Sexual Dysfunction Research Articles

(045) A PHYSICIAN'S GUIDE TO LUBRICANT FOR SEX

Abstract Introduction Lubricant use during sexual activity has numerous benefits, minimal harms, and can play a role in managing common concerns in primary care. However, navigating evidence-based conversations about lubricant use can be challenging since there is a lack of easily accessible and reliable information. As a result, physicians are often hesitant to discuss the topic and can only offer anecdotal advice. Objective To review literature on lubricants used during sexual activity to (1) inform the development of an inclusive and practical evidence-based tool for physicians to help incorporate patient-specific recommendations for lubricants into clinical practice, and (2) create accessible materials for patients. Methods We conducted a scoping review of peer-reviewed literature using the Arksey and O’Malley framework. Using relevant keywords, we searched two electronic databases, one search engine, and reference lists for articles published in 2003 and onward. Articles generated were manually reviewed for relevance with further inclusion criteria: (1) identifies patient populations most likely to benefit from using lubricant during sexual activity, (2) addresses benefits and drawbacks of different lubricant classes, or (3) describes ingredients in or properties of lubricants that may cause harm. All sexually active individuals were deemed eligible for inclusion in the study, with no restrictions placed on location, age, gender, or sexual orientation. Following the completion of our scoping review, we used an evidence-based approach to develop a clinical practice tool and patient handout. During their development and to validate our findings, family physicians, nurses, psychologists specializing in sexual concerns, and sexual health educators provided iterative review. Results 27 articles were deemed eligible for inclusion in our scoping review. Results showed lubricant use to be especially beneficial for patients who (1) experience dryness, pain, or sexual dysfunction during any type of sex, (2) are at a higher risk of STI transmission (by reducing condom breakage), or (3) want to reduce the risk of having an unplanned pregnancy (by reducing condom breakage). There are three main types of lubricant available: oil, water, and silicone-based. Oil-based lubricant is not recommended since it is incompatible with latex condoms and is more likely to irritate genital epithelium and negatively impact genital microbiota. When comparing silicone and water-based lubricant, silicone-based lubricant lasts longer but is more difficult to wash off. Silicone-based lubricant is not compatible with silicone-based sex toys, whereas water-based lubricant is compatible with all types of sex toys. Water-based lubricant is also more likely than silicone-based lubricant to contain potentially irritating ingredients and properties, such as glycerol, propylene glycol, parabens, or a high osmolality. For patients who are struggling with infertility, most lubricants should be avoided as they can negatively affect sperm motility and viability. Conclusions Numerous patients can benefit from lubricant use during sexual activity. In particular, silicone and water-based lubricant without harmful additives or properties are recommended. Our guide on lubricants will assist physicians in identifying patients who may benefit from using lubricant and incorporating patient-specific recommendations into clinical practice. This, in addition to our patient handout, will help to improve discussions between patients and healthcare providers regarding sexual well-being and lubricant use. Disclosure No.

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

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

(111) PLATELET-RICH PLASMA FOR IMPROVEMENT OF SEXUAL DYSFUNCTION: A PILOT STUDY

Abstract Introduction Platelet-rich plasma has been widely used in various field of medicine. Some studies have shown that PRP helps improving sexual function, but most studies were conducted on men. There are also studies showing that it helps women’s sexual function, but it is very limited. Objective This study conducted to determine whether PRP was effective for women complaining of sexual dysfunction. Methods This retrospective study included 34 women who underwent PRP for improving sexual function from December 2022 to September 2023. Patients underwent a total of three procedures on schedules 0, 1, and 4 months. Before performing each procedure, a survey was conducted on questionnaire related to sexual dysfunction. The results of a total of 22 questions were analyzed by dividing them into sexual desire or sexual interest, sexual excitement, lubrication, orgasm, satisfaction with sexual life, pain during intercourse, and urinary incontinence. Results In the categories of sexual desire or sexual interest, sexual excitement, and satisfaction with sexual life scores showed a significant increase after PRP treatment (p < 0.001, p < 0.001, and p < 0.003, respectively). There was a significant increase in orgasm between the first and third treatments (p < 0.021), but it was not statistically significant overall. Symptoms related with lubrication, pain, and urinary incontinence all improved, but did not show statistical significance. Conclusions This study demonstrated that PRP improved some categories of sexual dysfunction. Disclosure No.

