The Impact of the Loop Electrosurgical Excisional Procedure for Cervical Intraepithelial Lesions on Female Sexual Function

IntroductionVery limited knowledge exists concerning the impact of Loop Electrosurgical Excisional Procedure (LEEP) on female sexual function in women with cervical intraepithelial neoplasiaAimTo investigate sexual function in women who underwent LEEP for the treatment of cervical intraepithelial lesions, using a validated questionnaire (Female Sexual Function Index [FSFI]).Main Outcome MeasuresFSFI questionnaire on six domains of female sexuality (desire, arousal, lubrication, orgasm, satisfaction, and pain).MethodsConsecutive sexually active women, who underwent LEEP for the treatment of cervical intraepithelial neoplasia were enrolled in this study. All women were asked to complete a copy of FSFI questionnaire, at the time of LEEP and after 6 months. We finally compared the results of the pre-LEEP questionnaire and the post-LEEP questionnaire for each patient.ResultsA total of 67 sexually active women undergoing LEEP for the treatment of cervical intraepithelial lesions were enrolled. Nine of these patients (13.4%) completed only the questionnaire regarding their sexual function before LEEP; thus we did not include them for final analysis. In our study population, data showed a sexual function overall unchanged after LEEP; only the variable “desire” (sexual interest) became significantly worse (P = 0.02).ConclusionsLEEP for the treatment of cervical intraepithelial lesions doesn't affect women's sexuality, when compared with sexual function before surgery. In our study, all FSFI sexual function domains but desire, did not show significant change after LEEP. Serati M, Salvatore S, Cattoni E, Zanirato M, Mauri S, Siesto G, Cromi A, Ghezzi F, and Bolis P. The impact of the Loop Electrosurgical Excisional Procedure for cervical intraepithelial lesions on female sexual function.     

Sexual Function after Radical Hysterectomy for Early-Stage Cervical Cancer: Is There a Difference between Laparoscopy and Laparotomy?

IntroductionSurgical treatment for cervical cancer is associated with a high rate of late postoperative complications, and in particular with sexual dysfunction.AimTo evaluate sexual function in women who underwent radical hysterectomy (RH), in comparison with a control group of healthy women, using a validated questionnaire (Female Sexual Function Index [FSFI]). Then we tried to evaluate the possible differences between laparoscopic RH and abdominal RH in terms of their impact on sexuality.MethodsConsecutive sexually active women, who underwent RH for the treatment of early-stage cervical cancer between 2003 and 2007, were enrolled in this study (cases) and divided into two groups, according to the surgical approach. All women were administered the FSFI. The results of this questionnaire were compared between patients who underwent laparoscopic RH (LPS group) vs. women who underwent laparotomic RH (LPT group). The cases of RH were also compared with a control group of healthy women, who were referred to our outpatient clinic for a routine gynecologic evaluation.Main Outcome MeasuresFSFI questionnaire on six domains of female sexuality (desire, arousal, lubrication, orgasm, satisfaction, pain).ResultsA total of 38 patients were included. We also enrolled 35 women as healthy controls. FSFI score was significantly higher in the healthy controls vs. the cases of RH. In the LPS group, the total score and all the domains of the FSFI were lower in comparison with the healthy controls, whereas three of the six domains (arousal, lubrication, orgasm) and the total score of FSFI were lower in the LPT group if compared with the controls. There were no significant differences between LPS and LPT group.ConclusionsRH worsens sexual function, regardless of the type of surgical approach. In our experience, laparoscopy did not show any benefit on women's sexuality over the abdominal surgery for cervical cancer. Serati M, Salvatore S, Uccella S, Laterza RM, Cromi A, Ghezzi F, and Bolis P. Sexual function after radical hysterectomy for early-stage cervical cancer: Is there a difference between laparoscopy and laparotomy? J Sex Med 2009;6:2516–2522.     

