Female Sexual Health: Barriers to Optimal Outcomes and a Roadmap for Improved Patient-Clinician Communications

Patient-reported sexual health outcomes of cervical cancer patients treated with definitive chemoradiation and MRI-guided brachytherapy

BACKGROUND

Sexual health is an important survivorship issue in cervical cancer. We assessed patient-reported sexual health outcomes and correlations with oncologist-assessed vaginal toxicity (VT).

METHODS

This was a prospective, cross-sectional study of stage IB-IVA cervical cancer patients treated with definitive chemoradiation, who completed a socio-demographic questionnaire and the following patient-reported-outcomes (PROs): Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), Menopause Rating Scale (MRS), Hospital Anxiety and Depression Scale (HADS). VT was assessed using the CTCAE v4.0. Sociodemographic, clinical data, PROs and VT were summarized using descriptive statistics; correlations were evaluated using linear regression analyses.

RESULTS

Between August 2018 and April 2022, 73 patients were analyzed. Median age was 49 (range 25-81), 57.5% had vaginal involvement at diagnosis and 76.9% were partnered. Sexual dysfunction (FSFI score ≤ 26), sexual distress (FSDS-R ≥ 11), severe menopausal symptoms (MRS ≥ 17), anxiety (HAD-Anxiety >7) and depression (HAS-Depression >7) were reported in 86.3%, 54.5%, 36.2%, 46.6% and 24.7%, respectively. Grade 2+ VT was reported in 27.4%. No significant associations were found between PROs and VT. On multivariable analysis, non-partnered status, use of hormone replacement therapy, and International Commission on Radiation Units and Measurements - rectovaginal dose (ICRU-RV) >65Gy were associated with worse sexual health (p < 0.005).

CONCLUSION

Cervical cancer patients self-report high rates of sexual distress, dysfunction and menopause symptoms. Discordance between oncologist-assessed VT and PROs highlights the importance of evaluating the patient's experience. Proactive treatment of menopausal symptoms and attention to radiotherapy doses to the vagina should be considered.

Biopsychosocial Approaches for the Management of Female Chronic Pelvic Pain: A Systematic Review

BACKGROUND/OBJECTIVE

Current guidelines recommend biopsychosocial-informed treatment for chronic pelvic pain (CPP). The objective of this systematic review was to describe the available biopsychosocial approaches for the treatment of CPP, and the outcomes reported, to understand how guideline-recommended treatments can be applied.

SEARCH STRATEGY

MEDLINE, CINAHL, PsycINFO, EMBASE, Emcare, AMED and Cochrane trial registries were searched (inception to 17 November 2023).

SELECTION CRITERIA

CPP Studies in women where the principal treatment modality was a biopsychosocial approach were included. Prospero registration: CRD42022374256.

DATA COLLECTION/ANALYSIS

Data extraction included study setting, population, study design, intervention characteristics and outcome measures and is described via a narrative synthesis.

RESULTS

The review included 14 RCTs (871 patients) and identified four broad intervention categories (Acceptance Commitment Therapy n = 2, Cognitive Behavioural Therapy n = 6, Mindfulness-based approaches n = 2, and Physiotherapy-based interventions n = 4). Pain science education (PSE) and, exposure/engagement with valued activity were recognised as important aspects of treatment regardless of intervention type. The most utilised outcomes were pain reduction and emotional functioning, with all studies reporting improvements in these domains. Heterogeneity in outcomes prevented efficacy comparison. High risk of bias was identified in six studies (1/4 physiotherapy-based approaches, 2/6 CBT, 1/2 ACT and 2/2 mindfulness-based interventions).

CONCLUSIONS

CBT and ACT-based biopsychosocial approaches were found effective in reducing pain and improving psychometric outcomes for CPP. Evaluation indicated PSE, and exposure/engagement in valued activity are important components of biopsychosocial management. Outcome heterogeneity needs to be addressed in future trials.

Understanding the Values, Qualities, and Preferences of Patients in Their Relationships With Obstetrics and Gynecology Providers: Cross-Sectional Survey With a Mixed Methods Approach

BACKGROUND

The patient-provider relationship in obstetrics and gynecology (OBGYN) is uniquely complex due to the sensitive nature of examinations and topics. Patients often prefer health care providers who share similar racial, ethnic, gender, or linguistic backgrounds, particularly in sensitive health care situations, to improve communication and comfort, though historically, specific gender preferences for OBGYNs have not been evident.

OBJECTIVE

This study aims to describe the values, qualities, and preferences of patients in their relationships with OBGYN providers.

METHODS

This cross-sectional survey, conducted from October 2019 to December 2019, involved 1039 US OBGYN patients and used a mixed methods approach, integrating quantitative responses and qualitative insights from open-ended questions. Recruitment was facilitated through targeted social media campaigns, and the survey aimed to capture detailed patient preferences and barriers to care by assessing responses on provider traits, patient experiences, and demographic factors. The study's rigorous data collection and analysis were designed to fill gaps identified in previous research on patient-provider relationships in OBGYN care.

RESULTS

The findings underscore the paramount importance of trust and comfort, with listening skills identified as crucial. A notable finding is the marked preference for same-gender providers, observed in 80.7% (545/675) of participants. Primary barriers to seeking care reported included daily commitments, highlighting the need for accessible and flexible care options.

CONCLUSIONS

The study highlights a significant shift from previous scientific findings in patient preferences toward gender concordance and trust in OBGYN settings, diverging from previous research. These results emphasize the need for patient-centered care and tailored communication strategies to enhance patient experiences and outcomes. Future research should focus on diverse populations to broaden the findings' applicability and explore the impact of recent shifts in health care policies.

Female sexual function and distress and time-to-pregnancy in a prospective preconception cohort

BACKGROUND

Fertility success among mixed-sex couples often depends on frequency and timing of sexual intercourse, yet little research has evaluated the association between preconception sexual function and time-to-pregnancy.

OBJECTIVE

To evaluate the effects of female sexual dysfunction, distress related to sexual functioning, and painful intercourse on time-to-pregnancy.

STUDY DESIGN

We followed 2500 participants from Pregnancy Study Online, a prospective cohort study of self-identified females attempting pregnancy without the use of fertility treatments. Participants enrolled between 2021 and 2024. Thirty days after enrollment, participants completed a supplemental questionnaire that contained questions about sexual health, including a modified version of the 6-item Female Sexual Function Index (score range 2-30, score ≤19 defined as sexual dysfunction) and the Female Sexual Distress Scale (score range 0-48, score ≥20 defined as clinically relevant distress), which assess experiences in the previous 4 weeks. Participants completed the supplemental questionnaire no later than 6 months after initiating conception attempts. We estimated time-to-pregnancy based on self-reported pregnancy status on follow-up questionnaires completed every 8 weeks for up to 12 months. We used proportional probabilities regression to calculate fecundability ratios and 95% confidence intervals relating exposure measures with time-to-pregnancy, adjusting for a range of prespecified confounders. As an exploratory analysis, we evaluated individual domains of sexual function (ie, interest, arousal, orgasm, lubrication, and satisfaction) in relation to time-to-pregnancy.

RESULTS

The study population was primarily non-Hispanic White, high income, with college or graduate education. Exposure prevalence was 20.1% for female sexual dysfunction, 8.8% for distress, and 29.6% for any pain with intercourse. We observed no association between female sexual dysfunction and time-to-pregnancy (adjusted fecundability ratio 1.00, 95% confidence interval 0.890, 1.13) when female sexual dysfunction was defined using a clinically validated cut point, but observed that those in the first, second, and third quartile of scores had delayed conception compared to those in the fourth (highest function) (adjusted fecundability ratios 0.90, 95% confidence interval 0.76, 1.06; 0.88, 95% confidence interval 0.75, 1.04; and 0.90, 95% confidence interval 0.77, 1.04, respectively). We found 18% reduced fecundability among those with sexual distress as defined by a clinically validated cut point compared to those without (adjusted fecundability ratio 0.82, 95% confidence interval 0.69, 0.98). Participants reporting painful intercourse most or all the time had a longer time-to-pregnancy than those reporting no pain (adjusted fecundability ratio 0.81, 95% confidence interval 0.62, 1.06). In exploratory analyses, lower function in orgasm and lubrication domains, but not interest, desire, and arousal, were associated with longer time-to-pregnancy.

CONCLUSION

Preconception sexual dysfunction, specifically distress and frequent painful intercourse, was associated with delayed conception. Preconception clinical assessment of sexual function, including discussion of individual domains of sexual function, may elucidate important modifiable issues.

Consumer product-related female genital injuries in the USA from 2013 to 2022

BACKGROUND

Consumer product-related genital injuries in females across all age groups are understudied. Existing research focuses primarily on paediatric populations. We aimed to determine characteristics, trends and predictors of hospitalisation.

