Assessment of Female Sexual Function in Patients with Psoriasis

Impact of Genital and Non-Genital Psoriasis on Genital Self-Image, Quality of Life, and Sexual Dysfunction in Female Patients

INTRODUCTION

Psoriasis is a chronic systemic inflammatory disease that affects millions of people worldwide. While its physical manifestations are well-documented, the psychosocial impact of psoriasis, particularly on female patients, is an area of growing concern. Feelings of shame, inferiority, and stigma are common among individuals with psoriasis, and these emotional burdens can be especially pronounced in females, particularly when the genital area is affected.

OBJECTIVES

We aimed to shed light on the significance of genital psoriasis on the overall well-being of female patients.

METHODS

This cross-sectional, descriptive comparative study comprised 50 female participants diagnosed with psoriasis: 25 with genital psoriasis, 25 without genital psoriasis, and 25 healthy women matched for age and sex who served as the control group. All participants underwent an assessment of disease severity using the Psoriasis Area and Severity Index in the psoriasis group and completed questionnaires for the assessment of the Female Sexual Function Index (FSFI). Additionally, quality of life was evaluated using the Dermatology Life Quality Index, and the Female Genital Self-Image Scale (FGSIS) was used to assess genital self-image.

RESULTS

We found that females with genital lesions, experience a notable decline in sexual health with higher levels of sexual distress compared to healthy individuals. In terms of the six FSFI domains, the psoriatic group scored lower than the control group in all areas, except for pain, which showed a significant increase. Psoriatic females also exhibited a significantly more negative FGSIS compared to the control group, and there was a highly significant difference in FGSIS between females with and without genital psoriasis.

CONCLUSIONS

Understanding the impact of genital psoriasis on female sexual health and overall quality of life is essential for comprehensive patient care. This research is instrumental in addressing the psychosocial aspects of psoriasis and enhancing patient well-being.

Do complaints related to vitiligo affect sexual quality of life and marital adjustment?

The authors aimed at evaluating the effect of vitiligo on female sexual function and Dyadic Adjustment in a hospital-based study as gender negatively affected the marital quality of vitiligo patients, more in women. A total of 153 patients who applied to the dermatology outpatient clinic of a tertiary university hospital were interviewed. However, 120 vitiligo patients who were married and had a sexually active partner and suitable the inclusion criteria were included in the study. It is seen that the mean score of the DAC is 43.13±5.11, and the mean score of the SQOL-F is 52.57±5.39. Vitiligo has a negative effect on a woman's sexual life and Dyadic Adjustment. Early identification of sexual problems in vitiligo patients and planning their future course of management can aid in improving the marital adjustment and quality of life.

Sexual functioning in patients with psoriasis: the role of body dissatisfaction and cognitive biases toward sexuality

Psoriasis is a chronic disease, involving skin and joints, characterized by inflamed lesions. Psoriasis negatively impacts the patients' quality of life due to the physical, emotional, and social burden that accompanies this condition. Also, psoriasis is associated with a number of psychiatric comorbidities, including sexual dysfunctions. The present study investigates the variables associated with sexual functioning in psoriasis patients. One-hundred-three psoriasis patients and 101 matched control subjects took part in the present study. Each participant completed five self-report measures investigating the presence of depression, anxiety and stress symptoms, body image, quality of life, and sexual experience. Our results show that differences in sexual activity, but not in sexual functioning, emerged between groups. In men with psoriasis, more sexual difficulties were associated with more negative automatic thoughts about sexuality. In women, more sexual difficulties were associated with more negative automatic thoughts; anxiety, depression, and stress; severity of symptoms; comorbid disease; age; quality of life. Our findings expand the current knowledge about sexual functioning in psoriasis and shed light on specific cognitive, psychological, and demographic variables associated with sexual impairment in men and women with psoriasis.

