Total Female Sexual Function Index Research Articles

The association between sexual dysfunction and metabolic syndrome among Turkish postmenopausal women

Objective: The aim of this study is to determine the association between sexual dysfunction and metabolic syndrome (MS) among Turkish postmenopausal womenMethods: In total, 290 postmenopausal women between the ages of 50 and 70 years and 265 premenopausal women between the ages of 30 and 49 years who applied to Menopause and Gynecology Clinics at Marmara University-affiliated Pendik Education and Research Hospital, Istanbul, Turkey were included in this prospective survey. Sexual function was assessed using the Female Sexual Function Index (FSFI). A FSFI total score of <26.5 was suggestive of sexual dysfunction. MS was assessed by the National Cholesterol Education Program Adult Treatment Panel III criteria.Results: Sexual dysfunction prevalence among postmenopausal women was 64.6% in relation to 42.1% in premenopausal women (p = 0.001). MS prevalence was 13.5% among premenopausal women and 15.5% among postmenopausal women (p = 0.57). The total FSFI score and each score in the desire, arousal, lubrication, orgasm, satisfaction, and dyspareunia domains of the FSFI did not differ between premenopausal and postmenopausal women, regarding the MS status. In the premenopausal group, 45.7% of women without MS and 37% of women with MS had lower sexual dysfunction (p = 0.40); whereas in the postmenopausal group, 62.2% of women without MS and 77.4% of women with MS had lower sexual function (p = 0.22).Conclusion: In our study population, the rate of sexual dysfunction increased in postmenopausal women in contrast to premenopausal women. The MS status did not make a difference in terms of sexual dysfunction either in premenopausal or postmenopausal women. Since our survey was conducted in a tertiary medical center which gave medical care service to women from middle and low socioeconomic classes, our results should be confirmed by a large multicenter survey enrolling women from all different socioeconomic classes.

Effectiveness of sexual counseling using PLISSIT model on sexual function of women with type 2 diabetes mellitus: results from a randomized controlled trial

Sexual problems are very common in patients with type 2 diabetes mellitus and due to its chronic nature may affect women's sexual quality of life. To study the effect of permission, limited information, specific suggestions, intensive therapy (PLISSIT) model sexual counseling on sexual function of women with type 2 diabetes. This study is a randomized clinical trial that was conducted on 100 married women aged 35-55 year old with type 2 diabetes referred to endocrinology clinic. The subjects were randomly assigned to the intervention and control groups. In the intervention group, individual counseling was designed based on PLISSIT model, in at least three sessions. The control group received a general health training pamphlet at the end of the study. Before the first session and then 4 and 8 weeks after the intervention, questionnaires of demographic information, Brief Sexual symptom checklist for women (BSSC-W), and Female sexual Function Index (FSFI) were completed for two groups. Total FSFI score of the patients improved after sexual counseling (p < 0.001) and in subscales; sexual desire (p = 0.009), lubrication (p = 0.004), orgasm (p < 0.001), and sexual satisfaction (p < 0.001). Also sexual function in all subscales except for arousal (p = 0.181) and pain (p = 0.783) were increased significantly. Although pain was decreased significantly in intervention group over the time, no difference was seen between two groups (p = 0.783). The effect size of intervention to promote FSFI was determined 0.42. Considering the effectiveness of a PLISSIT model sexual counseling on sexual function of women with type 2 diabetes, the results of the present study, can be used to promote sexual health of diabetic patients.

Incidence and severity of sexual dysfunction among women with breast cancer: a meta-analysis based on female sexual function index.

Previous meta-analyses have examined the prevalence of sexual dysfunction among women with cancer, but there is no breast cancer (BC)-specific study. We therefore conducted a meta-analysis to examine the prevalence and severity of female sexual dysfunction (FSD) in women with BC. We searched PubMed, Embase, Cochrane Library, CNKI, WanFang Data, and VIP for relevant studies published between April 2000 and January 2017. Data were extracted from studies which assessed FSD prevalence and sexual function in women with BC using the female sexual function index (FSFI). Meta-analyses were performed by pooling the prevalence rates of FSD and total FSFI scores. Meta regression was performed to explore the sources of heterogeneity. We selected 19 published studies involving a total of 2684 women with BC. In this study population, overall FSD prevalence was 73.4% (95% confidence interval (CI) 64.0%, 82.8%), and the total FSFI score was 19.28 (95% CI 17.39, 21.16). Among Asian, American, and European women with BC, there were significant differences in FSD prevalence (P < 0.001), and there was marginally significant difference (P = 0.07) in sexual function between these groups. There was also a marginally significant difference between individuals from mainland China and from other countries in FSD prevalence (P = 0.06) and FSFI score (P = 0.07). Overall, women with BC have high FSD prevalence and low sexual function. American women with BC have a higher average FSD prevalence and lower average sexual function than Asian women with BC. The FSD prevalence in women with BC in mainland China was slightly higher than in other countries.

