Evaluating the Impact of Overactive Bladder on Sexual Health in Women: What Is Relevant?

IntroductionTo assess sexual health, relevant, valid, and reliable questionnaires need to be used.AimTo assess the relevance and content validity of three sexual health questionnaires in women with overactive bladder (OAB) and urinary incontinence.Main Outcome MeasuresSexual Quality of Life Questionnaire––Female (SQoL‐F), Sexual Function Questionnaire (SFQ), and Pelvic Organ Prolapse–Incontinence Sexual Function Questionnaire (PISQ).MethodsWomen with OAB and urinary incontinence were recruited from five urology clinics in the United States; those who were interested in participating were mailed questionnaire packets with instructions. Each questionnaire item was followed by three questions regarding the understandability, relevance, and impact of bladder condition when responding to the question. Patients returned the completed questionnaires by mail; clinical information was obtained from chart review.ResultsA total of 129 patients (74% response) returned the questionnaires. The mean age was 56 years; 78% were white; 64% were married. In this sample, 64% had urge incontinence; 32% had mixed incontinence; and 4% had stress incontinence. Participants experienced bladder symptoms for a mean of 12.2 years with the following treatments: surgery (43%), bladder training (26%), exercise/biofeedback (42%), and medications (67%). SQoL‐F items were understood by more than 97% of the respondents, more than 89% for SFQ, and more than 82% for PISQ. There were two SQoL‐F items, one SFQ item, and 11 PISQ items that less than 60% of the respondents deemed relevant to their bladder condition. Correlations among questionnaire items and relevance to bladder condition ranged from 0.04 to 0.64 for the SQoL‐F, 0.04 to 0.47 for the SFQ, and 0.01 to 0.58 for the PISQ.ConclusionWomen with OAB found the majority of items on all three questionnaires to be relevant to their bladder condition. Of these questionnaires, the SQoL‐F had the highest understandability, fewest questions considered irrelevant, and correlated well with OAB symptoms. Coyne KS, Margolis MK, Brewster‐Jordan J, Sutherland SE, Bavendam T, and Rogers RG. Evaluating the impact of overactive bladder on sexual health in women: What is relevant? J Sex Med 2007;4:124–136.     

Impact of Androgens on Sexual Function in Women With Rectal Cancer – A Prospective Cohort Study

BackgroundWomen treated for rectal cancer are at risk of sexual dysfunction and impaired ovarian androgen production.AimTo investigate a possible association between serum levels of endogenous androgens and sexual function in women with rectal cancer.MethodsWomen diagnosed with stage I–III rectal cancer were consecutively included and prospectively followed with the Female Sexual Function Index (FSFI) questionnaire from baseline to 2 years postoperatively and blood samples for hormone analyses, baseline to 1 year. Androgens were measured with liquid chromatography−mass spectrometry and electrochemiluminescence. The associations between the 4 measured androgens (testosterone, free testosterone, androstenedione, and dehydroepiandrosterone sulphate) and sexual function were assessed with generalized least squares random effects regression analysis in sexually active women.OutcomesThe primary outcome measure was the mean change observed in the FSFI total score when the serum androgen levels changed with one unit. Secondary outcomes were the corresponding mean changes in the FSFI domain scores: sexual desire, arousal, lubrication, orgasm, satisfaction, and pain/discomfort.ResultsIn the 99 participants, the median FSFI total score decreased from 21.9 (range 2.0 – 36.0) to 16.4 (3.5 – 34.5) and 11.5 (2.0 to 34.8) at 1 and 2-years follow-up. After adjustment for age, partner, psychological well-being, preoperative (chemo)radiotherapy, and surgery, total testosterone and androstenedione were significantly associated with FSFI total score (β-coefficients 3.45 (95% CI 0.92 – 5.97) and 1.39 (0.46 – 2.33) respectively). Testosterone was significantly associated with the FSFI-domains lubrication and orgasm, free testosterone with lubrication, androstenedione with all domains except desire and satisfaction, and dehydroepiandrosterone sulphate with none of the domains.Strengths and LimitationsThis is the first study investigating whether androgen levels are of importance for the impaired sexual function seen in women following rectal cancer treatment. The prospective design allows for repeated measures and the use of the FSFI for comparisons across studies. No laboratory data were collected at the 2-year follow-up, and the missing data could have further clarified the studied associations.Conclusion and Clinical ImplicationTestosterone and androstenedione were associated with sexual function in female rectal cancer patients. The results are of interest for future intervention studies and contribute to the understanding of sexual problems, which is an essential component of the rehabilitation process in pelvic cancer survivors.Svanström Röjvall A, Buchli C, Flöter Rådestad A, et al. Impact of Androgens on Sexual Function in Women With Rectal Cancer – A Prospective Cohort Study. J Sex Med 2021;18:1374–1382.     

