Women's Sexual Well-being Research Articles

The Fear of COVID-19 Pandemic Effects on Couples' Relationship and Sexual Quality of Life Female: A Study from Iran

Background: The enduring COVID-19 pandemic has implications for the sexual wellbeing of diverse populations, notably women. This worldwide emergency persists in affecting daily routines of individuals, as research indicates that alterations in lifestyle and imposed limitations are linked to mental health challenges. Aim: The objective of this research is to examine the interpersonal dynamics of couples and the sexual well-being of women in the aftermath of the COVID-19 pandemic. Methods: This cross-sectional research involved 395 female participants who utilized Google Forms to complete online questionnaires in Iran from November 2022 to December 2022. The data collection instruments comprised the Sexual Quality of Life-Female (SQOL-F) questionnaire, Depression Anxiety Stress Scale (DASS), Relationship Rating Scale (RAS), and Fear of COVID-19 Scale. Statistical analyses employed in the study included independent t-test, one-way ANOVA, Tukey post hoc test, and Univariate and Multiple linear regression. Results: The average age of female participants in the study was 31.97 years, with a standard deviation of 9.04. The mean scores for sexual quality of life among women were 64.82 with a standard deviation of 11.93, 18.28 with a standard deviation of 4.48 for DASS, 22.48 with a standard deviation of 4.30 for RAS, and 12.88 with a standard deviation of 3.93 for fear of COVID-19 scale. Univariate linear regression analysis indicated a significant association between the quality of sexual life and fear of COVID-19 (P = 0.001), DASS (P = 0.001), and RAS (P = 0.007). The study found a noteworthy and negative impact of fear related to COVID-19 and DASS on the sexual quality of life of women (P < 0.05). Conclusion: The anxiety stemming from the COVID-19 outbreak seems to have repercussions on the dynamics of romantic partnerships and the sexual well-being of women. Furthermore, the pandemic is associated with heightened levels of anxiety, stress, and depression. It is recommended that further research be undertaken to explore the mental health of women and its implications on their sexual experiences in the aftermath of the COVID-19 crisis.

Experiences of vaginal lengthening treatment and sexual well-being in women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome: An interview study.

To explore how women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome experience dilation or surgical vaginal lengthening treatment, and their current sexual well-being. A qualitative interview study. Denmark. Women aged ≥25 years diagnosed with MRKH syndrome. Semi-structured video interviews were conducted with 18 women. Interviews lasted a median of 92 min and were digitally recorded, transcribed and anonymised. Data were analysed using thematic analysis. A qualitative analysis of women's experiences. The analysis identified three themes. Firstly, Experiences with dilation treatment revealed dilation as an awkward routine, especially for adolescents living with parents and yet to sexually debut. While some experienced successful vaginal lengthening, others faced treatment failure leading to frustration and self-blame. Secondly, Experiences with neovaginal surgery described the procedure as extremely painful but resulting in a 'normal size' vagina. Some women felt that the procedure had negatively impacted their self-confidence, and all underscored the importance of maturity before opting for surgery. Lastly, Current sex life and sexual well-being indicated a well-functioning sex life for many women, but with reported low sexual confidence and genital self-image due to the perceived 'deviance' of their genitalia. For women with MRKH syndrome, vaginal lengthening treatment, whether through dilation or surgery, may result in a 'normal size' vagina. However, according to the women's experiences, vaginal lengthening treatment does not adequately foster positive sexual esteem and genital self-image.

Women’s Pornography Use Patterns and Sexuality Education in U.S. Public Schools

This study investigated the relationship between sexuality education in U.S. public schools and women's pornography use. Utilizing quantitative methods, we examined a sample of women attending U.S. public schools who reported regular pornography use. Results revealed that, regardless of the type of sexuality education received, women exhibited similar rates of pornography use, with 60% reporting its use. A substantial portion (69%) of the women began using pornography during childhood or adolescence. Women who received abstinence only sexuality education reported higher frequencies of pornography use compared to their comprehensive sexuality education counterparts. About 79% of women using pornography perceived it as a source of sexuality learning, especially regarding sexual pleasure. However, they expressed reluctance in using pornography for sexual education and did not consider it a preferred method for learning about sexuality. The findings suggest the need for comprehensive sexuality education that addresses essential topics, such as sexual pleasure and sexual script development, to cater to women’s diverse learning needs, ideally taught by parents or primary caregivers, but may be necessary for public education in the absence of parental instruction. Policymakers and educators should bridge these gaps to develop more effective sexuality education curricula. This study contributes valuable insights, highlighting the importance of an inclusive approach to sexuality education in U.S. public schools. Future research should explore the implications of different sexuality education approaches on women's sexual development and well-being, emphasizing comprehensive education to foster healthy sexual behaviors among women.