Clitoral Phimosis: Effects on Female Sexual Function and Surgical Treatment Outcomes

BackgroundSurgery is the optimal treatment for a severe form of clitoral phimosis (CP) that is initiated by lichen sclerosus (LS) and causes female sexual dysfunction. AimWe aimed to determine the etiology of clitoral phimosis, its influence on sexual function, and outcomes after surgical treatment. MethodsIn this prospective cohort study, we observed the occurrence of clitoral phimosis and related changes in a group of 3,650 sexually active heterosexual women with a mean age of 34.8 ± 14.9 years (20–45 years) from September 2014 to September 2016. Ultimately, we compared the changes in sexual function and distress and satisfaction with postoperative genital appearance in 9 patients with severe clitoral phimosis at 12 months after surgical treatment. Main Outcome MeasuresSexual function was evaluated using the Female Sexual Distress Scale–Revised and the Female Sexual Function Index, and the patient’s genital self-image was evaluated using the Female Genital Self-Image Scale; gynecologic examinations were performed on all patients. ResultsVarious forms of CP were found in 46 of 3,650 patients (1.3%). Severe forms of CP were found in 9 cases, but it was complicated by stenosis of vaginal introitus in only 2 cases. These 9 patients underwent circumcision, and 2 of them underwent perineoplasty. Female sexual dysfunction occurred mainly in those with LS and severe forms of phimosis. Sexual function, as indicated by the total Female Sexual Function Index score, was significantly improved at 12 months after surgery (17.9 ± 0.9 vs 26.6 ± 0.5; P < .001). The Female Genital Self-Image Scale score assessing genital perception was significantly higher after surgery than before in women who underwent clitoral circumcision (20 ± 3.0 vs 12.3 ± 3.3; P < .001). The Female Sexual Distress Scale–Revised score was significantly lower after surgery than before (21.3 ± 6.2 vs 33.8 ± 6.9; P < .001). Sexual function in 2 women with CP and stenosis of vaginal introitus improved after surgery, but the sexual distress level did not decrease significantly. Clinical ImplicationsThe results of this study will help clinicians to centralize treatment methods and advise patients on the management of clitoral phimosis. Strengths & LimitationsThis is a study evaluating postoperative results of sexual function, distress, and satisfaction with genitalia in women with severe CP, using validated questionnaires. However, the small number of patients and the absence of an appropriate control group are limitations. ConclusionSurgical treatment of clitoral phimosis can improve sexual function, but because LS—a common underlying cause—is chronic in nature, patients may experience recurrence.Chmel R, M Nováčková, Fait T, et al. Clitoral Phimosis: Effects on Female Sexual Function and Surgical Treatment Outcomes. J Sex Med 2019;16:257–266.

Clitoral Blood Flow Changes after Surgery with Tension-Free Vaginal Mesh for Pelvic Organ Prolapse.

We measured basal clitoral blood flow by Doppler sonography to determine whether tension-free vaginal mesh(TVM) affects the clitoral blood flow and sexual function in women with pelvic organ prolapse (POP). We performed a prospective study of 22 patients who underwent TVM for POP. Clitoral blood flow was measured by Doppler ultrasound. The resistance index (RI), pulsatility index (PI), peak systolic velocity (PSV), and end-diastolic velocity (EDV) of the clitoral arteries were measured preoperatively and at 1, 3, and 6 months postoperatively. Female sexual function was also investigated with the Female Sexual Function Index (FSFI). The mean PI and RI were increased at 1 month and significantly decreased at 6 months postoperatively (p<0.05). In contrast, the mean PSV and EDV decreased at 1 month postoperatively and increased at 6 months postoperatively. These four parameters recovered to baseline levels at 6 months following surgery. Total FSFI scores improved significantly from 10.2±7.9 at baseline to 18.2±8.9 at 6 months postoperatively. Color Doppler ultrasonography is potentially useful in measuring clitoral blood flow in patients treated with TVM for POP. Prospective long-term studies are needed to evaluate the utility of this modality as a diagnostic and prognostic tool for female sexual dysfunction.