The Impact of Mid‐Urethral Slings for the Treatment of Urodynamic Stress Incontinence on Female Sexual Function: A Multicenter Prospective Study

IntroductionUrinary incontinence is a common condition that negatively impacts on female sexuality (FS).AimTo evaluate FS before and after a mid‐urethral sling (MUS) procedure using the Female Sexual Function Index (FSFI). We included women that were both sexually and nonsexually active at baseline.MethodsOne hundred fifty‐seven women complaining of urodynamic stress incontinence underwent a MUS procedure and were enrolled in the study. All patients answered the Italian translation of FSFI, before and 12 months after surgery. To understand the real impact of the MUS on female sexual function, for the first time in the literature, we also monitored and included in the final analysis all the women who are nonsexually active at baseline. We evaluated the prevalence of female sexual dysfunction according to the FSFI cutoff point (26.55).Main Outcome MeasuresFSFI total score, pads use, and stress test presurgery and postsurgery.ResultsOne hundred thirty‐three patients completed the study protocol: 105 out of 133 underwent to a trans‐obturator procedure, while 28 out of 133 had a retropubic procedure. After the 12‐month follow up, 115 out of 133 patients (86%) were dry, 10 improved their symptoms, and the remaining 8 were unchanged. Seventy‐nine out of 133 (59%) patients reported an active sexual life before surgery. Fifty‐four (41%) reported they were not sexually active before surgery. Twelve months after surgery, 22 out of 54 nonsexually active women (40%) reestablished sexual activity, whereas only 6 out of 79 (7.5%) patients, sexually active at baseline, were not sexually active 1 year after surgery (P < 0.05). After adjusting for multiple testing, only age, menopause, and storage symptoms remained significantly correlated with the FSFI total score postsurgery as independent variables.ConclusionsOur data showed that after a MUS procedure, female sexual function improves. We also found that a very relevant percentage of nonsexually active women reported renewed sexual activity after MUS. Filocamo MT, Serati M, Frumenzio E, Li Marzi V, Cattoni E, Champagne A, Salvatore S, Nicita G, and Costantini E. The impact of mid‐urethral slings for the treatment of urodynamic stress incontinence on female sexual function: A multicenter prospective study. J Sex Med 2011;8:2002–2008.     

Quality of Sexual Life of Women on Oral Contraceptive Continued‐Regimen: Pilot Study

IntroductionTo date, women may use flexible oral contraceptive (OC) regimens.AimThe aim of this study was to evaluate the quality of sexual life of healthy women on continued‐regimen OCs.MethodsFifty women (age range 18–38) were enrolled. The Female Sexual Function Index (FSFI) and the Short Form‐36 (SF‐36) questionnaires were used to investigate, respectively, sexual behavior and the quality of life (QoL) of women on OC for 72 days with a 4‐day hormone‐free interval, for two cycles. Both the FSFI and the SF‐36 were administered before starting OC intake, at the first (72–82 days) and the second (144–154 days) follow‐ups.Main Outcome MeasureThe main outcomes are the FSFI and the SF‐36 questionnaires.ResultsThe FSFI score obtained at the first follow‐up detected a worsening with respect to baseline score (P < 0.05). The score obtained at the second follow‐up detected an improvement with respect to both the baseline and the first follow‐up total scores (P < 0.05). QoL improved at the first follow‐up only as regards body pain (P < 0.05), and at the second follow‐up as regards: physical role, body pain, general health, vitality, and social function (P < 0.05).ConclusionsoThe use of continued‐regimen OCs is able to improve the sexual behavior and the QoL of women. Caruso S, Malandrino C, Cicero C, Ciancio F, Cariola M, and Cianci A. Quality of sexual life of women on oral contraceptive continued‐regimen: Pilot study. J Sex Med 2013;10:460-466.     

Predictors of Task‐Persistent and Fear‐Avoiding Behaviors in Women with Sexual Pain Disorders

IntroductionDyspareunia and vaginismus are the most common sexual pain disorders (SPDs). Literature suggests that many women with dyspareunia continue with intercourse despite pain (task persistence), whereas many women with vaginismus avoid penetrative activities that may cause pain (fear avoidance). Both forms of sexual pain behavior may maintain or aggravate complaints.AimThis study examined (i) whether women with SPD differ from pain‐free controls in motives for sexual intercourse, sexual autonomy, maladaptive beliefs regarding vaginal penetration, and partner responses to pain; and (ii) which of these factors best predict whether women with SPD stop or continue painful intercourse (attempts).MethodsWomen with superficial dyspareunia (n = 50), women with lifelong vaginismus (n = 20), and pain‐free controls (n = 45) completed questionnaires.Main Outcome MeasuresFor Aim 1, the main outcome measures were (i) motives for intercourse; (ii) sexual autonomy; (iii) maladaptive beliefs regarding vaginal penetration; and (iv) partner responses to pain. For Aim 2, sexual pain behavior (to continue or discontinue with painful intercourse) was the outcome measure.Results(i) Women with dyspareunia exhibited more mate guarding and duty/pressure motives for intercourse and were less sexually autonomous than controls. (ii) Symptomatic women had more maladaptive penetration‐related beliefs than controls, with women with vaginismus reporting the strongest maladaptive beliefs. (iii) Partners of women with dyspareunia self‐reported more negative responses to pain than those of women with vaginismus. (iv) The factors that best predicted sexual pain behavior were the partner responses to pain and the woman's maladaptive beliefs regarding vaginal penetration.ConclusionsOur findings reveal support for task persistence in women with dyspareunia and fear avoidance in women with lifelong vaginismus. As such, it is important to consider these distinct types of responding to sexual pain when treating SPD. Brauer M, Lakeman M, van Lunsen R, and Laan E. Predictors of task‐persistent and fear‐avoiding behaviors in women with sexual pain disorders. J Sex Med 2014;11:3051–3063.     

