Female sexual dysfunction: a new urogynaecological research field

The International Female Coital Incontinence Questionnaire: Translation, Validation, and Reliability Study of the Persian Version

INTRODUCTION AND HYPOTHESIS

This study was aimed at validating the Persian version of the International Female Coital Incontinence Questionnaire (IFCI-Q).

METHODS

In the current study, 150 sexually active women with complaints of any kind of sexual dysfunction from January 2022 to July 2023, who were referred to urogynecology outpatient clinics, completed the IFCI-Q. Age ≥ 18 years and sexually active women were the inclusion criteria for the study. Quantitative calculations were made to determine the content validity ratio and content validity index. A test-retest procedure was utilized to determine the scale reliability.

RESULTS

The mean (SD) age of participants was 35.66 (7.03) years. Among a total of 150 women, 21 (14.0%) had coital incontinence (CI), and this disorder happened during penetration in 11 cases (7.3%), orgasm in 9 (6.1%), or both conditions in one woman (0.7%). The intraclass correlation coefficient (95% confidence interval) was 0.79 (0.74, 0.84), and the Cronbach's α coefficient was 0.89. A positive association between the Female Sexual Function Index and the IFCI-Q was also demonstrated by the criteria validity (r = 0. 87 and p = 0.001).

CONCLUSION

Regarding validity and reliability, the Persian version of the IFCI-Q can properly evaluate CI in women with sexual dysfunction or complaining of CI.

The effect of transobturator tape surgery on female sexual function: a systematic review and meta-analysis

PURPOSE

We aimed to review the literature regarding the effects of trans obturator tape surgery (TOT) on sexual functions in women with stress urinary incontinence (SUI) to reveal compact data and to reach more consistent and reliable results.

METHODS

PRISMA statement was used in the current review. The databases of PubMed (Medline), Science Direct, and Cochrane Central Register of Controlled Trials were detected independently. We evaluated the studies comparing the preoperative and postoperative sexuality parameters related to the TOT procedure in females. Studies presenting the mean and standard deviation(SD) of global and sub-item Female Sexual Function Index(FSFI) were included in the current study.

RESULTS

We identified 783 studies in full publications or abstract forms using the methodology above and the search terms. Finally, eight studies were included in the meta-analysis. The pooled analysis of the mean difference demonstrated that the total sexual function scores of the patients improved after TOT surgery.

CONCLUSION

The data collected from the current meta-analysis suggest that TOT surgery improves female sexual function.

Linguistic translation and validation of the Arabic version of International Female Coital Incontinence Questionnaire (IFCI-Q)

Objectives

Aim of the study was to translate the International Female Coital Incontinence Questionnaire (IFCI-Q) into Arabic (Egyptian) and validate it into among Egyptian population complaining of coital urinary incontinence (CI).

Methods

Original questionnaire has been translated and back-translated by an expert panel, to produce the Arabic version. A pilot study was performed to make sure the questionnaire was understandable. Sixty patients included in the study were divided into two groups: Group A comprised patients with CI, and Group B comprised females who attended the urology clinic for other complaints, without CI. Reliability of the Arabic IFCI-Q was evaluated for internal consistency using Cronbach alpha coefficient. Test-retest reliability was determined using the Weighted Cohen's k-test. Discrimination validity was evaluated by comparing scores of patients with those of healthy females not complaining of CI using Mann-Whitney test.

Results

83.3% of women of both groups (mean age: 43.1 ± 10.6 yrs [Group A], 38.9 ± 8 [Group B] yrs) reported OAB symptoms, 73.3% had stress urinary incontinence and 46.7% reported mixed urinary incontinence. Regarding Group A, 10 patients had CI during penetration, 12 during orgasm and 8 had both forms of CI. The comparison of the responses between Group A and Group B demonstrated a statistically difference (p < 0.00). The content validity was assessed by a panel of expert functional urologists. The Cronbach's alpha coefficients for the total score were high (0.9-1), indicating high internal consistency. The difference between the two groups revealed an internal consistency of IFCI-Q of 0.563-0.851. The test-retest procedure revealed that the k-values of each item are very good.

Conclusions

The Arabic version will allow utilizing this tool in a large population of Arabic-speaking countries, with different ethnic and demographic backgrounds.

