The Association Between Pelvic Discomfort and Erectile Dysfunction in Adult Male Bicyclists

BackgroundBicycle riding's impact on erectile function remains a topic of great interest given cycling's popularity as a mode of transportation and exercise.AimWe evaluated risk factors for sexual dysfunction in male cyclists with the primary intention of determining if genital/pelvic pain and numbness are associated with erectile dysfunction (ED).MethodsWe surveyed male cyclists using an online anonymous questionnaire. Cyclists were queried on their demographics, cycling experience, and sexual function using the Sexual Health Inventory for Men (SHIM). ED was diagnosed when a completed SHIM score was <22. Regression analysis was used to evaluate the risk of ED in men with genital/pelvic pain or numbness after riding. The survey was designed in the United States.OutcomesQuantitative characterization of cycling habits, onset and timing of genital pain and numbness, and SHIM score.ResultsA total of 1635 participants completed the survey. A majority of men were over the age of 50 (58%, 934/1,607), Caucasian (88%, 1,437/1,635), had been active cyclists for over 10 years (63%, 1,025/1,635) and used road bikes (97%, 1,578/1,635). Overall, 22%, 30%, and 57% of men reported ED, genital pain, and genital numbness, respectively. While controlling for cohort demographics, body mass index, cycling intensity and equipment, and medical comorbidities, no saddle characteristics were associated with the risk of developing genital numbness. However, men reporting penile numbness were at higher risk of reporting ED (odds ratio [OR] = 1.453, P = .048). In addition, quicker onset of numbness and resolution of numbness within a day was associated with impaired erectile function. For example, numbness occurring less than 1 hour after cycling had greater odds of leading to ED than numbness after 5 hours (OR = 2.002, P = .032). Similarly, genital pain occurring less than 1 hour (OR = 2.466, P = .031) after cycling was associated with higher ED risk.Strengths & LimitationsStrengths include a large sample size of high-intensity cyclists and validated questionnaire use. Limitations include reliance on anonymous self-reported survey data and minimal inquiry into the riding preferences and terrain traversed by cyclists.ConclusionsPelvic pain and numbness are common complaints among male riders in the United States. Men with such complaints are more likely to also report ED especially if it occurs earlier in the ride. Although direction of causality and temporality are uncertain, alleviation of factors resulting in pelvic discomfort may reduce cycling's impact on sexual function. Such interventions are critical given that cycling for both active travel and aerobic exercise confers numerous health benefits.Balasubramanian A, Yu J, Breyer BN, et al. The Association Between Pelvic Discomfort and Erectile Dysfunction in Adult Male Bicyclists. J Sex Med 2020;17:919–929.     

Male and Female Sexual Dysfunction in Pediatric Cancer Survivors

BackgroundPediatric cancer survivors suffer indirect long-term effects of their disease; however, there is a paucity of data regarding the effect of pediatric cancer survivorship on sexual function.AimTo assess the prevalence and risk factors associated with sexual dysfunction among pediatric cancer survivors.MethodsPediatric cancer survivors were recruited to complete an online survey using the Female Sexual Function Index (FSFI) or the International Index of Erectile Function (IIEF-5), both validated questionnaires to assess female sexual dysfunction (FSD) and erectile dysfunction (ED). Patient demographics, oncologic history, prior treatment, and sexual habits were also queried. Logistic regression was used to evaluate risk factors for sexual dysfunction, and Mann-Whitney U test was used to identify factors associated with individual domains of the FSFI.OutcomesThe main outcome measures were FSFI and IIEF-5 score, which are used to diagnose FSD (FSFI<26.55) and ED (IIEF-5<22).ResultsA total of 21 (72.4%) female respondents and 20 (71.4%) male respondents were sexually active and completed the survey and FSFI or IIEF-5 questionnaire, respectively. Mean (±SD) age was 23.7 (4.1) years, and average age at diagnosis was 9.1 (5.0), with no difference between genders. Overall, 25.0% (5/20) of male and 52.4% (11/21) of female pediatric cancer survivors reported sexual dysfunction (P = .11). Oncologic history and prior treatment were not associated with sexual function. Females who reported difficulty relaxing during intercourse in the last 6 months had higher odds of reporting sexual dysfunction (odds ratio: 13.6, 95% confidence interval: 1.2–151.2, P = .03). Subgroup analysis of FSFI domains found that previous radiation therapy was correlated with decreased lubrication and satisfaction during intercourse, whereas previous treatment to the pelvic region significantly reduced satisfaction and increased pain during intercourse.Clinical ImplicationsFemale pediatric cancer survivors have higher odds of reporting sexual dysfunction after treatment and should be screened appropriately to provide early intervention and to mitigate risk.Strength & LimitationsOur study includes validated questionnaires to assess FSD and ED and queries specific characteristics to assess their association with sexual dysfunction. However, the study is limited by sample size and its cross-sectional survey design.ConclusionsThe prevalence of female sexual dysfunction in this cohort is higher than that in the general population of equivalent-aged individuals, and clinicians should be aware of these potential long-term sequelae.Greenberg DR, Khandwala YS, Bhambhvani HP, et-al. Male and Female Sexual Dysfunction in Pediatric Cancer Survivors. J Sex Med 2020;17:1715–1722.     