Is polycystic ovary syndrome associated with risk of female sexual dysfunction? A systematic review and meta-analysis.

The aim of this study was to evaluate whether polycystic ovary syndrome (PCOS) is a risk factor for female sexual dysfunction (FSD) by conducting a systematic review and meta-analysis. The databases PubMed, EMBASE and the Cochrane Library were searched for relevant studies. The association between PCOS and risk of FSD was assessed by relative risk or standard mean differences with 95% confidence interval. The protocol for this meta-analysis is available from PROSPERO (CRD42018102247). Overall, 2626 participants (mean age 25-36 years) were included from 10 studies (five cross-sectional and five case-control studies), 1163 of whom were women with PCOS. The pooled results from eight included studies providing the number of cases revealed no significant association between PCOS and increased risk of FSD (RR = 1.09, 95% CI 0.9 to 1.32; heterogeneity: I2 = 11.0%). The combined overall standard mean difference from five studies reporting Female Sexual Function Index (FSFI) scores showed that patients with PCOS had similar values in total FSFI scores compared with healthy controls (standard mean difference = -0.03, 95% CI -0.12 to 0.05; heterogeneity: I2 = 0.0%). Sensitivity analyses yielded similar results. This meta-analysis suggests no direct association between PCOS and risk of FSD. Well-controlled trials with large sample sizes, however, are needed to validate this evidence.

Uterine Leiomyoma Is Associated with Female Sexual Dysfunction in Postmenopausal Women.

PurposeTo determine the relationship between uterine leiomyoma and female sexual dysfunction (FSD) among premenopausal and postmenopausal women.Materials and MethodsThe study population consisted of consecutive women who underwent gynecologic screening tests, including transvaginal ultrasound, and completed the questionnaires on FSD. A total of 841 women were included from January 2010 to December 2011. FSD was defined as Female Sexual Function Index (FSFI) ≤26.55. The relationship between uterine leiomyoma and FSD were compared according to menopausal status.ResultsIn premenopausal group (n=564), there were no differences in the frequency of FSD (55.0% vs. 58.8%, p=0.387) and total FSFI score. However, in postmenopausal group (n=277), women with uterine leiomyoma had a lower frequency of FSD than those without uterine leiomyoma (71.3% vs. 86.4%, p=0.003). This relationship between uterine leiomyoma and lower frequency of FSD in postmenopausal women remained significant after adjusting for confounding variables.ConclusionThe relationship between uterine leiomyoma and FSD is different depending on the menopausal status.

Sexual functioning in females with depression in remission receiving escitalopram

Background & objectives:Sexual functioning is a strong determinant of quality of life. Sexual dysfunction has been widely reported due to depressive disorder as well as selective serotonin reuptake inhibitors. Thus, treatment with antidepressants can culminate in a double-edged sword, leading to drug discontinuation and symptom relapse. The objective of this study was to assess the sexual functioning of sexually active females with depression, currently in remission, receiving escitalopram and to compare with healthy controls.Methods:Fifty female patients with depression, currently in remission, with self-reported normal pre-morbid sexual function and receiving escitalopram for at least three months, were assessed on female sexual function index (FSFI) questionnaire and compared with healthy controls.Results:Half of the patients (n=25, 50%) in group A were found to have sexual dysfunction (FSFI score <26.55), while, 90 per cent (n=45) had decreased desire, 86 per cent (n=43) had decreased arousal, 54 per cent (n=27) had decreased lubrication, 68 per cent (n=34) had decreased orgasm, 62 per cent (n=31) had decreased satisfaction and 32 per cent (n=16) had pain during sexual activity. Patients receiving escitalopram had significantly higher sexual dysfunction as compared to healthy controls in mean total FSFI score (P<0.001) and all mean domain scores of FSFI except pain.Interpretation & conclusions:A significant proportion of sexually active females with depression currently in remission, receiving escitalopram, reported dysfunction in all domains of sexual function; thus, routine screening for sexual dysfunction during follow up is advisable for early identification and prompt treatment.