METHODS

The National Electronic Injury Surveillance System database was queried for female genital injuries from 2013 to 2022. We stratified our population into four age groups (<18, 18-34, 35-54, >54 years). Automated text matching and manual reviews were employed for variable extraction. χ2 tests and logistic regression were conducted, accounting for survey design and weights.

RESULTS

9054 cases representing a national estimate of 252 329 injuries (95% CI 188 059 to 316 599) were identified. Paediatric injuries were most common (61%) and seniors had the highest hospitalisation rates (28%). Falls were common in paediatric (51%) and senior (48%) groups, whereas self-induced and topical application injuries were more frequent among adults aged 18-34 and 35-54. Injuries predominantly involved playground equipment and bicycles in children, razors and massage devices in adults aged 18-34 and 35-54 and household structures in seniors. Hospitalisation increased over the decade from 7% to 9%; significant predictors of hospitalisation were Asian race (OR=3.39, 95% CI 1.83 to 6.30), fractures (OR=7.98, 95% CI 4.85 to 13.1) and urethral injury (OR=3.15, 95% CI 1.30 to 7.63).

CONCLUSIONS

Our study identifies distinct patterns in female genital injuries across ages. In the paediatric cohort, injuries are often linked to playgrounds and bicycles. For adults, grooming products are frequently implicated. Seniors commonly suffer injuries from household structures such as bathtubs. These patterns may inform discussions on tailored preventive strategies.

Menopause in Plastic Surgery Patients: An Underrecognized and Undertreated Comorbidity

SUMMARY

Nearly half of all patients undergoing plastic surgery are middle-aged cisgender women, all of whom will experience menopause. Plastic surgeons do not treat menopause directly, but it can be a concern-and even a motivating factor-for patients seeking plastic surgery. In addition, the changes associated with menopause underlie problems that many plastic surgeons seek to address, including with face lifts, breast surgery, and vaginal rejuvenation. Hormone replacement therapy has the potential to improve quality of life by treating bothersome symptoms and delaying the physical changes brought on by loss of estrogen. However, recent reports in the media highlight that women face significant barriers to accessing menopause care due to a lack of trained providers willing to manage hormone replacement therapy, as well as historical concerns regarding increased cancer risk, which recent evidence suggests were overestimated. Plastic surgeons may be the first, or only, providers with whom women discuss how their bodies change with age. As a result, plastic surgeons should consider menopause as an underlying risk factor or comorbidity for any woman presenting with aging-related complaints, and to ensure that these patients have access to appropriate menopause care in their communities. This is especially important for surgeons offering vaginal rejuvenation therapies, given that locally acting topical estrogen is a safe and highly effective treatment. The authors present guidance and recommendations for how plastic surgeons should take menopause into account when evaluating and advising patients. In addition, the authors present a treatment algorithm for safe prescribing of locally acting hormone replacement therapy for vaginal rejuvenation.

Sexual Dysfunction in Patients with Overactive Bladder Syndrome Treated with Botulinum Toxin

Introduction: Overactive bladder (OAB) is a syndrome of the lower urinary tract characterized by urinary urgency, frequency, and nocturia, with or without urgency urinary incontinence. OAB significantly impacts all aspects of life-social, psychological, physical, professional, domestic, and sexual-for both women and men. The aim of this study was to investigate sexual dysfunction in both women and men with OAB treated with intravesical onabotulinumtoxinA (Botox) injections using the Sexual Quality of Life questionnaire in two versions: female (SQoL-F) and male (SQoL-M). Methods: Forty sexually active patients (thirty women and ten men) with idiopathic OAB were recruited. Patients completed the SQoL-F or SQoL-M questionnaire before treatment, and again at 3 and 6 months after treatment with intravesical onabotulinumtoxinA injections. Results: All 40 patients completed the study (30 women and 10 men). There were no statistically significant differences in SQoL results before the procedure or at 3- and 6-months post-treatment. Conclusions: OAB treatment with onabotulinumtoxinA did not significantly affect the quality of sexual life in either women or men. Further research is needed using questionnaires specifically designed to assess the sexual life of patients with OAB, especially in men.

Gynecologic cancer survivor preferences for provider communication regarding sexual health after treatment: a qualitative study

PURPOSE

Survivorship from gynecologic cancers is becoming increasingly prevalent. There are significant sexual side effects that influence quality of life that would be reduced with proper intervention; however, existing literature highlights the lack of understanding of the sexual health needs within this population. Furthermore, multiple studies show that one contributing factor to sexual well-being in survivorship is provider-patient communication. The aim of this study is to explore experiences of sexual distress and survivor experiences of sexual health communication.

METHODS

Adult participants who had been out of active treatment for 3 months were recruited to participate in focus groups. Six focus groups (n = 32) were conducted with survivors of gynecologic cancers via Zoom. Research team members analyzed content using thematic analysis.

RESULTS

Two broad themes were identified: Experiences of provider communication and Preferences for provider communication, with subthemes nested under both. Subthemes from the Experiences theme included absent/lacking communication, negative experiences, emotional reaction to lack of communication, and feeling like sexuality was not valued. Subthemes from the Preferences theme included more conversation and open communication about sexuality, more resources/referrals, and more provider training on sexuality.

CONCLUSION

Survivor experiences of subjective sexual health are often dependent on the type and quality of information they receive from their healthcare team during treatment. Unfortunately, the majority of participants endorsed negative or absent communication related to their sexual health needs, leading to additional distress.

The association between gynecologic healthcare providers' sexual health and their comfort discussing their patients' sexual function

OBJECTIVE

Stigma surrounding discussions of sexuality can prevent patients from discussing sexual health issues with their healthcare providers. Clinicians may also experience similar stigma, compounding the problem if also reticent to assess their patients' sexual health. We explored the association of healthcare providers' personal sexual experience and health with their comfort with and frequency of optimizing their patients' sexual function and satisfaction.

METHODS

We conducted an anonymous online survey of gynecologic care providers and their comfort with and frequency of addressing their patients' sexual function. Covariates examined via bivariate analysis included: socio-demographics, training level, prior sexual experiences and education, history of sexual trauma, and current sexual problems and satisfaction.

RESULTS

Most respondents (N = 189) identified as sexually active (82.5 %), heterosexual (90.5 %), female (85.7 %) medical trainees (63.5 %). A quarter (23.8 %) reported currently having at least 1 sexual problem and 27.0 % reported a history of sexual trauma. Notably, 91.0 % of respondents had never been asked about their own sexual health by a healthcare provider. Less than half (43.9 %) reported frequently bringing up sexual health issues with their patients, while about half (50.8 %) reported being comfortable optimizing patients' sexual function, which was significantly correlated (p < 0.05) with practicing at the attending level, being comfortable talking about their own sexuality, the absence of sexual problems, reported sexual satisfaction, and prior education in a greater number of sexual healthcare topics.

CONCLUSION

Variation in how gynecologic healthcare providers manage their patients' sexual function may be linked to their own sexual experiences and well-being.

Ending HIV Transmission in Australia: Expanding PrEP to Cisgender Women: A Scoping Review

Pre-exposure prophylaxis (PrEP) availability through the Pharmaceutical Benefits Scheme provides real potential for the elimination of HIV transmission in Australia, as evidenced by a rapid decline in HIV incidence among gay and bisexual men (GBM). However, HIV elimination will not be possible without also extending PrEP to other populations, including cisgender women. We conducted a scoping review to examine the extent to which PrEP access for cisgender women has been considered in Australia. A comprehensive search across five databases, grey literature, and hand search of references was conducted. A single reviewer conducted title and abstract screening and two reviewers completed full-text screening and data extraction. Nineteen documents were included in the final review and included both peer-reviewed journal articles and guidelines and strategies. Focused discussion of cisgender women's use of PrEP was largely missing from the literature and, although their use of PrEP is supported in some relevant guidelines, little has been done to actively develop strategies to inform cisgender women about PrEP as a precursor to prescribing for HIV prevention. Healthcare providers' narrow view of PrEP as being the domain of GBM further limits cisgender women's potential access. If HIV elimination in Australia is to be a reality, we need to develop mechanisms to specifically engage with cisgender women about PrEP.

The interrelationship between women's help-seeking experiences for vaginismus and their sense of self: a qualitative study and abductive analysis

Objective

There is a lack of research on women's holistic experiences of vaginismus, also called sexual pain-penetration disorder, from their perspective. To address this gap, an abductive qualitative study aimed to examine women's help-seeking experiences for vaginismus, and its impact on their sense of self.