(074) THE REPRESENTATION OF FEMALE SEXUAL MEDICINE AND GENITAL ANATOMY IN A USMLE STEP 1 RESOURCE

Abstract Introduction Sexual health is an essential component of overall health and wellness. Sexual dysfunction is pervasive and there are barriers to adequate diagnosis and treatment, including lack of instruction for medical students. Previous work from our group assessed the curricula of all seven medical schools within the Chicago area and highlighted the need to standardize both preclinical and clinical materials to enhance student education, exposure, and preparation in female sexual medicine (FSM). The United States Medical Licensing Exam (USMLE) Step 1 significantly informs content of pre-clinical undergraduate medical education. Comprehensive USMLE Step 1 resources therefore assume an integral role in exposing medical students to key topics which may or may not be included in their individual school’s curriculum. Thus, it is important to assess if information about FSM and female genital anatomy is delivered to medical students and to what extent in board exam materials. Objective This study aims to assess the coverage of sexual medicine topics in a USMLE Step 1 resource and to compare the representation of male- versus female-specific content. Methods Digital copies of First Aid for the USMLE Step 1 2020-2023 versions were collected and evaluated for inclusion of sexual medicine subjects and topics for both males and females. The content of the chapters titled “Reproduction” and “Psychiatry” were included. To standardize our data collection, existing literature was used to identify specific components of anatomy and physiology related to genital anatomy and orgasm. Additionally, the epidemiology, pathologies, and treatments of FSM were specifically searched for in this resource. Results Across the four editions of the resource included for evaluation, all covered the physiology of the male orgasm, however, none included the physiology of the female orgasm. Moreover, the only mention of female sexual dysfunction (FSD) was in the psychiatry chapter which only briefly addressed the pathophysiology of FSD, but not the epidemiology nor the treatment of FSD. Furthermore, only one out of seven relevant anatomical terms describing parts of clitoral anatomy were included. Homologous male genitalia was consistently labeled for the glans penis, prepuce, corpora cavernosa, and corpus spongiosum as four out of six anatomical terms of interest. Additionally, all four editions from 2020-2023 included content on penile neurovasculature and a penile cross-sectional diagram; however, there was no mention of clitoral neurovasculature nor were there any cross-sectional diagrams of female anatomic components in any of the four editions evaluated. Conclusions Despite this USLME Step 1 resource’s over 840 pages, the representation of topics related to FSM is lacking compared to analogous male topics. Recent literature which has highlighted the gaps in FSM education and the importance of comprehensive sexual medicine training for physicians, however, there have been no significant changes to the content of this resource over the past four editions. USMLE Step 1 resources play a vital role in enhancing the understanding of FSM among medical students. Content expansion is needed to provide accurate information to patients, help patients make informed decisions about treatments, destigmatize reproductive and sexual health, and overall advance medical knowledge of FSM. Disclosure No.

