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Krapf JM, Goldstein AT. Combined estrogen-progestin oral contraceptives and female sexuality: an updated review. Sex Med Rev 2024; 12:307-320. [PMID: 38515302 DOI: 10.1093/sxmrev/qeae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/19/2024] [Accepted: 01/28/2024] [Indexed: 03/23/2024]
Abstract
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.
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Affiliation(s)
- Jill M Krapf
- Center for Vulvovaginal Disorders Florida, Tampa, FL 33609, United States
| | - Andrew T Goldstein
- Center for Vulvovaginal Disorders New York, New York, NY 10036, United States
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Muhamad R, Horey D, Liamputtong P, Low WY. Managing Women with Sexual Dysfunction: Difficulties Experienced by Malaysian Family Physicians. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:949-960. [PMID: 30238183 DOI: 10.1007/s10508-018-1236-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 05/08/2018] [Accepted: 05/16/2018] [Indexed: 06/08/2023]
Abstract
Recognizing barriers to managing sexual issues makes it more likely that effective ways to overcome them will be found. In Malaysia, where discussion of sexual issues is taboo, sociocultural factors may influence how physicians manage patients with these types of problems. This article focuses on the challenges encountered by 21 Malay family physicians when women experiencing sexual problems and female sexual dysfunction (FSD) attended their clinics, an uncommon occurrence in Malaysia, despite their high prevalence. This qualitative study employed a phenomenological framework and conducted face-to-face in-depth interviews. Three main barriers to managing women with sexual problems were identified that can hinder assessment and treatment: insufficient knowledge and training; unfavorable clinic environments; and personal embarrassment. Some barriers were associated with physician characteristics but many were systemic. These were further evaluated using social cognitive theory. Professional attitudes appear important as those physicians with an interest in managing women's health seemed to make greater effort to explore issues further and work to gain trust. Physicians who appeared indifferent to the impact of FSD showed greater reluctance to find solutions. Systemic issues included unfavorable clinical settings, lack of training, and lack of local evidence. Any strategy to address FSD needs to be underpinned by appropriate policies and resources.
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Affiliation(s)
- Rosediani Muhamad
- Family Medicine Department, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia.
- Department of Public Health, College of Science, Health and Engineering, Melbourne Campus, La Trobe University, Bundoora, VIC, Australia.
| | - Dell Horey
- Department of Public Health, College of Science, Health and Engineering, Melbourne Campus, La Trobe University, Bundoora, VIC, Australia
| | - Pranee Liamputtong
- School of Science and Health, School of Medicine, Western Sydney University, Campbelltown, Penrith, NSW, Australia
| | - Wah Yun Low
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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3
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Nightingale G, Shehab Q, Kandiah C, Rush L, Rowe-Jones C, Phillips CH. The effect of intravesical instillations with Hyaluronic Acid on sexual dysfunction in women with recurrent urinary tract infections (RUTI). Eur J Obstet Gynecol Reprod Biol 2018; 221:105-108. [DOI: 10.1016/j.ejogrb.2017.12.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 10/09/2017] [Accepted: 12/14/2017] [Indexed: 11/30/2022]
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4
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Eeltink CM, Witte BI, Stringer J, Liptrott S, Babic A, Greenfield DM, Salooja N, Incrocci L, Visser O, Verdonck-de Leeuw IM, Duarte RF, Zweegman S. Health-care professionals' perspective on discussing sexual issues in adult patients after haematopoietic cell transplantation. Bone Marrow Transplant 2017; 53:235-245. [PMID: 29247220 DOI: 10.1038/s41409-017-0027-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 10/02/2017] [Accepted: 10/02/2017] [Indexed: 12/23/2022]
Abstract
The majority of adult patients have sexual concerns after post-haematopoietic cell transplantation. Even so, health-care professionals (HCP) do not routinely discuss these problems. We, therefore, surveyed all the members of the European Society for Blood and Marrow Transplantation to evaluate the barriers and facilitators to discussing sexual issues. The 73-item web-survey was completed by 166 registered nurses (RNs) and 126 medical doctors (MDs). Sixty-eight percent reported that they seldom discussed sexual issues. Younger MDs (p < 0.001) and those who work in non-western European countries (p = 0.003), RNs with probably less sexual education themselves (p = 0.002), MDs and RNs who have limited knowledge about sexual complications (p < 0.001) and MDs and RNs who feel uncomfortable discussing sexual issues (p < 0.001) are all less likely to discuss these matters. The major perceived barriers were that patients might be embarrassed if sexual issues were discussed in the presence of a relative (60% RNs, 67% MDs) and that professionals prefer patients to raise sexual issues themselves (54% RNs, 44% MDs). The most important perceived facilitator was for the patient to initiate discussion (≥ 90% for RNs and MDs). Overall, haematopoietic cell transplantation survivors may not be receiving the support on sexual issues they probably need.