The International Female Coital Incontinence Questionnaire (IFCI-Q): Development, Validation and Reliability Study

INTRODUCTION

Coital urinary incontinence is an underestimated urinary symptom characterized by urine leakage during intercourse with a serious impact on female sexual function, which often may lead to the abandon of sexual activity. To date, there are no specific validated questionnaires for coital incontinence (CI).

AIM

Aim of the study was to develop and validate a questionnaire "International Female Coital Incontinence- Questionnaire" (IFCI-Q) to evaluate the presence, severity and type of CI and its impact on quality of sexual intercourse.

METHODS

The IFCI-Q validation process included the following stages: (i) Questionnaire development and expert focus group (urologists and gynecologists experts in the field of functional urology); (ii) Administration of IFCI-Q to sexually active women complained for CI, by cognitive interview; (iii) Expert focus group to assess for content validity; (iv) Psychometric assessment of internal consistency by Cronbach's alpha calculation; (v) Test-retest reliability.

MAIN OUTCOME MEASURE

Aim of the questionnaire was to evaluate the presence, severity and type of CI, its impact on quality of sexual intercourse and psychological status and to identify concomitant urinary symptoms. Psychometric properties outcomes: internal consistency and reliability are considered acceptable for Cronbach's α coefficient >0.7 and Cohen's k-test >0.6, respectively. Test-retest reliability was detected by administering the questionnaire twice to the all included women with a time interval of 2 weeks. The content validity was evaluated by a panel of clinical experts.

RESULTS

Thirty women (mean ± SD age: 43.4 ± 17.1 years) complained of CI completed the IFCI-Q. A total of 43.4% of patients had OAB symptoms, 23.3% had mixed urinary incontinence (UI) and 6.6% complained of stress UI. Patients with CI during penetration had a higher prevalence of predominant SUI (7/10), and all women suffering from CI during orgasm had OAB symptoms (11/11). A total of 80% women feel depressed and 56.6% patients reported that CI restricts their sexual activity. Internal consistency and replicability of data were in the adequate range (Cronbach α = 0.737). The test-retest procedure revealed that the k-values of each item are very good.

CONCLUSION

IFCI-Q is a reliable questionnaire on CI and demonstrated a high level of internal consistency and reliability. Gubbiotti M, Giannantoni A, Rubilotta E, et al. The International Female Coital Incontinence Questionnaire (IFCI-Q): Development, Validation and Reliability Study. J Sex Med 2022;19:158-163.

Disfunción sexual femenina: una mirada a los últimos 44 años. Análisis bibliométrico

Objetivo La disfunción sexual femenina (DSF) es un trastorno prevalente que afecta la calidad de vida de las mujeres y combina factores biológicos, psicológicos e interpersonales. Su estudio ha sido de poco interés, en campos como la investigación y el tratamiento, debido a la dificultad en la medición de las respuestas sexuales en las mujeres y otros factores, como el tabú acerca de la sexualidad femenina. Este estudio caracteriza las tendencias de publicaciones científicas acerca del tema, para que los urólogos puedan comprender la necesidad de realizar la búsqueda de este trastorno en la práctica diaria.

Métodos Se realizó una búsqueda de la literatura en las bases de datos PubMed, FABUMED y Scopus, utilizando la estrategia «((«female sexual dysfunction» [Title/Abstract])». Se realizó un análisis bibliométrico descriptivo, de corte retrospectivo, de la literatura médica obtenida en MEDLINE. A través de las herramientas estadísticas FABUMED, PubReminer y Scopus, se recopilaron los datos y se obtuvo los resultados de las variables que posteriormente fueron analizadas de forma estadística y descriptiva. Con base en esta información, elaboramos tablas y gráficas en Microsoft Office Excel 2017. Adicionalmente, realizamos un análisis de mapeo bibliométrico utilizando el programa VOSviewer. Para la obtención del factor de impacto (FI), utilizamos el Journal Citation Reports 2017/2018.