Cycling and Female Sexual and Urinary Function: Results From a Large,Multinational, Cross-Sectional Study

Background

Bicycle riding has become an increasingly popular mode of transportation and exercise, especially among women, and previous studies have demonstrated a relationship between cycling and sexual dysfunction, albeit using non-validated questionnaires.

Is There an Association Between Contraception and Sexual Dysfunction in Women? A Systematic Review and Meta-analysis Based on Female Sexual Function Index

BackgroundA growing body of research investigates the sexual functioning status in women with contraceptives use; however, the evidence is still inconclusive.AimTo examine whether contraceptives use is associated with a higher risk of female sexual dysfunction (FSD).MethodsThe electronic databases MEDLINE, Embase, Cochrane Library databases, and PsychINFO were systematically screened for eligible studies before December 2019. We only included those studies assessing women's sexual functioning by the Female Sexual Function Index (FSFI). This study was registered on the PROSPERO (ID: CRD42020167723, http://www.crd.york.ac.uk/PROSPERO).OutcomesThe strength of the association between contraceptives use and risk of FSD was presented by calculating the standard mean dierences (SMDs) and the relative risk (RR) with a 95% confidence interval (CI). The pooled results were calculated using a random-effects model.ResultsA total of 12 studies (7 cross-sectional studies, 3 cohorts, and 1 case-control study) involving 9,427 participants were included. The mean age in the contraceptive users ranged from 22.5 ± 2.4 years to 38.2 ± 4.6 years, while the mean age in the nonusers was 22.5 ± 2.4 years to 36.0 ± 1.0 years. Pooled results showed that no significant difference in the total FSFI scores was observed between contraceptives use and noncontraception (SMD = −1.03, 95% CI: −2.08 to 0.01, P = .053; heterogeneity: I² = 98.2%, P < .001). In line with this finding, the pooled RR also yielded no association between contraception use and the risk of FSD (RR = 1.29, 95% CI: 0.72–2.28, P = .392; heterogeneity: I² = 76.0%, P = .0015). However, the subscale sexual desire showed a significant reduction in women who received contraceptives than those did not use contraception (SMD = −1.17, 95% CI: −2.09 to −0.24, P = .014; heterogeneity: I² = 97.7%, P < .001), while no significant differences were found in sexual arousal, lubrication, orgasm, satisfaction, and pain domain.Clinical ImplicationsThough evidence from this meta-analysis did not support an association between contraceptives use and the risk of FSD, the sexual desire could be significantly impaired by contraceptives use.Strengths & LimitationsThis is the first meta-analysis quantifying the relationship between contraceptives use and the risks of FSD. However, substantial heterogeneities were presented across the included studies.ConclusionNo direct association between contraceptives use and the risk of FSD was found. Nevertheless, declining sexual desire was significantly associated with contraceptives use. Additional double-blind, randomized, placebo-controlled trials are still warranted.Huang M, Li G, Liu J, et al. Is There an Association Between Contraception and Sexual Dysfunction in Women? A Systematic Review and Meta-analysis Based on Female Sexual Function Index. J Sex Med 2020;17:1942–1955.     

Opinion Paper: On the Diagnosis/Classification of Sexual Arousal Concerns in Women

BackgroundIn the professional literature and among our professional societies, female sexual dysfunction nomenclature and diagnostic criterion sets have been the source of considerable controversy. Recently, a consensus group, supported by the International Society for Women’s Sexual Health, published its recommendations for nosology and nomenclature, which included only one type of arousal dysfunction, female genital arousal disorder, in its classification system. Subjective arousal was considered an aspect of sexual desire and not part of the arousal phase.AimTo advocate for the importance of including subjective arousal disorder in the diagnostic nomenclature in addition to the genital arousal subtype.MethodsWe reviewed how the construct of subjective arousal was included in or eliminated from the iterations of various diagnostic and statistical manuals. The Female Sexual Function Index (FSFI) was used to examine the relations among subjective arousal, genital arousal, and desire in women with and without sexual arousal concerns.Main Outcome MeasuresSexual arousal through a self-report Film Scale, physiologic sexual arousal through vaginal photoplethysmography in response to an erotic film, and the FSFI.ResultsThe clinical literature and experience support differentiating subjective arousal from desire and genital arousal. Correlations between the FSFI domains representing desire and subjective arousal, although sufficient to suggest relatedness, share approximately 58% of the variance between constructs—a lower shared variance than FSFI domains representing subjective arousal and orgasm. Similarly, when looking at FSFI individual items best representative of sexual desire and subjective arousal, the large majority of the variance in subjective arousal was unexplained by desire. A third line of evidence showed no significant difference in levels of subjective arousal to erotic films between sexually functional women and women with desire problems. If desire and subjective arousal were the same construct, then one would expect to see evidence of low subjective arousal in women with low sexual desire.Clinical ImplicationsOptimized treatment efficacy requires differentiating mental and physical factors that contribute to female sexual dysfunction.Strengths and LimitationsSupport for our conclusion is based on clinical qualitative evidence and quantitative evidence. However, the quantitative support is from only one laboratory at this time.ConclusionThese findings strongly support the view that female sexual arousal disorder includes a subjective arousal subtype and that subjective arousal and desire are related but not similar constructs. We advocate for the relevance of maintaining subjective arousal disorder in the diagnostic nomenclature and present several lines of evidence to support this contention.Althof SE, Meston CM, Perelman M, et al. Opinion Paper: On the Diagnosis/Classification of Sexual Arousal Concerns in Women. J Sex Med 2017;14:1365–1371.     