Skin-Related Sexual Life Questionnaire (SRSLQ): Creation and Validation of the Questionnaire

Background and Objectives: The assessment of sexual dysfunction among psoriatic patients still remains a great diagnostic difficulty due to its subjective and embarrassing character. Various questionnaires have been used to assess sexual dysfunctions associated with skin conditions; however, none of them have been approved as a gold standard. The aim of our study was to create and validate the Skin-Related Sexual Life Questionnaire (SRSLQ) for the assessment of possible sexual dysfunction and related psychological burdens in patients with skin diseases. Materials and Methods: A total of 109 patients, including 45 women and 64 men (1:1.4) suffering from psoriasis and aged between 18 and 73 years (mean 48.0 ± 13.4 years), were included in the study. All subjects completed the 11-item SRSLQ and the Dermatology Life Quality Index (DLQI). In addition, all men were asked to fulfil the five-item version of the International Index of Erectile Dysfunction (IIEF-5) at the time of examination and 7 days after enrollment. The disease severity was assessed via the PASI scale. Results: The statistical analysis of internal consistency of SRSLQ showed very good integrity, with a Cronbach α coefficient of 0.94. The reproducibility level assessed with intraclass correlation coefficient (ICC) amounted to 0.96. A significant correlation between the total score of the 11-item SRSDQ and the DLQI (r = 0.39; p < 0.001) was found, confirming congruent validity. Conclusions: The validated 11-item Skin-Related Sexual Life Questionnaire can be successfully implemented in daily clinical practice as well as in clinical research.

Prevalence of Female Sexual Dysfunction Among Psoriatic Females: A Cross Sectional Case Controlled Study

INTRODUCTION

Sexual relationships are an integral part of females psychological and physiological wellbeing.

OBJECTIVES

The study aimed to identify prevalence and impact of Female Sexual Dysfunction (FSD) in women affected with psoriasis.

METHODS

This cross-sectional study was carried out on 150 married females who were interviewed to answer Female Sexual Function Index (FSFI) questionnaire and were divided into two groups: the first group included 100 female patients complaining of psoriasis (50 suffering from moderate psoriasis and 50 with severe psoriasis). The disease severity was graded according to the Psoriasis Area and Severity Index (PASI) while the second group included 50 age matched women who served as controls.

RESULTS

Female sexual dysfunction (FSD) in psoriasis female groups was higher than that in the control group (47%, 24%, P < 0.05). The mean total scores of FSFI ranged from 12.30 to 34.20 and were significantly lower in the severe PASI affected group (22.34 ± 5.35) when compared to moderate PASI group (26.24 ± 2.67) or control group (28.79 ± 2.22). In addition, total scores were significantly lower among moderate PASI affected females when compared to control group.

CONCLUSIONS

Sexual dysfunction should be routinely investigated in female patients with psoriasis in the case of moderate-severe disease due to its negative impact on quality of life. Further research over the effect of certain interventional programs on FSD should be considered for patients suffering from psoriasis.

Psoriasis and sexuality: Patients express their feelings

Background

In France, psoriasis is a chronic inflammatory skin disease. For several years now, particular attention has been given to the quality of life (Qol) of psoriasis patients. Sexual dysfunction (SD) defined as not wanting or enjoying sexual experience is an important component of Qol. Psoriasis through its physical symptoms and psychological consequences can thus be responsible for SD.

Method

The survey participants were recruited through the national psoriasis dermatitis patient association.

Result

41% (577) patients reported having SD related to their psoriasis. Women reported significantly more SD than men (387 [44.7%] vs. 190 [35%], p < 0.001). For 396 (28.1%) patients SD due to their psoriasis manifested as a reduction in the frequency of sexual activity, for 207 (14.7%) as change in their sexual practice, and for 284 (27.4%) as an absence of sexual activity without significant difference between women and men. The main consequence of sexual difficulties for patients was loss of self-confidence in 627 (44.5%) cases, guilt in 209 (14.8%) cases, couple life impairment in 214 (15.2%) cases, isolation in 260 (18.5%) cases and frustration.

