Sexual Function Questionnaire Research Articles

Distended Seminal Vesicles Are Involved in Specific Cerebral Sexual Arousal: A Pilot Study Using Functional Brain Imaging in Young Healthy Men

BackgroundWhether seminal vesicles play a role in sexual activity in men is unknown. No study so far has compared the neural processing of visual sexual stimuli in men depending on the filling state of the seminal vesicles. ObjectiveTo evaluate potential specific cortical activation by visual sexual stimuli with distended and empty seminal vesicles. Design, setting, and participantsA prospective case-control trial was conducted. Six male individuals underwent two visits on 2 consecutive days for hormone analyses; Derogatis Interview for Sexual Functioning (DISF) questionnaire; functional magnetic resonance imaging (fMRI) with passively viewing sexual, neutral, positive, and negative emotional pictures; and structural pelvic MRI. After the first visit, the participants had to empty seminal vesicles by masturbation. During fMRI, every participant viewed alternating blocks of sexual, neutral, positive, and negative emotional pictures. Outcome measurements and statistical analysisComparisons between days 1 and 2 were evaluated using paired t tests. Results and limitationsNo significant differences were observed regarding hormone analyses, DISF questionnaire score, and arousal scoring between days 1 and 2. Seminal vesicle volume was significantly lower on day 2 (p = 0.003). Significantly higher activation was observed in the right precentral gyrus, middle frontal gyrus, and right superior temporal sulcus when contrasted for sexual over neutral (p < 0.05). ConclusionsIn response to pictures with sexual emotional content, significantly higher activation was detected in brain areas involved in motor preparation (arousal) and coding of desirability of visual sexual stimuli in men with distended seminal vesicles than in the same men with emptied seminal vesicles. This suggests that the filling state of the seminal vesicles may influence sexual desire in men. Patient summaryWe compared brain activity of men with filled and emptied seminal vesicles by functional magnetic resonance imaging. We found that men with filled seminal vesicles had higher activation of brain areas involved in arousal and sexual desire.

Factors Associated with Postpartum Sexual Dysfunction in Spanish Women: A Cross-Sectional Study.

(1) Background: Female sexual dysfunction (FSD) has a high prevalence globally, and perinatal factors favor FSD, especially in the postpartum period. The aim was to determine the prevalence and factors influencing FSD in the postpartum period; (2) Methods: An observational study carried out in three primary care centers in southern Spain, with women in the postpartum period who had a single low-risk birth. One hundred and seventeen women answered the Female Sexual Function questionnaire during the 4th month postpartum, between January 2020 and December 2021. Sociodemographic, obstetric, neonatal variables and level of self-esteem were analyzed. A multiple logistic regression model was carried out; (3) Results: 78.4% had high level of self-esteem. FSD prevalence was 89.7%. Factors related to FSD were having an instrumental vaginal delivery, women with university studies, and prenatal preparation. Maternal age ≥ 35, multiparity, pathological processes in the child, a medium–low level of self-esteem and newborn weight were associated with disorders in some of domains of sexual function; (4) Conclusions: FSD is highly prevalent in the postpartum period and is associated with preventable factors. A preventive approach by health professionals to these factors is essential. Health services should implement postpartum follow-up programs, which may coincide in time and place with newborn follow-up programs.

Patient-Reported Sexual Function in Long-Term Survivors of Anal Cancer Treated With Definitive Intensity Modulated Radiation Therapy and Concurrent Chemotherapy

PurposePelvic chemoradiation can have a profound effect on sexual function. Few data exist describing long-term sexual function patient-reported outcomes (PROs) for patients treated with intensity modulated radiation and concurrent chemotherapy (CRT) for squamous cell carcinoma of the anus (SCCA). Methods and MaterialsWe identified 248 patients with SCCA treated with CRT from 2010 to 2018 who were alive and without recurrence. We sent a PRO survey to 148 patients who agreed to participate. The survey was comprised of the PROMIS sexual function and satisfaction questionnaire, the international index of erectile function 5-item questionnaire for men, and the female sexual function index questionnaire for women. Clinical and dosimetric data were collected for each patient. We used multiple regression models to identify factors associated with sexual function PROs. ResultsOne-hundred twelve patients (45.2% of all eligible patients, 75.7% of administered surveys) completed the survey; 90 (80.4%) were women, 107 (95.5%) were white. The median (interquartile range [IQR]) age was 61.5 (53.8-66.0) years. The median (IQR) interval since CRT was 51 (37-85) months. Twelve men (54.5%) and 52 women (57.1%) were sexually active. The median (IQR) age of sexually active patients was 58.2 (50.1-64) years compared with 64.8 (59.1-68.8) years for sexually inactive patients (P < .001). The median (IQR) female sexual function index score for sexually active women was 20.2 (13.6-25.1). The median (IQR) international index of erectile function 5-item questionnaire score was 14 (6.5-19). ConclusionsPatients treated with modern CRT for SCCA experience significant long-term sexual dysfunction as reported using validated PROs. Interventions to reduce sexual toxicities and improve patient support are needed.