Does the Severity of Overactive Bladder Symptoms Correlate With Risk for Female Sexual Dysfunction?

BackgroundSeveral studies have associated overactive bladder (OAB) with female sexual dysfunction (FSD); however, there are no reports using a quantitative approach to measure OAB severity and to relate OAB to the risk of FSD.AimTo evaluate women with OAB and to correlate the severity of their urinary symptoms with their sexual function.MethodsThis cross-sectional study included 267 women older than 18 years with untreated OAB. All subjects completed the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) and the Female Sexual Function Index (FSFI).OutcomesLinear regression was used to analyze the association between variables and the numeric FSFI score, and categorical FSFI scores were analyzed using logistic regression. Spearman rank correlation coefficient was used to assess the correlation between ICIQ-OAB results and the different FSFI domains. The significance level was 5%.ResultsSubjects’ mean age was 50.2 ± 11.9 years. Most women were married, had at least three children, and were postmenopausal (54.3%). Mean FSFI total score was 19.2 ± 9.8. For menopausal status, 65.6% of premenopausal women had a risk for FSD vs 86.2% of postmenopausal women. Mean ICIQ-OAB score was 10 ± 3.17. Postmenopausal women had the following risk factors statistically associated with sexual dysfunction: age, ICIQ score, and marital status. For these women, greater OAB severity, especially those with urgency and/or urge incontinence, was associated with worse scores in the arousal, lubrication, orgasm, and sexual pain domains. However, there was no statistically significant association for premenopausal women.Clinical ImplicationsHealth professionals have to pay attention to OAB in women because of the greater risk for FSD in these patients.Strengths and LimitationsThe strength was using a quantitative approach to measure OAB severity in a larger population. Limitations include a convenience sample with no power calculation; exclusion of women who did not have sexual intercourse in the past month; unmeasured distress caused by sexual disorders; and the impossibility of establishing causality between OAB and sexual dysfunction.ConclusionWomen with OAB frequently have a risk for sexual dysfunction. In the postmenopausal group, women with scores indicating severe OAB had worse sexual function, mainly in the arousal, lubrication, orgasm, pain, and total domains.Juliato CRT, Melotti IGR, Junior LCS, et al. Does the Severity of Overactive Bladder Symptoms Correlate With Risk for Female Sexual Dysfunction? J Sex Med 2017;14:904–909.     

Female Sexual Orgasmic Dysfunction and Genital Sensation Deficiency

IntroductionMost studies on female sexual dysfunction (FSD), and female sexual orgasmic disorder (FSOD) in particular, have qualitatively examined cultural and educational factors; only few have quantitatively examined physiological factors.AimThe aim of this study was to compare quantitative sensory testing (QST) between women for whom FSOD was their primary complaint and other women with FSD.MethodsIn this retrospective study of women who visited a sexual dysfunction clinic, the study group comprised women for whom FSOD was their primary complaint, and the control group comprised other women with FSD. Sexual dysfunction was assessed by the Female Sexual Function Index (FSFI). QST was performed with a thermal and vibration Genito-Sensory Analyzer (GSA; Medoc Ltd, Israel) aimed at the clitoral and vaginal areas.Main Outcome MeasureThe main outcome was clitoral and vibratory sensory thresholds in accordance with the presence of FSOD.ResultsThe study group comprised 89 (45%) women, with a mean age of 37.6 ± 1.9 years; and the control group comprised 110 (55%) women, with a mean age of 37.5 ± 11.3 years. Both mean FSFI-FSOD and total FSFI scores were significantly lower in the study group than in the control group (0.97 ± 0.94 vs 1.91 ± 1.3, P < 0.001) and (11.9 ± 3.2 vs 15.6 ± 3.6, P < 0.001), respectively. Mean clitoral vibratory sensory thresholds were higher in the study group than in the control group: 2.02 confidence interval (CI) 1.12–2.64 vs 1.55 CI 1.12–2.41, P < 0.001. No statistically significant difference was found between the groups in vaginal vibratory thresholds: 3.7 CI 2.6–6.6 vs 3.4 CI 1.9–5.4, P = 0.14.Clinical ImplicationsThe findings support the role of the clitoris in obtaining sexual orgasm, thus inferring a possible physiologic cause of FSOD in otherwise healthy women, beyond established psychological causes.Strength & LimitationsAssessments using an objective quantitative measure (QST) and a subjective tool (FSFI) in both the FSOD and control groups are strengths of this study. The retrospective design is a limitation.ConclusionQST showed a direct correlation between vibratory clitoral stimulation and FSOD; Compared with the control group, women with FSOD are relatively insensitive to clitoral stimulation, but not to vaginal stimulation.Gruenwald I, Lauterbach R, Gartman I, et al. Female Sexual Orgasmic Dysfunction and Genital Sensation Deficiency. J Sex Med 2020; 17:273–278.     

