Care for breast cancer survivors in Asian countries: A review of sexual dysfunction.

Breast cancer accounts for one in three new cancer cases in women each year. Despite having a higher survival rate than other cancers, it is associated with various side effects, including anorgasmia, vaginismus, hair loss, and decreased libido. This review aims to explore trends in the incidence of sexual dysfunction in breast cancer survivors, the etiology of sexual dysfunction, and the role of factors such as family history, age, duration of marriage, and depression in predisposing patients. We summarize the limitations of the treatment modalities already used to cater to sexual dysfunction in breast cancer survivors and patients. The authors conducted searches on databases such as PubMed and Google Scholar using relevant search terms: sexual dysfunction, breast cancer, breast cancer survivors, chemotherapy, dyspareunia, vaginismus, and anorgasmia from 1997-2023. The inclusion criteria encompassed all types of articles with abstracts or titles indicating research on sexual dysfunction in breast cancer survivors in Asia. A total of 64 articles were included out of which 10 were systematic reviews and meta-analyses. The literature search yielded results showing high incidence rates of breast cancer in Asia (45.4%), with 31.6%-91.2% of breast cancer survivors likely to experience sexual dysfunction. Regional differences were noted, as female sexual dysfunction occurred in 74.1% of Asian breast cancer women. Further randomized controlled trials should be conducted to assess the effectiveness of treatment modalities. Personalized approaches should be tailored to address beliefs, such as the potential impact of sexual activity on disease recovery. Utilizing a family history of breast cancer as a preemptive tool can help reduce the risk of developing female sexual dysfunction in survivors, and factors such as age and depression should be considered when formulating solutions.

Psychosocial interventions to improve sexual functioning in women with cancer: a systematic review of randomized controlled trials.

INTRODUCTION: Many women with cancer struggle with sexual side effects during and after treatment. Although preliminary evidence indicates that psychosocial interventions may be efficacious in improving sexual functioning for women with cancer, no systematic review has summarized the state of the science in this area. OBJECTIVES: The primary goal of this review was to narratively synthesize the results of randomized controlled trials (RCTs) testing the efficacy of psychosocial interventions to address sexual dysfunction in women with cancer. A secondary goal was to describe the diversity of the included samples (ie, racial/ethnic and sexual minority). METHODS: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic review was conducted examining RCTs of psychosocial interventions to improve sexual functioning for women with cancer. Articles were identified using MEDLINE, Embase, PsycINFO, and Cochrane CENTRAL. Two reviewers independently assessed each article for inclusion, with a third to resolve discrepancies. RESULTS: Seventeen studies were included in the review, 12 of which provided sufficient information to calculate effect sizes. Ten of the 12 studies primarily aimed to improve sexual functioning, all of which demonstrated positive effects on at least 1 outcome of sexual functioning. In the 2 RCTs of psychosocial interventions in which sexual function was a secondary aim, effects were negligible (ds = -0.04 and -0.15). Commonalities among the studies with large effect sizes were that they included education, mindfulness/acceptance, and communication/relationship skills as intervention components. Of note, there was an overall lack of sample diversity across studies, and most studies failed to report the race/ethnicity or sexual orientation of the participants. CONCLUSION: Results support interventions targeting sexual functioning outcomes for women with cancer and suggest that multimodal interventions including education, mindfulness/acceptance, and communication/relationship skills may be most effective. Future research should also focus on examining the efficacy and potential adaptations of extant sexual functioning interventions for underrepresented groups.

Daily Vaginal Dilator Use During Radiation for Women With Squamous Cell Carcinoma of the Anus: Vaginal Wall Dosimetry and Patient-Reported Sexual Function.

