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Liu C, Zhang Y, Xu Q, Yang C, Tang Y, Zhang Q, Liu X, Yue Y, Yu F. The risk of sexual dysfunction in Chinese women with recurrent pregnancy loss and the associated factors: a multicenter cross-sectional study. Sex Med 2024; 12:qfae031. [PMID: 38803794 PMCID: PMC11128721 DOI: 10.1093/sexmed/qfae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/15/2024] [Accepted: 04/18/2024] [Indexed: 05/29/2024] Open
Abstract
Background Recurrent pregnancy loss (RPL) is a severe traumatic event for women of childbearing age. However, the association between RPL and female sexual dysfunction was unknown. Aim The study sought to investigate the association between RPL and sexual dysfunction, and to explore the risk factors of sexual dysfunction for RPL patients. Methods A multicenter cross-sectional study involving both RPL patients and healthy women was performed in 3 different hospitals in West China from May 2021 to January 2023. Baseline information including sociodemographic data and disease histories were collected. The Female Sexual Function Index (FSFI) was used to assess the sexual function of participants. Outcomes The main outcome was the proportion of women at increased risk of sexual dysfunction (total FSFI scores <26.55), and the secondary outcome was risk factors of sexual dysfunction in RPL patients. Results A total of 233 RPL patients and 185 healthy women were included in this study. RPL patients had significantly lower total FSFI scores (median 31.7 [interquartile range, 26.6-33.5] vs 33.0 [interquartile range, 31.2-34.1]; P < .001) and a significantly higher risk of sexual dysfunction than healthy women (24.9% vs 8.6%; P < .001). Body mass index >24 kg/m2 (adjusted odds ratio [OR], 4.132; 95% confidence interval [CI], 1.902-8.976, P < .001), working >8 h/d (adjusted OR, 2.111; 95% CI, 1.020-4.369, P = .044), and unexplained RPL (adjusted OR, 3.785; 95% CI, 1.967-7.280, P < .001) were independent risk factors of sexual dysfunction for RPL patients. Clinical Implications RPL patients, especially those patients with the previously mentioned risk factors, should be focused on the risk of sexual dysfunction, and appropriate preventions could be applied. Strength and Limitations We explored the association between RPL and sexual dysfunction and explored the risk factors of sexual dysfunction among RPL patients for the first time, and the multicenter data increased the generalizability of results. However, the cross-sectional design did not provide an exact causal relationship between RPL and sexual dysfunction, and potential risk factors related to mental health were not investigated. Conclusion RPL patients were at an increased risk of sexual dysfunction. Overweight, fatigue caused by work, and unexplained RPL were risk factors of sexual dysfunction for RPL patients.
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Affiliation(s)
- Chuanjiao Liu
- Department of Laboratory Medicine, Chengdu Qingbaijiang Maternal and Child Health Care Hospital, Qingbaijiang District, Chengdu 610300, Sichuan Province, China
- Department of Laboratory Medicine, Chengdu Qingbaijiang Women’s and Children’s Hospital, West China Second University Hospital, Sichuan University, Chengdu 610300, Sichuan Province, China
| | - Yiduo Zhang
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610041, Sichuan Province, China
| | - Qian Xu
- Department of Laboratory Medicine, Chengdu Qingbaijiang Maternal and Child Health Care Hospital, Qingbaijiang District, Chengdu 610300, Sichuan Province, China
- Department of Laboratory Medicine, Chengdu Qingbaijiang Women’s and Children’s Hospital, West China Second University Hospital, Sichuan University, Chengdu 610300, Sichuan Province, China
| | - Chen Yang
- Department of Laboratory Medicine, Chengdu Qingbaijiang Maternal and Child Health Care Hospital, Qingbaijiang District, Chengdu 610300, Sichuan Province, China