Discussion

In this study investigating SD related to psoriasis, we found that the disease impact sexual relations of 41% of patients of both gender. The main causes of SD were both physical alone and psychological alone, in the same proportions. The physical symptoms of psoriasis are therefore not the only ones responsible for the sexual discomfort reported from patients in their sexual relations. This may be due to a discomfort of the patient or the physician when talking about sexuality because they can't find the terms to talk about this subject often considered taboo and the age or gender difference. This aspect of the disease should be considered by physicians who care for patients with psoriasis, especially dermatologists. Finally, other strategies should be implemented, such as patient talk groups, referral guides or personalised therapeutic education.

Hybrid high- and low-molecular weight chains of hyaluronan is an effective modality treatment for increasing female sexual satisfaction: An interventional, randomized-control parallel study

Background and Aims

Psychological, behavioral, hormonal, surgical, and psychopharmacologic approaches are the only acknowledged treatments for Female Sexual Dysfunction (FSD). The study is conducted to assess the efficacy of hybrid cooperative complexes of high and low molecular weight hyaluronan (hybrid H-HA/L-HA) in treating females with varying of sexual dysfunction and to assess the female genital self-image scale (FGSIS), female sexual function index (FSFI), and dermatology life quality index (DLQI) before and after treatment.

Methods

Sixty female patients were divided into two groups. The study group enrolled 30 female patients injected with hybrid H-HA/L-HA, while the control group enrolled 30 female patients injected with saline. Patients were recruited from the clinic searching for medical advice. Controls were selected from close associates of the cases who were attending with the patients or healthy escorts of dermatology patients attending the dermatology outpatient clinic. We assessed socio-demographic, clinical evaluation, the (FGSIS), (FSFI), and (DLQI) before and after treatment. The first assessment was conducted at the first visit, and the second assessment was conducted after 1 month of the second injection.

Result

Significant increase in the frequency of sexual intercourse/week in the study group after the first and second injection sessions compared to the controls was observed (p < 0.05). There was statistically significant amelioration in desire, arousal, lubrication, orgasm, satisfaction domains, and total score of the FSFI (p ≤ 0.05). The study demonstrated significant increasing differences in all domains of the FGSIS (p ≤ 0.05). The symptoms and feelings, leisure, personal relationships, and total scores were significantly higher post first and second injection of (hybrid H-HA/L-HA) sessions compared to the controls (p < 0.05).

Conclusion

The (hybrid H-HA/L-HA) injection for rejuvenating the genital area appears to be a safe and effective way to enhance female genital self-image, sexuality, and quality of life with high levels of satisfaction as a minimally invasive method.

Genital Self-Image, Sexual Function, and Quality of Life Among Individuals with Vulvar and Non-Vulvar Inflammatory Dermatoses

Vulvar inflammatory dermatoses (VID; e.g., lichen sclerosus, lichen planus, vulvar dermatitis) can significantly impact sexual function. Both vulvar and non-vulvar inflammatory dermatoses (NVID; i.e., skin conditions not impacting vulvar skin, such as non-genital psoriasis and eczema/dermatitis) have yet to be fully characterized with regard to impact on genital self-image. A 20-min web-based survey was distributed September-November 2020 through social media ads, support groups, and online research recruitment services. Individuals in the USA over age 18 who were assigned female at birth and self-reported having been diagnosed with an inflammatory dermatosis were eligible. The primary outcome was the Female Genital Self-Image Scale (FGSIS). Secondary outcomes included the Female Sexual Function Index (FSFI), the Skindex-16 (a skin-related quality of life measure), the PROMIS Global-10 (assessing global physical/mental health), and sexual behavior histories. Participants (n = 348) reported mean age of 43.1 ± 15.5 (range = 19-81). Nearly one-third (n = 101; 29.0%) reported VID, 173 (50%) had NVID, and 74 (21%) experienced both vulvar and non-vulvar symptoms; they were analyzed as part of the VID group. The mean FGSIS score among participants with VID was 16.9 ± 4.1 and was significantly (p < .01) lower than that of participants with NVID (M = 21.2 ± 4.3), indicating lower genital self-image. Mental health (as measured by PROMIS-Global 10) was also impaired in VID. Rates of sexual dysfunction were high in both groups (> 60%). Findings suggest that in VID, lower genital self-image is correlated with poorer sexual function, quality of life, and global physical and mental health. Additional recommendations for VID management are proposed.