Methods

This study was informed by a feminist approach to the theory of self focused on participants' negotiation of dis/empowerment when help-seeking for vaginismus. Twenty-one participants aged 19-37 years (mean 27.6 years) and diagnosed with vaginismus in Australia participated in semi-structured interviews, which were thematically analysed.

Results

Three themes were developed: Interconnected constructions of womanhood and help-seeking, Elicit agency to move forward, Resilience to surmount challenges with subthemes. Participant's overall help-seeking experiences, within and outside the healthcare system, shaped their sense of self in ways that drove their approach/es to future help-seeking behaviours.

Conclusions

Positive help-seeking experiences for vaginismus strengthened participants' sense of self to persevere with treatment even when it was difficult. Conversely, negative help-seeking experiences led to participants' weakened sense of self which was often caused by a gap between their ideal and perceived self. This led to negative feelings and responses of demotivation or halting subsequent help-seeking. Recommendations are provided to improve health professional practice to support women help-seeking for vaginismus, and to help close the gap between their ideal and perceived selves. Such insight can help to empower women's sense of self and motivate them to persevere with help-seeking to experience improvement for their vaginismus and quality of life.

Radical cystectomy in the female patient: The pelvic floor, sexual function, and patient/provider education

Radical cystectomy in women results in numerous deleterious anatomic impacts to the pelvic floor that can result in sexual dysfunction, pelvic organ prolapse, and other disorders of pelvic floor function. A comprehensive understanding of this relationship and the quality-of-life impacts of radical cystectomy in women is important. This narrative review provides an overview of female pelvic floor disorders in the setting of radical cystectomy, with focus on present understanding of related anatomy, incidence, and prevention strategies, as well as the importance of both provider and patient education.

Turkish Adaptation of the ADORE: A Study of Validity and Reliability

It is obvious that current tools in literature that are used to measure female's sexual quality of life focus only on the objective dimension of sexual function, failing to examine quality of life on a multidimensional level. The aim of this research is to examine the validity and reliability of the ADORE for Turkish society. In the methodological research, 500 females were included. The research data was collected with "Descriptive Information Form" "ADORE" and "Sexual Quality of Life-Female (SQOL-F)." ADORE is a five-Likert-type type and 36-item scale that was developed to assess female's sexual quality of life. It has six sub-dimensions. It is stated that ADORE can better evaluate female's sexual quality of life holistically and contextually. The validity of ADORE was analyzed as linguistic, content, and construct validities. In determining the reliability of the scale, item-total score correlation, Cronbach alpha (Cr α) coefficient, Pearson correlation, split-half analysis, test-retest, and parallel form were used. Content validity index was found to be 0.90. The confirmatory factor analysis was performed for construct validity. ADORE's Cr α reliability coefficient was determined to be .95. According to ADORE test-retest analyses, it was found that there is a positively strong and statistically high significant correlation among scores of the scale. It was determined that there is an acceptable correlation between ADORE and SQOL-F. In determining female's sexual quality of life in Turkish society, ADORE is a valid and reliable scale. It is a useful scale for health professionals working in the clinic to evaluate female's sexual quality of life.

Asking women with diabetes about sexual problems: An exploratory study of NHS professionals' attitudes and practice: A survey of healthcare professionals regarding communication and silences about sexual problems during the routine care of women with diabetes

AIMS

To explore UK healthcare professionals' practice and attitudes towards asking women with diabetes about sexual health problems, including symptoms of female sexual dysfunction (FSD).

METHODS

An online questionnaire to address the study aims was developed, piloted by ten healthcare professionals (HCPs) and completed by 111 eligible HCPs, recruited via professional networks and social media. Free text data were analysed and reported thematically. Two questions were analysed to test the hypothesis of differences between men's and women's responses.

RESULTS

The majority of respondents did not ask women with diabetes about sexual problems. Multiple barriers to inquiry were reported, including inadequate training, time constraints, competing priorities, the perceived likelihood that questions will cause surprise or distress (especially for certain groups of women), the belief that sexual problems are to be expected as women age, and the belief that FSD is complex or untreatable, with unclear management pathways. Exploratory findings indicated significant differences in men and women's responses (men disagreed more strongly with prioritisation, and fewer reported routine inquiry about sexual problems in their usual practice).

CONCLUSIONS

HCPs reported not asking women with diabetes about sexual problems during routine care. They described multiple factors reinforcing the silence about sexual health, including inadequate education and perceived social risk for individual HCPs who deviate from the patterns of topics usually discussed in diabetes consultations.

Let's talk about sex: consensus guidelines of the GINECOR working group of the Spanish Society of Radiation Oncology: clinical recommendations after pelvic radiotherapy

PURPOSE

The present consensus statement was developed by the GINECOR working group on behalf of the Spanish Society of Radiation Oncology (SEOR). This document addresses sexual health management in patients with gynaecological cancer after pelvic radiotherapy.

METHODS

A modified two-round online Delphi study was conducted, where GINECOR members were surveyed on the diagnosis, treatment, and follow-up of sexual health problems. An expert panel of radiation oncologists, nurses and a gynaecologist participated in the Delphi study to reach a consensus, applying GRADE criteria to establish the level of agreement.

RESULTS

The consensus recommendations cover both diagnosis and treatment, with an emphasis on patient-reported outcome measures (PROMs). They highlight recommendations such as the systematic assessment of genitourinary, gastrointestinal, and sexual symptoms, and the use of several treatments after radiotherapy. Recommendations include pharmacological options like vaginal lubricants and hormone therapy, and mechanical interventions such as vaginal dilators and vibrators. These suggestions stem from both scientific evidence and clinical expertise.

CONCLUSION

This consensus statement describes a comprehensive, multidisciplinary approach developed to address the sexual needs and enhance the quality of life of patients with gynaecological tumours after pelvic radiotherapy. It offers specific recommendations for managing sexual issues, emphasizing the importance of specialized care and regular assessment. The document underscores the significance of proactive, patient-centered sexual health management in gynaecological cancer patients.

Combined estrogen-progestin oral contraceptives and female sexuality: an updated review

INTRODUCTION

Sexual side effects of combined oral contraceptives (COCs) have not been fully understood, but increasing evidence prompts broader risk/benefit evaluation and merits inclusion in counseling on contraceptive options.

OBJECTIVES

The study sought to explore the impact of combined estrogens-progestin oral contraceptives on components of female sexuality, including sexual desire, anatomic genitourinary changes, lubrication, orgasm, provoked vestibulodynia, well-being, body image, partner preference, and relationship stability.

METHODS

A literature review was performed between April 2023 and January 2024 exploring the association between combined oral contraceptive pills and sexual health.

RESULTS

Although COCs decrease free testosterone, it is unclear if COCs affect sexual function, including desire. Antiandrogenic COCs do seem to have a negative effect on sexual arousal, lubrication, and orgasm. Provoked vestibulodynia may be related to early onset of COC use, low-estrogen pills, and antiandrogenic progestins. Emotional and sexual side effects are strong predictors of COC discontinuation. Longitudinal data indicate that using COCs when meeting and selecting a partner has implications on sexual satisfaction and relationship length. Analysis of data is complicated by various doses and forms of estrogen and progestin in COCs, which have changed over time.

CONCLUSION

Lack of randomized placebo-controlled studies and heterogenicity in study design hampers generalized statements about the effects of COCs on sexual function. Despite these challenges, consideration of sexual dysfunction when presenting and prescribing hormonal contraception is essential for informed consent, shared decision making, and ensuring reliable contraceptive choices.

Female Sexual Health: Screening and Evaluation

Female sexual dysfunction is highly prevalent, affecting 30% to 50% of cisgender women globally. Low sexual desire, sexual arousal disorder, and orgasm disorder affect 10% to 20%, 6% to 20%, and 4% to 14% of women, respectively. Dyspareunia or pain with intercourse affects 8% to 22% of women. Universal screening is recommended; and a thorough medical history and physical examination are the foundations of evaluation and assessment. Laboratory tests and imaging are sometimes warranted, but referral to a sexual medicine expert is suggested if the practitioner is unfamiliar or uncomfortable with treatment.

Determinants of Sexual Health Status of Menopausal Women in Osun State, Nigeria

OBJECTIVES

This study aimed to assess sexual health status and associated factors in menopausal women.

METHODS

The study employed a descriptive, cross-sectional design. It included 420 menopausal women aged 40-65 years from Ilesa West Local Government Area of Osun State. A structured questionnaire was used, and the data were analyzed using descriptive and inferential statistics.

