Sexual Distress Research Articles

Compulsive sexual behaviour in Iranian married women: Prevalence, sociodemographic, sexual, and psychological predictors across-country.

This study addresses the scarcity of research on Compulsive Sexual Behavior Disorder (CSBD) in non-Western cultures and women, exploring its prevalence, sociodemographic, sexual history characteristics, and sexual and psychological health factors in Iranian married women. A cross-sectional study involving 772 heterosexual married women was conducted between 2022 and 2023, covering all 31 provinces of Iran. Participants were categorized as CSBD+ (at-risk individuals) and CSBD- (low-risk individuals) based on a pre-established cut-off point of ≥18 by the Compulsive Sexual Behavior Disorder Scale -7. Depression, anxiety, obsessive-compulsive disorder, self-esteem, sexual distress, sexual satisfaction, relationship satisfaction, and sexual dysfunction were assessed as psychological and sexual health variables by standardized scales. The prevalence of CSBD was 3.8% in women. Linear regression analysis showed that lower education, being jobless, substance use, pornography use, paraphilic behaviors, conflict on sex frequency, relationship, orgasm and sexual dissatisfaction, higher sexual arousal, depression, and obsessive-compulsive symptoms were positively associated with CSBD. The univariate analysis, at a stringent significance level of 0.005, mirrored the regression findings. Additionally, women with CSBD+ exhibited lower religiousness and higher anxiety compared to those without CSBD-. Raising awareness of CSBD is crucial for health systems and individuals for better policy-making and help-seeking behavior. Identifying risk factors like substance use presents opportunities for prevention, and the association of CSBD with sexual and mental health variables suggests addressing co-occurring issues for improved treatment outcomes. Recognizing culture and gender-specific sexual and psychological correlates enables targeted and effective treatment approaches.

Polycystic ovarian syndrome elevates the distress of sexual pain in Iranian women with infertility

BackgroundSexual dysfunction may lead to sexual distress in women with infertility, while polycystic ovarian syndrome (PCOS) may escalate this distress. This study aimed to investigate the role of PCOS in the relationship between sexual dysfunction and sexual distress in Iranian women with infertility.MethodsThe Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), and Depression and Anxiety modules of the DASS-21 were cross-sectionally investigated in 190 women with infertility (103 women with PCOS and 87 women without PCOS).ResultsThere were negative correlations between sexual function domains and sexual distress (P < .001) in the total sample. Moderation analysis revealed that higher levels of impaired desire, arousal, and pain elevated sexual distress in the PCOS group. After adjusting for depression and anxiety, only the association between sexual pain and sexual distress was moderated by PCOS condition (P = .008).ConclusionsThe findings suggest that impaired sexual function is associated with increased levels of sexual distress in infertile female patients. Importantly, comorbid PCOS renders patients susceptible to sexual distress where sexual pain is increased. Further research may shed light on the physiological, psychological, and relational aspects of sexual pain and associated distress in infertile female patients with comorbid PCOS.

Sexual dysfunction in migraine-affected women: A prospective cross-sectional controlled study

IntroductionFemale sexual dysfunction (FSD) is a common health problem that is inadequately investigated in Arabic countries, especially Saudi Arabia. AimTo assess the prevalence and trace predictors of FSD in Saudi women who suffered from migraine headaches comparable to healthy women. Patients and methodsA prospective cross-sectional, controlled study involved 400 Saudi women complaining of migraine (Case Group) and another 400 healthy-looking Saudi women (Control Group) during three months; from January 1st, to March 31st 2023, in Jeddah city, Saudi Arabia. Data was collected by using a pre-structured Female Sexual Function Index (FSFI) questionnaire, Female Sexual Distress Scale (FSDS), Migraine Screen Questionnaire (MS-Q), with an evaluation of the severity of pain by Visual Analogue Scale (VAS), and its impact on daily activity by using both; Headache Impact Test (HIT-6) and Migraine Disability Assessment (MIDAS) Questionnaire. ResultsA total of 800 Saudi women were recruited. Their ages ranged from 18 to 45 years old. Women with abnormally low FSFI scores were 375 (93.75 %) out of 400 with migraine and 85 (21.25 %) out of 400 without migraine. The lowest FSFI scores were mainly for desire (2.75 ± 1.05) and arousal domains (3.0 ± 1.12) followed by sexual satisfaction (3.25 ± 1.30) and orgasmic domains (3.5 ± 1.15). The foremost predictive factor behind low FSFI scores and associated FSD in our study was migraine (P < 0.00001). Additional predictors of statistical significance were low educational level (P < 0.01), urban residency (P < 0.02), high parity (P < 0.02), chronic illness such as diabetes (P < 0.01), and bad habits such as smoking (P < 0.03) ConclusionA significant correlation exists between migraine and female sexual dysfunction (FSD). Desire and arousal dysfunctions were the most significantly affected domains followed by satisfaction and orgasmic problems.

The Need to Look at Transgender and Gender Diverse People's Health: A Preliminary Descriptive Report on Pain, Sexual Distress, and Health Profile of Five Transmasculine People and One Non-Binary Person with Endometriosis.

