Development and validation of the Female Sexual Function Index adaptation for breast cancer patients (FSFI-BC)

Female Sexual Function Index Adaptation for Breast Cancer Patients (FSFI-BC): Brazilian Portuguese Translation and Cultural Adaptation

BACKGROUND

The assessment of female sexual function after diagnosis and treatment of breast cancer is relevant, as cancer can negatively affect sexuality and, therefore, quality of life. Instruments assessing female sexuality can be useful in clinical practice. However, there are few validated instruments available for this purpose. This study aimed to translate the Female Sexual Function Index Adaptation for Breast Cancer Patients (FSFI-BC) into Brazilian Portuguese and culturally adapt it for use in Brazil.

PATIENTS AND METHODS

Translation and cross-cultural adaptation followed the linguistic validation process, according to international guidelines. The instrument was translated and back-translated by independent translators. Sixty women aged 25 to 70 years who had been diagnosed and surgically treated for breast cancer at least 6 months previously participated in the cultural adaptation process. Participants were stratified into sexually active or inactive. Internal consistency was analyzed using Cronbach's alpha coefficient.

RESULTS

Mean participant age was 52.5 years. For sexually active women, reliability analysis (Cronbach's alpha) showed excellent internal consistency between the items of the subscales 'Desire/Arousal' (α = 0.912) and 'Orgasm' (α = 0.904), and good internal consistency for 'Lubrication' (α = 0.814) and 'Pain' (α = 0.839). For sexually inactive women, excellent internal consistency was observed between the items of the subscale 'Reason for Inactivity - difficulty lubricating' (α = 0.930), and good internal consistency for the other subscales. The instrument had face and content validity.

CONCLUSIONS

FSFI-BC was translated and culturally adapted to the context of the Brazilian population.

Sexual function index adaptation for breast cancer patients (FSFI-BC)- translation and psychometric properties of Persian version

BACKGROUND

Effective interventions to improve sexual dysfunction in breast cancer survivors need screening of these dysfunctions with a suitable instrument. The aim of present study was translation and identifying psychometric properties of Female Sexual Function Index - Adapted for Breast Cancer (FSFI-BC) which has been specifically developed for breast cancer survivors.

METHOD

This methodological study was performed between February 2017 and October 2018. 200 breast cancer survivors in stage 1 or 2 who were selected through convenience sampling method, completed the questionnaire. Reliability was assessed by Cronbach's alfa and test re-test analysis and construct validity was performed through confirmatory (CFA) and exploratory factor analysis( EFA).

RESULTS

Six factors were extracted in exploratory factor analysis (EFA). These factors explained 74.6% of the total variance in in NSA group and 0.821 in SA group. Reliability evaluation indicated high internal consistency and good test re-test reliability. Cronbach's alpha coefficient in all areas of the tool was above 0.7 (the lowest and the highest measures were 0.885 and 0.945, respectively), which is a good indicator for reliability of an instrument. Confirmatory factor analysis showed an acceptable fitness for seven factors of FSFI-BC questionnaire (Normed Fit Index or NFI = 0.9 for both groups, Comparative of Fit Index or CFI = 0.93 and 0.92, χ 2/df = 1.68 and 1.71 for SA(Sexually Active) and NSA(No Sexually Active) individuals, respectively) .

CONCLUSION

Study findings suggest that Persian version of FSFI-BC is a suitable instrument for sexual dysfunction screening in breast cancer survivors.

Sexual dysfunction in women with breast cancer of Northeast Brazil: a retrospective longitudinal study

Breast cancer treatment leads to physical and psychological changes. The aim of this study was to analyze the incidence of sexual dysfunction and its risk factors in women diagnosed with breast cancer. This retrospective cohort study included women diagnosed and treated for breast cancer (exposed group, n = 90) and healthy women (non-exposed group, n = 93). Data were collected from February 2019 to October 2021 in the state of Rio Grande do Norte (Northeast Brazil), from medical records and using the Female Sexual Function Index (FSFI) questionnaire. Data were collected from medical records and using the Female Sexual Function Index (FSFI) questionnaire. Primary outcomes were analyzed using binary logistic regression. The Mann-Whitney test was used to analyze FSFI domains between groups. The exposed group had a 74% incidence of sexual dysfunction and 3.9 times increased chances of having sexual dysfunction compared with the non-exposed group (OR 3.9, CI 1.8 to 8.2, p < 0.001). Presence of comorbidities increased the chances of sexual dysfunction by 2.5 times (OR 2.5, CI 1.2 to 4.9, p = 0.009). Women diagnosed and treated for breast cancer had a higher incidence of sexual dysfunction than healthy women. Furthermore, comorbidities also increased the chances of sexual dysfunction regardless of exposure to breast cancer.