- Department of Laboratory Medicine, Chengdu Qingbaijiang Women’s and Children’s Hospital, West China Second University Hospital, Sichuan University, Chengdu 610300, Sichuan Province, China
| | - Yuanting Tang
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610041, Sichuan Province, China
| | - Qiong Zhang
- Department of Obstetrics and Gynecology, Ziyang Maternal and Child Health Care Hospital, Ziyang 641300, China
| | - Xiumei Liu
- Department of Obstetrics and Gynecology, Ziyang Maternal and Child Health Care Hospital, Ziyang 641300, China
| | - Yangang Yue
- Department of Laboratory Medicine, Chengdu Qingbaijiang Maternal and Child Health Care Hospital, Qingbaijiang District, Chengdu 610300, Sichuan Province, China
- Department of Laboratory Medicine, Chengdu Qingbaijiang Women’s and Children’s Hospital, West China Second University Hospital, Sichuan University, Chengdu 610300, Sichuan Province, China
| | - Fan Yu
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610041, Sichuan Province, China
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Baszak-Radomańska E, Wańczyk-Baszak J, Paszkowski T. Women's sexual health improvement: sexual quality of life and pelvic floor muscle assessment in asymptomatic women. Front Med (Lausanne) 2024; 11:1289418. [PMID: 38449880 PMCID: PMC10916695 DOI: 10.3389/fmed.2024.1289418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/06/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction Problems related to the quality of sexual life in gynecological practice are usually neglected. This study aimed to highlight the significance of this area of concern and evaluate the usefulness of tools, such as patient-reported outcomes (PROs) and pelvic floor examination, to improve women's sexual wellbeing and to identify predictors of poor quality of sexual life during the well-woman annual visit. Methods A cross-sectional study was designed to examine 300 healthy women to determine whether the sexual quality of life (SQOL) questionnaire (on electronic devices) and pelvic floor muscle assessment (the vulva, anus, muscles, and periurethral (VAMP) protocol) of asymptomatic women during the annual bimanual examination (BME) help differentiate patients who would benefit from discussing sexual problems with a gynecologist. Dyspareunia was an exclusion criterion. Results The majority of subjects experienced high sexual wellbeing (82.0% with SQOL score of ≥84), with a mean of 85.7 points. SQOL scores were lower for psychiatric disorders or symptoms (37.0% of subjects), although they did not correlate with age, BMI, parity, contraception use, history of vulvovaginal symptoms, neurosurgical/orthopedic problems, and rectal, bowel, or bladder symptoms. Patients with dyspareunia (16.0% of participants, although they denied it during the face-to-face consultation) had a 3.6 times higher prevalence of low or moderate quality of sexual life. The VAMP protocol score was low in asymptomatic women, 33.0% met positive criteria (VAMP+, NRS ≥3) for pelvic floor dysfunction (overactivity), although at borderline levels. VAMP+ was positively correlated with chronic pain and genitourinary symptoms, but neither with dyspareunia nor incontinence, and was unrelated to the SQOL score (p = 0.151). Conclusion Women's sexual health is a global health priority. Finding a way to start a discussion with an asymptomatic patient is crucial to increasing patients' interest in disclosing a sexual health problem to be resolved. PROs or simple questions about sexual wellbeing direct the discussion mainly toward the at-risk group for sexual deterioration: those with mental health problems and women with dyspareunia. Dyspareunia is considered a predictor of decreased quality of sexual life, a major sexual disorder that should not be overlooked. Gynecological consultation should resolve concerns, identify the problem, and refer for professional sexual care if still needed.