Sexual Function Following Treatment for Stress Urinary Incontinence With Bulk Injection Therapy and Mid-Urethral Sling Surgery

Peri-urethral bulking injections (PBI) gain popularity for the treatment of stress urinary incontinence (SUI), but - in contrast to mid-urethral sling (MUS) surgery - little is known about its impact on sexual function. This was a secondary analysis of a prospective cohort study that included patients with moderate to severe SUI undergoing either MUS surgery or PBI with polydimethylsiloxane Urolastic (PDMS-U). The validated Dutch and English version of the 'Pelvic Organ Prolapse and/or Urinary Incontinence Sexual Function Questionnaire - IUGA Revised' (PISQ-IR) was used to assess sexual function at baseline, at 6 and 12 months of follow-up. For between-group analysis, differences in baseline characteristics were corrected using multivariate analysis of covariance. The primary outcome was the PISQ-IR single summary score of sexually active (SA) women following both procedures, calculated by mean calculation. Secondary outcomes were the PISQ-IR subscale scores of SA and non-sexually active (NSA) women, the proportions of sexual activity and subjective improvement ('Patient Global Impression of Improvement' (PGI-I)). A total of 259 women (MUS: n = 146, PBI: n = 113) were included in this study. The PISQ-IR single summary score of SA women improved following both interventions (in the MUS group from 3.2 to 3.4 and in the PBI group from 3.0 to 3.3 after 12 months). After correcting for differences in baseline characteristics, the PISQ-IR summary score at 6 and 12 months was similar for both treatment groups. For SA women, condition-specific and condition-impact subscale scores significantly improved following both procedures. In treating SUI, PBI is inferior to MUS surgery. However, there is a need for less invasive strategies, especially for women who are unfit for surgery or have contraindications. Sexual function improves after PBI using PDMS-U, which is relevant for the counselling of women with SUI about available treatment options. Strength: until this study, there was a lack of knowledge about the effects of PBI on sexual function. Limitation: there may be indication bias as we did not perform a randomized controlled trial. PBI using PMDS-U and MUS surgery for the treatment of SUI improve sexual function equally in SA women, mainly by decreasing the condition's impact on sexual activity and quality.

Sexual function and associated factors at 24 months postpartum: a cohort study / Função sexual e fatores associados aos 24 meses de pós-parto: um estudo de coorte

The aim of this study was primarily to investigate the rates of indicative sexual dysfunction (SD) in the last gestational month and at 24 months postpartum. As a secondary objective, we sought to identify the main factors associated with SD at 24 months. The study sample included 131 women who gave birth in maternity wards at two public hospitals in southern Brazil between the period of October 2018 and April 2019. In the first stage (T1), an interview was carried out while the participants were hospitalized, during the immediate postpartum period, based on a clinical record and on the female sexual function questionnaire (Female Sexual Function Index – FSFI). In the second stage (T2), assessments were made via telephone, given the restrictions of the Covid-19 pandemic, 24 months after the initial data collection. At this stage, an updated clinical record was used, followed by the FSFI questionnaire. The final sample consisted of 82 women. Data analysis was performed using descriptive statistics. Data normality was verified using the Kolmogorov-Smirnov test. The chi-square test was used to compare categorical variables in two stages. The Wilcoxon test was used to compare the FSFI score and its domains, both in the last gestational month and at 24 months postpartum. To analyze the correlation of factors associated with the FSFI score, Spearman's test was used. As for sexual function (SF), of the women who were sexually active in the last four weeks of pregnancy (n=33), 39.4% (n=13) indicated SD, while at 24 months postpartum, the percentage was reduced to 20.7% (n=17). There was no statistically significant difference between the total FSFI scores for the two periods observed; however, the analysis of the FSFI domains showed a significant improvement in sexual desire (p=0.01) and a reduction in pain during intercourse (p=0.04) at the 24-month postpartum follow-up. Thus, indications of SD, both in the last month of pregnancy and at 24 months postpartum, can be considered moderate. Furthermore, it was possible to identify factors associated positively, as well as negatively, with SF at 24 months postpartum.

A Structural Equation Modeling Analysis of the Related Factors of Sexual Function and Dyspareunia After Vaginal Birth

Background: According to the importance of postpartum sexual dysfunctions and their effects of these cases on the quality of life of the couple, this study aimed to determine vaginal postpartum sexual function and dyspareunia. Methods: This descriptive-analytical study was performed on 400 women with a history of natural childbirth in 2020 - 2021 in Hormozgan Province, Iran. The demographic and obstetric checklist, sexual function, and postpartum dyspareunia questionnaires (Carol Scale) were used. For data analysis, “SPSS 18.0” Software and for Partial least squares (PLS) modeling, Smart PLS Software was used. Results: The mean age of the women was 26.74 ± 6.12 years, and the average overall sexual function and postpartum dyspareunia score were 27.18 ± 8.62. All amounts of cross-validated communality indicated the appropriate and acceptable quality of the present research model. The absolute goodness of fit (GOF) for the tested model was 0.41, indicating the tested model's appropriate fit. Age, spouse age, education, the average number of intercourse, and marital satisfaction directly affected sexual function after vaginal birth. In contrast, age, spouse age, education, duration of marriage were indirectly correlated with sexual function after vaginal birth through marital satisfaction (P &lt; 0.01). In the present study, age, spouse, and education had a direct and indirect effect on sexual function after vaginal birth. Conclusions: Poor marital satisfaction can cause sexual dysfunction after vaginal delivery. Therefore, it is hoped that by using the present study results and similar ones to identify the factors affecting sexual function, by training couples and healthcare providers, sexual relations and emotional performance between couples will be established and strengthened more than before.

