigger a craving for alcohol, leading to increased alcohol consumption. Further research is essential to elucidate the direct and indirect effects of alcohol consumption on sexual dysfunction. In addition, the impact of abstinence from alcohol on sexual dysfunction in postmenopausal women needs to be further explored. Understanding the impact of alcohol consumption on sexual function of postmenopausal women is critical for healthcare professionals, to provide appropriate guidance and interventions. These findings highlight the need for further research and increased awareness regarding the impact of alcohol use on sexual health during in pre-menopausal, peri and postmenopausal women. Disclosure No.

(129) WOMEN WHO REPORT PAIN WITH SEX HAVE VARYING MICROBIOME PROFILES BASED ON AGE

Abstract Introduction Even though the vaginal microbiome (VM) is a known contributor to vaginal epithelial health, the VM of women who report pain with sex has not been characterized. It is known that the VM shifts during menopause, therefore we segmented out analysis based on menopausal status. Objective An observational analysis comparing the vaginal microbiome composition and symptom profiles in individuals of both menopausal and reproductive age who experience moderate to severe pain with sex and those that do not report pain with sex. Methods This study involved the collection of self-reported health profiles and shotgun metagenomic analysis of vaginal samples from two distinct demographic groups: menopausal women and women of reproductive age (defined as non-pregnant, non-menopausal, and aged under 40 years). The focus was on identifying the microbial composition in individuals experiencing moderate to severe sexual intercourse pain and those without any reported pain, excluding samples from individuals with mild pain. An additional criterion for inclusion was a reported history of sexual activity within the preceding 30 days. The menopausal group comprised 157 individuals reporting pain and 367 individuals without pain. In the reproductive age cohort, there were 968 participants with pain and 968 age-matched controls without pain. Statistical analysis between the pain and control groups in both cohorts revealed no significant differences in body mass index (BMI, menopause p = 0.74, reproductive p = 0.19), reported hormone use (menopause p = 0.2, reproductive p = 0.24), or history of previous infections (menopause p = 0.29, reproductive p = 0.09). Results In both the menopausal and reproductive-aged cohorts, individuals experiencing pain during sexual intercourse exhibited a higher prevalence of symptomatic conditions, as illustrated in Figure 1 A & B. Reported symptoms included increased severity of burning, itchiness, vaginal and vulvar pain, erythema, dysuria, and vaginal dryness. A significant correlation was observed between these enhanced symptomatology and variations in vaginal microbiome compositions among the menopausal group, as depicted in Figure 2 A & B. Specifically, pain during sexual intercourse in menopausal women was linked to elevated vaginal microbiota (VM) diversity (p=0.047) and a reduction in lactobacilli levels (p=0.06). Conversely, in the reproductive-aged cohort, a higher VM diversity was noted in the control group (p=0.014), with no significant differences in Lactobacillus or Gardnerella concentrations between those experiencing pain and the control group. Conclusions Preliminary examination of the vaginal microbiome in women who self-report moderate to severe pain with sex reveals significant differences, particularly in menopausal women experiencing pain. These individuals exhibited a more diverse vaginal microbiome and lower levels of Lactobacillus. This study underscores the need for further research to explore the potential of targeted microbiome modifications as a therapeutic approach to alleviate pain symptoms in this demographic. Disclosure Yes, this is sponsored by industry/sponsor: Evvy. Clarification: Industry initiated, executed and funded study. Any of the authors act as a consultant, employee or shareholder of an industry for: Evvy.

(042) IMMUNOSTAINING FOR MARKERS OF MAST CELLS AND NERVES IN BOTH EXCISED VESTIBULAR AND ENDOMETRIOSIS IMPLANT TISSUES IN A SINGLE PATIENT