The role of sexual communication in the relationship between emotion regulation and sexual functioning in women: The impact of age and relationship status

ObjectiveThe aim of this study was to investigate sexual communication as a mechanism involved in the link between emotion regulation and sexual functioning in a sample of adult women, also testing the moderating role of relationship status and age in this association. Method1344 sexually active cisgender women (aged 18–57, M = 27.34; SD= 6.484) were recruited from March 30, 2021, to April 12, 2021, through an online survey. From the initial sample, 1280 women were retained and included in the analysis. Participants were asked to respond to three self-report questionnaires: the Difficulties in Emotion Regulation Scale (DERS), the Communication subscale of the Sexual Satisfaction Scale for Women (SSS-W), and the Female Sexual Function Index (FSFI). ResultsWe found that sexual communication mediated the link between emotion regulation abilities and female sexual functioning. Moreover, we found that age, but not relationship status, moderated the association between emotion regulation and sexual communication, so that older women with difficulties in emotion regulation processes showed worse sexual communication abilities as compared to younger women. ConclusionsAccording to this study's results, clinicians and sexual therapists should carefully consider emotion regulation abilities and sexual communication as crucial factors in promoting women's sexual well-being.

Network Analysis of Sexual Well-Being in Women with Heart Failure: The Psychocardiological Perspective.

Sexuality is an important sphere of every person's life. Sexual dysfunctions and sexual dissatisfaction may also be present in cardiac diseases. Individuals affected by heart failure (HF) deserve special attention since it can be the final stage of many cardiac diseases. Therefore, it is important to verify potential correlates of sexual well-being in individuals with HF. This study was conducted online between 2019 and 2023, and 262 Polish women aged between 18 and 59 years (M = 45.48; SD = 7.65) participated in it. The Short Sexual Well-Being Scale, Depression Anxiety and Stress Scale, Fatigue Assessment Scale, and authors' questionnaire were used. Relationships between tested variables were verified with the use of network analysis performed with the EBICglasso estimator. Centrality assessment showed that sexual well-being had the highest values of betweenness, closeness and degree, followed by fatigue and depression measures. Sexual well-being was negatively related to the number of declared sexual dysfunctions, fatigue, stress and depression levels. Participants' age and HF duration were not related to the sexual well-being of tested women. Multiple additional partial correlations were detected. The obtained results show that sexuality may be a central sphere of life in women with HF and that one's sexuality should not be negated when working with cardiac patients.

Women's sexual health improvement: sexual quality of life and pelvic floor muscle assessment in asymptomatic women.

Problems related to the quality of sexual life in gynecological practice are usually neglected. This study aimed to highlight the significance of this area of concern and evaluate the usefulness of tools, such as patient-reported outcomes (PROs) and pelvic floor examination, to improve women's sexual wellbeing and to identify predictors of poor quality of sexual life during the well-woman annual visit. A cross-sectional study was designed to examine 300 healthy women to determine whether the sexual quality of life (SQOL) questionnaire (on electronic devices) and pelvic floor muscle assessment (the vulva, anus, muscles, and periurethral (VAMP) protocol) of asymptomatic women during the annual bimanual examination (BME) help differentiate patients who would benefit from discussing sexual problems with a gynecologist. Dyspareunia was an exclusion criterion. The majority of subjects experienced high sexual wellbeing (82.0% with SQOL score of ≥84), with a mean of 85.7 points. SQOL scores were lower for psychiatric disorders or symptoms (37.0% of subjects), although they did not correlate with age, BMI, parity, contraception use, history of vulvovaginal symptoms, neurosurgical/orthopedic problems, and rectal, bowel, or bladder symptoms. Patients with dyspareunia (16.0% of participants, although they denied it during the face-to-face consultation) had a 3.6 times higher prevalence of low or moderate quality of sexual life. The VAMP protocol score was low in asymptomatic women, 33.0% met positive criteria (VAMP+, NRS ≥3) for pelvic floor dysfunction (overactivity), although at borderline levels. VAMP+ was positively correlated with chronic pain and genitourinary symptoms, but neither with dyspareunia nor incontinence, and was unrelated to the SQOL score (p = 0.151). Women's sexual health is a global health priority. Finding a way to start a discussion with an asymptomatic patient is crucial to increasing patients' interest in disclosing a sexual health problem to be resolved. PROs or simple questions about sexual wellbeing direct the discussion mainly toward the at-risk group for sexual deterioration: those with mental health problems and women with dyspareunia. Dyspareunia is considered a predictor of decreased quality of sexual life, a major sexual disorder that should not be overlooked. Gynecological consultation should resolve concerns, identify the problem, and refer for professional sexual care if still needed.

