The Genetics and Epidemiology of Female Sexual Dysfunction: A Review

IntroductionFemale sexual dysfunction (FSD) is an often underestimated and common problem with serious effects on women's quality of life. Despite a high overall prevalence in the female population—exceeding that of male sexual dysfunction—until recently, little research has focused on this area. In contrast to the successful advances of genetic research in a wide variety of human diseases, genetic exploration in FSD lags far behind.AimThe aim of this review is to acquaint the reader with the current behavioral and molecular genetic research in the field of FSD.MethodsBecause of the heterogeneity of the included studies, we are providing a nonsystematic review.ResultsRecent epidemiological and candidate gene studies have suggested a strong genetic influence on female sexual functioning. While these findings provide a clear rationale for more genetic research in the field, they need to be replicated on a much larger scale to be definitive.ConclusionsSuccessful identification of biomarkers and novel genes underlying FSD should improve the diagnosis, identification, and treatment of different subgroups. Future pharmacotherapeutic approaches to FSD will benefit from novel targets and the concept that individual variations have a genetic component may help destigmatize our views of sexual problems. Burri AV, Cherkas LM, and Spector TD. The genetics and epidemiology of female sexual dysfunction (FSD): A review. J Sex Med 2009;6:646–657.     

Female Sexual Function,Dysfunction, and Pregnancy: Implications for Practice

Women's sexual function is a complex and dynamic interplay of variables that involve physical, emotional, and psychosocial states. Sexual dysfunction may occur at any level, and diagnosing such issues begins with careful assessment through a sexual health history. However, discussions about female sexual health and function are often deficient in the primary care setting. This article reviews the published research on female sexual function, sexual dysfunction, and sexual function in pregnancy to gain a better understanding of how these aspects of a woman's life impact the health care services she receives. The evaluation of female sexual function is in need of consistent measurement tools and more dialogue during health care visits. Women's health care practitioners have an opportunity to advance patient satisfaction and overall health by evaluating and communicating with female patients about their sexual function.     

A Multivariate Twin Study of Female Sexual Dysfunction

IntroductionThere is little work on the etiology of female sexual dysfunction (FSD), a highly contentious and heterogeneous disorder from classification and clinical perspectives. Clarifying causative mechanisms may enhance current psychiatric nosology.AimTo elucidate the structure of genetic and environmental risk factors underlying the major subtypes of FSD.MethodsSelf‐report questionnaires and multivariate twin model fitting on a population‐based adult twin register (TwinsUK, London) including 1,489 female twins aged 18 to 85, comprising 244 MZ pairs, 189 DZ pairs, and 623 women whose co‐twins did not participate.Main Outcome MeasuresScores on the Female Sexual Function Index–Lifelong and its six dimensions (desire, arousal, lubrication, orgasm, satisfaction, and pain) were subject to univariate and multivariate variance component analysis.ResultsThe best‐fitting multivariate model was an ACE Cholesky model, in which both additive genetic effects and non‐shared environmental effects loaded on four FSD dimensions. There was significant genetic sharing between desire, arousal, lubrication and orgasm, but there was also significant genetic sharing between arousal, lubrication and orgasm independent of desire. These genetic loadings were small to modest effects (7% to 33%). Bivariate heritabilities suggested that a third of the covariance between these dimensions was genetic. Desire shared the least amount of genetic association with lubrication and orgasm. Non‐shared environmental effects (which were stronger than genetic effects) were somewhat more dimension‐specific.ConclusionsFSD is not etiologically homogeneous. There are at least two genetic factors to FSD symptomatology, and a tendency for more dimension‐specific non‐shared environmental factors as a more important indicative of unique factors involved in specific types of sexual problems reported by women. These results emphasize genetic factors as possible organizing principles for an etiologically based classification approach of FSD. Burri A, Greven C, Leupin M, Spector T, and Rahman Q. A multivariate twin study of female sexual dysfunction. J Sex Med **;**:**–**.     

