Significant Improvement In Sexual Function Research Articles

Is there a role for platelet rich plasma injection in vulvar lichen sclerosus? A self-controlled pilot study.

Owing to the evidence that as many as 30-40% of patients with vulvar lichen sclerosus (VLS) fail to report a remission of symptoms with first-line corticosteroid treatment (TCS), especially as what regards dyspareunia, we aimed to analyze patients' satisfaction following vulvar injection of autologous platelet-rich plasma (PRP). This is intended as an adjunctive treatment, to be used following TCS, and appears to promote tissue repair. It may also possibly have immunomodulatory proprieties. Patients with VLS were considered eligible for this pilot study if, despite having been treated with a 3-month TCS regimen, they reported a persistence of symptoms. PRP was produced in a referral center using a manual method and a standardized protocol. Each patient received three treatments 4 to 6weeks apart. A total of 50 patients with a median age of 53 years [IQR 38-59 years] were included in the study. 6 months after the last injection of PRP all patients were either satisfied or very satisfied with the treatment (100%; 95% CI 93-100%). Median NRS scores for itching, burning, dyspareunia and dysuria were significantly reduced (p < 0.05) and FSFI, HADS and SF-12 questionnaires revealed a significant improvement in sexual function, psychological wellbeing and quality of life (p < 0.05). The number of patients reporting the need for maintenance TCS treatment was reduced by 42% (p < 0.001) and an improvement in vulvar elasticity and color was reported in all patients. Following standard medical therapy, PRP may be effective not only in improving symptoms, but also in restoring function.

Feasibility and effectiveness of communication tools for addressing intimacy and sexuality in patients with cancer: a systematic review

PurposePatients diagnosed with cancer might experience changes in intimacy and sexuality due to the illness itself, treatment, or psychological and social factors. Healthcare professionals (HCPs) often feel reluctant to discuss these changes. This study aimed to provide an overview of the feasibility and effectiveness of communication tools that support communication regarding changes in intimacy or sexuality among patients with cancer.MethodsThis is a systematic review. Databases are PubMed, Embase, CINAHL, PsycInfo, Web of Science and Cochrane Library from inception to June 2023. The Mixed Methods Appraisal Tool was used to assess included studies. Data were summarized in data charting forms.ResultsIn total 35 studies were included, published between 2001 and 2023. Most had a quantitative design and moderate methodological quality. In 11 studies, the PLISSIT model (Permission, Limited Information, Specific Suggestions, Intensive Therapy) was used. Tools were integrated in counselling sessions or training programmes for individual patients, couples, groups of patients, or HCPs. All tools were considered feasible by patients or HCPs. Twenty studies reported significant improvement in sexual functioning, quality of life, quality of care or combined outcomes.ConclusionTools to support communication about changes in intimacy and sexuality among patients with cancer seem feasible and effective. The most commonly used tool, the PLISSIT model, proved to be feasible for HCPs and to have a positive effect on patients’ and partners’ sexual functioning and quality of life. Giving attention to changes in intimacy and sexuality seems to be important in itself, regardless of the communication tool or approach used.

Effect of anterior repair on sexual function in heterosexual couples.

Little is known about the impact of native tissue repair techniques on heterosexual intercourse. This study was aimed at investigating the effect of anterior colporrhaphy on women's and their partners' sexual function. Sexually active women with a male partner who were diagnosed with anterior wall prolapse without any incontinence were prospectively recruited from a single academic center. Demographic data were collected and a Pelvic Organ Prolapse Quantification examination was performed. Before and 3 months post-operatively, women completed two validated questionnaires to assess sexual function, the International Consultation on Incontinence Questionnaire Vaginal Symptoms short form (ICIQ-VS SF) 55, and the Female Sexual Function Index (FSFI), and their male partners completed the International Index of Erectile function-5. Pre- and post-operative results were compared using a paired t test. This study was conducted in the gynecology department of a university hospital between May 2022 and June 2023, where 50 heterosexual couples were enrolled and underwent isolated anterior repair. The mean age of women and their partners were 44.3 ± 5.12 and 48.1 ± 5.81 respectively. Overall, female sexual function improved significantly from pre- to 3 months postoperatively with a decrease in ICIQ-VS SF scores from 13.3 ± 3.27 to 1.7 ± 1.1 (p < 0.05) and an increase in FSFI scores from 21.74 ± 9.37 to 29.28 ± 9.97 (p < 0.05). The only domain that did not improve was sexual pain. For their male partners, there was a similar significant improvement in sexual function with an increase in scores from 48.71 ± 8.71 to 60.68 ± 8.63 (p < 0.05). Isolated anterior repair was associated with improved short-term sexual function amongst heterosexual couples.

