Vaginal Dryness Research Articles

P-733 Discrepancies between self-perceived and diagnosed cases of perimenopause - analysis of health data from 13,932 UK-based women

Abstract Study question Do individuals who self-reported “suspected perimenopause” in health assessments meet the diagnostic criteria for perimenopause, menopause or premature ovarian insufficiency (POI) based on clinical guidance? Summary answer Users were likely to experience more mood symptoms, compared to vasomotor symptoms or cycle irregularities and only 5.5% met the NICE perimenopause diagnostic criteria. What is known already An estimated 13 million individuals are currently experiencing perimenopause or menopause in the United Kingdom. The recent surge in media attention, while helpful in fostering awareness, may also carry the unintended consequence of leading individuals to self-identify with perimenopause without a clear understanding, due to the historical gap in comprehensive education on the subject. This study aims to investigate the prevalent symptoms reported by individuals who self-reported suspected perimenopause in a health assessment and assess whether these individuals meet diagnostic criteria for perimenopause, menopause or premature ovarian insufficiency (POI) based on clinical guidance. Study design, size, duration In this retrospective observational study, data was analysed from 13,932 users approaching women’s health testing services, citing “I think I am perimenopausal” as their reason for using the service between August 2022 and January 2024. We analysed data on age, menstrual cycle characteristics and symptoms self-reported via an online health assessment. A sub group analysis, done on 891 users aged 21-58, also analysed serum follicle-stimulating hormone (FSH) measured via immunoassay using a capillary blood sample. Participants/materials, setting, methods Among the 13,932 users, 8,101 (58.1%) were <40 years old, 4,947 (35.5%) were aged 40-45 and 884 (6.3%) were >45 years old. The dataset was compared with NICE criteria, stating that perimenopause/menopause is diagnosed in women >45 experiencing cycle irregularities and vasomotor symptoms, with the addition of two FSH measurements >30 IU/L to diagnose perimenopause/menopause or POI in those <45 or < 40 respectively. Main results and the role of chance The most frequently reported symptoms were fatigue 10,434 (74.9%), anxiety 8,526 (61.2%), irritability 8,361 (60.0%), depression 8,280 (59.4%), brain fog 7,898 (56.7%), headaches 6,483 (46.5%), hot flushes 5,289 (38.0%), hair thinning/loss 5,224 (37.5%), feeling cold often 4,999 (35.9%), night sweats 4,939 (35.5%), vaginal dryness 3,595 (25.8%) and pain during intercourse 3,525 (25.3%). In terms of menstrual cycle regularity, 7,515 (53.9%) had regular periods, 4243 (30.5%) selected irregular periods, 956 (6.9%) selected ‘I’m not currently/no longer getting periods’, 1195 (8.6%) selected ‘I don’t get periods because of contraception/HRT’. The subgroup analysis found that among users <40 years old, 1.2% (n = 6/524) would potentially fit the POI diagnostic criteria based on a single FSH measurement >30 IU/L, vasomotor symptoms and cycle regularity. Based on the same criteria, 2.9% (n = 8/279) of users aged 40-45 would be diagnosed with perimenopause/menopause and 39.8%(n = 35/88 ) of users >45 years old met the perimenopause/menopause criteria. However, of the total, only 5.5% (n = 49/891) of individuals who self-identified as perimenopausal met the NICE diagnostic criteria. Limitations, reasons for caution The online health assessment collects self-reported data, potentially influencing results. Subgroup analysis included individuals with at least 1 FSH test, however, guidelines advise 2 consecutive high FSH levels for perimenopause diagnosis, possibly reducing the number eligible for a potential perimenopause diagnosis. Wider implications of the findings Our data suggests users are most likely to experience mood symptoms, compared to vasomotor symptoms or cycle irregularities, which are required for a diagnosis. This spotlights the importance of including patient voices in clinical guidelines and the need for improved public awareness regarding perimenopause to promote healthcare-seeking behaviour for symptoms. Trial registration number NA

O-083 Sexual function in women with Premature Ovarian Insufficiency (POI): systematic review and meta-analysis

Abstract Study question What is the impact of idiopathic premature ovarian insufficiency (POI) on sexual function in women? Summary answer Women with POI exhibit significant reduced sexual function and a higher risk of sexual dysfunction than healthy control women. What is known already POI is a life-changing diagnosis with profound physical and psychological consequences. The impact of POI on sexual complaints, seems multifaceted. Many women report vaginal dryness, dyspareunia (painful intercourse), and diminished libido, but also psychosexual function could be impaired, with potential effects on sexual identity, sexual function, and sexual relationships. Furthermore, the POI diagnosis can have a significant impact on a woman's self-esteem and body image, which could result in problems with sexual function. The ESHRE Guideline emphasizes the importance of providing psychological support and counseling to address the emotional and psychosexual impact of POI. Study design, size, duration This systematic review and meta-analysis is reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The following online databases were systematically searched: EMBASE, Medline(Ovid), Web of Science, Coachrane, PsychInfo and Google Scholar up to January 2023. Participants/materials, setting, methods A total of ten studies were included in the systematic review and five studies involving 352 women with POI were included in the meta-analysis. Random effects models were used for analyses, with data reported as Hedges’ g and 95% confidence interval, and the risk of heterogeneity was evaluated. Main results and the role of chance Eight of the ten studies concluded that women with POI have a reduced sexual function. An overall medium Hedges’ g effect size of −0.72 was found (ranging between −0.20 to −1.29) in favor of control women, with moderate heterogeneity (I2 = 64%). When we stratified studies in which women were using hormone replacement therapy (HRT) we calculated an even higher Hedges’ g effect size of −0.82 (95% CI −1.18, −0.47). Pooled data from the different FSFI domains, revealed that women with POI scored significantly lower on all domains. Especially the domain ‘dyspareunia’ exhibited the greatest dissimilarity (Hedges g of −0.63, 95%CI −0.86, −0.39) in women with POI compared to control. Limitations, reasons for caution We have reported a moderate heterogeneity which may be caused by differences in age, duration of diagnosis, infertility status, and socioeconomic background in the various studies. Additionally, limitations such as selection bias, data duplication, and questionnaire variation were identified. Wider implications of the findings The results show that women with POI have reduced sexual function, and HRT use did not improve sexual function. This suggest that oral HRT is less effective for sexual dysfunction. There could be an important role for psychological factors in improving sexual well-being among women with POI. Trial registration number CRD42023437203 (PROSPERO)