The sexual health of transgender and gender diverse (TGD) people with endometriosis has been overlooked, and important emotional experiences, such as sexual distress and its correlates, have been ignored. This has prevented a more comprehensive look at the health experiences of TGD individuals. This descriptive online survey study preliminarily explored the experiences of pain symptoms, sexual distress, and mental health of N = 6 TGD individuals diagnosed with endometriosis. Descriptive results showed a mean delay of 10 years from the onset of symptoms to the diagnosis. Endometriosis-related pain was a common symptom, although with low to moderate intensity. Results also showed higher mean levels of pain impact, powerlessness and lack of control, somatization, depression, anxiety, and sexual distress, and lower mean levels of emotional well-being, social support, and worse self-image compared to reports on cisgender women with endometriosis in the literature. These results suggested that sexual and mental health in the context of TGD people with endometriosis has specificities and may be associated with factors that need to be accounted for to provide comprehensive and socially just healthcare, such as the recognition of the impact of endometriosis treatment on symptoms of gender dysphoria. To achieve sexual health equity for TGD people, continuous and updated professional training and inclusive research with multiple informants are necessary.

Ethnobotanical Studies of Reputed Aphrodisiac Plants Used in Traditional Medicine in Haut-Katanga in DR of Congo

The goal of this study is to identify the plants used to treat sexual dysfunction in Haut-Katanga (DRC). Since most couples in sexual distress believe that resolving sexual dysfunction (SD) is the key to happiness, an ethnobotanical survey using a questionnaire guide was conducted among 36 traditional practitioners in four sites in Haut-Katanga province, including Lubumbashi, the provincial capital. The survey identified 52 species of aphrodisiac plants that are used to treat SD. Of these, 51 have been scientifically identified; they belong to 45 different genera and are contained in 28 families, with the Fabaceae having the highest representation (15.7%). These species are employed singly or in combination to prepare eighty recipes; the most common plant organ was the root bark (63%) in these recipes. Aqueous decoction (44%) and oral administration (75.3%) are the most commonly used routes of drug preparation and administration. Nearly 80 additional indications for the same plant species were discovered to be employed, such as sexually transmitted infections (7.17%), diabetes (3.69%), and hemorrhoids (4.07%). For every species, the Informant Consensus Factor (ICF) was determined. The plants with higher values (ICF≥0.17) included Bersama abyssinica Fres, Garcinia huillensis Welw, Cassia petersiana Bolle, Chenopodium album L, Clerodendrum capitatum (Willd) Schumach, Dialiopsis africana Radlk., Albizia adianthifolia (Schum.) W. Wight, and Crossopteryx febrifuga Mull.Arg.

Preliminary Efficacy of Topical Sildenafil Cream for the Treatment of Female Sexual Arousal Disorder: A Randomized Controlled Trial.

To assess the efficacy of topical sildenafil cream, 3.6% among healthy premenopausal women with female sexual arousal disorder. We conducted a phase 2b, exploratory, randomized, placebo-controlled, double-blind study of sildenafil cream. Coprimary efficacy endpoints were the change from baseline to week 12 in the Arousal Sensation domain of the SFQ28 (Sexual Function Questionnaire) and question 14 of the FSDS-DAO (Female Sexual Distress Scale-Desire, Arousal, Orgasm). Two hundred women with female sexual arousal disorder were randomized to sildenafil cream (n=101) or placebo cream (n=99). A total of 174 participants completed the study (sildenafil 90, placebo 84). Among the intention-to-treat (ITT) population, which included women with only female sexual arousal disorder and those with female sexual arousal disorder with concomitant sexual dysfunction diagnoses or genital pain, although the sildenafil cream group demonstrated greater improvement in the SFQ28 Arousal Sensation domain scores, there were no statistically significant differences between sildenafil and placebo cream users in the coprimary and secondary efficacy endpoints. An exploratory post hoc subset of the ITT population with an enrollment diagnosis of female sexual arousal disorder with or without concomitant decreased desire randomized to sildenafil cream reported significant increases in their SFQ28 Arousal Sensation domain score (least squares mean 2.03 [SE 0.62]) compared with placebo cream (least squares mean 0.08 [SE 0.71], P =.04). This subset achieved a larger mean improvement in the SFQ28 Desire and Orgasm domain scores. This subset population also had significantly reduced sexual distress and interpersonal difficulties with sildenafil cream use as measured by FSDS-DAO questions 3, 5, and 10 (all P ≤.04). Topical sildenafil cream improved outcomes among women with female sexual arousal disorder, most significantly in those who did not have concomitant orgasmic dysfunction. In particular, in an exploratory analysis of a subset of women with female sexual arousal disorder with or without concomitant decreased desire, topical sildenafil cream increased sexual arousal sensation, desire, and orgasm and reduced sexual distress. ClinicalTrials.gov , NCT04948151.