Genital whitening with topical Cyperus rotundus Oil enhance sexuality and quality of life

BACKGROUND

Cyperus Rotundus Essential Oil (CREO) is an anti-inflammatory and depigmenting agent that helps treat hyperpigmentation.

OBJECTIVES

The purpose of this study was to evaluate the depigmenting effect of CREO on genital hyperpigmentation to that of arbutin (ARB), as well as to evaluate the association between genital lightening, genital self-image, sexual performance, and life quality.

MATERIAL AND METHODS

Three hundred and eight healthy people were categorized into 3 groups: the CREO group, the ARB group, and the cold cream group (CC). In genital pigmentation, the tristimulus colorimeter is used to assess erythema and pigmentation. Additionally, we aided in the development of the female genital self-image scale (FGSIS-4), the female sexual function index (FSFI), and the dermatology life quality index (DLQI).

RESULT

The reduction in genital hyperpigmentation was significantly greater in the CREO and ARB groups than in the CC group; in physician global assessment and patients' self-assessment, the results in treated bikini with the CREO and ARB groups were excellent when compared to the CC. Furthermore, no adverse effects were found in the CREO group, but mild irritation was found in the ARB group; additionally, the percentage of hair growth, color and luminance reduction, and hair thickness were significantly reduced in the CREO group only. In addition, there were significantly different in FGSIS, FSFI, and DLQI between the CREO and ARB groups and the CC group.

CONCLUSION

CREO is equivalently efficacious in decreasing pigmentation, inflammation, and hair growth in the genital area. Positive changes boost female genital self-image, self-esteem, and sexual performance. Improving sexual health has a positive impact on quality of life.

Sexual difficulties and associated factors among patients with psoriasis in Malaysia: data from the Malaysian Psoriasis registry

The impact of psoriasis on quality of life may have implications for the sexual function of patients. We aimed to determine the frequency of sexual difficulties and associated factors among adult patients with psoriasis. This cross-sectional study involved 13 673 patients notified to the Malaysian Psoriasis Registry. Sexual function was defined based on the Dermatology Life Quality Index (DLQI). Sexual difficulties were reported among 9.5% of subjects with significant predictors identified as younger age, male gender, married status, ethnicity, nail involvement, face and neck involvement and severity of disease. Smokers were more likely to report experiencing sexual difficulties. However, the presence of either ischemic heart disease, diabetes mellitus, hypertension or dyslipidemia was associated with lower odds of sexual issues due to psoriasis. Clinicians should be aware of factors associated with sexual health in psoriasis to implement targeted interventions. Further studies need to be conducted to delineate the different aspects of sexual function and the magnitude of the problem.

Dermatological diseases, sexuality and intimate relationships: A qualitative meta-synthesis

AIMS AND OBJECTIVES

To conduct a systematic review and meta-synthesis of findings from qualitative research about sexuality and intimate relationship among patients with dermatological diseases.

BACKGROUND

Over the last few decades, there has been an increase in clinical research investigating aspects related to sex and sexuality in patients living with dermatological diseases. In fact, studies recognise a negative impact on various aspects of intimacy, such as sexual function, self-esteem and romantic relationships. The body of qualitative literature about sexuality in the context of dermatological diseases is emerging but consists mainly of small studies that would benefit from aggregation, synthesis and interpretation to highlight and summarise the overarching dimensions to this clinical issue.

DESIGN

A systematic review and meta-synthesis of qualitative studies.

METHODS

BioMed Central, Cochrane Library, MEDLINE, CINAHL, PsycINFO, PsycARTICLES, ERIC, Scopus, and Web of Science were searched between June-November 2017 with no publication date limits. Screening and selection of studies was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). After retrieval, the qualitative data were subject to meta-synthesis to identify overarching themes.

