Associations between gynecologic clinician type and routine female sexual dysfunction screening

BACKGROUND

Female sexual dysfunction (FSD) is a common problem in the United States; however, only 14% to 40% of women are screened by their health care clinicians. There are few data on how differences in clinician type affects screening rates.

AIM

This study aimed to assess differences in FSD screening rates among gynecology clinician types, identify factors associated with screening, and compare screening rates of FSD against conditions with established screening recommendations.

METHODS

Data were collected by retrospective chart review of annual visits at an urban tertiary care center. Screening rates for FSD, depression, cervical cancer, and breast cancer were calculated and compared. Multivariable logistic regression modeling was utilized to assess the correlation between various patient characteristics and FSD screening rates.

OUTCOMES

Study outcome measures included percentages of women who were screened for FSD, depression, cervical cancer, and breast cancer.

RESULTS

FSD screening rate was significantly higher among resident-level clinicians vs nonresident clinicians (59% vs 31%; P < .001). When the nonresident clinicians were subanalyzed, certified nursing midwives were the second most likely to screen for FSD (odds ratio [OR], 0.41), followed by nurse practitioners (OR, 0.29) and attending physicians (OR, 0.22). According to multivariable logistic regression techniques, 5 factors were associated with an increased likelihood of a patient being screened for FSD at an annual examination: patient seen by a resident physician rather than an attending physician, patient history of FSD, patient age ≥40 years, patient report of being sexually active at the time of visit, and patient history of cervical procedures.

CLINICAL IMPLICATIONS

There is an opportunity to improve FSD screening rates by clinicians. Future research may assess what factors, such as increased sexual function education or greater incentives to document FSD screening, may result in higher screening rates. From this, targeted and effective interventions might be crafted to improve future screening rates.

STRENGTHS AND LIMITATIONS

This study is one of the first to compare FSD screening rates among clinician types in the same specialty. Study limitations include the inherent limitations of a retrospective design, including selection biases.

CONCLUSION

Residents were more likely to screen for FSD at annual well-woman visits than attending clinicians, nurse practitioners, and certified nurse midwives. Understanding the reasons for varied FSD screening rates among clinician types may aid in the development of strategies to improve screening for this important aspect of women's health.

The impact of cell-based therapy on female sexual dysfunction: a systematic review and meta-analysis

INTRODUCTION

Female sexual dysfunction (FSD) is a complex issue affecting women of all ages; it involves several overlapping body systems and profoundly affects quality of life. The use of cell-based therapy, such as mesenchymal stem cells, has recently been investigated as a potential treatment for FSD.

OBJECTIVES

This systematic review and meta-analysis aim to assess FSD outcomes following cell-based therapy.

METHODS

We evaluated peer-reviewed articles from multiple online databases through November 2022 to identify studies that used cell-based therapy and reported sexual function outcomes in women. We performed a meta-analysis using data pooled from 3 clinical trials at our institution: CRATUS (NCT02065245), ACESO (NCT02886884), and CERES (NCT03059355). All 3 trials collected data from the Sexual Quality of Life-Female (SQOL-F) questionnaire as an exploratory outcome.

RESULTS

Existing literature on this topic is scarce. Five clinical studies and 1 animal study were included in the systematic review, and only 2 clinical studies were considered good quality: 1 reported significant SQOL-F improvement in women 6 months after cell therapy, and 1 reported posttherapy sexual satisfaction in all women. When individual patient data were pooled in a meta-analysis from 29 women across 3 trials at our institution, the SQOL-F was not significantly improved.

CONCLUSION

Despite growing interest in cell-based therapy for women's sexual health, this important issue is understudied in the literature. The optimal route, source, and dose of cell therapy to produce clinically meaningful change have yet to be determined, and further research is needed in larger randomized placebo-controlled clinical trials.

Therapeutic effect of the temperature-controlled radio frequency technology in female sexual dysfunction

OBJECTIVES

To explore the therapeutic effect of the temperature-controlled radiofrequency technology in female sexual dysfunction (FSD).

MATERIAL AND METHODS

From July 2020 to June 2021, patients with FSD who visited the Gynecology Clinic of Peking University Shenzhen Hospital were treated with the temperature-controlled radiofrequency technology once every two weeks, for a total of five times. The therapeutic effect was objectively evaluated with pelvic floor dysfunction (PFD) indicators (FSFI score, pelvic floor muscles surface electromyography, sexual function test). The pre- and post-treatment (2 weeks)/follow-up (3 months) results were compared to evaluate the feasibility of this technology for treating FSD, as well as using PFD-related indicators in objective evaluation of FSD patients.

RESULTS

Fifty patients completed treatment; 31 patients completed follow-up. The mean FSFI score for post-treatment/follow-up was significantly higher than pre-treatment (p < 0.05). There were no significant changes in the mean pelvic floor resting surface myoelectric potential and its variability and mean myoelectric potential of sexual function test between pre- and post-treatment/follow-up. The mean surface myoelectric potential of the patients' type I and II muscle fibers of the pelvic floor for post-treatment/follow-up was significantly higher than pre-treatment (p < 0.05). The mean peak myoelectric potential for post-treatment was significantly higher than pre-treatment (p < 0.05).

CONCLUSIONS

Temperature-controlled radiofrequency technology has a certain therapeutic effect on FSD. Pelvic floor surface electromyography and sexual function test can be used as an objective indicator for PFD in FSD patients. Subsequent studies may involve a larger size sample and evaluate the effect over a consecutive time-point, to develop a better therapeutic approach.

History of infertility and sexual dysfunction in midlife women: Is there a link?

BACKGROUND

Infertility has been linked with an increased risk of sexual dysfunction in reproductive-aged women, with longer periods of infertility associated with a greater risk.