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Affiliation(s)
| | - Jadwiga Wańczyk-Baszak
- Terpa Clinic, OB/GYN Department, Lublin, Poland
- Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Tomasz Paszkowski
- Department of Gynecology, Medical University of Lublin, Lublin, Poland
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Merriam S, Kling JM, Thomas HN, Casas RS. Female Sexual Dysfunction: A Primer for Primary Care Health Professionals. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11312. [PMID: 37113246 PMCID: PMC10126124 DOI: 10.15766/mep_2374-8265.11312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 01/25/2023] [Indexed: 05/19/2023]
Abstract
Introduction Female sexual dysfunction (FSD) is common and associated with decreased quality of life, relationship satisfaction, and overall well-being. However, primary care practitioners report discomfort discussing, diagnosing, and treating FSD. Methods We delivered two sessions on the approach to evaluation and treatment of FSD: a 60-minute didactic session and a 90-minute workshop. The intended audience was primary health care professionals who care for women. The workshop utilized interactive teaching methods including a large-group discussion, case-based discussions, debrief of an observed patient-physician discussion, and language drills to develop participants' knowledge and skills. Participants were surveyed about their practice patterns and attitudes toward FSD following the sessions on a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree). Results We collected 131 evaluations from a national Veterans Health Administration 60-minute didactic and four evaluations from the Society of General Internal Medicine Annual Meeting 90-minute workshop (response rates were 60% and 15%, respectively). One hundred thirty-five interdisciplinary trainees and practitioners from both audiences highly rated the workshop content (M = 4.1) and the overall session (M = 4.3). Didactic participants (n = 131) also reported high satisfaction (M = 4.5), increased knowledge and skills (M = 4.4), and improved interprofessional collaborative practice (M = 4.4) as a result of the training. Discussion Our evaluation shows high satisfaction following interactive multimodal sessions on FSD. These adaptable resources can be used in multiple educational settings (didactic and workshop) and for multiple time frames to teach about FSD.
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Affiliation(s)
- Sarah Merriam
- Clinical Assistant Professor, Department of Medicine, University of Pittsburgh School of Medicine, and Department of Medicine, VA Pittsburgh Healthcare System
- Corresponding author:
| | | | - Holly N. Thomas
- Assistant Professor, Department of Medicine, University of Pittsburgh School of Medicine
| | - Rachel S. Casas
- Associate Professor, Department of Medicine, Penn State Health Milton S. Hershey Medical Center
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Tekgunduz S, Ozturk Altinayak S, Ejder Apay S, Ozdemir F, Mohammad Alipour M. The Relationship of Females with Sexual Dysfunctions to Different Sex Positions. JOURNAL OF SEX & MARITAL THERAPY 2022; 49:56-64. [PMID: 35502555 DOI: 10.1080/0092623x.2022.2067090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The aim of this study is to determine the relationship between different sex positions and female sexual dysfunction. This comparative and descriptive study was conducted at a hospital in a province in Eastern Turkey between March 2019 - June 2019. The data were collected using the "Personal Data Form" and "Female Sexual Function Index/FSFI" via the closed envelope technique to protect the participants' privacy. The study was conducted with 184 women. Number, mean, percentage distribution, and ANOVA tests were used to evaluate the data. The total mean score of the FSFI was determined to be 18.03 ± 4.17. When examining the mean scores of the sexual function index in terms of sex position, a statistically significant difference was found between both the FSFI total score and its subscales and all positions (p = 0.00). It was observed that based on the scores of the FSFI, the women had a form of sexual dysfunction and had higher mean scores in Desire, Arousal, Lubrication, Orgasm, and Satisfaction in the overall scale of female-on-top positions, and their mean scores for pain subscale were lower.
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Affiliation(s)
- Sibel Tekgunduz
- Department of Obstetrics and Gynecology, Erzurum City Hospital, Erzurum, Turkey
| | - Serap Ozturk Altinayak
- Faculty of Health Science, Department of Midwifery, Ondokuz Mayıs University, Samsun, Turkey
| | - Serap Ejder Apay
- Faculty of Health Science, Department of Midwifery, Atatürk University, Erzurum, Turkey
| | - Funda Ozdemir
- Faculty of Health Science, Department of Nursing, Ankara University, Ankara, Turkey