Resultados Desde 1975 hasta 2019, se publicaron 1.292 estudios, y la tasa anual de publicación permaneció estable entre 1975 y 2000. Pero, a partir del año 2000, se evidenció un aumento en el número de publicaciones, con un crecimiento del 92,1%. De las veinte revistas con más publicaciones, sólo cuatro son de urología. Los países con más publicaciones fueron: Estados Unidos (31,4%), Reino Unido (12,9%), Italia (8,9%), Turquía (5,9%), y Australia (4%). Estos datos son muy diferentes a los de los países de América Latina, en los que se encontraron muy pocas publicaciones, como Colombia, con tan sólo tres estudios.

Conclusiones Este análisis bibliométrico mostró las diferentes tendencias y tasas de publicación de estudios sobre DSF, y evidenció una baja tasa de producción con relación a otras temáticas, sobre todo en las revistas urológicas, con predominio de mujeres como autores, aunque en los últimos años se ha identificado un crecimiento importante y sostenido. Se hace evidente la necesidad de desarrollar estrategias para mejorar la formación tanto en los niveles de posgrado como de pregrado y, así, generar más adhesión a este tema en una especialidad quirúrgica como la nuestra.

Association of Baseline Pelvic Floor Muscle Activities With Sexual and Urinary Functions In Female Stress Urinary Incontinence

BACKGROUND

The presence of reactive and strong pelvic floor muscle (PFM) activities is supposed to be associated with better urinary and sexual functions in female stress urinary incontinence (SUI).

AIM

This study was to explore the association of baseline PFM activities, both volitional and reflex, with urinary and sexual functions in women with SUI but who had no experience of PFM training programs before.

METHODS

Secondary analysis of a prospectively maintained database identified 125 sexually active women with SUI who had met the eligibility criteria. All patients had undergone intravaginal digital examination and pelvic ultrasound to detect volitional and reflex PFM activities, respectively, and responded to questionnaire surveys, including short forms of the urogenital distress inventory, incontinence impact questionnaire-7, and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire. On pelvic ultrasound, an inward clitoral motion and an anorectal lift preceding or during coughing were regarded as the presence of reflex activities of the PFM.

OUTCOMES

The relationship of volitional and reflex PFM activities with pelvic floor dysfunction relating questionnaires and urethral function on urodynamic studies was analyzed.

RESULT

Of the 125 women studied, 30 (24.0%) had volitional PFM contraction strength less than grade 2, 74 (59.2%) grade 2 to 3, and 21 (16.8%) greater than grade 3 based on the modified Oxford grading scale. During or preceding coughing, an inward clitoral motion was not observed on ultrasound in 9 (7.2%) women and an anorectal lift was not observed in 8 (6.4%) women. The strength of volitional PFM contraction and the presence or absence of anorectal lift reflex was not associated with urethral and sexual function. In contrast, the absence of reflex inward clitoral motion was significantly associated with lower maximum urethral closure pressure (P = .042) and higher scores of urogenital distress inventory-6 (P = .006) and incontinence impact questionnaire-7 (P = .029).

CLINICAL IMPLICATIONS

Higher volitional PFM contraction strength was not associated with better sexual and urinary functions; however, loss of one reflex PFM activity was associated with poorer urinary function.

STRENGTHS & LIMITATION

To our knowledge, this is the first study that evaluates the association of baseline PFM activities with sexual and urinary functions in female SUI. Nevertheless, the cross-sectional design of this study cannot well support the cause-effect relationship CONCLUSION: Besides PFM physiotherapy for enhancing sexual and urinary functions in female SUI, additional treatment strategies such as neuromodulation should take into consideration for those who had absent reflex PFM activities. Yang E, Yang SH, Huang WC, et al. Association of Baseline Pelvic Floor Muscle Activities With Sexual and Urinary Functions In Female Stress Urinary Incontinence. J Sex Med 2021;18:1698-1704.

Multidisciplinary management of women with pelvic organ prolapse, urinary incontinence and lower urinary tract symptoms.A clinical and psychological overview

Although female sexual dysfunctions are common among women with urogynecological conditions, they have not been thoroughly studied and there are still many questions without an answer. The recent evidence on sexual disorders in women with urogynecological diseases shows a quite wide spectrum of therapeutic approaches, which require the physicians to take into account not only the primary symptoms, but also all the associated factors negatively affected. It has been widely underlined that gynecological diseases are often associated with high stress and have a negative impact on quality of life and psychological well-being of women affected. For this reason, a multidisciplinary approach for the management of these diseases is highly recommended. Also in the case of urogynecological disorders, it is important to take into account psychological outcomes throughout the diagnostic and therapeutic process. In the light of these considerations, the aim of this short review is to evaluate the impact of the main urogynecological diseases and the currently available therapeutic options in order to improve quality of life and sexuality of these patients and to stress the need for a multidisciplinary approach in order to minimize the negative consequences of these diseases for the sexual well-being of women and their partners.