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

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

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

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

(017) FLIBANSERIN IMPROVES LIBIDO AND SEXUAL SATISFACTION IN WOMEN WITH BREAST CANCER ON ENDOCRINE THERAPY

Abstract Introduction Decreased libido is a distressful symptom during and after cancer treatment. This is the first prospective longitudinal study that investigates the use of flibanserin to treat decreased libido in breast cancer patients on endocrine therapy. Objective This study evaluates the efficacy of flibanserin as measured by change in desire, sexual function, and distress from sexual dysfunction. These outcomes are measured using the following validated instruments: Female Sexual Function Index (FSFI) both desire and total scores, Patient-reported Outcomes Measurement Information System Sexual Function Instrument (PROMIS-SF) and patient distress via FSDS-R. Methods Forty-three women with stage 0-III ER+ breast cancer on endocrine therapy for at least 3 months who reported HSDD as defined by the DSM-IV and ISSWH consensus paper were enrolled on an IRB-approved prospective, longitudinal trial from both an academic center and an alliance community site. All patients took flibanserin 100mg nightly for 24 to 36 weeks. Patients were monitored closely for 52 weeks for adverse events, with medical exams and questionnaires at baseline, week 4, 8, 16, 24, 52 with optional week 36 appointments. Given the small sample size, descriptive, graphical, and nonparametric paired tests for pairwise comparisons of a measure were performed. Results Participants reported improved libido and sexual satisfaction as demonstrated by both the PROMIS-SF and FSFI data (see Table 1). 35/43 (83.3%) patients completed the FSFI and 25/43 (58.1%) completed the PROMIS-SF. The mean overall total FSFI score increased from 11 at baseline, to 17 at week 8 and 24 at week 36. The PROMIS data for interest in sexual activity improved from a baseline mean score of 43 to 51 at 8 weeks, to 54 at 24 weeks and 55 at 36 weeks. Similarly, the FSFI data in the domains of desire and arousal improved respectively from 1.90 and 1.56 at baseline to 3.03 and 3.05 at 8 weeks, 3.30 and 3.17 at week 16 and 3.53 and 4.01 at week 36. Satisfaction with sex life also improved from PROMIS baseline of 46 to 49 at week 8 and 55 at week 36. FSFI data for the domain of satisfaction indicate parallel trends with a baseline score of 2.36, increasing to 3.15 at week 8 and 4.45 at week 36. Furthermore, vaginal discomfort scores improved on both the PROMIS and FSFI. FSFI data on lubrication also showed improvement with a baseline mean score of 1.85 increasing to 2.84 by week 8, 3.24 at week 24 and 4.01 at week 36. However, the PROMIS suggests a decrease in lubrication from baseline to week 8. Patient distress also decreased throughout the study as measured on the FSDS-R and distress thermometer. There were no severe adverse events. The most common adverse events were nausea, somnolence and dizziness. Conclusions Flibanserin improves libido and overall sexual function as measured by the PROMIS-SF and FSFI in breast cancer patients on endocrine therapy. The exciting data from this pilot study is currently informing a larger randomized placebo-controlled study evaluating the efficacy of flibanserin in women with breast cancer. Disclosure Yes, this is sponsored by industry/sponsor: Sprout Pharmaceuticals Clarification: Industry funding only - investigator initiated and executed study Any of the authors act as a consultant, employee or shareholder of an industry for: Ms. Medicine, NanOlogy LLC, Paxman Cooling Ltd, Procter and Gamble, Rejoy, Revision Skincare, Sermonix, Shook, Hardy and Bacon, Spectrum Pharmaceuticals, Sprout Pharmaceuticals, TerSera.

(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<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<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 (<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.

(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<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<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 < 0.001, d 0.51) and with those who have differing sexuality from their own (p <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 < 0.006, d 0.40) and sexual problems related to a medical, pharmacological, or surgical treatment (p < 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.