PURPOSE: At our institution, we treat patients with a daily vaginal dilator (VD) during chemoradiation (CRT) for squamous cell carcinoma of the anus (SCCA). We evaluated compliance with daily VD use, radiation dose to the vaginal wall (VW), and anterior vaginal wall (AVW), and patient-reported long-term sexual function. METHODS AND MATERIALS: We included women with SCCA who received definitive, intensity-modulated radiation therapy-based CRT. Women who were alive without evidence of disease received a patient-reported outcome survey, which included the Female Sexual Function Index (FSFI). We identified factors associated with FSFI, such as radiation dose to the VW and AVW using linear regression models and used Youden index analysis to estimate a dose cutoff to predict sexual dysfunction. RESULTS: Three hundred thirty-nine consecutively treated women were included in the analysis; 285 (84.1%) were treated with a daily VD. Of 184 women alive without disease, 90 patients (49%) completed the FSFI, and 51 (56.7%) were sexually active with valid FSFI scores. All received therapy with a daily VD. Forty-one women (80%) had sexual dysfunction. Univariate analysis showed higher dose to 50% (D50%) of the AVW correlated with worse FSFI (ß -.262; P = .043), worse desire FSFI subscore (ß -.056; P = .003), and worse pain FSFI subscore (ß -.084; P = .009). Younger age correlated with worse pain FSFI subscale (ß .067; P = .026). Age (ß .070; P = .013) and AVW D50% (ß -.087; P = .009) were significant on multivariable analysis. AVW D50% >48 Gy predicted increased risk of sexual dysfunction. CONCLUSIONS: Daily VD use is safe and well tolerated during CRT for SCCA. Using a VD during treatment to displace the AVW may reduce the risk for sexual dysfunction. Limiting the AVW D50% <48 Gy may further reduce the risk but additional data are needed to validate this constraint.

Sexual dysfunction among early-onset colorectal cancer survivors: Sex-specific correlates of sexual health discussions between patients and providers.

PURPOSE: To examine the prevalence of female sexual dysfunction (FSD), male erectile dysfunction (ED), and the prevalence and correlates of sexual health discussions between early-onset CRC survivors and their health care providers. METHODS: An online, cross-sectional survey was administered in partnership with a national CRC advocacy organization. Respondents (n = 234; diagnosed < 50 years, 6-36 months from diagnosis/relapse) were colon (36.8%) and rectal (63.3%) cancer survivors (62.5% male). The Female Sexual Function Index (FSFI-6) was used to measure FSD, and the International Index of Erectile Function (IIEF-5) was used to measure ED. Survivors reported whether a doctor communicated with them about sexual issues during/after treatment. RESULTS: Among females (n = 87), 81.6% had FSD (mean FSFI-6 score = 14.3 [SD±6.1]). Among males (n = 145), 94.5% had ED (mean IIEF-5 score = 13.6 [SD±3.4]). Overall, 59.4% of males and 45.4% of females reported a sexual health discussion. Among the total sample, older age of diagnosis and relapse were significantly associated with reporting a discussion, while female sex was negatively associated with reporting a sexual health discussion. Among males, older age at diagnosis and relapse, and among females, older age of diagnosis, were significantly associated with reporting a sexual health discussion. CONCLUSION: The prevalence of FSD and ED were high (8 in 10 females reporting FSD, almost all males reporting ED), while reported rates of sexual health discussion were suboptimal (half reported discussion). Interventions to increase CRC provider awareness of patients at risk for not being counseled are needed to optimize long-term health outcomes.

Initial observations on sexual dysfunction as a symptom of chemotherapy-induced peripheral neuropathy.