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Affiliation(s)
- Corien M Eeltink
- Cancer Center Amsterdam, Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Birgit I Witte
- Cancer Center Amsterdam, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Jacqui Stringer
- Department of Complementary Health and Wellbeing, The Christie NHS Foundation Trust, Manchester, UK
| | - Sarah Liptrott
- Department of Haemato-oncology, European Institute of Oncology, Milan, Italy
| | - Aleksandra Babic
- IOSI-Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - Diana M Greenfield
- Specialised Cancer Services, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK.,Department of Oncology and Metabolism, University of Sheffield, England, UK
| | - Nina Salooja
- Department of Hematology, Hammersmith hospital, Imperial College, London, UK
| | - Luca Incrocci
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Otto Visser
- Department of Hematology, Isala Hospital, Zwolle, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Cancer Center Amsterdam, Department of Clinical Psychology, Vrije Universiteit, Amsterdam, The Netherlands.,Department of Otolaryngology, VU University Medical Center, Amsterdam, The Netherlands.,EMGO+ Institute, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Rafael F Duarte
- Department of Hematology, University Hospital Puerta de Hierro, Madrid, Spain
| | - Sonja Zweegman
- Cancer Center Amsterdam, Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
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Krouwel EM, Nicolai MP, van der Wielen GJ, Putter H, Krol ADG, Pelger RCM, Incrocci L, Elzevier HW. Sexual Concerns after (Pelvic) Radiotherapy: Is There Any Role for the Radiation Oncologist? J Sex Med 2016; 12:1927-39. [PMID: 26381533 DOI: 10.1111/jsm.12969] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Sexual function is an important aspect of quality of life, and may be impaired after (pelvic) radiation. AIM The aim of this study was to identify practice, responsibility attitudes, knowledge, and barriers of Dutch radiation oncologists regarding sexual counseling. METHODS A cross-sectional survey was performed using a 28-item questionnaire sent to all members of the Dutch Society for Radiotherapy and Oncology. MAIN OUTCOME MEASURES Self-reported practice, knowledge, barriers, need for training and responsibility attitudes in regard to demographic characteristics. RESULTS Of the surveyed sample, 54.6% of the radiation oncologists completed the instrument (n = 119). Frequency of discussing sexual function was fluctuating, depending on the type of tumor. The majority of the responding radiation oncologists (75%) agreed that discussing sexual function is their responsibility, about one-third (33.6%) pointed at the involved specialist (surgeon, urologist, gynecologist, or oncologist), a fifth also considered the general practitioner responsible (21%). Additional training about discussing sexuality was required according to 44.4%, the majority agreed that sexual counseling should be a regular component of radiation oncology residency (n = 110, 94%). Barriers most mentioned included patient is too ill (36.2%), no angle or reason for asking (32.4%), advanced age of the patient (27%) and culture/religion (26.1%). For prostate cancer patients, phosphodiesterase 5 inhibitor information was supplied regularly (49.2%) and often (40.7%). CONCLUSIONS Radiation oncologists generally perform sexual counseling in case of pelvic radiation therapy, but not consistently in case of gastrointestinal, breast, and other cancers. The majority of radiation oncologists considered counseling on sexual functioning as a part of their job, some also pointed at the referring specialist or general practitioner. The findings suggest that awareness about sexual dysfunction is present among radiation oncologists, but responsibility for active counseling is uncertain. Results emphasize the need for providing educational and practical training, as well as a list for specialized referral.