The Use of HIFEM Technology in the Treatment of Pelvic Floor Muscles as a Cause of Female Sexual Dysfunction: A Multi-Center Pilot Study

Introduction: Pelvic Floor Muscles (PFM) supports the pelvic floor organs, control continence and is crucial for adequate genital arousal and attainment of an orgasm. Due to the aging process, post-delivery condition or menopause, the PFM weaken. Therefore, they do not provide sufficient support to pelvic organs, bladder control, and they may negatively affect intimate satisfaction. Aim: We aimed to investigate the High-Intensity Focused Electromagnetic (HIFEM) technology for strengthening of PFM in women with impeded sexual functioning. Methods: 30 women (average age 36.41 ± 5.62) with limited arousal, ability to achieve orgasm and painful intercourse participated in the study. Patients underwent 6 treatments (28 minutes each) scheduled twice a week. Standardized Female Sexual Function Index (FSFI) questionnaire was used pre-, post-treatment, and at the 3- month follow-up visit. FSFI scores were statistically evaluated through student´s t-test (ɑ=0.05). Subsequently, Pearson correlation coefficient was calculated for sections arousal/lubrication, lubrication/orgasm, orgasm/ satisfaction, and pain/desire. Results: The average total FSFI score significantly (p<0.001) increased from 20.06 ± 6.55 to 30.69 ± 7.55 posttreatment and to 30.29 ± 7.37 during the 3-month follow-up. A significant improvement was observed in all FSFI sections. The most significant change at the 3-month follow-up was observed in desire (76%), satisfaction (76%) and orgasm (60%) items. The overall FSFI score was improved in 93% (n=28) of patients post-treatment. All patients (n=30; 100%) showed improvement during the 3-month follow-up. Conclusion: Our initial experience shows that HIFEM technology is a promising method in addressing women’s decreased sexual satisfaction through the strengthening of PFM.

The effect of pregnancy on female sexual function: a cross-sectional study

Objective The current study aims to evaluate the effect of pregnancy in its different trimesters on the female sexual function. A cross-sectional study was conducted at Assiut University Hospital, Assiut, Egypt. Patients and methods We included consecutive healthy sexually active pregnant women aged between 18 and 40 years who had attended the antenatal care clinic of Assiut Women Health Hospital between June 2014 and May 2015. We used the Arabic version of the female sexual function index (FSFI) in the interview to evaluate the sexual functions or problems during the past month. The cutoff score used to indicate sexual dysfunction was 28.1. Results A total of 600 healthy sexually active women were enrolled in this study: 300 women with uncomplicated pregnancy and 300 nonpregnant women. The percentage of women having total female sexual dysfunction during pregnancy was 63.3% compared with 61.2% of nonpregnant women. The percentage of women having total female sexual dysfunction was 70, 44, and 72% in the first, second, and third trimesters, respectively. The second trimester women had the highest total FSFI score, which was not significantly different from the total FSFI score in nonpregnant women (P = 0.922). Conclusion The current study reports no differences in the prevalence and indices of sexual function between pregnant and nonpregnant women. However, the second trimester represents the peak of sexual function throughout pregnancy, and the problem of sexual dysfunction is the highest during the third trimester.

Frequency and Correlates of Sexual Dysfunction among Women Attending Outpatient Gynecological Clinics

Background and purpose: Female sexual dysfunction (FSD) is a high-frequent multifactorial problem and may have a major effect on the quality of life. This study was conducted to investigate frequency of female sexual dysfunction and its correlated factors in women attending outpatient gynecological clinics.Methods: A total of 300 married women attending four gynecological outpatient clinics in Rasht, Iran were assessed. Sexual function was evaluated through Female Sexual Function Index (FSFI) questionnaire. Demographic characteristics, obstetric and surgical history, some medical conditions and body mass index (BMI), life style variants, knowledge about sexuality, and help-seeking behavior were assessed by a self-created questionnaire. Statistical analysis included Fisher exact test Chi-square and Spearman’s correlation coefficients.Results: 76.67% of all women in this study reported sexual dysfunction in at least one domain. The total frequency of FSD according to the low total FSFI score was 18.3%. The most frequent dysfunction was desire disorders (63.7%). The frequencies of other sexual disorders were as follows: pain disorders (35.7%), arousal disorders (34.7%), orgasmic disorders (16%), lubrication disorders (10.7%), and satisfaction disorders (10.7%). Age, number of deliveries, number of children, number of abortions, menopause, mode of delivery, episiotomy, anemia, psychiatric disease, psychotropic medication use, poor sexual knowledge, and husband’s age showed a significant statistical correlation with low total FSFI score. Women who thought they had a sexual problem involved 15.3% of all subjects, of which 67.4% have had no professional consultation about it.Conclusion: FSD is highly frequent in women referred to gynecological clinics. Thus, more attention to the state of women’s sexual health is recommended.