Overview of prevalence, etiology, clinical features, diagnosis, and management of primary ovarian insufficiency

Primary ovarian insufficiency (POI) is the development of primary hypogonadism before the age of 40 years in women with normal karyotypes. Patients present with symptoms that are similar to those of menopause, including irregular periods, reduced fertility, and climacteric symptoms due to hypoestrogenism, such as hot flashes, vaginal dryness, dyspareunia, irritability, and night sweats. The incidence of spontaneous POI is approximately 1 in 250 by 35 years of age and 1 in 100 by 40 years of age. Genetic, inflammatory, metabolic, autoimmune, and idiopathic factors contribute to POI. POI pathophysiology is explained by the presence of fewer primordial follicles and their rapid degeneration. Detailed history and examination are important for diagnosis. Diagnosis requires biochemical evidence and laboratory testing, including measurements of follicle-stimulating hormone, thyroid-stimulating hormone, prolactin, and estradiol (E2) levels. In addition, transvaginal ultrasound is preferred to evaluate ovarian reserve. POI should be managed through a multidisciplinary approach involving gynecologists, endocrinologists, and psychologists. Hormonal replacement therapy is the mainstay treatment for all women with POI. Lifestyle modifications such as weight-bearing exercises, smoking cessation, and Vitamin D and calcium supplementation are highly recommended to improve bone density and reduce fractures. Psychological care has been suggested to improve self-esteem and social support, along with family planning guidance. Despite recent discoveries, additional screening techniques are needed.

Understanding the Benefits of CO2 Laser Treatment for Vulvovaginal Atrophy.

Background and Objectives: Postmenopausal vaginal discomfort is often attributed to vulvovaginal atrophy (VVA). Women with VVA experience symptoms such as vaginal dryness, itching, burning, irritation, and dyspareunia. Materials and Methods: This pilot study was conducted to assess the effects of a micro-ablative fractional CO2 laser on the clinical symptoms of VVA, as well as concordant sexual function. The severity of VVA symptoms was evaluated by a visual analogue scale (VAS), while the condition of the vaginal mucosa was evaluated using the Vaginal Health Index Score (VHSI). Sexual function was evaluated using the Female Sexual Function Index (FSFI) Questionnaire. Results: Our cohort included 84 sexually active postmenopausal women with bothersome VVA, leading to sexual health complaints. The mean age of the participants in our study was 55.2 ± 5.4 years, with an average postmenopausal period of 6 ± 4.8 years. The age of our patients and the length of their postmenopausal period exhibited a significant negative correlation with VHSI scores, while a longer postmenopausal period was associated with increased severity of vaginal dryness and dyspareunia. Baseline VHSI values showed that 65% of patients had atrophic vaginitis with pronounced VVA symptoms (70.2% experienced vaginal itching, 73.8% reported vaginal burning, 95.3% had vaginal dryness, and 86.1% suffered from dyspareunia). Lower VHSI values significantly correlated with lower FSFI scores, while more severe VVA symptoms scores correlated with lower FSFI scores. VVA symptoms were significantly less severe after treatment. VHIS regained high non-atrophic values in 98.8% of patients post-treatment (p < 0.001). FSFI total and domain scores were significantly higher after treatment (p < 0.001). Conclusions: Our study revealed that fractional CO2 laser is a useful treatment option to alleviate VVA symptoms and improve vaginal health and sexual functioning in postmenopausal women.

Short and long-term effect of polycarbophil vaginal gel on vaginal atrophy of peri- and post-menopausal women. The TRIPLE study

ObjectivesThis TRIPLE study was aimed to evaluate the efficacy of polycarbophil vaginal gel (PCV) in treating symptoms of vaginal atrophy (VA) of peri- and post-menopausal women. Materials and methodsSexually active women in peri- (n = 29) and post-menopause (n = 54) suffering from VA, were progressively enrolled and treated for 30 days with PCV. Those wishing to continue (n = 73) were treated for additional 180 days. PCV was administered as one application twice a week. The vaginal health index (VHI; range 5 to 25) and the visual analogue score (VAS range for 0 to 100 mm for each item) for vaginal dryness, irritation, and pain at intercourse, along with the global symptoms score (GSS; range 1 to 15) and treatment safety, were evaluated at baseline and after 30 days. In those continuing the treatment an evaluation was performed after additional 180 days. ResultsWomen in peri and post-menopause were of 48.7 ± 3.3 years and 57.5 ± 5.7 years old., respectively. At baseline all outcomes were significantly worse (p<0.002) in postmenopausal group, except the VHI (p < 0.056). After 30 days VHI increased (p < 0.001) of 4.1 ± 0.5 (mean ± SE), and 5.1 ± 0.4 in peri- and post-menopausal women respectively. VAS of vaginal dryness decreased (p < 0.001) of −24.4 ± 3.6, and −52.7 ± 2.6 (p < 0.001), VAS of irritation decreased (p<0.001) of −18.6 ± 4.4 and −47.8 ± 3.2, VAS of pain decreased (p < 0.001) of −26.2 ± 4.3 and −55.6 ± 3.1 and the GSS decreased (p < 0.001) of −3.9 ± 0.3, and −4.9 ± 0.2, in peri and post-menopausal women, respectively. All the modifications were significantly greater (p < 0.001)(p < 0.032 for GSS) in postmenopausal women, and after 30 days all outcomes were similar in the two groups of women. In comparison to baseline, after 210 days of treatment VHI increased of 7.7 ± 0.3 (p < 0.001), VAS of vaginal dryness decreased of –53.6 ± 1.9 (p < 0.001) VAS of irritation of −42.6 ± 1.4 (p < 0.001) VAS of pain of −46.7 ± 2.3 (p < 0.001) and the GSS of −6.5 ± 0.2 ± 0.2 (p < 0.001). All outcomes improved (p < 0.001) over the values observed after 30 days of treatment (p < 0.001). No side effect was reported. ConclusionsIn peri- and post-menopausal women PCV administration rapidly improves VA symptoms, and its prolongation up to 6 months further increases its efficacy.