Female sexual dysfunction in female genital mutilation

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.

Quality of life in women with urinary incontinence

The aim of this study is to examine the relationship among psychological, clinical and sociodemographic variables, and quality of life in women with urinary incontinence. The sample consisted of 80 women diagnosed with urinary incontinence (UI) followed in a Northern Central Hospital in Portugal. Participants answered the Incontinence Quality of Life (I-QOL); Satisfaction with Sexual Relationship Questionnaire (SSRQ); Hospital Anxiety and Depression Scales (HADS) and the Brief Cope. The results revealed that women with higher quality of life considered their symptoms of urine loss as mild or moderated compared to those with severe urine loss. The less severe urine loss was associated with greater sexual satisfaction and less use of religion and self-blame as coping strategies. In terms of coping, women who considered the loss of urine as severe expressed more feelings regarding UI. Stress urinary incontinence, high sexual satisfaction, and less use of denial, distraction, and religion as coping strategies, predicted higher quality of life. According to the results, UI has an impact on women's sexual satisfaction and quality of life. Therefore, intervention programs should target these women, including their partners, helping them to adjust to their condition and teaching effective coping strategies in order to improve their sexual satisfaction and quality of life.

Validation of the Polish version of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire

INTRODUCTION AND HYPOTHESIS

The aim of the study was to develop a Polish version of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ) to evaluate sexual function in patients with stress urinary incontinence (SUI) and pelvic organ prolapse (POP) versus a control group.

METHODS

Before the validation study, a pilot study of the Polish version of the PISQ was performed in 22 women with pelvic floor dysfunctions. The respondents completed the questionnaire at recruitment and 2 weeks later. Test-retest reliability and internal consistency were determined. The validation study was performed in 249 sexually active women (123 with urodynamic SUI and POP; 126 healthy controls). The study group reported urinary incontinence (UI) at the urogynecological ambulatory clinic, where they underwent urogynecological and urodynamic examinations. All participants completed the questionnaire. PISQ results from both groups were compared and correlated with those of the King's Health Questionnaire (KHQ) and patient age.

RESULTS

Test-retest reliability was good according to Pearson's correlation coefficient (r = 0.89, p < 0.001). PISQ had high internal consistency (Cronbach's α = 0.878). The total PISQ score was significantly lower in the study group compared with the controls (83.6 ± 14.9 vs 95.7 ± 10.3, p < 0.001), as were scores for individual domains: Behavioral/Emotive, Physical, Partner-Related (33.9 ± 10.2 vs 39.8 ± 7.8, 31.7 ± 6.9 vs 37.1 ± 2.8, and 18.0 ± 3.1 vs 19.4 ± 2.6 respectively; p < 0.001), confirming the lower quality of sexual function in women with SUI and POP. A correlation between PISQ and KHQ scores and patient age was confirmed.

CONCLUSIONS

The Polish version of the PISQ is a reliable tool for evaluating sexual function in women with POP and UI.

Sexual and bladder comorbidity in women

Sexual dysfunction in women is defined as disorders of sexual desire, arousal, orgasm, and/or sexual pain, which result in significant personal distress and may have a negative effect on a woman's health and an impact on her quality of life. A comprehensive understanding of the anatomic, neurobiologic, and psychologic mechanisms behind women's sexual function and dysfunction is of paramount importance. This chapter reviews the most frequent comorbid conditions related to urinary tract symptoms (thus including symptoms related to overactive bladder syndrome and urinary incontinence) and sexual dysfunction in women. Likewise, it considers the different disorders from the point of view of daily clinical practice.