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

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

(075) THE USE OF ONLINE EDUCATIONAL MODULES TO REDUCE FEMALE SEXUAL DYSFUNCTION

Abstract Introduction Sex is fundamental to overall health, well-being, and quality of life yet, the prevalence of female sexual dysfunction is alarmingly high. This could be attributed to multiple factors such as an overall dearth of evidence-based information detailing female anatomy, arousal, orgasm, and sexual disorders. In addition, many women face numerous obstacles that limit their access to a comprehensive sexual and reproductive health education. The unavailability and inaccessibility of knowledge regarding the female sexual experience can prevent many women from truly appreciating and understanding their bodies. This can lead to a variety of negative outcomes, including depression, anxiety, low self-esteem, and decreased well-being. Objective Several of these outcomes are most prevalent in young women; thus, it is critical that we educate this age group using delivery methods best suited for a young demographic. Methods In this study, we created a brief online educational module for women between the ages of 18 and 29 years old, which explained various aspects of the female sexual experience including female anatomy, orgasm responses, and masturbation. The module also shared resources women may use if they are experiencing issues regarding sex or pleasure. We expected to see greater female sexual literacy among women who completed the module (intervention) compared to those who did not (control). 13 women between the ages of 18 and 29 years old who were attending their annual gynecologic well-visit were recruited and randomly assigned to the intervention or control group. Results Although all participants from both groups rated sex education as important (N=13), less than half (N=5) reported having received formal sex education including female sexual functioning. Furthermore, only half (N=6) correctly disagreed when asked if the outer part of the female reproductive system was called “vagina.” However, post-test surveys showed no significant difference in knowledge between those who watched the module and those who did not. We attribute this to the sample size being too small, to the age range being too wide, and to the information presented in the module being too basic for this age group. Conclusions It is imperative that we not only continue to explore the female sexual experience, but that we also continue to improve ways to deliver that information. Further research on the use of online modules for sex education should consider its population’s degree of knowledge, limit their sample’s age range, and focus on issues its population commonly inquires about. Disclosure No.

(093) IMPACT OF ENROLLMENT DIAGNOSIS ON EFFICACY ENDPOINTS 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 There are no FDA-approved treatments for female sexual arousal disorder (FSAD). Women with FSAD also often have co-existing secondary female sexual dysfunction (FSD) diagnoses. Objective Post-hoc subset analysis of the effect of enrollment FSD diagnoses on efficacy of Sildenafil Cream, 3.6% for treatment of FSAD. Methods Phase 2b, exploratory, randomized, placebo-controlled, double-blind study of Sildenafil Cream, 3.6% among premenopausal women with FSAD (NCT04948151). The change from baseline at week 12 in the arousal sensation (AS) domain (questions 6-9) of the 28-question sexual function questionnaire (SFQ28) was a co-primary efficacy endpoint. Changes from baseline in the mean number of satisfactory sexual experiences (SSEs) was a secondary endpoint. Exploratory efficacy endpoints included the Desire and Orgasm domains of the SFQ28. Enrollment FSD diagnoses were established during a clinical interview with independent experts. A retrospective review was performed of the clinical interviews for the intent-to-treat (ITT) population who completed the study (n=174) and enrollment diagnoses were categorized. Results Table 1 shows the breakdown of enrollment diagnoses by product group for the ITT population. Participants with FSAD and pain (n=6) were excluded. Although few women had FSAD as their sole diagnosis, when randomized to Sildenafil Cream, 3.6%, they had the largest mean increases in efficacy variables at week 12. Women with FSAD and secondary HSDD also experienced substantial benefit with Sildenafil Cream, 3.6% at week 12. Women with an enrollment diagnosis of FSAD with secondary FOD had the least benefit from Sildenafil Cream, 3.6% at week 12. Conclusions Data from this exploratory trial support the future target populations, including women with FSAD or FSAD with HSDD, will likely benefit the most from Sildenafil Cream, 3.6% treatment. Disclosure Yes, this is sponsored by industry/sponsor: Dare Bioscience and Strategic Science and Technologies LLC. Clarification: Industry initiated, executed and funded study. Any of the authors act as a consultant, employee or shareholder of an industry for: Dare Bioscience and Strategic Science and Technologies LLC.