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

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

(124) GENITOURINARY SYNDROME OF LACTATION (GSL): A NEW PERSPECTIVE ON POSTPARTUM AND LACTATION-RELATED GENITOURINARY SYMPTOMS

Abstract Introduction Genitourinary syndrome of menopause (GSM) is a well-documented and researched condition characterized by a range of genitourinary symptoms in peri- and postmenopausal women. Similar to GSM, postpartum and lactating women experience significantly reduced estrogen and androgen levels. However, there is limited research on the occurrence and impact of similar symptoms during the postpartum and breastfeeding period, as well as possible treatment options. Objective The aim of this project was to review the available literature for genitourinary health in the postpartum breastfeeding population and summarize the key findings and potential treatment options. Methods We performed a comprehensive literature review utilizing several databases and the following keywords individually or in combination “physiology of postpartum” or “physiology of lactogenesis” or “vulvovaginal health” or “vaginal atrophy” or “vaginal dryness” or “dyspareunia” or “urinary incontinence” or “lactation” or “breastfeeding” or “vaginal estrogen.” Full text review of 75 articles was performed, and ultimately 50 articles were included in this review. Results During lactation, high levels of prolactin inhibit estrogen and androgen secretion via negative feedback mechanisms (1). These hormonal changes lead to an increased prevalence (of up to 50% higher) of vulvovaginal atrophy in lactating and breastfeeding women compared to non-breastfeeding women (2,3). The shift in hormones also contributes to increased rates (~30% higher) of dyspareunia (4–7), likely due to a lack of vaginal lubrication (up to 46%) among breastfeeding women (8). Decreased sexual desire is also common and reported to be experienced by up to 46% of postpartum women (8). Despite these highly prevalent and potentially devastating symptoms, there is a lack of consistent screening at postpartum visits and no treatment guidelines available to healthcare providers. Similar to GSM, vaginal lubricants can be used by breastfeeding women with vaginal dryness. However, for lactating women with refractory vaginal dryness or significant vulvovaginal changes, vaginal estrogen or DHEA therapy may be considered. Studies have shown minimal or no transfer of estrogen to breast milk even at high concentrations, and no reduction in breast milk supply (9–11), likely because vaginal estrogen is not a systemic dose. Studies on vaginal estrogen therapy in postpartum women are limited, but one randomized placebo-controlled trial showed excellent compliance and a subjective improvement in women utilizing vaginal estrogen (12). Conclusions Postpartum breastfeeding women experience similar physiology and symptoms to the postmenopausal phase, as seen in GSM. We propose the introduction of a novel term to describe the genitourinary changes seen in breastfeeding individuals: Genitourinary Syndrome of Lactation (GSL). The creation and diagnostic use of a syndrome, such as GSL, will equip healthcare providers with an all-encompassing term to bring awareness to the symptoms experienced by postpartum breastfeeding individuals. This awareness can lead to improved screening and treatment guidelines for the high numbers of breastfeeding individuals suffering from these genitourinary changes. Disclosure No.

(051) METHAMPHETAMINE-INDUCED VAGINAL LUBRICATION IN RATS AND THE ESTROUS CYCLE

Abstract Introduction In an interview-based study performed by our lab of women who use methamphetamine (meth), we previously found that the drug, when delivered intravenously (IV), produces a feeling indistinguishable from an orgasm, which is accompanied by a flushing sensation and the production of excessive vaginal lubrication. We have also reported meth-induced vaginal lubrication in an anesthetized animal model. This production of vaginal transudate was dependent on the dose of meth used and the potent vasodilator nitric oxide. Objective The objective of the current study was to assess meth-induced vaginal lubrication across different stages of the estrous cycle and following ovariectomy (ovx) in anesthetized rats, and to assess plasma levels of two signaling molecules associated with sexual arousal. Methods Anesthetized rats, each previously implanted with a chronic indwelling jugular catheter, were anesthetized and given one IV infusion of meth (0.24 mg/kg) and vaginal lubrication was measured. A pre-weighed cotton-tipped swab, inserted into the vaginal canal, collected fluid secreted following the administration of meth. Blood was withdrawn before and at ten and fifteen minutes after meth administration either via the jugular catheter or via a small tail snip to measure plasma levels of estradiol and nitric oxide. Testing was completed at each stage of the estrous cycle as well as before and after ovariectomy. Results Estradiol and nitric oxide increased following meth infusion similarly across all stages of the estrous cycle. Vaginal lubrication increased more with meth treatment than with saline treatment. This was true across all stages of the estrous cycle and despite ovariectomy. Conclusions These findings have far-reaching implications for those who suffer from vaginal dryness. The mechanism underlying this phenomenon may present a novel pharmacotherapeutic target to treat vaginal dryness. Since meth still produced vaginal secretions in anesthetized rats, these results suggest that targeting this mechanism may even prove beneficial in post-menopausal women, a patient group likely at highest risk for experiencing vaginal dryness. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Embera Neuurotherapeutics &amp; JanOne.