Sexual and urinary function following anterior lumbar surgery in females.

Anterior lumbar interbody fusion procedures (ALIF) and total disc replacement (TDR) with anterior exposure of the lumbar spine entail a risk of a vascular injury and dysfunction of the sympathetic and parasympathetic nerves due to disturbance of the inferior and superior hypogastric plexus. While retrograde ejaculation is a known complication of the anterior spinal approach in males, post-operative sexual as well as urinary function in females has not yet been thoroughly investigated and was hence the aim of this study. Fifteen female patients documented their sexual and urinary function preoperatively, 3 months and 6 months postoperatively, using the validated questionnaires FSFI (Female Sexual Function Index) and ICIQ (International Consultation of Incontinence Questionnaire). Randomization tests were used to statistically analyze expectation values over time (two-sided, P < 0.05). While no statistically significant change in the total FSFI score occurred over time, a significant increase in FSFI desire score was noted between preoperative (2.95 ± 0.8) and 6 months follow-up (3.51 ± 0.6, P = 0.02). Urinary continence remained unchanged over time. In summary, ALIF and lumbar TDR do not seem to negatively influence sexual and urinary function in females. In contrast, increased sexual desire was noted, likely secondary to post-surgical pain relief.

Comparison of female sexual function in women who underwent abdominal or vaginal hysterectomy with or without bilateral salpingo-oophorectomy

ObjectiveTo compare the effect of abdominal and vaginal hysterectomy with or without bilateral salpingo-oophorectomy on female sexuality. MethodsPerimenopausal, sexually active, aged 45–50 years women who underwent abdominal or vaginal hysterectomy with or without bilateral salpingo-oophorectomy due to benign indications were included in this retrospective study. For the assessment of preoperative and postoperative female sexual function, Turkish validated Female Sexual Function Index form was used. ResultsOf the study population, 82 women (Group A) underwent hysterectomy + bilateral salpingo-oophorectomy and 78 women (Group B) underwent hysterectomy-only operations. The groups were statistically similar in terms of mean age, number of gravida and parity, body mass index, duration of postoperative evaluation, type of hysterectomy and presence of preoperative female sexual dysfunction. Both in Group A and B, postoperative total Female Sexual Function Index scores increased significantly compared to preoperative total scores. And there were no differences between the groups regarding the total preoperative and postoperative Female Sexual Function Index scores. However, postoperative arousal and orgasm scores were higher while pain score was lower in Group B than in Group A. ConclusionAbdominal and vaginal hysterectomy with or without bilateral salpingo-oophorectomy for benign causes positively affect female sexuality in general. But, premenopausal bilateral oophorectomy may cause more pain during intercourse, decreased libido and orgasm than ovary conservation.

Prevalence and Risk Factors for Sexual Problems and Distress in Chinese Unmarried Young Women: An Observational Study