Prevalence of Sexual Dysfunction and Impact of Contraception in Female German Medical Students

IntroductionFemale sexual dysfunction (FSD) is a very common disorder, with an estimated prevalence of having at least one sexual dysfunction of about 40%.AimTo investigate the prevalence and types of FSD and the relationship between hormonal contraception (HC) and FSD in female German medical students.Main Outcome MeasuresFemale Sexual Function Index (FSFI) with additional questions on contraception, sexual activity, and other factors that may influence sexual function.MethodsAn online questionnaire based on the FSFI was completed by students from six medical schools. Obtained data were screened for inconsistencies by programmed algorithms.ResultsA total of 1,219 completed questionnaires were received, and 1,086 were included in the analyses after screening. The mean total FSFI score was 28.6 +/? 4.5. 32.4% of women were at risk for FSD according to FSFI definitions. Based on domain scores, 8.7% for were at risk for FSD concerning orgasm, 5.8% for desire, 2.6% for satisfaction, 1.2% for lubrication, 1.1% for pain and 1.0% for arousal. The method of contraception and smoking were factors with significant effect on the total FSFI score whereby hormonal contraception was associated with lower total FSFI scores and lower desire and arousal scores than no contraception and non-hormonal contraception only. Other variables such as stress, pregnancy, smoking, relationship and wish for children had an important impact on sexual function as expected according to earlier studies.ConclusionsThe prevalence of students at high risk for FSD was consistent with the literature although domain subscores differed from samples previously described. The contraception method has a significant effect on the sexual functioning score and women using contraception, especially hormonal contraception, had lower sexual functioning scores. Stress and relationship among other variables were found to be associated with sexual function and may thus provide insight into the etiology of sexual disorders. Wallwiener CW, Wallwiener L-M, Seeger H, Mück AO, Bitzer J, and Wallwiener M. Prevalence of sexual dysfunction and impact of contraception in female german medical students.     

Les Lanternes Rouges: The Race for Information About Cycling‐Related Female Sexual Dysfunction

IntroductionCycling is growing in popularity among women. As in men, it is associated with genital neuropathies and decreased sensation in female riders. However, there is a gap in research and information addressing the relationship between cycling and female sexual dysfunction (FSD) in women.AimsTo review the literature investigating pelvic floor injuries and sexual dysfunction in female cyclists.MethodsSearches in several electronic databases were conducted, and relevant articles that met the inclusion criteria were identified for critical review.Main Outcome MeasuresThe main outcome measure to be determined was the strength of the current body of evidence in published literature of a correlation between cycling‐related pelvic floor injuries and FSD.ResultsData on FSD from cycling‐related injuries in women are limited. Research indicates that bicycle setup and riding equipment may be contributing factors. Women's ergonomics and physiology interact differently with the bicycle than men's. Current evidence offers insufficient foundation to recommend various effect‐mitigating equipment and products.ConclusionsWhile gender‐specific cycling products offer a promising direction for protecting women riders, studies addressing FSD and pelvic floor injuries in women cyclists are inadequate to indicate clear etiology or provide treatment recommendations. Current evidence is also insufficient to recommend effect‐mitigating equipment and products. Partin SN, Connell KA, Schrader SM, and Guess MK. Les lanternes rouges: The race for information about cycling‐related female sexual dysfunction. J Sex Med 2014;11:2039–2047.     

Sexuality and Psychopathological Aspects in Premenopausal Women with Metabolic Syndrome

IntroductionMetabolic syndrome (MetS) is a cluster of cardiovascular risk factors that have been suggested to impact female sexual function.AimsThis study aims to assess the prevalence of female sexual dysfunction (FSD) in premenopausal women with MetS compared with healthy controls (HC). Psychopathological aspects and the relationship to FSD were also evaluated in both groups.MethodsTwo hundred four premenopausal women, of whom 98 had diagnosis of MetS, were asked to complete the Female Sexual Function Index (FSFI), the Female Sexual Distress Scale (FSDS), and the Middlesex Hospital Questionnaire (MHQ). Routine laboratory tests and anthropometric measurements were routinely performed.Main Outcome MeasuresFSFI and FSDS questionnaires, prevalence of FSD, and MHQ scores.ResultsIn the MetS group compared with the HC group, we found: a lower global FSFI score (P = 0.005), higher prevalence of pathological scores compared with HC group, and lower scores in the desire, arousal, lubrication, and orgasm domains. An inverse correlation between the FSFI score and the number of risk factors for MetS was detected. MetS women reported significantly higher total scores in the somatization and depression domains when compared with the HC group. The logistic regression showed that high triglycerides (odds ratio [OR] 3.097; 95% confidence interval [CI] 1.272–7.542; P = 0.026) and somatization (OR 7.068; CI 95% 2.291–21.812; P = 0.001) are independently associated with FSD in premenopausal women.ConclusionsOur results indicate a higher prevalence of sexual dysfunction in MetS women. A number of risk factors for MetS are positively associated with FSD and higher triglycerides seem to be the strongest predictors of sexual dysfunction. Psychopathological dimensions such as somatization are strongly associated with sexual dysfunction. Alvisi S, Baldassarre M, Lambertini M, Martelli V, Berra M, Moscatiello S, Marchesini G, Venturoli S, and Meriggiola MC. Sexuality and psychopathological aspects in premenopausal women with metabolic syndrome. J Sex Med 2014;11:2020–2028.     