Continuing Medical Education: Sexual Functioning in Transsexuals Following Hormone Therapy and Genital Surgery: A Review (CME)

IntroductionSexual function following genital sexual reassignment surgery (SRS) is an important outcome for many transsexuals, affecting the choice of surgical technique, satisfaction with surgery, and quality of life. However, compared to other outcome measures, little clinical and research attention has been given to sexual functioning following SRS.AimTo discuss the potential impact of cross‐sex hormone therapy and SRS on sexual function and to summarize the published empirical research on postsurgical sexual functioning in male‐to‐female (MtF) and female‐to‐male (FtM) transsexuals.MethodsCross‐sex hormone therapy and SRS techniques are outlined, the potential roles of cross‐sex hormone therapy and SRS on sexual function are discussed, and peer‐reviewed literature published in English on postoperative sexual functioning in MtF and FtM transsexuals is reviewed.Main Outcome MeasuresSexual desire, sexual arousal, and ability to achieve orgasm following SRS.ResultsContrary to early views, transsexualism does not appear to be associated with a hyposexual condition. In MtF transsexuals, rates of hypoactive sexual desire disorder (HSDD) are similar to those found in the general female population. In FtM transsexuals, sexual desire appears unequivocally to increase following SRS. Studies with MtF transsexuals have revealed not only vasocongestion, but also the secretion of fluid during sexual arousal. Research on sexual arousal in FtM transsexuals is sorely lacking, but at least one study indicates increased arousal following SRS. The most substantial literature on sexual functioning in postoperative transsexuals pertains to orgasm, with most reports indicating moderate to high rates of orgasmic functioning in both MtF and FtM transsexuals.ConclusionsBased on the available literature, transsexuals appear to have adequate sexual functioning and/or high rates of sexual satisfaction following SRS. Further research is required to understand fully the effects of varying types and dosages of cross‐sex hormone therapies and particular SRS techniques on sexual functioning. Klein C, and Gorzalka BB. Sexual functioning in transsexuals following hormone therapy and genital surgery: A review.     

Quality of life and sexual function after type C2/type III radical hysterectomy for locally advanced cervical cancer: a prospective study

IntroductionThe introduction of screening programs have made cervical cancer detectable at earlier stages and in younger patients. Nevertheless, only a few studies have examined the QoL and sexual function in disease‐free cervical cancer survivors.AimThe objective of this study is to evaluate the sexual function in a cervical cancer patient's group treated with neoadjuvant chemotherapy (NACT) plus type C2/type III radical hysterectomy (RH).MethodsWe have enrolled in the oncologic group (OG) sexually active patients affected by cervical cancer (stage IB2 to IIIB) treated with NACT followed by RH.Main Outcome MeasuresIncluded subjects were interviewed with the European Organization for Research and Treatment of Cancer (EORTC) QLQ‐CX24 Questionnaire. Two consecutive assessments were recorded: at the first evaluation postoperatively (T1) and at the 12‐month follow‐up visit (T2). Results were compared with a benign gynecological disease group (BG) and with a healthy control group (HG).ResultsA total of 33 patients for OG, 37 for BG, and 35 women for HG were recruited. After surgery, sexual activity has been resumed by 76% of the OG patients and 83.7% of the BG patients (P = not significant). Cancer survivors had clinically worse problems with symptom experience, body image, and sexual/vaginal functioning than controls (P < 0.05). OG patients also reported more severe lymphedema, peripheral neuropathy, menopausal symptoms, and sexual worry. For sexual activity, the score difference between cancer survivors and women with benign gynecological disease is not statically significant. Concerning sexual enjoyment assessment, our study shows comparable results for OG and BG.ConclusionNevertheless, the worsening of symptom experience, body image, and sexual/vaginal functioning, OG patients have same sexual activity and sexual enjoyment data compared with those of BG patients. Thus, NACT followed by RH could be a valid therapeutic strategy to treat and improve well‐being especially in young cervical cancer patients. Plotti F, Sansone M, Di Donato V, Antonelli E, Altavilla T, Angioli R, and Panici PB. Quality of life and sexual function after type c2/type III radical hysterectomy for locally advanced cervical cancer: A prospective study. J Sex Med 2011;8:894–904.     

Aging and sexuality in women

A large number of biological, psycho-relational and socio-cultural factors are related to women's sexual health and they may negatively affect the entire sexual response cycle inducing significant changes in sexual desire, arousal, orgasm and satisfaction during the entire reproductive life span. In spite of the high prevalence of sexual problems with increasing age, sexual retirement is not an inevitable consequence of the passage of time and a high proportion of men and women remains sexually active well into later life, a result of changing attitudes toward sexuality and the availability of effective treatments for sexual dysfunction. Population-based studies reported an age-related decline of sexual functioning and an additional adverse effect of menopausal status. Ageing per se interferes with the level of sexual performance, but sexual behaviour of midlife and older women is highly dependent on several factors such as general physical and mental well-being, quality of relationship and life situation. Sex hormones, mainly low levels of estradiol, are relevant for the lack of sexual awareness and vaginal receptivity in naturally menopausal women. Even diminished levels of androgens, as it more frequently occurs in surgically menopausal women, has a negative impact on desire and sexual responsiveness. Several hormonal treatments have been used locally or systemically to alleviate sexual symptoms, especially by using estrogen plus androgen preparations and tibolone, with noticeable results on drive, enjoyment, lubrication, ability to reach orgasm and initiation of sex. However, sexual counseling and individualized management is mandatory to obtain meaningful and long-lasting results in clinical practice.     