The Association Between Female Sexual Dysfunction and Sexual Dysfunction in the Male Partner: A Systematic Review and Meta-Analysis

BackgroundThe field of study addressing the relationship between FSD and male sexual dysfunction (MSD) represents a pivotal worldwide health issue as interrelationship between FSD and MSD studies are still inconclusive.AimTo review the interrelationship between FSD and MSD and to conclude whether there is a definitive risk of men developing sexual dysfunction when his partner is suffering from FSD.MethodsThe investigation was conducted following the standard practice for conducting and reporting the findings of systematic reviews and meta-analyses comprising of 4 electronic databases, that is, Embase, PsycInfo, Cochrane Library and Ovid (Medline) from inception to December 2019. Search strategies were developed based on relevant keywords with appropriate truncation and Boolean operators’ approach. The quality of studies was employed using the McMaster Critical Review Form for Quantitative Studies and were assessed by independent reviewers. The levels of evidence of the included studies were also determined.OutcomesMSD who had been exposed to FSD.ResultsFrom more than 8,000 studies searched, 26 studies were finally included, and most included studies have reasonable quality. Meta-analysis found a significant sexual dysfunction in men who are partnered with women with FSD. It found a consistent correlation between FDS and sexual dysfunction in men with a significant 3-fold increase in MSD who are partnered with women with FSD (odds ratio = 3.011, 95% confidence interval: 1.856–4.885, P = <.001, I² = 42.26%). Among subtypes of MSD, likelihood increased 4-fold for erectile dysfunction and that of premature ejaculation doubled. The data for several other domains on their components were mixed.Clinical TranslationThese findings support the notion that clinicians should evaluate sexual function pertaining to both partners and encompassing several dimensions and needing an interdisciplinary approach.Strength & LimitationsThis review exhaustively examines data search from vast electronic databases and as the comparison of studies is extracted from English journal publications, not all regions worldwide are represented.ConclusionThis meta-analysis and systematic review found an association between sexual dysfunction in men partnered with women with FSD, especially in the domains of erectile and ejaculatory function.Chew PY, Choy CL, Sidi Hb, et al. The Association Between Female Sexual Dysfunction and Sexual Dysfunction in the Male Partner: A Systematic Review and Meta-analysis. J Sex Med 2021;18:99–112.     

Cardiometabolic Diseases and Female Sexual Dysfunction: Animal Studies

BackgroundThe association between erectile dysfunction and cardiometabolic disease is well characterized; men are often diagnosed with cardiovascular disease 2–5 years following the incidence of erectile dysfunction. There is evidence that this relationship may also exist for cardiometabolic diseases and female sexual dysfunction (FSD) – particularly sexual arousal disorders.AimTo provide a summary of the preclinical literature related to the evidence of FSD in animal models of cardiometabolic diseases and indicate where further research is needed.MethodsA detailed Medline search of peer-reviewed publications was performed on the associations between animal models of cardiometabolic diseases, FSD and underlying mechanisms.OutcomesA summary of the preclinical evidence of FSD in animal models of cardiometabolic diseases.ResultsCommon methods for assessing female sexual arousal and physiology in animal models include: 1) behavioral assessments (apomorphine-induced genital vasocongestive arousal; hormone-dependent lordosis), 2) nerve-mediated vaginal and clitoral blood flow, 3) pudendal artery, vaginal and clitoral smooth muscle physiology (vasoreactivity and molecular biology), 4) morphology of genital tissues. Twenty-eight studies examined female animal models of atherosclerosis, hypertension, diabetes (type 1 and 2) and obesity. They showed functional alterations, including decreased lordosis, lubrication, or vaginal and clitoral blood flow, and structural impairments, such as increased clitoral and vaginal fibrosis. Several possible mechanisms have been described including increased TGF-β, renin angiotensin system and endothelin/rho-kinase signaling, increased reactive oxygen species, and decreased nitric oxide/cGMP signaling.Clinical TranslationIn line with existing clinical studies, preclinical evidence supports that cardiometabolic diseases alter female genital tissue's function and structure leading to impaired sexual arousal.Strengths and LimitationsThis masterclass paper gives an overview of the preclinical research assessing FSD in cardiometabolic disease. Limitations include the small number of studies that have assessed sexual function and arousal in female cardiometabolic animal models.ConclusionPreclinical evidence exists showing cardiometabolic diseases alter the structure and function of female genital tissues. However, similar to clinical studies, there are few studies to draw from, particularly in models of type 2 diabetes, obesity and metabolic syndrome. More studies are required using optimized animal models and methodology to confirm the mechanisms underlying cardiometabolic disease-induced FSD.Angulo J, Hannan JL. Cardiometabolic Diseases and Female Sexual Dysfunction: Animal Studies. J Sex Med 2022;19:408–420.     