Peripheral Polyneuropathy and Female Sexual Dysfunction—Familial Amyloidotic Polyneuropathy as an Example Besides Diabetes Mellitus

IntroductionFemale sexual dysfunction (FSD) in peripheral polyneuropathies besides diabetes mellitus is still a poorly studied subject. Little is known about sexual function in women with amyloidosis, Guillain–Barré syndrome, or porphyria. Even for the world's most common peripheral polyneuropathies such as diabetes mellitus, knowledge and consensus are still lacking. Familial amyloidotic polyneuropathy (FAP) is the most common cause of genetic systemic amyloidosis, with neurological clinical manifestations similar to diabetes mellitus. Until today, no study on the sexual function of these young female patients has been published.AimTo evaluate FSD in female FAP patients and to compare the results with those of healthy, non‐FAP females.MethodsA questionnaire‐based, observational study comprising 94 nonmenopausal women with a sexual partner (51 FAP and 43 non‐FAP as the control group) was conducted. The Female Sexual Function Index (FSFI)—Portuguese‐validated version was used to assess FSD.Main Outcome MeasuresTotal and subscales scores of the FSFI.ResultsFSD was reported by 42% (95% confidence intervals [CI] 28.3–55.7) of FAP patients compared to 12% of healthy controls. Of all the FAP patients, 39.2% reported problems with desire (95% CI 25.6–52.4), 72.5% reported problems with arousal (95% CI 60.2–84.8), 68% reported lubrication problems (95% CI 55.1–80.9), 62% reported orgasm problems (95% CI 48.5–75.5), 39.2% experienced pain (95% CI, 25.8–52.6), and 49% experienced sexual dissatisfaction (95% CI, 35.3–62.7).Even after multiple logistic regression analysis, FAP is associated with sexual dysfunction in women (OR 4.3, 95% CI 1.2–15.5, P < 0.03), and the affected domains are desire (OR 5.1, 95% CI 1.3–19.7, P < 0.02), arousal (OR 4.7, 95% CI 1.5–14.1, P < 0.007), orgasm (OR 5, 95% CI 1.6–16, P < 0.007), and sexual satisfaction (OR 4.8, 95% CI 1.4–16.9, P < 0.02). Only the use of medication with potential for sexual dysfunction was found as a significant predictor of orgasm disorder (OR 4.2, 95% CI 1.1–15.6, P < 0.03), as did age for sexual dissatisfaction (OR 1.1, 95% CI 1.0–1.2, P < 0.04).ConclusionsFAP as a peripheral polyneuropathy results in FSD, presenting a risk factor four times greater and related to disease severity in terms of desire, arousal, and orgasm disorders, as well as sexual dissatisfaction. Oliveira‐e‐Silva T, Campos Pinheiro L, Rocha Mendes J, Barroso E, and Monteiro Pereira N. Peripheral polyneuropathy and female sexual dysfunction—Familial amyloidotic polyneuropathy as an example besides diabetes mellitus. J Sex Med 2013;10:430-438.     

Differential DNA Methylation in Monozygotic Twins Discordant for Female Sexual Functioning

BackgroundResearch has repeatedly suggested genetic and environmental factors in the etiology underlying female sexual dysfunction (FSD). Because sexual functioning is a highly variable trait, epigenetics could provide a promising approach to tackle the origins of FSD and consequently offer a step-change in our understanding of these problems.AimTo identify differentially methylated CpG positions for sexual functioning in a sample of monozygotic twin pairs discordant for sexual functioning.MethodsThe sample consisted of 33 trait-discordant monozygotic twin pairs (mean age = 54.1 years, SD = 9.05) from the Twins UK Registry. Phenotypic data on sexual desire, arousal, lubrication, orgasm, satisfaction, and pain were collected using the Female Sexual Function Index–Lifelong (FSFI-LL). The Illumina Infinium HumanMethylation 450 DNA BeadChip was used for epigenome-wide analyses of DNA methylation in whole-blood samples.OutcomesComparison of DNA methylation patterns associated with the FSFI-LL total score and its six subdomains.ResultsTwo differentially methylated CpG positions (cg09580409 and cg14734994) reaching experiment-wide statistical significance were found for overall sexual functioning, mapping to MGC45800 and the threonine synthase-like 2 gene (THNSL2), respectively. Furthermore, potential biologically relevant candidates for sexual desire (CUB and zona pellucida-like domains 1, CUZD1) and satisfaction (solute carrier family 6 member 19, SLC6A19) were identified.Clinical TranslationTHNSL2 and SLC6A19, which have been linked to weight and adiposity, might represent novel candidates for sexual problems in women.Strengths and LimitationsThis is the first study to investigate epigenetic mechanisms underlying FSD. The study used a relative small sample of monozygotic female twins. The cutoff to determine discordance in sexual problems was chosen based on a 10% FSFI score difference. Therefore, the results have to be interpreted with caution and need replication in larger clinical samples.ConclusionUnderstanding how genes and environment interact to influence our sexuality might inform clinical practice and lead to new treatments for women experiencing FSD.Burri A, Leupin M, Spector T, Marinova Z. Differential DNA Methylation in Monozygotic Twins Discordant for Female Sexual Functioning. J Sex Med 2017;14:1357–1364.     