Sexual function in women treated with dilators for vaginal agenesis

OBJECTIVE: To discover the sexual satisfaction of young women treated with vaginal dilators for vaginal agenesis. DESIGN: Anonymous questionnaire study. MAIN OUTCOME MEASURES: Comparison of sexual desire arousal lubrication, orgasm satisfaction and pain with a normal population. RESULTS: There was no significant difference between the study population and controls for the domains of sexual desire, sexual arousal, and satisfaction with a sexual relationship. There was, however, a significant difference for vaginal lubrication and orgasm where the Rokitansky patients scored lower. 22.3% of patients reported some degree of dyspareunia following vaginal penetration. However, this did not affect their enjoyment of the sexual act. CONCLUSION: The use of graduated vaginal dilators for patients with Mullerian agenesis is highly successful in creating a neovagina. Although the lack of adequate lubrication, pain and difficulty in reaching orgasm is significantly higher in this group, the patients subsequently enjoy sexual satisfaction that is comparable to a normal population.     

Sexual Functioning in Women after Surgical Treatment for Endometrial Cancer: A Prospective Controlled Study

IntroductionEndometrial cancer (EC) can affect sexual functioning based on anatomical, physiological, psychological, and relational mechanisms.AimThe aim of this study was to prospectively investigate sexual adjustment of women with EC during a follow‐up period of 2 years after surgical treatment and to compare the results with women who underwent a hysterectomy for a benign gynecological condition and healthy control women.Methods/Main Outcome MeasuresIn this prospective controlled study, participants completed the Short Sexual Functioning Scale, Specific Sexual Problems Questionnaire, Beck Depression Inventory Scale, World Health Organization‐5 Well‐being Scale, and Dyadic Adjustment Scale to assess various aspects of sexual and psychosocial functioning before undergoing a hysterectomy and 6 months, 1 year, and 2 years after surgery.ResultsEighty‐four women with EC, 84 women with a benign gynecological condition, and 84 healthy controls completed the survey. In EC survivors, no differences were found in sexual functioning during prospective analyses. In comparison with women with a benign gynecological condition, significantly more EC patients reported entry dyspareunia 1 year after surgical treatment. Moreover, compared with healthy women, pre‐ and postoperatively, significantly more EC patients reported sexual dysfunctions, including sexual desire dysfunction, arousal dysfunction, entry dyspareunia, and a reduced intensity of orgasm. Furthermore, compared with healthy controls, EC patients reported significantly lower overall well‐being 1 year after surgical treatment. Nevertheless, consensus in the partner relationship was significantly higher in EC patients compared with healthy controls. Moreover, before treatment, quality of partner relationship was negatively associated with sexual arousal dysfunction and orgasm dysfunction.ConclusionsIn EC patients, no differences were found in sexual functioning when prospectively comparing the situation before surgery with the situation after surgery. However, when compared with healthy controls, EC patients are at high risk for sexual dysfunctions, both before and after surgical treatment. Aerts L, Enzlin P, Verhaeghe J, Poppe W, Vergote I, and Amant F. Sexual functioning in women after surgical treatment for endometrial cancer: A prospective controlled study. J Sex Med 2015;12:198–209.     