Standards for Clinical Trials in Male and Female Sexual Dysfunction: IV. Unique Aspects of Clinical Trials in Female Sexual Dysfunction

The focus of this article, the fourth in the series, Standards for Clinical Trials in Male and Female Sexual Dysfunction, is on aspects of clinical trial design and measurement that are specific to clinical trials for treatments of female sexual dysfunction. Challenges in this area include the limited extent of treatment development and clinical trial research across the spectrum of female sexual dysfunctions, changing regulatory considerations, changing diagnostic criteria for female sexual dysfunction, and the need to articulate assessment procedures to these changes. Discussion focuses on approaches to addressing these challenges in clinical trials in female sexual dysfunction.     

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.     

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.     

The Etiological Relationship Between Anxiety Sensitivity,Sexual Distress,and Female Sexual Dysfunction Is Partly Genetically Moderated

IntroductionPresence of sexual distress is diagnostic requirement for female sexual dysfunction (FSD). However, previous correlational research indicates that sexual distress in women may be related to general anxiety per se rather than being an outcome of FSD.AimIn this exploratory study, we test, for the first time, whether the correlation between anxiety sensitivity, sexual distress, and FSD can be explained by shared genetic and nongenetic factors using multivariate twin modeling.MethodsQuestionnaire data were available on a representative final sample of 930 Caucasian British female twin individuals (119 monozygotic twin pairs, 67 dizygotic twin pairs, and 558 single twins; aged 18–85 years). Validated scales assessed anxiety sensitivity, sexual distress, and FSD and included the Female Sexual Function Index, the Female Sexual Distress Scale, and the Anxiety Sensitivity Index.Main Outcome MeasuresQuestionnaire responses were subject to trivariate heritability analyses to assess common genetic and environmental influences underlying specific trait variance and the covariance between the phenotypes.ResultsHeritability for FSD was 28%, 48% for anxiety sensitivity, and 44% for sexual distress. The phenotypic associations among anxiety sensitivity, sexual distress, and FSD were all significant. Trivariate analysis indicated that additive genetic factors accounted for approximately 75% of the covariance between anxiety sensitivity and FSD 35% of the covariance between anxiety sensitivity and sexual distress, and 11% between sexual distress and FSD.ConclusionsThe association between anxiety sensitivity and FSD has a common genetic component. There is a weaker genetic link between anxiety sensitivity and sexual distress and between sexual distress and FSD. These data, while silent on direction of causality, suggest a role for pleiotropic genetic factors influencing anxiety sensitivity and FSD. They also highlight a need to refine the inclusion of distress in classifications of disorders of female sexual functioning. Burri A, Spector T, and Rahman R. The etiological relationship between anxiety sensitivity, sexual distress and female sexual dysfunction is partly genetically moderated. J Sex Med 2012;9:1904–1913.     

Association Between Multiple Sclerosis and Risk of Female Sexual Dysfunction: A Systematic Review and Meta-Analysis

Introduction

It has been reported that multiple sclerosis (MS) would increase the susceptibility to female sexual dysfunction (FSD).

Evaluating the Link Between Self-Reported Endometriosis and Female Sexual Dysfunction