Genito-Sensory Analysis in Women with Arousal and Orgasmic Dysfunction

IntroductionDiagnosis and treatment of female sexual dysfunction (FSD) are currently based on subjective female reports and physical examination. The GenitoSensory Analyzer (GSA) is a quantitative sensory testing tool designed to quantify vibratory and thermal sensation in the vagina and clitoris in a reproducible manner, and may therefore contribute to the diagnosis and management of FSD.AimTo address the question of whether women with arousal and/or orgasmic sexual disorders have genital sensory abnormalities as measured by the GSA.Main Outcome MeasuresThresholds for warm, cold, and vibratory sensation at predetermined points in the vaginal wall and clitoris.MethodsFemale subjects complaining of arousal and/or orgasmic sexual disorders for more than 6 months were evaluated using a questionnaire based on the female sexual function index (FSFI). Women with a desire disorder, pain disorder, vulvar vestibulitis syndrome, or acute vaginal or/and introital infection were excluded. The GSA device measured thresholds for warm, cold, and vibratory sensation at predetermined points in the vaginal wall and clitoris. Eight measurements were obtained, and deviations from previously published normative values were identified.ResultsTwenty-eight women (age 40.4 ± 13 years) complaining of arousal and/or orgasmic FSD comprised the study cohort. Twenty-five of them (89%) had at least one pathologic genitor-sensory threshold on GSA testing and 19 (68%) had >3 pathologic thresholds. Pathologic GSA results were associated with lower arousal scores on the FSFI questionnaire, older age, and menopausal status.ConclusionsMost of the study women had at least one genitor-sensory pathology on GSA testing, indicating a possible organic component in their disorder. Our findings support the incorporation of the GSA as a quantitative tool in the assessment and diagnosis of patients with FSD. Helpman L, Greenstein A, Hartoov J, and Abramov L. Genito-sensory analysis in women with arousal and orgasmic dysfunction. J Sex Med **;**:**–**.     

Effects of vaginal discharge on female sexual function

Objective

To assess the effects of vaginal discharge on female sexual dysfunction (FSD) by using the Female Sexual Function Index (FSFI).

Methods

In a study at a university hospital in Canakkale, Turkey, women affected by vaginal discharge and age-matched healthy control women were recruited between January and December 2012. Women were grouped in accordance with their vaginal discharge complaints and each participant completed the FSFI questionnaire.

Results

A total of 114 women were included in the study. Women in the first group (n = 58) had no vaginal discharge or had physiologic vaginal discharge, those in the second group (n = 29) had abnormal vaginal discharge with itching, and those in the third group (n = 27) had abnormal vaginal discharge without itching. Compared with the first group, women in the second and third groups had higher FSFI scores for desire, arousal, orgasm, and pain, in addition to higher overall FSFI scores. Women with genital malodor had significantly higher FSFI scores than patients without genital malodor (23.83 ± 5.07 vs 21.15 ± 4.78; P = 0.008).

Conclusion

Women with abnormal vaginal discharges were found to have better FSFI scores for some domains. This finding may be attributed to the adverse effects of sexual intercourse on vaginal infections.     

Sexual Functions in Women With Stress Urinary Incontinence After Mid-Urethral Sling Surgery: A Systematic Review and Meta-Analysis of Prospective Randomized and Non-Randomized Studies

BackgroundStress urinary incontinence (SUI) is a common, distressing health issue which affects many women. Mid-urethral sling (MUS) surgeries are recommended as gold standard interventions, although evidence regarding their impact on female sexual function remains controversial.AimTo provide high-quality evidence of the impact of MUS surgeries on sexual functions in women with SUI.MethodsA systematic search of PubMed, Embase, and the Cochrane Library was conducted to identify studies assessing the effect of MUS treatments on sexual functions in women with SUI. The included studies were prospective randomized or non-randomized trials which assessed patients using 2 validated questionnaires, the Female Sexual Function Index (FSFI) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Pre- and postoperative data regarding sexual function were extracted. Meta-analysis of comparable data was performed using Review Manager (version 5.3) software.Main outcome measuresThe relationship between MUS interventions and sexual functions was analyzed by pooling weighted mean differences (WMD) with 95% CI from studies which used either the FSFI or PISQ-12 questionnaires, before and after receiving surgical interventions.ResultsOf the 22 eligible studies, 13 utilized FSFI and 9 adopted the PISQ-12. Pooled analysis indicates that 6-month postoperative PISQ-12 scores were significantly higher than preoperative scores (WMD −3.31 points; 95% CI −5.32 to −1.30; P = .001). Similar results were found at the 12-month juncture (WMD −3.30 points; 95% CI −6.01 to −0.58; P = .02) and at 24 months (WMD −4.44 points; 95% CI −5.45 to −3.44; P < .00001). Likewise, pooled postoperative FSFI total scores were significantly higher than preoperative scores at 6 months (WMD −2.22 points; 95% CI −3.36 to −1.08; P = .00001) and 12 months (WMD −3.49 points; 95% CI −5.96 to −1.02; P = .006). Postoperative FSFI sub-scores also suggest that desire, arousal, orgasm, lubrication, satisfaction, and pain during sexual intercourse significantly improved postoperatively (all P < .05). Moreover, combined evidence highlighted a significant reduction in coital incontinence postoperatively (risk ratio 5.78; 95% CI 3.16–10.58; P < .00001).Clinical ImplicationsThese assessment tools might be more appropriately used to create opportunities for counseling.Strengths & LimitationsWe encountered substantial heterogeneity and insufficient long term follow-up data. There is also a distinct lack of standards, in terms of data recording and reporting across this evidence base which adds to the problems with the PISQ-12 and FSFI which, even though validated, appear unsophisticated and not necessarily fit-for-purpose.ConclusionThis meta-analysis confirms that sexual functions do improve after MUS surgeries for women with SUI.Lai S, Diao T, Zhang W, et al. Sexual Functions in Women With Stress Urinary Incontinence After Mid-Urethral Sling Surgery: A Systematic Review and Meta-Analysis of Prospective Randomized and Non-Randomized Studies. J Sex Med 2020;17:1956–1970.     