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Affiliation(s)
- Esmée M Krouwel
- Department of Urology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Melianthe P Nicolai
- Department of Urology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Hein Putter
- Department of Medical Statistics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Augustinus D G Krol
- Department of Radiation Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Rob C M Pelger
- Department of Urology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Luca Incrocci
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Henk Willem Elzevier
- Department of Urology, Leiden University Medical Centre, Leiden, The Netherlands
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Krouwel E, Nicolai M, van Steijn-van Tol A, Putter H, Osanto S, Pelger R, Elzevier H. Addressing changed sexual functioning in cancer patients: A cross-sectional survey among Dutch oncology nurses. Eur J Oncol Nurs 2015; 19:707-15. [DOI: 10.1016/j.ejon.2015.05.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 04/28/2015] [Accepted: 05/05/2015] [Indexed: 10/23/2022]
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Scheepe JR, Alamyar M, Pastoor H, Hintzen RQ, Blok BF. Female sexual dysfunction in multiple sclerosis: Results of a survey among Dutch urologists and patients. Neurourol Urodyn 2015; 36:116-120. [DOI: 10.1002/nau.22884] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 09/01/2015] [Indexed: 01/23/2023]
Affiliation(s)
- Jeroen R. Scheepe
- Department of Urology and Pediatric Urology; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
| | - Mustafa Alamyar
- Department of Urology and Pediatric Urology; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
| | - Hester Pastoor
- Department of Gynecology; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
| | - Rogier Q. Hintzen
- Department Neurology; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
| | - Bertil F.M. Blok
- Department of Urology and Pediatric Urology; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
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8
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Leaver RB. Female urology - too long the poor relation? INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2015. [DOI: 10.1111/ijun.12082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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9
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Castagna G, Montorsi F, Salonia A. Sexual and bladder comorbidity in women. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:165-76. [PMID: 26003244 DOI: 10.1016/b978-0-444-63247-0.00010-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
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.
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Affiliation(s)
- Giulia Castagna
- Universitá Vita-Salute San Raffaele, Milan, Italy; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Universitá Vita-Salute San Raffaele, Milan, Italy; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Salonia
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy.
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10
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Cuzin B. Le couple face aux difficultés sexuelles liées aux troubles urinaires. SEXOLOGIES 2014. [DOI: 10.1016/j.sexol.2014.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Salonia A, Clementi MC, Graziottin A, Nappi RE, Castiglione F, Ferrari M, Capitanio U, Damiano R, Montorsi F. Secondary Provoked Vestibulodynia in Sexually Active Women with Uncomplicated Recurrent Urinary Tract Infections. J Sex Med 2013; 10:2265-73. [DOI: 10.1111/jsm.12242] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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12
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Roos AM, Thakar R, Sultan AH, Burger CW, Paulus ATG. Pelvic floor dysfunction: women's sexual concerns unraveled. J Sex Med 2013; 11:743-52. [PMID: 23347592 DOI: 10.1111/jsm.12070] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Sexual function of women suffering from pelvic organ prolapse (POP) and/or urinary incontinence (UI) is adversely affected. However, our current understanding of the exact relationship between female sexual dysfunction and POP and/or UI is incomplete. A qualitative study can improve our understanding by describing what women themselves perceive as the real problem. AIM To gain a more in-depth understanding of the impact of POP and/or UI on the different categories of female sexual dysfunction by way of a qualitative study. METHODS Qualitative semistructured interviews were conducted in 37 women scheduled for pelvic floor surgery, and one was excluded from analysis due to incomplete recordings. MAIN OUTCOME MEASURES The impact of POP and/or UI on female sexual function. RESULTS Only 17% of women were completely positive about their sex life. Both POP and UI had a negative effect on body image. Women with POP had a negative image of their vagina, which caused them to be insecure about their partner's sexual experience, while women with UI were embarrassed about their incontinence and pad use, and feared smelling of urine. Worries about the presence of POP during sexual activity, discomfort from POP, and reduced genital sensations were the most important reasons for decreased desire, arousal, and difficulty reaching an orgasm in women with POP. Fear of incontinence during intercourse affected desire, arousal, and orgasm and could be a cause for dyspareunia in women with UI. Desire was divided into two main elements: "drive" and "motivation." Although "drive," i.e., spontaneous sexual interest, was not commonly affected by POP and/or UI, a decrease in "motivation" or the willingness to engage in sexual activity was the most common sexual dysfunction mentioned. CONCLUSIONS Body image plays a key role in the sexual functioning of women with POP and/or UI with the biggest impact on women's "motivation."