(039) DIVERSITY OF CAUSES OF DYSPAREUNIA IN REAL CLINICAL PRACTICE IN THE OUTPATIENT GYNECOLOGY DEPARTMENT

Abstract Introduction Dyspareunia is a women's sexual health problem that still often goes undiagnosed, despite its high prevalence and negative impact on sexual, marital and psychological well-being. Genito-pelvic pain/penetration disorder (GPPPD) refers to significant pain and difficulty with penetrative sex that lasts for at least six months and might be caused by various diseases alone and their combinations. Objective Thus, the purpose of this study is to determine the contribution of different conditions to the total number of patients who applied for a primary appointment for GPPPD. Methods Women who agreed to participate in the study were presenting complaints on painful intercourse or inability to have intercourse for more than 6 months. Patients underwent a gynecological examination consisted of inspection, Q-tip testing, pelvic floor muscle testing and bimanual palpation in the lithotomy position (if it was possible). Diagnoses were documented according to the International Classification of Diseases Tenth Revision World Health Organization guidelines. Pain was assessed via the McGill Pain Questionnaire and a visual analogue scale. Assessment of pelvic floor muscle dysfunction was based on an International Continence Society report on the terminology for pelvic floor muscle assessment. Vulvar pain conditions were classified based on the consensus vulvar pain terminology committee of the International Society for the Study of Vulvovaginal Disease, the International Society for the Study of Women's Sexual Health, and International Pelvic Pain Society. Statistical analyses were performed by SPSS Statistics. Results The average age of the examined women was 30,63±0,69 years. As a cause of GPPPD vaginismus and dyspareunia were diagnosed in 19.31 and 80.69 % respectively. Predominant cause of dyspareunia was pelvic floor muscles dysfunction (66,19%) which was combined with other pathologies (scar deformity of the perineum, endometriosis and chronic pelvic pain, candidiasis, etc.) in 20 cases. The percentage of women diagnosed with endometriosis without the formation of central pain mechanisms was 11.36%. The overlapping chronic pain conditions such as migraine, interstitial cystitis/bladder pain syndrome, irritable bowel syndrome, endometriosis and vulvodynia were diagnosed in 21.13% patients with dyspareunia. Dyspareunia due to vaginal atrophy associated with lactation, combined oral contraception use and menopause was diagnosed in 4 patients (2.82%, 1.41% and 1.41%, respectively). Scar changes of the perineum due to traumatic delivery or episiotomy amounted to 4.23%. Lichen planus was diagnosed in one patient (1.41%). Vulvodynia was diagnosed in 8 patients with dyspareunia (11.26%) and was associated with pelvic floor tension myalgia and pelvic floor myofascial pain syndrome in 75% of cases. Conclusions GPPPD can be caused by various conditions with significant involvement of the pelvic floor muscles in the process of pain formation. Taking into account the risk of overlapping chronic pain conditions, a multidisciplinary approach is required in the treatment of this group of patients. Disclosure No.

(133) SELF-REPORTED EFFICACY OF PELVIC FLOOR PHYSICAL THERAPY AS A TREATMENT FOR PUDENDAL NEURALGIA: A CROSS-SECTIONAL STUDY

Abstract Introduction Pudendal neuralgia (PN) is a devastating sexual pain disorder characterized as pain of the genital and/or perineal regions and is often due to injury, irritation, or entrapment of the pudendal nerve. Pelvic floor physical therapy (PFPT) is a recommended treatment for PN despite the lack of clinical evidence supporting its use. Objective We aimed to understand the efficacy of PFPT for treating PN by evaluating self-reported efficacy from PN patients. Methods An online survey was conducted on PN patients who had participated in PFPT as a treatment for PN. Participants were asked to evaluate the efficacy of PFPT specifically regarding its effects on PN symptoms using a seven-point Patient Global Impression of Change (PGIC) scale: 1=very much worse, 2=much worse, 3=minimally worse, 4=no change, 5=minimally improved, 6=much improved, 7=very much improved. If lasting symptom improvement was achieved, participants were asked how many sessions before they first noticed an improvement in symptoms. Results The average PGIC score among participants was 4.6 ± 1.3 (n=144), indicating no to minimal improvement in symptoms. Twelve percent of participants scored 3 or lower, indicating worsening of symptoms, and only 22% scored 6 or 7, indicating much or very much improvement of symptoms. For those who had symptom improvement, 14.6% of participants reported improvement after only one PFPT session, and five was the median number of sessions before first noticing improvement. Conclusions PFPT is a minimally effective, and sometimes harmful, treatment for pudendal neuralgia. Better transparency should be provided to patients regarding PFPT’s lack of efficacy and potential harm for treating PN symptoms. Disclosure No.

