Sexual Function of Women With Deep Endometriosis Before and After Surgery: A Prospective Study

BackgroundDeep endometriosis (DE) may significantly affect women's quality of life. Limited data exists on the effect of surgery on the several domains of sexual function.AimTo prospectively compare various domains of sexual function before and after laparoscopic surgery for DE.MethodsA prospective observational cohort study in a tertiary university-affiliated referral center. Patients with suspected DE who were planned to undergo laparoscopic surgery completed the Female Sexual Function Index questionnaire before surgery. The same questionnaire was completed by the participants 6 weeks, 6 months, and 12 months after surgery. Rate of sexual dysfunction over time was compared using multilevel logistic regression. Summary scores were then compared at each time point to the corresponding score before surgery using multilevel linear regression. Multivariable analysis was performed of potential confounders.OutcomesChange in desire, arousal, orgasm, lubrication, satisfaction and pain summary scores as well as in the full-scale score between before and after surgery.ResultsWe followed 149 patients with surgically confirmed DE. Sexual dysfunction rate as per the full-scale score was 75.5% before surgery and remained over 60% to 12 months after. The full-scale sexual function score improved at 6 (change in score = 2.8 ± 9.5, P = .004) and 12 months (change in score = 2.1 ± 9.9, P = .03). None of the summary scores improved at 6 weeks. Desire score (P < .001), arousal score (P = .02), and pain score (P = .01) improved at 6 months. Desire score (P = .03) and pain score (P = .01) also improved at 12 months, as compared to before surgery. On multivariable multilevel analysis, scores before surgery significantly contributed to the scores after surgery (P < .001).Clinical translationWhile sexual function improved after surgery, dysfunction rate remained substantial. Proper preoperative counseling should address sexual function measures and clinical and research attention should be given to seek ways to further reduce sexual dysfunction.Strengths and limitationsThe main strengths of our study are the prospective design, the relatively long follow-up and the use of a detailed validated questionnaire allowing assessment of a large variety of clinically relevant sexual function domains and scores as well as a full-scale score. Among our limitations are the lower response rate at 12 months and the limited generalizability as this is a single center study.ConclusionSexual function is a major and often under reported domain of quality of life. Further research is needed to identify the specific populations who may improve, not change or experience deterioration in their sexual functioning after surgery.Dior UP, Reddington C, Cheng C, et al. Sexual Function of Women With Deep Endometriosis Before and After Surgery: A Prospective Study. J Sex Med 2022;19:280–289.     

Effectiveness of an Enhanced Recovery After Surgery Program in Gynaecology Oncologic Surgery: A Single-Centre Prospective Cohort Study

Objective

This study sought to evaluate whether the partial implementation of an Early Recovery After Surgery (ERAS) program lowers length of hospital stay (LOS) without compromising postoperative outcome.

Dyadic and Solitary Sexual Desire in Patients With Fibromyalgia: A Controlled Study