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Athey RA, Kershaw V, Radley S. Systematic review of sexual function in older women. Eur J Obstet Gynecol Reprod Biol 2021; 267:198-204. [PMID: 34826667 DOI: 10.1016/j.ejogrb.2021.11.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/02/2021] [Accepted: 11/05/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE As life expectancy increases and women are remaining healthy in to older age, sexual function in later life is an increasingly important and relevant topic for both women and clinicians. As a foundation to a wider project examining sexual function in later life, we undertook a systematic review and meta-analysis to investigate sexual frequency and sexual function in women over the age of 60. METHODS A literature search of the AMED (Allied and Complementary Medicine), EMBASE and MEDLINE databases was performed, using search terms including 'sexual function', 'elderly', 'female', 'woman', 'sexuality'. Quality assessment of studies was performed using the Newcastle-Ottawa scale. RESULTS There were 10 eligible cross-sectional studies, 4 of which reported sufficient data for meta-analysis. There was a wide range of study sizes from 59 to 27, 500 participants. Each study utilised a different tool for assessing sexual function. The largest study reported that up to 73% of women remain sexually active in later life [1]. Other studies documented decreasing sexual desire with age and an association between enjoyment of sex in the past with good sexual function in the present. Meta-analysis was performed with 4 studies comparing women over the age of 60 with women under 60. This demonstrated a significant decrease in the proportion of women who were sexually active over the age of 60 (SMD 9.73, [4.69, 14.78], p = 0.0002). There were non-significant trends towards poorer sexual function (p = 0.06) and decreased interest in sex (p = 0.19) in older age. CONCLUSION Female sexual activity declines significantly with age and there is a non-significant association with poorer sexual function and decreasing sexual desire. Multiple biopsychosocial factors can impact on sexual function however, information relating to specific areas of sexual dysfunction with aging is sparse. This systematic review will inform a large-scale primary research project examining sexual function and dysfunction and impact on quality of life in older women, specifically in the context of women with pelvic floor disorders, in order to gain further insight and enhance clinical and holistic approaches to assessment and management.
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Affiliation(s)
- Ruth A Athey
- Sheffield Teaching Hospitals Obstetrics and Gynaecology Unit, Sheffield, South Yorkshire, United Kingdom.
| | - Victoria Kershaw
- Sheffield Teaching Hospitals Obstetrics and Gynaecology Unit, Sheffield, South Yorkshire, United Kingdom
| | - Stephen Radley
- Sheffield Teaching Hospitals Obstetrics and Gynaecology Unit, Sheffield, South Yorkshire, United Kingdom
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Reliability of the Polish Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and Assessment of Sexual Function before and after Pelvic Organ Prolapse Reconstructive Surgery-A Prospective Study. J Clin Med 2021; 10:jcm10184167. [PMID: 34575276 PMCID: PMC8467811 DOI: 10.3390/jcm10184167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/08/2021] [Accepted: 09/13/2021] [Indexed: 11/17/2022] Open
Abstract
It is estimated that 31–44% of all patients with symptomatic POP and/or UI suffer from sexual dysfunction. We aimed to validate the PISQ-12 in pre-and postmenopausal women and to assess the sexual function before and after POP reconstructive surgery. One hundred and forty sexually active patients were hospitalized due to symptomatic POP and 50 healthy controls were enrolled into the study. The patients were asked to complete PISQ-12, the FSFI and Beck’s depression scale questionnaires twice. The Cronbach’s alpha (α) was used to estimate the internal consistency. The scores were compared using the Intraclass Correlation Coefficient (ICC). Improvement in the QoSL (quality of sexual life) was observed in each age group of women. Pre-menopausal patients’ QoSL was much better, both before and after surgery (29.62 and 34.64 points, respectively). The correlation between questionnaires before surgery was 0.63, and after was −0.76. The α value for the PISQ-12 was 0.83 before the procedure and 0.80 afterwards. In all the groups, the test–retest reliability was good—ICC = 0.72. Vaginal reconstructive surgeries improve the QoSL. The only demographic factor influencing the QoSL was the menopausal status. The Polish version of the PISQ-12 is a reliable and responsive instrument for assessing the sexual function in patients with diagnosed POP and/or UI.