(129) WOMEN WHO REPORT PAIN WITH SEX HAVE VARYING MICROBIOME PROFILES BASED ON AGE

Abstract Introduction Even though the vaginal microbiome (VM) is a known contributor to vaginal epithelial health, the VM of women who report pain with sex has not been characterized. It is known that the VM shifts during menopause, therefore we segmented out analysis based on menopausal status. Objective An observational analysis comparing the vaginal microbiome composition and symptom profiles in individuals of both menopausal and reproductive age who experience moderate to severe pain with sex and those that do not report pain with sex. Methods This study involved the collection of self-reported health profiles and shotgun metagenomic analysis of vaginal samples from two distinct demographic groups: menopausal women and women of reproductive age (defined as non-pregnant, non-menopausal, and aged under 40 years). The focus was on identifying the microbial composition in individuals experiencing moderate to severe sexual intercourse pain and those without any reported pain, excluding samples from individuals with mild pain. An additional criterion for inclusion was a reported history of sexual activity within the preceding 30 days. The menopausal group comprised 157 individuals reporting pain and 367 individuals without pain. In the reproductive age cohort, there were 968 participants with pain and 968 age-matched controls without pain. Statistical analysis between the pain and control groups in both cohorts revealed no significant differences in body mass index (BMI, menopause p = 0.74, reproductive p = 0.19), reported hormone use (menopause p = 0.2, reproductive p = 0.24), or history of previous infections (menopause p = 0.29, reproductive p = 0.09). Results In both the menopausal and reproductive-aged cohorts, individuals experiencing pain during sexual intercourse exhibited a higher prevalence of symptomatic conditions, as illustrated in Figure 1 A &amp; B. Reported symptoms included increased severity of burning, itchiness, vaginal and vulvar pain, erythema, dysuria, and vaginal dryness. A significant correlation was observed between these enhanced symptomatology and variations in vaginal microbiome compositions among the menopausal group, as depicted in Figure 2 A &amp; B. Specifically, pain during sexual intercourse in menopausal women was linked to elevated vaginal microbiota (VM) diversity (p=0.047) and a reduction in lactobacilli levels (p=0.06). Conversely, in the reproductive-aged cohort, a higher VM diversity was noted in the control group (p=0.014), with no significant differences in Lactobacillus or Gardnerella concentrations between those experiencing pain and the control group. Conclusions Preliminary examination of the vaginal microbiome in women who self-report moderate to severe pain with sex reveals significant differences, particularly in menopausal women experiencing pain. These individuals exhibited a more diverse vaginal microbiome and lower levels of Lactobacillus. This study underscores the need for further research to explore the potential of targeted microbiome modifications as a therapeutic approach to alleviate pain symptoms in this demographic. Disclosure Yes, this is sponsored by industry/sponsor: Evvy. Clarification: Industry initiated, executed and funded study. Any of the authors act as a consultant, employee or shareholder of an industry for: Evvy.

(131) EFFECTIVENESS OF AN INTERACTIVE PATIENT LEARNING MODULE: INTIMACY IN PREGNANCY

Abstract Introduction Two-thirds of women experience negative sexual symptoms during their pregnancy. Women suffer with dyspareunia, arousal issues, decreased libido, and anorgasmia frequently throughout pregnancy, with a significant worsening of symptoms during the third trimester. Also, many women restrict their sexual activity due to fear and misconceptions of inducing preterm labor or harming the fetus and social parameters of sexual conduct during pregnancy. Due to the lack of readily available medical education regarding sexual function in pregnancy, many women of various religious backgrounds may feel lack of trusting asking family members or medical professionals regarding sexual wellness. Objective Patient education given during pregnancy will increase patient knowledge of intimacy during pregnancy as well as improve sexual satisfaction and relationship quality and mental health in pregnancy. Moreover, this module will address gaps in common misconceptions by introducing supportive literature findings regarding benefits of intercourse during pregnancy dispensing the social stigma. Methods This prospective study is a single group before and after pilot study. This study recruited 25 patients beyond 12 weeks’ gestation. We approached 34 of patients and 25 agreed to participate in review an educational module titled “Sexual Intimacy and Pregnancy” build from ACOG guidelines. This module was created at an 8th grade reading level. Patients completed a presurvey, used the module on an electronic device and then completed a post-module assessment. Results 68% of women currently experience sexual dysfunction as either one of more of the following: pain with sex, decreased libido, anorgasmia, or vaginal dryness. Compared to their pre-module response, more women correctly answered the items “What percentage of pregnant women experience sexual dysfunction?” (28.0% versus 76.0%; p = .001) and “Having sex will cause labor” (28.0% versus 4.0%; p = .03). Additionally, women were more comfortable asking their doctor about sex while pregnant following the module (OR = 2.26, 95% CI: 1.06 – 4.83; p = .04). Through the recruitment process, we noticed that patients more likely to participate based on age, level of education received and most significant gravidity. The key for this recruitment was to create an environment in the exam room where both parents were able to see and engage with the module. During the module, partners spoke about current sexual dysfunction initially followed by confirmation by the pregnant patient. Prior to viewing this module, most participants predicted a much smaller percentage of women would be afflicted by sexual dysfunction in pregnancy which illustrating the broad deficits in sexual health education. Conclusions All participants would recommend this educational module to fellow pregnant women and all participants rated the completion and content of this module at easy or very easy to follow. This education module demonstrates baseline improvement in knowledge of sexual function in pregnancy and increases comfort level of discussing sexual function during prenatal care. Future direction of this study aims to target education in various socioeconomic cultures where intimacy education is not discussed in the clinical setting. Disclosure No.