(018) PILOT TESTING A NEW COUPLE-BASED SEX THERAPY INTERVENTION FOR SEXUAL INTEREST/AROUSAL DISORDER

Abstract Introduction Sexual interest/arousal disorder (SIAD) includes persistent and distressing symptoms of low sexual desire and/or arousal, which are the most common sexual difficulties among women. Meta-analyses of randomized clinical trials show that psychological therapies produce moderate to large improvements in clinically low sexual desire (Banbury et al., 2021; Frühauf et al., 2013; Günzler &amp; Berner, 2012). However, these therapies focus on individuals, neglecting the partner’s experience, which is known to affect and be affected by SIAD symptoms (Rosen et al., 2019). Despite the prevalence of SIAD and importance of interpersonal factors in the development and maintenance of low sexual desire, there are no empirically supported couple-based sex therapy interventions for this disorder. Objective To develop a new couple-based sex therapy intervention for SIAD following a cognitive-behavioral couple therapy (CBCT) framework. To test the CBCT intervention for SIAD in terms of feasibility, acceptability, and preliminary efficacy. Methods Nineteen couples in which a woman was diagnosed with SIAD completed a 16-session CBCT intervention delivered via Zoom by therapists with PhD-level training in clinical psychology. The goals of the CBCT intervention were to re-conceptualize SIAD in biopsychosocial-interpersonal terms, modify psychological and interpersonal factors associated with low sexual desire/arousal (Rosen &amp; Bergeron, 2019), and consolidate skills. Participants completed measures of dyadic sexual desire and sexual distress (primary outcomes) as well as sexual communication, sexual satisfaction, relationship intimacy, and relationship satisfaction (secondary outcomes) at pre-treatment, post-treatment, and at 6-month follow-up. We assessed preliminary efficacy using multilevel models guided by the actor-partner interdependence model (Kenny et al., 2020) to account for the interdependence of couple members’ data. Results The CBCT intervention was feasible as indicated by therapists’ high adherence to the treatment manual (96.8%) and couples’ high rates of homework completion (82.0%). The intervention was acceptable to couples, based on high session attendance rates (97.4%) and treatment satisfaction ratings (7.39/10 for women, 7.33/10 for partners). The intervention produced moderate to large pre- to post-treatment improvements in women’s dyadic sexual desire for their partner (p = .002, d = 0.73) and couple members’ sexual distress (p = .001, d = -0.93 for women, p = .002, d = -0.54 for partners) that were maintained at 6-month follow-up. Couples also reported moderate improvements in sexual communication and satisfaction immediately post-treatment (ps = .001-.02, ds = 0.40-0.53), but there were little to no changes in relationship intimacy or satisfaction post-treatment (ps = .05-.84, ds = 0.10-0.19). Conclusions Findings show that a couple-based sex therapy intervention grounded in theory and dyadic research evidence reduces SIAD symptoms (greater sexual desire, lower distress) and more broadly improves couples’ sexual wellbeing (improved sexual communication, satisfaction; lower distress). The lack of change in relationship outcomes may have been the result of couples having relatively high relationship wellbeing as a prerequisite for participation in the study. Also, the focus of the CBCT intervention was on sexual, rather than relationship wellbeing. This pilot study was based on a small sample and had no control group by design. A randomized clinical trial of the CBCT intervention is needed. Disclosure No.

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

Abstract Introduction The diagnosis of female sexual arousal disorder (FSAD) requires that individuals experience clinically significant distress from their symptoms. Pre-trial content validity investigations were conducted by the sponsor to understand how women with FSAD best described their distress associated with this female sexual dysfunction (FSD) diagnosis. Objective Responses to the Female Sexual Distress Scale – Desire, Arousal, Orgasm (FSDS-DAO) survey among healthy premenopausal women enrolled in a Phase 2b, exploratory, randomized, placebo-controlled, double-blind study of Sildenafil Cream, 3.6% for FSAD treatment (NCT04948151). Methods After informed consent, enrollment diagnoses for each participant were established during a one-on-one clinical interview with independent experts. Baseline assessments were measured after a one-month, single-blind, placebo, run-in period. Participants were then randomized to Sildenafil Cream, 3.6% (n=101) versus Placebo (n=99) and used the investigational product (IP) as needed at home for 12 weeks, with monthly in-clinic assessments. The change from baseline at week 12 in question 14 (Q14) of the FSDS-DAO was a co-primary efficacy endpoint. All 15 FSDS-DAO questions begin with “How often did you feel, in the past 30 days” with a Likert score of 0 (Never) to 4 (Always). Results Although changes from baseline at week 12 in FSDS-DAO Q14 responses were not different among active versus placebo users in the intent-to-treat population (p=0.84) or the future target population (women with FSAD only or primary FSAD with secondary hypoactive sexual desire disorder (HSDD)) (p=0.95), responses to several FSDS-DAO questions, showed reduced sexual distress among Sildenafil Cream, 3.6% users (Table 1). While Q14 asked specifically about concerns with sexual arousal, the other 5 questions asked about generalized sexual distress, using verbiage more congruent with pre-trial content validity investigations. Post-trial psychometric validation studies selected question 5 as the most appropriate for measuring sexual distress among this population. Conclusions Data from this exploratory trial support that women with a diagnosis of FSAD only or primary FSAD with secondary HSDD experienced reduced sexual distress after receiving Sildenafil Cream, 3.6%. Disclosure Yes, this is sponsored by industry/sponsor: Dare Bioscience and Strategic Science and Technologies. 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.

(054) OPTIMIZING INTERNET-BASED PSYCHOSOCIAL INTERVENTION FOR BREAST CANCER-RELATED SEXUAL MORBIDITY: PROTOCOL FOR A FACTORIAL TRIAL