Benefit of pelvic floor muscle therapy in improving sexual function in women with stress urinary incontinence: a pretest-posttest intervention study

Very few data are available on the effect of pelvic floor muscle training on sexual function in incontinent women. The authors used the Female Sexual Function Index to assess the effect of pelvic floor muscle training on female sexual function. Participants included women with stress urinary incontinence, without overactive bladder symptoms, who completed a 3-month pelvic floor muscle training. All patients completed the Female Sexual Function Index and the International Consultation on Incontinence Questionnaire-Short Form at baseline and at the 3-month follow-up. Thirty-four patients completed all of the questionnaires; 64.7% patients were referred with stress urinary incontinence without sexual disorders, while 35.3% complained of stress urinary incontinence and sexual symptoms. The International Consultation on Incontinence Questionnaire-Short Form score significantly decreased after 3 months of pelvic floor muscle training (p =.01). The Female Sexual Function Index score significantly improved after pelvic floor muscle training even in women with sexual disorders (12.5 ± 9.5 vs. 29.7 ± 3.7; p <.001). This study showed that pelvic floor muscle training may improve female sexual function in women with pure stress urinary incontinence.

Assessment of female sexual function among women with pelvic organ prolapse or urinary incontinence via an Arabic validated short-form sexual questionnaire

OBJECTIVE

To assess female sexual function among women with pelvic organ prolapse or urinary incontinence via an Arabic, validated, short-form sexual questionnaire (PISQ-12).

METHODS

The present study was conducted among women attending Suez Canal University Hospital, Ismailia, Egypt, between September 2009 and August 2011. In the pilot study, 42 women completed the final version of the Arabic PISQ-12 at recruitment and then 2 weeks later, and the data were compared to evaluate reliability and internal consistency. The formal comparative study included 154 premenopausal sexually active women: 80 control women, and 74 women with some degree of pelvic prolapse with or without stress incontinence. All participants had a vaginal examination and completed the questionnaire. The main outcome measures were the mean questionnaire scores within its 3 domains (behavioral, physical, and partner-related).

RESULTS

The test-retest reliability and internal consistency of the Arabic PISQ-12 were excellent. Validity was approved by an expert panel. The case group had a significantly lower mean total questionnaire score (31.07 ± 4.2 vs 34.7 ± 6.2; P<0.05) but a higher partner-related score (9.0 ± 2.4 vs 8.4 ± 2.5; P<0.05).

CONCLUSION

The Arabic version of PISQ-12 was shown to be an effective and objective method of evaluating sexual function among patients with pelvic organ prolapse.

An insight into pelvic floor status in nulliparous women

INTRODUCTION AND HYPOTHESIS

Few studies have comprehensively investigated the prevalence of various types of pelvic floor Dysfunction (PFD) in women before their first pregnancy. However, no previous studies have investigated in detail all four compartments of PFD and the correlation between them.

METHODS

This was a cross-sectional study nested within a parent prospective study Screening for Pregnancy Endpoints (SCOPE) performed in a tertiary referral teaching hospital with approximately 9,000 deliveries per annum. Nulliparous women completed the validated Australian Pelvic Floor Questionnaire at 15 weeks' gestation, at the time of recruitment to the SCOPE study. The questionnaire contained four sections, with questions about urinary, faecal, prolapse and sexual dysfunction in the prepregnancy period.

RESULTS

A total of 1,484 participants completed the prenatal questionnaire. Urinary dysfunction was present in 61 % of participants, faecal in 41 %, prolapse in 5 % and sexual in 41 %; in 37 %, dysfunction was perceived as bothersome . At least one clinically significant symptom, defined as severity grade 2 or 3, or grade 1 associated with being bothersome, was reported by 58.2 % of participants. More than one type of PFD was present in 57.6 % of cases. The severity score of each symptom within a PFD section was associated with total section score.

CONCLUSIONS

We confirmed a high rate of PFD in nulliparous women. Clinically significant symptoms and associated bother were very common among symptomatic participants. The majority of affected women had more than one type of PFD. Postnatal follow-up is needed in order to elucidate the role of prepregnancy symptoms in the aetiology of postnatal pelvic floor pathology.

Sexual function in women with stress urinary incontinence treated with the SPARC sling system

AIM

To evaluate the impact of SPARC on female sexual function.

METHODS

151 women with a mean age of 60 ± 11.90 and SUI had a complete urodynamic investigation and underwent SPARC operation. 98 women completed the validated female sexual function index questionnaire (FSFI) at baseline and 94 women at follow-up. A minimum follow-up of 12 months was required for study inclusion.