AIM

The study's aim was to examine whether a history of infertility treatment in women is linked to sexual dysfunction during midlife.

METHODS

The cross-sectional study was conducted among sexually active women, between the ages of 45 and 65 years, who sought consultation at the women's health clinics at a US tertiary care center. History of infertility treatment was assessed with a single question that asked participants if they were treated for infertility in the past. The association between a history of infertility treatment and sexual dysfunction-which was diagnosed by a combination of Female Sexual Function Index score ≤26.55 and Female Sexual Distress Scale-Revised score ≥11-was assessed in a multivariable logistic regression model that adjusted for multiple confounders.

OUTCOMES

The primary outcome was sexual dysfunction in midlife women.

RESULTS

The analysis included 5912 women, with a mean age of 54.1 years. Nearly 16% of women reported receiving treatment for infertility. More than half the women (55%) had sexual dysfunction: 56.3% of those with previous fertility treatments and 54.4% of those without any fertility treatment (P = .3). Receiving treatment for infertility in the younger years did not significantly increase the odds of sexual dysfunction in midlife in univariate (odds ratio, 1.08; 95% CI, 0.94-1.24; P = .3) and multivariable analyses (odds ratio, 1.11; 95% CI, 0.96-1.29; P = .17).

CLINICAL IMPLICATIONS

While infertility is known to be predictive of sexual dysfunction in women during their reproductive years, there was no association between a history of infertility treatment and sexual dysfunction in midlife women in the current study.

STRENGTHS AND LIMITATIONS

The study used validated questionnaires accounting for sexual complaints and distress and adjusted for multiple confounding factors. Limitations include the selection bias introduced by the study of women presenting for evaluation of sexual dysfunction, which may have been a result of factors stronger than the influence of infertility. Other limitations include the study's cross-sectional nature with suboptimal racial and ethnic representation.

CONCLUSION

Although infertility is commonly associated with female sexual dysfunction in women of reproductive age, the association was not present in midlife women in the current study.

Female sexual medicine: an assessment of medical school curricula in a major United States city

Background

Although approximately 41% of women experience sexual dysfunction, limited education on female sexual medicine (FSM) in medical school results in underpreparedness among physicians when addressing these bothersome conditions.

Aim

This study aims to evaluate the extent to which FSM is represented in medical education by examining current preclinical and clinical curricula.

Methods

Preclinical curriculum materials on female sexual anatomy, physiology, and pathology, as well as obstetrics and gynecology clinical materials (syllabi, lecture materials, and supplemental resources), were collected from medical schools in the Chicago area. We utilized previous literature to identify specific components of medical school content to evaluate.

Outcomes

Upon reviewing each institution's curricula, we evaluated materials for topic saturation and assessed goals of each syllabus in terms of required content.

Results

Curriculum materials were collected from 7 medical schools. In the preclinical assessment, 1 institution identified all anatomic components of the clitoris in our review, 4 discussed the physiology of the female orgasm, 3 highlighted the prevalence and epidemiology of female sexual dysfunction (FSD), 3 addressed treatments for FSD, and 1 instructed a genitourinary physical exam specific to assessing FSD. When assessing obstetrics and gynecology clinical materials, 5 institutions included topics related to FSM. Of these, only 1 institution had corresponding required synchronous clerkship time dedicated to these topics as a 1-hour lecture, in addition to an optional online training to third-year clinical students in comprehensive sexual history-taking practices, including screening for FSD. One other institution offered supplemental case-based gynecology modules including vulvovaginal diseases and chronic pelvic pain, though sexual pleasure, arousal, and libido were not included.

Clinical Implications

The results of this study highlight the need for the inclusion of standardized curricula related to FSM in medical education to equip future physicians to treat patients with sexual dysfunction.

Strengths and Limitations

The strengths of this study include that it is the first of its kind to complete a comprehensive review of FSM curricula at a cohort of undergraduate medical institutions. Its limitations include a small sample size of 7 medical schools limited to 1 geographical area.

Conclusion

Our focused needs assessment of medical schools in the Chicago area reveals inconsistencies in outlined institution-specific course goals related to FSM and thus highlights the need for restructuring the curricula to prepare future physicians to recognize and treat patients with sexual dysfunction.

Female sexual dysfunction in undergraduate medical education: a survey of U.S. medical students

Background

Physicians often report low levels of confidence in diagnosing and treating female sexual dysfunction (FSD), which may stem from inadequate education and exposure to the topic.

Aim

The study sought to determine the extent to which FSD is covered in undergraduate medical education and evaluate student comfort with the topic and familiarity with treatments.

Methods

We created a novel, 50-question survey to be administered online to any current U.S. medical student. Obstetrician-gynecologist clerkship directors at 146 U.S. medical schools were contacted and asked to invite any current student at their school to participate. A link to the electronic REDCap (Research Electronic Data Capture) survey was distributed to eligible students via the clerkship directors. The survey collected data regarding (1) coverage of FSD and male sexual dysfunction (MSD) in preclinical and clinical curricula, (2) student self-ratings of comfort in hypothetical scenarios in which a patient exhibits symptoms of FSD or MSD, and (3) student familiarity with treatments for FSD and MSD.

Outcomes

Outcomes included the proportion of students reporting that their school covered FSD/MSD in its preclinical/clinical curriculum, the mean comfort ratings for each of the FSD and MSD scenarios, and the proportion of students indicating knowledge of various FSD and MSD treatments.

Results

A smaller proportion of students (N = 236) reported receiving instruction in FSD (58.5%) compared with MSD (78.4%) in their preclinical curriculum (P < .001). Students' average self-ratings of comfort in the sexual dysfunction scenarios were significantly lower for patients with symptoms of FSD compared with MSD (P < .001). Students had higher average self-ratings of confidence in FSD scenarios if their intended specialty was obstetrician-gynecologist (P = .003), if their school included FSD in its clinical curriculum (P = .01), and if they had ever participated in the care of a patient with FSD (P = .006).