Comparing the Efficacy and Safety of Treatment with Fixed Dose of Tadalafil Monotherapy versus Its Combination with Silodosin in Patients with Benign Prostatic Hyperplasia and Erectile Dysfunction

Background Benign prostate hyperplasia (BPH) is a histological diagnosis which is identified by non-malignant hyperplasia of prostatic tissue due to smooth muscle and epithelial cell proliferation in the prostatic transition zone. Aim of the Work To assess the efficacy and safety of fixed-dose of Tadalafil monotherapy versus its combination with Silodosin in treatment of BPH patient and erectile dysfunction (ED) by comparing IPSS score, PVR, Q max and The international Index of Erectile Function (IIEF questionnaire). Methodology This prospective randomized control clinical study was conducted at tertiary care hospital at Ain Shams University hospitals from June 2021 till January 2022 and performed on total 60 men patients which were 45 years old or older with a history of LUTS secondary to BPH of at least 6 months. Results Our study results revealed that there was no statistically significant difference found between the studied groups regarding IPSS and Q-max at baseline while there was statistically significant difference found in IPSS and Q-max at 1 month, 2 months and 3 months, with statistically significant decrease in IPSS and significant increase in Q-max through follow-up from baseline in each group. Conclusion This analysis suggested that the combination-therapy of tadalafil and Silodosin was more effective than tadalafil alone in improving subjective LUTS, but there was no significant improvement in sexual function.

Does Significant Weight Loss After Bariatric Surgery Affect Sexual Function and Urinary Symptoms? An Iranian Study.

For sexual dysfunction and lower urinary tract symptoms (LUTS), obesity is identified as an independent risk factor. The current study aimed to evaluate the effect of significant rapid weight loss by bariatric surgery on LUTS and sexual function among men and women with class III obesity. A group of patients who were planned to undergo bariatric surgery was enrolled in the study. Male patients were given the International Index of Erectile Function (IIEF) and the International Prostate Symptom Score (IPSS) questionnaires. In the female group, they filled in the female sexual function index (FSFI) and the International Consultation on Incontinence Questionnaire short form (ICIQ-SF) questionnaires. Patients were followed up 1year after their bariatric surgery. All questionnaires were completed by eighty-one patients. (mean age ± SD: 39.4 ± 9.2years; mean body mass index (BMI) ± SD: 47.15 ± 5.4kg/m2). The total score of the IPSS questionnaire decreased from 5.83 ± 3.01 preoperatively to 2.37 ± 1.66 postoperatively. The weight loss caused significant improvement in the storage phase of LUTS domains, but there were no considerable changes in the voiding phase. In the IIEF questionnaire, domains of sexual desire, overall satisfaction, and orgasmic function improved significantly. There was not a significant change in any FSFI domains after bariatric surgery. Mean ICIQ-SF decreased, but it was not substantial. Bariatric surgery can significantly improve the storage phase in men, but not the voiding phase. Sexual desire, orgasmic function, and overall satisfaction were significantly improved in men. No significant improvement in sexual function and UI in women was observed.

Effect of an 8-Week Tailored Physiotherapy Program on Sexual Health in Women with Scleroderma and Myositis: A Controlled Pilot Study.

Systemic sclerosis (SSc) and idiopathic inflammatory myopathies (IIM) are very rare rheumatic diseases burdened by a high prevalence of sexual dysfunctions. However, no specific treatment has been proposed to date. To our knowledge, this is the first (pilot) study aiming to investigate the effect of an 8-week tailored physiotherapy program on the sexual health of women with SSc and IIM. In total, 12 women with SSc and 4 women with IIM were enrolled in the study. Based on the patients' capability to participate in the program, they were divided into an intervention group (IG) (mean ± SD age 46.8 ± 8.6years) and a control group (CG) (mean ± SD age 46.3 ± 8.5years). IG underwent the 8-week program (1h of supervised physiotherapy twice weekly), whereas CG received no physiotherapy. At weeks 0 and 8, all patients filled in questionnaires assessing sexual function (Female Sexual Function Index [FSFI], Brief Index of Sexual Functioning for Women [BISF-W]), sexual quality of life (Sexual Quality of Life-Female [SQoL-F]), functional ability (Health Assessment Questionnaire [HAQ]), quality of life (Medical Outcomes Short Form-36 [SF-36]), and depression (Beck's Depression Inventory-II [BDI-II]). The changes were analyzed with two-way ANOVA and Friedmann's test. Compared to the statistically significant deterioration in CG over weeks 0-8, we found statistically significant improvements in the total scores of FSFI and BISF-W, and some of their domains, functional status, and the physical component of quality of life. Our 8-week physiotherapy program not only prevented the natural course of progressive deterioration of functional ability but also led to a significant improvement in sexual function and quality of life in women with SSc and IIM. However, due to the lack of randomization and a relatively small sample size resulting from the strict inclusion criteria, further validation of our results is needed. ISRCTN91200867 (prospectively registered).