IntroductionResearch conducted in the West has shown that sexual function and distress was common in white women from younger to older adulthood; however, little research attention to date has been given to Chinese young women. AimOur primary aim is to assess the prevalence and factors associated with sexual problems and distress in Chinese unmarried young women. MethodsBetween November 2015 and June 2017, 431 young women who visited 3 sexual health clinics completed an anonymous questionnaire detailing their demographics, sexual behavior, current sexual relationship, sexual function, and sexual distress. Descriptive bivariate analysis and logistic regression analyses were performed. Main Outcome MeasuresSexual function and distress were assessed by the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised (FSDS-R), respectively. ResultsOverall, 76 young women (17.6%) obtained total FSFI score ≤23.45 (Chinese cut-off), 47 of whom scored 11 or above for FSDS-R. Individual domain and total FSFI scores were significantly correlated with FSDS-R score (P < .001). Based on domain scores, 35.5%, 18.8%, 12.8%, and 10.7% of them were at risk for orgasmic, pain, arousal, and desire problems, respectively. Arousal and lubrication problems were strongly associated with distress. Sexual problems were associated with not initiating sex (odds ratio [OR] 2.50, P = .001), often had sexual fantasy (OR 0.55, P = .036), and willingness for vaginal sex (OR 0.49, P < .001). Sexual distress was associated with having life stressors (OR 1.88, P = .012) and willingness for vaginal sex (OR 0.61, P = .003). Self-perception of body being unattractive to boyfriend (OR 3.33, P = .015), not initiating sex (OR 3.21, P = .001), willingness for vaginal sex (OR 0.39, P < .001), and no life stressors (OR 0.46, P = .036) were associated with both sexual problem and distress. Clinical ImplicationsPhysicians should be alerted to sexual problems in young women and encourage those with distress to seek help. Strengths & LimitationsUsing validated psychometric tools to assess sexual problems and distress provides reference for future comparison. Admission and recall biases are unavoidable in observational questionnaire study. Depression was not evaluated and might bias the estimation of distress. ConclusionAbout 11% of Chinese young women had sexual problems and were distressed (ie, sexual dysfunction). They were characterized by having a self-perception that their body was unattractive to their boyfriend, not initiating sex, unwilling for vaginal sex, and having life stressors.Lo SS-T, Kok W-m. Prevalence and Risk Factors for Sexual Problems and Distress in Chinese Unmarried Young Women: An Observational Study. J Sex Med 2018;15:1620–1628.

Comparison of the Effect of Intermittent and Continuous Aerobic Physical Training on Sexual Function of Women With Polycystic Ovary Syndrome: Randomized Controlled Trial

BackgroundPolycystic ovary syndrome (PCOS) is a common condition characterized by hyperandrogenism, anthropometric changes (increased weight and waist-to-hip ratio [WHR]), behavioral changes (sexual dysfunction, anxiety, and depression), and reduced quality of life. Physical exercise may reduce many of the adverse effects of PCOS. However, no studies have yet evaluated the effects of aerobic exercise on the sexual function of women with PCOS. AimTo compare the effects of continuous and intermittent aerobic physical training on the sexual function and mood of women with PCOS. MethodsThis is a secondary analysis of a controlled clinical trial in which women with PCOS (18–39 years of age) were randomly allocated to 1 of 3 groups for 16 weeks: continuous aerobic training (CAT, n = 23), intermittent aerobic training (IAT, n = 22), or no training (control group, n = 24). The Female Sexual Function Index (FSFI) was used to assess sexual function, and the Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression. Main Outcome MeasureThe main outcome measure used was the FSFI. OutcomesThe primary outcomes were changes from baseline in total FSFI score and HAD scores at week 16 to prove the superiority of intermittent aerobic exercise compared with continuous aerobic exercise. ResultsAfter 16 weeks, the CAT group had a significant increase in the total FSFI score, improvements in the FSFI domains of satisfaction and pain, and a reduction in the WHR. The CAT and IAT groups also had significantly lower levels of testosterone after 16 weeks. The IAT group had a significant increase in the total FSFI score and improvements in the desire, excitation, lubrication, orgasm, and satisfaction FSFI domains. The CAT and IAT groups both had significant reductions in anxiety and depression scores after 16 weeks. Clinical ImplicationsAerobic physical training protocols could be indicated to promote mental and sexual health in women with PCOS. Strength & LimitationsThis is one of the first studies to examine the effects of different physical training protocols on the sexual function of women with PCOS. The limitations of this study are that we did not consider diet or the frequency of sexual relations of participants with their partners. These factors could have interfered with the outcomes. ConclusionThe CAT and IAT protocols improved the sexual function and reduced the anxiety and depression of women with PCOS. Both protocols were similar to improve FSFI domain scores.Lopes IP, Ribeiro VB, Reis RM, et al. Comparison of the Effect of Intermittent and Continuous Aerobic Physical Training on Sexual Function of Women With Polycystic Ovary Syndrome: Randomized Controlled Trial. J Sex Med 2018;15:1609–1619.

Effects of dehydroepiandrosterone (DHEA) supplementation on sexual function in premenopausal infertile women.