RESULTS

The mean age of the study respondents was 54.74 ± 5.49 years. A little over half (52.4%) of the respondents exhibited good sexual health status, whereas 47.6% had poor sexual health status. Logistic regression analysis revealed that lack of financial resources (P = 0.01; odds ratio [OR], 4.00; 95% confidence interval [95% CI], 1.45-11.02), loss of partner (P = 0.01; OR, 9.18; 95% CI, 2.89-29.09), and limited communication with partner (P = 0.01; OR, 3.12; 95% CI, 1.51-6.46) were predictors of poor sexual health status.

CONCLUSIONS

This study provides insight into the determinants of the sexual health status of menopausal women, which may help health care providers and policymakers develop effective strategies to improve the sexual health of menopausal women.

Female sexual dysfunction-knowledge, attitude, practices, and barriers encountered by medical fraternity across the country: A web-based cross-sectional study

Introduction

Sexual dysfunction in women is common yet often remains underdiagnosed due to the lack of adequate training and experience of the doctors to manage female sexual dysfunctions. This study was done to assess the knowledge and attitude of medical professionals toward female sexual dysfunction and the various practices and barriers they encounter while managing women with sexual dysfunction.

Materials and Methods

A web-based cross-sectional study was done using the snowball sampling method. A well-structured, self-administered, and pre-validated questionnaire containing 27 items was administered through social media. Data was collected and evaluated to assess their knowledge, practices they follow, and barriers encountered while managing female sexual dysfunction.

Results

A total of 513 doctors participated in the study. Out of all, only 11.1% of the doctors were often seeing patients with sexual dysfunction. Loss of desire (44%), painful intercourse (33%), lack of lubrication (18%), and anorgasmia (5%) are common symptoms with which women present. The majority of doctors (78.9%) were comfortable in starting a conversation, over half (52.6%) were confident in making a diagnosis, and 51.3% were confident in providing sexual counseling. Yet, only 11.1% were routinely screening women for sexual dysfunctions, and 33.8% were providing counseling regarding sexual issues. Lack of time (31.6%), lack of adequate training (57.3%), unavailability of effective treatment (11.9%), patient discomfort (60.62%), and patient's reluctance to seek treatment (15.8%) were the barriers encountered by doctors. When assessed for knowledge, around 30.9% had excellent knowledge (≥75th percentile) about female sexual dysfunction.

Conclusion

Sexual dysfunction among women is an important health issue that significantly affects the social, mental, and physical well-being of those suffering from it. Screening for sexual dysfunction should be done routinely in day-to-day clinical practice to improve the overall quality of life of a couple.

Patients' recommendations to improve help-seeking for vaginismus: a qualitative study

BACKGROUND

Research to improve healthcare experiences for women with vaginismus tends to be produced from the perspective of healthcare professionals or health-based researchers. There is lacking research on women's experiences and recommendations to improve help-seeking for vaginismus from their perspective. To address this research gap, this qualitative study aimed to identify the issues that women face when help-seeking for vaginismus and their recommendations to address it. This sought to support the wellbeing of patients to advocate for their healthcare needs which is often overlooked.

METHODS

Using a feminist theoretical approach, semi-structured interviews were conducted with 21 participants who sought help for their vaginismus. Thematic analysis was employed to analyse participants' recommendations.

RESULTS

Four main themes emerged: Increase awareness of vaginismus, Dismantle myths about sex, Destigmatise vaginismus, and Empower people with vaginismus during medical consultations. Subthemes were identified as actionable strategies that participants recommended to improve help-seeking and healthcare for vaginismus.

CONCLUSIONS

The findings from this study can inform healthcare practice and policy to foster better synchronicity between health professionals and their patients' perceptions and expectations of treating vaginismus. This can promote more acceptance of patients' advocacy of their needs and goals to improve the therapeutic alliance and treatment outcomes for vaginismus in healthcare practice. The strategies recommended to increase awareness of vaginismus and challenge its stigma should be considered in policy to incite a culture of change in healthcare practice and broader society.

Investigating sexual health after breast cancer by longitudinal assessment of patient-reported outcomes

BACKGROUND

Sexual concerns are a major unaddressed need among survivors of breast cancer (BC) with significant negative effects on quality of life. We longitudinally analyzed sexual health over time, using patient-reported outcomes.

METHODS

Patients with stage I-III BC prospectively included from the CANcer TOxicity cohort (CANTO) provided data at diagnosis, then 1, 2, and 4 years afterward. Sexual concerns outcomes included poor body image (score ≤91/100), poor sexual functioning (≤16/100), poor sexual enjoyment (≤66/100), and sexual inactivity (EORTC QLQ-B23). Multivariate generalized estimating equation models assessed associations with sexual concerns after diagnosis, adjusting for age, sociodemographic, tumor, treatment, and clinical characteristics.

RESULTS

Nearly 78.1% among 7895 patients reported at least one sexual concern between diagnosis and 4 years' follow-up. Over time, the proportion of patients reporting sexual concerns either increased or remained constant with diagnosis. Less than half (46%, range 11.4-57) of the patients with sexual concerns reported the use of supportive care strategies, including gynecological or psychological consultations (range 11.4-57.4). Factors consistently associated with sexual concerns up to 4 years after diagnosis included already reporting the same concern at diagnosis [odds ratio (OR)poor body image 3.48 [95% confidence interval (CI) 3.11-3.89]; ORsexual inactivity 9.94 (95% CI 8.84-11.18), ORpoor sexual function 9.75 (95% CI 8.67-10.95), ORpoorsexual enjoyment 3.96 (95% CI 3.34-4.69)], endocrine therapy use [ORpoor body image 1.15 (95% CI 1.01-1.31); ORsexual inactivity 1.19 (95% CI 1.02-1.39), ORpoor sexual function 1.17 (95% CI 1.01-1.37), ORpoor sexual enjoyment 1.23 (95% CI 1.00-1.53)], and depression [ORpoor body image 2.00 (95% CI 1.72-2.34); ORsexual inactivity 1.66 (95% CI 1.40-1.97), ORpoor sexual function 1.69 (95% CI 1.43-2.00), ORpoor sexual enjoyment 1.94 (95% CI 1.50-2.51)]. Outcome-specific associations were also identified.

CONCLUSIONS

Sexual concerns seem frequent, persistent, and insufficiently addressed. Pretreatment concerns, endocrine therapy, and emotional distress are commonly associated factors. A proactive evaluation of sexual health across the care continuum is needed, to promptly identify patients suitable for multidisciplinary counseling, referral, and supportive interventions.

PrEP prescription in indiana 2017-2022: Implications for clinical practice

The Ending the HIV Epidemic initiative is poised to eradicate HIV through increasing screening and linkage to care. Despite this, the rate of HIV testing remains inadequate, and effective preventive measures like pre-exposure prophylaxis (PrEP) are not adequately prescribed. A retrospective chart review was conducted to include 2017 through July 2022 from a large nonprofit health care system in the Midwest. Inclusion criteria included an HIV-negative diagnosis between 2017 and July 2022. Additional information includes gender, age, race/ethnicity, the primary payment method, the facility where screening occurred, history of PrEP prescription, and the provider who documented sexual health screening. Most patients were female (73%, n = 3366), followed by 27% (n = 1242) who identified as male. The majority identified as white (52.4%, n = 2415), and patients who identified as Black represented 45.3% (n = 2087) of the sample. Of the participants in the sample, n = 3030 (65.8%) did not have a documented sexual health assessment at the time of HIV screening. Black patients were 0.40 times less likely to report a PrEP prescription than their white counterparts. Patients screened by the provider and identified with infectious disease via a sexual mode of transmission demonstrated three times increased odds of being prescribed PrEP. This research highlights the importance of updating medical records systems to capture salient sexual health factors. Ongoing professional development should be made readily available so providers can conduct comprehensive sexual health assessments.

The barriers and enablers to accessing sexual health and sexual well-being services for midlife women (aged 40-65 years) in high-income countries: A mixed-methods systematic review

Midlife, beginning at 40 years and extending to 65 years, a range that encompasses the late reproductive to late menopausal stages, is a unique time in women's lives, when hormonal and physical changes are often accompanied by psychological and social evolution. Access to sexual health and sexual well-being (SHSW) services, which include the prevention and management of sexually transmitted infections, contraception and the support of sexual function, pleasure and safety, is important for the health of midlife women, their relationships and community cohesion. The objective was to use the socio-ecological model to synthesise the barriers and enablers to SHSW services for midlife women in high-income countries. A systematic review of the enablers and barriers to women (including trans-gender and non-binary people) aged 40-65 years accessing SHSW services in high-income countries was undertaken. Four databases (PubMed, PsycINFO, Web of Science and Google Scholar) were searched for peer-reviewed publications. Findings were thematically extracted and reported in a narrative synthesis. Eighty-one studies were included; a minority specifically set out to study SHSW care for midlife women. The key barriers that emerged were the intersecting disadvantage of under-served groups, poor knowledge, about SHSW, and SHSW services, among women and their healthcare professionals (HCPs), and the over-arching effect of stigma, social connections and psychological factors on access to care. Enablers included intergenerational learning, interdisciplinary and one-stop women-only services, integration of SHSW into other services, peer support programmes, representation of minoritised midlife women working in SHSW, local and free facilities and financial incentives to access services for under-served groups. Efforts are needed to enhance education about SHSW and related services among midlife women and their healthcare providers. This increased education should be leveraged to improve research, public health messaging, interventions, policy development and access to comprehensive services, especially for midlife women from underserved groups.