Introduction: Peripheral neuropathy (PNP) in feet and/or hands and sexual dysfunction are common side effects of cancer therapies. In patients with other diseases, there is evidence of an association between peripheral nervous system disorders and sexual dysfunction due to the impact of impaired neuronal control on genital organ sensitivity. In cancer patient interviews, it has now been observed that PNP and sexual dysfunction may be related. The aim of the study was to investigate the potential association between PNP, sexual dysfunction, and physical activity behavior. Methods: Ninety-three patients with PNP of the feet and/or hands were interviewed in August/September 2020 in a cross-sectional study regarding medical history, sexual dysfunction and functionality of the genital organs. Results: Thirty-one persons who participated in the survey provided seventeen evaluable questionnaires (four men, thirteen women). Nine women (69%) and three men (75%) reported sensory disorders of the genital organs. Three men (75%) had erectile dysfunction. All men who had sensory symptoms of the genital organs received chemotherapy, and one man also received immunotherapy. Eight women were sexually active. Five (63%) of them reported genital organ symptoms and mainly lubrication disorders. Four (80%) of the five sexually inactive women reported genital organ symptoms. Eight of the nine women with sensory symptoms of the genital organs received chemotherapy, and one woman received immunotherapy. Discussion: Our limited data suggest genital organ sensory symptoms in chemotherapy and immunotherapy patients. Genital organ symptoms do not appear to be directly related to sexual dysfunction, and the association between PNP and genital organ symptoms appears to be more pronounced in sexually inactive women. Chemotherapy could cause sensory symptoms of the genital organs and sexual dysfunction by damaging genital organ nerve fibers. Chemotherapy and anti-hormone therapy (AHT) could trigger a disturbance of the hormone balance, which in turn could be causative for sexual dysfunction. It remains open whether the cause of these disorders is the symptomatology of the genital organs or the altered hormone balance. The significance of the results is limited due to the small number of cases. To our knowledge, this study is the first of its kind in cancer patients and allows a better understanding of the association between PNP, sensory symptoms of the genital organs, and sexual dysfunction. Conclusion: In order to be able to narrow down the cause of these initial observations in cancer patients more precisely, larger studies are needed that can relate the influence of cancer therapy-induced PNP, physical activity level and hormone balance to sensory symptoms of the genital organs and sexual dysfunction. The methodology of further studies should take into account the frequent problem of low response rates in surveys on sexuality.

Iron deficiency and sexual dysfunction in women.

INTRODUCTION: Sexual dysfunction negatively affects approximately 40% to 50% of adult women across various stages of life. Common risk factors include sexual traumas, relationship problems, chronic conditions, medication side effects, and poor physical health, including iron deficiency. OBJECTIVES: This review summarizes a presentation from a symposium that discussed the types and causes of sexual dysfunction at key times in women's lives, focusing on the relationship between iron deficiency and sexual dysfunction. METHODS: The symposium was held at the XV Annual European Urogynaecological Association Congress, Antibes, France, in October 2022. Symposium content was identified through literature searches of PubMed. Original research, review articles, and Cochrane analyses discussing sexual dysfunction in association with iron deficiency/anemia were included. RESULTS: Iron deficiency in women is commonly caused by abnormal uterine bleeding, but women may develop iron deficiency anemia (IDA) because of increased iron needs or reduced iron intake/absorption. Treatment with oral iron supplementation has been shown to improve sexual function in women with IDA. Ferrous sulphate is considered as a standard of care for oral iron treatment; prolonged-release iron formulations have improved tolerability, enabling lower doses and better tolerability. CONCLUSION: IDA and sexual dysfunction are related, so the identification of sexual dysfunction or iron deficiency in a woman should prompt an investigation of the other condition. Testing for iron deficiency is an inexpensive and simple step that can be routinely included in the workup of women with sexual dysfunction. Once identified, IDA and sexual dysfunction in women should be treated and followed to optimize quality of life.

Care needs of Japanese men for sexual dysfunction associated with prostate cancer treatment.

PURPOSE: Prostate cancer (PC) treatment causes sexual dysfunction (SD) and alters fertility, male identity, and intimate relationships with partners. In Japan, little attention has been paid to the importance of providing care for SD associated with PC treatment. This study is aimed at clarifying the care needs of Japanese men regarding SD associated with PC treatment. METHODS: One-to-one semi-structured interviews were conducted with 44 PC patients to identify their care needs. Data were analyzed using thematic analysis. RESULTS: Four core categories emerged from the analysis. (1) "Need for empathy from medical staff regarding fear of SD": patients had difficulty confiding in others about their sexual problems, and medical staff involvement in their SD issues was lacking. (2) "Need for information that provides an accurate understanding of SD and coping strategies before deciding on treatment": lack of information about SD in daily life and difficulty understanding information from medical institutions, caused men to regret their treatment. (3) "Need for professional care for individuals and couples affected by SD": men faced loss of intimacy because of their partners' unwillingness to understand their SD issues or tolerate non-sexual relationships. (4) "Need for an environment that facilitates interaction among men to resolve SD issues": men felt lonely and wanted to interact with other patients about their SD concerns. CONCLUSION: These findings may help form care strategies tailored to these needs and applicable to other societies with strong traditional gender norms.

