Effect of suture material and construction on frictional properties of sutures

The results overwhelmingly support the view that the coefficient of friction is not a material constant of the sutures but a function of several variables, including applied tension, suture construction and suture material. The coefficient of friction decreased with an increase in applied tension with the rate of change depending upon the suture material. Prolene and Ethilon had the highest frictional values among all sutures at low tension, but dropped to a position of lowest values at high tension. On an average, braided sutures gave higher frictional values than did the monofilament sutures. Sutures with special surface coatings (silicone or Teflon) generally gave lower values than did the sutures without any such coatings. Similar results were reported in other studies on coated materials. The differences in frictional profiles are governed by the differences in the viscoelastic nature of the suture materials. The unusual traces produced by Prolene were considered as being due to its high degree of stretch and elasticity. Others similarly found that Prolene behaved peculiarly due to a high degree of stretch. Finally, coefficient of friction is an important property of suture materials as it is expected to have a direct bearing on the security of knots. A careful study of this parameter under a variety of clinical conditions is essential to gain an understanding of the behavior of surgical knots in clinical practice. The present study gives detailed information on the frictional behavior of various types of surgical suture materials.     

A temporary nontoxic lubricant for a synthetic absorbable suture

Synthetic absorbable sutures have been coated with lubricants to improve their handling characteristics. A unique surfactant, poloxamer 188, has been used to coat the surface of the polyglycolic acid sutures. This lubricant was chosen because it does not damage the tissues defenses of the host and invite infection. Since poloxamer 188 is readily soluble in aqueous solutions, it is rapidly absorbed in the tissue environment resulting in an uncoated suture that displays increased knot security. The coating of polyglactin 910 is also minimally reactive in tissues and does not damage tissue defense. In contrast with the coated polyglycolic acid sutures, the knot security of the coated polyglactin 910 sutures is not altered by exposure to an aqueous environment or implantation. The increased knot security of the coated polyglycolic acid suture after implantation is considered to be a distinct clinical advantage over that of the coated polyglactin 910 sutures.     

Unique performance characteristics of Novafil

Polybutester is a unique copolymer that can be extruded as a flexible monofilament nonabsorbable suture. The mechanical performance of this new suture material was compared with that of polypropylene and nylon. The results indicate that polybutester sutures are as strong, have the same degree of total elongation at break and knot as the other monofilament sutures. In contrast with polypropylene and nylon sutures, the polybutester sutures have a perceptible stretch, are more elastic and flexible, and exhibit less creep. Polybutester sutures appear to be an acceptable alternative to polypropylene and nylon sutures and their unique mechanical properties may even prove to be superior in vivo.     

Mechanical performance of polyglycolic acid and polyglactin 910 synthetic absorbable sutures

The mechanical performance of polyglycolic acid and polyglactin 910 sutures has been assessed using standardized reproducible tests. The results of these studies demonstrated distinct differences in their performance that can be related, in part, to their structural configuration. The size of the 4-0 polyglactin suture was significantly larger than that of the 4-0 polyglycolic acid suture. Since the strength of any suture is proportional to its cross sectional area, the strength of unknotted and knotted polyglactin 910 sutures was signficantly greater than that of the polyglycolic acid sutures. The strength of both sutures was similarly diminished by the formation of the knot. When these sutures were added to tissue, the breaking strength was even further reduced. The rate of decline in breaking strength of the two absorbable sutures in healing skin wounds was comparable. These absorbable sutures displayed knot security with a two throw square knot, 1 = 1. The ability of these sutures to reach knot break with this knot configuration is characteristic of sutures in which the surface exhibits a high coefficient of friction. Their rough surface also caused them to drag through tissue, making difficult to adjust tension on a continuous running suture.     

Studies on the efficacy and safety of polydioxanone monofilament absorbable suture

Preclinical animal studies have clearly indicated that dyed and undyed polydioxanone monofilament absorbable sutures have prolonged breaking strength retention, a reliable absorption profile and minimal tissue reaction. The suture provides wound support throughout extended postoperative periods and is most useful in those situations in which prolonged suture integrity is desirable. Based upon these clinical studies, polydioxanone monofilament absorbable sutures must be considered as a reliable, easy to use suture material which fulfills all performance criteria. The over-all clinical results were excellent. Polydioxanone was rated as significantly superior to gut in every category evaluated. The results of this study support the claim that polydioxanone monofilament absorbable sutures are the suture of choice for general surgical use as well as in a variety of other clinical applications in which an absorbable suture is required.     