Open‐Label Extension Study of Flibanserin in Women with Hypoactive Sexual Desire Disorder

IntroductionHypoactive Sexual Desire Disorder (HSDD) is a common form of Female Sexual Dysfunction characterized by low sexual desire that causes distress or interpersonal difficulty.AimThis 52‐week open‐label extension study aimed to assess the safety and tolerability of flibanserin, a postsynaptic 5‐HT_1A agonist/5‐HT_2A antagonist, in women with HSDD.MethodsWomen with HSDD who had completed a trial of flibanserin or flibanserin placebo received flexible‐dose flibanserin (50 or 100 mg once daily at bedtime [qhs] or 25 or 50 mg twice daily [bid]) for 52 weeks.Main Outcome MeasuresPrimary end points were: proportions of women with somnolence, sedation, fatigue, dizziness, nausea, and vomiting (adverse events [AEs] known to be associated with flibanserin); discontinuations due to AEs; and serious AEs. Secondary end points included change from baseline in Female Sexual Distress Scale‐Revised total and Item 13 scores and Female Sexual Function Index (FSFI) total and desire domain score scores. FSFI total scores were used to classify women into FSFI remitters (FSFI score >26.55, indicating no clinical sexual dysfunction) and FSFI non‐remitters (FSFI score <26.55).ResultsOf the 1723 women who received flibanserin, 962 (55.8%) completed 12 months' treatment, and 883 women were exposed to flibanserin 100 mg qhs for ≥180 days. Somnolence, sedation, fatigue, dizziness, nausea, and vomiting were reported by 15.8, 1.6, 7.6, 6.9, 6.3, and 1.4% of participants, respectively. A total of 185 participants (10.7%) discontinued due to AEs. Serious AEs were reported by 1.2% of participants. At study end, 42% of baseline non‐remitters had improved their FSFI score to remission level. The proportion of baseline FSFI remitters in remission rose from 83% at week 4 to a stable value of ～90%.ConclusionFlibanserin was well tolerated. Sexual function improved in women who were not FSFI remitters at baseline, and was maintained in those who were remitters at baseline. Jayne C, Simon JA, Taylor LV, Kimura T, and Lesko LM. Open‐label extension study of flibanserin in women with Hypoactive Sexual Desire Disorder. J Sex Med 2012;9:3180–3188.     

Clinical and Biopsychosocial Determinants of Sexual Dysfunction in Middle‐Aged and Older Australian Men

IntroductionErectile dysfunction (ED) and other related sexual dysfunctions in men have recently been shown to associate with a range of conditions and biopsychosocial factors. However, few studies have been able to control for these related factors simultaneously.AimTo determine the prevalence of and associated risk factors for ED and low solitary and dyadic sexual desire.Main Outcome MeasuresErectile function (International Index of Erectile Function‐erectile function) and sexual desire (Sexual Desire Inventory 2), as well as associated sociodemographic, lifestyle, biological, and clinical risk factors.MethodsData were collected from 1,195 randomly selected, community‐dwelling men as part of the Florey Adelaide Male Ageing Study.ResultsThe prevalence of ED, low solitary, and dyadic sexual desire was 17.7%, 67.7%, and 13.5%, respectively. Increasing age, abdominal fat mass, obstructive sleep apnea risk, and the absence of a regular partner were associated with both degrees of ED severity. Insufficient physical activity, low alcohol consumption, and hypertension were associated with mild ED only, and voiding lower urinary tract symptoms, diabetes, and lower plasma testosterone were independently associated with moderate to severe ED. Increasing age, lower alcohol consumption, insufficient physical activity, and a diagnosis of depression, anxiety, or insomnia were associated with both low dyadic and solitary sexual desire. Postschool qualifications and lower plasma testosterone were associated with low dyadic desire, whereas lower education and income, unemployment, and migration were associated with low solitary sexual desire. The absence of a regular partner and postschool qualifications were associated with higher solitary sexual desire.ConclusionsWhile ED and low dyadic and solitary sexual desire share some risk factors, we were able to demonstrate that unique factors exist for each of these domains. Attention should first be given to addressing these modifiable risk factors. Martin S, Atlantis E, Wilson D, Lange K, Haren MT, Taylor A, Wittert G, and Members of the Florey Adelaide Male Ageing Study. Clinical and biopsychosocial determinants of sexual dysfunction in middle‐aged and older Australian men. J Sex Med 2012;9:2093–2103.     