Vaginal Laser Treatment for the Genitourinary Syndrome of Menopause in Breast Cancer Survivors: A Narrative Review

Vulvovaginal atrophy (VVA) is a chronic condition resulting from reduced estrogen levels during menopause. The North American Menopause Society and the International Society for the Study of Women's Sexual Health suggested the term "genitourinary syndrome of menopause" (GSM) to indicate the broader aspects of VVA. Breast cancer treatments, such as chemotherapy and endocrine therapy, can induce early and abrupt menopausal symptoms, including GSM, which negatively affects sexual function and the quality of life of the survivors. Vaginal laser therapy has emerged as a safe and effective option for the management of GSM in breast cancer survivors (BCSs). Two main types of lasers, the non-ablative erbium:YAG laser and fractional microablative CO2 vaginal laser, have been evaluated for GSM treatment. While there are few randomized controlled trials (RCTs) on the subject of BCSs, a wealth of prospective and retrospective studies have highlighted the beneficial effects of vaginal laser therapy on the symptoms of VVA, vaginal health, sexual function, and overall quality of life. More comprehensive research is essential to confirm its enduring effectiveness and safety, with a focus on conducting standardized and meticulously controlled investigations. This study is a narrative review that summarizes clinical trials ranging from the earliest to the most recent ones on laser treatment for GSM in BCSs.

Emerging Use of Vaginal Laser to Treat Genitourinary Syndrome of Menopause for Breast Cancer Survivors: A Review

Breast cancer treatment, such as chemotherapy and endocrine therapy, can cause earlier and more sudden menopausal symptoms. Genitourinary syndrome of menopause (GSM) is one of the most bothersome side effects of breast cancer treatment, resulting in sexual dysfunction and impaired quality of life. GSM includes genital, urinary, and sexual symptoms. However, alleviating symptoms of GSM for breast cancer survivors may be challenging due to ineffectiveness, contraindications, and low adherence to treatment. The most recent data show the feasibility and safety of vaginal laser to treat GSM for breast cancer survivors. This narrative review provides the aspects of GSM in breast cancer patients, putting the focus on the efficacy and safety of vaginal laser therapy.

Opioid-Induced Sexual Dysfunction in Cancer Patients

Simple Summary

Sexual disorders affect up to 80% of cancer patients, depending on the type of cancer, yet they are commonly overlooked and untreated. Opioid-induced sexual dysfunction (OISD) is reported in half of opioid users. The pathophysiology of OISD—still a subject for research—may include disorders of both the endocrine and nervous systems, expressed in, among other things, erectile dysfunction and declined sexual desire, sexual arousal, orgasm, and general satisfaction with one’s sex life. The etiology of sexual dysfunction in cancer patients is usually multifactorial, so the management should be multifaceted and individualized by targeting pathophysiological factors. The treatment options for OISD are few and include testosterone replacement therapy, bupropion, opioid antagonists, phosphodiesterase type 5 inhibitors, plant-derived substances, and non-pharmacological treatments, although the evidence is insufficient. One of the treatment options may also be a choice of an opioid that is less likely to cause sexual dysfunction, yet further research is necessary.