Evaluation of Long-Term Sexual Satisfaction in Women Submitted to Laparoscopic Sacrocolpopexy: Retrospective Tertiary Center Study

Introduction: Traditional treatments for apical compartment prolapse and multicompartment prolapse, such as open sacrocolpopexy, have been associated with concerns regarding sexual function. In recent years, laparoscopic or robotically assisted sacrocolpopexy has emerged as an alternative with potential benefits, including enhanced visualization, symptom relief, and comparable anatomical results. However, the impact of laparoscopic sacrocolpopexy (LSP) on long-term sexual satisfaction in women remains an important area of investigation. This retrospective tertiary center study aimed to evaluate the long-term sexual satisfaction in women who underwent LSP for the treatment of POP. The objective was to assess postoperative sexual satisfaction among patients with a history of active sexual life before the surgery. Methods: A total of 30 patients who underwent laparoscopic sacrocolpopexy between August 2014 and December 2016 were included in the analysis. The patients’ sexual satisfaction was assessed using The New Sexual Satisfaction Scale, a validated questionnaire in the Portuguese language with a mean follow-up of 7 years. Baseline characteristics, surgical and function outcomes were also evaluated. Results: Among the participants, 70% remained sexually active after the surgery. The mean score on The New Sexual Satisfaction Scale was 75.1, indicating a moderate to very satisfied level of sexual satisfaction. Out of the patients who reported a change in their sexual satisfaction after surgery, 69.2% would still recommend the procedure to others. The mean rate of global satisfaction with the surgery was 6.97 out of 10, with 83.3% of the patients recommending the surgery to someone else. Conclusion: The study provides valuable insights into the impact of laparoscopic sacrocolpopexy on sexual well-being in women with POP. Despite potential changes in sexual function, the majority of patients remained sexually active and perceived the procedure as beneficial, expressing overall satisfaction and recommending it to others. The findings highlight the importance of considering sexual function in the management of POP and suggest that LSP can be an effective treatment option that preserves sexual activity. However, further studies with larger sample sizes and comprehensive assessments are warranted to better understand the complex relationship between pelvic organ prolapse surgery, sexual function, and patient outcomes.

Psychosexual care could protect and promote sexual well-being in women undergoing infertility treatment: A randomised controlled trial

ABSTRACT This study aimed to examine the effectiveness of psychosexual care using the conceptual framework of the Salutogenic Model in promoting sexual well-being in women undergoing infertility treatment. This was a two-armed parallel randomised controlled trial which conducted with seventy primary infertility women undergoing infertility treatment assigned to receive either psychosexual care (intervention group, n = 35) or routine care (control group, n = 35). The effects of psychosexual care were estimated by the t-test with the intention-to-treat principle. Sexual function was improved in the intervention group and significantly reduced in the control group. Sexual satisfaction was preserved in the intervention group and significantly reduced in the control group. Sexual esteem and self-efficacy significantly improved in women after psychosexual care compared with routine care. Although depression levels were improved in the intervention group, the difference in depression levels was not statistically significant between the intervention and the control groups. However, sense of coherence was significantly improved in the intervention group compared with the control group. Psychosexual care protected and promoted sexual well-being in women undergoing infertility treatment. Application of the health-oriented Salutogenesis Model may be useful to develop care interventions that enable women to reach a state of sexual well-being.