RESULTS

Ten qualitative studies were found. We identified four themes: (a) Embarrassment and shame; (b) Impaired sense of attractiveness and sexual avoidance; (c) Relationship issues; and (d) Lack of professional support. The patients in these studies adopted negative coping styles, such as avoidance and hiding their bodies.

CONCLUSION

When assessing and evaluating patient care in dermatology, it is important that sexuality and the impact the disease could have on relationships is included.

RELEVANCE TO CLINICAL PRACTICE

An important part of nursing care is ensuring that patients are helped to develop positive coping strategies rather than negative ones. Patients with dermatological conditions also need advice and treatment to address any physically related sexual problems. Nurses need to be the initiators of these sensitive conversations to put patients at ease and work together to implement positive measures to reduce the sexuality-related issues patients face.

Significant Effects of Body Image on Sexual Functions and Satisfaction in Psoriasis Patients

Negative body image appraisals may effect the sexual functions, avoidance, and level of finding oneself sexually attractive. The aim of the study is to assess the levels of sexual dysfunction and sexual satisfaction in patients with psoriasis and the effect of the body image appraisal on sexual functions and satisfaction. In all, 216 individuals were included in the study, and 112 of them had psoriasis; 104 individuals who never experienced any skin problems participated in the study and answered questions that assess depression and anxiety levels, sexual problems and satisfaction, as well as body image appraisal. Psoriasis patients showed significantly higher levels of sexual impairments and less satisfaction with sexual life compared to controls. The psoriasis group had lower body image satisfaction compared to the controls. Depression and anxiety levels in the psoriasis group were higher than in the control group. The cognitive meaning of skin involvement as body image satisfaction was found to be the most significant risk factor that affected sexual functions in psoriasis patients. It also predicted sexual satisfaction in the patient group. However, the objective measure of the severity of the disease as Psoriasis Area and Severity Index (PASI) was not a determinant of sexual dysfunctions and satisfaction.

Risk Factors of Sexual Dysfunction in Patients with Hidradenitis Suppurativa: A Cross-Sectional Study

BACKGROUND

Hidradenitis suppurativa (HS) has a high impact on quality of life. However, sexual health has scarcely been investigated.

OBJECTIVE

To describe the frequency of sexual dysfunction (SD) in women and erectile dysfunction (ED) in men with HS and to explore potential risk factors.

PATIENTS AND METHODS

We conducted a cross-sectional study using a crowd-sourced online questionnaire spread by the Spanish hidradenitis suppurativa patients' association (ASENDHI).

RESULTS

In total, 393 participants answered the questionnaire. SD was found in 51% (95% CI 45-57%) of women and ED in 60% (95% CI 49-70%) of men. Factors related to SD were education status, patient's global assessment for disease activity, numeric rating scale for pain and unpleasant odour and the absence of a stable relationship. Factors related to ED were increasing age, the presence of active lesions in the genital area and the number of areas affected by active lesions.

CONCLUSIONS

There is a high prevalence of SD and ED in HS patients. Being in a stable relationship has been a protective factor of SD in women. The results suggest that sexual impairment in HS patients is due, at least in part, to disease activity, symptoms and active lesions.

Sexual Distress in Patients with Hidradenitis Suppurativa: A Cross-Sectional Study

Hidradenitis suppurativa (HS) is a chronic auto-inflammatory skin disease with a great impact in quality of life. However, there is little research about the impact of HS on sex life. The aims of this study are to describe the frequency of sexual distress (SD) in patients with HS and to explore potentially associated epidemiological and clinical factors. We conducted a cross-sectional study by means of a crowd-sourced online questionnaire hosted by the Spanish hidradenitis suppurativa patients’ association (ASENDHI). Sexual distress (SD) was evaluated with a Numeric Rating Scale (NRS) for HS impact on sex life. A total of 393 participants answered the questionnaire. The mean NRS for HS impact on sex life was 7.24 (2.77) in women and 6.39 (3.44) in men (p < 0.05). Variables significantly associated (p < 0.05) with SD in the multiple linear regression model were sex, with a higher risk in females, the presence of active lesions in the groin and genitals and NRS for pain and unpleasant odor; being in a stable relationship was an important protector factor. Regarding these results, it seems that SD in HS patients is due, at least in part, to disease symptoms and active lesions in specific locations, emphasizing the importance of disease control with a proper treatment according to management guidelines. Women and single patients are more likely to suffer from sexual distress.