(005) A Systematic Review of Preventative BRCA Surgeries and Sexual Function Outcomes

Abstract Introduction BRCA 1 and 2 genes increase a patient’s risk for developing cancer of breast and ovarian origin. There are two methods of preventative care offered to BRCA-positive patients: prophylactic surgery or high risk screening for cancer accompanied by endocrine therapy. Preventative surgeries for BRCA-positive patients – bilateral salpingo-oophorectomy (BSO) and mastectomy - have been linked to decreased sexual function and dyspareunia. A patient’s decision whether or not to undergo preventive surgery as opposed to high risk screening (with or without hormone therapy) is heavily reliant on the advice received from their health care providers. The association of risk-reducing mastectomy and BSO with quality of life, including postoperative dyspareunia, should be taken into account when conducting shared decision-making with patients. Objective The objective of this systematic review is to assemble and analyze findings related to patient reported sexual function after these surgeries, to see if and how either surgery affects sexual dysfunction from patient baseline, and to compare the effects the two surgical procedures have on sexual function and whether these effects can be mitigated with hormone replacement therapy. Methods A literature review using Pubmed, Embase and MEDLINE databases from inception through January 25, 2022 was conducted. Included in the literature search were any form of observational study, clinical trial or article type. Conference abstracts were also included. To be included, studies had to meet an a priori list of Medical Subject Headings (MeSH) terms “BRCA” AND “sexual dysfunction” OR “dyspareunia”. Results The search yielded 13 results, of which seven reported sufficient data for systematic review. Participant numbers ranged from 15 to 804. Sexual dysfunction and dyspareunia were measured via both validated and investigator-generated surveys, three studies used the Female Sexual Function Index (2 BSO, 1 breast) and 2 of the studies used the Sexual Activity Questionnaire (both BSO). All of the studies, no matter the survey metric, found there to be significant sexual dysfunction with either BSO or mastectomy post surgery. All but one of the studies found that hormone replacement therapy was not show a significant improvement in sexual function, and all of the studies reported that sexual function post op could not reach baseline level with therapy. Menopausal status was not a significant moderator. No studies found preventative screenings to have an effect on sexual dysfunction or dyspareunia, and future studies could look into this group as a possible study control. Conclusions To our knowledge this is the first systematic review to incorporate the effects of both risk reducing mastectomies and BSO on sexual function among BRCA patients. The data can help decision making for BRCA positive patients and clinicians choosing between surgeries and high risk screening. Patients should be properly informed and counseled about dyspareunia before deciding to undergo irreversible procedures, and as part of shared decision making on which prevention approach is the best fit for their goals and preferences. Disclosure No

MP78-12 OUR EXPERIENCE IN PENILE IMPLANT AFTER ANASTOMOTIC URETHROPLASTY FOR PELVIC FRACTURE URETHRAL INJURY

You have accessJournal of UrologyCME1 Apr 2023MP78-12 OUR EXPERIENCE IN PENILE IMPLANT AFTER ANASTOMOTIC URETHROPLASTY FOR PELVIC FRACTURE URETHRAL INJURY Cora Fogaing, Pankaj Joshi, Daniel Esteban Gomez Zapata, Apurva Anand, Rathish Rajenderan, Shreyas Bhadranavar, Amey Talpallikar, Aryan Gune, and Sanjay Balwant Kulkarni Cora FogaingCora Fogaing More articles by this author , Pankaj JoshiPankaj Joshi More articles by this author , Daniel Esteban Gomez ZapataDaniel Esteban Gomez Zapata More articles by this author , Apurva AnandApurva Anand More articles by this author , Rathish RajenderanRathish Rajenderan More articles by this author , Shreyas BhadranavarShreyas Bhadranavar More articles by this author , Amey TalpallikarAmey Talpallikar More articles by this author , Aryan GuneAryan Gune More articles by this author , and Sanjay Balwant KulkarniSanjay Balwant Kulkarni More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003355.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pelvic fracture urethral injury (PFUI) results from traumatic disruption of the urethra and is treated with anastomotic urethroplasty. Up to 60% of those patients have erectile dysfunction. Majority are treated with medical management. For those who fail, we perform penile implant. We present outcomes for a series of 41 patients who underwent penile implant insertion post anastomotic urethroplasty for PFUI. METHODS: Our centre is a tertiary referral centre and published the world’s largest series of PFUI experience. We analyzed a prospectively maintained database of 41 patients who underwent penile implant insertion post PFUI. Choice of implant was based on patient’s preference and insurance coverage. Functional outcomes using the IIEF-5 questionnaire and complications were analyzed. RESULTS: Mean delay between anastomotic urethroplasty and penile implant was 47 months. Semirigid penile implant was used in 92.7% of patients while three-piece inflatable penile implant was used in 7.3% of patients. Patients reported significant improvement in sexual function post implant with mean IIEF-5 score of 21.88 points compared to 3.27 points before the implant. Intraoperative complications included two septal perforations and one proximal crural perforation. Postoperative complications included two hematomas, two glans extrusion that were salvaged and one proximal urethral erosion that lead to implant removal CONCLUSIONS: Erectile dysfunction is a common occurrence in PFUI patients. Penile implant insertion in those patients is challenging due to ischemia of the corpora. If performed by experts, it is safe and leads to significant sexual function improvement. To date, this is the largest series of penile prosthesis insertion in PFUI patients post anastomotic urethroplasty. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1136 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cora Fogaing More articles by this author Pankaj Joshi More articles by this author Daniel Esteban Gomez Zapata More articles by this author Apurva Anand More articles by this author Rathish Rajenderan More articles by this author Shreyas Bhadranavar More articles by this author Amey Talpallikar More articles by this author Aryan Gune More articles by this author Sanjay Balwant Kulkarni More articles by this author Expand All Advertisement PDF downloadLoading ...