IntroductionAlthough fibromyalgia symptoms negatively affect patients’ sexual life, sexual desire in women diagnosed with fibromyalgia has been understudied.AimTo describe and compare sexual desire in women diagnosed with fibromyalgia and healthy control women, and to investigate the influence of fibromyalgia and its pharmacologic treatment on sexual desire among women diagnosed with fibromyalgia.Methods164 women diagnosed with fibromyalgia participated in the study. Participants’ sexual desire, fibromyalgia symptoms, symptom interference in daily life activities, and perceived quality of life were measured. Further sociodemographic and health-related data were also recorded. 87 healthy women were selected as a control group, and their sexual desire was compared with those of women diagnosed with fibromyalgia.Main Outcome MeasuresMain outcome measures included the Sexual Desire Inventory and the Fibromyalgia Impact Questionnaire.ResultsWhen compared with healthy control subjects, women diagnosed with fibromyalgia exhibited a significantly lower mean score on total desire (47.92 ± 17.48 vs 26.33 ± 21.95; P < .001), solitary desire (10.52 ± 5.96 vs 5.74 ± 7.01; P < .001), and dyadic desire (37.40 ± 13.98 vs 20.59 ± 16.94; P < .001). Women diagnosed with fibromyalgia who were taking antidepressants scored significantly lower on dyadic desire (P < .001), solitary desire (P < .001), and total desire (P < .001) than those who were not. Furthermore, a negative correlation between desire (dyadic and solitary) and Revised Fibromyalgia Impact Questionnaire (total and all subscales) was found. Linear regression showed that taking antidepressants, age, and the total Fibromyalgia Impact Questionnaire score explained 16% of the variance of total desire.Clinical ImplicationsKnowing how fibromyalgia symptoms and their pharmacologic treatment affect women’s sexual desire may have implications for designing care strategies according to individual needs.Strengths & LimitationsTo the best of our knowledge, this is the first study that focuses on studying the impact of fibromyalgia on dyadic and solitary sexual desire. Limitations are related to having used an online questionnaire for data collection, having recruited the participants through a convenience sampling technique and not being able to isolate whether certain results are related to fibromyalgia symptoms or are side effects of the pharmacologic treatment used for symptom control.ConclusionFibromyalgia impact seems to negatively influence dyadic and solitary sexual desire in women. In addition, other factors such as age or taking antidepressant drugs may result in lower sexual desire in these patients.López-Rodríguez MM, Pérez Fernández A, Hernández-Padilla JM, et al. Dyadic and Solitary Sexual Desire in Patients With Fibromyalgia: A Controlled Study. J Sex Med 2019;16:1518–1528.     

A Longitudinal Study of Motivations Before and Psychosexual Outcomes After Genital Gender-Confirming Surgery in Transmen

BackgroundGenital dissatisfaction is an important reason for transmen to undergo genital gender-confirming surgery (GCS; phalloplasty or metoidioplasty). However, little is known about motives for choosing specific techniques, how transmen benefit postoperatively, and whether psychosexual outcomes improve.AimTo evaluate motivations for and psychosexual outcomes after GCS.MethodsA longitudinal study of 21 transmen at least 1 year after GCS was conducted. Participants were recruited through their surgeon. Data were collected when they applied for surgery and at least 1 year after surgery.OutcomesData collection included semistructured questionnaires on motivations for surgery, postoperative experiences, and standardized measures of psychological symptoms, body image, self-esteem, sexuality, and quality of life (pre- and postoperative). Information on surgical complications and corrections was retrieved from medical records.ResultsMost participants underwent phalloplasty with urethral lengthening using a radial forearm flap. Although problematic voiding symptoms were prevalent, many participants were satisfied with their penile function. The strongest motivations to pursue penile surgery were confirmation of one's identity (100%), enabling sexual intercourse (78%), and voiding while standing (74%). No significant differences between postoperative and reference values were observed for standardized measures. After surgery, transmen were more sexually active (masturbation and with a partner) and used their genitals more frequently during sex compared with before surgery (31–78%).Clinical ImplicationsThe present study provides input for preoperative decision making: (i) main motives for surgery include identity confirmation, voiding, and sexuality, (ii) surgery can result in more sexual activity and genital involvement during sex, although some distress can remain, but (iii) complications and voiding symptoms are prevalent.Strength and LimitationsStudy strengths include its longitudinal design and the novelty of the studied outcomes. The main limitations include the sample size and the nature of the assessment.ConclusionCounseling and decision making for GCS in transmen should be a highly personalized and interdisciplinary practice.van de Grift TC, Pigot GLS, Boudhan S, et al. A Longitudinal Study of Motivations Before and Psychosexual Outcomes After Genital Gender-Confirming Surgery in Transmen. J Sex Med 2017;14:1621–1628.     

Sexual Health Problems and Discussion in Colorectal Cancer Patients Two Years After Diagnosis: A National Cross-Sectional Study

Background

Colorectal cancer (CRC) is accompanied by specific treatment-related physical (ostomy, incontinence) and psychosexual (body image, depression) consequences on sexual health.