Sex after seventy: a pilot study of sexual function in older persons

IntroductionLimited information is available regarding sexual functioning among adults aged 70 years and older.AimsTo assess sexual functioning among older men and women, and ascertain patient–physician communication patterns about sexual functioning.MethodsProspective participants were approached prior to scheduled appointments with their primary care physician. In-depth sexual histories were obtained along with data on their demographic, medical, psychological, and cognitive status.Main Outcome MeasuresSexual functioning was assessed using standardized questionnaires, and simple yes/no questions were administered to ascertain information regarding patient–physician communication practices about sex.ResultsOf the 74 eligible patients approached, 50 (68%) participated. The participants had a mean age ± standard deviation (SD) of 81 ± 6 years and most (56%) were women. Eighteen percent of the women and 41% of the men were sexually active. The most commonly reported sexual activity was intercourse for men and masturbation for women. Among the women, the most commonly cited reason for being sexually inactive was “no desire,” whereas for most men, it was “erectile dysfunction.” Sexual function scores for women were low across each category (lubrication, desire, orgasm, arousal, pain, and satisfaction.) For men, low sexual function scores were found in the domains of erectile function, orgasm, and overall satisfaction, but not desire. Only 4% of the women (vs. 36% of men) reported initiating a discussion about sexual function with their physician in the past year, whereas 7% of the women (vs. 32% of men) reported that their physician inquired about the topic in the preceding year. Finally, 32% of the women (vs. 86% of men) felt that physicians should initiate discussions about sexual function.ConclusionIn this study of older adults, a minority reported current sexual activity. Among sexually inactive women, most did not wish to resume activity, whereas desire for sexual activity remained high among men, despite substantial problems with erectile dysfunction. Smith LJ, Mulhall JP, Deveci S, Monaghan N, and Reid MC. Sex after seventy: A pilot study of sexual function in older persons.     

FSFI Scores of Women with Persistent Genital Arousal Disorder Compared with Published Scores of Women with Female Sexual Arousal Disorder and Healthy Controls

IntroductionAlthough persistent genital arousal disorder (PGAD) has been mistaken for hypersexuality, there is no research documenting the sexual functioning of PGAD women to support or refute such an assumption.AimTo compare the Female Sexual Function Index (FSFI) scores of PGAD women to that of women diagnosed with female sexual arousal syndrome (FSAD) and healthy controls.MethodsThe FSFI scores of heterosexual women who met all five features qualifying for a diagnosis of PGAD (N = 172) on an online questionnaire were compared with previously published FSFI scores of women diagnosed with FSAD (N = 128) and healthy controls (N = 131).Main Outcome MeasureTotal and subscale scores on the FSFI.ResultsOn every subscale of the FSFI with the exception of desire, the PGAD women obtained scores between that of the FSAD and the healthy control group. The FSAD women displayed the greatest problems in desire, arousal, lubrication, orgasm, and pain while women with PGAD reported somewhat more desire than the control group but did not meet the cutoff score for sexual dysfunction. PGAD women are more similar to the normal control group than women with FSAD.ConclusionsThere is no evidence to support the belief that women who meet criteria for a diagnosis of PGAD are “hypersexual.” In fact, their overall sexual functioning falls within the normal range and is significantly better than that of women diagnosed with FSAD. Leiblum SR, and Seehuus M. FSFI scores of women with persistent genital arousal disorder compared with published scores of women with female sexual arousal disorder and healthy controls. J Sex Med 2009;6:469–473.     

Nerve‐Sparing Approach Reduces Sexual Dysfunction in Patients Undergoing Laparoscopic Radical Hysterectomy

IntroductionAlthough growing evidence suggests the beneficial effects of a nerve‐sparing (NS) approach to surgery in cervical cancer patients, only limited data on NS laparoscopic radical hysterectomy (LRH) are available, and no studies have investigated the effects of NS‐LRH on sexual function.AimThis study aims to determine whether the implementation of NS‐LRH impacts on sexual function in cervical cancer patients.MethodsSexually active cervical cancer patients undergoing type C (class III) LRH between 2004 and 2013 were enrolled in this prospective study.Main Outcome MeasuresPreoperative and postoperative sexual function were assessed using a validated questionnaire, the Female Sexual Function Index (FSFI). The FSFI evaluates desire, arousal, lubrication, orgasm, satisfaction, and pain.ResultsForty patients undergoing radical hysterectomy (20 conventional LRH vs. 20 NS‐LRH) represented the study group. Baseline characteristics were similar between groups (P > 0.05). No differences in preoperative FSFI scores were recorded (P > 0.05). We observed that both LRH and NS‐LRH worsened postoperative FSFI scores (P < 0.001). However, patients undergoing NS‐LRH had higher postoperative FSFI scores than patients undergoing LRH (21.3 ± 9.4 vs. 14.2 ± 12.5; P = 0.04). Considering postoperative domain scores, we observed that desire, arousal, orgasm, and pain scores were similar between groups (P > 0.05), while patients undergoing NS‐LRH experienced higher lubrication (3.4 ± 2.3 vs. 1.7 ± 2.2; P = 0.02) and satisfaction (4.6 ± 3.9 vs. 2.8 ± 2.2; P = 0.004) scores in comparison with patients undergoing conventional LRH. No between‐group differences in survival outcomes were found.ConclusionsBoth conventional LRH and NS‐LRH impact negatively on patients' sexual function. However, the NS approach impairs sexual function less, minimizing the effects of radical surgery. Bogani G, Serati M, Nappi R, Cromi A, di Naro E, and Ghezzi F. Nerve-sparing approach reduces sexual dysfunction in patients undergoing laparoscopic radical hysterectomy. J Sex Med 2014;11:3012–3020.     