Impact on sexual functioning: total versus subtotal hysterectomy

Objective To evaluate and compare postoperative sexual functioning following total (TH) versus subtotal hysterectomy (STH). Design A longitudinal, prospective and comparative study in women undergoing hysterectomy for benign diseases in Ibn El Jazzar Hospital, Kairouan in Tunisia. Sample Sixty women undergoing hysterectomy for benign disease. Main outcome measures Sexual functioning evaluation using the Arizona Sexual Experiences Scale (ASEX) and Female Sexual Function Index (FSFI) before the operation and after 6 months. Results Following surgery, significant improvement in sexual functioning according to both scales. In fact, the mean total score of the ASEX scale went from 25.14 to 21.15 and from 11,99 to 19,31 for the FSFI. The average time to resume sexuality postoperatively was 50 days. No significant difference was found in these results between total and subtotal hysterectomy. Conclusion Hysterectomy, whether total or subtotal, has a positive impact on the overall sexual satisfaction of the patients especially in those with an impaired sexuality before surgery. There were no statistically significant differences in sexual function between the two groups TH versus STH. Therefore, cervix preservation for the purpose of improving overall sexual satisfaction cannot be recommended. Keywords Hysterectomy . Sexual dysfunction . Supracervical hysterectomy . Cervix

Changes in sexual function over 12months after native-tissue vaginal pelvic organ prolapse surgery with and without hysterectomy.

There is a need to determine how preoperative sexual activity, uterine preservation, and hysterectomy affect sexual function after pelvic organ prolapse surgery. (1) To determine changes in sexual function in women, stratified by preoperative sexual activity status, after native-tissue pelvic organ prolapse surgery. (2) To examine the impact of hysterectomy and uterine preservation on sexual function. (3) To determine predictors for postoperative dyspareunia. This was a planned secondary analysis of a prospective cohort study. Sexual function was evaluated preoperatively and 6 and 12months postoperatively. Sexual function was compared between those who had a hysterectomy and those who had uterine-preserving prolapse surgery. A logistic regression analysis was performed to assess predictors for dyspareunia. Pelvic Organ Prolapse-Urinary Incontinence Sexual Function Questionnaire. At 12months, 59 patients underwent surgery and were followed up (hysterectomy [n = 28, 47.5%] vs no hysterectomy [n = 31, 52.5%]; sexually active [n = 26, 44.1%] vs non-sexually active [n = 33, 55.9%]). Of those who did not undergo a hysterectomy, 17 (54.8%) had a uterine-preserving procedure. At 12months, sexually active patients had significant improvement in sexual function (mean ± SD, 0.37 ± 0.43; P = .005), while non-sexually active patients reported significant improvement in satisfaction of sex life (P = .04) and not feeling sexually inferior (P = .003) or angry (P = .03) because of prolapse. No variables were associated with dyspareunia on bivariate analysis. It did not appear that either uterine preservation or hysterectomy had any impact on sexual function. There was a 10% increase in people who were sexually active after surgery. The major strength of our study is the use of a condition-specific validated questionnaire intended for sexually active and non-sexually active women. We interpreted our results utilizing a validated minimal clinically important difference score to provide interpretation of our results with statistical and clinical significance. The limitation of our study is that it was a secondary analysis that was not powered for these specific outcomes. At 12months, for patients who were sexually active preoperatively, there was a clinically meaningful improvement in sexual function after native-tissue pelvic organ prolapse surgery. Non-sexually active women reported improvement in satisfaction of sex life. There was no difference in the sexual function of patients undergoing uterine preservation or posthysterectomy colpopexy when compared with those with concurrent hysterectomy, though this sample size was small.