A 10-Year Interval Study About the Sexual Life and Attitudes of Korean Women: The Korean Internet Sexuality Survey (KISS) 2014, Part 2

BackgroundMany studies on sexual attitudes and behavior have been performed to improve sexual health.AimTo evaluate changing trends in Korean female sexual life and attitudes in an internet-based survey at 10-year intervals.MethodsThe survey was targeted toward 20- to 59-year-old women who were asked to complete the questionnaire only if they were sexually active. The survey contained 110 questions about demographic statistics, sexual life, and attitudes that were crafted based on the 2004 study.OutcomesResults of the 2004 study vs those of the 2014 study.ResultsIn total, 516 women participated in the study; the questionnaire response rate was 16.0%. The mean frequency of intercourse (FOI) per month was 3.46 ± 2.56 in 2014 vs 5.34 ± 3.84 in 2004. Women in their 20s and 30s in 2014 reported a lower mean FOI than those in 2004. There was no significant difference in the mean FOI in 2004 vs 2014 for women who in their 40s. Risk factors for lower FOI were being older, being single, and having dyspareunia. Most Korean women had positive attitudes toward sex (3.2 ± 0.6 of 5) and considered it as important (3.3 ± 0.7 of 5) as those surveyed in 2004. However, women 20 to 39 years old had less positive attitudes toward sex than in the past decade. Women in their 40s were more active and had more conversations with their partners. Of women using contraceptives, 63.8% were found to use less effective methods, such as intercourse withdrawal and the fertility awareness method.Clinical ImplicationsAssessment of changing trends in Korean female sexual life, attitudes, and contraceptive methods could help to establish proper national sexual education programs and campaigns.Strengths and LimitationsThis study was not a cohort study, because subjects in the 2014 were not identical to those in the 2004 study. Nevertheless, we applied the same inclusion and exclusion criteria for this internet survey, a suitable tool to evaluate the sex life of women, which is often considered a sensitive and private issue in Asian culture.ConclusionsCompared with the 2004 survey, young Korean women had fewer sexual relationships and had a less positive attitude toward sex. In addition, many women used less effective methods of contraception.Park J, Min B, Shin H, et al. A 10-Year Interval Study About the Sexual Life and Attitudes of Korean Women: The Korean Internet Sexuality Survey (KISS) 2014, Part 2. J Sex Med 2017;14:1142–1151.     

Sexual Function in Women 3 Days and 6 Weeks After Childbirth: A Prospective Longitudinal Study Using the Taiwan Version of the Female Sexual Function Index

IntroductionChildbirth impacts sexual function in women, but few reports have addressed sexual function shortly after childbirth.AimUsing the Taiwan version of the Female Sexual Function Index (FSFIT), this study aimed to describe women's sexual function and to examine differences between groups in sexual function shortly after delivery.MethodsA prospective longitudinal investigation was performed in women who completed the FSFIT, a numeric analog scale, the Taiwan version of the Center for Epidemiologic Studies Depression Scale (CES-D), and a demographic questionnaire in a Taiwanese medical center at 3 days and 6 weeks postpartum.Main Outcome MeasuresUsing a general linear model, differences were tested between groups, including those defined by delivery mode, type of feeding, depression score, pain score, and birth history.ResultsAfter adjusting for covariates, (i) significant differences in sexual function and desire were found between the vaginal delivery and Cesarean section groups at day 3 and week 6 postpartum (P = 0.0419 and <0.0001, respectively); (ii) differences in desire and satisfaction between the tubal ligation and not groups were significant at both time points (P = 0.0346 and 0.0338); (iii) differences in sexual function and sexual activity or intercourse between low and high CES-D scores were significant at 6 weeks postpartum (P = 0.0040 and 0.0043, respectively); and (iv) differences between pain level groups in sexual activity or intercourse and desire were significant at 6 weeks (P = 0.0493 and 0.0004). At 3 days postpartum, significant differences between educational level and ethnic groups were observed (P = 0.0002 and 0.0414).ConclusionsThe results showed significant differences in sexual function shortly after delivery between groups based on delivery method, tubal ligation, depression, pain, ethnicity, and educational level. This information may help health professionals to be more aware of women's perception of sexuality and may foster sensitivity in assessing their sexual function after childbirth. Chang S-R, Chang T-C, Chen K-H, and Lin H-H. Sexual function in women 3 days and 6 weeks after childbirth: A prospective longitudinal study using the Taiwan version of the Female Sexual Function Index.     