Evaluation of the occurrence of sexual dysfunction and general quality of life in female patients with psoriasis

BACKGROUND

Psoriasis has a significant impact on quality of life (QoL). Sexual life can also be affected, with sexual dysfunction being reported by 25-70% of patients.

OBJECTIVES

To determine the occurrence of sexual dysfunction and evaluate QoL in women with psoriasis.

METHODS

This case-control study included women aged 18-69 years. The validated Brazilian Portuguese versions of the Female Sexual Function Index (FSFI) and of the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) were administered to all participants to assess sexual function and QoL, respectively. Patients with psoriasis underwent clinical evaluation for the presence of comorbidities, especially psoriatic arthritis and other rheumatic manifestations. Location of lesions and the extent of skin involvement were also assessed.

RESULTS

The sample consisted of 150 women, 75 with diagnosis of psoriasis and 75 healthy controls. Prevalence of sexual dysfunction was high in women with psoriasis (58.6% of the sample). Prevalence was statistically higher in women with psoriasis than in controls (P = 0.014). The SF-36 domain scores were also lower in women with psoriasis, with role limitations due to physical health, limitations due to emotional problems, and mental health being the most affected domains.

STUDY LIMITATIONS

Sample size was calculated to evaluate the association between the occurrence of sexual dysfunction and psoriasis, but it did not include the determination of the possible causes of this dysfunction.

CONCLUSIONS

QoL and sexual function were altered in women with psoriasis and should be taken into consideration when assessing disease severity.

The emotional burden of chronic skin disease dominates physical factors among women, adversely affecting quality of life and sexual function

BACKGROUND

Both physical and emotional effects are linked with the natural history of chronic skin diseases (CSD). Skin lesions can be confined to covered areas or involve emotionally charged regions (genitalia/exposed areas).

OBJECTIVE

To investigate the contribution of the physical effects of CSD and their emotional burden in adversely affecting the quality of life (QOL) and sexual function.

METHODS

Two groups were included: A group of women suffering from CSD and a control group. All participants answered the 19-item Female Sexual Function Index (FSFI) questionnaire. Women suffering from CSD answered the 10-item Dermatology Life Quality Index (DLQI) questionnaire; this group was divided into various subgroups according to the type of disease and regional involvement.

RESULTS

Neither the DLQI score (P = .06) nor the FSFI scores were significantly affected by the type of disease. The DLQI score was significantly higher in the subgroups with involvement of genitalia or exposed areas (P: < 0.001and 0.01, respectively). Moreover, genital involvement was associated with pervasive and significantly lower FSFI scores, and the arousal, satisfaction, and total scores were significantly lower among women with the involvement of exposed areas. The DLQI score was significantly negatively correlated with the FSFI scores.

CONCLUSION

The emotional burden of CSD should not be overlooked as it dominates the physical effects of disease by adversely affecting QOL and sexual function among women. It is necessary to provide this information to dermatologists and patients, especially in light of effective cognitive-behavior therapy that can be undertaken to ameliorate the emotional stresses.

Prevalence of genital psoriasis in patients with psoriasis

BACKGROUND

Psoriatic lesions in the genital area (GenPs) can cause considerable physical and emotional distress. To increase physician awareness, we estimated the GenPs prevalence among patients with psoriasis.

METHODS

An English language literature search was performed. Articles reporting GenPs prevalence met the search criteria and were included. Because GenPs is rarely reported in demographics of prospective clinical trials, GenPs prevalence and baseline demographics of patients with and without GenPs in two prospective randomized phase 3b trials (NCT02561806 and NCT02634801) involving patients with moderate-to-severe psoriasis are reported.