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

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

(012) THE IMPACT OF SEXUAL ORIENTATION ON THE EXPERIENCE OF ENDOMETRIOSIS

Abstract Introduction Endometriosis affects an estimated one in ten people assigned female at birth (AFABs) worldwide (WHO, 2021), yet it remains understudied. In particular, there is a lack of literature on the impact of endometriosis on marginalized groups, including those with underrepresented sexual orientations (USOs). In the present study, I examine the impact of identifying with a USO on the experience of living with endometriosis. Endometriosis is a chronic disease characterized by tissue similar to the lining of the uterus growing outside of the uterus. Symptoms can include severe pelvic pain especially during menstruation, pain with intercourse and bowel movements/urination, nausea, fatigue, and infertility, and can have a profound effect on quality of life (Gao et al., 2006). There is presently no cure, with surgical excision being the gold standard for treatment; however, this is costly, often ineffective for long-term relief, and largely inaccessible (WHO, 2021). Although endometriosis is not classified as a sexual health disorder, it can have an enormous impact on sufferers' sexual function, including, but not limited to, painful sex, desire/libido, and satisfaction (Yang et al., 2021). There is limited research on the impact of identifying with a USO on the experience of living with endometriosis. A review of the literature found only one study that mentioned sexual orientation, in which one participant mentioned that it was easier to cope with the pain “because vaginal penetration was not essential to her sexual relationship” (Wahl et al., 2021). Objective The goal of the present study was to determine how identifying with a USO affects AFABs’ experience of living with endometriosis. Methods 150 AFAB participants between the ages of 20-50 years old (M = 31.93, SD: 6.75) who had been surgically diagnosed with endometriosis completed a Qualtrics survey. Participants reported their sexual orientation using the following categories: asexual, bisexual, gay, lesbian, pansexual, queer, heterosexual, and other. Due to the small number identifying as USOs (N = 31), participants were coded as either USO or heterosexual for analysis. The impact of endometriosis was measured using the Endometriosis Impact Questionnaire (EIQ, Moradi et al., 2019), which consists of six subscales assessing its impact on different aspects of participants’ lives. Results An independent-samples t-test revealed that participants who reported identifying with a USO had higher EIQ impact scores on the physical, psychological, and social subscales than heterosexual participants (all p’s < .008). However, the effect of endometriosis on participants’ fertility appeared to have a lower impact for USO than for heterosexual participants (p = .008). Additionally, it took longer for USOs to be diagnosed (M = 12.58 years) than for heterosexual participants (M = 7.62, p = .002). Conclusions These results suggest practitioners and health educators need to consider the sexual orientation of patients with endometriosis. These results also make a valuable contribution to the psychological, public health, and women’s sexual health literatures that will help practitioners better understand, interact with, and treat patients who identify with a USO. Disclosure No.

Early and midterm efficacy of oxiplex gel on postoperative pain intensity, physical disability, and musculoskeletal power in patients undergoing lumbar discectomy

IntroductionCarboxymethylcellulose/polyethylene oxide, also known as Oxiplex gel, is commonly used during lumbar discectomy operations. It serves to cover the surgical site, preventing adhesions and providing relief from pain and symptoms. However, there is ongoing debate regarding the extent of its beneficial effects on postoperative pain intensity, level of disability, and overall improvement of musculoskeletal conditions. Therefore, the objective of this study is to evaluate the advantages and limitations of using Oxiplex gel in lumbar laminectomy procedures specifically for herniated discs.MethodsA randomized controlled trial was conducted on 56 consecutive patients who were candidates for unilateral lumbar discectomy on one lumbar surface. The patients were chosen based on their clinical manifestations and imaging findings. After the initial assessment, the patients underwent either laminectomy or laminotomy surgery. Following the surgery, the patients were randomly assigned to either the intervention group (receiving Oxiplex gel) or the control group. This assignment was done using a computerized random number generator. Assessments were conducted before the operation, as well as 3 and 6 months post-surgery for all patients.ResultsThere was no significant difference found between the Oxiplex gel and control groups in terms of radicular and low back pain intensity, as well as disability scores, at different time points after surgery (p = 0.336, p = 0.65, and p = 0.336, respectively). Additionally, there were no significant differences found in the prevalence of sexual or sphincteric disorders between the two groups during postoperative assessments (p = 0.639 and p = 0.15, respectively). Furthermore, no significant differences were observed in the results of the postsurgical neuromuscular evaluation under different lower extremities conditions between the two groups.ConclusionsBased on our findings, it was observed that Oxiplex gel did not demonstrate any improvement in post-unilateral lumbar discectomy symptoms or musculoskeletal power.