BackgroundStudies have found that women with endometriosis have a higher risk of female sexual dysfunction (FSD).AimTo evaluate the relationship between self-reported endometriosis and FSD utilizing validated surveys.MethodsA cross-sectional analysis was conducted among sexually active women aged 18–90 who presented to 3 Mayo Clinic sites from 2015 to 2021. FSD was determined utilizing a combined endpoint of Female Sexual Function Index score ≤ 26.55 and Female Sexual Distress Scale-Revised score ≥ 11. Associations between history of endometriosis and FSD were evaluated by fitting 3 multivariable logistic models and were stratified by menopause status. In the first model, the association was adjusted for age, BMI, race/ethnicity, marital status, and education. The second model adjusted for the variables in Model 1 and hormone therapy, hormonal contraceptive use, self-reported history of abuse within the last year, and co-morbidities including the history of diabetes, heart disease, hypertension, osteoporosis, and stroke. The third model adjusted for the variables in Model 1, Model 2, and anxiety, depression, relationship satisfaction, and SSRI/SNRI use.OutcomesThe outcomes included self-reported endometriosis and female sexual dysfunction determined utilizing a combined endpoint of Female Sexual Function Index score ≤ 26.55 and Female Sexual Distress Scale-Revised score ≥ 11.ResultsOf 7118 patients (mean age 51.3), 92.2% were white, 78.4% were peri- or postmenopausal, 8.7% reported endometriosis history, and 57.2% met the criteria for FSD. Women with endometriosis were more likely to be overweight or obese, be smokers, have had a history of heart disease and osteoporosis, have had anxiety and depressed mood, have had a hysterectomy and bilateral salpingo-oophorectomy, and have used hormone therapy. Compared to those without endometriosis, women with endometriosis were significantly more likely to have FSD only among premenopausal women (74.2% vs 57.4%). Similarly, in multivariable analysis the relationship was only seen for premenopausal women in all 3 models (Model 1: OR 2.74 (95% CI 1.43–5.27); Model 2: OR 2.55 (95% CI 1.30–5.04); Model 3: OR 2.30 (95% CI 1.13–4.68)).Clinical ImplicationsThese findings highlight the opportunity for healthcare practitioners to evaluate sexual function in premenopausal women with endometriosis. For peri and postmenopausal women with endometriosis, the risk of FSD was lower than for premenopausal women with endometriosis.Strengths and LimitationsThis study analyzed the association between endometriosis and FSD in women by menopause status using validated tools that included a measure of distress associated with sexual dysfunction. Limitations include its cross-sectional design which does not allow for determination of the direction of this association.ConclusionThe risk for FSD associated with endometriosis depends on menopause status. Endometriosis increased the odds of FSD only in premenopausal women.Kling JM, Ghaith S, Smith T, et al. Evaluating the Link Between Self-Reported Endometriosis and Female Sexual Dysfunction. J Sex Med 2022;19:1533–1561.     

Prevalence,Risk Factors,and Predictors of Female Sexual Dysfunction in a Primary Care Setting: A Survey Finding

IntroductionFemale sexual dysfunction (FSD) is a highly prevalent sexual health problem but poorly investigated at the primary care level.AimThis article examines the prevalence of sexual dysfunction and its possible risk factors associated with women at high risk of FSD in a hospital-based primary practice.MethodsA validated Malay version of the Female Sexual Function Index (MVFSFI) was utilized to determine FSD in a cross-sectional study design, involving 163 married women, aged 18–65 years, in a tertiary hospital-based primary care clinic in Kuala Lumpur, Malaysia. Sociodemographic, marital profile, health, and lifestyle for women at high risk of FSD and those who were not at high risk were compared and their risk factors were determined.Main Outcome MeasuresPrevalence of FSD in Malaysian women based on the MVFSFI, and its risk factors for developing FSD.ResultsSome 42 (25.8%) out of 163 women had sexual dysfunction. Prevalence of sexual dysfunction increased significantly with age. Sexual dysfunctions were detected as desire problem (39.3%), arousal problem (25.8%), lubrication problem (21.5%), orgasm problem (16.6%), satisfaction problem (21.5%) and pain problems (16.6%). Women at high risk of FSD were significantly associated with age (OR 4.1, 95% CI 1.9 to 9.0), husband's age (OR 4.3 95% C.I 1.9 to 9.3), duration of marriage (OR 3.3, 95% CI 1.6 to 6.8), medical problems (OR 8.5, 95% CI 3.3 to 21.7), menopausal status (OR 6.6, 95% CI 3.1 to 14.3), and frequency of sexual intercourse (OR 10.7, 95% CI 3.6 to 31.7). Multivariate analysis showed that medical problem (adjusted OR 4.6, 95% CI 1.6 to 14.0) and frequency of sexual intercourse (adjusted OR 7.2, 95% CI 2.1 to 24.0) were associated with increased risk of having FSD. Those who practiced contraception were less likely to have FSD.ConclusionSexual health problems are prevalent in women attending primary care clinic where one in four women were at high risk of FSD. Thus, primary care physician should be trained and prepared to address this issue. Ishak IH, Low WY, and Othman S. Prevalence, risk factors and predictors of female sexual dysfunction in a primary care setting: A survey finding.     