Depressive Symptoms as a Predictor of Sexual Function during Pregnancy

IntroductionBiopsychological and sociocultural factors have been reported to be associated with sexual function in pregnancy. To date, very few studies have focused on the relationship between sexual function and depression during pregnancy.AimTo determine whether depressive symptoms predict overall sexual function, desire, arousal, lubrication, orgasm, satisfaction, and pain during pregnancy by using the Female Sexual Function Index (FSFI).MethodsPregnant women undergoing prenatal examinations were randomly selected for this cross‐sectional investigation. The study included 555 pregnant women who completed the Taiwanese versions of the Center for Epidemiologic Studies Depression Scale (CES‐D), FSFI, and a demographic questionnaire during pregnancy.Main Outcome MeasuresCES‐D scores for depressive symptoms, scores for overall sexual function on the FSFI, and the FSFI domains: desire, arousal, lubrication, orgasm, satisfaction, and pain.ResultsAfter adjusting for demographic factors, CES‐D scores during the first trimester negatively predicted overall sexual function (P = 0.0004), arousal (P = 0.0104), lubrication (P = 0.0016), orgasm (P = 0.0022), and pain (P < 0.0001). Moreover, CES‐D scores during the third trimester negatively predicted sexual desire (P = 0.0005) and satisfaction (P < 0.0001). Furthermore, gestational age negatively predicted overall sexual function, arousal, lubrication, orgasm, and pain (all P < 0.0001). Parity was a positive predictor of overall sexual function, arousal, lubrication, and orgasm (all P < 0.0005). Medical conditions were positive predictors of sexual desire (P = 0.0023).ConclusionsThe present study revealed that depressive symptom scores during early and late pregnancy were significant negative predictors of sexual function during pregnancy. Chang S‐R, Ho H‐N, Chen K‐H, Shyu M‐K, Huang L‐H, and Lin W‐A. Depressive symptoms as a predictor of sexual function during pregnancy. J Sex Med **;**:**–**.     

Improvement of sexual function after transobturator tape procedure in women with stress urinary incontinence

Sling procedures are a widely proven treatment for stress urinary incontinence. The aim of this prospective study was to evaluate the effect of the transobturator tape on female sexual functioning. Fifty-four women treated for stress urinary incontinence with transobturator tape filled out self-administered questionnaires on quality of life, urinary incontinence, and sexual function prior to surgery and 6 weeks and 12 months postoperatively. Preoperatively, 40 women (78%) were sexually active. There were no significant postoperative changes regarding frequency of sexual activity, sexual desire, and problems with lubrication or orgasm. Preoperatively, 55% reported urinary leakage during sexual activity and after surgery 6.5%. Sexual satisfaction was significantly improved 6 weeks (p = 0.05) and 12 months (p = 0.03) postoperatively. Pain during or after sexual activity was declined, only one patient reported worsening of pain. The transobturator tape procedure has a positive effect on female sexual functioning by reducing urinary leakage and pain during or after sexual activity. It seems to improve the overall sexual satisfaction. Further research is warranted to support these preliminary findings.     

Tadalafil 5 mg Daily Treatment for Type 1 Diabetic Premenopausal Women Affected by Sexual Genital Arousal Disorder