Psychometric Properties of the Iranian Version of the Female Sexual Distress Scale‐Revised in Women

IntroductionSeveral tools for the assessment of sexuality‐related distress are now available. The Female Sexual Distress Scale (FSDS) and its revised version (FSDS‐R) are extensively validated and among the most widely used tools to measure sexually related personal distress.AimThe aim of the study was to determine the psychometric properties of the Iranian version of the FSDS‐R in a population sample of Iranian women.MethodsA total of 2,400 married and potentially sexually active women were recruited and categorized into three groups including (i) a healthy control group; (ii) a group of women with hypoactive sexual desire disorder (HSDD); and (iii) a group of women suffering from other female sexual dysfunction (FSD). Participants were asked to complete a set of questionnaires including the Iranian version of the Female Sexual Function Index (FSFI‐IV), the FSDS‐R, and the Hospital Anxiety and Depression Scale.Main Outcome MeasuresSexuality‐related distress and FSD as assessed by the Iranian version of the FSDS‐R and the FSFI‐IV are the main outcome measures.ResultsInternal consistencies and test–retest reliability of the FSDS‐R across the three assessments points for the three groups were >0.70. The FSDS‐R correlated significantly with anxiety, depression, and the FSFI total score. Significant differences in the FSDS‐R scores were found between healthy women, women with HSDD, and women with other types of FSD. Factor analysis of the FSDS‐R yielded a single‐factor model with an acceptable fit.ConclusionsThe Persian version of the FSDS‐R is a valid and reliable instrument for the assessment of sexuality‐related distress in Iranian women and can be used to screen patients with HSDD. Azimi Nekoo E, Burri A, Ashrafti F, Fridlund B, Koenig HG, Derogatis LR, and Pakpour AH. Psychometric properties of the Iranian version of the Female Sexual Distress Scale‐Revised in women. J Sex Med 2014;11:995–1004.     

Sexual Function,Incontinence, and Wellbeing in Women after Rectal Cancer—A Review of the Evidence

IntroductionColorectal cancer (CRC) is the second most common cancer. One‐third of these cancers occur in the rectum. Treatment of rectal cancer involves surgery with/without radiotherapy and chemotherapy. Surgery is undertaken to prevent damage to the nerves controlling bladder, bowel, and sexual organs, whether this translates into preservation of urinary and fecal continence and sexual function and, ultimately, quality of life (QoL) is not known.AimThe aim of this review was to summarize the literature regarding the impact of treatment for rectal cancer on bladder and bowel continence, sexual function and QoL in women.Main Outcome MeasuresA comprehensive review of the current literature on sexual function, incontinence and wellbeing in women after treatment for rectal cancer highlighting prevalence rates, trial design, and patient population.MethodsWe conducted a systematic search of the literature using A systematic search of the literature using Medline (Ovid, 1946–present) and PubMed (1966–2011) for English‐language studies that included the following search terms: “colorectal cancer,” or “rectal cancer,” or “rectal neoplasm,” and “sexual function,” or “sexual dysfunction,” or “wellbeing,” or “QoL,” or “urinary or fecal incontinence.”ResultsAlthough around 1/3 of women aged 50 to 70 years report lack of sexual desire, sexual function problems after treatment for rectal cancer are in the order of 60% among women. QoL improves with length of survival. Urinary and fecal incontinence are ongoing concerns for many women after treatment with rates up to 60%.ConclusionThere is a gap in our knowledge of the effects of rectal cancer and its treatment on urinary and fecal continence, sexual function and QoL in women. There is a need for studies of sufficient size and duration to gain a better understanding of the disease and its management and the long‐term effects on these parameters. This information is needed to develop preventative health care plans for women treated for rectal cancer that target those most at risk for these adverse outcomes. Panjari M, Bell RJ, Burney S, Bell S, McMurrick PJ, and Davis SR. Sexual function, incontinence, and wellbeing in women after rectal cancer—A review of the evidence. J Sex Med 2012;9:2749–2758.     