Developing a Menopausal Transition Health Promotion Intervention With Indigenous, Integrative, and Biomedical Health Education: A Community-Based Approach With Urban American Indian/Alaska Native Women

Background

Few studies have examined the menopausal transition in American Indian and Alaska Native (AI/AN) women; these reports indicate they are the most likely group to report bothersome vasomotor symptoms (VMS). Evidence demonstrates VMS may be a biomarker for chronic diseases. Thus, evidence-based interventions to improve VMS and other symptoms and health-screening rates for urban midlife AI/AN women are needed.

Objective

The objectives of this community-based project were to form a Community Advisory Board (CAB) with whom to: 1) conduct CAB meetings (similar to a focus group) with midlife AI/AN women to understand their lived health care experiences and needs during the menopausal transition; and 2) obtain guidance in creating a tailored intervention.

Methods

Eligible participants indicated they were registered members of American Indian Tribes, self-identified as a woman, aged 35 or older, and were recruited through the Urban Indian Center of Salt Lake and community outreach. Three CAB meetings were conducted via Zoom. A qualitative-descriptive approach was used for analysis, with the aim of staying close to the data to understand AI/AN women's experiences and needs. Transcripts were iteratively coded using content/thematic analysis.

Results

Four themes emerged: 1) lack of and desire for information about the menopause transition; 2) barriers to accessing care; 3) matriarchal priorities impacting personal health outcomes; and 4) preferences for Indigenous and integrative medicine as first-line interventions, followed by conventional medicine.

Conclusions

Among this sample of urban AI/AN women, there was a great need for and interest in information about menopause, both for themselves and for their daughters and family. Integrative and Indigenous approaches were preferred. Proposed next steps include developing and pilot-testing a nurse-delivered health-education intervention with Indigenous, integrative, and conventional medical content.

Sexual dysfunction among early-onset colorectal cancer survivors: Sex-specific correlates of sexual health discussions between patients and providers

PURPOSE

To examine the prevalence of female sexual dysfunction (FSD), male erectile dysfunction (ED), and the prevalence and correlates of sexual health discussions between early-onset CRC survivors and their health care providers.

METHODS

An online, cross-sectional survey was administered in partnership with a national CRC advocacy organization. Respondents (n = 234; diagnosed < 50 years, 6-36 months from diagnosis/relapse) were colon (36.8%) and rectal (63.3%) cancer survivors (62.5% male). The Female Sexual Function Index (FSFI-6) was used to measure FSD, and the International Index of Erectile Function (IIEF-5) was used to measure ED. Survivors reported whether a doctor communicated with them about sexual issues during/after treatment.

RESULTS

Among females (n = 87), 81.6% had FSD (mean FSFI-6 score = 14.3 [SD±6.1]). Among males (n = 145), 94.5% had ED (mean IIEF-5 score = 13.6 [SD±3.4]). Overall, 59.4% of males and 45.4% of females reported a sexual health discussion. Among the total sample, older age of diagnosis and relapse were significantly associated with reporting a discussion, while female sex was negatively associated with reporting a sexual health discussion. Among males, older age at diagnosis and relapse, and among females, older age of diagnosis, were significantly associated with reporting a sexual health discussion.

CONCLUSION

The prevalence of FSD and ED were high (8 in 10 females reporting FSD, almost all males reporting ED), while reported rates of sexual health discussion were suboptimal (half reported discussion). Interventions to increase CRC provider awareness of patients at risk for not being counseled are needed to optimize long-term health outcomes.

"O" no: a Reddit analysis of orgasmic dysfunction

Background

Female Reddit users frequently discussed potential causes of orgasm difficulties and its implications on mental health and relationships.

Aim

This study aimed to evaluate the experiences of women discussing orgasms on the Internet site Reddit. We sought to qualitatively analyze the topics that arose in users' discussions to better understand the potential causes of orgasm difficulties and its implications on quality of life.

Methods

Posts on the subreddit r/TwoXChromosomes containing the keywords "orgasm" and "climax" were included in the dataset. Posts and their associated comments were qualitatively analyzed using the grounded theory approach. Two independent researchers coded each thread to identify dominant themes and emergent concepts.

Outcomes

The most frequently coded primary topics included: (1) orgasm (32.2% [n = 337]), (2) psychological (17.8% [n = 186]), (3) relationships (15.4% [n = 161]), and (4) treatment (10.7% [n = 112]).

Results

Qualitative analysis of 107 threads and approximately 6300 comments resulted in 5 major categories: psychological aspect of orgasms, difficulty orgasming with partners, partners' responses to orgasmic dysfunction, types of orgasms, and treatments for orgasmic dysfunction. Preliminary themes included (1) the presence of an emotional component or history of trauma related to orgasmic difficulty, (2) difficulty orgasming with a partner regardless of ability to orgasm during masturbation and a variety of stimulation required to orgasm, (3) mixed partner responses to orgasmic dysfunction, (4) the definition of a normal orgasm, and (5) self-motivated treatment for orgasmic dysfunction, including clitoral stimulation devices and masturbation techniques. Notably, few posters discussed their orgasmic dysfunction with healthcare providers.

Clinical Translation

The study reveals insights into the possible causes, psychosocial implications, and treatment of orgasm difficulties from a patient perspective, and can guide future research on female orgasms in a more precise, patient-oriented direction.

Strengths and Limitations

The anonymous nature of the forum allowed for insight into sensitive topics related to female orgasms and sexual trauma. Limitations include the demographic distribution of Reddit users, which was primarily younger women in their 20s and 30s, which restricts generalizability.

Conclusion

Reddit provides a medium for individuals with orgasm difficulties to discuss their experiences. Posts addressed users' inability to orgasm, their mental health and relationships, the stimulation required for orgasm, and treatments for orgasmic dysfunction. Interestingly, very few posts discussed healthcare, potentially suggesting that women do not classify their orgasmic dysfunction as a health issue.

Impact of Perceived Social Support and Depression in Married Turkish Women on the Sexual Quality of Life: An Online Survey

BACKGROUND

Sexual life is very important for people's physical health, psychological health, and reproductive health. Depression and social support are among the factors that affect the quality of sexual life.

AIM

The present study aimed to determine the impact of perceived social support on the sexual quality of life and depression in married women between the ages of 18 and 49.

MATERIALS AND METHODS

A total of 976 married women aged 18 to 49 were included in this cross-sectional study in which an online data collection method was used Sexual Life Quality Scale, Multidimensional Perceived Social Support Scale, and Beck Depression Scale, which were used as data collection tools. Statistical analysis used: Analyses were performed using SPSS version 26.0. Descriptive statistics were used for number, percentage, mean, and standard deviation, as well as independent group t-test, correlation, and regression analysis. The "Enter" model was used in the logistic regression analysis.

RESULTS

It was established that nearly one-third of married women aged 18-49 had low levels of perceived social support and sexual quality of life, and almost half of them experienced symptoms of depression. The quality of sexual life was 3.6 times (P = 0.001) lower in those with low social support and 1.6 times (P = 0.024) lower in those with depression.

CONCLUSION

Considering the fact that women's sexual problems, low social support and depression are important predictors of sexual quality of life, special attention should be paid to increasing social support to women, handling women's sexual problems more carefully, and detecting and treating such problems.