Abstract Introduction Although 3 in 4 breast cancer survivors report significant sexual concerns following treatment, few receive support for these concerns. Delivering sexual health care to breast cancer survivors via the Internet could overcome many of the barriers to in-person interactions, including limited availability of resources and stigma. Prior research on telehealth interventions for breast cancer survivors’ sexual health has limitations. First, survivors continue to endorse time burden as a leading reason for declining telehealth sexual health interventions. Second, prior trial designs have not been able to determine which intervention components work best for which survivors. This knowledge is crucial to refine and personalize sexual health care for survivors. Objective Use the Multiphase Optimization Strategy (MOST) methodological framework to achieve the following aims: (1) develop an Internet intervention for breast cancer-related sexual health that is optimized for greatest impact; and (2) determine how intervention components work (i.e., mediators) and for whom they work best (i.e., moderators). Methods 320 partnered, post-treatment female breast cancer survivors who endorse at least one bothersome sexual symptom (i.e., pain with sex, vaginal dryness, low sexual desire, difficulty with orgasm) related to their breast cancer treatment will be enrolled. Recruitment will be conducted via a US-national community oncology research program representing more than 1,000 individual practice locations. In this factorial trial, participants will be randomized to receive a combination of 4 intervention components: psychoeducation about cancer-related sexual morbidity, training for communication with their health care team, training for communication with their partners, and intimacy promotion skills training. These components were selected as they are supported by our intervention research, are consistent with survivorship guidelines, and align with survivors’ preferences found in our qualitative research. Components will be implemented using a robust Internet intervention platform with tailoring and highly-engaging elements like animation, video, and automated email prompts. Survivors will complete assessments at baseline (pre-randomization) and 3- and 6-month post-assessments. First, the impact of intervention components on survivors’ sexual distress (Female Sexual Distress Scale-Desire, Arousal, Orgasm) and sexual functioning (Female Sexual Function Inventory) will be tested. Next, a select set of mediators (i.e., sexual functioning knowledge, sexual communication self-efficacy with clinicians and partner, emotional intimacy with partner) and moderators (i.e., menopausal status, adjuvant endocrine therapy use, psychological distress, relationship duration and satisfaction) will be evaluated. Results Institutional review board approvals are in progress, with clinical trial registration to follow. Data collection is anticipated to begin in Spring 2024 and be completed in 2027. Conclusions Findings from this trial will accelerate the development of more effective sexual health interventions for breast cancer survivors by determining how intervention components work and for whom various components work best. By identifying the combination of intervention components likely to provide breast cancer survivors the greatest sexual health benefit for the least burden, this study will result in the first Internet intervention optimized for maximum impact for the undertreated, prevalent, and distressing problem of breast cancer-related sexual morbidity. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: AHC: grants from Janssen, Relmada Therapeutics, Inc., and Sage Therapeutics; personal fees from Acadia, Alkermes, Allergan, AMAG Pharmaceuticals, Inc., Fabre-Kramer, Ovoca Bio plc, Pure Tech Health, Sage Therapeutics, Takeda/Lundbeck, WCG MedAvante-ProPhase, Ballantine Books/Random House, Changes in Sexual Functioning Questionnaire, Guilford Publications; personal fees and other from S1 Biopharma; and other from Euthymics and Mediflix LLC. GL: consultant or research affiliation with Agios Pharmaceuticals, Inc; Denovo Biopharma; IN8bio; Incyte Corporation; Novocure Inc.; oblato; ONO Pharma; Sumitomo Dainippon Pharma Co., Ltd. LR: financial and/or business interest in BeHealth Solutions and is a consultant to Mahana Therapeutics.

(118) ORGASM AND HEART RATE VARIABILITY IN FEMALE BREAST CANCER SURVIVORS: RESULTS FROM A PSYCHOPHYSIOLOGY STUDY

Abstract Introduction Over 70 % of female breast cancer survivors suffer from sexual dysfunction. Sexual dysfunction can cause great amounts of stress and negatively impact overall health and well-being. Most studies focus on sexual arousal disorders and hypoactive sexual desire disorders. The research on orgasm in this specific group is limited. A better understanding of sexual function in breast cancer patients may yield potential targets for new treatment strategies for sexual dysfunction in this population. Low heart rate variability (HRV) has been shown to be predictive of erectile dysfunction and female sexual arousal as well as orgasm frequency. Reduced HRV and low cardiac vagal tone have previously been reported in breast cancer survivors during the first year post-treatment. If HRV is a reliable indicator of female sexual dysfunction, it could be used to assess and monitor it in a clinical setting. Objectives This study aimed to explore whether there is a link between HRV and both, sexual arousal and the ability to orgasm. We were expecting to find a difference in HRV between breast cancer survivors and healthy controls as well as orgasmic and anorgasmic women. Methods Participants were prescreened during a telephone interview. We included 40 premenopausal breast cancer survivors currently on hormonal treatment with an age range of 29 to 57 years (M = 43.5, SD = 6.4) and 20 healthy controls with an age range of 22 to 35 (M = 27.6, SD = 3.2). The vaginal pulse amplitude, heart rate variability (SDNN), subjective sexual arousal and self-reported number of orgasms were assessed in response to audiovisual sexual stimuli and vibrotactile clitoral stimulation in breast cancer survivors and healthy controls. Validated patient-reported outcome measures were used to assess sexual dysfunctions (Female Sexual Function Index, Female Sexual Distress Scale − Desire/Arousal/Orgasm), sexual self-esteem (Sexual Self-Esteem Inventory-Short Form), health-related quality of life (Patient-Reported Outcomes Measurement Information System 29 (PROMIS-29) profile questionnaire). Results Breast cancer survivors showed lower sexual function, health-related quality of life, sexual self-esteem and higher sexual distress than healthy controls. Preliminary results show a difference in baseline HRV scores between healthy controls and breast cancer survivors. However, this finding is likely due to age differences between our two groups and not cancer treatment effects. We could find no apparent differences in baseline HRV between anorgasmic and orgasmic women. Further analyses on the predictive value of HRV during sexual arousal for orgasm occurrence will be conducted. Conclusions Our data did not corroborate either of our hypotheses related to baseline HRV. For the evaluation of HRV as a predictor for orgasm occurrence, further exploratory analyses will follow. More research on the physiological parameters of sexual dysfunction is needed to reveal underlying mechanisms and find targets for future therapies.