Co-creating sexual and reproductive health interventions with adolescents: the experience from Rajasthan

Despite a clear policy recognition of the need for special programmatic attention for adolescents to ensure access to sexual and reproductive health information and services, almost all existing programs in India face critical challenges in effectively delivering sexual and reproductive health information and services, which leads to early marriages and teenage pregnancies. Teenage pregnancies directly threaten women's sexual and reproductive health and well-being. States like Rajasthan with high adolescent pregnancy rates demand better solutions. IPE Global implemented project Udaan to reduce teenage pregnancies in the state, adopting a 360 degree approach. Improving Sexual and Reproductive Health was one of the critical components of the project, and a human-centred design method was adopted to co-create an effective sexual and reproductive health intervention relevant to the community. The human-centred design approach incorporated multiple steps, including formative research, iterations, prototyping and piloting. Five potential interventions emerged after a series of iterative explorations. The in-school SRH intervention has emerged as an excellent model of reaching adolescents effectively in culturally sensitive rural geographies in the evaluation of the pilot, which successfully covered over 10,800 adolescent boys and girls across 66 government high schools in the Bari block of Dholpur. An independent evaluation suggested a significant increase in the awareness of contraceptive methods in the intervention area from 24 per cent to 50 per cent. Contraceptive self-efficacy, a measure of girls' agency, increased by 18 per cent in the intervention area. Further, qualitative findings showed a significant improvement in SRH awareness and service utilization.

(078) Assessing Women's Sexual Well-being in the Context of Relationship Status and Nonconsensual Sexual Experience History

Abstract Introduction Being involved in a romantic relationship has consistently been associated with better general well-being and life satisfaction, relational and sexual satisfaction, and sexual function. Research indicates that these relationships also buffer women against negative mental and sexual health outcomes after traumatic experiences. Regardless of quality, the presence of a romantic relationship is associated with better general and sexual outcomes for women. Though it has been well established that romantic relationships are positively associated with better sexual and general well-being for heterosexual individuals, the influence of relationship status on other important indicators of sexual well-being has received significantly less attention. Research has not assessed sexual well-being by self-schemas and sexual excitation and inhibition propensities. Given the associations of sexual schemas and sexual excitation and inhibition with sexual function and satisfaction, these two constructs are important to consider when evaluating sexual well-being for women. Additionally, it is imperative to consider nonconsensual sexual experiences (NSEs) when evaluating women’s sexual well-being as 20% of women in the U.S. experience an NSE in their lifetime. NSEs are known to negatively impact sexual excitation and inhibition, self-schemas, and sexual and general well-being. Objective The current study expands upon existing research on sexual well-being by including measures of excitation and inhibition and sexual schemas as well as considering participants’ NSE history. Filling these gaps in the extant literature could prove important for understanding the combined effects of relationship status and NSE history on women’s sexual well-being. Methods The data for the current study was taken from a larger assessment of female sexuality in February and July of 2016. Data from 1152 women was analyzed in the current study. The women completed assessments of previous consensual and nonconsensual sexual experiences using the Nonconsensual Sexual Experiences Inventory, sexual excitation and inhibition using the Sexual Excitation and Sexual Inhibition Inventory for Women, sexual self-schemas using the Sexual Self-Schema Scale and relationship status. Results The results from an ANOVA and subsequent independent t-test pairwise comparisons indicate significant differences in sexual schemas and excitation and inhibition propensities across various relationship statuses (p values < 0.05). After Bonferroni corrections, there were a few significant findings. Women in married or cohabitating relationships report significantly more conservative/embarrassed sexual self-schemas than single women. Single women with NSE histories also reported significantly lower scores on the “setting” excitation subscale of the SESII-W compared to single women with no NSE histories. Conclusions The results indicate that women conceptualize their sexual schemas and experience facilitators and inhibitors of arousal differently across various relationship statuses. Consistent with previous literature, married and cohabitating women reported more conservative/embarrassed self-schemas. Interestingly, single women with an NSE history reported that sex in novel or public settings was less activating for their sexual arousal than the sexual setting for women with no NSE histories. These findings highlight the importance of considering relationship status and NSE history when examining sexual well-being, sexual self-schemas, and sexual excitation and inhibition. Disclosure No