Prevalence of sexual desire and arousal difficulties among women veterans: A retrospective cohort design

Low sexual desire and arousal are associated with several negative health outcomes, including reduced quality of life, depression, anxiety, and relationship discord. Although women veterans have high rates of risk factors for sexual dysfunctions (e.g., elevated rates of trauma, depression, anxiety), research on their sexual functioning is lacking. Using a retrospective cohort design, we examined the prevalence of documented sexual desire and arousal disorder diagnoses or symptoms, using International Classification of Diseases, 10th Revision codes, among 790,726 women veterans receiving care in the Veterans Health Administration (VHA). In fiscal year 2020, these symptoms and disorders were documented for only 0.19% (n = 1,494) of women veterans receiving care and symptoms of low sexual desire were documented more frequently than formal desire and arousal diagnoses. Most women veterans with desire and arousal problems were married (53.88%), and most (52.28%) were prescribed antidepressants. Mental health (MH) treatment for desire and arousal difficulties was commonly delivered in person (as compared to telephone or telehealth). Psychologists primarily treated desire and arousal concerns, providing an average of 2.81 MH encounters (SD = 7.53) compared to an average of 1.62 (SD = 5.25) MH encounters by social workers and 1.22 (SD = 2.53) by psychiatrists. Problems with low sexual desire and arousal are likely underassessed and undertreated within the VHA. Better assessment of women veterans' low desire and arousal is warranted to improve their well-being and quality of life. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Sex and aging: Perspectives of older adult women with experience of incarceration

To explore perspectives on sexuality, sexual health, and sexual health care of older adult women with a history of criminal legal system involvement, we conducted phone interviews with women aged 50 years or older who were living in the community but had a history of jail and/or prison incarceration. Interview questions and initial analysis were guided by the sexual health framework for public health and Mitchell's sexual wellness model. Data analysis followed a framework method. Nine women, aged 53-66, participated in phone interviews between December 2020 and December 2021. Slightly over half the participants were Black; none were Hispanic. Most were single. We formulated a sex-in-aging (SAGE) framework comprising three categories and two overarching themes. Women with a history of criminal-legal system involvement have heterogeneous views on sex and sexual health and describe a range of desire and sexual activity as they age, including shifting ideas about what they expect from partners, how they keep themselves safe in sexual and intimate relationships, and how life circumstances that are often associated with criminal legal system involvement (substance use, trauma) impact their interest in sex as they age. The SAGE framework integrates these categories and themes and offers a starting point for further research and intervention development.

The yin and yang of GSM and low sexual desire

Numerous surveys have documented that sexuality and/or sexual activity is important to women at all stages of adulthood, including postmenopause. Genitourinary syndrome of menopause (GSM) and hypoactive sexual desire disorder (HSDD) are common disorders in postmenopausal women and may co-occur. Both are often undiagnosed due to a lack of knowledge of the disorder, health-care professional discomfort in discussing sexual problems or a lack of routine screening. It is incumbent upon health-care professionals to identify and differentiate these conditions in women through a biopsychosocial assessment, and may require a focused physical examination. Numerous treatments, both non-pharmacologic and pharmacologic, are available to address GSM and HSDD.

Inflammation, lipids, and pain in vulvar disease

Localized provoked vulvodynia (LPV) affects ∼14 million people in the US (9% of women), destroying lives and relationships. LPV is characterized by chronic pain (>3 months) upon touch to the vulvar vestibule, which surrounds the vaginal opening. Many patients go months or years without a diagnosis. Once diagnosed, the treatments available only manage the symptoms of disease and do not correct the underlying problem. We have focused on elucidating the underlying mechanisms of chronic vulvar pain to speed diagnosis and improve intervention and management. We determined the inflammatory response to microorganisms, even members of the resident microflora, sets off a chain of events that culminates in chronic pain. This agrees with findings from several other groups, which show inflammation is altered in the painful vestibule. The vestibule of patients is acutely sensitive to inflammatory stimuli to the point of being deleterious. Rather than protect against vaginal infection, it causes heightened inflammation that does not resolve, which coincides with alterations in lipid metabolism that favor production of proinflammatory lipids and not pro-resolving lipids. Lipid dysbiosis in turn triggers pain signaling through the transient receptor potential vanilloid subtype 4 receptor (TRPV4). Treatment with specialized pro-resolving mediators (SPMs) that foster resolution reduces inflammation in fibroblasts and mice and vulvar sensitivity in mice. SPMs, specifically maresin 1, act on more than one part of the vulvodynia mechanism by limiting inflammation and acutely inhibiting TRPV4 signaling. Therefore, SPMs or other agents that target inflammation and/or TRPV4 signaling could prove effective as new vulvodynia therapies.

Norwegian general population normative data for the European Organization for Research and Treatment of Cancer questionnaires: the Quality of Life Questionnaire-Core 30, the Sexual Health Questionnaire QLQ-SHQ22 and the sexual domains of the QLQ-BR23/BR45

OBJECTIVE

The aim of this study was to provide sex-, age-, and morbidity-specific Norwegian general population normative values for the European Organization for Research and Treatment of Cancer Quality of Life Questionnaires QLQ-C30, the sexual health questionnaire QLQ-SHQ22 and the sexual domains of the breast modules QLQ-BR23 and QLQ-BR45.

METHODS

A random nationwide sample stratified by sex and age groups (18-29, 30-39, 40-49, 50-59, 60-69 and ≥70 years) was drawn from the Norwegian National Population Register. Participants were notified through national online health services (HelseNorge) and postal mail. The survey included sociodemographic background information, health-related quality of life assessed by the EORTC questionnaires, and morbidity assessed by the Self-Administered Comorbidity Questionnaire. Multivariable linear regression was carried out to estimate the associations of age, sex and morbidity with the EORTC scale and item scores.

RESULTS

Of the 15,627 eligible individuals, 5135 (33%) responded. Women and persons with morbidities reported lower functioning and higher symptom burden than men and persons without morbidities, respectively, on nearly all EORTC scales. Sex differences were most prominent for emotional functioning, pain, fatigue and insomnia (QLQ-C30), body image, sexual functioning (QLQ-BR23/45), importance of sexual activity, libido and fatigue (QLQ-SHQ22). The score differences between persons with and without morbidity were highly significant and largest in the youngest and middle-aged groups.

CONCLUSION

This is the first study to provide normative values for the EORTC sexual health questionnaire QLQ-SHQ22 and the sexual subscales of the QLQ-BR23 and QLQ-BR45 for all, separately in age groups by sex and morbidity.

An overview of menopause, and why this should feature within pre-registration education

BACKGROUND

Over half the population (51%) of England and Wales is female, most of whom will experience menopause, either as a result of endocrine ageing or medical treatment.

AIM

The project aimed to undertake a review of the literature to determine the level of knowledge about menopause that healthcare students are exposed to, and to highlight why it is important for them to have an understanding of this subject both for their own clinical practice and for supporting colleagues in the workplace.

METHOD

A literature review was conducted by the project team.

FINDINGS

There is a lack of education for healthcare students, who will go on to care for those affected by menopause, and will also work with colleagues experiencing menopause.

CONCLUSION

Educational programmes should include menopause as a component, which will allow for a breaking down of barriers on a subject that is still generally considered taboo.

RECOMMENDATIONS

A national audit should be conducted on menopause coverage in UK pre-registration nursing. The addition of menopause to the Liverpool John Moores University pre-registration nursing curriculum is also recommended based on agreed competencies.

Association of Pelvic Trauma With Rates of Cesarean Section, Sexual Dysfunction, and Genitourinary Dysfunction in a National Database

INTRODUCTION

Pelvic fractures are severe injuries that can drastically affect a woman's quality of life through sexual dysfunction (SD), genitourinary dysfunction (GD), and increasing the potential need for future cesarean section (C-section). Limited research has captured long-term outcomes after pelvic fractures in women of childbearing age. This study aimed to determine the association between pelvic fractures and rates of C-section, SD, and GD.

METHODS

All women of childbearing age who sustained a pelvic fracture were identified in a national insurance database. A comparison group of patients with lower extremity long-bone fractures was selected. Patients who gave birth after injury were additionally identified. A minimum of 5 years of follow-up was required for inclusion. Rates of C-section, SD, and GD were compared between cohorts. Multivariate logistic regression analysis was conducted with the inclusion of diabetes, tobacco, hypertension, obesity, and advanced maternal age.

RESULTS

A total of 6,174 patients with pelvic fracture and 27,154 control fracture patients were identified. 434 patients with pelvic fracture (7.0%) and 1,258 control fracture patients (4.6%) gave birth after fracture. Patients with pelvic fracture had a significantly higher rate of C-section (50.0% versus 38.8%, P < 0.001), SD diagnosis (10.9% versus 8.8%, P < 0.001), and urinary retention diagnosis (3.5% versus 2.8%, P < 0.001). No significant difference in global GD diagnosis was identified. Multivariate analyses showed that pelvic fracture was associated with C-section (odds ratio [OR]: 1.78; 95% confidence interval [95% CI]: 1.42 to 2.23, P < 0.001), SD diagnosis (OR: 1.23; 95% CI: 1.12 to 1.35, P < 0.001), and urinary retention diagnosis (OR: 1.35; 95% CI: 1.15 to 1.57, P < 0.001).

DISCUSSION

Pelvic fractures confer an intrinsic level of risk of C-section, SD, and urinary retention that is elevated beyond what would be expected from a traumatic lower extremity injury alone. Treating orthopaedic surgeons should actively counsel women regarding increased risks, openly discuss postinjury sequelae, and coordinate interspecialty care beyond initial treatment of acute trauma.