(117) EVALUATING THE USE OF THE FEMALE SEXUAL HEALTH AFTER CANCER SCREENING CHECKLIST WITH YOUNG ADULT CANCER SURVIVORS

Abstract Introduction Sexual health, a key component of general well-being and quality of life, is often significantly disrupted by cancer treatment. In particular, when patients undergo cancer treatment early in life, disruptions to physical, sexual, and social development can have a considerable impact on sexual health by the time survivors reach young adulthood. However, extant sexual health measures are primarily intended for sexually active adults and do not accurately capture the range of sexual health concerns experienced by young adult cancer survivors (YACS). In order to provide comprehensive sexual health screening and care for this vulnerable population, measures must be developed specifically for young survivors. This study represents a critical next step in measure development for YACS: evaluating the utility and gaps of an existing sexual health screening checklist for cancer survivors. Objective To elicit feedback from female YACS regarding how the Female Sexual Health After Cancer Checklist captures their sexual health concerns as well as how the checklist may be updated for this population. Methods Cognitive interviews were conducted with 17 female YACS (ages 23-39). Participants were presented with the Female Sexual Health After Cancer Checklist and asked to provide feedback on each item. Specifically, Willis’s Concurrent Verbal Probing Technique was used to gather information on relevance of each item to YACS, item comprehension, item acceptability, decision processes, and response processes. For example, participants were asked whether the checklist items accurately captured their sexual health concerns (i.e., response processes). Results Overall, young adult participants reported that checklist items were relevant to their sexual health concerns. However, several participants noted wording for two items seemed to assess change in symptoms after cancer (e.g., “decreased vaginal lubrication”) which is difficult for YACS to answer if their cancer occurred prior to becoming sexually active. More broadly, participants reported that the checklist failed to capture many of their most pressing concerns (e.g., delays in sexual and romantic experience). Additionally, participants felt it would be important to assess barriers to sexual and romantic relationships such as negative body image and difficulty explaining cancer history to a prospective partner. Sexually inactive participants, in particular, noted adding items about barriers to sexual and romantic relationships would make the checklist more applicable to them. Conclusions Findings suggest that existing measures, such as the Female Sexual Health After Cancer Checklist, may be a starting point for a targeted YACS’ sexual health measure. However, revision and addition of items is necessary to fully capture the needs of this younger population. As a next step, we are currently amending items based on participant feedback. For example, items implying change after cancer (e.g., “decreased vaginal lubrication”) will be updated to focus on current symptoms (e.g., “vaginal dryness”) to better apply to YACS who were treated before sexual debut. Items capturing delays in sexual and romantic experience will also be added. Revised and new items will then be gathered into an item pool for further revision by YACS and sexual health experts as part of the process of creating and validating a YACS’ specific sexual health measure. Disclosure No.

(041) SEXUAL DYSFUNCTION: A COMMON PROBLEM IN INDIVIDUALS WITH MULTIPLE SCLEROSIS

Abstract Introduction An estimated 2.8 million people worldwide are currently diagnosed with Multiple Sclerosis (MS). Moreover, cis-gender females are almost twice as likely to have the diagnosis than cis-gender males. Among the many physical symptoms secondary to MS, the ones related to the sex organs include numbness, vaginal dryness, erectile dysfunction and loss of libido, low desire, issues with lubrication, lack of sensation, difficulties with arousal, difficulties reaching orgasm and sexual pain. These symptoms are typically underreported, under diagnosed, and patients may find it difficult to address with a clinician. In addition, generalized fatigue, spasticity, muscle weakness, psychological changes, bowel and bladder dysfunction that also occur with MS can place strain on sexual relations with a partner and overall quality of life. Data suggest that 59.8% of cis gender females with MS report sexual dysfunction but only about 22.4% brought it up with a physician. Moreover, this study also found that 80% of these individuals wanted treatment for their sexual symptoms, highlighting the importance of exploring interventions for sexual dysfunction in MS patients. Objective This review investigated the options available for sexual dysfunction in cis gender females with MS. Methods Online databases such as Rutgers Library, PubMed, ScienceDirect, Cochrane Library and Google Scholar with key phrases such as “MS and endocrine symptoms” and “MS and sexual changes”, were used. Results Data suggest that several non-pharmacological interventions may be effective in decreasing the severity of symptoms related to sexual dysfunction in individuals with MS. One study investigated the effectiveness of sex therapy and found that sex therapy improved quality of life for those reporting sexual dysfunction. Another study examined the effects of physical therapy on sexual symptoms and found that practices such as pelvic floor exercises also contributed to a decrease in symptom severity. Other data, reported that mindfulness psych-education group intervention also was instrumental in improving female sexual function. Further, the use of clitoral stimulation devices also were found to be highly recommended to improve sexual effects. Finally, several pharmacologic agents have been explored such as flibanserin and sildenafil, but their effectiveness was limited in regard to sexual function. Conclusions Sexual dysfunction is a major concern for individuals with MS. In this population, there is often a sense of embarrassment or feeling ashamed. Therefore, clinicians should create an open environment for patients to bring up this topic of sexuality in order to develop a comprehensive treatment plan. Additionally, more research is needed on effective treatment options, both short and long term for MS patients dealing with sexual dysfunction. Disclosure No.

(054) OPTIMIZING INTERNET-BASED PSYCHOSOCIAL INTERVENTION FOR BREAST CANCER-RELATED SEXUAL MORBIDITY: PROTOCOL FOR A FACTORIAL TRIAL