Abstract

Sexual dysfunction is common in patients with advanced cancer, although it is frequently belittled, and thus consistently underdiagnosed and untreated. Opioid analgesics remain fundamental and are widely used in cancer pain treatment. However, they affect sexual functions primarily due to their action on the hypothalamus–pituitary–gonadal axis. Other mechanisms such as the impact on the central and peripheral nervous systems are also possible. The opioid-induced sexual dysfunction includes erectile dysfunction, lack of desire and arousal, orgasmic disorder, and lowered overall sexual satisfaction. Around half of the individuals taking opioids chronically may be affected by sexual dysfunction. The relative risk of sexual dysfunction in patients on chronic opioid therapy and opioid addicts increased two-fold in a large meta-analysis. Opioids differ in their potential to induce sexual dysfunctions. Partial agonists and short-acting opioids may likely cause sexual dysfunction to a lesser extent. Few pharmaceutical therapies proved effective: testosterone replacement therapy, PDE5 inhibitors, bupropion, trazodone, opioid antagonists, and plant-derived medicines such as Rosa damascena and ginseng. Non-pharmacological options, such as psychosexual or physical therapies, should also be considered. However, the evidence is scarce and projected primarily from non-cancer populations, including opioid addicts. Further research is necessary to explore the problem of sexuality in cancer patients and the role of opioids in inducing sexual dysfunction.

Breast-Specific Sensuality in Breast Cancer Survivors: Sexually Active or Not

BACKGROUND

We sought to better understand breast-specific sensuality (BSS) in sexually inactive breast cancer survivors.

METHODS

We conducted an anonymous cross-sectional survey of breast cancer survivors during surveillance appointments from 2014 to 2016. Sexual inactivity was defined as no sexual activity within 4 weeks prior. Categorical data were analyzed using Fisher's exact test. Multiple logistic regression adjusted for age and menopausal status, and Firth's bias correction accommodated sparse data.

RESULTS

Of 585 respondents, 546 (93.3%) were between the ages of 40 and 79 years, of whom 285 (48.7%) were sexually inactive. Favorable post-treatment appearance satisfaction was reported by 413 (71.0%) respondents. Sexually inactive respondents were more likely to score discomfort with their partner seeing their chest after surgery compared with sexually active respondents (41 [20.4%] vs. 34 [11.4%]; p = 0.002). Both sexually inactive and active respondents reported that their chest was important in intimacy after surgery but at significantly different rates (117 [44.3%] vs. 217 [72.6%]; p < 0.001). Post-surgical appearance satisfaction for sexually inactive respondents was positively associated with level of comfort with partner seeing their chest after surgery (p < 0.001) and with rating of a pleasurable caress of the treated breast (p < 0.001).

CONCLUSIONS

Over 40% of sexually inactive respondents reported their chest was important in intimacy after surgery, suggesting that BSS may be a route to intimacy for sexually inactive breast cancer survivors. Post-surgical breast appearance satisfaction significantly correlated with comfort being seen by one's partner and appreciation of a pleasurable breast caress. Optimizing breast cancer surgical aesthetic outcomes may improve survivorship.

A psychometric evaluation of the Female Sexual Function Index in women treated for breast cancer

Background

We aimed to determine the psychometric properties and factor structure of the 19‐item Female Sexual Function Index (FSFI) in 132 sexually active women previously treated for breast cancer.

Methods

Confirmatory factor analysis explored three models: (a) second‐order six‐factor, (b) six‐factor, and (c) five‐factor models combining the desire and arousal subscales.

Results

Results revealed excellent reliability for the total score (Cronbach's α = 0.94), and domain scores (all Cronbach's αs > 0.90), and good convergent and discriminant validity. The six‐factor model provided the best fit of the models assessed, but a marginal overall fit (Tucker–Lewis index = 0.91, comparative fit index = 0.93, root mean square error of approximation = 0.09). Exploratory factor analyses (EFA) supported a four‐factor structure, revealing an arousal/orgasm factor alongside the original pain, lubrication, and satisfaction domains.

Conclusion

The arousal/orgasm factor suggests a “sexual response” construct, potentially arising from an underlying latent factor involving physical and mental stimulation in conceptualizations of arousal and orgasm in women treated for breast cancer. Finally, the EFA failed to capture an underlying desire factor, potentially due to measurement error associated with the small number of items (two) in this domain. Despite evidence that the FSFI has sound psychometric properties, our results suggest that the current conceptualizations of the FSFI might not accurately represent sexual functioning in women previously treated for breast cancer. Further research is required to elucidate the factors that influence desire, arousal, and orgasm in sexually active women in this population, and the reasons underlying sexual inactivity. Practical and theoretical implications for FSFI use in this population are discussed.