Effect of Drug Use and Influence of Abstinence on Sexual Functioning in a Spanish Male Drug‐Dependent Sample: A Multisite Study

IntroductionTo date, it has been difficult to address the issue of sexual functioning and drug use, and many approaches to it have basic problems and methodological errors.AimThe present cross‐sectional study compared the sexual functioning scores of a group of drug users with those of a group of nondrug users. It explored the relationship between drug abstinence and sexual functioning.Main Outcome MeasuresA sample of 905 males participated in this study (549 met the substance dependence criteria and 356 were controls). All of them were assessed with the Changes in Sexual Functioning Questionnaire‐Drugs version.MethodThe assessment was conducted from September 2009 to January 2011. The clinical sample was evaluated in nine different substance abuse treatment facilities.ResultsResults show that, overall, all dimensions (pleasure, desire, arousal, and orgasm) were moderately impaired. Yet, differences regarding preferred substance were observed. Pleasure and orgasm were the two areas most significantly impaired. In these areas, all drugs seemed to negatively affect sexual functioning. However, desire and arousal were not affected by all the substances. In addition, at least after 2 weeks of drug abstinence, no relationship was found between drug abstinence and improvement in sexual functioning. The sample studied had an average of 1 year of drug abstinence and was found to have poorer sexual functioning than the control group.ConclusionsTherefore, these results seem to contradict those that argue that drug use only impairs sexual functioning temporarily. Moreover, they suggest that sexual functioning does not improve just by stopping drug use. Vallejo‐Medina P and Sierra JC. Effect of drug use and influence of abstinence on sexual functioning in a Spanish male drug‐dependent sample: A multisite study. J Sex Med **;**:**–**.     

Sexual Function in the Late Postmenopause: A Decade of Follow‐Up in a Population‐Based Cohort of Australian Women

IntroductionThere is a paucity of longitudinal studies assessing sexual function of women in the late postmenopause.AimThis study aims to describe sexual function of women in the late postmenopause and to investigate change from early postmenopause.MethodsCross‐sectional analysis of 2012/13 and longitudinal analysis from 2002/04 of the population based, Australian cohort of the Women's Healthy Ageing Project, applying validated instruments: Short Personal Experience Questionnaire (SPEQ), Female Sexual Distress Scale (FSDS), Hospital Anxiety and Depression Scale, Geriatric Depression Scale, and California Verbal Learning Test.Main Outcome MeasuresSexual activity, SPEQ, and FSDS.ResultsTwo hundred thirty women responded (follow‐up rate 53%), mean age was 70 years (range 64–77), 49.8% were sexually active. FSDS scores showed more distress for sexually active women (8.3 vs. 3.2, P < 0.001). For 23 (23%) sexually active and for five (7%) inactive women, the diagnosis of female sexual dysfunction could be made. After adjustment, available partner (odds ratio [OR] 4.31, P < 0.001), no history of depression (OR 0.49, P = 0.036), moderate compared with no alcohol consumption (OR 2.43, P = 0.019), and better cognitive function score (OR1.09, P = 0.050) were significantly predictive for sexual activity. Compared with early postmenopause, 18% more women had ceased sexual activity. For women maintaining their sexual activity through to late postmenopause (n = 82), SPEQ and FSDS scores had not changed significantly, but frequency of sexual activity had decreased (P = 0.003) and partner difficulties had increased (P = 0.043). [Correction added on 10 July 2014, after first online publication: Mean age of respondents was added.]ConclusionsIn late postmenopause, half of the women were sexually active. Most important predictors were partner availability and no history of depression. However, being sexually active or having a partner were associated with higher levels of sexual distress. Compared with early postmenopause, sexual function scores had declined overall but were stable for women maintaining sexual activity. Further research into causes of sexual distress and reasons for sexual inactivity at this reproductive stage is warranted. Lonnèe‐Hoffmann RAM, Dennerstein L, Lehert P, and Szoeke C. Sexual function in the late postmenopause: A decade of follow‐up in a population‐based cohort of Australian women. J Sex Med 2014;11:2029–2038.     

Effects of Female Genital Cutting on the Sexual Function of Egyptian Women. A Cross‐Sectional Study

IntroductionThe existing literature is conflicting regarding effects of female genital cutting (FGC) on sexual functions. Several studies from Africa over the past 20 years have challenged the negative effect of genital cutting on sexual function as defined by performance on the following domains: desire, arousal, lubrication, orgasm, satisfaction, and sexual pain. Other studies however indicated that sexual function of genitally cut women is adversely altered.AimThe aim of the study was to investigate the effects of FGC on the female sexual function of Egyptian women.MethodsThis is a cross‐sectional study conducted between February and May 2011 at the outpatient clinic of Cairo University Hospitals. The study included 650 Egyptian females between 16 and 55 years of age (333 genitally cut women and 317 uncut women). Participants were requested to complete the Arabic Female Sexual Function Index (ArFSFI) and were then subjected to clinical examination where the cutting status was confirmed.Main Outcome MeasuresThe total score of the ArFSFI and its individual domains.ResultsThe mean age of cutting was 8.59 (±1.07) years. Of the cut participants, 84.98% showed signs of type I genital cutting, while 15.02% showed signs of type II genital cutting. After adjusting for age, residential area, and education level, uncut participants had significantly higher ArFSFI total score (23.99 ± 2.21) compared with cut participants (26.81 ± 2.26). The desire, arousal, lubrication, orgasm, and satisfaction domains were significantly higher in the uncut participants (4.02 ± 0.78, 4.86 ± 0.72, 4.86 ± 0.75, 4.86 ± 0.68, 5.04 ± 0.71, respectively) compared with those of the cut participants (3.37 ± 0.89, 4.13 ± 0.71, 4.16 ± 0.84, 4.50 ± 0.79, 4.69 ± 0.92, respectively). No significant difference between the two groups was found regarding the sexual pain domain.ConclusionIn Egyptian women, FGC is associated with reduced scores of ArFSFI on all domain scores except the sexual pain domain. Anis TH, Aboul Gheit S, Awad HH, and Saied HS. Effects of female genital cutting on the sexual function of Egyptian women. A cross‐sectional study. J Sex Med **;**:**–**.     