Early Adaptive Schemas and Sexual Wellbeing in Women: Exploring Differences in Menopausal Status

There is limited research concerning the relationship between early adaptive schema, from Young’s Schema Theory, and women’s sexual wellbeing. Schema Theory posits that early adaptive schema start forming in early childhood from core emotional needs being met, and positively influence individuals’ concept of self, relationships with others, and their behaviours. Building on this theory, the current study explored the relationship of early adaptive schema and adult women’s sexual wellbeing at pre-, peri-, and post-menopause. Four hundred and sixty-seven women, mostly partnered and heterosexual, from over ten countries, participated in an online survey measuring relationships between early adaptive schema and sexual wellbeing, measured by sexual functioning and sexual satisfaction. The strength of association of early adaptive schema and sexual well-being were evaluated in addition to known predictors. The results showed higher early adaptive schema were associated with higher sexual wellbeing, measured by sexual satisfaction and sexual functioning, with medium-to-large effect sizes, at pre and peri-menopause, and produced a non-significant result for post-menopause. The association of early adaptive schema continued after known factors were accounted for. The results support the use of early adaptive schema to promote sexual wellbeing for women at pre- and peri-menopause.

Women's disordered eating and sexual function: the role of interoception.

Among women, disordered eating and sexual difficulties commonly co-occur. We investigated whether interoceptive dysfunction (ie, altered processing of body cues) may be a common cause (ie, third variable) contributing to these concomitant outcomes above and beyond body mass index (BMI) and body image concerns. Women (n = 1201; mean age = 25.92 years; mean BMI = 25.46 kg/m2; 61.6% heterosexual, 27.5% bisexual) were recruited from sexual education courses at a midsize southeastern university and Reddit communities related to women's health, sex, and disordered eating. Participants completed online measures of self-reported interoception (Multidimensional Assessment of Interoceptive Awareness Version 2), disordered eating attitudes and behaviors (Eating Disorder Examination Questionnaire), sexual function (Female Sexual Function Index), and demographic information, including height and weight. Regression, commonality, and dominance analyses were completed in R. Sexual function was assessed via the Female Sexual Function Index. Both general interoception and body trust (a facet of interoception concerned with trust of internal sensations) predicted dietary restraint and sexual function (Ps < .001). After accounting for both general interoception (β = 0.27, P < .001) and body trust (β = 0.32, P < .001) in hierarchal regression models predicting sexual function, dietary restraint either evidenced a reduction in its standardized beta or was no longer associated with sexual function. Body image concerns also emerged as a robust predictor of women's sexual function. Body trust accounted for the most unique variance (4.45%) in women's sexual function and commonly accounted for another 3.70% of variance with body image concerns. Interoceptive exposure interventions may contribute to better outcomes for women with disordered eating, sexual difficulties, or co-occurring concerns, a notion worthy of future investigation. Strengths include a large diverse sample in terms of sexual orientation (>35% sexual minority) and body size (BMIs from underweight to class 3 obesity). The cross-sectional nature of this study precludes any conclusions regarding temporal precedence or causality. Future studies should use different measures of dietary restraint for nonclinical populations (eg, objective measures of caloric intake). Findings suggest that both interoception and body image concerns contribute to the co-occurrence of disordered eating behaviors and sexual difficulties, and that both may be important risk/maintaining factors to consider in future work. Interoception should be integrated into models of women's sexual function, as it may be just as important to women's sexual well-being as body image concerns.

Sexual function and quality of life in women with idiopathic premature ovarian insufficiency.