Abstract Introduction Although 3 in 4 breast cancer survivors report significant sexual concerns following treatment, few receive support for these concerns. Delivering sexual health care to breast cancer survivors via the Internet could overcome many of the barriers to in-person interactions, including limited availability of resources and stigma. Prior research on telehealth interventions for breast cancer survivors’ sexual health has limitations. First, survivors continue to endorse time burden as a leading reason for declining telehealth sexual health interventions. Second, prior trial designs have not been able to determine which intervention components work best for which survivors. This knowledge is crucial to refine and personalize sexual health care for survivors. Objective Use the Multiphase Optimization Strategy (MOST) methodological framework to achieve the following aims: (1) develop an Internet intervention for breast cancer-related sexual health that is optimized for greatest impact; and (2) determine how intervention components work (i.e., mediators) and for whom they work best (i.e., moderators). Methods 320 partnered, post-treatment female breast cancer survivors who endorse at least one bothersome sexual symptom (i.e., pain with sex, vaginal dryness, low sexual desire, difficulty with orgasm) related to their breast cancer treatment will be enrolled. Recruitment will be conducted via a US-national community oncology research program representing more than 1,000 individual practice locations. In this factorial trial, participants will be randomized to receive a combination of 4 intervention components: psychoeducation about cancer-related sexual morbidity, training for communication with their health care team, training for communication with their partners, and intimacy promotion skills training. These components were selected as they are supported by our intervention research, are consistent with survivorship guidelines, and align with survivors’ preferences found in our qualitative research. Components will be implemented using a robust Internet intervention platform with tailoring and highly-engaging elements like animation, video, and automated email prompts. Survivors will complete assessments at baseline (pre-randomization) and 3- and 6-month post-assessments. First, the impact of intervention components on survivors’ sexual distress (Female Sexual Distress Scale-Desire, Arousal, Orgasm) and sexual functioning (Female Sexual Function Inventory) will be tested. Next, a select set of mediators (i.e., sexual functioning knowledge, sexual communication self-efficacy with clinicians and partner, emotional intimacy with partner) and moderators (i.e., menopausal status, adjuvant endocrine therapy use, psychological distress, relationship duration and satisfaction) will be evaluated. Results Institutional review board approvals are in progress, with clinical trial registration to follow. Data collection is anticipated to begin in Spring 2024 and be completed in 2027. Conclusions Findings from this trial will accelerate the development of more effective sexual health interventions for breast cancer survivors by determining how intervention components work and for whom various components work best. By identifying the combination of intervention components likely to provide breast cancer survivors the greatest sexual health benefit for the least burden, this study will result in the first Internet intervention optimized for maximum impact for the undertreated, prevalent, and distressing problem of breast cancer-related sexual morbidity. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: AHC: grants from Janssen, Relmada Therapeutics, Inc., and Sage Therapeutics; personal fees from Acadia, Alkermes, Allergan, AMAG Pharmaceuticals, Inc., Fabre-Kramer, Ovoca Bio plc, Pure Tech Health, Sage Therapeutics, Takeda/Lundbeck, WCG MedAvante-ProPhase, Ballantine Books/Random House, Changes in Sexual Functioning Questionnaire, Guilford Publications; personal fees and other from S1 Biopharma; and other from Euthymics and Mediflix LLC. GL: consultant or research affiliation with Agios Pharmaceuticals, Inc; Denovo Biopharma; IN8bio; Incyte Corporation; Novocure Inc.; oblato; ONO Pharma; Sumitomo Dainippon Pharma Co., Ltd. LR: financial and/or business interest in BeHealth Solutions and is a consultant to Mahana Therapeutics.

NRG-CC004 ancillary data study-exploring the effect of bupropion on sexual desire in female cancer survivors with and without vulvovaginal symptoms.

Female cancer survivors often experience estrogen-deprivation symptoms, which may lead to decreases in sexual desire, vulvovaginal health (lubrication, dryness, discomfort), and sexual satisfaction. Interventions are needed to address these concerns. The objective of this secondary analysis was to determine if women with higher (better) scores on the Female Sexual Function Index (FSFI) lubrication and pain subscales reported higher desire scores based on treatment with bupropion vs placebo. Participants were part of NRG Oncology's NRG-CC004 (NCT03180294), a randomized placebo-controlled clinical trial evaluating bupropion (150 vs 300mg) to improve sexual desire in survivors of breast or gynecologic cancer. All participants with baseline data from the FSFI lubrication, pain, and desire subscales with 5- and/or 9-week data were analyzed. The FSFI subscale scores were correlated using Spearman correlation coefficients. Logistic regression was used to determine associations between FSFI desire and other FSFI subscales while accounting for treatment arm and other covariates. The primary outcome of NRG Oncology's NRG-CC004 (NCT03180294) randomized phase II dose-finding trial was change from baseline to 9weeks on the FSFI desire subscale score. Similar to the parent study, the primary outcome for this ancillary data study was the FSFI desire subscale score at 5 and 9weeks. Overall, 230 participants completed the FSFI at baseline and 189 at 9weeks. The strongest correlations were between lubrication and pain at baseline (all participants, rho= 0.77; bupropion arms, rho = 0.82), week 5 (all participants, rho = 0.71; bupropion arms, rho = 0.68), and week 9 (all participants, rho = 0.75; bupropion arms, rho = 0.78), and the weakest correlations were between desire and pain. In patients in the treatment arms there were no interactions between lubrication or pain.The impact of various covariates on the FSFI score for desire at 9weeks demonstrated that participants of non-White race (odds ratio [OR],0.42; 95% CI, 0.21-0.81; P= .010), with a high lubrication score (OR,0.36; 95% CI, 0.21-0.61; P= .0002), with a high pain score (less pain) (OR,0.50; 95% CI, 0.29-0.87; P= .014), or with prior pelvic surgery (OR,0.38; 95% CI, 0.23-0.63; P= .0002) had lower odds of having low desire. Acute estrogen-deprivation symptoms should be addressed prior to sexual desire intervention. This secondary analysis was not powered to examine all variables. Lubrication and pain were predictors of low desire. Therefore, vulvovaginal atrophy and associated genitourinary symptoms of menopause such as vaginal dryness and dyspareunia should be addressed prior to or in parallel with interventions for sexual desire.