Absorbable versus non-absorbable sutures in ovarian microsurgery: experimental results in the rabbit model

Microsurgery has been shown to reduce the risk of adhesion formation when compared to conventional surgery in cases of benign ovarian pathology. However, the microsurgeons have contrasting opinions concerning the use of absorbable versus non-absorbable suture materials. In the present study we compared nylon versus vicryl sutures for ovarian surgery using the rabbit as an experimental model. No differences were found in terms not only of post-operative adhesions but also in terms of post-operative reproductive outcome for the sutures analyzed.     

Frequency,Reasons for,and Perceptions of Lubricant Use among a Nationally Representative Sample of Self‐Identified Gay and Bisexual Men in the United States

IntroductionFew previous studies have examined lubricant use among gay and bisexual men outside the context of human immunodeficiency virus risk reduction associated with condom use during penile–anal intercourse and the potential use of lubricants to deliver rectal microbicides. The vast majority of studies examining lubricant use among gay and bisexual men have employed convenience sampling strategies for participant recruitment. Additionally, most studies have collapsed gay men and bisexual men into one category of “gay and bisexual men.”AimsThis study aimed to provide overall rates of lubricant use and related factors among a nationally representative sample of self‐identified gay and bisexual men. Frequencies of lubricant use, reasons for using lubricant, and perceptions of lubricant use were examined separately for subsamples of both gay and bisexual men.MethodsData were from the 2012 National Survey of Sexual Health and Behavior, which involved the administration of an online questionnaire to a nationally representative probability sample of women and men in the United States aged 18 and older, and we oversampled self‐identified gay and bisexual men and women; the results from male participants are included in this article.Main Outcome MeasuresMeasure included demographic characteristics, recent and lifetime commercial lubricant use, lubricant use during specific sexual behaviors, frequency of lubricant use, and reasons for lubricant use during sexual activity.ResultsOver 90% of both gay and bisexual male participants reported lifetime lubricant use. Use was most common during partnered sexual activities, particularly among men aged 25–29 years old. The most commonly reported reasons for lubricant use included to increase comfort during anal intercourse, curiosity, and to make sex more comfortable.ConclusionsMost gay and bisexual men in the United States have used lubricant to enhance a wide range of sexual activities, including but not limited to anal intercourse. Findings from this study will be of utility to clinicians and other health practitioners who seek to understand and promote sexual health among gay and bisexual men and other traditionally underserved public health populations. Dodge B, Schick V, Herbenick D, Reece M, Sanders SA, and Fortenberry JD. Frequency, reasons for, and perceptions of lubricant use among a nationally representative sample of self‐identified gay and bisexual men in the United States. J Sex Med 2014;11:2396–2405.     

Remarkable Lubricating Capabilities of Amniotic Surfactant

Summary: Surface-active phospholipid (SAPL) extracted from amniotic fluid or elutriated from the chorioamnionic sacs of placentas recovered from normal full term deliveries has been shown to be a remarkable lubricant. Coefficients of kinetic and static friction were reduced to 0.009 by SAPL from amniotic fluid and 0.011 for a membrane extract, even under high load (3 kg/cm²), compared with 0.04 for the best nonbiological boundary lubricants. The antiwear properties were equally remarkable, giving a mean scar diameter under extreme pressure of only 0.76mm for amniotic SAPL and 1.00 mm for membrane extract compared with 0.85-0.95 mm for aqueous lubricants commercially available.
These results support the hypothesis that premature rupture (PROM) is less likely to occur if movement between the fetus and the amnion or between the decidual surface of the uterus and the chorion is well lubricated.     