The effect evaluation of traditional vaginal surgery and transvaginal mesh surgery for severe pelvic organ prolapse: 5 years follow-up.

The objective of this study was to compare the clinical effectiveness of traditional vaginal surgery and transvaginal mesh (TVM) surgery on severe pelvic organ prolapse (POP). We performed a retrospective chart review study of 258 severe POP patients who underwent surgery between November 2010 and September 2016. One hundred forty patients underwent traditional vaginal surgery and 118 TVM surgery. The Pelvic Organ Prolapse Quantitation (POP-Q) staging was used for objective evaluation. The Pelvic Floor Distress Inventory-20 (PFDI-20), Pelvic Floor Disease Life Impact Questionnaire Simplified Version-7 (PFIQ-7), and Pelvic Organ Prolapse/Incontinence Sexual Function Questionnaire (PISQ-12) were used for subjective evaluation. Their complications were also recorded. All the data were collected in the outpatient department through the follow-up at 3 months, 1, 3, and 5 years after the operation. Forty patients in the traditional vaginal surgery group and 25 in the TVM group were lost to follow-up. There was no difference in the POP-Q score between the groups (P = 0.346). The recurrence rate increased with follow-up time, reaching nearly 20% in the two groups by 5 years. The TVM group has higher PFDI-20 and PFIQ-7 scores and lower PISQ-12 scores than the traditional vaginal surgery group at six months, 1, 3, and 5 years, respectively (P < 0.001). Mesh exposure has occurred in the TVM group. Both surgeries showed similar objective satisfaction and recurrence rate. However, traditional vaginal surgery has higher subjective satisfaction than TVM in our study and does not risk exposure to prosthetic material.

Sexual Satisfaction Results With the Vaginal pH Modulator From the Phase 3 AMPOWER Study

The novel vaginal pH modulator (VPM; Phexxi) is a non-hormonal, woman-controlled, on-demand, water-based, surfactant-free contraceptive vaginal gel; VPM has also been cleared by the Food and Drug Administration for use as a personal lubricant. The aim of this study is to report on sexual satisfaction results from the phase 3 AMPOWER study. AMPOWER was a single-arm, open-label, multicenter study to assess the safety and efficacy of VPM in preventing pregnancy. Women were enrolled who were healthy, age 18-35 years, and sexually active with regular cyclic menses. Women's satisfaction (including sexual satisfaction) was an exploratory endpoint measured at Baseline and Visits 3-5; sexual satisfaction-related patient reported outcomes (PROs) were assessed via 3 different questions: (i) a question related to the impact on a woman's sex life; (ii) a question from the Sexual Function Questionnaire (SFQ) related to the frequency of ten sexual problems; and (iii) a question from the Female Sexual Function Index (FSFI) related to lubrication. For sexual satisfaction-related PRO measures with baseline assessments, the majority of women reported the same or improved scores at Visit 5 (ranging from 85.8% to 98.4%). The percentage of women who reported that their sex life was improved and/or maintained was higher in Visit 3, 4, and 5 (95.4%, 95.1%, and 93.6%, respectively) compared to Baseline (87.6%). The mean impact on sex life score significantly improved at Visit 5 compared to Baseline (P < .001). In the SFQ, the mean score significantly improved (P < .005) at Visit 5 vs Baseline in 7 of the 10 variables measured (vaginal dryness, lack of sexual interest and/or desire, vaginal tightness, pain, anxiety, unable to orgasm, and vaginal bleeding or irritation). In women who reported sexual activity in the last 4 weeks, the mean FSFI score also significantly improved from Baseline to Visit 5 (P = .037). In this post-hoc analysis of the phase 3 AMPOWER study, the PRO results demonstrate a high level of sexual satisfaction with VPM. The primary strength of this analysis was the large study size of 1,330 women. Limitations included the non-randomized study design, the post-hoc nature of the analysis, and the fact that sexual satisfaction was an exploratory endpoint. As a non-hormonal, woman-controlled, on-demand, lubricating contraceptive gel, VPM offers women a unique set of benefits with positive impacts on their sexual health.

Predictors of Sexual Function and Performance in Young- and Middle-Old Women.

Background: Maintaining sexual life in older women might be perceived as a measure of healthy and successful aging. This study aimed to establish the prevalence of female sexual dysfunction (FSD) based on the DSM-5 criteria and predictors of sexual performance in older women. Methods: A total of 185 women between 55 and 79 years old were included in the study. Validated scales were used to assess sexual function (Changes in Sexual Function Questionnaire (CSFQ)), the propensity for sexual excitation/inhibition (Sexual Excitation/Sexual Inhibition Inventory for Women), and sexual anxiety/avoidance (Body Exposure during Sexual Activity Questionnaire (BESAQ)). Multiple regression was used to assess the factors affecting sexual function and the prevalence of FDS. Results: Sexual distress was diagnosed in 14.1% of women, and FSD in 16.2% (n = 53), whereas sexual problems (CSFQ) were diagnosed in 33.3% of women, and distressing sexual concerns in 35.1%. Women with a lower number of male sexual partners (β = −0.22), a better attitude toward sex (β = 0.25), higher importance of sex (β = 0.31), a higher level of sexual excitation (β = 0.34), and that were sexually active (β = 0.39) had better sexual function, as evaluated by CSFQ. Conclusions: Most older women remain sexually active. The diversity of sexual activity in later life should be affirmed to encourage women to be sexually active and to strengthen the response to sexual stimuli.