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Hjorth S, Kirkegaard H, Olsen J, Thornton JG, Nohr EA. Mode of birth and long-term sexual health: a follow-up study of mothers in the Danish National Birth Cohort. BMJ Open 2019; 9:e029517. [PMID: 31685494 PMCID: PMC6858091 DOI: 10.1136/bmjopen-2019-029517] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To investigate the relation between mode of birth and women's long-term sexual health. DESIGN Maternal follow-up of the Danish National Birth Cohort (1996-2002) in 2013-2014 including questions on sexual health. Logistic regression was used to relate registry-based information about mode of birth and perineal tears with data on sexual problems. SETTING Denmark. PARTICIPANTS Of 82 569 eligible mothers in the Danish National Birth Cohort, 43 639 (53%) completed the follow-up. Of these, 37 417 women had a partner, and answered at least one question on sexual health. MAIN OUTCOME MEASURES Self-reported sexual health. RESULTS Participants were on average 44 years old, and 16 years after their first birth. The frequency of sexual problems among women with only spontaneous vaginal births, the reference group, was 37%. For women who only had caesarean sections, more problems were reported (OR 1.18; 95% CI 1.09 to 1.28). For women who had a spontaneous vaginal birth subsequent to a caesarean, and for women with only vaginal births who had experienced one or more instrumental vaginal births, the odds of sexual problems did not differ from women with only spontaneous vaginal births (OR 1.00; 95% CI 0.91 to 1.11) and (OR 1.01; 95% CI 0.95 to 1.08), respectively. CONCLUSIONS These findings indicate that caesarean section does not protect against long-term sexual problems. Rather, vaginal birth, even after caesarean section, was associated with fewer long-term sexual problems.
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Affiliation(s)
- Sarah Hjorth
- Department of Clinical Research, Research Unit of Obstetrics and Gynecology, Syddansk Universitet, Odense, Denmark
| | - Helene Kirkegaard
- Department of Clinical Research, Research Unit of Obstetrics and Gynecology, Syddansk Universitet, Odense, Denmark
| | - Jørn Olsen
- Department of Clinical Epidemiology, Aarhus University, Aarhus N, Denmark
| | - Jim G Thornton
- Department of Child Health, Obstetrics and Gynaecology, University of Nottingham, Nottingham, UK
| | - Ellen A Nohr
- Department of Clinical Research, Research Unit of Obstetrics and Gynecology, Syddansk Universitet, Odense, Denmark
- Centre of Women's, Family and Child Health, University of South-Eastern Norway, Kongsberg, Norway
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Chang JH, Shin DW, Jeon MJ, Hong H, Kim SM, An A, Son KY, Park JH, Cho B, Kim SK, Lee SM. Uterine Leiomyoma Is Associated with Female Sexual Dysfunction in Postmenopausal Women. Yonsei Med J 2019; 60:791-795. [PMID: 31347335 PMCID: PMC6660434 DOI: 10.3349/ymj.2019.60.8.791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 06/19/2019] [Accepted: 06/20/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To determine the relationship between uterine leiomyoma and female sexual dysfunction (FSD) among premenopausal and postmenopausal women. MATERIALS AND METHODS The study population consisted of consecutive women who underwent gynecologic screening tests, including transvaginal ultrasound, and completed the questionnaires on FSD. A total of 841 women were included from January 2010 to December 2011. FSD was defined as Female Sexual Function Index (FSFI) ≤26.55. The relationship between uterine leiomyoma and FSD were compared according to menopausal status. RESULTS In premenopausal group (n=564), there were no differences in the frequency of FSD (55.0% vs. 58.8%, p=0.387) and total FSFI score. However, in postmenopausal group (n=277), women with uterine leiomyoma had a lower frequency of FSD than those without uterine leiomyoma (71.3% vs. 86.4%, p=0.003). This relationship between uterine leiomyoma and lower frequency of FSD in postmenopausal women remained significant after adjusting for confounding variables. CONCLUSION The relationship between uterine leiomyoma and FSD is different depending on the menopausal status.