Evaluating sexual function among women after recurrent pelvic organ prolapse transvaginal mesh repair

We aimed to evaluate women’s sexual function before and after pelvic organ prolapse (POP) surgery utilising light transvaginal mesh after a prior hysterectomy. Only sexually active women with recurrent cystocele stage 3–4 according to POP-Q, who had previously undergone vaginal hysterectomy with anterior native tissue repair without apical fixation, were enrolled in the study. Women with previous mesh implant POP surgery, persistent vaginal infection or pelvic inflammatory disease were excluded. All patients were surgically treated between 2012 and 2015 using single-incision transvaginal mesh Calistar A. Sexual function was evaluated before a surgery and two years postoperatively. The assessment was accomplished via the standardised validated Czech translation of PISQ-12SF questionnaire. For each patient, age, BMI and parity were monitored. Out of all (89) eligible patients, 48 patients met inclusion criteria and were subsequently enrolled in our study. Two years postoperatively, 31 women (79.5%) improved their PISQ-12 score; five (12.8%) had equivalent scores, and three patients (7.7%) reported lower scores. Overall PISQ-12 score was 37.1 ± 2.6 postoperatively with a 2.9 ± 2.3 statistically significant positive difference compared to the score preceding surgery. The majority of patients undergoing surgery using Calistar A experienced a significant improvement in sexual function. IMPACT STATEMENT What is already known on this subject? Pelvic organ prolapse has a significant impact on women’s sexual functioning in an adverse manner. Mesh implant repair is associated with lower rates of prolapse awareness and prolapse re-operation; however, it is linked with safety concerns. One of these concerns is the negative impact on women’s sexual function. Evaluative study results following sexual function among women with mesh implant transvaginal repair are contradictory. What do the results of this study add? The results showed, that contrary to finding some of the previous studies, transvaginal mesh implant use could benefit patients with previous native tissue POP surgery failure with a low risk of sexual function deterioration. What are the implications of these findings for clinical practice and/or further research? The study provides clinical data for vaginal mesh implants on women’s sexual function in the mid-term outcome. These data can be crucial for selecting the right POP surgical technique and evaluating its benefits and risks.

Chronische Sakralnervenstimulation (SNS) bei Sexualfunktionsstörungen der Frau – ein systematischer Review

IntroductionSexual health should be a natural component of contemporary patient care. There is a high prevalence of sexual dysfunction, which significantly affects the quality of life even though the resulting costs for the healthcare system can at best only be estimated. In women treatment should address sexual appetency, sexual arousal, orgasm experience and lubrication. Sacral nerve stimulation (SNS) has previously been used primarily for neurogenic bladder dysfunction, idiopathic pelvic pain, nonobstructive urinary retention and fecal incontinence. This article reviews the evidence to date on the impact of SNS on sexual function and examines its potential as a new treatment alternative.MethodA literature search was conducted with the healthcare databases advanced search (HDAS) platform using the Medline, EMBASE and CINHAL search engines and considering only publications from international peer-reviewed journals.ResultsTo date there are no studies on sexual function as a primary outcome parameter of SNS. Overall, 16 studies including a total of 662 women that examined the effect of SNS on sexual function when used for other indications could be identified. The analysis found indications of significant improvements in sexual function, although it is unclear whether these were primary or secondary effects of SNS.DiscussionThe mode of action of SNS and the direct anatomical and physiological relationship of the functions to urinary bladder voiding, urinary bladder continence, pelvic pain, fecal continence and sexual function strongly suggest a possible primary effect of SNS on sexual function. This should be tested in high-quality studies with sexual function as the primary endpoint.

Effectiveness of Kegel exercise and lubricant gel for improving sexual function in menopausal women: A randomized trial

BackgroundThere are different approaches to improving sexual function among menopausal women including Kegel exercise and using lubricant gel. However, it is not clear which of these methods could be more effective. This study aimed to compare the effectiveness of these two methods on sexual function in menopausal women. MethodsThe present randomized trial was conducted on 150 menopausal women in Dezful, Iran. Eligible women were randomly assigned to two interventions (Kegel exercise and lubricating gel) and one control groups. The Kegel exercise group received training on the exercise method; the lubricant gel group was given the lubricating gel and taught how it should be used, while the control group received no intervention. The interventions continued for 12 weeks, and sexual function was assessed at four times: baseline, one month, two months, and three-months follow-up. Chi-square test, one-way analysis of variance, repeated measures, analysis of covariance, and logistic regression analyses were applied. ResultsNo significant difference was found between groups regarding demographic and obstetrics variables. After adjusting for the baseline sexual function score, covariate analysis showed a significant improvement in sexual function in Kegel and gel groups as compared to the control group. Similarly, within-group comparison using repeated measures analysis showed that sexual function in both Kegel and gel groups improved during the study follow-up periods while women in the control group showed no changes in their sexual function. Finally, logistic regression analysis indicated a significantly higher odds ratio for better sexual function in both Kegel and gel groups. However, the odds of better sexual function for the Kegel group (OR = 4.19, 95% CI: 1.81–9.72, P = 0.001) was higher than the gel group (OR = 3.7, 95% CI: 1.42–7.52, P = 0.005). ConclusionBoth Kegel exercise and gel were effectively improved sexual function in menopausal women. However, the findings indicated that sexual function was more likely to be improved after using Kegel exercise than using lubricant gel. Trial registrationIRCT20150128020854N7. Registered 30 September 2019, https://fa.irct.ir/user/trial/40878/view.

