Sexual Complaints Research Articles

Examination of the relationship between dimensions of sexual perfectionism and female sexual function and sexual performance anxiety among Iranian married women of reproductive age: a cross-sectional study

BackgroundPerfectionism is a multidimensional personality trait that manifests itself through various aspects of life as well as sexuality. Yet, the specific nexus between perfectionism and women’s sexual experiences continues to remain unaddressed. Hence, this research aimed to investigate the relationship between the dimensions of sexual perfectionism, sexual function, and sexual performance anxiety (SPA) among Iranian married women of reproductive age in Gonabad, Iran.MethodA cross-sectional study was conducted in Gonabad City in 2021, involving 450 women of reproductive age. Stratified sampling was used to select public healthcare centers, and participants were chosen via simple random sampling. Data were collected online through platforms like WhatsApp and Telegram, using the Multidimensional Sexual Perfectionism Questionnaire (MSPQ), Female Sexual Function Index (FSFI), and Brief Sexual Performance Anxiety Scale (BSPAS). The validity and reliability of these instruments were confirmed through content validity assessments and Cronbach’s α. Hierarchical linear regression was performed using SPSS version 26, with the significance level set at p < 0.05.ResultsLinear regression analysis indicated that self-oriented sexual perfectionism was positively associated with all FSFI domains, including desire, arousal, lubrication, orgasm, satisfaction, total FSFI (p < 0.001), and pain (p < 0.01). Partner-oriented sexual perfectionism was positively associated with satisfaction (p < 0.05). In contrast, partner-prescribed sexual perfectionism was negatively associated with all domains of FSFI, including desire, pain (p < 0.05), arousal, lubrication, total FSFI (p < 0.001), orgasm, and satisfaction (p < 0.01). Socially-prescribed sexual perfectionism was positively associated with desire and negatively associated with pain (p < 0.05). In particular, only partner-prescribed and socially-prescribed sexual perfectionism were positively associated with SPA (p < 0.01).ConclusionThe association found between dimensions of sexual perfectionism, sexual function, and SPA in Iranian women underscores the necessity for educational initiatives tailored to psychologists, psychiatrists, counselors, sexologists, and other healthcare practitioners. These programs would help to build a deeper insight into the origins of women’s sexual complaints and identify and manage them within the context of marital relationships.

The Vaginal Penetration Skills Scale (VPSS): a paradigm shift in genito-pelvic pain/penetration disorder screening, assessment, and stratification.

Receptive vaginal penetration skills have been implicated in the etiology, explanatory models, and treatment of genito-pelvic pain penetration disorder (GPPPD). However, there are no psychometric skills measures designed to screen, assess, and stratify GPPPD. We aimed to develop and psychometrically evaluate a new scale-the Vaginal Penetration Skills Scale (VPSS)-to screen, assess, and stratify GPPPD. This study included 148 Brazilian females with GPPPD symptoms (113 lifelong and 35 acquired) and 251 Brazilian females without sexual complaints. We conducted factor analyses considering all participants (n= 399). Then, we conducted latent class analysis within the GPPPD group to identify clusters of individuals with similar VPSS profiles. We assessed convergent validity through intercorrelation with the Brazilian versions of the Female Genital Self-Image Scale (FGSIS) and the 6-item Female Sexual Function Index (FSFI-6). We developed complete and short-form versions of the VPSS (VPSS-29 and VPSS-SF11, respectively), each with 3 dimensions, to screen, assess, and stratify GPPPD. Factor analysis yielded a 3-factor VPSS model with the "Nonsexual Genital Self-Exploration," "Nonsexual Vaginal Penetration Skills," and "Sexual Vaginal Penetration Skills" dimensions for both VPSS versions. The reliability was excellent for the VPSS-29 (ω= 0.981, α= 0.981) and the VPSS-SF11 (ω= 0.959, α= 0.961). All 3 dimensions could detect significant differences between patients with GPPPD and healthy females. They also differentiated the patients with GPPPD, distinguishing gradient levels. For convergent validity, we found moderate to strong correlations (rho = 0.715-0.745) between the VPSS, FGSIS, and FSFI-6. The VPSS can be applied easily in both clinical and research settings. The VPSS provides a concise and thorough evaluation of receptive vaginal penetration skills in both sexual and nonsexual contexts among patients with GPPPD. The sample had limited diversity regarding gender and sexual orientation; therefore, it is important to validate the use of this scale in populations beyond the cisgender heterosexual female population to ensure its applicability in diverse settings. These results support the reliability and psychometric validity of the VPSS as a self-report measure to screen, assess, and stratify GPPPD symptoms.