IntroductionType 1 diabetic women may be affected by sexual dysfunction, mainly due to peripheral vascular disease.AimTo determine whether daily tadalafil 5 mg is effective in type 1 premenopausal women affected by sexual genital arousal disorder.MethodThirty‐three volunteers were enrolled in a 12‐week daily tadalafil 5 mg prospective study.Main Outcome MeasuresThe efficacy of daily tadalafil 5 mg on sexual genital arousal (primary end point), and desire, orgasm, enjoyment and frequency of sexual activity, and genital pain (secondary end points) were assessed (i) subjectively by the Short Personal Experiences Questionnaire; and (ii) objectively by translabial color Doppler sonography of clitoral blood flow. Moreover, the Short Form‐36 questionnaire was used to assess Quality of Life (QoL).ResultsThirty‐two women completed the study. Women reported a QoL improvement at the 12th week follow‐up (P < 0.05). Tadalafil improved the experience of sexual genital arousal, and orgasm, sexual enjoyment, satisfaction by frequency of sexual activity, and frequency of sexual thoughts or fantasies (P < 0.05). Finally, dyspareunia decreased with respect to baseline (P < 0.001). After tadalafil administration, the mean peak systolic velocity increased and the mean diastolic velocity decreased from baseline (P < 0.001). Moreover, the mean resistance index and the mean pulsatility index were significantly higher compared with baseline values (P < 0.001).ConclusionsDaily tadalafil 5 mg treatment seems to improve subjective sexual aspects and could be used to treat genital arousal disorder of premenopausal women with type 1 diabetes. The limits of the study were the small sample and the lack of a placebo control group. Caruso S, Cicero C, Romano M, Lo Presti L, Ventura B, and Malandrino C. Tadalafil 5 mg daily treatment for type 1 diabetic premenopausal women affected by sexual genital arousal disorder. J Sex Med 2012;9:2057–2065.     

Sexual function after surgery for stress urinary incontinence: vaginal sling versus Burch colposuspension

Objective We prospectively investigated the effect of surgery for stress urinary incontinence (SUI) on sexual function and also compared preoperative and postoperative sexual functions according to vaginal or abdominal surgery for SUI. Methods The study included 94 women who underwent surgery for SUI, and the women were divided into two groups: 53 women had vaginal sling, and 41 women had Burch colposuspension. Female sexual function was evaluated with a detailed 19-item questionnaire, the female sexual function index (FSFI), including sexual desire, arousal, lubrication, orgasm, satisfaction, and pain. In all women, sexual function was compared before and after surgery for SUI, and the differences in postoperative sexual functions were also compared between the women undergoing vaginal sling and Burch colposuspension. Results In all women, total sexual function score significantly decreased from 20.8 ± 9 to 17.3 ± 9.3 after surgery (P = 0.000). Total sexual function score decreased from 19.2 ± 10 to 17.2 ± 9.9 in the vaginal sling group and decreased from 23.6 ± 6.2 to 17.6 ± 7.7 in the Burch colposuspension group, revealing significant difference between the two groups (P = 0.011). Statistically significantly higher decreases in postoperative sexual desire (P = 0.014), arousal (P = 0.026), lubrication (P = 0.004), and orgasm scores (P = 0.008) were also observed in the Burch colposuspension group than in the vaginal sling group. Based on total score, postoperative sexual function improved in 13 women (24.5%) of the vaginal sling group and in 5 women (12.2%) of the Burch colposuspension group, remained unchanged in 15 (28.3%) and 10 (24.4%), respectively, and deteriorated in 25 (47.2%) and 26 (63.4%), respectively. Conclusion Our findings show that sexual functions may be impaired after surgery for SUI. Burch colposuspension may deteriorate sexual functions much more than vaginal sling surgery in women. Therefore, women who will need surgery for SUI should be informed of the risk of deterioration of sexual function after surgery.     

Preliminary study on the effect of four-phasic estradiol valerate and dienogest (E2V/DNG) oral contraceptive on the quality of sexual life

IntroductionA new oral contraceptive containing the natural estrogen estradiol and a 19‐nortestosterone derivate dienogest (DNG) in a four‐phasic 28‐day regimen may be used by women.AimTo investigate the quality of sexual life of healthy women on estradiol valerate and DNG (E2V/DNG) oral contraceptive.MethodsFifty‐seven women (age range 18–48 years) were enrolled. The Short Form‐36 (SF‐36) questionnaire to assess quality of life (QoL) was administered at baseline and at the 26th day of both the 3rd and 6th cycles of oral contraceptive (OC) intake. The Short Personal Experience Questionnaire (SPEQ) to measure the change of sexual behavior was used at the 2nd, 7th, 14th, 21st, 26th, and 28th days of the baseline cycle, as well as at the same days of both the 3rd and 6th cycle of contraceptive intake.Main Outcome MeasureThe SF‐36 and the SPEQ questionnaires.ResultsWomen reported QoL improvement at the 3rd (P < 0.05) and at the 6th cycles (P < 0.01). By SPEQ, improvement of sexuality during the 3rd and the 6th cycle with respect to baseline experience was observed (P < 0.05). The frequency of sexual activity remained basically unchanged (P = NS). Enjoyment and desire improved at the 6th cycle with respect to the 3rd cycle (P < 0.05). All women reported decreased dyspareunia at the 3rd and 6th cycles (P < 0.05). Interestingly, desire, arousal, orgasm, enjoyment, and sexual activity improved, reaching a peak around the 14th day of the menstrual cycle (P < 0.05). At the 3rd and 6th cycle, women on OCs were sexually cyclic, but the peak improvement of desire, arousal, orgasm, enjoyment, and sexual activity appeared around the 7th day of OC intake (P < 0.05).ConclusionReduced hormone‐free interval is a new concept in low‐dose OC regimens. Moreover, the E2V/DNG multiphasic extended regimen has been found to positively modify the sexuality of users. Caruso S, Agnello C, Romano M, Cianci S, Lo Presti L, Malandrino C, and Cianci A. Preliminary study on the effect of four‐phasic estradiol valerate and dienogest (E2V/DNG) oral contraceptive on the quality of sexual life. J Sex Med 2011;8:2841–2850.     