Factor structure, internal consistency and distribution of Female Sexual Function Index among Mexican women with early diagnostic of breast cancer

 Background: Female Sexual Dysfunction (FSD) occurs frequently in women with breast cancer due to oncologic treatments. It is essential to have a validated instrument to diagnose and quantify FSD in this population accurately. Objective: To validate the Female Sexual Function Index (FSFI). Method: The FSFI was applied to 272 sexually active Mexican women with recent diagnosis of breast cancer who had not initiated systemic cancer treatment. Results: The FSFI six-factor model is valid by confirmatory factor analysis, and the inventory and its factors have adequate internal consistency reliability. Conclusions: This study provides enough evidence about the reliability and factor structure of the FSFI questionnaire in the context of breast cancer clinical practice in Mexico.

Measurement invariance of Female Sexual Function Index: a study with heterosexual and lesbian Portuguese women

The Female Sexual Function Index is a powerful screening tool for female sexual dysfunction extensively used worldwide. Nonetheless, its factorial structure and psychometric properties have been tested almost exclusively with heterosexual samples. The current study aimed to testing the original factorial structure, reliability and temporal stability in two samples of women (heterosexual and lesbian), and to assess the measurement invariance across sexual orientation. An online sample of 752 Portuguese women (376 lesbian women and 376 heterosexual women) recruited between May 2012 and 2013 participated in the study and completed a sociodemographic questionnaire and the FSFI. For temporal stability, 30 Portuguese women were recruited online in May 2017. Confirmatory factor analysis, reliability analysis and temporal stability were assessed independently for each sample. Measurement invariance (configural, metric, and scalar) was also assessed. Main findings for both samples corroborate the six-factor structure and revealed excellent levels of temporal stability, with Cronbach alphas and McDonalds Omega of .95 for heterosexual sample, and .96 for lesbian women sample. Results corroborate measurement invariance (configural, metric, and scalar) across sample type. Overall, the FSFI revealed a good-fit for the six-factor model in both heterosexual and women sample, with excellent levels of reliability and temporal stability, and showed measurement invariance across sexual orientation. These findings support the use of the FSFI with lesbian women.

Benefits of a Multidisciplinary Women's Sexual Health Clinic in the Management of Sexual and Menopausal Symptoms After Pelvic Radiotherapy

OBJECTIVE

The objective of this study was to examine patterns of care and outcomes of female cancer patients treated for sexual and menopausal symptoms following pelvic radiotherapy (PRT) at our institution's multidisciplinary Sexuality, Intimacy, and Menopause (SIMS) Program.

MATERIALS AND METHODS

We performed a retrospective review of 69 female patients who received PRT for gynecologic or gastrointestinal malignancies and were referred for SIMS Program intervention. Indications for referral and treatment patterns were summarized. Preintervention and postintervention, patients were screened at follow-up visits, and symptoms were recorded. Statistics were performed using Stata 13.1.

RESULTS

Cancer types included cervical (53.6%), endometrial (31.9%), anorectal (5.8%), and vulvar/vaginal (8.7%). The median age was 48 years (interquartile range: 38 to 58 y). Patients were educated on vaginal lubricants, moisturizers, and dilator therapy both before and after PRT. Reasons for SIMS referral included persistent menopausal symptoms (50.7%), dyspareunia (40.6%), vaginal dryness (37.7%), decreased libido (17.4%), intimacy concerns (17.4%), and/or physical examination alterations (27.5%). SIMS interventions included vaginal estrogen (77.3%), nonhormonal climacteric interventions (53%), systemic hormone therapy (31.8%), dehydroepiandrosterone (4.6%), testosterone cream (4.6%), and/or psychological pharmacotherapy or counseling (13.6%). With a median follow-up of 36 months (interquartile range: 18 to 58 mo), sexual symptoms improved or were stable in 83.6%, while menopausal symptoms improved or were stable in 80.5%.