Sexual Health Screening for Gynecologic and Breast Cancer Survivors: A Review and Critical Analysis of Validated Screening Tools.

IntroductionStudies have shown that the sexual health concerns of gynecologic and breast cancer survivors are not adequately being addressed by clinicians.AimTo provide a comprehensive narrative review of validated sexual health screening tools and aid clinicians in choosing a screening tool that will allow them to best address their patients' sexual health concernsMethodsA review of PubMed and Google Scholar databases was conducted, using search terms “sexual health”, “screening”, “tools”, “cancer”, and “survivors” to identify sexual health screening tools meeting the following inclusion criteria: 1) published in a peer-reviewed journal, 2) were written in English, 3) included breast and/or gynecological cancer patient population, 4) included self-reported measure of sexual health and function, and 5) underwent psychometric validation.Main Outcome MeasureCriteria used to evaluate identified screening tools included ability to assess desire, arousal, satisfaction, orgasm, dyspareunia, solo sexual expression, relationship with partner, body image, distress over changes in sexual function, and support systems. Pre and post- treatment comparisons, differentiation between lack of sexual desire and inability, heterosexual bias, diversity in patient population, and ease of scoring were also evaluated.ResultsBased upon the inclusion criteria, the following 10 sexual health screening tools were identified and reviewed: Female Sexual Function Index, European Organization for Research and Treatment of Cancer Quality of Life Questionnaires for both Cervical and Endometrial Cancer, Sexual Adjustment and Body Image Scale, Sexual Adjustment and Body Image Scale- Gynecologic Cancer, Sexual Function and Vaginal Changes Questionnaire, Gynaecologic Leiden Questionnaire, Information on Sexual Health: Your Needs after Cancer, Sexual Satisfaction Questionnaire, and Sexual Activity Questionnaire. Most tools assessed satisfaction (n=10), desire (n=9), and dyspareunia (n=8). Fewer addressed objective arousal (n=7), body image/femininity (n=7), partner relationship (n=7), orgasm (n=5), pre/post treatment considerations (n=5), distress (n=4), and solo-sexual expression (n=2). Heterosexual bias (n=3) and failure to differentiate between lack of desire and inability (n=2) were encountered.ConclusionUnderstanding the strengths and limitations of sexual health screening tools can help clinicians more effectively address cancer survivors' sexual health concerns, which is essential in providing comprehensive care and improving quality of life. Screening tools have room for improvement, such as eliminating heterosexual bias and including cancer and treatment-specific questions. Clinicians can use this guide to select the most appropriate screening tool for their patients and begin bridging the gap in sexual healthcare.Tounkel I, Nalubola S, Schulz A, et al. Sexual Health Screening for Gynecologic and Breast Cancer Survivors: A Review and Critical Analysis of Validated Screening Tools. Sex Med 2022;10:100498.

Transvaginal single-port versus multi-port laparoscopic sacrocolpopexy: a retrospective cohort study

BackgroundSacrocolpopexy is the gold standard treatment for apical prolapse. With the development of minimally invasive surgical techniques, the new approach of transvaginal single-port laparoscopic sacrocolpopexy (TS-LSC) has become available. However, its therapeutic effects remain unclear. The aim of this study is to compare the middle-term clinical outcomes of transvaginal single-port laparoscopic sacrocolpopexy with multi-port laparoscopic sacrocolpopexy (LSC) for apical prolapse.MethodsWe conducted a retrospective cohort study. Patients with advanced apical prolapse who underwent either TS-LSC or LSC between May 2017 to June 2019 were enrolled. Baseline demographics, perioperative results, perioperative and postoperative complications, pelvic organ prolapse quantification (POPQ) scores, pelvic floor distress inventory (PFDI-20) score and pelvic organ prolapse/urinary incontinence sexual function questionnaire (PISQ-12) score were collected at 2 years.Results89 subjects were analyzed: 46 in TS-LSC and 43 in LSC group. Follow-up time was 38.67 ± 7.46 vs 41.81 ± 7.13 months, respectively. Baseline characteristics and perioperative outcomes were similar except that pain score was lower (2.37 ± 0.90 vs 3.74 ± 1.05) and cosmetic score was higher (9.02 ± 0.75 vs 7.21 ± 0.89) in TS-LSC group (P < 0.05). Complication rates did not differ between groups. 3 mesh exposure in each group were noted. Recurrence rate was 2.17% in TS-LSC and 6.98% in LSC, no apical recurrence occurred. Constipation was the most common postoperative symptom. Besides, patients in TS-LSC group had better POP-Q C point (− 6.83 ± 0.54 vs − 6.39 ± 0.62, P < 0.05), and similar Aa, Ap and TVL values. Bladder and pelvic symptoms were improved in both groups, but colorectal symptoms were not relieved. There were no differences of PISQ-12 scores between groups.ConclusionTS-LSC was not inferior to LSC at 2 years. Patients may benefit from its mild pain, better cosmetic effect and better apical support as well as good safety and efficacy. TS-LSC is a promising considerable choice for advanced vaginal apical prolapse.Trial registration ChiCTR2000032334, 2020-4-26 (retrospectively registered)

Recovery of male reproductive endocrine function after ceasing prolonged testosterone undecanoate injections.