A Population-Based Epidemiologic Study of Female Sexual Dysfunction Risk in Mainland China: Prevalence and Predictors

BackgroundEpidemiologic data on female sexual dysfunction in China are sparse.AimTo assess the prevalence of risk of female sexual dysfunction in mainland China and its regional and sociodemographic variations and physiologic, pathologic, and behavioral risk factors.MethodsA survey of the general female population was conducted in mainland China from February 2014 through January 2016. Women were randomly selected using multistage, stratified, cluster sampling. The prevalence rate of sexual dysfunction, as measured by the Female Sexual Function Index and a score lower than 23.45 as the cutoff threshold, was determined. Multivariate logistical regression models were used to examine the effects of sociodemographic, physiologic, pathologic, and behavioral factors on women’s risk of experiencing sexual dysfunction and domain-specific sexual problems.OutcomesThe questionnaire on sexual dysfunction was completed by 25,446 women 20 to 70 years old.ResultsThe prevalence of sexual dysfunction in women 20 to 70 years old in mainland China was estimated at 29.7% (99% CI = 28.9–30.4), with large regional variations. The prevalence rates of potential domain-specific sexual problems were 21.6% (99% CI = 20.9–22.2) for low desire, 21.5 (99% CI = 20.8–22.2) for arousal disorder, 18.9% (99% CI = 18.3–19.6) for lubrication disorder, 27.9% (99% CI = 27.2–28.7) for orgasm disorder, and 14.1% (99% CI = 13.6–14.7) for sexual pain. Higher educational attainment and urban residency were associated with a decreased risk of sexual dysfunction. Women of ethnic minorities (or non-Han ethnicity) had fewer reports of sexual dysfunction than women of Han ethnicity (odds ratio = 0.67, 99% CI = 0.47–0.97). Diabetes, cancers, pelvic inflammatory disease, and pelvic organ prolapse significantly increased the reports of sexual dysfunction.Clinical TranslationThis survey provided the prevalence and risk factors of female sexual dysfunction in China, information that could be useful for potential prevention and clinical treatment.Strengths and LimitationsThis is the first large-scale, nationally based epidemiologic study of female sexual dysfunction in mainland China. The limitations of the study design included an overpowered study caused by the large sample, the under-representation of younger and unmarried women, and no information on the women’s partners, their values and knowledge, and detailed medical conditions.ConclusionsThe prevalence rate of female sexual dysfunction in mainland China was modest overall, although variations existed across regions and social groups.Zhang C, Tong J, Zhu L, et al. A Population-Based Epidemiologic Study of Female Sexual Dysfunction Risk in Mainland China: Prevalence and Predictors. J Sex Med 2017;14:1348–1356.     

Sexual Activity,Function and Dysfunction After a Diagnosis of Bladder Cancer

BackgroundSexual dysfunction is common in those affected by cancer and local and radical treatments for Bladder Cancer (BC) can affect sexual function directly.AimTo evaluate sexual function following a bladder cancer (BC) diagnosis.MethodsSelf-reported sexual function was collected 10 years after a diagnosis of BC as part of a cross-sectional patient reported outcome measure (PROM) survey exploring life after BC diagnosis and treatment.OutcomesParticipants completed a combined EORTC QLQ-BLM30 and QLQ-NMIBC24 questionnaire, including questions on sexual activity, intimacy, erectile/ejaculatory function and vaginal dryness.ResultsA total of 1796 participants returned a completed survey out of 3279 eligible participants (55%). Of the participants who returned a completed survey, a total of 1530 (85%) participants answered sexual function questions. The median (IQR) age was 75 (70–81). Participants were predominantly men (78%) and married/in civil partnerships (66%). In total, 31% were sexually active. Vaginal dryness was common (66%) in women. Erectile and ejaculatory dysfunction (80% and 58% respectively) were common in men. Compared to TURBT +/- intravesical treatments, those who had radical treatment were less likely to be sexually active (adjusted OR 0.56, 95% CI: 0.44–0.72, P<0.001) and had worse mean scores for intimacy problems (29.1 [radical treatment] vs 12.1, P<0.001), male sexual problems (72.2 [radical treatment] vs 45.7, P<0.001) and overall sexual function (17.1 [radical treatment] vs 20.3, P=0.01).Clinical ImplicationsThese findings highlight the magnitude of sexual dysfunction in the BC patient cohort and can help inform patients during the pre-op counselling process and shared decision making prior to BC treatments.Strengths and LimitationsThis study provides the largest in-depth analysis of sexual activity and function after BC diagnosis and treatment, to date. Limitations include the lack of data on participants’ sexual function prior to BC treatment and the heterogeneity with respect to time passed since last BC treatment.ConclusionSexual dysfunction in BC patients is common and rates appear higher following radical treatments compared to endoscopic. It is important to elicit these problems in clinics to enable counselling and treatment.Jubber I, Rogers Z, Catto JWF, et al. Sexual Activity, Function and Dysfunction After a Diagnosis of Bladder Cancer. J Sex Med 2022;19:1431–1441.