(095) CHRONIC EPIDURAL SPINAL CORD STIMULATION AS A POTENTIAL TREATMENT FOR SEXUAL DYSFUNCTION IN WOMEN WITH SPINAL CORD INJURY

Abstract Introduction Spinal cord injury (SCI) is a lifelong condition that affects approximately 294,000 individuals in the United States, with an estimated 17,900 new cases occurring each year. Despite sexual function being reported as a top priority to restore after injury, research on sexual dysfunction after SCI is scarce, especially among people with gynecological anatomy. One major challenge in treating female sexual dysfunction (FSD) after SCI is the heterogeneity of symptoms. Women can have impacted libido, genital sensitivity, lubrication, and/or ability to orgasm. This is further complicated by the comorbidities of bladder and bowel dysfunction, which are also common after SCI. Epidural spinal cord stimulation (eSCS) has emerged as a promising treatment for SCI, demonstrating positive results across various domains for motor-complete patients, including bladder, bowel, and sexual function. Objective The primary objective is to determine if chronic eSCS improves survey-reported sexual function after SCI in women. The secondary objective is to determine if chronic eSCS improves survey-reported bladder and bowel function. Methods Seven female participants who are motor and sensory complete after traumatic SCI with injury levels between cervical (C)6 and thoracic (T)10 were recruited for the study. Participants were implanted with a 16-contact paddle lead epidural spinal cord stimulation at the T11-T12 level and followed for 13 months. The Female Sexual Distress Scale (FSDS), Neurogenic Bowel Dysfunction Score (NBDS), and Neurogenic Bladder Symptom Score (NBSS) were administered monthly. Participants received continuous stimulation over 13 months. A generalized linear model was created for each outcome to examine trends in function over time with an alpha of 0.025 (Bonferroni corrected). Results In the first 6 participants analyzed, we found that sexual distress improves over time (p&amp;lt;0.001) in the largest series of women participants with SCI targeted for restoration of function (Figure 1). One woman reported restoration of orgasm after five years of chronic SCI. Additionally, we found a statistically significant improvement in bowel function as measured by the NBDS with stimulation (p&amp;lt;0.003) from the generalized linear mixed effects fit corresponding to the follow-up visit number. There were no statistically significant trends in the NBSS scores, however, one participant noted that she no longer uses an intermittent catheter to empty her bladder indicating functional improvements that are not captured by the survey. Conclusions Epidural SCS is a promising therapy to improve female sexual function after chronic SCI. Although quantitative surveys remain the most valid and reliable measures of pelvic organ function after SCI, we saw improvements in function that were not captured by the questionnaires. Still, we found significant improvements in validated surveys of bowel function and female sexual distress over time. These high-priority outcomes for women with SCI are potential targets of restoration using commercially available spinal cord stimulation. Disclosure Yes, this is sponsored by industry/sponsor: Abbott. Clarification: No industry support in study design or execution. Any of the authors act as a consultant, employee or shareholder of an industry for: Stim Sherpa.

(076) IMPACT OF AN ONLINE EDUCATION INTERVENTION ON HEALTHCARE PROVIDERS' SELF-EFFICIENCY FOR ASSESSMENT AND CARE OF CLIENTS EXPERIENCING FEMALE SEXUAL DYSFUNCTION

Abstract Introduction In the United States, nearly half of all women will report having at least one type of female sexual dysfunction at any given point in their lives. Female Sexual Dysfunction (FSD) is defined as a disturbance in sexual desire, psychophysiological changes that characterize the sexual response cycle, and marked sexual distress and interpersonal difficulty. Most women feel their healthcare provider should discuss their sexual concerns, yet few report being asked or screened about their sexual health. Women may seek care to address their sexual health concerns because sexual concerns can affect their quality of life. Objective The specific aim of this study was to evaluate the effectiveness of an online educational intervention about female sexual dysfunction on the knowledge and self-efficacy of healthcare providers. Methods The project is a single-arm effectiveness study that used a pre-test/post-test design, aiming to improve self-efficacy of physicians, physician assistants, nurse practitioners, and certified nurse-midwives who provide gynecological care. Participants were recruited via convenience and snowball sampling. The participants provided demographic and pre-test data before viewing the educational intervention and completed the post-test immediately following. Results Forty-three participants completed responses to the entire questionnaire, including pre and post-test. The majority of participants identified as female (91%), Caucasian (51%), nurse practitioners (81%) providing gynecological care for 6-15 years (53%) and live in the South (58%). Following the intervention, participants demonstrated a significant increase in confidence in their ability to communicate about sex with older adults (p &amp;lt; 0.001, d 0.51) and with those who have differing sexuality from their own (p &amp;lt;0.00, d 0.53). There was an increase in confidence in the knowledge to care for patients with religious/spiritual convictions about sexuality (p &amp;lt; 0.006, d 0.40) and sexual problems related to a medical, pharmacological, or surgical treatment (p &amp;lt; 0.009, d 0.38). Participants reported fewer learning needs following the educational module with a moderate to large effect size across different competencies. Conclusions Educating health care providers using an online educational module may lead to more confidence in the healthcare providers’ communication with, knowledge of, and attitudes related to female sexual concerns. Healthcare providers can provide the necessary support and care for the women they serve by educating themselves to properly obtain sexual health history screening, physical exams, diagnoses, and treatment options. Online educational modules have enhanced healthcare providers' knowledge on various topics. The results of this study can be useful in creating education for healthcare providers in caring for FSD. Further studies are needed to determine the long-term effect of online education modules on the screening of female sexual dysfunction, attitudes and behaviors, effect on the self-efficacy of healthcare providers. 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.