The Role of Mental Health on Maternal‐Fetal Attachment in Low‐Income Women

ObjectiveTo examine and describe the influence of maternal depressive symptoms on maternal‐fetal attachment (MFA) in predominantly low‐income women.DesignMixed method.SettingThree urban obstetric/gynecologic (OB/GYN) clinics serving predominantly low‐income women.ParticipantsA convenience sample of 166 women participated in the quantitative component and a purposeful subsample of 12 women participated in the qualitative component; all women were between 24 and 28 weeks gestation at the time of data collection.MethodsLinear regression models were used to examine the influence of depressive symptoms and social support on MFA. Individual in‐depth interviews were conducted among a subsample of women to explore the influence of maternal depressive symptoms on MFA.ResultsFifty‐nine percent (n = 98) of participants had scores that were clinically significant for depressive symptoms. In the final model of social support and depressive symptoms regressed on MFA, social support (b = .23, 95% CI [0.09, .37], p = .002) and depressive symptoms (b = −1.02, 95% CI [−1.32, −.73], p < 0.001) were significant predictors. This multivariate linear regression model with two variables accounted for 65.2% of the total variance in overall MFA. Qualitative participants discussed the importance of social support in contributing to their mood state and MFA.ConclusionsFindings from this study highlight the importance of assessing for depressive symptoms during pregnancy given its influence on MFA. By understanding how important it was for these women to have a supportive person to experience their pregnancies with, nurses can improve the pregnancy experience for vulnerable populations.     

Are Postpartum Women in Denmark Being Given Helpful Information About Urinary Incontinence and Pelvic Floor Exercises?

Introduction : The aim of this study was to determine where and from whom postpartum women recalled receiving information about urinary incontinence (UI) and pelvic floor exercises (PFEs), the helpfulness of this information, and their preferred sources of help with UI. Methods : Women who had recently given birth in a Danish hospital (N = 439) were mailed a survey that elicited information about their experiences of receiving information about UI and PFEs. Results : Surveys were returned from 266 women, representing a response rate of 61%. Although almost all participants recalled receiving information about PFEs (95%), only half (55%) recalled being provided with information about UI. Midwives were the health care professionals who most commonly provided women with information about UI (33%) and PFEs (55%). Women generally perceived the information as being helpful, with the information from physiotherapists obtaining the highest mean ratings for helpfulness. Postpartum women indicated that they would prefer to consult with continence nurses or general nurses if they experienced UI. Health care professionals did not consistently provide postpartum women with information on UI and PFEs. Discussion : A coordinated multidisciplinary approach is needed to ensure that women are adequately informed about the risk of developing UI after childbirth and the ways in which this condition can be managed or resolved. J Midwifery Womens Health 2010;55:171–174 Crown Copyright c̊ 2010 Published by Elsevier Inc. on behalf of the American College of Nurse‐Midwives. All rights reserved.     

Differentiating Components of Sexual Well-Being in Women: Are Sexual Satisfaction and Sexual Distress Independent Constructs?

IntroductionSexual satisfaction and sexual distress are common outcome measures in studies of sexual health and well-being. However, confusion remains as to if and how the two constructs are related. While many researchers have conceptualized satisfaction and distress as polar opposites, with a lack of satisfaction indicating high distress and vice versa, there is a growing movement to view satisfaction and distress as relatively independent factors and measure them accordingly.AimThe study aimed to assess the level of independence between sexual satisfaction and distress in female clinical and nonclinical samples.MethodsNinety-nine women (mean age = 25.3) undergoing treatment (traditional sex therapy and/or gingko biloba) for sexual arousal disorder with or without coexistent hypoactive sexual desire disorder and/or orgasmic disorder completed surveys assessing sexual satisfaction, sexual distress, sexual functioning, and relational functioning at pretreatment, mid-treatment, posttreatment, and follow-up. Two hundred twenty sexually healthy women (mean age = 20.25) completed similar surveys at 1-month intervals.Main Outcome MeasuresSexually dysfunctional women completed the Sexual Satisfaction Scale for Women (SSS-W), the Female Sexual Function Index (FSFI), and the Dyadic Adjustment Scale. Sexually healthy women completed the SSS-W, the FSFI, the Relationship Assessment Scale, and the Dimensions of Relationship Quality Scale.ResultsSexual satisfaction and distress were generally closely and inversely related; however, distress was more closely related to sexual functioning variables than was satisfaction in the clinical sample, and satisfaction was more closely related to relational variables than was distress in the nonclinical sample. Additionally, satisfaction and distress showed partially independent patterns of change over time, and scales of distress showed a larger change in response to treatment than did scales of satisfaction.ConclusionAlthough sexual satisfaction and distress may be closely related, these findings suggest that they are, at least, partially independent constructs. Implications for research on sexual well-being and treatment outcome studies are discussed. Stephenson KR, and Meston CM. Differentiating components of sexual well-being in women: Are sexual satisfaction and sexual distress independent constructs?     