Early Detection and Pelvic Floor Rehabilitation for Sexual Dysfunction with or Without Incontinence in the Breast Cancer

Introduction: Sexual health is an important aspect of human life, and cancer should not change that. Data suggested that issues related to sexual function are quite common among women treated for cancer ranged from 30% to 100% [1]. However, clinicians often spend little to no time on the topic. However, the treatment options are available. The literature also supports the use of pelvic floor exercises and dilators to improve sexual function and urinary incontinence in women and specially those presenting with orgasm problems [2]. Objective: To explore the effectiveness of the pelvic floor rehabilitation on sexual dysfunction or sexual dysfunction combined with incontinence in the Saudi breast cancer survivors during, or post chemotherapy intervention. Methods: Thirty breast cancer women who had either sexual dysfunction, or sexual dysfunction combined with incontinence, during or post chemotherapy were evaluated using the Oxford scale for muscle power assessment before and after the intervention. Additionally, FSFI &amp; UDI-6 questionnaire responses were received and analyzed before and after the pelvic floor rehabilitation. The supervised pelvic floor rehabilitation (which included the pelvic floor muscle training (seven Yoga poses: Mountain pose, Tree pose, standing forward bend pose, worrier pose, bridge pose, bound angle pose, and seated twist pose), manual therapy, and dilator) were conducted for 45 minutes once a week for eight weeks (a total of 8 sessions). Main Outcome Measures: The domain scores of the Female Sexual Function Index-Breast cancer (FSDI-BC) which included desire, arousal, lubrication, orgasm, satisfaction, and pain, were calculated. Furthermore, the domain of the Urinary Distress Inventory (UDI-6) which included frequent urination, urgency leakage, activity leakage, leakage with coughing or sneezing, difficulty emptying the bladder, and pain or discomfort in the lower abdominal or genital area were also analyzed. Muscle power (Oxford scale) was measured before and after the treatment. Results: All subjects successfully completed the study with no adverse events. Significant improvement in sexual function as assessed by the FSFI-BC indicated that sex desire improved by 86%, sexual arousal improved by 83%, lubrication improved by 76.3%, orgasm improved by 70%, general satisfaction improved by 44-54%, 73.3% felt pain minor, and 23% free of pain during intercourse. Muscle power as measured by the Oxford scale improved from grade 1 or 2 out of 5 to3 or 3+ out of 5. Significant improvement in UDI-6 were also observed in all participants by 80%. Conclusion: In this study, we observed the influence of chemotherapy side effects for breast cancer on women’s quality of life, sexual function and continence. The study confirmed that Pelvic floor muscle training, manual therapy and dilator use showed significant improvement in the symptoms of continence and sexual function in breast cancer patients.

Psychological interventions for sexual function and satisfaction of women with breast cancer: A systematic review and meta-analysis.

To systematically evaluate the effectiveness of psychological interventions for women with breast cancer on sexual function, sexual satisfaction, sexual relationships, sexual distress and sexual quality of life. Sexual dysfunction is common in women with breast cancer and seriously affects their quality of life and marital harmony. Several studies have explored the effects of psychological interventions related to sexual function of women with breast cancer, but results were inconclusive. A systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of PubMed, EMBASE, PsycINFO, Web of Science, the Cochrane Library, Scopus, CINAHL, ProQuest Dissertations and Theses Global, ClinicalTrials.gov. and Open Grey was conducted from inception to 9 May 2021. Two reviewers independently screened studies, extracted data and conducted a quality appraisal of included studies using the Joanna Briggs Institute critical appraisal checklists. Fifteen studies involving 1307 participants were included. The current study showed that psychological interventions made statistically significant improvements in sexual function (SMD=0.82; 95% CI=[0.43, 1.20]; p<.001), sexual satisfaction (SMD=0.95; 95% CI=[0.19, 1.72]; p=.01), sexual relationships (SMD=0.37; 95% CI=[0.15, 0.60]; p=.001) and sexual distress (MD=-5.05; 95% CI=[-7.88, -2.22]; p=.0005) of women with breast cancer. A subgroup analysis regarding the types of psychological interventions indicated that cognitive behavioural therapy and psychoeducational therapy were beneficial to sexual function and satisfaction, and psychosexual counselling could also improve sexual function. Psychological interventions, especially psychoeducational therapy and cognitive behavioural therapy, are effective for improving the sexual health of women with breast cancer. This current study provides evidence for the application of psychosexual interventions in women with breast cancer. The study has been registered on the PROSPERO on 6 June 2021, with the registration number CRD42021253493.