Clinical Implications

There are important gaps in the coverage of FSD in undergraduate medical education that may be mitigated through improvements to curriculum and increased exposure to patients with FSD.

Strengths and Limitations

This is the first study, to our knowledge, to directly survey medical students regarding their educational experience and comfort with FSD. Our study was limited by a small sample size, the use of a novel and nonvalidated questionnaire, and the potential for bias given our sampling method.

Conclusion

Medical schools must work toward improving instruction in FSD for their students to address these disparities and improve students' comfort with the topic.

Investigation on sexual function in young breast cancer patients during endocrine therapy: a latent class analysis

Backgrounds

The aim of this study was to investigate the sexual function status of young breast cancer patients during endocrine therapy, identify potential categories of sexual function status, and analyze the factors affecting the potential categories of sexual function status during endocrine therapy.

Methods

A cross-sectional survey was conducted on 189 young breast cancer patients who underwent postoperative adjuvant endocrine therapy in Shanghai Ruijin Hospital. The latent class analysis was used to identify potential categories of patient sexual function characteristics with respect to the FSFI sex health measures. Logistic regression analysis was used to analyze the influencing factors for the high risk latent class groups. A nomogram prognostic model were then established to identify high risk patients for female sexual dysfunction (FSD), and C-index was used to determine the prognostic accuracy.

Results

Patients were divided into a "high dysfunction-low satisfaction" group and a "low dysfunction-high satisfaction" group depending on the latent class analysis, accounting for 69.3% and 30.7%, respectively. Patients who received aromatase inhibitors (AI) combined with ovarian function suppression (OFS) treatment (p = 0.027), had poor body-image after surgery (p = 0.007), beared heavy medical economy burden(p < 0.001), and had a delayed recovery of sexual function after surgery (p = 0.001) were more likely to be classified into the "high dysfunction-low satisfaction" group, and then conducted into the nomogram. The C-index value of the nomogram for predicting FSD was 0.782.

Conclusion

The study revealed the heterogeneity of sexual function status among young breast cancer patients during endocrine therapy, which may help identify high-risk patients and provide early intervention.

The Paradox of Sexual Dysfunction Observed during Pregnancy

The aim of this study is to analyze the evolution of sexual function throughout pregnancy and highlight the predicting factors of sexual dysfunction in pregnant women. Our study included 144 participants, aged 16 to 45. Patients were evaluated three times during pregnancy by filling out the Female Sexual Function Index (FSFI) and the Body Exposure in Sexual Activities Questionnaire (BESAQ). At the time of the last evaluation, we asked patients to also fill out Beck's Depression Inventory (BDI-II) and a questionnaire regarding their psychological status and relationship satisfaction. We observed that the FSFI lubrication, satisfaction, and pain domains and the FSFI total score significantly decreased from the 1st to the 3rd evaluation. We observed that an increase in BDI score and the presence of abortion in the patient's history increase the risk of developing female sexual dysfunction (FSD). Higher BMIs were found to be a protective factor against FSD, as was being unmarried. The relationship satisfaction score was found to be an independent predictor of FSD. These findings support previous studies that indicate that pregnancy and postpartum sexuality are multifaceted phenomena and that psycho-social factors have a greater impact on sexuality than biological factors.

Prevalence of Female Sexual Dysfunction Among Psoriatic Females: A Cross Sectional Case Controlled Study

INTRODUCTION

Sexual relationships are an integral part of females psychological and physiological wellbeing.

OBJECTIVES

The study aimed to identify prevalence and impact of Female Sexual Dysfunction (FSD) in women affected with psoriasis.

METHODS

This cross-sectional study was carried out on 150 married females who were interviewed to answer Female Sexual Function Index (FSFI) questionnaire and were divided into two groups: the first group included 100 female patients complaining of psoriasis (50 suffering from moderate psoriasis and 50 with severe psoriasis). The disease severity was graded according to the Psoriasis Area and Severity Index (PASI) while the second group included 50 age matched women who served as controls.

RESULTS

Female sexual dysfunction (FSD) in psoriasis female groups was higher than that in the control group (47%, 24%, P < 0.05). The mean total scores of FSFI ranged from 12.30 to 34.20 and were significantly lower in the severe PASI affected group (22.34 ± 5.35) when compared to moderate PASI group (26.24 ± 2.67) or control group (28.79 ± 2.22). In addition, total scores were significantly lower among moderate PASI affected females when compared to control group.

CONCLUSIONS

Sexual dysfunction should be routinely investigated in female patients with psoriasis in the case of moderate-severe disease due to its negative impact on quality of life. Further research over the effect of certain interventional programs on FSD should be considered for patients suffering from psoriasis.

Managing antipsychotic-related sexual dysfunction in patients with schizophrenia

INTRODUCTION

Schizophrenia is a psychotic disorder and one of the most severe and impactful mental illnesses. Sexual dysfunction is highly prevalent in patients with schizophrenia but remains underdiagnosed and undertreated. Sexual dysfunction is frequently attributed to antipsychotics which may reduce medication adherence, but negative symptoms can also reduce sexual drive.

AREAS COVERED

This review provides an overview of the current knowledge about sexual dysfunction in patients with schizophrenia. The authors first review the literature concerning the mechanisms of sexual dysfunction and explore the impact of antipsychotics on sexual function. Finally, they present the available non-pharmacological and pharmacological treatment strategies for sexual dysfunction in patients with schizophrenia.