CONCLUSIONS

This study highlights the importance of multidisciplinary care in improving the sexual and menopausal symptoms of women after PRT. Future work examining the impact of intervention timing with respect to PRT and measures of patient satisfaction is warranted.

Effects of local laser treatment on vulvovaginal atrophy among women with breast cancer: a prospective study with long-term follow-up

PURPOSE

Women with breast cancer (BC) often suffer from severe vulvovaginal atrophy (VVA) which ultimately leads to poor sexual and urinary quality of life. We conducted a prospective study among women with BC and VVA, in order to evaluate the long-term effect of laser therapy on VVA.

METHODS

Women with BC and VVA were proposed to have fractional microablative CO₂ laser therapy (MonaLisaTouch®, DEKA) once per month for 3 months. Efficacy of laser therapy was assessed at baseline, 6 months and 18 months after treatment, using Female Sexual Function Index (FSFI) score, Ditrovie score and vaginal pH. A pap smear was also performed and the epithelial maturation pattern was noted. Paired statistical tests were used to compare results between baseline, 6 months and 18 months.

RESULTS

46 women with BC (median age [interquartile range] 56.5 years [47.0 - 59.4]) were included between May and October 2018. PH level slightly decreased over time (mean Δ at 18 months -0.3, SD = 0.7, p = 0.02) whereas maturation pattern on pap smear did not change. Sexual quality of life was significantly improved at 6 months and 18 months (mean Δ at 6 months 8.3, SD = 6.2 (p < 0.0001) and mean Δ at 18 months 4.3, SD = 8.4 (p = 0.01)). Ditrovie total score improved at 6 months (mean Δ -1.2, SD = 2.7, p = 0.01) but returned to baseline afterwards. Side effects were very mild. Three women developed low (2)- and high (1)-grade HPV-linked cervical lesions during follow-up.

CONCLUSION

Among women with BC, fractional microablative CO₂ laser is effective on the long term on VVA symptoms and gynaecological quality of life.

TRIAL REGISTRATION NUMBER

ID-RCB 2018-A01500-55.

Patient-reported outcomes in the Translational Breast Cancer Research Consortium

Members of the Translational Breast Cancer Research Consortium conducted an expert-driven literature review to identify a list of domains and to evaluate potential measures of these domains for inclusion in a list of preferred measures. Measures were included if they were easily available, free of charge, and had acceptable psychometrics based on published peer-reviewed analyses. A total of 22 domains and 52 measures were identified during the selection process. Taken together, these measures form a reliable and validated list of measurement tools that are easily available and used in multiple cancer trials to assess patient-reported outcomes in relevant patients.

The Female Sexual Function Index (FSFI)-A Systematic Review of Measurement Properties

INTRODUCTION

The Female Sexual Function Index (FSFI) is a patient-reported outcome measure measuring female sexual dysfunction. The FSFI-19 was developed with 6 theoretical subscales in 2000. In 2010, a shortened version became available (FSFI-6).

AIM

To investigate the measurement properties of the FSFI-19 and FSFI-6.

METHODS

A systematic search was performed of Embase, Medline, and Web of Science for studies that investigated measurement properties of the FSFI-19 or FSFI-6 up to April 2018. Data were extracted and analyzed according to COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. Evidence was categorized into sufficient, insufficient, inconsistent, or indeterminate, and quality of evidence as very high, high, moderate, or low.

MAIN OUTCOME MEASURES

The Main Outcome Measure is the evidence of a measurement property, and the quality of evidence based on the COSMIN guidelines.

RESULTS

83 studies were included. Concerning the FSFI-19, the evidence for internal consistency was sufficient and of moderate quality. The evidence for reliability was sufficient but of low quality. The evidence for criterion validity was sufficient and of high quality. The evidence for structural validity was inconsistent of low quality. The evidence for construct validity was inconsistent of moderate quality. Concerning the FSFI-6, the evidence for criterion validity was sufficient of moderate quality. The evidence for internal consistency was rated as indeterminate. The evidence for reliability was inconsistent of low quality. The evidence for construct validity was inconsistent of very low quality. No information was available on structural validity of the FSFI-6, and measurement error, responsiveness, and cross-cultural validity of both FSFI-6 and FSFI-19.