Premature ovarian insufficiency (POI) is a disruptive diagnosis for women, with major consequences on fertility but also on quality of life and sexual functioning. The aim of this study was to evaluate the impact of vaginal symptoms from the genitourinary syndrome of menopause on the quality of life and sexual functioning of women with POI. This cross-sectional observational study involved 88 women who were investigated in a specialized setting at the University Hospital of Toulouse (France) between 2014 and 2019. All women completed the Day-to-Day Impact of Vaginal Aging (DIVA) questionnaire on well-being and quality of life and the Female Sexual Function Index (FSFI) on sexual functioning. Analysis of total scores and subdomains of the questionnaire was performed and compared according to use of hormone replacement therapy or local low-dose estrogen treatment, age at POI, and use of antidepressant therapy or current psychological support. Outcomes included the DIVA questionnaire and the FSFI. Among the 88 women who fulfilled the inclusion criteria, 66 (75%) answered the questionnaires. Mean ± SD age at POI diagnosis was 32.6 ± 6.9 years and mean age at questionnaire time was 41.6 ± 6.9 years. The highest mean scores on the DIVA questionnaire were found in the self-perception and body image domain (2.05 ± 1.36), followed by the sexual functioning domain (1.52 ± 1.28). The mean FSFI score was 23.08 (95% CI, 21.43-24.73), with 32 women (78% of sexually active women) having a score <26.55, which defines sexual dysfunction. There was no difference in the FSFI score and for all DIVA domains whether or not women were taking hormone replacement therapy or local hormone therapy. This should encourage practitioners to systematically discuss the impact of POI on sexuality and vulvovaginal symptoms to provide women with specific care and advice to improve their quality of life. This is the first French study that aimed to assess the impact of the genitourinary syndrome of menopause on the quality of life and sexual well-being in women with POI by using standardized validated questionnaires with a very good participation rate (75%). The sample size was limited, and we could not eliminate selection bias due to university hospital recruitment. POI can have a negative impact on sexual quality of life, which raises the needs for specific advice and care.

Sexual health and sexual well-being of women with Mayer-Rokitansky-Kuester-Hauser syndrome after vaginal reconstruction: a qualitative analysis.

Contradictory findings on sexual health in women with Mayer-Rokitansky-Kuester-Hauser syndrome (MRKHS) after vaginal reconstruction point toward the need for more profound assessment of this subject, particularly as it is still unclear what constitutes sexual well-being, especially genital self-image or sexual self-esteem, in women with MRKHS and neovagina. The aim of this qualitative study was to assess individual sexual health and sexual well-being in the context of MRKHS after vaginal reconstruction, with an emphasis on genital self-image, sexual self-esteem, sexual satisfaction, and coping with MRKHS. Qualitative semistructured interviews were conducted with women with MRKHS after vaginal reconstruction (n = 10) with the Wharton-Sheares-George surgical method and a matched control group without MRKHS (n = 20). Women were surveyed about their previous and current sexual activities, perception of and attitudes toward their genitals, disclosure to others, coping with the diagnosis, and perception of surgery. Data were analyzed through qualitative content analysis and compared with the control group. The primary outcomes of the study were major categories, such as sexual satisfaction, sexual self-esteem, genital self-image, and dealing with MRKHS, as well as subcategories related to the content analysis. Although half the women in the present study indicated that they were coping well with their condition and were satisfied with sexual intercourse, most felt insecure about their neovagina, were cognitively distracted during intercourse, and showed low levels of sexual self-esteem. A better understanding of expectations and uncertainties regarding the neovagina might help professionals to support women with MRKHS after vaginal reconstruction to increase sexual well-being. This is the first qualitative study focusing on individual aspects of sexual well-being, especially sexual self-esteem and genital self-image, in women with MRKHS and neovagina. The qualitative study indicates good interrater reliability and data saturation. The limitations of this study include the inherent lack of objectivity resulting from the method but also the fact that all the patients had a particular surgical technique, consequently resulting in limited generalizability of these findings. Our data indicate that integrating the neovagina into the genital self-image is a prolonged process that is essential for sexual well-being and should thus be the focus of sexual counseling.

Sexual harassment experiences and their consequences for the private lives of Chinese women

Sexual harassment is a global issue threatening individuals’ safety and rights, especially for women. Previous studies mainly focused on the negative impact of sexual harassment on women's health, work, and education. Using data from the Chinese Private Life Survey, this article examines the effect of sexual harassment in both physical and non-physical forms and probes the effect of the perpetrator's relationship to the victim on women's sexual behaviors, sexual and marital well-being, and desires for marriage and childbearing. The results indicate that both physical and non-physical sexual harassment lowered married or cohabitating women's sexual satisfaction and functioning. Sexual harassment by a family member/relative, an intimate partner or an acquaintance produced a larger negative effect on women's sexual well-being than that by others. Married women's marital satisfaction and stability were also undermined if they experienced sexual harassment. A family member/relative, an intimate partner and a stranger as the perpetrator had a larger effect on women's marital well-being than other perpetrators. For unmarried women, sexual harassment was not associated with the desire for marriage. However, those who were physically harassed by an acquaintance were unlikely to have a desire for childbearing. Comparing with non-physical sexual harassment, physical sexual harassment was found to have a larger negative impact on women's private lives.