EXPERT OPINION

Sexual dysfunction in patients with schizophrenia is still underrated by clinicians despite having a negative impact on the quality of life and therapeutic adherence. Antipsychotic treatment is still perceived as a major cause of sexual impairment. Psychiatrists must be aware of this condition and actively question the patients. A comprehensive approach, addressing pharmacological and non-pharmacological aspects, is fundamental for managing sexual dysfunction in schizophrenia. Pharmacological strategies include (1) Serum-level adjustment of the antipsychotic dose, if possible (2) switching to a well-tolerable antipsychotic (aripiprazole, brexpiprazole) and (3) adding a coadjuvant drug (phosphodiesterase-5 inhibitors).

Multidisciplinary approach to the treatment of sexual dysfunction in couples using a biopsychosocial model

BACKGROUND

Given the complexity of the psychological and biological pathologies associated with sexual dysfunction, which affects at least a third of adult women and men worldwide, a multidisciplinary approach has been advocated.

AIM

To assess sexual functioning, relationship satisfaction, and mood stability pre- and post- treatment at the Loyola University Sexual Wellness Program.

METHODS

Couples attending the 6-week multidisciplinary Sexual Wellness Program provided consent and completed pre- and post- intervention assessments. Linear mixed effects models were used to estimate the mean change from baseline to first follow-up. A covariance matrix was used to account for dependency.

OUTCOMES

All patients completed self-reported surveys: Dyadic Adjustment Scale, PROMIS Sexual Function and Satisfaction Measures Brief Profile (Patient-Reported Outcomes Measurement Information), and International Index of Erectile Function.

RESULTS

There were 85 respondents: 42 men and 43 women. The mean age was 49.82 years (range, 25-77). The largest improvement was on the total Dyadic Adjustment Scale score, which increased by approximately 5.18 points (95% CI, 2.55-7.81). PROMIS scores for global satisfaction with sex life, erectile function, and interest in sexual activity significantly increased from baseline, while the vaginal discomfort score significantly declined. Overall the score for global satisfaction with sex life increased from baseline by approximately 5.57 points (95% CI, 3.03-8.10). On average, men reported a 4.33-point increase (95% CI, 0.04-8.62) in their International Index of Erectile Function score from baseline.

CLINICAL IMPLICATIONS

A multidisciplinary treatment approach focused on the couple positively affects a couple's relationship, including global satisfaction with sex life, relationship satisfaction, interest in sexual activity, and erectile function.

STRENGTHS AND LIMITATIONS

This study is one of the few to document the effects of a multidisciplinary treatment approach for both members of a heterosexual couple-male and female. Limitations include the narrow demographics and lack of a control group in our population. Furthermore, this was completed at 1 academic center.

CONCLUSION

These findings emphasize that multidisciplinary sexual therapy programs aimed at the couple can help address multiple aspects of sexual well-being.

The vagina as source and target of androgens: implications for treatment of GSM/VVA, including DHEA

The vagina is traditionally thought of as a passive organ in the female reproductive system, serving primarily as a passageway for menstrual blood, sexual intercourse and childbirth. However, recent research has shed light on the vagina's role as an endocrine organ that plays a crucial role in female hormonal balance and overall health. Particularly, growing evidence shows that the human vagina can be considered both as source and target of androgens, in view of the novel concept of 'intracrinology'. Besides the well-known role of estrogens, androgens are also crucial for the development and maintenance of healthy genitourinary tissues in women. As androgen levels decline with age, and estrogen levels fall during the menopausal transition, the tissues in the vagina, together with those in the urinary tract, become thinner, drier and less elastic, leading to a variety of uncomfortable and sometimes painful symptoms, clustered in the genitourinary syndrome of menopause (GSM). Given the lack of testosterone-based or androstenedione-based products approved by regulatory agencies to treat GSM, the possibility of using intravaginal prasterone, which works by providing a local source of dehydroepiandrosterone (DHEA) to the vaginal tissues, appears to be a targeted treatment. Further studies are needed to better assess its safety and efficacy.

Mindfulness in sex therapy and intimate relationships: a feasibility and randomized controlled pilot study in a cross-diagnostic group

Background

Mindfulness facets can be trained with structured mindfulness interventions, but little is known regarding application on a broader level within sex therapy (e.g. men, partners and different sexual dysfunctions).

Aim

To evaluate the feasibility and preliminary efficacy of an 8-week intervention-specifically, mindfulness for sex and intimacy in relationships (MSIR)-as a supplement to treatment as usual (TAU) as compared with only TAU in a clinical sample of men and women referred for sexual difficulties with or without a partner.

Methods

In this randomized controlled feasibility pilot study, 34 participants were randomized to MSIR + TAU (n = 15) or TAU (n = 19). Six healthy partners were also included in the study. MSIR was administered as 2 individual evaluations and six 2-hour group sessions of mixed gender and different types of sexual dysfunction.

Outcomes

The primary outcome measures were as follows: (1) feasibility, defined as the implementation of recruitment, acceptance, and attendance of intervention in daily clinical practice and the MSIR completion rate; (2) sexual functioning, as measured on a visual analog scale ("bothered by problem") and by validated questionnaires (Changes in Sexual Function Questionnaire for Females and Males, Female Sexual Function Index, Female Sexual Distress Scale, International Index of Erectile Function).

Results

MSIR was feasible and well received by patients, with high rates of acceptance and intervention completion. As compared with pretreatment, the MSIR + TAU group and TAU control group were significantly less bothered by their sexual problems at the end of treatment, but the change was significantly larger in the MSIR + TAU group (P = .04). Participants in the MSIR + TAU group did not receive fewer TAU sessions than the TAU group (MSIR + TAU mean, 6 sessions; TAU mean, 8 sessions).

Clinical Implications

MSIR could be effectively used in a clinical setting as an add-on to TAU in the treatment of female and male sexual dysfunction and healthy partners.