Switching from nonsteroidal aromatase inhibitors to exemestane and its impact on menopausal symptoms.

e13098 Background: Aromatase inhibitors (AIs) are the most used adjuvant treatment in post-menopausal women with favorable oncotype, hormone receptor-positive (HR+) early breast cancer. Nonsteroidal AIs, such as anastrozole and letrozole, are associated with menopausal side effects including arthralgias, vaginal dryness, and hot flashes. Steroidal AIs, such as exemestane, however, have mild androgenic activity, thus minimizing the risk for these side effects. While studies show exemestane exhibits less bone toxicity compared to anastrozole, there has not yet been a proven significant difference in all menopausal symptoms. Nevertheless, switching from nonsteroidal to steroidal AI is still commonly seen in clinical practice. In this study, we aimed to examine the impact of switching from nonsteroidal to steroidal AI on menopausal side effects. Methods: We performed a retrospective review of patients diagnosed with HR+ breast cancer managed at an urban academic center from 2010-2023. Patients initially treated with anastrozole or letrozole and switched to exemestane were identified. Pathology records, treatment plans, and documented side effects were abstracted from medical records, as were baseline demographics. Symptoms were graded based on severity before and after each hormone therapy: mild grade described intermittent symptoms that did not require intervention; moderate grade described persistent daily symptoms or those that improved with additional intervention; severe grade described persistent disabling symptoms that required change in hormone therapy. Wilcoxon signed-rank tests were used to compare severity of menopausal symptoms before and after switching to exemestane. Results: There were 128 patients included in the study. Median age at diagnosis was 62.5 years; 13% pre-menopausal, 80% post-menopausal, 4% perimenopausal, and 3% unknown. Most patients were diagnosed with invasive ductal carcinoma (80%) and 45% were found to have stage IA breast cancer. The median amount of time on first and second lines of endocrine therapy were 11 and 25 months, respectively. Ninety-six patients (75%) reported menopausal symptoms on nonsteroidal AI, and 66% subsequently switched to exemestane due to severity of these symptoms. The most reported symptoms were arthralgias (79%), hot flashes (27%), body aches (25%), fatigue (10%), and vaginal dryness (9%). Of those with menopausal symptoms, 51% noted a decrease in symptom severity after switching to exemestane: 4 improved from moderate to mild, 21 from severe to moderate, and 24 from severe to mild. This decrease in severity was statistically significant across all menopausal symptoms (p&lt;0.001). Conclusions: HR+ breast cancer patients exhibited a significant decrease in all menopausal symptoms when switching from nonsteroidal to steroidal AI. Further research is needed to examine the impact of this switch on a wider range of symptoms.

Effect and acceptability of jasmine compound essential oil for premenopausal breast cancer survivors suffering from genitourinary syndrome of menopause: A prospective interventional study.

1063 Background: Genitourinary syndrome of menopause (GSM) includes dyspareunia, vaginal dryness, vaginal burning, urinary urgency, and recurrent urinary tract infections. Breast cancer survivors (BCSs) exhibit more severe symptoms of GSM than healthy aging women, especially premenopausal BCSs in sexually active lifetime. GSM detrimentally impacts their quality of life and contributes to the premature cessation of endocrine therapy for breast disease. This study aims to explore the efficacy and safety of Jasmine compound essential oil in the treatment of GSM in premenopausal breast cancer women. Methods: Premenopausal sextually-active women with hormone receptor (HR) positive stage I to III BC taking ovarian function suppression (OFS) treatment and endocrine therapy with self-reported vaginal dryness, dyspareunia, or decreased libido were enrolled to the 12 weeks topically applied Jasmine compound essential oil trial. E2 and FSH was measured at baseline and weeks 12. A series of validated sexual quality-of-life questionnaires were completed at baseline, and subsequently at weeks 4, 8, and 12. The primary endpoint is the improvement in sexual pain evaluated based on the Female Sexual Function Index scale (FSFI). Acceptability was measured by patient preference and reported intention to continue using the products. Gynecologic examinations and metagenomic profiling of the vaginal microbiota were conducted at baseline and post-treatment for patients in an exploratory cohort. Results: Overall, 96 BCSs signed consent (mean [range] age, 45 [32-55] years) and 89 completed 12 weeks of treatment. E2 and FSH were maintained within the postmenopausal range without significant fluctuations during the treatment. Topically applied Jasmine compound essential oil resulted in significant improvements in dyspareunia, vaginal dryness, irritation and quality of life over time (all P&lt; 0.001). Both BCSs and their sexual partners reported being satisfied with the essential oil treatment and the adherence rate reached 95% (SD 10). In the 20-patient exploratory cohort, there were improvements in vaginal pH (baseline mean 6.07 compared with 12-week mean 4.68[ P&lt;.001]), and vaginal maturation index (45.3 compared with 52.1[ P&lt;.001]). We also observed a positive influence on the vaginal microbiota after intervention. In patients with elevated baseline abundance of Lactobacillus in the vaginal microbiome, there was a more pronounced improvement in scale scores following essential oil access. Conversely, a high baseline abundance of Escherichia coli may be considered a detrimental factor associated with less benefit from essential oil. Conclusions: Jasmine compound essential oil could relieve vaginal symptoms and improve vaginal health in breast cancer survivors who have experienced menopause after cancer treatment.

Sexual health and therapy adherence of hormone-sensitive breast cancer survivors on maintenance endocrine therapy: The SHE-CAN project in Toronto, Canada.