CLINICAL IMPLICATIONS

Conflicting and lack of evidence for some of the measurement properties of the FSFI-19 and FSFI-6 indicates the importance of further research on the validity of these patient-reported outcome measures. We advise researchers who use the FSFI-19 to perform confirmatory factor analyses and report the factor structure found in their sample. Regardless of these concerns, the FSFI-19 and FSFI-6 have strong criterion validity. Pragmatically, they are good screening tools for the current definition of female sexual dysfunction.

STRENGTH & LIMITATION

A strong point of the review is the use of predefined guidelines. A limitation is the use of a precise rather than a sensitive search filter.

CONCLUSIONS

The FSFI requires more research on structural validity (FSFI-19 and FSFI-6), reliability (FSFI-6), construct validity (FSFI-19), measurement error (FSFI-19 and FSFI-6), and responsiveness (FSFI-19 and FSFI-6). Further corroboration of measurement invariance (both across cultures and across subpopulations) in the factor structure of the FSFI-19 is necessary, as well as tests for the unidimensionality of the FSFI-6. Neijenhuijs KI, Hooghiemstra N, Holtmaat K, et al. The Female Sexual Function Index (FSFI)-A Systematic Review of Measurement Properties. J Sex Med 2019;16:640-660.

Translation, Adaptation, and Preliminary Validation of the Female Sexual Function Index into Spanish (Colombia)

The Female Sexual Function Index (FSFI) subjectively explores the dimensions of female sexual functioning. This research undertook to adapt and validate the FSFI to Spanish language in a Colombian sample. To this effect, this study was conducted in two steps, namely: (1) cultural adaptation of the scale with the collaboration of seven experts; and (2) preliminary validation of the scale in a sample of 925 participants. Reliability indices were appropriate in this sample, and external validity in relation to other measures showed significant relationships. Findings suggest that the FSFI is reliable and valid in Spanish for a Colombian population. Further research is needed to establish the test-retest reliability and discriminant validity of this Spanish version.

A Systematic Review of Sexual Distress Measures

BACKGROUND

Sexual distress is an important component of sexual dysfunction and quality of life and many different measures have been developed for its assessment.

AIM

To conduct a literature review of measures for assessing sexual distress and to list, compare, and highlight their characteristics and psychometric properties.

METHODS

A systematic review was conducted using Scopus and PubMed databases to identify studies that developed and validated measures of sexual distress. The main characteristics and psychometric properties of each measure were extracted and examined.

OUTCOMES

Psychometrically validated measures of sexual distress and a summary of relative strengths and limitations.

RESULTS

We found 17 different measures for the assessment of sexual distress. 4 were standalone questionnaires and 13 were subscales included in questionnaires that assessed broader constructs. Although 5 measures were developed to assess sexual distress in the general population, most were developed and validated in very specific clinical groups. Most followed adequate steps in the development and validation process and have strong psychometric properties; however, several limitations were identified.

CLINICAL TRANSLATION

This literature review offers researchers and clinicians a list of sexual distress measures and relevant characteristics that can be used to select the best assessment tool for their objectives.

STRENGTHS AND LIMITATIONS

A thorough search procedure was used; however, there is still a chance that relevant articles might have been missed owing to our search methodology and inclusion criteria.

CONCLUSION

This is a novel and state-of-the-art review of assessment tools for sexual distress that includes valuable information measure selection in the study of sexual distress and sexual dysfunction. Santos-Iglesias P, Mohamed B, Walker LM. A Systematic Review of Sexual Distress Measures. J Sex Med 2018;15:625-644.

Survivorship, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology

Many cancer survivors experience menopausal symptoms, including female survivors taking aromatase inhibitors or with a history of oophorectomy or chemotherapy, and male survivors who received or are receiving androgen-ablative therapies. Sexual dysfunction is also common in cancer survivors. Sexual dysfunction and menopause-related symptoms can increase distress and have a significant negative impact on quality of life. This portion of the NCCN Guidelines for Survivorship provide recommendations for screening, evaluation, and treatment of sexual dysfunction and menopausal symptoms to help healthcare professionals who work with survivors of adult-onset cancer in the posttreatment period.