An event-level analysis of adding exogenous lubricant to condoms in a sample of men who have vaginal sex with women

IntroductionLittle is known about the characteristics of sexual events during which individuals choose to use lubricant with condoms.AimsThe aims of this article were to evaluate the determinants of adding lubricant to condoms during baseline and at the event level, to assess the event‐level variables' influence on adding lubricants to condoms, and to assess the event‐level influence of using condoms with lubricant on event‐level condom attitudes.MethodsA total of 1,874 men completed a 30‐day Internet‐based prospective daily diary study of sexual behavior and condom use.Main Outcome MeasuresBaseline data included demographic variables and information about condom education. Daily diary data included reports of penile‐vaginal sex regarding intercourse duration, intercourse intensity, intoxication level, condom application method, partner contraceptive method, and partner and relationship characteristics.ResultsLubricant was added to 24.3% of the study‐provided condoms and 26.2% of the condoms selected by study participants. Those with more education and those who were married were more likely to add lubrication to condoms. Adding lubricant to condoms, a female partner putting the condom on with her hands and using contraception, and the event occurring with a wife (vs. girlfriend) was significantly associated with longer intercourse. Event‐level lubricant and condom use significantly predicted lower willingness to buy the condom it was used with, as well as to recommend the condom. Adding exogenous lubricant was not related to the participants' confidence in condoms as a method to prevent pregnancy and sexually transmitted infections.ConclusionsThe event‐level nature of this study provided for a more comprehensive assessment of the situational factors that are associated with applying lubricant to condoms. Findings from this study suggest that men are adding lubricant to condoms for reasons other than to increase condom efficacy. Reece M, Mark K, Herbenick D, Hensel DJ, Jawed‐Wessel S, and Dodge B. An event‐level analysis of adding exogenous lubricant to condoms in a sample of men who have vaginal sex with women. J Sex Med 2012;9:672–678.     

Adhesion formation and histologic reaction with polydioxanone and polyglactin suture

A suture material associated with a minimal inflammatory response might be expected to induce less frequent and less severe peritoneal adhesions. A comparison between polydioxanone and polyglactin 910 suture was performed in a rabbit model. Ten sexually mature virgin female New Zealand white rabbits underwent laparotomy and bilateral incisions into the distal uterine cavities. The serosa of the left uterine horn was always reapproximated with polyglactin 910 suture whereas the right uterine horn was repaired with polydioxanone suture. All animals were put to death 28 days later. An adhesion score was given for each uterine horn. Representative sections were obtained for histologic review. Similar histologic responses were found in both groups. No significant difference was noted in adhesion scores between the two sutures. The present study cannot justify the use of one of these sutures over the other with regard to adhesion formation or tissue reaction.     

To lube or not to lube: experiences and perceptions of lubricant use in women with and without dyspareunia

IntroductionThere are few studies examining the relationship between lubricant use and sexual functioning, and no studies have examined this relationship in women with dyspareunia. Vaginal dryness is a prevalent complaint among women of all ages. There is an association between vaginal dryness and painful intercourse; therefore, women with dyspareunia represent a particularly relevant sample of women in which to investigate lubricant use.AimThe aim of this study was to examine differences between women with and without dyspareunia in self‐reported natural lubrication and attitudes toward and use of personal lubricants.MethodsRespondents completed an online survey including questions on demographics, gynecological/medical history, sexual functioning, and lubricant use and attitudes.Main Outcome MeasuresThe main outcome measures used were the Female Sexual Function Index (FSFI) and questions regarding attitudes toward and use of lubricants.ResultsControls scored higher on the lubrication subscale of the FSFI than women with dyspareunia (P < 0.001). Women with dyspareunia reported greater frequency of lubricant use during sexual activity over the last year (P < 0.01). They were also more likely to use lubricant prior to penetration (P < 0.05). The most common use for controls was to enhance sexual experiences. This was also a common answer for women with dyspareunia; however, in this group, the most common reason was to reduce/alleviate pain. Lubricants were rated as less effective among women with dyspareunia vs. controls across all reported reasons for use. Nevertheless, lubricant use was still rated as being moderately effective in alleviating pain for women with dyspareunia.ConclusionsWomen with dyspareunia have more difficulty with natural lubrication; it is consequently not surprising that they reported using lubricant more frequently than control women. Women with dyspareunia reported using lubricants more often than controls to try to prevent or alleviate pain and reported this as being a moderately effective strategy, suggesting that it may be a useful tool for some women with dyspareunia. Sutton KS, Boyer SC, Goldfinger C, Ezer P, and Pukall CF. To lube or not to lube: Experiences and perceptions of lubricant use in women with and without dyspareunia. J Sex Med 2012;9:240–250.     