Abstract Introduction Neuroproliferative vestibulodynia (NPV) is a chronic genital pain condition characterized by severe vestibular allodynia and hyperalgesia. The clinically suspected diagnosis of NPV is confirmed in excised vestibular tissue by immunohistochemical staining of > 8 cells per 100x magnification positively immunostained for CD 117, a mast cell marker, and 10 times the area compared to controls positively immunostained for PGP 9.5, a neuronal marker, Endometriosis, on the other hand, is a chronic pelvic pain condition associated with growth of ectopic endometrial-like tissue outside the uterus. The clinically suspected diagnosis is confirmed in excised endometriosis tissue revealing, in some patients, endometrial type glands and/or stroma. In patients with NPV and endometriosis, it is hypothesized that excess mast cells release cytokines and growth factors that promote neuroproliferation in their respective tissues, resulting in chronic genital and pelvic pain symptoms, respectively. In a study involving 65 patients with pathologically confirmed NPV, 63% reported having additional conditions associated with aberrant mast cell activity, including endometriosis. The conditions of NPV and endometriosis may both be focal to the vestibule and pelvis, respectively, but both may also share pathologies of aberrant mast cell activity with other systemic disorders. Objective To perform immunostaining for markers of mast cells and nerves in excised vestibular and endometriosis implant tissues from a single patient. Methods Fixed, paraffin-embedded vestibular tissue specimens from the 1:00-11:00 and 12:00 vestibule, and from excised endometriosis fibroadipose tissue on the rectosigmoid colon, were sectioned and immunostained for CD 117 (C-kit) and PGP 9.5. The immunostained slides were examined and digital photomicrographs taken. A minimum of 2 photomicrographs were examined at 100x magnification for each stained slide, identifying representative regions of the excised tissue. Manual counting of CD117 and PGP 9.5 immunopositive profiles, cells/nerves per 100x magnification, was performed for each photomicrograph. Results A 23-year-old woman presented with a history marked by painful and prolonged menstrual periods, inability to insert tampons, and discomfort with both entry and deep thrusting during intercourse. After excluding other forms of vestibulodynia, she underwent complete 1:00-11:00 and 12:00 subepithelial vestibulectomy with vaginal advancement flap reconstruction. Post-operatively, she reported “very much better” symptoms, with a reduction of entrance dyspareunia, but continued to experience deep thrusting pain with penetrative sexual activity. She subsequently underwent endometriosis excision surgery with positive lesions identified in 12 locations in the pelvis and retroperitoneum. Tissue stained for CD117 and PGP9.5 analyzed by manual counting exhibited > 20 immunopositive cells and nerves per 100x microscopic field in the epithelial basement membrane and adjacent subepithelial regions of the 1:00-11:00 and 12:00 vestibule, as well as in the endometriosis fibroadipose tissue on the rectosigmoid colon. Conclusions We report for the first time, in a single patient diagnosed with both NPV and endometriosis, immunostaining findings of high densities of mast cells and nerves in their respective tissues. These findings reinforce the hypothesis that NPV and endometriosis are linked to a broader condition associated with aberrant mast cell activity. Disclosure No.

(092) SEXUAL EXPERIENCES IN AN EXPLORATORY, PHASE 2B, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED CLINICAL TRIAL OF SILDENAFIL, 3.6% CREAM FOR THE TREATMENT OF FEMALE SEXUAL AROUSAL DISORDER

Abstract Introduction Quantifying the change in the mean number of satisfactory sexual experiences (SSEs) is an efficacy endpoint recommended by the US Food and Drug Administration in studies of treatments for female sexual dysfunctions (FSD), including female sexual arousal disorder (FSAD). Objective Post-hoc analysis of sexual experiences in a study of Sildenafil Cream, 3.6% for treatment of FSAD Methods Phase 2b, exploratory, randomized, placebo-controlled, double-blind study of Sildenafil Cream, 3.6% among premenopausal women with FSAD (NCT04948151). Following a baseline, single-blind, placebo, run-in period, participants were randomized and used investigational product (IP) at home for 12 weeks. Between monthly, in-clinic assessments, participants answered questions in an electronic diary (eDiary), within 24-hours of each sexual experience. Sexual experiences were categorized as “Partnered” versus “By Myself” and “Satisfactory” versus “Not Satisfactory”. eDiary question 11 (Q11) asked “Were conditions appropriate for satisfactory sexual activity (enough time, no distractions, etc.)?”. Changes from baseline in the mean number of SSEs was a secondary efficacy endpoint. The Orgasm domain (questions 22-24) of the Sexual Function Questionnaire (SFQ28) was an exploratory efficacy endpoint. Un-partnered women and women with sexual partners who did not sign informed consent were enrolled in the study, but in these cases (n=15), IP was only used in solo sexual experiences. Results Sildenafil Cream users had more sexual experiences and more un-partnered sexual experiences during the double-blind treatment period compared to Placebo Cream users. Sildenafil Cream users were significantly more likely to engage in sexual experiences even when conditions were not appropriate for a satisfactory experience. Although, the change from baseline in the mean number of SSEs at week 12 decreased during solo, un-partnered sexual experiences for both product groups (-0.12±0.27 for Sildenafil versus -0.04±0.32 for Placebo, p=0.85), during the double-blind treatment period, Sildenafil Cream users reported significantly higher proportions of SSEs during un-partnered sexual experiences (197/261, 75.5%) compared to Placebo users (116/187, 62.0%) (p=0.002). Despite Sildenafil Cream users engaging in a sexual experience more frequently when conditions were not appropriate, the proportion of SSEs during these events when Q11=“No” were not different between active (17/59, 28.8%) versus placebo (8/25, 32.0%) users (p=0.77). Finally, un-partnered women and women with un-enrolled sexual partners, who by definition had only solo sexual experiences, had an increase from baseline in their SFQ Orgasm at week 12 with Sildenafil use (2.58±1.13) versus Placebo users in this subset, who had decreases in this score (-0.34±1.13) (p=0.13). Conclusions These data support that Sildenafil Cream 3.6% enhanced solo, un-partnered sexual experiences, which represented approximately 1 in 5 events in this FSAD treatment study. Disclosure Yes, this is sponsored by industry/sponsor: Dare Bioscience and Strategic Science and Technologies LLC Clarification: Industry initiated, executed and funded study Any of the authors act as a consultant, employee or shareholder of an industry for: Dare Bioscience and Strategic Science and Technologies LLC.