What Sexual Behaviors Relate to Decreased Sexual Desire in Women? A Review and Proposal for End Points in Treatment Trials for Hypoactive Sexual Desire Disorder

INTRODUCTION

Counts of satisfying sexual events (SSEs) per month have been criticized as an end point in treatment trials of women with hypoactive sexual desire disorder (HSDD) but grounding improvement in sexual desire by assessing changes in sexual behavior remains of some importance.

METHODS

We conducted a literature review to find validated measurements that are specific sexual behavioral correlates of low sexual desire. We compared expert-proposed criteria for dysfunctional desire, expert-developed sets of scale items, and self-rated scales developed before issuance of, or in accordance with, the Food and Drug Administration's guidance on developing patient-reported outcomes. Behavioral measurements of HSDD were isolated from these sets of criteria or scales.

MAIN OUTCOME MEASURES

We outline a plan to evaluate such behavioral measurements of HSDD with reference to SSEs.

RESULTS

Eleven rating scales, four expert-originated and seven self-rated scales mainly derived from patient input were identified as well validated and relevant to HSDD. Three recent sets of diagnostic criteria for conditions such as HSDD were compared with the scales. Twenty-four different symptoms were found in the scales. Content found relevant to HSDD during development of the rating scales varied highly among measurements, including the self-rated scales developed in conformity with current recommendations for patient-reported outcome measurements. The only item on all sets was desire for sexual activity. Four other items were in approximately at least half the sets: sexual thoughts or fantasies, frequency of sexual activity, receptivity, and initiations. Sexual thoughts or fantasies were in every expert-derived set but in only three of the seven patient-derived sets. Receptivity was in five of the seven expert-derived sets vs two of the seven patient-derived sets. Frequency of sexual activity was in one of the seven expert-derived sets but in five of the patient-derived sets. Initiation was in approximately half the two sets. All other items were on one to three sets each. We identified three sexual behaviors of validated specificity for female HSDD: frequency of sexual activity, receptivity, and initiations. Six or seven items are relevant and informative. The item on frequency of sexual activity in the Changes in Sexual Functioning-Female scale is the only item that covers frequency of dyadic and solitary sexual activity. An item in the Female Sexual Desire Questionnaire (FSDQ) covers the intuitively relevant topic of frequency of sexual activity motivated by the woman's desire. Three FSDQ items on initiations and two items on receptivity reflect expert opinion on the sexual behaviors of most relevance to HSDD, but the FSDQ has not been validated in women with HSDD.

CONCLUSIONS

SSEs have been discredited as the primary measurement in clinical trials of women with HSDD, but it would be meaningful to include at least one sexual behavioral symptom specific to HSDD as an end point. Expert-recommended sexual behaviors specifically related to HSDD are irregularly represented in self-rating scales whether developed as in the Food and Drug Administration guidance on patient-reported outcomes or not. Six or seven items on sexual behavior in self-rated scales can be recommended for relevance to women with HSDD in clinical trials. Items on female sexual behavior should be tested in comparison with SSEs in women with HSDD for relevance and for treatment sensitivity, and responder and functional and dysfunctional cutoffs should be determined before incorporation into large-scale clinical trials. Pyke R and Clayton A. What Sexual Behaviors Relate to Decreased Sexual Desire in Women? A Review and Proposal for End Points in Treatment Trials for Hypoactive Sexual Desire Disorder. Sex Med 2017;5:e73-e83.

Sexual satisfaction and inflammatory bowel diseases: an interdisciplinary clinical challenge

Inflammatory bowel diseases (IBD), most commonly Crohn's disease and ulcerative colitis, have the highest incidence during the reproductive years. IBD and its treatments increase the risk of sexual dysfunction for both men and women with these diseases. Women with IBD often seek care from their gynecologist and may preferentially discuss sexual experiences with them over other providers. An understanding of IBD and its impact on sexual functioning and satisfaction will improve screening, evaluation, and management for these patients. Identifying interdisciplinary providers for referrals, such as pelvic floor physical therapists and health psychologists, is a key component to long-term improvements in sexual satisfaction for women with IBD.