The psychological side of menopause: evidence from the comorbidity network of menopausal, anxiety, and depressive symptoms.

Numerous studies have uncovered a correlation between menopausal, anxiety, and depressive symptoms. How these symptoms interrelate and influence each other, however, remains unclear. This study aimed to identify the associations between menopausal, anxiety, and depressive symptoms using network analysis. The participants comprised 423 women ( Mage = 49.21 ± 4.01 y; range, 40-60 y) recruited from a menopause clinic at a tertiary hospital in Beijing, China. Demographic characteristics and menopausal, anxiety, and depressive symptoms were obtained through self-report questionnaires. Two networks were established: a partial correlation network and a Bayesian network. The menopausal symptom of nervousness exhibited a robust association with anxiety symptoms in both networks. Within the partial correlation network, the depressive symptom of tiredness emerged as a pivotal symptom, facilitating the co-occurrence of menopausal and depressive symptoms. Bayesian network analysis exhibited that the depressive symptom of a loss of interest was related to certain menopausal symptoms through depressive symptoms of tiredness and motor problems, both serving as critical links between menopausal symptoms and depression. Notably, four menopausal symptoms-arthralgia/myalgia, formication, sexual complaints, and urinary tract infection-appeared independent of other menopausal, anxiety, and depressive symptoms. Both psychological (eg, fatigue) and somatic (eg, hot flashes, headaches, and dizziness) menopausal symptoms demonstrate strong associations with depression. In providing optimal support for women's health during menopause, psychological interventions aimed at depression, particularly among those experiencing a loss of interest or pleasure in activities, should complement conventional therapies.

O-083 Sexual function in women with Premature Ovarian Insufficiency (POI): systematic review and meta-analysis

Abstract Study question What is the impact of idiopathic premature ovarian insufficiency (POI) on sexual function in women? Summary answer Women with POI exhibit significant reduced sexual function and a higher risk of sexual dysfunction than healthy control women. What is known already POI is a life-changing diagnosis with profound physical and psychological consequences. The impact of POI on sexual complaints, seems multifaceted. Many women report vaginal dryness, dyspareunia (painful intercourse), and diminished libido, but also psychosexual function could be impaired, with potential effects on sexual identity, sexual function, and sexual relationships. Furthermore, the POI diagnosis can have a significant impact on a woman's self-esteem and body image, which could result in problems with sexual function. The ESHRE Guideline emphasizes the importance of providing psychological support and counseling to address the emotional and psychosexual impact of POI. Study design, size, duration This systematic review and meta-analysis is reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The following online databases were systematically searched: EMBASE, Medline(Ovid), Web of Science, Coachrane, PsychInfo and Google Scholar up to January 2023. Participants/materials, setting, methods A total of ten studies were included in the systematic review and five studies involving 352 women with POI were included in the meta-analysis. Random effects models were used for analyses, with data reported as Hedges’ g and 95% confidence interval, and the risk of heterogeneity was evaluated. Main results and the role of chance Eight of the ten studies concluded that women with POI have a reduced sexual function. An overall medium Hedges’ g effect size of −0.72 was found (ranging between −0.20 to −1.29) in favor of control women, with moderate heterogeneity (I2 = 64%). When we stratified studies in which women were using hormone replacement therapy (HRT) we calculated an even higher Hedges’ g effect size of −0.82 (95% CI −1.18, −0.47). Pooled data from the different FSFI domains, revealed that women with POI scored significantly lower on all domains. Especially the domain ‘dyspareunia’ exhibited the greatest dissimilarity (Hedges g of −0.63, 95%CI −0.86, −0.39) in women with POI compared to control. Limitations, reasons for caution We have reported a moderate heterogeneity which may be caused by differences in age, duration of diagnosis, infertility status, and socioeconomic background in the various studies. Additionally, limitations such as selection bias, data duplication, and questionnaire variation were identified. Wider implications of the findings The results show that women with POI have reduced sexual function, and HRT use did not improve sexual function. This suggest that oral HRT is less effective for sexual dysfunction. There could be an important role for psychological factors in improving sexual well-being among women with POI. Trial registration number CRD42023437203 (PROSPERO)