Implementation of Legal Protection (Study of Decision Number: 5/Pid.Sus/2024/PN.Kng) for Children Who Are Sexually Abused

The goal of this research is to outline the criminal penalties for those who engage in sexual activity with minors in terms of victim protection. The normative approach method is used in this investigation. Secondary data is used. Documents and literature are examined to implement data collection procedures. In the meantime, the analysis is descriptive and employs qualitative analysis. The study's findings indicated that the criminal penalties meted out to those who engage in sexual activity with minors do not fairly compensate for the victims' protection.

Prevalence and associated factors of teenage childbearing among Ethiopian women using semi-parametric and parametric proportional hazard and accelerated failure time models

BackgroundTeenage childbearing is a common issue for young people’s sexual and reproductive health in the world, particularly in low-income countries, and affects teenagers between the ages of 13 and 19. According to several academics, adolescent pregnancy accounts for the majority of Ethiopia’s population increase, and there has been little effort to address this threat. This study aimed to determine the prevalence and associated factors of the time to teenage childbearing in Ethiopia.MethodThis paper compares the results of the semi-parametric proportional hazard (PH), parametric PH, and accelerated failure time (AFT) models to find the model that best fits the data. The Akaike Information Criterion (AIC) was used to evaluate the performance of models examined in this investigation. Time to teenage childbearing was the study’s outcome variable, while the analysis considered various independent variables. We analyze data from the 2016 National Demographic Health Survey to assess the influence of different risk factors on teenage pregnancy among Ethiopian women.ResultsOut of the 10,274 teenagers (aged between 13 and 19) who participated in the 2016 survey, 6,430 (62.59%) were parents. The study findings revealed that these teenage parents were influenced by various time-related factors before becoming parents. The log-normal AFT model has the lowest AIC value and hence it is the best fit for this data. Results from this model indicated that significant factors influencing the time to teenage childbearing include the age of the household head, current age of the respondents, region, religion, educational attainment, wealth status, intention to use contraception, and recent sexual activity.ConclusionThis study reveals that 62.59% of surveyed teenagers aged 13 to 19 were parents. Various factors at both the individual and community levels: including the age of the household head, regional differences, religious affiliation, educational level, economic status, contraceptive intentions, and recent sexual activity, determine the time to teenage childbearing. Targeted interventions addressing these factors are essential for reducing teenage pregnancies and supporting adolescent parents effectively.

Association Between Early Sexual Debut and New HIV Infections Among Adolescents and Young Adults in 11 African Countries

We investigated the association between early sexual debut and HIV infection among adolescents and young adults. Analyzing data from nationally representative Population-Based HIV Impact Assessment (PHIA) surveys in 11 African countries, the research employed a multivariate logistic regression model to assess the relationship between the early sexual debut and new HIV infections in the age group of 10–24 years. The results revealed a significant and robust association, indicating that young individuals who experienced early sexual debut were approximately 2.65 times more likely to contract HIV than those who did not, even after accounting for other variables. These findings align with prior research suggesting that early initiation of sexual activity may increase vulnerability to HIV infection due to factors such as biological susceptibility and risky behaviors like low condom use and multiple sexual partners. The implications of these findings for HIV prevention strategies are substantial, suggesting that interventions aimed at delaying sexual debut could be an effective component in reducing HIV risk for this population. Targeted sex education programs that address the risks of early sexual debut may play a pivotal role in these prevention efforts. By employing a comprehensive approach, there is a possibility to advance efforts towards ending AIDS by 2030.