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Affiliation(s)
- Jae Hoon Chang
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
| | - Dong Wook Shin
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Family Medicine & Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myung Jae Jeon
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeri Hong
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
| | - Sun Min Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
- Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Ahreum An
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
- Health Promotion Center, Seoul National University Hospital, Seoul, Korea
| | - Ki Young Son
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Family Medicine, Asan Medical Center, Seoul, Korea
| | - Jin Ho Park
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
- Health Promotion Center, Seoul National University Hospital, Seoul, Korea
| | - Belong Cho
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
- Health Promotion Center, Seoul National University Hospital, Seoul, Korea
| | - Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Seung Mi Lee
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
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Abstract
Sexual dysfunction in women with prolapse and incontinence is well documented in the literature, but the impact of treatment, particularly surgical correction, remains very limited and confusing. Age, on the other hand, has been shown to be an independent risk factor for deteriorating sexual function, with all aspects of the sexual function (i.e. desire, arousal, penetration, and orgasm) being affected. When combined with surgical correction of prolapse or incontinence there is potential for further worsening of sexual function, and hence this should be assessed before any pelvic floor surgery and patient expectations established. In this article the current evidence will be reviewed looking at the impact of pelvic floor dysfunction on sexual function and the effect of commonly performed surgery for these problems. Ways and means of preserving sexual function in women undergoing corrective surgery will also be investigated.
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Affiliation(s)
- S Jha
- a Department of Urogynaecology , Sheffield Teaching Hospitals NHS Foundation Trust , Sheffield , UK
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Doğanay M, Kokanalı D, Kokanalı MK, Cavkaytar S, Aksakal OS. Comparison of female sexual function in women who underwent abdominal or vaginal hysterectomy with or without bilateral salpingo-oophorectomy. J Gynecol Obstet Hum Reprod 2019; 48:29-32. [DOI: 10.1016/j.jogoh.2018.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 10/30/2018] [Accepted: 11/09/2018] [Indexed: 11/26/2022]
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Catamero D, Noonan K, Richards T, Faiman B, Manchulenko C, Devine H, Bertolotti P, Gleason C, Board A. Distress, Fatigue, and Sexuality: Understanding and Treating Concerns and Symptoms in Patients With Multiple Myeloma. Clin J Oncol Nurs 2017; 21:7-18. [DOI: 10.1188/17.cjon.s5.7-18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
Female genital mutilation (FGM), otherwise known as female genital cutting (FGC), is currently very topical and has become a significant global political issue. The impact of FGM on the lives of women and girls is enormous, as it often affects both their psychology and physical being. Among the complications that are often under-reported and not always acknowledged is female sexual dysfunction (FSD). FSD presents with a complex of symptoms including lack of libido, arousability and orgasm. This often occurs in tandem with chronic urogenital pain and anatomical disruption due to perineal scarring.To treat FSD in FGM each woman needs specifically directed holistic care, geared to her individual case. This may include psychological support, physiotherapy and, on occasion, reconstructive surgery. In many cases the situation is complicated by symptoms of chronic pelvic pain, which can make treatment increasingly difficult as this issue needs a defined multidisciplinary approach for its effective management in its own right. The problems suffered by women with FGM are wholly preventable, as the practice need not happen. The current global momentum to address the social, cultural, economic and medical issues of FGM is being supported by communities, governments, non-governmental agencies (NGOs) and healthcare providers. It is only by working together that the practice can be abolished and women and girls may be free from this practice and its associated consequences.
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Affiliation(s)
- Sohier Elneil
- Consultant in Urogynaecology and Uro-neurology, University College London Hospitals NHS Foundation Trust, London, UK
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Pelvic floor dysfunction, and effects of pregnancy and mode of delivery on pelvic floor. Taiwan J Obstet Gynecol 2015; 53:452-8. [PMID: 25510682 DOI: 10.1016/j.tjog.2014.08.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2014] [Indexed: 11/24/2022] Open
Abstract
Pelvic floor dysfunction (PFD), although seems to be simple, is a complex process that develops secondary to multifactorial factors. The incidence of PFD is increasing with increasing life expectancy. PFD is a term that refers to a broad range of clinical scenarios, including lower urinary tract excretory and defecation disorders, such as urinary and anal incontinence, overactive bladder, and pelvic organ prolapse, as well as sexual disorders. It is a financial burden on the health care system and disrupts women's quality of life. Strategies applied to decrease PFD are focused on the course of pregnancy, mode and management of delivery, and pelvic exercise methods. Many studies in the literature define traumatic birth, usage of forceps, length of the second stage of delivery, and sphincter damage as modifiable risk factors for PFD. Maternal age, fetal position, and fetal head circumference are nonmodifiable risk factors. Although numerous studies show that vaginal delivery affects pelvic floor structures and their functions in a negative way, there is not enough scientific evidence to recommend elective cesarean delivery in order to prevent development of PFD. PFD is a heterogeneous pathological condition, and the effects of pregnancy, vaginal delivery, cesarean delivery, and possible risk factors of PFD may be different from each other. Observational studies have identified certain obstetrical exposures as risk factors for pelvic floor disorders. These factors often coexist; therefore, the isolated effects of these variables on the pelvic floor are difficult to study. The routine use of episiotomy for many years in order to prevent PFD is not recommended anymore; episiotomy should be used in selected cases, and the mediolateral procedures should be used if needed.