(132) MICONAZOLE VAGINAL CREAM AND ACQUIRED NEUROPROLIFERATIVE VESTIBULODYNIA

Abstract Introduction The vestibular epithelium is non-keratinized and is thus susceptible to injury from an allergic reaction. Topical pharmaceutical agents applied to the genitals for various medical indications, such as miconazole vaginal cream to treat vaginal yeast infections, may absorb through the non-keratinized vestibular epithelium. Active and inactive ingredients in miconazole vaginal cream include miconazole nitrate, benzoic acid, cetyl alcohol, isopropyl myristate, polysorbate 60, potassium hydroxide, propylene glycol, purified water and stearyl alcohol. Patients without vestibular pain previously have reported applying miconazole vaginal cream to their genitals and immediately experienced excruciating burning that resulted in persistent unrelenting severe pain throughout the vestibule, symptoms consistent with acquired neuroproliferative vestibulodynia (NPV). Objective To review reports of clinic patients who used miconazole vaginal cream prior to a diagnosis of acquired NPV to provide awareness of the management of this condition. Methods We performed a chart review of individuals with vulvas presenting to a single sexual medicine clinic between June 2019 and June 2023 to identify those who met the following inclusion criteria. They were clinically suspected to have acquired NPV after an allergic reaction following use of miconazole vaginal cream. They failed conservative treatments for provoked vestibular pain and underwent vestibulectomy. Their excised vestibular specimens revealed an excess of CD117 immunopositive stained cells (&amp;gt;8 per high-power field), consistent with mast cells, and PGP9.5 immunopositive stained area, consistent with nerves, histopathologically confirming the diagnosis of NPV. In addition, demographic data, prior diagnoses and treatments, results from validated questionnaires, pertinent physical exam findings and treatment outcomes were collected. Results A total of 7 individuals met inclusion criteria. Mean age at the time of exposure to miconazole vaginal cream was 23 (range 18-29) years. Mean age at presentation to our sexual medicine facility was 28 (range 22-33) years, thus a delay in diagnosis of miconazole vaginal cream-induced acquired NPV of 5 (range 1-12) years. 71% were previously diagnosed and unsuccessfully managed as hormonally-mediated vestibulodynia and 29% as interstitial cystitis. The mean pain domain score and overall score for the Female Sexual Function Index was 1.2/6 (range 0-3.2/6) and 11.7/36 (range 4.2-18.1/36), respectively. A total score of &amp;lt;26 is indicative of sexual dysfunction. The mean Female Sexual Distress Scale-Revised score was 32.2/52 (range 21-39/52), consistent with significant distress. Conclusions Our cohort of patients with miconazole vaginal cream-induced acquired NPV experienced several years of misdiagnoses, unsuccessful treatments, significant pain, and distress. It is hypothesized that miconazole vaginal cream induces NPV in genetically susceptible individuals in part because the vestibular epithelium is non-keratinized and therefore more easily absorbs the ingredients in the miconazole vaginal cream, which may result in an allergic response in the subepithelial region of the vestibule. This allergic reaction results in accumulation of mast cells in the subepithelial stroma that release nerve growth factor leading to neuroproliferation with subsequent allodynia and hyperalgesia. In individuals who develop yeast infections, use of systemic strategies and rather than topical medication is encouraged to avoid potential allergic reactions and resultant acquired NPV. Disclosure No.

(001) INHIBITION AND EXCITATION IN THE SEXUAL BRAIN: AN USEFUL TOOL FOR THE PREDICTION OF THE DIAGNOSIS AND TREATMENT OF HYPOACTIVE SEXUAL DESIRE IN WOMEN WITH SEXUAL DYSFUNCTION