The time course of male reproductive hormone recovery after stopping injectable testosterone undecanoate (TU) treatment is not known. The aim of this study was to investigate the rate, extent, and determinants of reproductive hormone recovery over 12 months after stopping TU injections. Men (n = 303) with glucose intolerance but without pathologic hypogonadism who completed a 2-year placebo (P)-controlled randomized clinical trial of TU treatment were recruited for further 12 months while remaining blinded to treatment. Sex steroids (testosterone (T), dihydrotestosterone, oestradiol, oestrone) by liquid chromatography-mass sprectometry, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and sex hormone-binding globulin (SHBG) by immunoassays and sexual function questionnaires (Psychosexual Diary Questionnaire, International Index of Erectile Function, and short form survey (SF-12)) were measured at entry (3 months after the last injection) and 6, 12, 18, 24, 40, and 52 weeks later. In the nested cohort of TU-treated men, serum T was initially higher but declined at 12 weeks remaining stable thereafter with serum T and SHBG at 11 and 13%, respectively, lower than P-treated men. Similarly, both questionnaires showed initial carry-over higher scores in T-treated men but after 18 weeks showed no difference between T- and P-treated men. Initially, fully suppressed serum LH and FSH recovered slowly towards the participant's own pre-treatment baseline over 12 months since the last injection. After stopping 2 years of 1000 mg injectable TU treatment, full reproductive hormone recovery is slow and progressive over 15 months since the last testosterone injection but may take longer than 12 months to be complete. Persistent proportionate reduction in serum SHBG and T reflects lasting exogenous T effects on hepatic SHBG secretion rather than androgen deficiency.

Pilot study to assess sexual function, quality of life (QOL) and change in vaginal dimensions following vaginal brachytherapy (VBT)

METHODS63 patients with early stage endometrial carcinoma treated with VBT 30 Gy in three fractions to the vaginal surface were invited to participate. 18 patients enrolled. Vaginal length and diameter were measured using original VBT cylinders to assess change. Patients completed sexual function, QOL, and toxicity questionnaires. The assessment of patients’ sexual function relative to national mean was calculated and reported by the Health Measures Scoring Service, a third party. RESULTSMedian length of time from VBT start until research visit was 3.6 years. Mean original vaginal length of the 18 women was 13.7 cm (Range: 11–18 cm); mean original diameter was 3.0 cm (Range: 2.5–3.5 cm). There was a significant decrease in vaginal length of 1.2 cm (p = 0.0005). There was a mean vaginal diameter decrease of 0.03 cm that was not significant. Toxicities were grade 1–2 and infrequent. There were no grade two acute toxicities, and 1 patient (5.6%) who had a chronic toxicity, diarrhea. 7 patients had evaluable sexual function responses. Reported sexual function was above the national mean in global satisfaction, interest, and lubrication (52.9, 50.2, and 56.2 percentile). Patients performed beneath national mean in the categories of orgasm and discomfort (3.1, 46.7 percentile) which was not correlated with the decrease in vaginal length. DISCUSSION/CONCLUSIONVBT resulted in significant vaginal shortening. Patients underperformed in the categories of orgasm and vaginal discomfort relative to national mean. This report adds to the scarce literature of objective data on sexual satisfaction and vaginal sequelae of VBT for endometrial carcinoma.

Female Sexual Dysfunction and Pelvic Floor Muscle Function Associated with Systemic Sclerosis: A Cross-Sectional Study.

Only a few studies have addressed sexual health in patients with systemic sclerosis (SSc). This study aimed to compare female sexual function and pelvic floor muscle function in SSc patients with healthy controls (HC) matched by age, and to identify the potential implications of clinical features on sexual function. Our cohort included 90 women with SSc and 90 HC aged 18–70 years that completed six well-established and validated questionnaires assessing sexual function (Brief Index of Sexual Function for Women, Female Sexual Function Index, Sexual Quality of Life Questionnaire–Female, Sexual Function Questionnaire) and pelvic floor function (Pelvic Floor Impact Questionnaire–Short Form 7 and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire Short Form). Results from women with SSc and HC were contrasted and correlated with relevant clinical features. The prevalence of female sexual dysfunction was 73% in SSc patients (vs. 31% in HC). Women with SSc reported significantly worse pelvic floor function and sexual function than HC. Impaired sexual function was correlated with higher disease activity, the presence of dyspnea and interstitial lung disease, increased systemic inflammation, reduced physical activity, functional disability, more severe depression, more pronounced fatigue, and impaired quality of life. We demonstrate that sexual dysfunction is highly prevalent among women with SSc. This aspect of the disease deserves more attention both in clinical care and at the level of international research collaboration.