(134) EFFECTIVE TREATMENT OF MENOPAUSAL HOT FLASHES IMPROVES DOWNSTREAM FEMALE SEXUAL COMPLAINT

Abstract Introduction Approximately 75% of women aged between 45 years and 55 years suffer from symptoms of menopause. Untreated hot flashes have many downstream effects including but not limited to fatigue, low energy, memory complaints, lowered libido, sexual dysfunction and may even be linked to increased cardiovascular disease. While the gold standard for effective treatment is hormonal therapy, many women (especially those with a family history of breast cancer) may decline their use due to concerns regarding efficacy and safety. Lack of sensitivity training and level of comfort to disclose menopausal symptoms is often a significant barrier to effective treatment. Dose optimization, close surveillance of efficacy of hormone utilization is essential to maintain patient compliance. Objective Menopausal hot flashes are associated with a variety of downstream sexual complaints including lowered libido. This retrospective study was done to assess if optimal treatment of hot flashes with hormones and over the counter products would have a downstream effect on concurrent reported sexual complaints. Methods A retrospective review of a random convenience sample was conducted to assess women who presented with complaints of hot flashes. Concurrent associated symptoms were also reported. Treatment interventions and symptom resolution was evaluated. Data was collected and stored in private HIPPA protected database. Results A random convenience sample (n=56) from the HerMD centers (Cincinnati and Kentucky) was assessed for women (mean age 51.3; range 30-73) who presented with complaints of hot flashes. Associated symptoms included: brain fog/memory complaints (66%); sleep disturbances including insomnia (59%), decreased libido (49%), weight management concerns (38%), vaginal dryness (31%) and dyspareunia (14%). A family history of breast cancer was present in 18% of the sample. Treatment included: behavioral intervention counseling (100%), over the counter supplements n=2, (3.5%) and systemic hormonal therapy n=54 (96.5%) and over the counter recommendations (100%). All patients (100%) with a family history of breast cancer received hormonal therapy. Overall, 96% of patients responded to their intervention with self-reported improvement in hot flashes, and improvement in dyspareunia, vaginal dryness and improved libido at scheduled follow up visits. Patients had multiple office/telehealth visits to ensure dose optimization, efficacy of symptom resolution and ensure no treatment emergent adverse effects. There were n=3 (5%) reported adverse effects (minimal vaginal spotting) yet no patients discontinued treatment Conclusions Hot flashes are associated with a variety of sexual complaints including but not limited to decreased libido (49%), vaginal dryness (31%) and dyspareunia (14%). Optimal treatment of hot flashes will have downstream efficacy with FSD complaints. At HerMD, HCP have internal continuing menopausal medical education which includes standardized clinical algorithms, bibliotherapy, article data base, 1-1 didactic education/supervision and preceptorships with national menopausal experts. Systemic hormones will help with vaginal dryness and dyspareunia. HerMD advocates close clinical surveillance with treatment efficacy and safety review which allows for interventions to be modified henceforth allow for outcome optimization and enhance compliance. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Michael Krychman is a consultant for exeltis pharmaceuticals, Astellas, Uberlube and CEEK.

Safūf-i Aslussūs: A time-tested polyherbal formulation for the management of Premature Ejaculation- A comprehensive review

Premature Ejaculation (PE) is the most prevalent male sexual complaint worldwide. The ability to control the timing of ejaculation is very important to get pleasure and to maintain the couple’s sexual health. PE is believed to have a multifactorial etiology which mainly includes psychogenic and biogenic factors. Currently available conventional drugs are based on mere assumptions and their use in PE is considered off-label as they have not been approved by the regulatory bodies. On the other hand, Unani System of Medicine has a holistic approach to the prevention and treatment of diseases and provides a line of treatment for PE which is mainly focused on the internal and external use of specific drugs for the restoration of lost powers, elimination of morbid humor and strengthening of organs, muscles, and nerves. In classical Unani literature, PE/Surʻat-i-Inzāl are described in detail under the heading of Amrāz-i-Bāh. In the series of drug therapy a polyherbal Unani formulation, Safūf-i Aslussūs mentioned in different Unani Pharmacopoeias for the management of PE, and Spermatorrhoea is widely prescribed and recommended for a long time by Unani physicians and it is a time-tested drug. This manuscript is an attempt to summarize scientific studies in support of the claim made by Unani physicians regarding Safūf-i Aslussūs. Keywords: Safoof-i Aslussoos, Surʻat-i-Inzāl, Premature ejaculation, Unani System of Medicine

Anxiety, depression, urinary continence, and sexuality in patients undergoing radical prostatectomy: preliminary findings.

Evaluate the relationship between psychological distress, namely anxiety and depression, with urinary continence and recovery of erectile function in patients undergoing radical prostatectomy (RP). We retrospectively analyzed data from 33 consecutive patients who underwent RP in a single tertiary-referral academy between 01/2018 to 01/2019. We used the International Index of Erectile Function (IIEF-15), the Sexual Complaints Screener for Men (SCS-M), and the Hospital Anxiety and Depression Scale (HADS), validated questionnaires for the assessment of sexual function, anxiety, and depression experiences, respectively. These questionnaires were administered at the pre-surgical visit, after surgery, and at intermediate follow-ups (three, six, and twelve months). The analysis of the questionnaires completed during follow-up shows that erectile function is the most affected, with 90% erectile dysfunction (ED) at three months after surgery. In terms of emotional states, anxiety prevails in the first months following surgery and is statistically significantly associated with incontinence (p = 0.02). Depressive symptoms, on the other hand, appear later and prevail over anxiety at six months after surgery, although not statistically significant. In the early post-surgical phase anxiety and ED are the most frequently detected components, while depressive experiences and decreased desire, typical of later stages, have not yet fully emerged.