Prevalence of and risk factors for sexual dysfunction in young Chinese women according to the Female Sexual Function Index: an internet-based survey

Objectives: Female sexual dysfunction (FSD) is a very common sexual health problem worldwide. The prevalence of FSD in Chinese women is, however, unknown. This is the first study to investigate a large number of young women throughout China via the internet, to determine the prevalence and types of FSD and to identify the risk factors for FSD. Methods: The primary endpoint was the Female Sexual Function Index (FSFI) score, with additional questions on contraception, sexual activity, relationship stability, pregnancy and other factors which may influence sexual function. The online questionnaire was completed by women from 31 of the 34 Chinese provinces. Results: A total of 1618 completed questionnaires were received, and 1010 were included in the analyses after screening (62.4%). The mean age of the respondents was 25.1?±?4.5 years. The mean total FSFI score was 24.99?±?4.60. According to FSFI definitions (cut-off score 26.55), 60.2% of women were at risk of FSD. Based on domain scores, 52 were considered at high risk of dysfunction for pain (5.1%), 35 for orgasm (3.5%), 33 for desire (3.3%), 20 for arousal (2.0%), 6 for satisfaction (0.6%) and 2 for lubrication (0.2%). Conclusions: The prevalence of FSFI scores indicating risk of sexual dysfunction was about 60% in Chinese women. An unstable relationship, pressure to become pregnant, non-use of contraception, negative self-evaluation of appearance and increasing age were significantly associated with FSD in young Chinese women.     

Is Mode of Delivery Associated With Sexual Response? A Pilot Study of Genital and Subjective Sexual Arousal in Primiparous Women With Vaginal or Cesarean Section Births

IntroductionAlthough postpartum sexual concerns are common, limited data exist on postpartum sexual response. Furthermore, the physiological process of vaginal birth may negatively impact genital response compared with unlabored cesarean section (C-section), but this hypothesis has yet to be tested.AimTo (i) compare genital and subjective sexual response and sexual concordance by mode of delivery with inclusion of a control group, (ii) compare groups on self-reported sexual function over the past month, (iii) examine the relationship between laboratory measurement of sexual response and self-reported sexual function, and (iv) investigate association between obstetrical factors and breastfeeding and between sexual response and self-reported sexual function.Methods3 groups of cisgender women were recruited from the community: primiparous women who delivered via vaginal birth within the past 2 years (VB group; n = 16), primiparous women who delivered via unlabored C-section within the past 2 years (CS group, n = 15), and age-matched nulliparous women (NP group, n = 18). Laser Doppler imaging was used to assess genital response while participants watched a neutral and erotic film.Main Outcome MeasuresThe main outcome measures were change in flux units from neural to erotic video as a measure of genital response, subjective sexual arousal rated continuously throughout films, perceived genital response rated after films, and Female Sexual Function Index (FSFI).ResultsWomen in the VB group had significantly lower change in flux units than women in the CS (P = .005, d = 1.39) and NP (P < .001, d = 1.80) groups. Groups did not differ on their subjective indices of sexual response or in sexual concordance. Women in both postpartum groups reported lower FSFI scores than women in the NP group. No relationship was determined between FSFI scores and sexual response in the laboratory. Results suggested that genital trauma and breastfeeding may negatively impact FSFI scores, but they were not related to genital response or subjective sexual arousal as measured in the laboratory.Clinical ImplicationsResults underscore the importance of balancing objective and subjective indices of sexual response and function, especially considering the biopsychosocial nature of postpartum sexuality.Strengths & LimitationsThe present study is the first to apply modern sexual psychophysiological methodology to the study of postpartum sexuality. Cross-sectional methodology limits the ability to make causal inferences, and the strict inclusion criteria limits generalizability.ConclusionPhysiological changes as a result of labor and delivery may have a detrimental impact on genital response; however, these physiological differences may not impact women's subjective experience of postpartum sexuality.Cappell J, Bouchard KN, Chamberlain SM, et al. Is Mode of Delivery Associated With Sexual Response? A Pilot Study of Genital and Subjective Sexual Arousal in Primiparous Women With Vaginal or Cesarean Section Births. J Sex Med 2020; 17:257–272.     

Prevalence of Female Sexual Dysfunction in Urban Chinese Women Based on Cutoff Scores of the Chinese Version of the Female Sexual Function Index: A Preliminary Study