Methods for myometrium closure and other factors impacting effects on cesarean section scars of the uterine segment detected by the ultrasonography

OBJECTIVE: Ultrasound examination is an objective method for assessment of uterine scar defects. The present study was conducted to compare single-layer interrupted sutures (Group A) with double-layer interrupted sutures (Group B) and our new method (Group C) as well as other perioperative parameters in relation to risk of wedge defects in scars. METHODS: We have introduced a new myometrium closure procedure consisting of continuous suture with decidual closure followed by interrupted myometrium suture. In this prospective study, women undergoing cesarean operation (n = 137) were examined by transvaginal ultrasound one month after surgery to assess the appearance of lower uterine scars. Multivariate logistic regression analysis was performed to identify associations of perioperative parameters and methods for lower myometrium closure with abnormal wedge formation. RESULTS: Wedge defects were observed in a total of 27 patients (19.7%). The analysis revealed Groups B and C to have reduced risks with odds ratios of 0.28 and 0.077, respectively, as compared to Group A. Furthermore, increasing gestational week at delivery, plural fetal pregnancies, premature rupture of membranes and pre-eclampsia were also linked with an increased risk, with odds ratios of 1.4-8.9. CONCLUSION: The incidence of uterine scar defects 1 month after cesarean sections varies with the method applied for myometrial suture and perioperative variables. The data suggest that methods for myometrium closure as well as other factors influence the condition of myometrial healing.     

Quantitative evaluation of stiffness of commercial suture materials

The bending stiffness of 22 commercial suture materials of varying size, chemical structure and physical form was quantitatively evaluated using a stiffness tester (Taber V-5, model 150B, Teledyne). The commercial sutures were Chromic catgut; Dexon (polyglycolic acid); Vicryl (polyglactin 910); PDS (polydioxanone); Maxon (polyglycolide-trimethylene carbonate); Silk (coated with silicone); Mersilene (polyester fiber); Tycron (polyester fiber); Ethibond (polyethylene terephthalate coated with polybutylene); Nurolon (nylon 66); Surgilon (nylon 66 coated with silicone); Ethilon (coated nylon 66), Prolene (polypropylene); Dermalene (polyethylene), and Gore-tex (polytetraflouroethylene). These are both natural and synthetic, absorbable and nonabsorbable and monofilament and multifilament sutures. All of these sutures were size 2-0, but Prolene sutures with sizes ranging from 1-0 to 9-0 were also tested to determine the effect of suture size on stiffness. The bending stiffness data obtained showed that a wide range of bending stiffness was observed among the 22 commercial sutures. The most flexible 2-0 suture was Gore-tex, followed by Dexon, Silk, Surgilon, Vicryl (uncoated), Tycron, Nurolon, Mersilene, Ethibond, Maxon, PDS, Ethilon, Prolene, Chromic catgut, coated Vicryl, and lastly, Dermalene. The large porous volume inherent in Gore-tex monofilament suture was the reason for its lowest flexural stiffness. Sutures with a braided structure were generally more flexible than those of a monofilament structure, irrespective of the chemical constituents. Coated sutures had significantly higher stiffness than the corresponding uncoated ones. This is particularly true when polymers rather than wax were used as the coating material. This increase in stiffness is attributable to the loss of mobility under bending force in the fibers and yarns that make up the sutures. An increase in the size of the suture significantly increased the stiffness, and the magnitude of increase depended on the chemical constituent of the suture. The flexural stiffness of sutures was also found to depend on the duration of bending in the test for stiffness. In general, monofilament sutures exhibited the largest time-dependent stiffness. This was most pronounced with the Gore-tex suture. Most braided sutures also showed less time-dependence in stiffness. Nylon sutures did not exhibit this time-dependent phenomenon regardless of physical form.     

Uterine compression sutures for postpartum hemorrhage: is routine postoperative cavity evaluation needed?

Postpartum hemorrhage due to uterine atony continues to be one of the major causes of maternal morbidity and mortality. Several uterine compression suture techniques have been described and are increasingly being used worldwide as a conservative approach. However, little is known about the long-term effects on the uterine cavity, as well as fertility and pregnancy outcomes. We reviewed the reported complications and uterine findings after the use of compression sutures, both in examinations to evaluate the cavity (hysteroscopy, hysterosalpingography or sonohysterography) and at cesarean section, in order to assess the possible usefulness of routine postoperative cavity evaluation. Overall, the use of uterine compression sutures is effective and safe; however, some severe and potentially life-threatening complications have been reported and could possibly have been prevented if uterine cavity evaluation had been performed. Routine follow-up, both by hysteroscopy and an imaging technique, seems worthwhile.     