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Affiliation(s)
- Anne-Marie Roos
- Department of Obstetrics and Gynaecology, Croydon University Hospital, Croydon, Surrey, UK; Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Cour F, Robain G, Claudon B, Chartier-Kästler E. [Childhood sexual abuse: how important is the diagnosis to understand and manage sexual, anorectal and lower urinary tract symptoms]. Prog Urol 2012; 23:780-92. [PMID: 23830273 DOI: 10.1016/j.purol.2012.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Accepted: 10/15/2012] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To understand and manage the sequels of childhood sexual abuse on sexual, anorectal and lower urinary tract functions. MATERIAL AND METHODS Review of articles published in the Medline database, selected according to their scientific relevance and published guidelines on this subject together with our own experience. RESULTS A history of sexual abuse is frequently found when assessing dysfunction or symptoms of the lower urinary tract. In this context, urinary stress incontinence is rarely involved but it can be linked by epidemiological factors. Dysuria with urgency is the most frequent expressed symptom. When associated with anorectal disorders and pelvic pain or a sexual disorder in particular dyspareunia, a sexual abuse should be evoked and specific questions asked to the patient. Although these symptoms are frequently encountered in 12 to 33% of women, and 8 to 16% of men, few practitioners, whatever their speciality ask about them as routine. It is important that the physician diagnose the existence of sexual abuse, in particular when the symptoms mentioned by the patient are not conclusive, in spite of thorough urological assessment. Patients finding the initial examination difficult and painful and the failure of the initial treatment should lead to questions concerning abuse, if neglected by the initial medical inquiry. CONCLUSIONS Clinicians involved in perineal functional pathology are able to acquire standardized modalities of inquiry about child sexual abuse for a better time management and efficacy in the therapeutic approach. The interest of a multidisciplinary diagnostic and therapeutic approach is primordial, associating psychological therapy and if necessary perineal re-education. This can avoid unnecessary tests and out-patient visits. Directing patients towards a multidisciplinary approach is highly advisable.
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Affiliation(s)
- F Cour
- Service d'urologie, université de Versailles-Saint-Quentin-en-Yvelines, hôpital Foch, 40, rue Worth, 92150 Suresnes, France.