Strengths and Limitations

The major strength of the study is that it is a randomized controlled study. This study is novel in the sense that it included men and women with different types of sexual dysfunction in the same mindfulness group. Limitations include the pilot nature of the study (e.g. a small sample size), and statistical conclusions should be made with caution. More accurate results may be found in a larger sample.

Conclusion

Results from this study support already existing evidence that mindfulness-based interventions are feasible and effective for targeting sexual dysfunctions in men and women.

Effects of Hormonal Profile, Weight, and Body Image on Sexual Function in Women with Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a hyperandrogenic endocrinological disorder associated with chronic oligo-anovulation and polycystic ovarian morphology. Compared to women without PCOS, women with PCOS have a risk of sexual dysfunction that is more than 30% higher. Although alterations in sex hormones and psychosocial wellbeing have been proposed, the precise mechanisms of FSD in PCOS remain unclear. The aim of our study was to analyze how the hormonal, clinical and psychometric parameters of PCOS patients are involved in the development of sexual dysfunction. The study group consisted of 54 women, aged between 21 and 32 years, diagnosed with PCOS. We collected the following parameters: age, body mass index (BMI), the Ferriman-Gallwey score (FG), maximum duration of oligomenorrhea, abdominal circumference (AC), free testosterone value (FT), luteinizing hormone/follicle stimulating hormone (LH/FSH) ratio value, serum cortisol value and ovarian ultrasound appearance. At the time of the examination, patients were asked to fill in the Female Sexual Function Index (FSFI) and the Body Exposure during Sexual Activities Questionnaire (BESAQ). Statistically significant differences were observed between normal weight and overweight women regarding BESAQ (p-value = 0.02) and FSFI total (p-value <0.001). Elevated BMI, AC or BESAQ scores correlated with a lower FSFI score. The most involved domains of the scale were orgasm, arousal, and desire. Elevated BESAQ scores increase the risk of female sexual dysfunction (FSD) by 4.24 times. FT, BESAQ score, BMI, and LH/FSH ratio were found to independently predict FSD. The cutoff point for the BESAQ score in detecting FSD was found to be 1.97. Weight, body image and anxiety related to sexual activities seem to be significant components in the development of sexual dysfunction in PCOS patients, beyond the effect due to hyperandrogenism. FT value has a U-shape effect in sexual dysfunction, because both in the case of deficit and in the case of excess, sexual function is impaired. BESAQ is a strong predictor for sexual dysfunction in women with PCOS, along with FT value, LH/FSH ratio and BMI.

The Associations between Kidney Function and Sexual Dysfunction among Males and Females with Type 2 Diabetes Mellitus

Background and Objectives: Diabetic kidney disease (DKD), expressed either as albuminuria, low estimated glomerular filtration rate (eGFR) or both, and sexual dysfunction (SD), are common complications among type 2 diabetes mellitus (T2DM) patients. This study aims to assess whether an association exists between DKD and SD, erectile dysfunction (ED) or female sexual dysfunction (FSD) in a T2DM population. Materials and Methods: A cross-sectional study was designed and conducted among T2DM patients. The presence of SD was assessed using the International Index of Erectile Function and the Female Sexual Function Index questionnaires for males and females, respectively, and patients were evaluated for DKD. Results: Overall, 80 patients, 50 males and 30 females, agreed to participate. Sexual dysfunction was present in 80% of the study population. Among the participants, 45% had DKD, 38.5% had albuminuria and/or proteinuria and 24.1% had an eGFR below 60 mL/min/1.73 m². The eGFR was associated with SD, ED and FSD. Moreover, SD and ED were proven as significant determinants for lower eGFR values in multiple linear regression analyses. DKD was associated with lower lubrication scores and eGFR was associated with lower desire, arousal, lubrication and total scores; however, the multivariate linear regression analyses showed no significant associations between them. Older age resulted in significantly lower arousal, lubrication, orgasm and total FSFI scores. Conclusions: SD is commonly encountered in older T2DM patients and DKD affects almost half of them. The eGFR has been significantly associated with SD, ED and FSD, while SD and ED were proven to be significant determinants for the eGFR levels.

Adverse childhood experiences and sexual dysfunction in midlife women: Is there a link?

BACKGROUND

One in 3 children has had at least 1 adverse childhood experience (ACE), and ACEs have been associated with multiple medical and psychiatric morbidities in women later in life, including greater menopause symptom burden.

AIM

To evaluate the association between ACEs and female sexual dysfunction (FSD) in midlife women.

METHODS

A cross-sectional analysis from DREAMS-the Data Registry on Experiences of Aging, Menopause, and Sexuality-was conducted with questionnaires completed by women aged 40 to 65 years who presented to a women's health clinic at Mayo Clinic in Rochester, Minnesota, from May 2015 to December 2016. History of ACEs was obtained with the validated ACE questionnaire. FSD was assessed by the Female Sexual Function Index and the Female Sexual Distress Scale-Revised.

OUTCOMES

The association between ACEs and FSD (defined as Female Sexual Function Index score ≤26.55 and Female Sexual Distress Scale-Revised score ≥11) was evaluated via a multivariable logistic regression model, adjusting for age, menopause status, hormone therapy use, anxiety, depression, relationship satisfaction, hot flash severity, and history of abuse in the past year.

RESULTS

Women (N = 1572) had a mean age of 53.2 years. Overall 59% reported having at least 1 ACE. When compared with no ACEs, a history of ≥4 ACEs significantly increased the odds of not being sexually active (odds ratio, 1.83; 95% CI, 1.30-2.57; P < .001). Among sexually active women, the proportion of women with FSD increased sequentially as the number of ACEs increased. In the univariate analysis, a history of ≥4 ACEs significantly increased the odds of FSD as compared with no ACEs (odds ratio, 2.12; 95% CI, 1.50-2.99; P < .001). The association remained statistically significant in the multivariable analysis after adjusting for confounders (odds ratio, 1.75; 95% CI, 1.15-2.68; P = .009).