RESULTS

Overall, 600 references were screened. Eighteen articles met the search criteria. Patient populations were highly heterogeneous across articles. Broadly, the presence of GenPs was either physician-reported (physical examinations) or patient-reported (questionnaires). In the literature, GenPs prevalence at the time of reporting ranged from 7% to 42% and the prevalence of GenPs at any time during the course of psoriasis ranged from 33% to 63%. In the two prospective clinical trials, the prevalence of GenPs at the time of enrollment was 35-42%.

CONCLUSION

A substantial proportion of patients experience genital lesions at some time during the course of psoriasis. Increased awareness of GenPs prevalence may drive improved assessment and treatment.

Impact of ixekizumab treatment on skin-related personal relationship difficulties in moderate-to-severe psoriasis patients: 12-week results from two Phase 3 trials

BACKGROUND

Psoriasis symptoms may decrease quality of life for patients. Skin-related personal relationship difficulties in psoriasis patients are common, under-reported and poorly understood.

OBJECTIVE

To assess the effect of ixekizumab (IXE) treatment on skin-related personal relationship difficulties in patients with moderate-to-severe psoriasis.

METHODS

Pooled data (N = 2570) on skin-related relationship problems were obtained from two large phase 3 trials (UNCOVER-2 and UNCOVER-3) in patients with moderate-to-severe plaque psoriasis randomized to subcutaneous placebo (PBO, N = 361), etanercept (ETN; 50 mg twice weekly, N = 740), or 80 mg IXE as one injection every 4 (IXEQ4W, N = 733) or 2 weeks (IXEQ2W, N = 736) for 12 weeks, following a 160-mg initial dose. The Dermatology Life Quality Index (DLQI) Personal Relationships Domain (PRD) (Items 8 and 9) was used to assess how much the skin caused any personal relationship difficulties at weeks 0, 2, 4 and 12. Improvement was compared for IXE vs PBO and ETN using logistic models. Factors associated with improvement were assessed using multiple linear regressions. DLQI Item 9, assessing sexual difficulties, was also analysed separately.

RESULTS

PRD scores (mean ± standard deviation) at baseline were similar across all treatment groups (PBO: 1.8 ± 1.9; ETN: 1.7 ± 1.8; IXEQ4W: 1.6 ± 1.8; IXEQ2W: 1.7 ± 1.8). Treatment with IXE rapidly and significantly improved the mean PRD score compared to PBO and ETN (P < 0.001 at all time points). Baseline PRD score was the strongest negative predictor of improvement. IXE enabled significantly more patients with moderate-to-severe plaque psoriasis to reduce their skin-related sexual difficulties at Week 12 compared to PBO (P < 0.001) or ETN (P < 0.001).

CONCLUSION

Ixekizumab improves patient-reported skin-related PRD difficulties in patients with moderate-to-severe psoriasis.

Female Genital Dialogues: Female Genital Self-Image, Sexual Dysfunction, and Quality of Life in Patients With Vitiligo With and Without Genital Affection

Vitiligo has a major effect on sexual health because of the disfiguring skin lesions affecting self-image and self-esteem. However, this topic has not explored. This article aimed to assess the effect of vitiligo on genital self-image, sexual function, and quality of life in female patients. This cross-sectional study included 50 sexually active women with vitiligo and 25 women without vitiligo. All participants subjected to full history taking and examination. Extent of vitiligo was assessed with the Vitiligo Area Scoring Index score, sexual function with the Female Sexual Function Index, genital self-image with Female Genital Self-Image Score and quality of life with the Dermatology Life Quality Index questionnaires. The main outcome measures were correlation between Vitiligo Area Scoring Index, Female Genital Self-Image Score, Female Sexual Function Index, and Dermatology Life Quality Index domains was determined using t test and Pearson correlation. This study revealed a negative correlation between the Vitiligo Area Scoring Index score and sexual satisfaction. Vitiligo Area Scoring Index and Dermatology Life Quality Index score was significantly correlated with Arabic Version of the Female Genital Self-Image Score alone and with Arabic Version of the Female Sexual Functioning Index alone and with both the Arabic Version of the Female Genital Self-Image Score and the Arabic Version of the Female Sexual Functioning Index (p <.05). Sexual and psychological assessment of patients with vitiligo is imperative to improve outcomes and increase patients' compliance with treatment.