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Howard HS. Sexual Adjustment Counseling for Women with Chronic Pelvic Pain. J Obstet Gynecol Neonatal Nurs 2012; 41:692-702. [DOI: 10.1111/j.1552-6909.2012.01405.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Feldner PC, Delroy CA, Martins SB, Castro RA, Sartori MGF, Girão MJBC. Sexual function after anterior vaginal wall prolapse surgery. Clinics (Sao Paulo) 2012; 67:871-5. [PMID: 22948452 PMCID: PMC3416890 DOI: 10.6061/clinics/2012(08)03] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 04/03/2012] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare female sexual function after surgical treatment of anterior vaginal prolapse with either small intestine submucosa grafting or traditional colporrhaphy. METHODS Subjects were randomly assigned, preoperatively, to the small intestine submucosa graft (n = 29) or traditional colporrhaphy (n = 27) treatment group. Postoperative outcomes were analyzed at 12 months. The Female Sexual Function Index questionnaire was used to assess sexual function. Data were compared with independent samples or a paired Student's t-test. RESULTS In the small intestine submucosa group, the total mean Female Sexual Function Index score increased from 15.5±7.2 to 24.4±7.5 (p<0.001). In the traditional colporrhaphy group, the total mean Female Sexual Function Index score increased from 15.3±6.8 to 24.2±7.0 (p<0.001). Improvements were noted in the domains of desire, arousal, lubrication, orgasm, satisfaction, and pain. There were no differences between the two groups at the 12-month follow-up. CONCLUSIONS Small intestine submucosa repair and traditional colporrhaphy both improved sexual function postoperatively. However, no differences were observed between the two techniques.
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Affiliation(s)
- Paulo Cezar Feldner
- Section of Urogynecology and Pelvic Surgery, Department of Gynecology, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
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16
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van Driel MF. Re: Sexual Activity and Cardiovascular Disease: A Scientific Statement from the American Heart Association. Eur Urol 2012; 62:349. [DOI: 10.1016/j.eururo.2012.05.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Nicolai MPJ, Fidder HH, Bekker MD, Putter H, Pelger RCM, Elzevier HW. Pelvic floor complaints in gastroenterology practice: results of a survey in the netherlands. Frontline Gastroenterol 2012; 3:166-171. [PMID: 24124626 PMCID: PMC3793542 DOI: 10.1136/flgastro-2012-100133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 02/28/2012] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The pelvic floor is an integrated structure; dysfunctions may lead to a wide range of symptoms, involving voiding, defecation and sexual functioning (SF). Functional symptoms such as constipation and lower abdominal pain are often caused by pelvic floor dysfunction (PFD), and they highly impact the quality of life. Multiple specialists are responsible for a specific part of the pelvic floor, but its treatment asks for a holistic approach. The authors are still unaware of gastroenterologists' knowledge on PFD or whether they are addressing pelvic floor complaints in their daily practice. DESIGN A 42-itemed anonymous questionnaire was mailed to all 402 members of the Dutch Society of Gastroenterology (gastroenterologists and residents-in-training). RESULTS 169 (42%) questionnaires were analysed. Most gastroenterologists address lower urinary tract symptoms in their history-taking, 92% in female patients and 84% in male patients. When patients indicate irritable bowel syndrome-like complaints, more than 60% of the physicians inquire about SF to their female patients, compared with 38% inquiries to male patients (p<0.001). A reason not to inquire about SF is a lack of knowledge about female and male sexuality (19% and 23%, respectively). Forty-six per cent of the respondents regard it rather important to receive more training on PFD in male patients versus 61% in female patients. CONCLUSION Awareness of PFD is not yet routinely integrated into the history taken by gastroenterologists.
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Affiliation(s)
| | - Herma H Fidder
- Department of Gastroenterology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Milou D Bekker
- Department of Surgery, Haaglanden Medical Center, the Hague, The Netherlands
| | - Hein Putter
- Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Rob C M Pelger
- Department of Urology, Leiden University Medical Center, Leiden, The Netherlands
| | - Henk W Elzevier
- Department of Urology, Leiden University Medical Center, Leiden, The Netherlands
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Wehbe SA, Kellogg S, Whitmore K. Urogenital complaints and female sexual dysfunction. Part 2. J Sex Med 2011; 7:2304-17; quiz 2318-9. [PMID: 20653832 DOI: 10.1111/j.1743-6109.2010.01951.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
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.
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Affiliation(s)
- Salim A Wehbe
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Drexel University College of Medicine, Philadelphia, PA, USA.