Abstract Introduction HSDD (Hypoactive Sexual Desire Disorder) is one of the most common sex-related disorders among women. Despite its considerable prevalence, factors affecting sexual desire as well as therapeutic outcomes of treatment of HSDD in women have been scarcely studied. According to the Dual Control Model (DCM), for years female sexual desire has been identified as the result of two mainly centrally acting brain processes: excitation or inhibition towards sexual cues. In this context, the SIS (Sexual Inhibition Scale)/SES (Sexual Excitation Scale) validated questionnaire could represent an useful tool for the clinician to better characterize patients’ lack of desire. Objective This study was aimed at exploring both the inhibitory and excitatory components of sexual desire in women referring to our Clinic for sexual dysfunction, in order to find a cut-off value in the SIS/SES score predicting a diagnosis of HSDD. A secondary aim was also to identify clinical, relational and biochemical parameters significantly associated with these two dimensions of sexual desire. Methods We retrospectively recruited a consecutive series of 133 women consulting for Female Sexual Dysfunction (FSD). Patients underwent clinical and biochemical evaluation, a structured interview and completed several self-administered questionnaires, including SIS/SES, Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), Body Uneasiness Test (BUT), Emotional Eating Scale (EES) and Middlesex Hospital Questionnaire (MHQ). Results The ROC curve for SES score showed an accuracy of 0.687 ± 0.05 (p&amp;lt;0.0001) in identifying HSDD; considering a cut-off value of 47.5, the sensitivity and specificity for HSDD detection were 70.5% and 55.6%, respectively. In addition, the best cut-off value for SIS1 to diagnose HSDD was 32.5, with 0.664 ± 0.048 AUC (p=0.002), 68.2% sensitivity and 53.3% specificity. We next stratified FSD women according to these SES/SIS1 cut-off values, thus identifying patients with pathological (pSES, pSIS1) or non-pathological (npSES, npSIS1) scores and the following 4 different subgroups: group 1 npSES/npSIS1; group 2 npSES/pSIS1; group 3 pSES/npSIS1; group 4 pSES/pSIS1. Among the 4 groups we did not find any statistically significant difference concerning the main characteristics explored, including lifestyle, hormonal and metabolic factors, with the exception of age, which was associated with a progressive worsening of either SES and SIS1 scores (F=4.299, p=0.006). Concerning relational factors, we demonstrated that the longer the duration of the relationship, the more pathological the excitatory/inhibitory scores, even when adjusted for age (F=5.588, p=0.001). Noteworthy, with exception for FSFI orgasm (FSFI-O) and satisfaction (FSFI-S) domains, all others FSFI domains scores showed similar significant differences with the worst values observed in pSES subgroups, independently from the presence of pSIS1. In contrast, FSDS-R score showed a highly significant variation among subgroups, but with the pSIS1 subgroup displaying the worst distress score independently from the presence of pSES. Among endocrinological factors, only total testosterone levels showed significant variation among groups (F=5.952, p&amp;lt;0.001), with the lower level observed in FSD women with pSES or pSIS1, in whatever combination as compared to npSES/npSIS1, even after age-adjustment (F=3.176, p=0.027). Regarding psychopathological factors, in an age-adjusted model, we found a significantly different MHQ total score among the 4 groups, with the worst value associated with the pSIS1 group combined or not with pSES. We also explored eating disorder symptoms. The 4 groups reported significantly different values in the EES, with pSES/pSIS1 group showing the highest score, even after adjusting for age (F=3.316, p=0.023). We then investigated the relevance of stratifying HSDD patients according to SIS1 and SES np/p scores in predicting the beneficial effects of treatments for HSDD (improvement yes/no). Interestingly, we found that SES, but not SIS scores, could predict HSDD treatment outcome after 6 months; in particular, the lower the level of SES at baseline, the higher the improvement in FSFI-D domain during treatment is predictable. Finally, we explored which were the main determinants for SES/SIS1 scores in the study population. Noteworthy, a significantly stepwise increase of SES score was observed as a function of total testosterone levels (r=0.192, p=0.049). Conclusions In conclusion, the cutoffs of SIS1/SES found in this study could help characterizing HSDD women and identifying subgroups of patients with the highest probability to benefit from testosterone treatment. From a broader viewpoint, our study suggests that women diagnosed with HSDD should be evaluated by using more appropriate tools, including those not routinely employed in clinical practice, so that different “nuances” of this sexual disorder could be recognized and consequently adequately treated in a tailored therapy perspective. Disclosure No.

(056) PSYCHOSOCIAL FACTORS IN NEUROPROLIFERATIVE VESTIBULODYNIA PATIENTS WHO UNDERWENT COMPLETE VESTIBULECTOMY

Abstract Introduction Neuroproliferative vestibulodynia (NPV) is characterized by severe allodynia and hyperalgesia during entry penetration. Multiple psychosocial factors may contribute to the experience of pain from NPV. Concerning psychologic factors, women afflicted with NPV report difficulty with mental health issues such as anxiety and depression, high rates of negative emotions, substantial difficulties with psychosocial adjustment, and experience suicidal ideation. Objective This study focuses on psychosocial factors identified in a cohort of patients diagnosed with NPV who underwent vestibulectomy. Methods This is a chart review of 65 patients, median age 26 years (IQR 23-31) clinically diagnosed and pathologically confirmed with NPV. They completed validated instruments administered including the Female Sexual Function Index (FSFI), Sexual Distress Scale-Revised (SDS-R), McGill Pain Questionnaire-Short Form (SF-MPQ), Perceived Stress Scale (PSS), and Patient Health Questionnaire-9 (PHQ-9). The sex therapy evaluation performed on initial patient intake assessed psychosocial issues including effect of symptoms on quality of life, self-image, past trauma, and past/current relationship(s). Patients identified as having significant psychosocial issues were advised to undergo pre-op and/or post-op therapy. Results Based on history, initial psychological assessment, and psychosocial experiences with vestibular pain, post-operative therapy was recommended to 94% of our study cohort to maximize post-operative outcome. Our study cohort exhibited high levels of anxiety (53.8%) and depression (50.8%). Sexual abuse, assault and/or incest had been experienced by 32.3%. Other psychological issues included eating disorder (10.8%), bipolar (6.2%) as well as suicidal ideation (4.6%). Problems revolving around personal relationships include panic attacks around sex/men (21.5%), not pursuing sexual relationships (9.2%), lack of attraction toward current partner (4.6%) or being attracted to unavailable people (3.1%). A total of 15.4% of this cohort had complaints of low desire and 9.2% had a history of drug or alcohol abuse. Median FSFI total score was 13/36 (&amp;lt;26), with distress (≥11) consistent with sexual dysfunction in 56 of 61 patients. Median FSFI pain domain was 0/6; median FSDS-R (n=61) was 35/52, indicative of significant distress; median PHQ-9 was 6.5/27 with 23 patients’ scores consistent with possible need for depression treatment based on clinical judgment and 14 patients with score consistent with warranting treatment for depression. Median PSS was 22/40 with the most common level of stress being moderate (n=54). SF-MPQ median results (n=63) were 15/33 for sensory, 3/12 for affective and 4/5 for present pain intensity. With 3-46 month follow-up, 86.3% of patients (44/51) reported improvement on the Patient Global Impression of Improvement with 72.5% (37/51) reporting significant improvement. Conclusions While NPV is a biologic diagnosis, psychological factors likely contribute to the development, continuation, and consequences of NPV. We believe that the significant mental health issues in this NPV patient population made recovery from vestibulectomy more protracted than typically experienced after surgery. Psychological therapy would be beneficial in this population and should be continued postoperatively, as needed, to address psychological concerns and enhance quality of life. Disclosure No.