Management of hypoactive sexual desire dysfunction at a specialized service in women’s sexual health

Hypoactive sexual desire dysfunction (HSDD) is prevalent among women. This retrospective cohort study aimed to verify the results of the strategies used by Gynecologists and Obstetricians (Ob-gyn) residents in the management of female HSDD. For this, we conducted a data collection of patient medical records of women with HSDD from the Human Sexuality Studies outpatient clinic of the Human Reproduction Center, Department of Gynecology and Obstetrics of FMRP-USP, from 2005 to 2019. Among the 437 women included, 361 (82.6%) answered the question concerning the effect of the protocol to which they were submitted, whereas 234 (64.8%) reported improvements in sexual desire. The univariate model showed that patients without chronic pelvic pain were 19.0% less likely to report improvements in HSDD than those with chronic pelvic pain (p = 0.03). Patients without depression and without orgasmic dysfunction were, respectively 32% and 23% more likely to show improvements in their HSDD than those who had depression or orgasmic dysfunction (respectively p = 0.001, p = 0.008). However, the multivariate model did not identify any associations. The assistance regarding HSDD by the Ob-gyn resident in training to deal with female sexual complaints may be effective in improving sexual complaints.

(180) Female Sexuality of Tunisian Women with Treated Breast Cancer

Abstract Introduction Breast cancer is a major health problem. Several treatment strategies are used to treat it such as lumpectomy or mastectomy surgery, chemotherapy, radiotherapy, and hormone therapy, which leads us to ask the following question: what impact does breast cancer and its treatments have on female sexuality? Objective The aims of our study were to assess the sexuality of Tunisian women with breast cancer in remission, and to determine the prevalence and nature of sexual dysfunction in this population. Methods We carried out a descriptive cross-sectional study, involving women aged under 60, followed up for treated non-metastatic breast cancer currently in remission, and having a regular sexual partner during the last month. Outpatients in the surgery and radiotherapy department of the "Salah-Azaiez" Institute were interviewed using a questionnaire including a validated Arabic version of FSFI (Female sexual function desire). Our study was carried out throughout a period of 3 months, from January 1st, 2023 to March 31st, 2023, this period allowed us to collect our necessary data. Results We included 120 women in our study. The majority were between 40 and 49 years with an average of 46.53. One-third (33.3%) had a university degree and 16.7% were senior executives. More than half of our population (56.7%) were menopausal and 12% were smokers. 85% of the women had children, and only 36% had breastfed their children exclusively. Half of the women had discovered the disease at stage II, and 52% of them had discovered it during breast self-examination. Surgical treatment was radical in 61.7% of women and conservative in 38.3%. Thus, 75% of the population had undergone chemotherapy, 93.3% had undergone radiotherapy and 71.7% were receiving hormone therapy. Only 5% of our study population had a sexual dysfunction prior to the disease and 78% of women had reported a change in their sex life after breast cancer, with the frequency of intercourse as the main parameter affected. Among the most common sexual complaints were decreased or absent sexual desire in 68.1% of cases, lack of sexual initiative (74.4%), vaginal dryness (48.9%), and dyspareunia (42.6%). The majority of interviewed women (83.3%) had presented with global sexual dysfunction, i.e. a total FSFI score ≤26.55 and the areas most affected were pain, lubrication, and orgasm. Radical surgical treatment, chemotherapy, and hormone therapy were significantly associated with impaired female sexuality (respectively p=0.0036; p=0.047 and p=0.001). Conclusions Our study highlighted the impact of breast cancer treatment on women's sex lives. Healthcare providers should acquire the necessary skills in order to explore female sexual disorders and suggest suitable management. Disclosure No.