(009) SEXUAL FANTASY AND DESIRE DIFFER FOR PLURISEXUAL PEOPLE IN SAME-GENDER VS. MIXED-GENDER RELATIONSHIPS

Abstract Introduction In recent years there has been a surge of research on plurisexuality (the ability to experience attraction to more than one gender). Evidence strongly suggests that plurisexual people experience desire differently, face unique stressors, and have increased risk for sexual dysfunction compared to gay and lesbian groups (Björkenstam et al., 2020). These factors may differ between plurisexual people in same-gender relationships and those in mixed-gender relationships. Fantasy and desire, two fundamental constructs of sexology theory and sex therapy, merit further research in this population. Objective We hypothesize that plurisexual people experience fantasy and desire differently depending on their relationship type (same-gender vs. mixed-gender). Methods Data was collected for a larger study of sexual health and behaviors in undergraduate students at a large university in the Midwestern US. The sample included participants in relationships (n=493; mean age = 20.48 years; 80% women, 16% men, 4% gender minority; 78% White). Respondents who identified as “bisexual,” “pansexual,” “mostly heterosexual,” “mostly lesbian/gay,” or a combination of these were coded as plurisexual, and other respondents (e.g., “heterosexual,” “lesbian/gay,” “asexual”) were coded as not plurisexual. Respondents were coded as being in same-gender relationships if they identified as a man dating a man, a woman dating a woman, or any gender minority (e.g., “non-binary,” “gender fluid”) dating a man, woman, or other gender minority person (i.e., relationships likely to be perceived as queer). Respondents were coded as being in mixed-gender relationships if they identified as a man dating a woman or a woman dating a man. Fantasy was measured with an adapted Sex Fantasy Questionnaire (SFQ; Wilson, 1988), and desire with the Sexual Desire Inventory-2 (Spector, Carey, & Steinberg, 1996). We conducted two-way ANOVAs to evaluate the influence of plurisexual identity and relationship type on fantasy and desire. Results There was a significant main effect of plurisexual identity on sexual fantasy (F(1, 391)=58.61, p<0.01) and desire (F(1, 469)=7.26 p<0.01), with plurisexual participants reporting higher levels of both. There was also a significant interaction effect between plurisexual identity and relationship type for fantasy (F(1, 391)=4.73, p=0.03) and sexual desire (F(1, 469)=5.78, p=0.02), such that the effect of plurisexuality was amplified for participants in mixed-gender relationships and attenuated for participants in same-gender relationships (see Figures). Conclusions Results suggest that plurisexual people experience higher levels of fantasy and desire when in mixed-gender vs. same-gender relationships. These differences could be attributed to perceptions that plurisexual people in same-gender relationships are queer and those in mixed-gender relationships are straight (Arriaga & Parent, 2019). Additionally, the fluidity of sexual identity suggests that experiences of attraction, desire, and fantasy change substantially based on the gender of one’s partner (Diamond, 2008). Clinically, our findings point to different applications of interventions on fantasy intended to stimulate desire in plurisexual patients with low desire, address desire discrepancy between partners, or separate problematic desire from behavior. As most research surrounding fantasy and its role in desire was developed in straight cisgender samples, clinicians and researchers should consider sexual orientation, relationship type, and their interaction when intervening upon fantasy. Disclosure No.