RESULTS

52/98 women were sexually active at baseline. Postoperatively only 33 patients were sexually active. The FSFI score of all 33 pre- and postoperative sexually active women increased from 25.3 ± 5.7 at baseline to 27.4 ± 4.8 at follow-up (P = 0.1). Scores of women with reduced sexual function at baseline increased significantly in the domains desire, arousal, and lubrication as well as orgasm and satisfaction and total FSFI-score (P = 0.002) postoperatively.

CONCLUSIONS

Our results suggest that the SPARC-sling procedure for SUI did not negatively interfere with female sexual function.

Should questionnaires of female sexual dysfunction be used in routine clinical practice?

AIMS

The aim of this paper is to explore the potential value of questionnaires in routine clinical practice to assess female sexual dysfunction (FSD), and to identify if this could increase the competence of a physician in the initial management of women with these problems. The rationale to encourage Health Care Professionals (HCPs) to engage women in dialogue about their sexual health is that it may enhance a woman's quality of life (which may lead to improved general health) and might lead to timely interventions and possible preventative measures for certain diseases.

METHOD

A short literature review of the most relevant publications was undertaken evaluating current practice.

RESULTS

FSD can have a negative impact on women's well-being and can also be an early symptom of underlying disease. Many HCPs do not broach the subject, consequently women do not get the opportunity either to voice their sexual concerns or access appropriate services. Review of currently available FSD questionnaires suggests that many but not all are generally inappropriate for use in routine clinical practice. Kriston et al.'s STEFFI-2 may be an appropriate starting point. Evidence suggests that this would facilitate discussion of sexual matters between the HCP and the women, and increase the likelihood of FSD being diagnosed.

CONCLUSIONS

Following this review of the literature, the authors strongly recommend that HCPs include FSD questionnaires as part of their routine engagement with women. However, the questionnaire would need to be used as part of the overall assessment and cannot replace a detailed case history and examination, which should lead to effective treatment and management of FSD. The authors recommend further research in the following areas: • Effective training for HCPs. • FSD as an early presentation of sub-clinical disease. • The cost-benefit of early treatment of FSD. • A standardised, validated FSD screening tool. • Benefits of using FSD screener in routine clinical practice.

Urogenital complaints and female sexual dysfunction. Part 2

INTRODUCTION

Female sexual dysfunction (FSD) is common in women with urogenital disorders that occur as a result of pelvic floor muscle and fascial laxity.

AIM

Provide a comprehensive review of FSD as it relates to common urogenital disorders including pelvic organ prolapse (POP) and stress urinary incontinence (SUI) and to discuss the impact of the surgical repair of these disorders on sexual function.

METHODS

Systematic search of the medical literature using a number of related terms including FSD, POP, SUI, surgical repair, graft augmentation, complications, and dyspareunia.

MAIN OUTCOME MEASURES

Review of the medical literature to identify the relation between FSD and common urogenital disorders in women and to describe appropriate treatment strategies to improve quality of life (QOL) and sexual function.

RESULTS

FSD is common in women with POP and SUI. Treatment options for POP and SUI include behavioral, pharmacological, and surgical methods which can also affect sexual function.

CONCLUSIONS

Sexual dysfunction is a common, underestimated complaint in women with POP and SUI. Treatment should be tailored toward improving sexual function and QOL. Surgical correction is generally beneficial but occasionally can result in negative alterations in sexual function. Patient selection and methods used for surgical repair are important factors in determining anatomical and functional success.

Vaginal tactile imaging

Changes in the elasticity of the vaginal walls, connective support tissues, and muscles are thought to be significant factors in the development of pelvic organ prolapse, a highly prevalent condition affecting at least 50% of women in the United States during their lifetimes. It creates two predominant concerns specific to the biomechanical properties of pelvic support tissues: how does tissue elasticity affect the development of pelvic organ prolapse and how can functional elasticity be maintained through reconstructive surgery. We designed a prototype of vaginal tactile imager (VTI) for visualization and assessment of elastic properties of pelvic floor tissues. In this paper, we analyze applicability of tactile imaging for evaluation of reconstructive surgery results and characterization of normal and pelvic organ prolapse conditions. A pilot clinical study with 13 patients demonstrated that VTI allows imaging of vaginal walls with increased rigidity due to implanted mesh grafts following reconstructive pelvic surgery and VTI has the potential for prolapse characterization and detection.