International Urogynaecology Consultation chapter 1 committee 4: patients' perception of disease burden of pelvic organ prolapse.

This manuscript from Chapter 1 of the International Urogynecology Consultation (IUC) on Pelvic Organ Prolapse (POP) reports on the patients' perception of disease burden associated with pelvic organ prolapse. An international group containing a team of eight urogynaecologists, a physiotherapist and a statistician performed a search of the literature using pre-specified search terms in PubMed and Embase (January 2000 to August 2020). The division of sections within this report includes: (1) perception of POP and the relationship with body image and poor health; (2) a vaginal bulge as it impacts health and wellbeing in women; (3) the impact of POP on sexual life; (4) body image and pelvic floor disorders; (5) POP and mood; (6) appropriate use of treatment goals to better meet patients' expected benefits; (7) using health-related quality of life questionnaires to quantify patients' perception of POP; (8) The financial burden of POP to patients and society. Abstracts were reviewed and publications were eliminated if not relevant or did not include populations with POP or were not relevant to the subject areas as noted by the authors. The manuscripts were next reviewed for suitability using the Specialist Unit for Review Evidence (SURE) checklists for cohort, cross-sectional and case-control epidemiologic studies. The original individual literature searches yielded 2312 references of which 190 were used in the final manuscript. The following perceptions were identified: (1) women were found to have varying perceptions of POP including shame and embarrassment. Some regard POP as consequence of aging and consider there is no effective therapy. (2) POP is perceived as a vaginal bulge and affects lifestyle and emotional wellbeing. The main driver for treatment is absence of bulge sensation. (3) POP is known to affect frequency of sexual intercourse but has less impact on satisfaction. (4) Prolapse-specific body image and genital self-image are important components of a women's emotional, physical and sexual wellbeing. (5) POP is commonly associated with depression and anxiety symptoms which impact HRQoL although are not correlated with objective anatomical findings. (6) Patient-centered treatment goals are useful in facilitating communication, shared decision-making and expectations before and after reconstructive surgery. (7) Disease-specific HRQoL questionnaires are important tools to assess bother and outcome following surgery, and there are now several tools with Level 1 evidence and a Grade A recommendation. (8) The cost of POP to the individual and to society is considerable in terms of productivity. In general, conservative measures tend to be more cost-effective than surgical intervention. Patients' perception of POP varies in different patients and has a far-reaching impact on their overall state of health and wellbeing. However, recognizing that it is a combination of body image and overall health (which affects mental health) allows clinicians to better tailor expectations for treatment to individual patients. There are HRQoL tools that can be used to quantify these impacts in clinical care and research. The costs to the individual patient (which affects their perception of POP) is an area that is poorly understood and needs more research.

Predictors of sexual health quality of life after hysterectomy and sentinel lymph node mapping for endometrial cancer

There is a lack of data regarding the impact of surgery for endometrial cancer (EC) on women's sexual health and wellbeing. Additionally, in women who have undergone sentinel lymph node (SLN) dissection for EC, data on outcomes of sexual health, satisfaction, and functioning are limited. We sought to characterize sexual health related quality of life (HRQOL) and patient reported outcomes (PRO) in women who have undergone hysterectomy and SLN dissection for EC, and determine demographic and symptom-related predictors of sexual satisfaction.