CLINICAL IMPLICATIONS

The findings highlight an opportunity for clinicians to screen for ACEs in women with sexual dysfunction and offer appropriate treatment and counseling as indicated.

STRENGTHS AND LIMITATIONS

Strengths of the study include the large cohort, the use of validated tools for assessment of ACEs and FSD, and the adjustment for multiple potential confounding factors. Limitations include the cross-sectional study design, recall bias in reporting ACEs and recent abuse, and the low representation of racially and ethnically diverse women in the cohort.

CONCLUSION

The study demonstrates an increased risk of sexual inactivity and sexual dysfunction in midlife women who experienced childhood adversity. The sexual dysfunction in women with ACEs seems to be independent of other factors that potentially affect female sexual function in midlife.

Women's sexual activity and experiences following female genital fistula surgery

BACKGROUND

Surgical repair has a transformative impact on the lives of women affected by female genital fistula; however, various physical, social, and economic challenges may persist postrepair and prevent complete reengagement in relationships and communities. Nuanced investigation of these experiences is needed to inform programming that aligns with women's reintegration needs.

AIM

We investigated the sexual activity resumption, experiences, and concerns of women in Uganda during the year following genital fistula repair surgery.

METHODS

Women were recruited from Mulago Hospital between December 2014 and June 2015. We collected data at baseline and 4 times postsurgery about sociodemographic characteristics and physical/psychosocial status; we also assessed sexual interest and satisfaction twice. We performed in-depth interviews with a subset of participants. We analyzed quantitative findings via univariate analyses, and qualitative findings were coded and analyzed thematically.

OUTCOMES

We assessed sexual readiness, fears, and challenges following surgical repair of female genital fistula using quantitative and qualitative measures of sexual activity, pain with sex, sexual interest/disinterest, and sexual satisfaction/dissatisfaction.

RESULTS

Among the 60 participants, 18% were sexually active at baseline, which decreased to 7% postsurgery and increased to 55% at 1 year after repair. Dyspareunia was reported by 27% at baseline and 10% at 1 year; few described leakage during sex or vaginal dryness. Qualitative findings showed wide variance of sexual experiences. Some reported sexual readiness quickly after surgery, and some were not ready after 1 year. For all, fears included fistula recurrence and unwanted pregnancy.

CONCLUSION

These findings suggest that postrepair sexual experiences vary widely and intersect meaningfully with marital and social roles following fistula and repair. In addition to physical repair, ongoing psychosocial support is needed for comprehensive reintegration and the restoration of desired sexuality.

HIGHLIGHTS

Female sexual health digital resources: women and health care providers need more options

INTRODUCTION

Female sexual health and female sexual dysfunction (FSD) are usually poorly diagnosed and treated because of the numerous barriers providers and patients face. Internet platforms, such as mobile applications (apps) are potential tools that help overcome these barriers and improve patient access to education and management options for FSD.

OBJECTIVES

The aim of this review was to identify existing applications on female sexual health and evaluate their educational content and services.

METHODS

We searched the internet and Apple App Store using multiple keywords. A panel of physicians specialized in the treatment of FSD reviewed the apps for content quality, the scientific basis of provided information, interactivity, usability, and whether they would recommend it as a reference tool for patients.

RESULTS

Of the 204 apps identified, 17 met the inclusion criteria and were reviewed further. The selected apps were organized into groups based on common themes such as educational (n = 6), emotions and communication (n = 2), relaxation and meditation (n = 4), general sexual health (n = 2), and social and fun (n = 3). All apps from the educational category provided scientific information in collaboration with health experts. When assessed for usability, 1 app received good and 5 received excellent scores based on the System Usability Scale. Most apps (n = 5) provided information on pathology and treatments of orgasmic dysfunction, but only 1 app, created by a physician, provided comprehensive information on all the types of FSD.

CONCLUSION

Digital technology could be an effective way to overcome barriers to accessing information and ultimately care for female sexual health. Our review demonstrated that there is still a need for more accessible educational resources addressing female sexual health and FSD for patients and providers.

Female sexual dysfunction in chronic obstructive pulmonary disease

Background

Sexual life of women with chronic obstructive pulmonary disease (COPD) can be affected by breathing difficulties, a decrease in functional status, depressive mood and fatigue.

Objetive

To evaluate the sexual dysfunction in female COPD patients and the possible explanatory mechanisms or correlations between these conditions.

Methods

The study included 70 female patients with COPD aged between 36-65 and 70 age-matched controls. All the subjects completed questionnaires for the Female Sexual Functional Index (FSFI), BECK depression inventory and, spirometry.

Results

Statistically significant sexual dysfunction was noted in COPD patients compared to the non-COPD group (p<0.001). BECK depression inventory scores of the COPD patients were also significantly lower (p<0.001). no correlation between FSFI and BECK depression scores in 'patients' characteristics (r=-0.055, p=0.651). No significant difference was found in age, forced expiratory volume (FEV)1%, and exacerbation history of the previous year according to severity of depression (p>0.005). In linear regression analysis determining depression, no statistically significant factor was found among age, number of comorbidities, and FEV1/ forced vital capacity (FVC) % predicted (p>0.05). In multivariable analysis, only fatigue during intercourse was found to be a statistically significant factor in predicting sexual dysfunction among factors like age, presence of comorbidities, duration of the disease, smoking status, FEV1%, m MRCpoints, 6-minutes walk test, BECK depression scores (p=0.008).

Conclusion

Sexual dysfunction is reported in many COPD females and seems to be related not to spirometric measures or exercise capacity but to fatigue. Depression is also a common comorbidity, of which both disorders are often neglected.