Risk of high-grade cervical dysplasia and cervical cancer in women with systemic inflammatory diseases: a population-based cohort study

BACKGROUND

Previous studies have suggested a potential risk of cervical cancer in patients with systemic inflammatory diseases (SID) such as inflammatory bowel disease (IBD) and systemic lupus erythematosus (SLE).

OBJECTIVES

To assess the risk of high-grade cervical dysplasia, a surrogate endpoint for cervical cancer and cervical cancer, in women with SID, including IBD, psoriasis, rheumatoid arthritis (RA) or SLE, compared with the risk in women without SID.

METHODS

Using US insurance data (2001-2012), we conducted a cohort study of 133,333 women with SID, based on two or more diagnoses and one or more dispensed prescription for disease-specific treatment, and 533,332 women without SID. High-grade cervical dysplasia and cervical cancer was defined by a validated algorithm with a positive predictive value of ≥81%.

RESULTS

Over the mean follow-up of 2.1 years, the crude incidence rate of high-grade cervical dysplasia and cervical cancer per 100,000 person-years was the highest at 141.1 in SLE and the lowest at 82.2 in psoriasis among women with SID, and 73.4 in women without SID. The multivariable HR adjusted for potential confounders was 1.07 (95% CI 0.79 to 1.45) in IBD, 0.96 (95% CI 0.73 to 1.27) in psoriasis, 1.49 (95% CI 1.11 to 2.00) in RA and 1.53 (95% CI 1.07 to 2.19) in SLE. Multivariable HRs were increased, but not statistically significant, in IBD, RA and SLE with baseline use of systemic immunosuppressive drugs or steroids.

CONCLUSIONS

The risk of high-grade cervical dysplasia and cervical cancer was 1.5 times higher in women with RA and SLE than in those without SID. The risk may be increased in IBD with use of systemic immunosuppressive drugs or steroids.

The Female Sexual Function Index (FSFI): linguistic validation of the Italian version

INTRODUCTION

Although several new measurements for female sexual dysfunction (FSD) have recently been developed, the Female Sexual Function Index (FSFI) remains the gold standard for screening and one of the most widely used questionnaires. The Italian translation of the FSFI has been used in several studies conducted in Italy, but a linguistic validation of the Italian version does not exist.

AIM

The aim of this study was to perform a linguistic validation of the Italian version of the FSFI.

METHODS

A multicenter cross-sectional study conducted in 14 urological and gynecological clinics, uniformly distributed over Italian territory. We performed all steps necessary to determine the reliability and the test-retest reliability of the Italian version of the FSFI. The study population was a convenience sample of 409 Italian women.

MAIN OUTCOME MEASURES

The reliability of the questionnaire was calculated using Cronbach's alpha, which was considered weak, moderate, or high if its value was found less than 0.6, between 0.6 and 0.8, or equal to or greater than 0.8, respectively. The test-retest reliability was assessed for all women in the sample by calculating Pearson's concordance correlation coefficient for each domain and for the total score, both at baseline and after 15 days (r range between -1.00 to +1.00, where +1.00 indicates the strongest positive association).

RESULTS

Cronbach's alpha coefficients for total and domain score were sufficiently high, ranging from 0.92 to 0.97 for the total sample. The test-retest procedure revealed that the concordance correlation coefficient was very high both for FSFI-I total score (Pearson's P = 0.93) and for each domain (Pearson's P always >0.92).

CONCLUSION

For the first time in the literature, our study has produced a validated and reliable Italian version of the FSFI questionnaire. Consequently, the Italian FSFI can be used as a reliable tool for preliminary screening for female sexual dysfunction for Italian women.