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Abstract
Hysterectomy remains the most common major gynecological surgery. Postoperative sexual function is a concern for many women and their partners. In this respect, a beneficial effect of hysterectomy for benign disease independent of surgical techniques or removal of the cervix has been demonstrated in the past decade by the majority of studies. For about 20 % of women, deteriorated sexual function has been reported and current research is attempting to identify mechanisms and predictive factors explaining these postoperative changes. Alternative treatments of benign uterine disorders or uterus preserving surgery for genital prolapse appeared to have similar outcomes in terms of sexual function. Concomitant oophorectomy had negative effects on sexual function and long-term health, particularly in premenopausal women. This may not be reversed by estrogen replacement. Hysterectomy performed for malignancy had a detrimental effect on sexual function. Individualized risk assessment and information should be aimed at during preoperative decision making.
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Ulrich D, Dwyer P, Rosamilia A, Lim Y, Lee J. The effect of vaginal pelvic organ prolapse surgery on sexual function. Neurourol Urodyn 2014; 34:316-21. [PMID: 24501075 DOI: 10.1002/nau.22569] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 01/08/2014] [Indexed: 01/23/2023]
Abstract
AIMS Data on female sexual function after prolapse surgery are conflicting. The aim of the study was to evaluate the change in sexual function and vaginal symptoms using patient reported outcomes following prolapse surgery in addition to the anatomical stage. METHODS Prospective observational study of women undergoing pelvic organ prolapse (POP) surgery. The validated International Consultation on Incontinence modular Questionnaire-Vaginal Symptoms (ICIQ-VS) questionnaire was completed preoperatively, 6 and 12 months postoperatively. RESULTS Ninety-three women participated in the study with 83 (89%) returning the 6 months questionnaire and 80 (86%) the 12 months questionnaire. Twenty-four healthy women without prolapse were included as a control group. The mean vaginal- and sexual-symptom score both improved with a significant decrease at 6 months and 12 months after surgery (P < 0.001, P < 0.05, respectively). The POP-Q scores of each compartment also improved significantly after 6 and 12 months (P < 0.001) with 75% reaching anatomical success. There was no correlation between anatomical success and subjective ICIQ-VS outcomes. The vaginal and sexual matters score had a lesser reduction in women who had additional levator plication sutures during posterior vaginal repair compared to those without. Women with levator plication also showed a significant increase in postoperative dyspareunia. CONCLUSIONS Surgical intervention for POP improved the vaginal and sexual matters scores at 6 and 12 months postoperatively. Levator plication additionally to posterior vaginal repair is associated with an increase in postoperative dyspareunia rates and with decreased sexual function.