To investigate the effects of dehydroepiandrosterone (DHEA) supplementation on female sexual function in premenopausal infertile women of advanced ages. This observational study was conducted in an academically affiliated private fertility center. Patients included 87 premenopausal infertile women, 50 of whom completed the study including the Female Sexual Function Index (FSFI) questionnaires and comprehensive endocrine evaluation before and 4-8 weeks after initiating 25 mg of oral micronized DHEA TID. Age of patients was 41.1 ± 4.2 years, BMI 24.4 ± 6.1 kg/m2, 86% were married, and 42% were parous. Following supplementation with DHEA, all serum androgen levels increased (each P < 0.0001), while FSH levels decreased by 2.6 ± 4.4 from a baseline of 10.3 ± 5.4 mIU/mL (P = 0.009). The FSFI score for the whole study group increased by 7% (from 27.2 ± 6.9 to 29.2 ± 5.6; P = 0.0166). Domain scores for desire increased by 17% (P = 0.0004) and by 12% for arousal (P = 0.0122); lubrication demonstrated an 8% trend towards improvement (P = 0.0551), while no changes in domain scores for orgasm, satisfaction, or pain were observed. Women in the lowest starting FSFI score quartile (<25.7), experienced a 6.1 ± 8.0 (34%) increase in total FSFI score following DHEA supplementation. Among these women, improvements in domain categories were noted for desire (40%), arousal (46%), lubrication (33%), orgasm (54%), satisfaction (24%), and pain (25%). This uncontrolled observational study implies that supplementation with DHEA improves sexual function in older premenopausal women with low baseline FSFI scores.

Sexual Function and Contraception Use in Women With Inflammatory Bowel Disease

Introduction: IBD likely influences sexual function in women. Prior studies show impaired sexual function in female IBD patients, pain during sexual intercourse, low desire, and difficulty attaining orgasm[1,2]. The aim of our study was to evaluate sexual function and contraceptive methods in IBD patients vs. controls. Methods: A prospective, cross-sectional study was conducted at Women & Infants Hospital of RI, Center for Women's Gastrointestinal Health. Women aged 18-45 with and without IBD completed a questionnaire that assessed 6 subdomains of the Female Sexual Function Index (FSFI), similar to a study by Bel et al.1,3 Contraception and age at diagnosis were assessed, which have been previously studied in varying cohorts2,4. Results: Surveys were completed by 32 IBD patients and 45 controls. Total FSFI score did not vary significantly between IBD and control groups, but IBD patients scored lower than controls in all subdomains. Within the IBD group, a statistically significant correlation was found between age at diagnosis and sexual function. Patients diagnosed at age 16 or younger (N=4) scored lower than patients diagnosed at age 17 or older (N=20) in total FSFI score and in four subdomains (Table 1). Although no differences were found in contraception rates between IBD and control groups, IBD patients were more likely to have received a tubal ligation (Table 2). Conclusion: This study suggests that age at IBD diagnosis may be a determinant of future sexual function. Women with IBD were more likely to have a tubal ligation, suggesting that voluntary childlessness, found to be higher in IBD patients5, may have a role in decisions regarding contraception. A limitation of this study was sample size. The results of this study suggest that gastroenterologists can improve the sexual function and reproductive health of their female IBD patients through history and referral for psychological or sexual-therapeutic interventions.721_A Figure 1. Independent samples test for mean FSFI scores between IBD patients diagnosed at age 16 or younger vs. those diagnosed at age 17 or older721_B Figure 2. Chi-square test for differences in rates of tubal ligation in IBD Group vs. Control Group

Transcutaneous Electrical Nerve Stimulation to Improve Female Sexual Dysfunction Symptoms: A Pilot Study