Prevalence of sexual complaints in subjects aged 20 to 40 consulting at the central hospital of Yaoundé

Background: Male sexual dysfunction is a problem that is becoming more common with the increase in life expectancy. Few data are available in sub-Saharan Africa, and in Cameroon, no study has been documented. The objective was to determine the prevalence of sexual complaints among subjects aged 20 to 40 consulting the Urology Service at the Central Hospital of Yaoundé. Methods: We conducted a descriptive cross-sectional study at the Central Hospital of Yaoundé over a 4-month period from January 1 to April 30, 2019. Men aged 20 to 40, sexually active, and freely consenting to participate were included in our study (66 had sexual complaints and 39 had other complaints). Results :105 patients were included in the study, with 66 reporting sexual complaints and 39 presenting other complaints. The average age of our study population was 31.7 years. Alcohol was found in 60.6% of cases, followed by tobacco at 30.3% for toxicological history. 78.7% of patients were overweight. Digital rectal examination was mostly normal; however, hemorrhoids were the most common finding at 14.2%. Decreased libido was very common in our study population, with a proportion of 41%, followed by erectile dysfunction at 37.1%. 66.3% of patients had a normal ejaculation time of 1 to 20 minutes. 21.2% of patients had premature ejaculation. 80.3% of patients had a Perceived Stress Scale (PSS) score higher than 27. 9.2% of patients had severe erectile dysfunction according to the IIEF5 score. 3.8% of patients had low testosterone levels. 62.2% of patients had never talked to anyone in their circle about sexual problems. 68.1% of patients resorted to self-medication, while 18.1% turned to traditional medicine. Conclusion: Despite the increasing frequency of sexual disorders worldwide, the subject remains taboo in our context, leading to underdiagnosis and undertreatment.

(357) The Importance of Assessing Adult ADHD/ADD Diagnoses in Patients Presenting with Concomitant Sexual Disorders and Sexuality Related Challenges to Both Sex Therapists and Medical Providers

Abstract Introduction A 2020 literature review in The Journal of Sexual Medicine concluded that research subjects with ADHD reported more sexual desire, more masturbation frequency, less sexual satisfaction, and more sexual dysfunctions than the general population. Another study showed that all participants with self-reported ADHD showed higher rates of avoidant attachment while males with ADHD and anxious attachment reported using a greater amount of online pornography/sexually explicit media. There are unique challenges that affect singles’ and couples’ sex lives when a partner has Adult ADHD/ADD. Many patients seek out medical treatment of sex therapy for Erectile Disorder, Delayed Ejaculation, Premature/Uncontrolled Ejaculation, Genital Pelvic Penetrative Pain Disorder, and low desire and seek out sex therapists for the above diagnoses as well as infidelity, out-of-control-sexual-behavior, orgasmic disorders or sexless relationships. These patients seek to address what they regard as exclusively a medical or a relational problem. However, only through accurate assessment and treatment by both sex therapists and doctors of an intersectionality of an adult ADHD diagnosis impacting the sexual disorder will the client or couples’ challenges fully improve. Objective Many patients show up in both sex therapists’ and doctors’ offices with sexual complaints without either having been formerly diagnosed with ADHD or by sharing with the provider that they have this disorder. The ADHD/ADD diagnosis can be a treatment blind spot for both sex therapists and medical providers that can be greatly improved upon due to the integral impact it has on both a single patient's concomitant sexual disorder and a couples’ sex life. In this talk, the presenter hopes to improve participants assessment skills to treat the co-occurring symptoms that impact both sexual functioning and health. Methods In this presentation, an overview of common sexual issues occurring in single clients and couples where one partner has ADHD/ADD, will be presented along with clinical case examples. The presenter will offer some key questions to pose when assessing a patient to yield more information regarding how their sexual functioning has been impacted over the course of various stages of their adult life. This talk will also assist in educating providers on how to provide sexuality education so clients can protect their sexual health, understand the interplay of ADHD and their sexual functioning problems, and provide referrals needed to sex therapists, ADHD-specialized psychiatrists, urologists, gynecologists, and pelvic floor therapists so the patient has a holistic treatment plan. Results Clinical experience suggests assessing and treating comorbid adult ADHD in single and coupled patients may be a key to treating a common matrix of sexual comorbidities: Erectile Disorder, Anorgasmia, Out of Control Sexual Behavior, Premature Ejaculation, Anxiety and Depression. In this group these hard-to-treat problems may become more responsive to directed treatment if the disability of ADHD can be mitigated. Addressing adult ADHD provides an opportunity to reverse demoralization and open up doors to effective sexual functioning for a portion of our patients who have struggled to get a full-spectrum treatment plan. Conclusions As a sex therapist in practice for over 25 years, I have found that many adults have not been formally be diagnosed with ADHD and that their previous experiences with medical providers and general couples counselors have missed out on the impact the disorder's symptoms has on their sexual functioning. There is still scant research on ADHD and sexual functioning in the literature and I feel that our patients would improve more quickly if this disorder were taken into account by their medical and sex therapy providers. Disclosure No.