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Affiliation(s)
- Daniela Ulrich
- Monash Medical Centre, Monash Health, Melbourne, VIC, Australia; Monash Institute of Medical Research, Monash University, Melbourne, VIC, Australia; Medical University Graz, Graz, Austria
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16
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Celik DB, Kizilkaya Beji N, Yalcin O. Sexual function in women after urinary incontinence and/or pelvic organ prolapse surgery. J Clin Nurs 2013; 23:2637-48. [DOI: 10.1111/jocn.12496] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | - Nezihe Kizilkaya Beji
- Faculty of Florence Nightingale Nursing; Department of Obstetric and Gynecologic Nursing; İstanbul University; Istanbul Turkey
| | - Onay Yalcin
- Istanbul Medical Faculty; Department of Obstetric and Gynecology; Division of Urogynecology; Istanbul University; Istanbul Turkey
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17
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Berry MD, Berry PD. Contemporary Treatment of Sexual Dysfunction: Reexamining the Biopsychosocial Model. J Sex Med 2013; 10:2627-43. [DOI: 10.1111/jsm.12273] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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18
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Lonnée-Hoffmann RA, Salvesen Ø, Mørkved S, Schei B. What predicts improvement of sexual function after pelvic floor surgery? A follow-up study. Acta Obstet Gynecol Scand 2013; 92:1304-12. [DOI: 10.1111/aogs.12237] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 08/12/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | - Øyvind Salvesen
- Institute of Cancer Research and Molecular Medicine; Norwegian University of Science and Technology; Trondheim; Norway
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19
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Rodríguez MC, Chedraui P, Schwager G, Hidalgo L, Pérez-López FR. Assessment of sexuality after hysterectomy using the Female Sexual Function Index. J OBSTET GYNAECOL 2012; 32:180-4. [DOI: 10.3109/01443615.2011.634035] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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20
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Richards TA, Bertolotti PA, Doss D, McCullagh EJ. Sexual dysfunction in multiple myeloma: survivorship care plan of the International Myeloma Foundation Nurse Leadership Board. Clin J Oncol Nurs 2011; 15 Suppl:53-65. [PMID: 21816710 DOI: 10.1188/11.cjon.s1.53-65] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The World Health Organization describes sexuality as a "central aspect of being human throughout life and encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy, and reproduction. Sexuality is influenced by the interaction of biological, psychological, social, economic, political, cultural, ethical, legal, historical, religious, and spiritual factors." Currently, no research has been conducted regarding sexual dysfunction in patients with multiple myeloma; therefore, information related to the assessment and evaluation of sexual dysfunction is gleaned from other malignancies and diseases. In this article, members of the International Myeloma Foundation's Nurse Leadership Board discuss the definition, presentation, and causes of sexual dysfunction; provide recommendations for sexual assessment practices; and promote discussion among patients with multiple myeloma, their healthcare providers, and their partners.
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Affiliation(s)
- Tiffany A Richards
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center in Houston, USA.
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21
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Fall M, Baranowski AP, Elneil S, Engeler D, Hughes J, Messelink EJ, Oberpenning F, de C Williams AC. EAU guidelines on chronic pelvic pain. Eur Urol 2009; 57:35-48. [PMID: 19733958 DOI: 10.1016/j.eururo.2009.08.020] [Citation(s) in RCA: 237] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 08/19/2009] [Indexed: 12/21/2022]
Abstract
CONTEXT These guidelines were prepared on behalf of the European Association of Urology (EAU) to help urologists assess the evidence-based management of chronic pelvic pain (CPP) and to incorporate the recommendations into their clinical practice. OBJECTIVE To revise guidelines for the diagnosis, therapy, and follow-up of CPP patients. EVIDENCE ACQUISITION Guidelines were compiled by a working group and based on a systematic review of current literature using the PubMed database, with important papers reviewed for the 2003 EAU guidelines as a background. A panel of experts weighted the references. EVIDENCE SYNTHESIS The full text of the guidelines is available through the EAU Central Office and the EAU Web site (www.uroweb.org). This article is a short version of the full guidelines text and summarises the main conclusions from the guidelines on the management of CPP. CONCLUSIONS A guidelines text is presented including chapters on chronic prostate pain and bladder pain syndromes, urethral pain, scrotal pain, pelvic pain in gynaecologic practice, neurogenic dysfunctions, the role of the pelvic floor and pudendal nerve, psychological factors, general treatment of CPP, nerve blocks, and neuromodulation. These guidelines have been drawn up to provide support in the management of the large and difficult group of patients suffering from CPP.
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Affiliation(s)
- Magnus Fall
- Department of Urology, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
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22
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Thakar R. Review of current status of female sexual dysfunction evaluation in urogynecology. Int Urogynecol J 2009; 20 Suppl 1:S27-31. [DOI: 10.1007/s00192-009-0830-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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