Examining the Health-Related Needs of Females during Menopause: A Systematic Review Study

Menopause is one the most crucial stages in a female's life. Identifying the education gaps regarding menopause is important, thus this study aims to explain the health-related needs of females during menopause. Scopus, PubMed, Scientific Information Database, and Web of Science databases were searched for the available observational (cohort, case-control, and cross-sectional), systematic review, meta-analysis, and clinical trial studies (2007-2021) using keywords, such as 'Educational Needs Assessment,' 'Assessment of Healthcare Needs,' 'menopause,' 'climacteric,' 'premenopause,' and 'postmenopause.' A total of 180 out of 5,705 papers were evaluated after considering the inclusion and exclusion criteria. The educational needs of females during menopause in the reviewed studies include osteoporosis, oral and dental problems, metabolic disorders, cardiovascular diseases, hypertension, lung diseases, infectious diseases, musculoskeletal problems, urinary problems, breast cancer, defecation problems, genital disorders, special diseases such as eye diseases and hypothyroidism and hormone therapy, mental disorders, cognitive function, sleep disorders, sexual disorders, physical activity, supplement consumption, public health issues, health education, fall, and nutrition. The study results reveal that females during postmenopause require training, counseling, and support in all aspects to get through this challenging time, and providing these services, infrastructure, appropriate policy, and the use and support of the medical team's capacity are all required.

Web-Based Digital Storytelling for Endometriosis and Pain: Qualitative Pilot Study

BACKGROUND

Endometriosis is a complex chronic disease characterized by pain, including painful sex, that can contribute to considerable sexual function, self-esteem, and relationship challenges. Digital storytelling is an arts-based, participatory methodology wherein individuals create and share their illness experiences in detailing their lived experiences.

OBJECTIVE

The study objective was to pilot-test a web-based digital storytelling workshop focused on endometriosis to understand storytellers' experiences of workshop participation. We assessed the feasibility of story cocreation and sharing, including the emotional impact of workshop participation, the acceptability of the workshop for the subject matter, and the storytellers' willingness to share their stories with broader audiences as a method for knowledge translation.

METHODS

This study used a community-based participatory methodology supplemented with patient-oriented research and integrated knowledge translation. Study participants, referred to as storytellers, cocreated 3- to 5-minute individual digital stories about their lived experiences of endometriosis during a web-based workshop (comprising five 2-hour sessions over 6 weeks) facilitated by The Center for Digital Storytelling. Data were collected through participant observations at the workshop, storyteller weekly reflective journals, and an end-of-workshop focus group interview with storytellers. These data were analyzed using a qualitative interpretive description approach.

RESULTS

A total of 5 women and 1 nonbinary storyteller aged 19 to 39 years who had experienced endometriosis for 4 to 22 years participated in the study. We characterized storytelling workshop participation and the acceptability of story cocreation by describing participants' experiences of opportunity, commitment, and connection; complex emotions that were healing; and a desire to share. Feasibility was demonstrated through 100% engagement in the workshops. All 6 storytellers reported feeling empowered by publicly sharing their cocreated digital stories through social media and the Sex, Pain & Endometriosis website.

CONCLUSIONS

Despite the complexities of the story-building process, the workshop and the cocreation and sharing of digital stories were feasible. The storytellers found that this process allowed for emotional healing and personal empowerment by offering a unique way to talk about painful sex, which also facilitated a connection among those in the workshop. The use of digital storytelling as a knowledge translation tool shows promise, and this approach also has potential as a therapeutic intervention.

The effects of sexual shame, emotion regulation and gender on sexual desire

Sexual desire is of importance to sexual health, functioning, and well-being. Although an increasing number of studies address disorders related to sexual functioning, there is still a limited understanding of the underlying individual factors affecting sexual desire. The aim of the current study was to investigate the effect of sexual shame, emotion regulation strategies, and gender on sexual desire. In order to investigate this, sexual desire, expressive suppression, cognitive reappraisal, and sexual shame was measured in 218 Norwegian participants using the Emotion Regulation Questionnaire-10, the Sexual Desire Inventory-2, and the Sexual Shame Index-Revised. A multiple regression analysis indicated that cognitive reappraisal predicted sexual desire, β = 0.343, (218) = 5.09, p < 001, CI [0.407, 0.920], whereas sexual shame and expressive suppression were unrelated to sexual desire. Men scored significantly higher than women on expressive suppression, F(1, 216) = 24.968, p < 0.001; partial η2 = 0.104. The current study did not find any significant differences between women and men on cognitive reappraisal, sexual desire or sexual shame, all p > 0.05. Results from the current study indicates that the inclination toward cognitive reappraisal as a preferred emotion regulation strategy may positively affect the strength of sexual desire.

Patient reported improvement in sexual health outcomes following care in a sexual health clinic for women with cancer

PURPOSE

Sexual health concerns are common among female cancer survivors. Few data exist regarding patient-reported outcomes following interventions in this population. We aimed to determine patient-reported adherence and impact of interventions provided in an academic specialty clinic for treatment of sexual health problems.

METHODS

A cross-sectional quality improvement survey regarding sexual problems, adherence with recommended therapies, and improvement following intervention was administered to all women seen at the Women's Integrative Sexual Health (WISH) program at the University of Wisconsin-Madison between November 2013 and July 2019. Descriptive and Kruskal-Wallis tests were used to explore differences between groups.

RESULTS

Two hundred twenty women (median age at first visit = 50 years, 53.1% breast cancer) were identified; N =113 surveys were completed (response rate = 49.6%). The most common presenting complaints were pain with intercourse (87.2%), vaginal dryness (85.3%), and low libido (82.6%). Menopausal women were more likely than premenopausal women to present with vaginal dryness (93.4% vs. 69.7%, p = .001) and pain with intercourse (93.4% vs. 76.5%, p = .02). Nearly all women adhered to recommendations for vaginal moisturizers/lubricants (96.9-100%) and vibrating vaginal wands (82.4-92.3%). A majority found recommended interventions helpful regardless of menopausal status or cancer type and reported persistent improvement. Nearly all women had improvement in understanding sexual health (92%) and would recommend the WISH program to others (91%).

CONCLUSION

Women with cancer report integrative sexual health care to address sexual problems that are helpful and result in long-term improvement. Patients are overall highly adherent to recommended therapies, and nearly all would recommend the program to others.

IMPLICATIONS FOR CANCER SURVIVORS

Dedicated care to address sexual health in women after cancer treatment improves patient-reported sexual health outcomes across all cancer types.

The contribution of the cervix to sexual response: an online survey study

BACKGROUND

The role of the cervix in sexual response has been poorly studied, despite previous research indicating that some women experience pleasurable sexual sensations from cervical stimulation; given previous reports of sexual issues after cervix electrocautery, it is possible that cervical injury may compromise the role of the cervix in sexual functioning.

AIM

The aims of this study were to examine locations of pleasurable sexual sensations, to identify sexual communication barriers, and to investigate if cervical procedures are associated with negative impacts on sexual function.

METHODS

Women with (n = 72) and without (n = 235) a history of a gynecological procedure completed an online survey assessing demographics, medical history, sexual function (including locations of sexual pleasure and pain on diagrams), and barriers. The procedure group was divided into subgroups of those who had experienced a cervical (n = 47) or noncervical (n = 25) procedure. Chi-square analyses and t tests were conducted.

OUTCOMES

Outcomes included locations and ratings of pleasurable and painful sexual stimulation, as well as sexual function.

RESULTS

Over 16% of participants reported experiencing some pleasurable sexual sensations from the cervix. The gynecological procedure group (n = 72) reported significantly higher pain in the vagina and lower rates of pleasure in their external genitals, vagina, deep vagina, anterior and posterior vaginal walls, and clitoris vs the non-gynecological procedure (n = 235) group. The gynecological procedure group and the cervical procedure subgroup (n = 47) reported significant decreases in desire, arousal, and lubrication and increased avoidance of sexual activity due to vaginal dryness. The gynecological procedure group reported significant pain with vaginal stimulation, whereas the cervical subgroup identified significant pain with cervical and clitoral stimulation.

CLINICAL IMPLICATIONS

Cervical stimulation elicits some pleasurable sexual sensations for many women, and gynecological procedures that affect the cervix are associated with pain and sexual issues; thus, health care providers should counsel patients about the possibility of related sexual concerns.

STRENGTHS AND LIMITATIONS

This study is the first to examine locations of pleasure and pain and experiences of sexual pleasure and function in participants who underwent a gynecological procedure. A hybrid measure was used to assess sexual issues, including symptoms of dysfunction.