536 Background: Endocrine therapy (ET) is the standard of care for hormone sensitive (HR) breast cancer. While these drugs are highly efficacious and patients remain on them for extended periods of time, there are many side effects. It is estimated that 20-30% of women on ET stop early due to these side effects, most commonly due to gynecological symptoms of menopause (GSM). The purpose of this study is to better understand the vaginal health, sexual health, quality of life, sexual dysfunction, and adherence to therapy for HR breast cancer patients treated with anti-estrogen therapy. Methods: From August 2021 to January 2024, women from Mount Sinai Hospital’s outpatient oncology clinic and Women’s College Hospital After Cancer Treatment Transition (ACTT) clinic, who presented with HR breast cancer and who were being treated with anti-estrogen agents for a minimum of three months, were invited to participate in the study. Participants were asked to complete a survey examining their treatment experience and adherence, occurrence and frequency of GSM, patient-provider communication, along with two validated measurement tools (Female Sexual Function Index [FSFI} and Menopause-Specific Quality of Life questionnaire [MENQOL]). Medical history was also reviewed from the participant’s medical chart. Analysis was conducted using Excel. Results: A total of 417 participants completed the questionnaire. The median age was 60 years [IQR:52-69] with 401 participants (96.2%) being treated in the adjuvant setting versus 16 patients (3.8%) in the metastatic setting. At the time of diagnosis, 156 participants (37.4%) were pre-menopausal, 52 participants (12.5%) were peri-menopausal, and 185 participants (44.4%) were post-menopausal. When surveyed, 134 participants (32.1%) were on tamoxifen and 272 participants (65.2%) were on an aromatase inhibitor. Within six months prior to survey completion, 214 participants (51.3%) stopped taking their medication for a period of time. Within the past year, participants reported experiencing the following symptoms “all of the time”: vaginal dryness (24.9%), hot flashes (24.7%), and decreased sex drive (34.5%). Only 144 participants (34.5%) reported that a healthcare provider had asked them about experiencing GSM. The mean FSFI score was 21.9 ± 7.7 among 168 sexually active participants. Of these 168 participants, 116 (69.0%) had a final score of 26.5 or less, the cut-point used to demonstrate female sexual dysfunction. Symptoms captured in the MENQOL’s sexual domain (3.7 ± 2.3) and physical domain (3.7 ± 1.4) were found to be most bothersome. Conclusions: In our study, patients with breast cancer on ET report significant sexual dysfunction. Management of GSM and improved communication between patients and healthcare providers is required and should be prioritized to improve sexual dysfunction and treatment adherence.

European Board and College of Obstetrics and Gynaecology (EBCOG) position statement on the use of laser vaginal devices for treatment of genitourinary syndrome of menopause, vaginal laxity, pelvic organ prolapse and stress urinary incontinence

One in three women will experience pelvic floor disorders in her lifetime and nearly 60 percent of postmenopausal women are affected by vaginal dryness. Conservative management is recommended as first line treatment for pelvic organ prolapse and stress urinary incontinence. Also, vaginal estrogens are often prescribed for symptomatic vaginal atrophy. Lasers have been used in cosmetic industry for connective tissue remodeling and repair of skin. Their use in the last decade for treating genitourinary symptoms of menopause, pelvic organ prolapse and stress urinary incontinence has gained popularity but there is lack of robust evidence to support its use in routine practice. The European Board and College of Obstetrics and Gynaecology calls for high quality evidence with patient related outcome measures before adopting to routine clinical practice.

Genitourinary syndrome of lactation: a new perspective on postpartum and lactation-related genitourinary symptoms.

The genitourinary syndrome of menopause (GSM) is a well-documented condition characterized by a range of genitourinary symptoms in peri- and postmenopausal women. As with GSM, postpartum lactating women experience reduced estrogen and androgen levels. However, there is limited research on the impact of symptoms during the postpartum breastfeeding period. The aim was to review the literature for genitourinary health in the postpartum breastfeeding population and summarize key findings and potential treatments. We performed a comprehensive literature review in PubMed, Google Scholar, and Scopus from inception of database to November 2023 using the following keywords individually and in combination: "physiology of postpartum" or "physiology of lactogenesis" or "vulvovaginal health" or "vaginal atrophy" or "vaginal dryness" or "dyspareunia" or "urinary incontinence" or "lactation" or "breastfeeding" or "vaginal estrogen." All identified articles published in English were considered. Relevant studies were extracted, evaluated, and analyzed. The work presented in this article represents a summative review of the identified literature. During lactation, high levels of prolactin inhibit estrogen and androgen secretion via negative feedback, which leads to an increased prevalence of vulvovaginal atrophy, vaginal dryness, dyspareunia, and urinary incontinence in lactating postpartum women. Despite these highly prevalent and potentially devastating symptoms, there is a lack of consistent screening at postpartum visits and no treatment guidelines available to health care providers. Postpartum breastfeeding women experience similar physiology and symptoms to the postmenopausal phase, as seen in GSM. We propose the introduction of a novel term to describe the genitourinary changes seen in postpartum breastfeeding individuals: genitourinary syndrome of lactation. The diagnostic use of genitourinary syndrome of lactation will equip health care providers with an all-encompassing term to bring awareness to the symptoms experienced by postpartum breastfeeding individuals and lead to improved screening and treatment for the high numbers of individuals experiencing these genitourinary changes.

Thai postmenopausal woman's view in genitourinary syndrome of menopause.

To determine the prevalence of genitourinary syndrome of menopause (GSM) and their awareness, attitudes, and perception of this issue. Using a specifically designed questionnaire, interviews were performed on 500 Thai postmenopausal women who attended at Vajira Hospital, Bangkok, Thailand, from August 2021 to April 2022. The mean age of the 500 participants was 60.39 ± 8.12years. The prevalence of GSM was 47.2%. The common symptoms affected by GSM were vaginal dryness (38.5%), urinary urgency (24.6%), dyspareunia (13.6%), vaginal irritation (10.2%), vaginal burning (7.2%), and dysuria (5.9%). One-half of the women were uncomfortable talking about GSM. Three-quarters who did not reveal GSM symptoms believed that the problem was a part of aging. Only 20.3% of women who suffer from symptoms consulted a health care provider (HCP). Of the women who had been prescribed treatment, 84.6% of these women reported better quality of life. GSM is a meaningful decrement in quality of life. Most Thai postmenopausal women who had symptoms believed that the problem was the aging process. Awareness of GSM and available treatment would be a further benefit.