Sexual and Gender Minority Persons’ Perception of the Female Sexual Function Index

BackgroundPatient-reported outcome instruments to assess sexual functioning typically assume that patients are heterosexual and have a single sexual partner, thus they may have limited applicability for sexual and gender minority (SGM) populations as well as for nonpartnered individuals or those with multiple partners. AimTo explore the perceptions of SGM persons regarding the Female Sexual Function Index (FSFI), a commonly used sexual functioning questionnaire. MethodsWe conducted 2 rounds of cognitive interviews with 27 SGM persons with and without a cancer diagnosis. Interviews were audio-recorded and transcribed. Two researchers independently coded the transcripts using inductive thematic analysis to identify major themes. OutcomesThemes identified via qualitative analysis. ResultsCognitive debriefing with the participants provided critical insights about the way we ask questions about sexual functioning in the oncology clinic. Three overarching themes arose from the data: (i) Certain aspects of the questionnaire were felt to unnecessarily medicalize sexuality; (ii) FSFI domains were perceived to represent a narrow and heteronormative experience of sexuality focused on penile-vaginal intercourse; (iii) Questionnaire domains emphasizing sexual “performance” were perceived as male-oriented. Clinical implicationsQuestionnaires such as the FSFI that were developed in research studies with specific eligibility criteria need to be adapted to the broader population seen in clinical practice. Strengths & LimitationsStrengths of the study include purposive sampling of SGM persons through LGBTQ networks. Our sample included individuals of different sexual orientations, gender identities, marital status, and cancer histories. However, a limitation is that the the majority of the sample was white and college-educated. Other limitations of the study include the potential sampling bias of self-selected participants with a particular interest in the study questions. ConclusionThe findings provide important evidence for the development of a more inclusive sexual function measure, moving away from the traditional heteronormative, cisnormative approach to measuring sexual function.Austria MD, Lynch K, Le T, et al. Sexual and Gender Minority Persons’ Perception of the Female Sexual Function Index. J Sex Med 2021;18:2020–2027.

Sexual and psychological health of couples with azoospermia in the context of the COVID-19 pandemic.

BackgroundTo date, there have been no reports on the sexual and psychological health of patients with azoospermia during the coronavirus disease 2019 (COVID-19) pandemic. Previous studies on the sexual health of couples with azoospermia are limited and are especially lacking in data on the wives of azoospermic men.MethodsWe conducted a case–control cross-sectional study between 1 July 2020 and 20 December 2020. In total, 100 couples with azoospermia comprised the experimental group and 100 couples with normozoospermia comprised the control group. The couples’ sexual health was measured using standardised sexual function questionnaires (male: International Index of Erectile Function-15 [IIEF-15] and Premature Ejaculation Diagnostic Tool [PEDT]; female: Female Sexual Function Index [FSFI]) and a self-designed questionnaire to evaluate changes in sexual behaviours (sexual satisfaction, desire, frequency of sexual activity, masturbation, and pornography use) during lockdown. The couples’ psychological health was measured using the 7-item Generalized Anxiety Disorder (GAD-7) scale and 9-item Patient Health Questionnaire (PHQ-9). The Actor–Partner Interdependence Model (APIM) was used to analyse the associations between sexual health and psychological health.ResultsThe IIEF-15 scores (53.07 ± 11.11 vs. 57.52 ± 8.57, t = − 3.17, p = 0.00) were lower and the PEDT scores (6.58 ± 3.13 vs. 5.17 ± 2.22, t = 3.67, p = 0.00) and incidence of premature ejaculation (χ2 = 14.73, p = 0.00) were higher for men with azoospermia than for men with normozoospermia. Compared with those of wives of men with normozoospermia, the total FSFI scores (25.12 ± 5.56 vs. 26.75 ± 4.82, t = − 2.22, p = 0.03) of wives of men with azoospermia were lower. The chi-square test showed that the perceived changes in sexual satisfaction (χ2 = 7.22, p = 0.03), frequency of masturbation (χ2 = 21.96, p = 0.00), and pornography use (χ2 = 10.90, p = 0.01) were significantly different between the female groups with azoospermia and normozoospermia, but there were no significant changes in sexual behaviour between the male groups. The GAD-7 (men: 7.18 ± 5.56 vs. 5.68 ± 4.58, p = 0.04; women: 6.65 ± 5.06 vs. 5.10 ± 3.29, p = 0.01) and PHQ-9 scores (men: 10.21 ± 6.37 vs. 7.49 ± 6.10, p = 0.00; women: 8.81 ± 6.50 vs. 6.98 ± 4.43, p = 0.02) were significantly higher for couples with azoospermia than for couples with normozoospermia. The APIM showed that for couples with azoospermia, sexual function negatively correlated with their own anxiety (men: β = −0.22, p = 0.00; women: β = −0.38, p = 0.00) and depression symptoms (men: β = −0.21, p = 0.00; women: β = −0.57, p = 0.00) but not with their partner’s anxiety and depression symptoms (p > 0.05).ConclusionsCouples with azoospermia had a lower quality of sexual function and higher levels of psychological distress than couples with normozoospermia. Their sexual health negatively correlated with psychological distress.