Sexual Function after Sacrocolpopexy

IntroductionPelvic organ prolapse affects approximately 50% of parous women over 50 years of age and has a lifetime risk of 30–50%. Vault descent or prolapse occurs in about 20% after hysterectomy and can have a negative effect on sexual function.Sacrocolpopexy is the gold standard of surgical treatment for apical prolapse in fit, sexually active patients. Few data exist which determine sexual function after sacrocolpopexy.AimThe aim of this study was to determine sexual function in sexually active patients before and after sacrocolpopexy for the treatment of vault prolapse or descent.Main Outcome MeasuresMain outcome measures were the International Continence Society (ICS) Pelvic Organ Prolapse (ICS POP) Staging and the Female Sexual Function Index, which were filled in before the intervention and at follow-up.MethodsBetween December 2000 and December 2009, we asked sexually active female patients who were to undergo sacrocolpopexy for vault descent or prolapse to participate in this study. The patients were gynecologically examined before and after surgery and prolapse staging was performed using the ICS POP Staging.ResultsSixty-two patients were included in the study and follow-up was 24 months.The domains sexual desire, arousal, lubrication, satisfaction, and pain improved significantly postoperatively but orgasm remained unchanged.There was no vaginal shortening postoperatively, and no serious intra- or postoperative complications occurred.ConclusionSacrocolpopexy is a valuable option for sexually active patients with vault descent or prolapse with an amelioration of most aspects of sexual function but not all.Other factors as hormonal treatment, concomitant surgery, physiological, and psychological factors have to be taken into consideration. Kuhn A, Häusermann A, Brandner S, Herrmann G, Schmid C, and Mueller MD. Sexual function after sacrocolpopexy.     

ORIGINAL RESEARCH—EPIDEMIOLOGY: Correlates of Sexually Related Personal Distress in Women with Low Sexual Desire

IntroductionSexual distress is an important component of diagnostic criteria for sexual dysfunctions, but little is known about the factors associated with sexual distress in women with low sexual desire.AimTo investigate the correlates of sexual distress in women with self-reported low sexual desire.MethodsThe Prevalence of Female Sexual Problems Associated with Distress and Determinants of Treatment Seeking study was a cross-sectional, nationally representative, mailed survey of U.S. adult women. There were 31,581 respondents (response rate 63.2%) to the 42-item questionnaire that measured sexual function, sexual distress, demographic, and health-related factors. Multivariable logistic regression was used to explore the correlates of distress.Main Outcome MeasuresLow sexual desire was defined as a response of “never” or “rarely” to the question, “How often do you desire to engage in sexual activity?” Sexual distress was measured with the Female Sexual Distress Scale (range 0–48), with a score of 15 or higher indicating presence of distress.ResultsOf 10,429 women with low desire, 2,868 (27.5%) had sexual distress (mean age 48.6 years, 81% with a current partner). Women without distress were 10 years older on average, and 44% had a current partner. Having a partner was strongly related to distress (odds ratio 4.6, 95% confidence interval 4.1–5.2). Other correlates were age, race, current depression, anxiety, lower social functioning, hormonal medication use, urinary incontinence, and concurrent sexual problems (arousal or orgasm). Dissatisfaction with sex life was more common in women with low desire and distress (65%) than in those without distress (20%).ConclusionsAge has a curvilinear relationship with distress, and the strongest correlate of sexual distress was having a current partner. Sexual distress and dissatisfaction with sex life are strongly correlated. Distress is higher in women with low sexual desire in a partner relationship; further research on this factor is needed. Rosen RC, Shifren JL, Monz BU, Odom DM, Russo PA, and Johannes CB. Correlates of sexually related personal distress in women with low sexual desire. J Sex Med 2009;6:1549–1560.     