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19
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Bekker MD, Van Driel MF, Pelger RCM, Lycklama à Nijeholt GAB, Elzevier HW. How do continence nurses address sexual function and a history of sexual abuse in daily practice? Results of a pilot study. J Sex Med 2010; 8:367-75. [PMID: 20946147 DOI: 10.1111/j.1743-6109.2010.02044.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION There is a strong association between urological complaints, sexual dysfunction, and history of sexual abuse (SA), and it is unknown whether urological continence nurses integrate this knowledge in their daily practice. AIM To evaluate how, in their daily practice, Dutch urological continence nurses address sexual dysfunction and possible SA. METHODS An anonymous 19-item questionnaire was distributed among all Dutch urinary continence nurses visiting their yearly congress. MAIN OUTCOME MEASURES The survey results. RESULTS The response rate was 48.9% (93/190). Of the respondents, 11.8% did not ask their female patients about sexual function; 37.6% asked only rarely; 44.1% asked often; and 6.5% always asked. Sexual functioning in males was not evaluated by the majority of the nurses (13.2% never, and 46.2% rarely). A minority of continence nurses asked males about sexual functioning (36.3% often and 4.3% always). Important reasons for not asking were insufficient knowledge of how to adequately ask males (38.9%) and females (47.8%) about sexual problems, and because nurses assumed the urologist had addressed this issue (48.1% asking males, 39.1% asking females). Younger nurses found it particularly difficult to raise sexual issues with both male and female patients (P=0.001 and P=0.003, respectively). Screening for sexual dysfunction was stated to be important by almost all nurses (65.2% "quite important," and 31.5% "very important"). Within their patient population, both male and female, 28% of the nurses never asked about SA and 49.5% asked only rarely. CONCLUSION Dutch urological incontinence nurses acknowledge the importance of sexual problems in their patient population, but asking about this issue was not part of routine care. The main reasons for not asking, according to the nurses' responses, were that they had insufficient knowledge and that they assumed the urologist had already asked about sexual problems.
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Affiliation(s)
- Milou D Bekker
- Department of Urology, Leiden University Medical Center, Leiden, The Netherlands.
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The practice of the first check cystoscopy following radiotherapy for the treatment of muscle-invasive (T3N0M0) bladder cancer: a UK national survey. Int Urol Nephrol 2010; 43:377-81. [PMID: 20563846 DOI: 10.1007/s11255-010-9789-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Accepted: 06/04/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To determine the current trends in the follow-up of patients with muscle-invasive bladder cancer following radiotherapy, among consultants in the United Kingdom and the republic of Ireland in terms of cystoscopic survey and imaging of the upper tracts. METHODS A national postal survey was carried out in 2006 including 602 urologists registered with the British Association of Urological Surgeons (BAUS). RESULTS About 40% of the consultants participated in the survey. Seventy-seven per cent performed cystoscopy 3 months post-radiotherapy and 78% used rigid cystoscopy. The majority (91%) did not take routine random biopsies at the time of the first cystoscopy if it looked normal. Seventy-eight per cent of the participants requested upper-tract imaging in the presence of cystoscopic abnormalities, and long-term follow-up was recommended by 75%. CONCLUSIONS There is a wide-range of practice regarding the first check cystoscopy following radiotherapy for muscle-invasive bladder cancer and it could prove the foundation for more randomised trials to determine the evidence-based practice.
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Wehbe SA, Whitmore K, Kellogg-Spadt S. Continuing Medical Education: Urogenital Complaints and Female Sexual Dysfunction (Part 1) (CME). J Sex Med 2010; 7:1704-13; quiz 1703, 1714-5. [DOI: 10.1111/j.1743-6109.2010.01769.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Beck J, Bekker M, Van Driel M, Putter H, Pelger R, Lycklama A. Nijeholt A, Elzevier HW. Female Sexual Abuse Evaluation in the Urological Practice: Results of a Dutch Survey. J Sex Med 2010; 7:1464-8. [DOI: 10.1111/j.1743-6109.2009.01702.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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