ORIGINAL RESEARCH—PAIN: Sexual Functioning in Women with Chronic Pelvic Pain: The Role of Anxiety and Depression

IntroductionChronic pelvic pain (CPP) in women is a long lasting and often disabling condition. It seems reasonable to expect that as a result of the pain, extreme fatigue and/or emotional problems, women with CPP may report a variety of sexual problems.AimThe present study investigated differences in the report of sexual problems in women with CPP compared with healthy controls, and whether the association of CPP with sexual problems was moderated or mediated by somatic and psychological factors as manifested in women suffering from CPP.MethodOne hundred fifty-four women with CPP and 58 age-matched controls completed self-report measures for sexual functioning, pain, physical impairment, anxiety, depression, and sexual and physical abuse.Main Outcome MeasureGolombok Rust Inventory of Sexual Satisfaction.ResultsWomen with CPP reported higher levels of vaginistic complaints, sexual avoidance, nonsensuality and sexual dissatisfaction than healthy controls. Sexual problems were associated with anxiety, depression, and sexual abuse history but not with somatic factors as pain and physical impairment. Anxiety as well as depression, irrespective of the report of sexual abuse experiences, mediated the effect of CPP on sexual problems. Sexual abuse was a general predictor of sexual problems in both women with CPP and controls.ConclusionsAnxiety and depression constitute important factors in the evaluation of sexual problems in women with CPP. ter Kuile MM, Weijenborg PTM, and Spinhoven P. Sexual functioning in women with chronic pelvic pain: The role of anxiety and depression.     

What is the Impact on Sexual Function of Laparoscopic Treatment and Subsequent Combined Oral Contraceptive Therapy in Women with Deep Infiltrating Endometriosis?

IntroductionDeep infiltrating endometriosis (DIE) is a form of endometriosis in which the lesion penetrates for more than 5 mm under the peritoneal surface. It is a chronic disease which can impair women's sexual function. There is a growing body of evidence supporting combined surgical/medical treatment in the management of DIE.AimsThe aims of this article are to evaluate the impact of the laparoscopic full excision of endometriosis and postoperative combined oral contraceptives (COC) administration on sexual function in patients with DIE and to compare sexual function outcomes of women submitted to intestinal resection and nodule excision.MethodsIt is a prospective cohort study in a tertiary care university hospital on 106 sexually active women, with histologically confirmed DIE, managed by laparoscopy and subsequent COC therapy for 6 months. Patients filled preoperatively and 6‐month postoperatively a quality of sexual life questionnaire, the Sexual Health Outcomes in Women Questionnaire (SHOW‐Q) and they ranked their symptom intensity using a 10‐point visual analogue scale (VAS).Main Outcome MeasuresSexual function was measured through the SHOW‐Q scores and pain symptoms through VAS scores. Intraoperative details, type of intervention and perioperative complications were noted.ResultsSix months after surgery and postoperative COC treatment, a significant improvement was observed in the SHOW‐Q domains of pelvic problem interference, sexual satisfaction and desire (P < 0.05). Laparoscopic management of DIE did not change significantly the orgasm area of the sexual functioning (P = 0.7). No significant difference was found in SHOW‐Q scores between patients submitted to intestinal resection and patients submitted to intestinal nodule excision (P > 0.05).ConclusionsSexual desire, satisfaction with sex and pelvic problem interference with intercourse are significantly improved after 6 months from laparoscopic excision of DIE combined with postoperative COC therapy. No difference in sexual outcomes was detected between patients submitted to intestinal resection and nodule excision. Mabrouk M, Montanari G, Di Donato N, Del Forno S, Frascà C, Geraci E, Ferrini G, Vicenzi C, Raimondo D, Villa G, Zukerman Z, Alvisi S, and Seracchioli R. What is the impact on sexual function of laparoscopic treatment and subsequent combined oral contraceptive therapy in women with deep infiltrating endometriosis? J Sex Med 2012;9:770–778.     