Assessment of Relationship between Lifestyle Behaviors and Severity of Perimenopausal Symptoms among Women

Menopause is a stage of transition from a reproductive to a non-reproductive state in the life of a woman. The perimenopause transition is defined as the period immediately before the menopause. The most common symptoms of menopause can be broken down into vasomotor, physical, emotional, or sexual complaints. Lifestyle behaviors play a significant role in women's experiencing menopausal symptoms during the perimenopause. Aims:It aims to assess the relationship between women's lifestyle behaviors and the severity of perimenopausal symptoms. Methods:Adescriptive correlational study of 120 perimenopausal women using a purposive sample was conducted at gynecology outpatient clinics and general medicine outpatient clinics at Assuit University hospitals from the first of January to the end of June 2023. Three tools were used for this study: a structured interview questionnaire, a modified menopausal rating scale, and a health promotion lifestyle profile. Results:This study reveals that 85.8% of perimenopausal women's lifestyle was poor. Also, 31.6% of perimenopausal women reported moderate perimenopausal symptoms. Somatic symptoms were the most prevalent symptoms on the menopausal rating scale, followed by psychological symptoms and, lastly, urogenital symptoms. There has been a highly statistically significant difference as regards the relationship between the severity of perimenopausal symptoms and women's lifestyle behaviors (p&gt;0.001). Conclusion:There has been an intense negative correlation between women's lifestyle behaviors and the severity of perimenopausal symptoms. So, women need to get health education from the nurse specialists during perimenopause and nurses should plan and implement educational programs for the perimenopausal women about the healthy life style behaviors to reduce and manage their menopausal symptoms. Recommendation: Plan and implement a necessary educational program for perimenopausal women about healthy lifestyle behaviors to manage menopausal symptoms.

A High Incidence of Perineal Post-Related Complications After Hip Arthroscopy Is Self-Reported by Patients in Anonymous Online Forums

PurposeTo evaluate online, self-reported pudendal nerve or perineal injuries related to the use of a perineal post during hip arthroscopy. MethodsPublic posts on Reddit and the Health Organization for Pudendal Education were searched to identify anonymous individuals reporting symptoms of pudendal nerve or perineal injury following hip arthroscopy. Included posts were by any individual with a self-reported history of hip arthroscopy who developed symptoms of pudendal nerve injury or damage to the perineal soft tissues. Demographic information and details about a person’s symptoms and concerns were collected from each post. Descriptive statistics was used to analyze the data. ResultsTwenty-three online posts reported on a perineal post-related complication following hip arthroscopy. Gender information was available in 16 (70%) posts (8 male, 8 female). Twenty-two posts reported a sensory injury, and four posts reported a motor injury with sexual consequences (sexual dysfunction, dyspareunia, impotence). Symptom duration was available in 15 (65%) posts (8 temporary, 7 permanent). Permanent symptoms included paresthesia of the perineum or genitals (7) and sexual complaints (5). Two posts stated they were counseled preoperatively about the possibility of this injury. Zero patients reported that a postless hip arthroscopy alternative was an option made available to them before surgery. ConclusionA high incidence of permanent pudendal nerve, perineal skin, and genitourinary/sexual complications are self-reported and discussed online by patients who have undergone post-assisted hip arthroscopy. These patients report being uninformed and undereducated about the possibility of sustaining a post-related complication. No patient reported being informed of postless hip arthroscopy pre-operatively. Clinical RelevanceIdentifying and evaluating self-reported patient information in online medical forums can provide important information about patient experiences and outcomes. Level of EvidenceLevel IV Cross-Sectional/Observational.

Quality of life after risk-reducing salpingo-oophorectomy in women with a pathogenic BRCA variant.

Risk-reducing salpingo-oophorectomy (RRSO) is recommended to women with a pathogenic BRCA variant, but as a main side effect, RRSO could lead to an early onset of menopause. To evaluate the impact of RRSO and preoperative menopausal status on menopausal symptoms, sexual functioning, and quality of life (QOL). The study was conducted between November 2019 and April 2020. Women were included who tested positive for a pathogenic BRCA1/2 variant between 2015 and 2018. Depression levels, QOL, and global health status were measured and compared with those of women who opted against RRSO. Furthermore, women who underwent RRSO treatment were asked to report menopausal complaints that they experienced at 1 month postsurgery and any current complaints. RRSO had no significant impact on QOL, but women who were premenopausal at the time of surgery reported more sexual complaints than postmenopausal women. In total, 134 carriers of a BRCA mutation were included: 90 (67%) underwent RRSO and 44 (33%) did not. At the time of the survey, neither the control nor experimental group experienced significant changes in QOL (b = -0.18, P = .59). Women who underwent RRSO reported a significantly lower global health status (b = -0.66, P = .05). Women who were premenopausal at the time of surgery were bothered more by sexual symptoms (b = 0.91, P = .19) but experienced fewer vasomotor complaints (b = -1.09, P = .13) than women who were postmenopausal at the time of RRSO. The decrease of sexual functioning after RRSO should be an integral part of preoperative counseling because it is important for BRCA carriers, especially for premenopausal women. Some strengths of the present study were the long follow-up, a high response rate, and the existence of a control group, whereas defining menopausal status by last menstrual bleeding and self-report of data (eg, breast cancer history) increased the risk of errors. Our study indicated that women who underwent RRSO experienced no difference in QOL when compared with women without RRSO and that patients with premenopausal status seemed to be at higher risk to experience sexual complaints after surgery.