To perform a pilot study using transcutaneous electrical nerve stimulation (TENS) on the dorsal genital nerve and the posterior tibial nerve for improving symptoms of female sexual dysfunction (FSD) in women without bladder problems. We hypothesize that this therapy will be effective at improving genital arousal deficits. Nine women with general FSD completed the study. Subjects received 12 sessions of transcutaneous dorsal genital nerve stimulation (DGNS; n = 6) or posterior tibial nerve stimulation (PTNS; n = 3). Stimulation was delivered for 30 min at 20 Hz. Sexual functioning was evaluated with the female sexual functioning index (FSFI), and surveys were also given on general health, urological functioning, and the Patients' Global Impression of Change (PGIC) after treatment. Surveys were given before treatment (baseline), after 6 and 12 weeks of treatment, and 6 weeks after the completion of stimulation sessions. The average total FSFI score across all subjects significantly increased from 15.3 ± 4.8 at baseline to 20.3 ± 7.8 after six sessions, 21.7 ± 7.5 after 12 sessions, and 21.3 ± 7.1 at study completion (p < 0.05 for all time points). Increases were observed in both DGNS and PTNS subjects. Significant FSFI increases were seen in the subdomains of lubrication, arousal, and orgasm, each of which is related to genital arousal. Bladder and general health surveys did not change across the study. PGIC had a significant increase. This study provides evidence that transcutaneous stimulation of peripheral nerves has the potential to be a valuable therapeutic tool for women with FSD.

Initial Study of Sexual Function Among Cervical Cancer Survivors in Almaty, Kazakhstan

Background: There were not any evaluation of sexual dysfunction of cervix cancer patients in Almaty, Kazakhstan, to date. The study of 58 CC patients is an attempt to start filling this gap and to develop recommendations for the treatment of this kind of patients. Aim: The objective of this study was to examine sexual function of cervical cancer (CC) survivors receded different treatment approaches. Methods: 58 women subjected to CC treatment of at least 1 year in the past were examined at the initial stage of the research. The examined women were split into 5 groups by treatment methods: conization of cervix, hysterectomy with removal of ovaries, hysterectomy without removal of (one or both) ovaries, chemotherapy with radiotherapy, and those passed exclusively radiotherapy. The sexual function of the examined women was evaluated through Female Sexual Function Index (FSFI) instrument consisted of 19 questions. The questions were mainly related to the main aspects like desire, arousal, lubrication, orgasm, satisfaction and pain. The data were collected by online and face-to-face interviews. Results: The median age of the 58 interviewed women was 44.5 years. 49 of the interviewees reported that they experienced desire. 79% of the interviewed women had sexual activity, among which 74% answers pointed out high lubrication condition above 2 within 0-5 possible range, 66% indicated high score of excitation, while 72% replied positively on orgasm section of the questionnaire. The highest portion of sexual active women experienced satisfaction (76%) although 33 of the interviewees felt the pain during coitus. The total FSFI score varied between 3.9 and 32.4 in the group of women who reported their sexual activity. Conclusion: This study demonstrates that lower total score of sexual function index is found in the patients passed chemotherapy with radiotherapy, or those cured exclusively with radiotherapy. In parallel, the highest score is traced in the women treated surgically. Therefore, it proves that surgery is more preferable treatment to keep higher level of sexual function in patients with cervix cancer. For the purpose of higher accuracy at the next stages of the research the inclusion of control group of women without history of cancer and with similar social, economic and demographic characteristics is needed.

Effects of etonogestrel implant on quality of life, sexual function, and pelvic pain in women suffering from endometriosis: results from a multicenter, prospective, observational study.

Progestins are successfully employed as treatment for endometriosis. Our study evaluates the effects of the etonogestrel (ENG) implant on pelvic pain, quality of life, and sexual function in women requiring long-term reversible contraception and presenting ovarian cysts of probable endometriotic origin. We enrolled 25 women asking for contraception with the ENG implant and presenting a cyst with the ultrasound features of an endometrioma and pain symptoms. Patients were interviewed on pain symptoms (dysmenorrhea, dyspareunia, dyschezia, and dysuria) using a VAS score (0-10), on quality of life (QoL) using the Short Form-36 questionnaire, and on sexual activity using the Female Sexual Function Index (FSFI) questionnaire before inserting the implant (T0) and after 6 (T1) and 12months (T2). We found a significant decrease in dysmenorrhea and dyspareunia VAS scores comparing baseline scores to 6 and 12months. After 12months, the bodily pain, general health, vitality, social functioning, and mental health domains of the QoL score were significantly improved. The total FSFI score results increased in comparison with baseline both at 6 and 12months. In particular, we highlighted a significant improvement in desire, satisfaction, and pain domains already at 6months; the arousal domain improved only after 12months. Finally, mean diameters of endometrioma-like cysts were not changed after 12months of treatment. Etonogestrel implants seem to be able to reduce pelvic pain, improve sexual function, and quality of life in patients with ovarian cysts suspected of endometriotic origin.