Assessment of Body Image,Sexual Function,and Attractiveness in Women With Genital Prolapse: A Cross-Sectional Study With Validation of the Body Image in the Pelvic Organ Prolapse (BIPOP) Questionnaire

Introduction

Women’s sense of attractiveness and body image, and the impact of pelvic organ prolapse (POP) over these constructs, are likely influenced by social and cultural background.

Labia Minora Surgery in the Adolescent Population: A Cross-Sectional Satisfaction Study

BackgroundLabia minora surgeries are gaining popularity and we have limited data available to help counseling patients, especially in the adolescent population.AimThis study is meant to assess the complications and satisfaction of patients who had the surgery as adolescent.MethodsWe identified and reviewed all labia minora surgeries performed to address symptoms within the adolescent population from 2006 to 2016. A cross-sectional study was then performed. Questionnaires were sent through an Internet-based survey. Adolescent and adult populations from the literature were used for comparison.OutcomesA three-part questionnaire assessed surgical indications, current satisfaction regarding the surgery, and the sexual function, including the Female Sexual Function Index (FSFI) and the Female Genital Self-Image Scale (FGSIS).ResultsA total of 44 cases, from 12 to 18 years old, were included for the retrospective review. The major complaint leading to surgery was described as daily basis discomfort (39%) and aesthetics (33%). Surgical indications were similar for the survey responder group. 3 patients (6.8%) underwent redo surgery. We were able to reach 28 of the 44 potential participants for the cross-sectional study. A total of 17 questionnaires were completed (39%). We found a 20.5% rate of complication with 14% dehiscence, 9.3% significant bleeding, and 1 case of wound infection. This complication rate is higher than what has been found in the literature so far. All responders were partially (53%) or fully (47%) satisfied with the surgery. Results of FSFI were different in two of the 6 domains: lower lubrification (P = .0416) and higher orgasm (P = .0495) score compared to adolescent controls. The cutoff criteria for Hypoactive Sexual Desire Disorder was met by 75%. Patients responded positively to the FGSIS questionnaire (M = 21.65, 95% CI: 20.31-22.98).Clinical ImplicationsThis study helps to identify specificities of the adolescent population who underwent labia minora surgery, potential increased complication rates compared to the adult population, even with overall significant postoperative satisfaction.Strengths & LimitationsLack of adequate control group for the FSFI and FGSIS, a small sample size, and a low response rate could have biased our results. To our knowledge, this is the biggest study to date to address this issue exclusively within the adolescent population, with the addition of validated questionnaires. The long delay since surgery (Mean = 8.3 yrs) permits to highlight temporal changes and potential long term complications.ConclusionsPatients seem to have no regret about the surgery and sexual dysfunction rate comparable to the literature data, except for possible increased hypoactive sexual desire disorder.Jodoin A, Dubuc E. Labia Minora Surgery in the Adolescent Population: A Cross-Sectional Satisfaction Study. J Sex Med 2021;18:623–631.     

Childhood Abuse Experiences and the COMT and MTHFR Genetic Variants Associated With Male Sexual Orientation in the Han Chinese Populations: A Case-Control Study

Background

Although it is widely acknowledged that genetic and environmental factors are involved in the development of male homosexuality, the causes are not fully understood.

Combined Transvaginal/Transabdominal Pelvic Ultrasonography Accurately Predicts the 3 Dimensions of Deep Infiltrating Bowel Endometriosis Measured after Surgery: A Prospective Study in a Specialized Center

Study Objective

To assess the sensitivity and accuracy of combined transvaginal/ transabdominal ultrasonography (TV/TA US) for evaluation of deep infiltrating bowel endometriosis nodules measured after surgery.