Effects of long-term proton pump inhibitor use on sexual hormones and sexual and reproductive health in female patients.

Proton pump inhibitors (PPIs) are widely used to treat a range of gastrointestinal diseases around the world. Long-term use of PPIs has been associated to a variety of undesirable effects. Although short-term therapy has been shown to have little or no effect on endocrine hormone in women, however, its long-term safety has received little attention. We aimed at evaluating long-term use of PPIs and its effects on female reproductive hormones as well as related clinical consequences. A cross-sectional study was conducted in two outpatient gastroenterology clinics in the province of Khyber Pakhtunkhwa. This study included female patients who had been using PPIs on a regular basis for 3 months or more. In total of 101 participants, patients with sexual complaints have significantly altered levels of prolactin (p = 0.05), estrogen (p < 0.001) and progesterone (p = 0.001) than patient without sexual complaints. The frequency of amenorrhea (p < 0.001), cyclic disturbances (p < 0.001), breast augmentation (p = 0.001) and painful breast (p = 0.004) were statistically significant in patients with raised serum prolactin values. Serum values of Sex hormone binding globulin SHBG (p < 0.001), estradiol (p = 0.002) and total testosterone (p < 0.001) were significantly altered between normal prolactin and hyperprolactinemic patients. These findings suggest that long-term PPI use may cause endocrine hormone disturbances leading to sexual difficulties in women.

Prevalence, lifestyle, and risk factors of erectile dysfunction, premature ejaculation, and low libido in middle-aged men: first results of the Bavarian Men's Health-Study.

Erectile dysfunction (ED), premature ejaculation (PE), and low libido (LL) are reported as the most common male sexual dysfunctions. To evaluate the prevalence of ED, PE, and LL and associations with lifestyle risk factors and comorbidities in middle-aged men. This study included a population-based random sample of 2500 50-year-old men who completed validated questionnaires, including the International Index of Erectile Function, the Erection Hardness Score, the Sexual Complaints Screener, and further questionnaires. Multiple logistic regression of outcomes ED, PE, and LL was used to model the association with explanatory factors. The prevalence of at least one sexual dysfunction was 30%. 21%, 5.2%, and 7.2% of men had ED, PE, and LL, respectively. The risk of ED increased with PE (odds ratio [OR]: 1.94, 95% confidence interval [95%CI]: 1.22-3.08), LL (OR: 2.04, 95%CI: 1.26-3.29), higher waist circumference (OR: 2.23, 95%CI: 1.67-2.96), and lower urinary tract symptoms (LUTS) (OR: 1.88, 95%CI: 1.39-2.55), partnership was associated with a lower risk (OR: 0.57, 95%CI: 0.39-0.85). The risk of PE increased with ED (OR: 1.94, 95%CI: 1.23-3.07), partnership (OR:5.42, 95%CI: 1.30-22.60), depression (OR: 2.37, 95%CI: 1.09-5.14), and LUTS (OR: 2.42, 95%CI: 1.52-3.87), and decreased with physical activity (OR: 0.44, 95%CI: 0.21-0.93). The risk of LL increased with ED (OR: 2.09, 95%CI: 1.31-3.34) and poorer self-rated health (OR: 2.97, 95%CI: 1.54-5.71). Roughly one in three 50-year-old men experience some form of sexual dysfunction and risk factors identified in this study underline the multifactorial nature of ED, PE, and LL. Many risk factors are modifiable which underlines the role of patient education. Modifiable risk factors should be addressed in patient education and men should take active measures to remove the risk posed by these factors.