Bio-psychosocial factor of vaginismus in Iranian women

Background and aimVarious physical, psychological, social and cultural factors contribute to vaginismus. Therefore, given the multidimensionality of this disorder and the need to pay more attention to all biological, psychological and social dimensions in its treatment, the present study was conducted to investigate the bio-psychological factors contributing to vaginismus.MethodsThis descriptive cross-sectional study was conducted on 180 Iranian women with vaginismus who had been referred to sexual health clinics of Tehran province in 2020. Multistage random sampling method was used in this study, and vaginismus was diagnosed in women by a specialist through using a questionnaire. Data collection tools included demographic and obstetric information form, valid and reliable Sexual Function Questionnaire, Depression Anxiety Stress Scales (DASS), Sex Fear Questionnaire, Vaginal Penetration Cognition Questionnaire, Sexual Self-Efficacy Scale, Sexual Knowledge and Attitude Scale, Sexual Quality of Life-Female, Inventory of Sexual Satisfaction, ENRICH Marital Satisfaction Scale, Sexual Intimacy Scale and Questionnaire for Diagnosis of Vaginismus. In order to determine the factors related to vaginismus, multiple linear regression model was used through SPSS software version 25 (SPSS Inc., Chicago, IL).ResultsBased on the results of the present study, the mean age of women and the mean duration of their marriage were 27.77 ± 5.36 and 4.07 ± 3.87 years respectively. As the results of multiple linear regression revealed, the variables of fear of sex (B = 0.141, P = 0.036), positive cognition (B = 0.197, P = 0.046), self-image (B = 0.651, P = 0.001), sexual intimacy (B = -0.116, P = 0.021), quality of sexual life (B = 0.115, P = 0.002) and education (B = 2.129, P = 0.024) from the bio-psychosocial model were the final predictors of vaginismus diagnosis score in women with this disorder. According to the results of multiple linear regression, 45.5% of the variance of vaginismus diagnosis total score was explained by these variables (R = 0.706, R2 = 0.498 and ADJ.R2 = 0.455).ConclusionThe results of the present study showed that the variables of fear of sex, positive cognition and negative self-image, sexual intimacy, quality of sexual life and education were the final predictors of vaginismus diagnosis score. This disorder is, thus, considered to be multidimensional.

PD18-11 THE "BUTTERFLY", A NOVEL MINIMALLY INVASIVE TRANSURETHRAL RETRACTION DEVICE FOR BPH

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology III (PD18)1 Sep 2021PD18-11 THE "BUTTERFLY", A NOVEL MINIMALLY INVASIVE TRANSURETHRAL RETRACTION DEVICE FOR BPH Ran Katz, Ali Safadi, Muhamad Abu Ahmed, Shmuel Roizman, Amnon Zisman, Maharan Kabha, Yoram Dekel, Jack Baniel, and shachar Aharoni Ran KatzRan Katz More articles by this author , Ali SafadiAli Safadi More articles by this author , Muhamad Abu AhmedMuhamad Abu Ahmed More articles by this author , Shmuel RoizmanShmuel Roizman More articles by this author , Amnon ZismanAmnon Zisman More articles by this author , Maharan KabhaMaharan Kabha More articles by this author , Yoram DekelYoram Dekel More articles by this author , Jack BanielJack Baniel More articles by this author , and shachar Aharonishachar Aharoni More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002007.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Butterfly Prostatic Retraction Device is a novel minimally invasive, non-surgical implant that is delivered into the prostatic urethra in order to retract the lateral lobes of the prostate, increase the diameter of the prostatic urethra thus treating symptoms associated with BPH. The device is made of nitinol and consists of two lateral wings connected by several transverse rails and is available in five sizes. It is folded into a 5 mm introducer, inserted via rigid cystoscopy and deployed in the prostatic urethra between the verumontanum and the bladder neck. In body temperature the device expands, pushes the prostate lobes laterally, opening a wide path in the prostatic urethra while preserving the bladder neck. It is designed for day surgery or in office settings. We present our results in the management of men suffering from BPH. METHODS: A prospective, Open-Label clinical study for assessing the safety and efficacy of the Butterfly device in male patients suffering from LUTS due to BPH was performed enrolling up to date 50 men who were treated for BPH for at least one year and were candidates for prostatectomy. All patients had Qmax≤ 13 ml/sec and IPSS > 12. Patients with previous prostate procedure, prostatitis, cystolithiasis, prostate median lobe, urethral/bladder neck stricture and atonic bladder were excluded. The study was approved by the hospitals’ IRBs. Insertion of the device was performed under sedation in a day care setting. No catheter was left. Follow up visits were performed at 2 weeks, 1, 3, 6, and 12 months and included uroflowmetry, IPSS, QoL and sexual function questionnaires. Cystoscopy was performed on 3 and 12 months. RESULTS: Patient age range was 50-82 years. 23 patients completed a 1 year follow up and median follow up was 9 months. In one-year Qmax improved by 33%, IPSS score by 40% and QoL score improved by 38% compared to baseline. No patient reported deterioration of sexual function and all sexually active patients reported antegrade ejaculation. On cystoscopy, gradual coverage of the device with urethral mucosa was observed and there were no cases of encrustation. No unanticipated device related AE occurred. In one patient the device was re-positioned. Five patients elected to remove the device and returned to alpha blocker therapy. Seven patients underwent TURP. One patient developed a bulbar urethral stricture. CONCLUSIONS: The butterfly device is simple and efficient minimally invasive device for the management of LUTS due to BPH with a low complication rate, comparable to other minimally invasive devices, and good tolerability. Source of Funding: Butterfly Medical - Yokneam, Israel © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e359-e359 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ran Katz More articles by this author Ali Safadi More articles by this author Muhamad Abu Ahmed More articles by this author Shmuel Roizman More articles by this author Amnon Zisman More articles by this author Maharan Kabha More articles by this author Yoram Dekel More articles by this author Jack Baniel More articles by this author shachar Aharoni More articles by this author Expand All Advertisement PDF downloadLoading ...