Sexual function remains persistently low in women after treatment for colorectal cancer and anal squamous cell carcinoma

BACKGROUND

Women diagnosed with colorectal cancer (CRC) or anal squamous cell carcinoma (ASCC) are at high risk of sexual dysfunction after treatment, yet little is known about recovery and risk factors for chronic dysfunction.

AIM

We aimed to describe sexual function and sexual activity among women who underwent definitive treatment for CRC or ASCC, examine relationships between time since treatment completion and sexual function, and explore factors associated with desire and changes in sexual desire over time.

METHODS

As part of a prospective cohort study of patients with gastrointestinal cancer at the University of California San Francisco, female-identifying participants who finished definitive treatment for CRC or ASCC completed the Female Sexual Function Index (FSFI) at 6- to 12-month intervals. We used multivariable linear mixed models to explore factors associated with the FSFI desire subscale.

OUTCOMES

Outcomes were rates of sexual activity, proportion at risk for sexual dysfunction (FSFI score <26.55), total FSFI score, and FSFI desire subscale.

RESULTS

Among the 97 cancer survivors who completed at least 1 FSFI, the median age was 59 years, the median time since treatment end was 14 months, and 87% were menopausal. Fifty-five women (57%) had a history of colon cancer; 21 (22%), rectal cancer; and 21 (22%), ASCC. An additional 13 (13%) had a current ostomy. Approximately half the women were sexually active (n = 48, 49%). Among these 48 sexually active women, 34 (71%) had FSFI scores indicating risk for sexual dysfunction. Among the 10 sexually active women who completed a FSFI ≥2 years since end of treatment, the median total score was 22.6 (IQR, 15.6-27.3). None of the evaluated characteristics were associated with desire (age, tumor site, treatment, menopause status, or ostomy status).

CLINICAL IMPLICATIONS

Consistent with prior studies, we found low desire scores after treatment for CRC or ASCC, with little recovery over time, suggesting that patients should not expect an eventual rebound of sexual function.

STRENGTHS AND LIMITATIONS

Strengths of our study include longitudinal data and use of the validated FSFI. Women with ASCC composed 22% of our cohort, allowing for insight into this rare disease group. Limitations of this study include the small sample size, particularly for longitudinal analyses, and the enrollment of patients at variable times since treatment end.

CONCLUSION

We observed a high prevalence of sexual health concerns, including low desire, after the treatment of CRC and ASCC that persisted for years after treatment was completed.

Clitoral adhesions: a review of the literature

INTRODUCTION

Clitoral adhesions occur when the prepuce adheres to the glans. These adhesions have been found in up to 22% of women seeking evaluation for sexual dysfunction. The etiology of clitoral adhesions remains largely unclear. Studies published to date on the presentation and management of clitoral adhesions are relatively recent and raise questions for future research.

OBJECTIVES

We sought to provide a background of existing knowledge on the prevalence, presentation, etiology, associated conditions, and management of clitoral adhesions and to identify areas for future research.

METHODS

A review of literature was performed for studies that investigate clitoral adhesions.

RESULTS

Conditions associated with chronic clitoral scarring appear to have a role in the development of clitoral adhesions. Symptoms include clitoral pain (clitorodynia), discomfort, hypersensitivity, hyposensitivity, difficulty with arousal, and muted or absent orgasm. Complications include inflammation, infection, and the development of keratin pearls and smegmatic pseudocysts. There are surgical and nonsurgical interventions to manage clitoral adhesions. Additionally, topical agents can be included in conservative and/or postprocedural management. Although many studies on clitoral adhesions are limited to patients with lichen sclerosus (LS), clitoral adhesions are not confined to this population.

CONCLUSION

Areas for future research include etiologies of clitoral adhesion; such knowledge is imperative to improve prevention and management. Also, in previous studies, patients were instructed to apply various topical agents and manually retract the prepuce for conservative management or postlysis care. However, the efficacy of these interventions has not been investigated. Surgical and nonsurgical lysis procedures have been described for the management of pain and difficulties with arousal and orgasm that are causes of the sexual dysfunction associated with clitoral adhesion. Although previous studies have assessed efficacy and patient satisfaction, many of these studies were limited to small sample sizes and focused solely on patients with LS. Future studies are needed to inform a standard of care for the management of clitoral adhesions.

Changes in sexual activities, function, and satisfaction during the COVID-19 pandemic era: a systematic review and meta-analysis

Introduction

Little is known about the impact of the coronavirus on sexual behavior, function, and satisfaction.

Aim

The aim of the present study was to systematically review people’s sexual function and behaviors and their changes in sexual activities during the COVID-19 pandemic.

Methods

Comprehensive searches in PubMed, Web of Science, and Scopus were conducted with keywords in accordance with MeSH terms: COVID-19, SARS-CoV-2, coronavirus, sexual health, sexual function, sexual dysfunctions, sexuality, sexual orientation, sexual activities, and premarital sex. Two reviewers independently assessed full-text articles according to predefined criteria: original design, English studies, and investigating either the general population or sexual minorities.

Results

Risk of bias in the studies was assessed by the Newcastle-Ottawa Scale, and data were pooled via random effects meta-analyses. We utilized the standardized mean difference to evaluate the effects of the COVID-19 pandemic on sexual activity, functioning, and satisfaction. We included 19 studies in the analysis and 11 studies in the meta-analysis, with a sample size of 12 350. To investigate sexual activity changes, a sample size of 8838 was entered into the subgroup analysis, which showed a significant decrease in both genders (5821 women, P < .033; 3017 men, P < .008). A subgroup meta-analysis showed that the sexual function of men and women during the COVID-19 pandemic significantly declined (3974 women, P < .001; 1427 men, P < .001). Sexual desire and arousal decreased in both genders, though mainly in women. In investigating sexual satisfaction changes during the COVID-19 pandemic, a meta-analysis with a sample size of 2711 showed a significant decrease (P < .001). The most indicative changes in sexual behaviors during the pandemic were the increase in masturbating and usage of sex toys. Greater COVID-19 knowledge was associated with lower masturbation, oral sex, and vaginal sex. The more protective behaviors were associated with less hugging, kissing, cuddling, genital touching, watching porn with a partner, and vaginal sex.