Prevalence, impact and management of postmenopausal symptoms among postmenopausal women in Rwanda

Objective This study aimed at evaluating the prevalence and management of postmenopausal symptoms among Rwandan women. Methods A descriptive cross-sectional study was conducted at the four largest Rwandan referral hospitals from August 2017 to March 2018 among postmenopausal women. Data on postmenopausal symptoms were collected using the Modified Blatt–Kupperman Menopausal Index and score ranges of 0–6, 7–15, 16–30 and >30 were used to rate the degree of severity as none, mild, moderate, and severe, respectively. Results Six hundred participants were recruited. The mean age at natural menopause was 51.7 ± 5.6 years. Common symptoms were hot flushes (82%), sexual complaints (66%) and headache (61%). The mean Blatt–Kupperman index score was 21.2 (1–58). Participants’ symptoms were classified as severe (35.8%), moderate (49.0%), mild (11.3%) and none (3.8%). Among 41.2% who had sought medical care, 1.7% were given hormonal replacement and 36% were given only pain medications. Age >50 years and lack of a male partner were significantly associated with higher scores. Conclusions Postmenopausal symptoms remain a burden among Rwandan women and little consideration is given for optimal management. There is a need for health managers to consider this inevitable phase of life on the health policy agenda for equitable healthy aging.

Hormone therapy for sexual function in perimenopausal and postmenopausal women.

Hormone therapy for sexual function in perimenopausal and postmenopausal women.

Sexual Dysfunction in a Sample of Women Having Infertility and Its Impact on Quality of Life

Conflict of interest None of the above authors have any conflict of interest to disclose. Background Female sexual disorders are prevalent disorder which is underdiagnosed due to cultural barriers in seeking help in management, having huge impact on mental health quality of life. The studies investigating the impact of infertility on female sexual dysfunction are scarce, but they have consistently demonstrated that sexual complaints are very common among infertile women. Sometimes appropriate treatment of female sexual dysfunction can preclude the use of expensive and unnecessary treatment for infertility. This study will compare sexual dysfunction and quality of life among infertile women and fertile women. Aim of the Work To assess the female sexual function among infertile women and comorbid psychiatric disorders among infertile women. Subjects and method: This is cross sectional study, which was conducted on random sample of 168 infertile females and 167 fertile females, attending outpatient infertile clinic, and the gynaecology outpatient clinic, Ain Shams University hospital, the study started September 2017 until February 2019, all females who fulfil inclusion criteria were subjected to SCID-I, The Arabic version of (FSFI), The Arabic version of PCASEE. Results there was a statistically significant relationship between female sexual dysfunction among infertile group and fertile group, in the infertile group, 123 females (73.2%) of the infertile females did not have mental disorder and 45 females (26.7%) had mental disorder, 19 females (11.3%) of them had anxiety disorder (generalized anxiety disorder, social phobia, and panic disorder) and 26 females (15.5%) of them had major depression disorder. Conclusion There is high prevalence of female sexual dysfunction among the infertile female group, and there was strong association between infertility, sexual dysfunction and developing comorbid psychiatric disorder. Further assessments should be considered in the infertility clinic, proper documentation as well. Management should include psychotherapy, lubricants, targeted sexual-therapy and pharmacological treatment. Abbreviation SCID-I: Structured Clinical Interview for the DSM-IV Axis I Disorder; FSFI: Female sexual dysfunction index; PCASEE: Physical, cognitive, Affect, Social, economic, ego, quality of life

The Impact of Systemic Sclerosis on Sexual Health: An Italian Survey.

To evaluate the impact of systemic sclerosis (SSc) on vulvovaginal atrophy (VVA) and sexual health in an Italian population. An Italian survey about the prevalence and severity of VVA (on a 0 to 10 scale) and sexual dysfunction (using the Female Sexual Function Index-FSFI) through an anonymous online questionnaire. We investigated couple relationships and intimacy with partners, the predisposition of patients to talk about their sexual problems, physicians' receptivity, and treatment scenarios. Risk factors for VVA symptoms and sexual dysfunction were assessed. A total of 107 women affected by SSc were enrolled. Of these, 83.2% of women (89/107) complained about VVA symptoms and 89.7% (among sexually active women; 87/97) about sexual dysfunction. Menopausal status did not affect VVA symptoms, while age was the only independent risk factor for sexual dysfunction. About 70% (74/107) of women reported a negative impact of disturbances on intimacy with their partner. A total of 63 women (58.9%) had never discussed their sexual problems and VVA condition with a physician. Lubricants were the only treatment prescribed, and 75% of women would welcome new therapies, even if experimental (62.9%). In women with SSc, VVA symptoms and sexual dysfunction are highly prevalent, independently from menopause. In more than half of the investigated women with SSc, we found reluctance to talk about their sexual problems, despite being symptomatic. This should encourage physicians to investigate vulvovaginal and sexual health. SSc patients would welcome the advent of new treatment possibilities for their VVA and sexual complaints.