Sexual dysfunction among men with diabetes mellitus attending chronic out-patient department at the three hospitals of Northwest Amhara region, Ethiopia: Prevalence and associated factors.

Sexual dysfunction is the commonest reproductive health problem observed among men with diabetes mellitus affecting their quality of life. Previous studies conducted in this area were concentrated on the specific domains of sexual dysfunction, and factors were not well-addressed. Therefore, this study was aimed to determine the prevalence of all forms of sexual dysfunction and to identify its associated factors among diabetic men patients attending at the three hospitals of the Amhara region, Ethiopia. An institutional-based cross-sectional study was conducted involving 462 men diabetic patients at the three hospitals of the northwest Amhara region. A systemic random sampling technique was employed. A face-to-face interviewer-administered change in the sexual functioning questionnaire was used to collect the required data from the 20th of February to the 15th of April 2020. The binary logistic regression was employed and a multivariable logistic regressions model was used to control the effect of confounders. Variables that had an independent correlation with the sexual dysfunction were identified based on a p-value≤ 0.05. Likewise, the direction and strength of association were interpreted using Adjusted Odds Ratio (AOR) with its corresponding 95% CI. The prevalence of sexual dysfunction was found to be 69.5% (95%CI: (65.1-73.9)). The magnitude of sexual dysfunction was prevalently observed among participants who were older (> 50 years) (AOR = 8.7, 95%CI: (3.3-23.1)). Likewise, the odds of sexual dysfunction was significantly higher among men who have lived with diabetes for a longer duration (AOR = 10.8, 95%CI: (5.3-21.9)), with poor metabolic control (AOR = 3.57, 95%CI: (1.81-7.05)), with comorbid illnesses (AOR = 5.07, 95%CI: (2.16-11.9)), and diabetic-related complications (AOR = 3.01, 95%CI: 1.31-6.92). On the other hand, participants who were physically active (AOR = 0.41, 95%CI: (0.12-0.7)) and satisfied with their relationship (AOR = 0.15, 95%CI: (0.03-0.7)) showed a lesser risk of experiencing sexual dysfunction. Well over two-thirds of men with diabetes mellitus have experienced sexual dysfunction, implying a public health pressing problem. Older age, lack of physical activity, living longer duration with diabetes, having diabetic complications, experiencing co-morbid illnesses, being unsatisfied with couple relationship, and poor metabolic control increased the risk of developing SD. Therefore, promoting physical exercise, preventing co-morbid illnesses, and couples counseling to build up a good couple relationship are recommended to promote the sexual and reproductive health of men with diabetes.

Improvement in dyspareunia after vaginal mesh removal measured by a validated questionnaire.

The objective was to examine the effect of the surgical removal of vaginally placed prolapse and incontinence mesh on sexual function. We hypothesize that patients with painful complications of mesh will experience improvement in dyspareunia and sexual function after mesh removal. The eligible cohort consisted of 133 women who presented with a new onset of pain attributed to mesh-augmented incontinence or prolapse surgery and who elected to undergo mesh removal between 1 August 2012 and 1 July 2013. Sexual function symptoms were assessed before and after mesh removal surgery using the Pelvic Organ Prolapse and Urinary Incontinence Sexual Function Questionnaire short form (PISQ-12). Multivariate analysis was performed to identify predictors of improvement in dyspareunia. Ninety-four patients undergoing mesh removal completed a pre-operative questionnaire, 63 of whom also completed a post-operative questionnaire. After mesh removal, there was a nearly 50% reduction in the proportion of women reporting always experiencing post-operative pain with intercourse among those experiencing pre-operative pain. There was a statistically significant quantitative improvement in pain with intercourse after mesh removal based on mean change score of PISQ-12 question 5 "How often do you experience pain with intercourse?". In multivariate analysis, only history of vaginal delivery was associated with symptom improvement. Removal of transvaginal prolapse mesh is associated with improvement in self-reported dyspareunia based on a standardized question on a validated instrument in a small cohort of women. Although larger studies are needed to confirm the relationship between mesh-augmented surgeries and post-procedural dyspareunia, these data suggest that consideration of mesh removal is a reasonable step for patients with painful intercourse attributed to mesh-augmented prolapse and incontinence surgeries.