Pelvic Floor Dysfunction: Women’s Sexual Concerns Unraveled

IntroductionSexual 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.AimTo 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.MethodsQualitative semistructured interviews were conducted in 37 women scheduled for pelvic floor surgery, and one was excluded from analysis due to incomplete recordings.Main Outcome MeasuresThe impact of POP and/or UI on female sexual function.ResultsOnly 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.ConclusionsBody image plays a key role in the sexual functioning of women with POP and/or UI with the biggest impact on women's “motivation.” Roos A‐M, Thakar R, Sultan AH, Burger CW, and Paulus ATG. Pelvic floor dysfunction: Women's sexual concerns unraveled. J Sex Med 2014;11:743–752.     

Sexual functioning after vaginal hysterectomy or transvaginal sacrospinous uterine suspension for uterine prolapse: a comparison

OBJECTIVE: To examine changes in sexuality after total vaginal hysterectomy (TVH) or transvaginal sacrospinous uterine suspension (SSUS)for uterine prolapse. STUDY DESIGN: One hundred fifty-eight women with moderate to severe uterine prolapse undergoing TVH (78) or SSUS (80) were included in a prospective study from January 2001 to June 2002. All women were <50 years old and sexually active within the last 6 months before surgical intervention. None had major medical disorders. Sexual functioning before and 6 months after surgery was examined via a face-to-face questionnaire. Sexual interest, sexual satisfaction, frequency of sexual intercourse and frequency of orgasm were measured using an analogue scale. RESULTS: Of women undergoing TVH, 5.1% had decreased sexual interest, and 21% had less frequent orgasms postoperatively. For women undergoing SSUS, 13% had decreased sexual interest, and 20% had less frequent orgasms postoperatively. Frequency of orgasm was the only parameter that changed significantly after surgery in the 2 groups. All women with less frequent orgasms said that they were afraid of wound disruption or disease recurrence and so refrained from vigorous or exciting sexual intercourse. About four-fifths of the women in both groups accepted or were satisfied with their sexuality after surgery. For women undergoing TVH, 2.6% had increased frequency of orgasm, and 5% had better overall sexual satisfaction postoperatively. For women undergoing SSUS, 10% had increased sexual satisfaction postoperatively. There was a 2.5% and 2.6% increase in postoperative sexual interest in the SSUS and TVH groups, respectively. The sexual functioning scores were not different before or after surgical intervention in either group. CONCLUSION: There is a decrease in thefrequency of orgasm after both TVH and SSUS. However, there is no significant difference in postoperative sexual functioning between women with and without preservation of the uterus in correcting uterine prolapse.     

When Are Sexual Difficulties Distressing for Women? The Selective Protective Value of Intimate Relationships

IntroductionRecent studies have shown that sexual functioning and sexually related personal distress are weakly related in women, with only a minority of sexual difficulties resulting in significant levels of distress. However, there has been little systematic research to date on which factors moderate the relationship between sexual functioning and sexual distress.AimTo assess the degree to which relational intimacy and attachment anxiety moderate the association between sexual functioning and sexual distress in college-age women.MethodsTwo hundred women (mean age = 20.25) completed surveys assessing sexual functioning, relational intimacy, attachment anxiety, and sexual distress.Main Outcome MeasuresParticipants completed the Sexual Satisfaction Scale for Women, the Female Sexual Function Index, the Dimensions of Relationship Quality Scale, and the Revised Experiences in Close Relationships Measure of Adult Romantic Attachment.ResultsRelational intimacy and attachment anxiety moderated the association between multiple aspects of sexual functioning and sexual distress. For lubrication and sexual pain, functioning was more strongly associated with distress in low-intimacy vs. high-intimacy relationships, but only for women with high levels of attachment anxiety. Results regarding desire were mixed and neither intimacy nor attachment anxiety interacted with subjective arousal or orgasm in predicting distress.ConclusionBoth relational intimacy and attachment anxiety are important moderators of the association between sexual functioning and subjective sexual distress in women. Theoretical and practical implications are discussed. Stephenson KR, and Meston CM. When are sexual difficulties distressing for women? The selective protective value of intimate relationships.