Cognitive-behavioral group therapy for women with hypoactive sexual desire: A pilot randomized study

BackgroundHypoactive Sexual Desire Disorder (HSDD) is a very prevalent sexual problem, with limited options for treatment. Given that psychological factors are major contributors to the disorder, a therapy such as Cognitive-Behavioral Therapy (CBT) may be useful to treat HSDD. ObjectiveTo evaluate the effects of group CBT on women with HSDD. MethodClinical trial randomized study with 106 women diagnosed with HSDD, who were divided as follows: Group 1 (n = 53) underwent group CBT for 8-weeks, and Group 2 (n = 53), were put on a waiting list and used as a control group. Sexual function was assessed by the Female Sexual Quotient (FSQQ) at the initial interview and after 6-months. Mann Whitney test was used for group comparison. Main Outcome Measures: demographics, education, sexual history, FSQQ and its domains for sexual function assessment. ResultsBoth groups had similar characteristics regarding sexual response, self-image, and relationship with a partner at the initial interview. Women undergoing therapy showed significant improvement in sexual function when compared with the control group. The overall FSQQ result showed an average growth of 18.08 points (95% CI 12.87‒23.28) for the therapy group against a decrease of 0.83 points (95% CI 3.43‒1.77) for controls (p < 0.001). The five domains of the questionnaire also exhibited significant improvement in the therapy group: desire and interest (p = 0.003), foreplay (p = 0.003), excitation and tuning (p < 0.001), comfort (p < 0.001), and orgasm and satisfaction (p < 0.001). ConclusionGroup CBT was shown to be an effective tool for treating HSDD.

Vaginal length and sexual function after vertical versus horizontal closure of the vaginal cuff after abdominal hysterectomy: a randomised clinical trial

This randomised clinical trial aimed to evaluate the vaginal length and female sexual function after vertical and horizontal closure of the vaginal cuff after abdominal hysterectomy. The patients were allocated into two groups, vertical closure and horizontal closure groups. The vaginal length was determined using transperineal ultrasound, once preoperative and again 3 months after the operation. Female sexual function was determined using an Arabic validated female sexual function index questionnaire. Both techniques resulted in a significant shortening of the vaginal length (p-value .001). There was a significant improvement in sexual function in the vertical closure group rather than the horizontal closure one. We concluded that there was no significant difference in the vaginal length after vertical or horizontal closure of the vaginal cuff. However, female sexual function improved significantly in the vertical closure group. Trial registration number: PACTR201909573801168. IMPACT STATEMENT What is already known on this subject? Conflicting results exist regarding the effect of different techniques of vaginal length closure on vaginal length and sexual function after hysterectomy. What do the results of this study add? There was no significant difference in the vaginal length after vertical or horizontal closure of the vaginal cuff. However, female sexual function improved significantly in the vertical closure group. This study is considered to be the first one to evaluate the correlation between the vaginal length and the female sexual function. What are the implications of these findings for clinical practice and/or further research? The correlation between vaginal length and female sexual function needs to be evaluated in a multicenter study, recruiting larger number of sexually active women.

Comparison of Effect of Nebivolol and Bisoprolol on Sexual Function of Hypertensive Female Patients

Introduction Male and female sexual dysfunction is frequently found in patients with hypertension. Many studies indicate that this is found more frequently in patients treated with beta-blockers rather than due to hypertension itself; however, almost all studies have been done on male population. This study aims to study the effect of two commonly used beta-blockers on sexual function of a hypertensive female patient. Methods This two-arm open-label randomized prospective study was conducted from April 1, 2019 to March 30, 2020 in a tertiary care hospital at Pakistan. One hundred and fifty participants randomized to group A were given nebivolol 5 mg once daily in addition to their current hypertensive treatment. Another 150 participants randomized to group B were given bisoprolol 5 mg once daily in addition to their hypertensive therapy. Sexual function was assessed on day 0 and day 90 using female sexual function index (FSFI). Results The mean sexual score in the nebivolol group significantly improved after day 90 in comparison to day 0 (24.16 ± 2.1 vs. 26.91 ± 2.6; p-value &lt; 0.0001), while no difference in sexual score in bisoprolol group after day 90 was observed (24.14 ± 2.1 vs. 24.12 ± 2.0; p-value = 0.91). Conclusion In this study, nebivolol group was associated with a significant improvement in sexual function. This can be due to additional vasodilation properties and a low risk of sexual side effects associated with nebivolol. https://www.cureus.com/articles/59290-comparison-of-effectof-nebivolol-and-bisoprolol-on-sexual-function-of-hypertensivefemale-patients DOI: 10.7759/cureus.15062