Intimacy Promotes Couples' Sexual Well-Being on a Daily Basis and Over One Year: The Role of Positive Sexual Cues.

There is growing interest in identifying factors that promote sexual well-being in romantic relationships. One such factor is intimacy-a process involving self-disclosure and empathic response that is positively associated with sexuality outcomes. However, most work among community couples examined cross-sectional associations in mixed-sex/gender couples using a single sexual outcome, which may not capture daily variations in intimacy and different dimensions of sexual well-being among a diversity of unions over time. Additionally, potential mediating mechanisms of the intimacy-sexual well-being association, such as attention to positive sexual cues (i.e., sexual thoughts and feelings), have been neglected. Adopting daily diary and longitudinal designs, the present study examined whether greater intimacy was associated with higher levels of positive sexual cues and, in turn, higher sexual well-being (sexual desire, satisfaction and distress). A convenience sample of 211 couples (Mage = 30.2years; SD = 8.3; 75 sexually diverse couples) completed a survey on days of sexual activity with their partner, over a 35-day period and 12 months later. Daily results showed that intimacy was related to greater attention to positive sexual cues for both partners, which in turn was associated with their greater sexual desire and satisfaction and lower sexual distress. Longitudinal results showed that a person's greater daily intimacy was linked to their own greater sexual desire and satisfaction 12months later via their own higher positive sexual cues, but not to their partner's cues or well-being. Findings extend interpersonal models of sexual well-being and support the role of intimacy and positive sexual cues therein.

Under Pressure: Men’s and Women’s Sexual Performance Anxiety in the Sexual Interactions of Adult Couples

ABSTRACT Most research on sexual performance anxiety has focused on men’s experiences and links to erectile functioning and premature ejaculation, with little research attention given to women’s experiences or to relationship dynamics. At times, sexual performance anxiety has been examined in the context of dysfunction, but rarely as a focus in its own right. Study 1 asked 51 participants reporting sexual performance anxiety to describe the cognitive and affective components of their experiences, coping strategies, and perceived impact on their relationship using open-ended responses from online surveys. Through directed content analysis, Study 1 revealed that men and women experience a range of cognitive and affective processes with predominant feelings of inadequacy, and overall promoting more approach coping strategies. Study 2 used quantitative surveys to examine whether sexual performance anxiety was associated with higher sexual distress and lower sexual and relationship satisfaction in a sample of 228 community-based couples. Guided by the Actor-Partner Interdependence Model, multilevel modeling analyses indicated that higher sexual performance anxiety was linked to higher sexual distress and lower sexual and relationship satisfaction in both individuals and their partners. This work advances knowledge of sexual performance anxiety to women’s experiences, not just men’s, and to couples’ experiences. Effective treatment for those suffering from this anxiety may incorporate education around sexual beliefs and expectations.

Understanding the Interplay Between Premenstrual Dysphoric Disorder (PMDD) and Female Sexual Dysfunction (FSD).

Premenstrual dysphoric disorder (PMDD) is a severe variant of premenstrual syndrome (PMS), categorized as a mood disorder due to marked symptoms of depression and anxiety, compounded with severe physical symptoms. Female sexual dysfunction (FSD) can manifest as low libido, difficulty achieving sexual pleasure, and dyspareunia, causing functional and psychological distress. PMDD and FSD are globally prevalent conditions with postulated biological, psychological, and social associations between them. Nevertheless, sexual dysfunction in PMDD is an important aspect of women's health that has been understudied and has notable methodological limitations. In this narrative review, we summarize the existing literature on sexual function in women with PMDD and PMS, specify the distinctions between PMDD and other general symptoms of PMS, highlight the significance of understanding sexual dysfunction in the female population, and outline some available therapeutic options. Studies show that women frequently experience debilitating sexual distress during the premenstrual phase; however, there is an essential need to formulate standardized tools for definite diagnosis. Selective serotonin re-uptake inhibitors (SSRIs) and combined oral contraceptive pills (COCPs) are approved medications for PMDD, while flibanserin and bremelanotide are effective in treating FSD. However, the potential effects of these treatment modalities on the two comorbid conditions render them inconclusive. Awareness of PMDD and FSD among clinicians and society can allow the implementation of targeted interventions to alleviate the suffering of women and enhance their quality of life.

Predicting Sexual Distress Based on Self-compassion in Women with a History of Mastectomy: Investigation of the Mediating Role of Body Image and Difficulties in Emotion Regulation

Predicting Sexual Distress Based on Self-compassion in Women with a History of Mastectomy: Investigation of the Mediating Role of Body Image and Difficulties in Emotion Regulation