CONCLUSION

Results indicate an association between cervical procedures and sexual issues, supporting the need to inform patients of this possibility following cervical procedures.

Guidelines, Policies, and Recommendations Regarding the Sexuality of Individuals with Severe Mental Disorders in Psychiatric Units, Institutions, and Supported Housing Across Europe: A Systematic Review

Sexual behavior of psychiatric inpatients is often inadequately addressed within psychiatric institutions. This systematic review aimed to identify existing policies, guidelines, and recommendations regarding inpatient sexual behavior in psychiatric units, institutions, and supported housing across Europe in existing literature. It also aimed to assess the attitudes held by mental health professionals (MHPs) and inpatients toward existing policies, guidelines, and recommendations. Nine databases were searched in seven languages for articles published between 2000 and 2020. Double-blind bias assessment was performed on 10 articles. Five thematic categories emerged from the selected studies: (1) types of policies and guidelines; (2) MHPs' and inpatients' attitudes toward inpatient sexual behavior; (3) impact and strategies related to inpatient sexual behavior; (4) barriers to inpatient sexual behavior; and (5) facilitators to inpatient sexual behavior. Most screened publications reported implicit norms addressing inpatient sexual behavior among the staff. Surveyed MHPs and inpatients typically showed opposing attitudes regarding inpatient sexual behavior, with MHPs generally deeming such behavior unsafe and inpatients emphasizing it as their human right. The aims of this systematic review were partially fulfilled as articles reported little or no policy documents and guidelines and, therefore, did not allow for the assessment of policy impact. MHPs' attitudes toward inpatient sexual behavior were addressed and trends in several countries outside of Europe addressing inpatient sexual behavior were discussed. Finally, capacity to consent with respect to inpatient sexual behavior is discussed in the context of human rights.

Ethnic Minority Representation in Female Sexual Dysfunction Questionnaire Validation: A Scoping Review

BACKGROUND

Female sexual dysfunction (FSD) is a significant cause of distress for an estimated 12-24% of women, and over the past 5 decades several questionnaires have been developed for clinical practice.

AIM

The purpose of this scoping review is to evaluate the ethnic representation of sample populations used in the studies to validate FSD questionnaires.

METHODS

A scoping review was performed using electronic databases, including PubMed and Scopus, to identify FSD questionnaires validated between 1976 and 2021. Weighted averages from the combined ethnicity data were compared to population data from 2019 US census data and 2018 healthcare workforce reports to evaluate epidemiologic diversity. Ethnicity data from each questionnaire were also investigated longitudinally to evaluate trends in representation over the past 50 years.

OUTCOMES

Our outcome of interest was comparison of the weighted averages for ethnicity categories from validation populations to the US female general population, US female health care workforce, and US census data.

RESULTS

48 validation studies were reviewed and showed that the average ethnic representation of the study populations relative to the US general population and US female health care workforce, respectively, was: Caucasian (83.7% vs 62.7% and 68.5%), Black (7.8% vs 13.3% and 8.3%), Hispanic (3.6% vs 16.0% and 9.6%), Native American (0.1% vs 0.8% and 0.3%), Asian (0.6% vs 6.4% and 6.2%), and Other (3.1% vs 0.7% and 1.4%).

CLINICAL IMPLICATIONS

FSD questionnaires are relied upon in research and clinical settings, so lack of diversity in validation populations could lead to under recognition and undertreatment in ethnic minority women.

STRENGTHS & LIMITATIONS

Our results are dependent on the quality of data available from previously published validation studies. We attempted to account for biases in lack of data and size of validation populations by using weighted averages for making comparisons. We chose the US general population and female healthcare workforce for comparison and analyzed validation populations across multiple decades and geographic locations. Many of the validation studies were performed at least 10 years ago and may not reflect the current state of FSD and potential of questionnaire responses of ethnic minority women. This manuscript raises critical awareness regarding the lack of validated instruments for FSD in ethnically diverse women.

CONCLUSION

Study populations used to validate FSD questionnaires demonstrate a trend of ethnic minority underrepresentation relative to the US female general and healthcare workforce populations. Battle CR, Rubin RS, Kingsberg SA, et al. Ethnic Minority Representation in Female Sexual Dysfunction Questionnaire Validation: A Scoping Review. J Sex Med 2022;19:1824-1838.

Pharmacologic therapeutic options for sexual dysfunction

PURPOSE OF REVIEW

Sexual problems are reported by up to 45% of individuals assigned female at birth. Although sexual function is a complex biopsychosocial construct, there are a number of pharmacologic treatment options aimed at addressing the changing vaginal hormonal milieu in postmenopausal individuals and moderating the excitatory and inhibitory aspects of the central nervous system in those with hypoactive sexual desire disorder.

RECENT FINDINGS

The last decade has seen an increase in the number and type of pharmacologic treatment options for dysfunction primarily associated with menopause and hypoactive sexual desire disorder. Recent publications and systematic reviews have strengthened the safety data of existing FDA-approved medications as well as off-label therapies.

SUMMARY

Pharmacologic treatment with local estrogen and testosterone replacement in postmenopausal individuals and with centrally-acting therapies such as flibanserin, bremelanotide, and testosterone in premenopausal individuals assigned female at birth are safe and can be used to improve sexual desire and sexual satisfaction.

Examining Associations Among Sexual Health, Unmet Care Needs, and Distress in Breast and Gynecologic Cancer Survivors

OBJECTIVES

This study evaluated breast and gynecologic cancer patients' sexual function, unmet needs related to sexuality, and distress.

DATA SOURCES

Secondary analyses of a cross-sectional survey study evaluated measures of sexual function (Female Sexual Function Index [FSFI]), unmet needs (Supportive Care Needs Scale), and distress (Patient Health Questionnaire). χ2 test, t tests, and analysis of variances (ANOVAs) tested bivariate relationships. Subgroup comparisons were made based on the Female Sexual Function Index sexual dysfunction diagnostic cut-off score (<26.55; lower scores indicate greater dysfunction). A regression model tested associations between sexual function and unmet needs with distress as the outcome variable.

CONCLUSION

Clinically significant sexual dysfunction was common in this cohort of women. In multivariate modeling, worse sexual function and greater unmet sexuality needs related to greater distress. Future work should explore reasons behind the high levels of sexual dysfunction and unmet needs in female survivors.

IMPLICATIONS FOR NURSING PRACTICE

It is important to routinely screen for sexual health concerns among female cancer survivors at all phases of the cancer trajectory including years posttreatment.

Telemedicine Experience for PrEP Care among PrEP-Eligible Women and Their Primary Care Providers during the First Year of the COVID-19 Pandemic in the United States

(1) Background: During the two-year-long siege from the COVID-19 pandemic, a significant proportion of doctor visits transitioned from in-person to virtual. Scare evidence is available to assess the quality of patient-provider communication via the platform of telemedicine, especially for PrEP care within primary care settings. (2) Methods: Participants included 18 primary care providers and 29 PrEP-eligible women. Through content analysis and thematic analysis, facilitators and barriers embedded at different levels of telemedicine were identified and assessed. (3) Results: Women and providers reported pros and cons regarding their telemedicine experiences during the initial wave of COVID-19. Both groups of participants agreed that telemedicine visits were more convenient, efficient, and comfortable than in-person visits. However, without face-to-face interactions, some women felt less empathy, caring, and connected with their providers during virtual visits. Health providers expressed concerns with telemedicine, including patients’ privacy, lack of intimacy between patients and providers, and delayed lab work. (4) Conclusions: Our data indicate multi-level factors may affect telemedicine experience among PrEP-eligible women and health providers. Participants expressed concerns that may further entrench these long-existing health disparities in healthcare. Proactive efforts from policymakers, health professionals, researchers, and stakeholders are urgently required to tackle identified barriers and to pave the way for the new infrastructure that ensures health equity in society.

Sexual Modesty in Sexual Expression and Experience: A Scoping Review, 2000 - 2021

Sexual modesty is the social, cultural, interpersonal, and psychological systems - defined by the tenets of Script Theory - that regulate individuals' sexual expression and experience at the social, legal, and interpersonal boundaries of acceptable/not-acceptable, private/public, and personal/social. Almost all aspects of sexual expression and experience are touched by the pervasive modesty standards for sexual communication, sexual display, sexual relations, and sexual behaviors. Sexual modesty influences an array of sexual and reproductive health outcomes. Many aspects of sexual modesty are enforced by legal as well as social, cultural, and religious proscriptions, including social shaming and ostracism as well as corporal and capital punishments. The purpose of this paper is to summarize a diverse literature related to sexual modesty from the years 2000 to 2021 in order to clarify its role in sexual health and sexual wellbeing and to identify directions for new research.