Healthcare resource utilization and expenditures of women diagnosed with hypoactive sexual desire disorder

OBJECTIVE

To describe healthcare utilization and costs among commercially insured women with a diagnosis of hypoactive sexual desire disorder (HSDD) in the US and to compare them with an age-matched control cohort.

METHODS

The Thomson Reuters MarketScan * Commercial Database was used to identify women aged 18-64 with an ICD-9-CM coded diagnosis of HSDD from 1/1/1998 to 9/30/2006. A control group of women with no diagnosis of any sexual dysfunction was matched 3:1 to cases based on age, health plan, and enrolment period. Healthcare utilization and costs were examined in the year prior to (pre-period) and following (post-period) index. Multivariate analyses were used to determine the adjusted difference in cost between women with and without HSDD in the post-period.

RESULTS

In both the pre- and post-periods, women with HSDD had more outpatient office visits, radiology services, prescription medication use, and medical visits (e.g., laboratory and outpatient surgeries) relative to controls. In the 12-month post-period, women with HSDD had significantly higher total costs relative to controls ($5,504 ± 11,132 vs. $4,606 ± 12,601, p < 0.001). After adjusting for clinical characteristics, women with HSDD had total healthcare expenditures that were 16.8% higher than controls (p < 0.001).

LIMITATIONS

There is a potential for selection bias among the women who actually received a diagnosis of HSDD from a clinician. Women who received a diagnosis may be different from women without a diagnosis in ways that cannot be measured in this study. Additionally, it is possible that some women in the control group had HSDD but were undiagnosed. To the extent that the control group included women who did have HSDD, the study estimates of differences between the two groups would be underestimated.

CONCLUSIONS

Women diagnosed with HSDD use significantly more healthcare services than women without diagnosed sexual dysfunction. These higher costs are driven by a greater use of outpatient services and prescription medications.

EAU guidelines on chronic pelvic pain

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.

The place of female sexual dysfunction in the urological practice: results of a Dutch survey

INTRODUCTION

Female sexual dysfunction (FSD) is a highly prevalent and often underestimated problem. There is a strong association between urological complaints and FSD.

AIMS

The purpose of this survey was to evaluate how Dutch urologists address FSD in their daily practice.

METHODS

We performed an anonymous survey study. A 17-item anonymous questionnaire was mailed to all 405 registered members of the Dutch Urology Association (urologists and residents in urology).

MAIN OUTCOME MEASURES

The survey results. RESULTS. One hundred eighty-six complete surveys of eligible respondents were returned (45.9% response rate). Ten respondents (5.5%) stated that they ask each female patient for sexual function; 87.1% stated that they ask for sexual function when a patient complains about lower abdominal pain (87.2%), incontinence (75.8%), urgency or frequency (70.5%), or urinary tract infections (65.8%). Many respondents (40.3%) do not think that FSD is meaningful in a urological practice. The majority of respondents (91%) underestimate the frequency of FSD in a urological clinic. Respondents who believe the frequency of FSD to be at least 30% tend to ask more often for sexual function than the rest of the group (P = 0.08).

CONCLUSION

Overall, many urologists do not consistently ask each female patient for sexual function and underestimate the prevalence of FSD. For the majority of the members of the Dutch Urological Association, FSD is not part of routine urological practice. There is, therefore, a need for better implementation of education and training at both undergraduate and postgraduate levels.

Sexual dysfunction in dermatological diseases

Decrease or loss of sexual function in many chronic diseases has recently attracted significant attention owing to its impact on quality of life. Generic and disease-specific quality-of-life questionnaires measure changes in work, school, social life and emotional status regarding the disease and its treatment. Specific questionnaires have been designed to evaluate changes in sexuality and sexual function. Sexual dysfunction, especially female sexual dysfunction, in different diseases became a popular and important health concern in recent years. There are a lot of studies about sexual dysfunction in the areas of other specialities of medicine, but there are only a few studies in dermatological diseases. In this paper, sexual dysfunction and the studies performed about this subject in dermatology will be reviewed.