Conclusion

The COVID-19 pandemic led to increased challenges and changes for individuals’ sexual behaviors. Efforts for preventive strategies should therefore be concentrated between pandemics, while ensuring that there is information available to the population during a pandemic for help in times of psychological distress or crisis.

Premenstrual dysphoric disorder and sexual function: a narrative review

INTRODUCTION

Premenstrual dysphoric disorder (PMDD) and female sexual dysfunction (FSD) are 2 prevalent illnesses in women that cause distress and affect quality of life. There are plausible biological, social, and psychological links between these 2 conditions. Nevertheless, few studies have examined sexual function in women with PMDD.

OBJECTIVES

In this narrative review we summarize the existing literature on sexual function in women with PMDD and with the broader diagnostic classification of premenstrual syndrome and discus the differences between PMDD and more general premenstrual symptomatology, as well as why studying sexual function specifically in PMDD is necessary. We explored reasons why these 2 illnesses may be comorbid and the importance of studying sexual function in this population of women.

METHODS

PubMed literature searches were conducted using relevant keywords.

RESULTS

Currently, there are few studies examining PMDD and FSD, and the studies available have significant methodologic limitations.

CONCLUSIONS

Investigation of sexual function in women with PMDD is needed. Awareness of the comorbidities for PMDD and FSD can allow implementation of targeted interventions for women suffering from these disorders.

Sexual dysfunction in women with systemic autoimmune rheumatic disorders: a systematic review and meta-analysis

OBJECTIVES

In women with systemic autoimmune rheumatic diseases (SARDs), female sexual dysfunction (SD) remains underestimated. We aimed to explore the prevalence and correlates of SD in females with SARDs.

METHODS

We performed a systematic review and meta-analysis of studies assessing the prevalence of SD and the pooled Female Sexual Function Index (FSFI) scores in this setting (PROSPERO: CRD42021287346). We searched PubMed, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) databases and grey literature until February 2022. We evaluated the quality of the selected records using the Hoy Risk of Bias tool. A random-effects meta-analysis of proportions with the double arcsine transformation was conducted. Subgroup and sensitivity analyses, as well as meta-regression of important correlates, were conducted.

RESULTS

We included 68 studies with 5457 females diagnosed with a SARD (mean age: 43.7 [12.9] years). The overall SD prevalence was 63% (95% CI: 56, 69%, I2 = 94%) and the overall FSFI total score was 19.7 points (95% CI: 18.4, 21, I2 = 97%). Including only sexually active females, the SD prevalence was estimated as 60% (95% CI: 53, 67%, I2 = 88%), whereas the FSFI total score was 22 points (95% CI: 20.8, 23.1, I2 = 93%). Across the different SARDs, women with Sjögren's syndrome and systemic sclerosis reported the highest levels of SD (74%, 95% CI: 58, 87%, I2 = 84% and 69%, 95% CI: 54, 83%, I2 = 94%, respectively).

CONCLUSION

Sexual function in females with SARDs seems to be severely impaired, irrespective of the type of SARD. Screening and treatment of SD in females with SARDs should become an integral part of healthcare clinical practice.

Symptoms and associated impact in pre- and postmenopausal women with sexual arousal disorder: a concept elicitation study

BACKGROUND

Approximately 26% of adult women in the United States suffer from female sexual arousal disorder (FSAD), yet little has been done to compare the experience of FSAD in pre- and postmenopausal women, which is critical to enhance the current understanding of FSAD and inform the development and assessment of treatment options for these patient populations.

AIM

To explore the experience of condition-associated symptoms and the relative importance of FSAD symptoms, including their severity, bother, and impact, on participants' health-related quality of life (HRQoL) in pre- and postmenopausal women with FSAD.

METHODS

In-depth, qualitative, semistructured concept elicitation interviews were conducted with premenopausal (n = 23) and postmenopausal (n = 13) women who were clinically diagnosed with FSAD by a trained sexual medicine clinician. All interviews were audio recorded and transcribed verbatim by a professional transcription company. Thematic analysis was performed with the assistance of NVivo qualitative analysis software.

OUTCOMES

Outcomes included qualitative interview data about FSAD symptoms and HRQoL, as well as a comparison between pre- and postmenopausal populations.

RESULTS

The most frequently reported symptom in both cohorts was "inability or difficulty with orgasm" (premenopausal, n = 21; postmenopausal, n = 13). The symptom that premenopausal women most desired to have treated was lubrication, and for postmenopausal women, it was a lack of lubrication or wetness and loss of feeling/sensation. In total, 21 of 23 premenopausal women and all 13 postmenopausal women reported a lack of feeling or sensation in the genitals. The most frequently reported HRQoL impact in both groups was decreased confidence.

CLINICAL IMPLICATIONS

Results from this study suggest that the manifestation and experience of FSAD are similar in pre- and postmenopausal women and that the unmet need for an FSAD treatment in the postmenopausal population is just as great as that of the premenopausal population.

STRENGTHS AND LIMITATIONS

This study involved in-depth qualitative interviews with a relatively small group of women (N = 36) recruited from only 5 study sites across the United States.

CONCLUSION

The analysis of qualitative data from the concept elicitation interviews revealed a substantial physical and emotional burden of FSAD, underscoring the need for Food and Drug Administration-approved treatment options for pre- and postmenopausal women with FSAD.