Pilot Study on Quality of Life and Sexual Function in Men‐Who‐Have‐Sex‐with‐Men Treated for Prostate Cancer

IntroductionThere is limited data on post‐treatment quality of life (QoL) for men‐who‐have‐sex‐with‐men (MSM) with prostate cancer (PCa). QoL in MSM may not be reflected by assessment tools designed for the heterosexual population.AimsOur goals were to evaluate post‐treatment QoL in PCa patients who are MSM, and to investigate the utility of current QoL assessment tool.MethodsPCa patients treated with surgery and/or radiation were recruited from the local MSM community. Each participant completed the Expanded Prostate Cancer Index Composite (EPIC) questionnaire, Male Sexual Health Questionnaire (MSHQ), and a questionnaire focused on insertive and receptive roles of anal intercourse.Main Outcome MeasuresResponse scores were calculated based on questionnaire design and compared by treatment modality.ResultsSeven participants treated with surgery (mean age 58) and eight participants treated with radiation (mean age 67) were recruited. No participant in the surgical group received androgen deprivation therapy (ADT) while two in radiation group were treated with ADT.The sample size of this study did not permit formal statistical analysis, although potential differences in Urinary and Bowel Domains from EPIC and Ejaculation Scale from MSHQ were observed. More participants from the radiation group seemed to be able to maintain both insertive and receptive anal intercourse roles after treatment compared to participants who received surgery.ConclusionsWhile the two validated assessment tools suggested similar QoL scores including sexual function for both surgical and radiation groups, post‐treatment sexual function related to anal intercourse may be better in the radiation group, as compared to the surgical group. Larger studies in PCa patients from MSM community are warranted to verify these data. Lee TK, Breau RH, and Eapen L. Pilot study on quality of life and sexual function in men‐who‐have‐sex‐with‐men treated for prostate cancer. J Sex Med 2013;10:2094–2100.     

More than Sexual Function: Predictors of Sexual Satisfaction in a Sample of Women Age 40–70

IntroductionThe literature provides a complex picture of sexual satisfaction and its predictors. To date, studies have provided a list of predictors of sexual satisfaction, including relational and psychological factors, but very little information is available on the direct effects of these predictors in midlife women, independently from the effects of sexual function on sexual satisfaction.AimThe main aim of this article is to provide empirical evidence on factors that predict sexual satisfaction in middle-aged women above and beyond the explanation provided by sexual function.Main Outcome MeasuresThe three items on sexual satisfaction from the Female Sexual Functioning Index were used to assess different aspects of sexual satisfaction.MethodsA sample of 86 women age 40–70 years recruited from a clinic completed a battery of questionnaires on sexual satisfaction and potential predictors, including, psychological well-being, body attitudes, menopausal symptoms, and relationship adjustment.ResultsRelationship adjustment, psychological well-being, and menopausal symptoms predicted sexual satisfaction above and beyond sexual functioning. Body attitudes did not predict sexual satisfaction in midlife women.ConclusionsData supported the hypothesis that sexual satisfaction is only partially explained by sexual function. Other factors involved in women's lives, such as psychological well-being, relationship adjustment, and, to a lesser extent, menopausal symptoms, affect sexual satisfaction independently from sexual function. Dundon CM, and Rellini AH. More than sexual function: Predictors of sexual satisfaction in a sample of women age 40–70.     

Does Metabolic Syndrome Impair Sexual Function in Middle‐ to Old‐Aged Women?

IntroductionTo date, there are few studies dealing with the impact of metabolic syndrome (MS) on female sexual function, and the association between MS and female sexual dysfunction (FSD) in middle‐ to old‐aged women remains unclear.AimTo evaluate the impact of MS on sexual function in middle‐ to old‐aged women.MethodsFrom May 2009 to January 2010, we performed a cross‐sectional study of sexually active women (≥40 years old) who visited a health‐screening clinic. Comprehensive history taking, anthropometric measurement, laboratory testing, and questionnaire administration were performed for each of the total 773 women enrolled.Main Outcome MeasuresThe Female Sexual Function Index (FSFI) was used to assess the key dimensions of female sexual function.ResultsThe median age of enrolled subjects was 48 (40–65) years, and the rates of MS and FSD were 12.2% (94/773) and 54.7% (423/773), respectively. We found that the demographics of women with and without MS (P < 0.05) differed significantly from one another in terms of age, menopausal status, body mass index, educational status, household income, and urinary incontinence (UI) symptoms, although their frequency of FSD was similar (52.1% vs. 55.1%). After adjusting clinical confounders, we found that only the pain domain score was significantly different between women with MS and without MS, while the total FSFI score and other constituent domain scores showed little difference between the two groups. However, in the multivariate logistic regression model, MS and most of its components were not associated with FSD; only age, menopausal status, smoking, depression, and symptomatic UI proved to be independent risk factors for FSD (P < 0.05).ConclusionsOur study suggests that MS may have little impact on sexual function in middle‐ to old‐aged women. Further studies with population‐based and longitudinal design should be conducted to confirm this finding. Kim YH, Kim SM, Kim JJ, Cho IS, and Jeon MJ. Does metabolic syndrome impair sexual function in middle‐ to old‐aged women?