Sexual Function in Women With Differences of Sex Development or Premature Loss of Gonadal Function

Previous studies have suggested that sexual function may be compromised in women born with differences of sex development (DSD) or early loss of gonadal function. To describe sexual function and sexual wellbeing in women with complete androgen insensitivity syndrome (CAIS), complete gonadal dysgenesis (GD) and premature ovarian insufficiency (POI) in relation to gynecological measures and in comparison with unaffected women. A cross sectional study including 20 women with CAIS, 8 women with 46,XY GD, 8 women with 46,XX GD, 21 women with POI, and 62 population-derived controls. Study participants underwent gynecological examination for anatomical measurements and evaluation of tactile sensitivity. They responded to the validated Sexual Activity Log (SAL), Profile of Female Sexual Function (PFSF), and the Personal Distress Scale (PDS). The women with CAIS, XY GD, XX GD and POI showed overall satisfying sexual function in comparison to unaffected age-matched population female controls with a median of 1 to 2 satisfying sexual episodes per week among both the patients and the controls depending on available partner. Women with CAIS had shorter vagina and smaller clitoris and women with XY GD had a significantly shallower vagina in comparison to controls. Clitoral width was also significantly smaller among women with XX GD compared to controls. However, results showed overall good genital touch sensitivity with no significant differences between groups. Women with DSD or POI can be informed on overall satisfactory sexual function and normal genital touch sensitivity. The strength is the use of age-matched population-based controls to these rare conditions of DSD and POI. Limitations are the nonresponder rate of recruited controls, as well as the small groups of women with DSD. Women with differences of sex development or early loss of gonadal function show overall good sexual well-being, however clinicians have to make efforts to optimize caretaking and treatment to ensure good sexual quality of life for all patients.

Pelvic Organ Prolapse Takes Up Space in the Bedroom: A Mixed Method Exploration of the Circular Sexual Response Cycle in Women With Pelvic Organ Prolapse.

Pelvic organ prolapse (POP) is a multidimensional reproductive health issue, which negatively affects women's sexual well-being. Using the circular sexual response cycle as a framework, we sought to evaluate women's sexual experiences living with POP. Measures of genital self-image, sexual distress, sexual satisfaction, and sexual function were administered before conducting semistructured interviews. Participants were 16 heterosexual partnered women seeking surgical and nonsurgical treatment for symptomatic POP. Standardized questionnaires indicated normal genital self-image, sexual satisfaction, and sexual function; however, sexual distress scores exceeded normal cutoffs. Eight themes emerged, including reasons for having sex, willingness to initiate and sexual receptivity, contextual factors, sexual stimuli, sexual arousal, responsive desire, outcomes, and spontaneous sexual desire. In contrast to quantitative findings, themes demonstrated sexual difficulty. Women with POP mainly engage in sex out of obligation and report reduced sexual initiation and receptiveness, as well as a negative impact on genital self-image. Pelvic organ prolapse was perceived to adversely affect subjective arousal, responsive desire, and spontaneous desire, despite intact physiological arousal. Difficulty experiencing subjective arousal was profound and seemed to be limited by preoccupation with POP. Sexual satisfaction and rewards were diminished after POP, including orgasmic capacity. Rewarding motivators to engage in sex were seldom discussed and often overshadowed by experiencing guilt and obligation related to sex. The circular sexual response cycle largely fit participants' experiences; however, POP inhibits subjective arousal, which prevents responsive desire for many. Patients may need better support to cope with preoccupation with POP, indicating that addressing the psychosocial symptoms of POP should be prioritized.

Sexual victims - supporting women's sexual and reproductive choices and wellbeing

In Japan, support systems for female victims of sexual violence are lacking. Assistant Professor Risa Koyake, Faculty of Contemporary Social Studies, Department of Contemporary Children, Doshisha Women's College of Liberal Arts, Japan, is working to ensure these women have the support they need and deserve. Her work is particularly focused on women in Japan and the US who are pregnant as a result of sexual violence. Abortion tends to be the assumed preference but the choice of whether or not to have an abortion is tied to the sexual and reproductive freedom of the victim and some of these women wish to give birth. Unfortunately, support is particularly lacking for female survivors of sexual violence who wish to give birth. In her work, Koyake conducts consultations and conversations with survivors of rape. She has experience as a volunteer at a group for survivors of domestic violence so is used to having sensitive and challenging discussions with women seeking expert support and guidance. Koyake's current project is entitled 'The Choice of Adoption or Abortion Among Women Pregnant as a Result of Sexual Violence in Japan and America', and involves looking at existing support and options for women in Japan who are pregnant as a result of sexual violence, ultimately seeking to build on exisiting support to ensure that it is adequate, particularly for rape victims who choose to give birth.