Fractional CO2 laser treatment as adjunctive therapy to topical steroids for managing vulvar lichen sclerosus

ObjectivesUncontrolled vulvar lichen sclerosus (VLS) is often associated with distressful symptoms of genital itch, irritation, and pain and can lead to a pathological process including anatomical changes, scarring, and an elevated risk of cancer in the genital area. First‐line topical corticosteroid as monotherapy is frequently not adequate to fully suppress disease activity and control symptoms. This study evaluated the efficacy of fractional CO2 laser treatments as adjunctive therapy where recalcitrant VLS had been improved, but not adequately controlled, with topical corticosteroid treatment. Outcomes were evaluated up to 12 months after a series of CO2 laser treatments delivered via a fractional handpiece.Materials and MethodsWomen with a diagnosis of VLS supported by histologic findings on biopsy and/or clinical signs on physical examination received up to five monthly laser treatments. Subjects maintained existing topical corticosteroid and any exogenous hormone treatment during the study. Investigators assessed severity (0 = not present, 1 = mild, 2 = moderate, or 3 = severe) of clinical signs and architectural changes present before adjunctive study interventions and at follow‐up visits. Subjects reported the presence of clinical symptoms and impact on quality of life on 4‐ or 5‐point Likert scales. The validated Female Sexual Function Index (FSFI) was used to assess changes in sexual function. Four subjects were biopsied before adjunctive laser treatment and at follow‐up.ResultsTwelve females, 11 postmenopausal, with a mean age of 57 ± 10 years received three to five monthly CO2 laser treatments. Significant improvement in all prominent clinical signs and architectural changes were reported at the 3‐ and 6‐month follow‐ups after the treatment series. Significant improvement was maintained at the 12‐month follow‐up, with 89% of subjects showing at least one‐point improvement in elasticity compared to baseline; 86% in lichenification; 88% in sclerosis; and 80% in whitening and parchment‐like skin. Labial fusion and the extent of disease improved in 50% of patients. Ulcerations present in three subjects at baseline resolved after treatment. Subjects reported 86% improvement in dyspareunia and 83% in skin tearing. Quality of life improved significantly after treatment (p < 0.01). The 6‐month follow‐up FSFI showed significant improvement in sexual function compared to baseline (p < 0.05), with a mean point improvement of 4.5. Histology findings after treatment showed some positive improvement, as a decrease in dermal hyalinized zone thickness. There were no treatment complications or adverse events related to the treatment.ConclusionsFractional CO2 laser treatment outcomes showed improvement in predominant clinical signs and architectural changes in VLS recalcitrant to topical corticosteroid treatment. Adjunctive laser treatment relieved symptoms and improved quality of life as well as sexual function. Fractional CO2 laser treatment may provide an advanced treatment modality for the management of recalcitrant VLS with improved patient care and sustainable outcomes. Further study in a larger population and with CO2 laser treatment to both vulvar tissue and the vaginal canal should be explored.

Physiotherapy Outcomes on Sexual Dysfunction among Ischemic and Hemorrhagic Stroke Survivors

Background and Purpose: Stroke is a major cause of disability and premature death in various developing countries, including India. Although various physical and psychological dysfunctions are associated with stroke, sexual dysfunction that is not often addressed either by the patient or by the health care provider can greatly influence the quality of living among stroke survivors. Aim: The study is aimed at comparing the physiotherapy outcomes of sexual rehabilitation on sexual dysfunction among ischemic and hemorrhagic post-stroke survivors. Materials and Methods: A total of 109 stroke patients, Ischemic (n=76) and Hemorrhagic (n=29) were selected for this research. A written consent was taken after inclusion criteria is satisfied. Both groups were given structured physiotherapy daily for a one-hour session along with psychological support by verbal communication. The sexual functioning is calculated by CSFQ-14 before intervention and after six months of follow-up. Results: After sexual rehabilitation, both groups showed statistically significant improvement in sexual functioning (CSFQ-14 scores), pIS LESS THAN 0.001. But there was no significant difference between ischemic and hemorrhagic post-stroke survivors in sexual functioning statistically. Conclusion: Both ischemic and hemorrhagic post-stroke survivors showed similar results on sexual functioning after physiotherapy. Hence, both ischemic and hemorrhagic post-stroke survivors can be included in a sexual rehabilitation program.