A comparison of three techniques for ovarian reconstruction

We compared three methods of ovarian reconstruction in 23 mature female New Zealand White rabbits. Each animal was its own control. The right ovary in each rabbit was incised and repaired by placing three 8-0 nylon sutures through and through the base of the defect (method A). The left ovary was repaired without these through-and-through sutures. In 16, hemostasis was achieved by microbipolar cautery (method B); in seven, hemostasis was achieved with three sutures placed entirely inside the defect (method B1). The cortex of each ovary was repaired identically by continuous 8-0 nylon suture. Outcome was evaluated by laparoscopy 14 days after mating. Through-and-through sutures (right ovary) caused a significant increase in adhesion formation and decrease in nidation index. When these animals were put to death 14 weeks later, the right ovaries were significantly smaller. On the left, there was no difference in any outcome variable between methods B and B1. This study clearly shows the detrimental effect of through-and-through sutures for ovarian reconstruction.     

Lifetime Lubricant Use among a Nationally Representative Sample of Lesbian- and Bisexual-Identified Women in the United States

IntroductionThe diversity in self-identified lesbian and bisexual women's sexual interactions necessitates better understanding of how and when they integrate personal lubricant into different experiences. However, little is known about lesbian and bisexual women's lifetime lubricant use, particularly at the population level.AimsThe aim of this study was to examine the prevalence and characteristics of lubricant use among adult lesbian and bisexual women in the United States.MethodsData were drawn from a subset of lesbian and bisexual participants who participated in the 2012 National Survey of Sexual Health and Behavior, an online questionnaire administered to a nationally representative probability sample of U.S. adults ages 18 and older.Main Outcome MeasuresWe examined socio-demographic characteristics, recent and lifetime lubricant use, lubricant use in associated with specific sexual behaviors and condom use, frequency of use, motivations for use, as well as perception of lubricant when used.ResultsA majority of lesbian- (60.1%) and bisexual-identified (77.1%) women reported ever using lubricant; 25.7% of lesbian women and 32.7% of bisexual women used it in the last 30 days. Across most age groups, lubricant was commonly used during partnered sexual play, partnered sexual intercourse, or when a vibrator/dildo was used. Lesbian and bisexual women reported using lubricants to increase arousal/sexual pleasure/desire, to make sex more fun, or to increase physical comfort during sex.ConclusionsLubricant use is identified as a part of lesbian and bisexual women's sexual experience across the life span, as a part of both solo and partnered experiences. As part of evolving sexual health assessments, clinicians and health educators may find value in integrating lubricant-focused conversation with their lesbian and bisexual patients and clients, particularly. Hensel DJ, Schick V, Herbenick D, Dodge B, Reece M, Sanders SA, and Fortenberry JD. Lifetime lubricant use among a nationally representative sample of lesbian- and bisexual-identified women in the United States. J Sex Med 2015;12:1257–1266.     

Women's Use and Perceptions of Commercial Lubricants: Prevalence and Characteristics in a Nationally Representative Sample of American Adults

IntroductionUse of commercial lubricant is common in the United States among adult women. However, little is known about the sexual behaviors for which women use lubricant, women's perceptions of lubricant, or reasons for use, particularly in a nationally representative sample.AimThe aim of this study was to document the prevalence and characteristics of lubricant use among adult women in the United States and their perceptions of lubricants in relation to subjective sexual experiences.MethodsData are from a subset of individuals who were sampled as part of the 2012 National Survey of Sexual Health and Behavior, which involved the administration of an online questionnaire to a nationally representative probability sample of U.S. adults ages 18 and older.Main Outcome MeasuresSociodemographic characteristics, recent and lifetime commercial lubricant use, lubricant use during specific sexual behaviors, frequency of lubricant use, and reasons for lubricant use of participants were studied for the article.ResultsOf the women who participated in the study, 65.5% (n = 1,021) reported ever having used lubricant and 20% had used a lubricant within the past 30 days. Across age groups, lubricant was most commonly used during intercourse (58.3% of women) or partnered sexual play (49.6%). Common reasons for lubricant use included to make sex more comfortable, fun, and pleasurable and to decrease discomfort/pain.ConclusionsMost American women have used lubricant. Also, lubricant is more common as part of partnered intercourse and sexual play or foreplay compared with other solo and partnered sexual behaviors. Clinicians may find it helpful to broaden conversations with patients to include questions about their sexual behaviors, comfort and/or pain during sex, and lubricant use and to share, particularly with younger women, that lubricant use is prevalent and commonly used for reasons related to pleasure as well as comfort. Herbenick B, Reece M, Schick V, Sanders SA, and Fortenberry JD. Women's use and perceptions of commercial lubricants: Prevalence and characteristics in a nationally representative sample of American adults. J Sex Med 2014;11:642–652.     