IntroductionThe Female Sexual Function Index (FSFI) remains the most widely used scale for screening female sexual dysfunction (FSD), and the Chinese Version of the FSFI (CVFSFI) has been validated, but cutoff scores for the CVFSFI to distinguish between cases and noncases have not been developed, so the real prevalence of FSD in China is unknown.AimTo establish clinical cutoff scores for the CVFSFI and to evaluate the prevalence of FSD in urban Chinese women.MethodsA cross‐sectional study was conducted between June and December 2011. A total of 586 (age range of 22–60 years) women participated in the study. Receiving operating characteristic curve and classification and regression trees methodology were combined to establish clinical cutoff scores for the CVFSFI. The cutoff scores we developed were used to determine the prevalence of FSD in urban Chinese women.Main Outcome MeasuresThe prevalence of FSD based on cutoff scores developed herein.ResultsThe optimal CVFSFI cutoff score for the FSFI total score was 23.45 (sensitivity = 66.9%; specificity = 72.7%; area under curve [AUC] = 0.75). The cutoff score for each domain was also established as follows: ≤2.7 low desire (sensitivity = 55.2%; specificity = 78.3%; AUC = 0.73); ≤3.15 arousal disorder (sensitivity = 62.1%; specificity = 76.9%; AUC = 0.74); ≤4.05 lubrication disorder (sensitivity = 86.4%; specificity = 69.8%; AUC = 0.85); ≤3.8 orgasm disorder (sensitivity = 83.3%; specificity = 74.2%; AUC = 0.85); and ≤3.8 sexual pain (sensitivity = 65.4%; specificity = 80.6%; AUC = 0.79). Using these cutoff scores, we determined the prevalence for FSD, low desire, arousal disorder, lubrication disorder, orgasm disorder, and sexual pain to be 37.6%, 23.6%, 25.4%, 36.8%, 30.6%, and 21.8% in urban Chinese women, respectively.ConclusionsThe present data may suggest that urban Chinese women might have a lower FSD prevalence than women from some other countries; however, further study to achieve a better understanding of its epidemiology in China is a high necessity. Ma J, Pan L, Zhang A, and Kan Y. Prevalence of Female Sexual Dysfunction in Urban Chinese Women Based on Cutoff Scores of the Chinese Version of the Female Sexual Function Index. J Sex Med 2014;11:909–919.     

Female Sexual Function in Young Women With Type 1 Diabetes and Additional Autoimmune Diseases

BackgroundFemale sexual dysfunctions (FSDs) are frequent concerns in women with type 1 diabetes (T1D), which is frequently associated with other autoimmune diseases (ADs).AimTo assess sexual function in young type 1 diabetic women with or without additional ADs.MethodsWomen with T1D aged 18–35 years with a stable couple relationship and no oral contraceptive use were enrolled. Diabetic women with concomitant ADs were also identified. All women completed the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale.OutcomesThe main outcome was the prevalence of FSD. The FSFI-single domain scores were also evaluated in diabetic women with or without additional ADs.ResultsThe global population included 154 diabetic women, of whom 66 (42%) had at least one additional AD. The prevalence of FSD was similar among diabetic women with and those without (30% vs 32%, P = .980) additional ADs. The FSFI-desire score was significantly lower among diabetic women with concomitant ADs than those without ADs [median (interquartile range), 4.1 (3.6, 4.8) vs 4.6 (4.0, 5.0), P = .042].Clinical ImplicationsAn early evaluation of sexual function in women with T1D and concomitant ADs should be encouraged.Strengths & LimitationsMajor strengths are the use of 2 validated tools to diagnose FSD and the relatively large number of subjects investigated. The limitations include the cross-sectional nature of the study, which does not allow to make inference regarding the cause and effect.ConclusionDiabetic women with additional ADs show an impairment in sexual desire as compared with those suffering only from diabetes.Longo M, Cirillo P, Scappaticcio L, et al. Female Sexual Function in Young Women With Type 1 Diabetes and Additional Autoimmune Diseases. J Sex Med 2021;18:219–223.     

The Effect of Behçet's Disease on Sexual Function and Psychiatric Status of Premenopausal Women

IntroductionLittle is known about the relationship between Behçet's disease (BD) and female sexual dysfunction (FSD).AimsThe aims were to evaluate the prevalence of FSD in premenopausal BD patients and to compare hormonal and psychiatric conditions to healthy subjects.MethodsA total of 71 married women with BD and 63 healthy married women between 18 and 44 years old were enrolled into the study. After evaluating detailed history and physical examination, serum steroid hormone levels were measured. Presence of genital ulcerations in physical examination and any medical treatment were recorded in patients. All subjects were asked to complete the Female Sexual Function Index (FSFI) for sexual status and Beck Depression Inventory (BDI) for psychiatric assessment.Main Outcomes MeasuresFSFI and BDI scores and serum sex steroid hormone levels were measured in women with BD and healthy controls.ResultsThe mean BDI score of patients was significantly greater than that for controls (P = 0.001), and there was a statistically significant difference between BDI scores (Pearson χ² = 19.109, P = 0.001). FSD was found in 34 patients with BD (47.9%) and in 11 controls (17.5%). A statistically significant difference was found between the two groups (Pearson χ² = 13.855, P = 0.001). While the most common sexual problem in the patients with BD was diminished arousal (n = 49, 69.0%), diminished desire was found in 32 patients (45.1%) and lubrication problems in 36 patients (50.7%). There was a statistically significant negative correlation between BDI and FSFI score in BD patients. On the contrary, there was no relationship between FSFI and presence of genital ulcerations.ConclusionFSD is more common in BD patients than in healthy subjects. We conclude that depressive mood according to the BDI scale correlates with the sexual status of BD patients, and this may be because of the depressive effect of BD as a chronic disease. Koçak M, Ba?ar MM, Vahapo?lu G, Mert HÇ, and Güngör?. The effect of Behçet's disease on sexual function and psychiatric status of premenopausal women. J Sex Med 2009;6:1341–1348.