Surgical treatment of prolapsed uterus and vagina using the RFV (reposition and fixation of the vagina) method R. Napierala

OBJECTIVES: I am presenting a new and personal method of surgical treating a uterovaginal prolapses using vaginal approach. MATERIAL AND METHODS: From 30th July to 30th November 2004, 12 patients between the ages of 40 and 83 years were operated on using the RFV method. The RFV Surgical Method is a new, inexpensive and technically simple procedure with little risk of complications using vaginal approach. It involves repositioning a prolapsing vagina and uterus to their proper positions as well as stabilizing them with the use of circular, parallel, non-absorbent sutures on the vagina and then the formation of scar tissue around the sutures. RESULTS: After the surgical procedures, all 12 patients anatomical relations returned to normal. There was only one incident where absorbent sutures were used and 2 months after surgery the uterus once again began to prolapse. The patient was operated on once again using nonabsorbent sutures and to this day, four months after surgery, there is no evidence of the uterus or vaginal walls descending. CONCLUSIONS: The above named surgical procedure is recommended for older women who also suffer from other illnesses which might disqualify them from undergoing more traditional, extensive procedures. Preliminary results have been introduced at work of 12 patients operated on using this method.     

The in vitro and in vivo effects of a surgical lubricant on the recovery of gonococci from the endocervical canal.

A surgical lubricant containing phenylmercuric borate, tested in vitro, was shown to alter the recovery of the gonococcus. In vivo studies of 150 patients, 60 (40%) of whom were infected with Neisseria gonorrhoeae, were performed to determine if examination with the surgical lubricant, as compared to tap water, altered the ability to recover N. gonorrhoeae from the cervix. Results indicated that although the surgical lubricant containing phenylmercuric borate was bacteriostatic in vitro, it did not alter the recovery of N. gonorrhoese from infected patients.     

Association of lubricant use with women's sexual pleasure, sexual satisfaction, and genital symptoms: a prospective daily diary study

IntroductionAlthough lubricant use is commonly recommended to women for solo and partnered sexual activities, little is known about women's use of lubricant or their relationship to sexual pleasure and satisfaction.AimThe aim of this study was to assess: (i) how adult women used lubricant during partnered and solo sexual activities; (ii) relations between women's reports of sexual pleasure and satisfaction and their use of a lubricant during a particular sexual event; and (iii) to what extent lubricant use was associated with subsequent genital symptoms.MethodsA total of 2,453 women completed a 5‐week internet‐based, double‐blind prospective daily diary study in which they were assigned to use one of six water‐ or silicone‐based lubricants.Main Outcome MeasuresBaseline data included demographics, contraceptive use, and sexual behavior during the 4 weeks prior to study enrollment. Daily diary data included reports of penile–vaginal sex, penile–anal sex, solo sex, lubricant use, lubricant application, ratings of sexual pleasure and satisfaction, and genital symptoms.ResultsWater‐based lubricants were associated with fewer genital symptoms compared with silicone‐based lubricants. In addition, the use of a water‐based or silicone‐based lubricant was associated with higher ratings of sexual pleasure and satisfaction for solo sex and penile–vaginal sex. Water‐based lubricant use was associated with higher ratings of sexual pleasure and satisfaction for penile–anal sex as compared with no lubricant use.ConclusionThe water‐ and silicone‐based lubricants used in this study were associated with significantly higher reports of sexual pleasure and satisfaction and rarely associated with genital symptoms. Herbenick D, Reece M, Hensel D, Sanders S, Jozkowski K, and Fortenberry JD. Association of lubricant use with women's sexual pleasure, sexual satisfaction, and genital symptoms: A prospective daily diary study. J Sex Med 2011;8:202–212.