Evaluation of sexual dysfunction in females with neck and upper back myofascial pain syndrome: a cross-sectional study.

Myofascial pain syndrome (MPS) is a prevalent chronic musculoskeletal pain disorder that is frequently encountered in clinical practice and can cause sexual dysfunction in women. While there have been studies examining sexual function in various painful rheumatic conditions, particularly fibromyalgia, no studies have been conducted specifically on primary MPS. In this context, we aimed to investigate the frequency of sexual intercourse and the factors associated with it in women diagnosed with MPS. The study was designed as a cross-sectional study at a tertiary rehabilitation center between May 2022 and April 2023. Forty-five consecutive sexually active women (mean age: 38.1 ± 6.8 years) diagnosed with primary MPS were included in the study. They were compared to 45 healthy women of similar ages. The participants were interviewed regarding their weekly frequency of sexual intercourse and the importance of sexual life. Also, the Beck Depression Inventory (BDI) and the Visual Analog Scale (VAS) were assessed. The importance of sexual life score (p = 0.008), BDI (p < 0.001), VAS pain (p < 0.001), and VAS fatigue (p < 0.001) values were found to be lower in the patient group compared to the control group. The frequency of sexual intercourse was lower in the patient group, although this difference did not reach statistical significance (p = 0.083). In patients with a higher BDI score (≥ 17), the number of sexual intercourse was lower (p = 0.044), and the severity of fatigue was higher (p = 0.013). Significant associations were observed in MPS patients between the weekly frequency of sexual intercourse and VAS pain, VAS fatigue, BDI, and the importance of the sexual life score. A positive correlation was observed between the number of weekly sexual intercourses and the importance of the sexual life score (r = 0.577, p < 0.001), and negative correlations were found between BDI (r = - 0.478, p < 0.001), VAS pain (r = - 0.409, p < 0.001), and VAS fatigue (r = - 0.439, p < 0.001). Patients with MPS should be assessed for depressive mood and fatigue, as these factors may contribute to sexual dysfunction. These results may also emphasize the importance of adopting a multidisciplinary approach in the management of MPS patients with concurrent sexual dysfunction. Clinicaltrials.gov identifier: NCT05727566.

Diagnosis, causes, and treatment of dyspareunia in postmenopausal women.

IMPORTANCE AND OBJECTIVES: Evaluation and treatment of dyspareunia remains a significant unmet need despite the availability of safe and effective treatments. The objectives of this review are to consider evaluation techniques, the medical causes, and treatment options for dyspareunia in postmenopausal women. METHODS: This narrative review used PubMed to search for English-language articles related to postmenopausal dyspareunia. Search terms included, but were not limited to, dyspareunia, genitourinary syndrome of menopause, sexual dysfunction, postmenopausal dyspareunia, posthysterectomy dyspareunia, and postcancer dyspareunia. FINDINGS: Many postmenopausal women with dyspareunia do not discuss their symptoms with their physicians. Healthcare clinicians should broach the topic of dyspareunia with their patients using oral or written questionnaires. In addition to a thorough medical history and physical examination, various tools can be used as further assessments, including vaginal pH, vaginal dilators, imaging, vulvar biopsy, vulvoscopy and photography, the cotton swab test, sexually transmitted infection screening, and vaginitis testing. Although dyspareunia in postmenopausal women is often due to the genitourinary syndrome of menopause, other conditions can also cause dyspareunia, including hypertonic pelvic floor, hysterectomy, cancer treatment, lichen conditions, vulvar cancer, vestibulodynia, and pelvic organ prolapse. Some of the treatments discussed include lubricants, moisturizers, vaginal estrogen, ospemifene, dehydroepiandrosterone, local testosterone therapy, cannabidiol, and fractional CO 2 laser treatments. In some cases, dyspareunia may need to be specifically addressed by pelvic floor physical or sex therapists. CONCLUSIONS: Dyspareunia is a common issue in postmenopausal women, which remains largely untreated. Women with dyspareunia require a thorough history, targeted physical examination, and coordination of multiple disciplines including medical clinicians, pelvic floor physical therapists, and sex therapists.

Association of Pelvic Trauma With Rates of Cesarean Section, Sexual Dysfunction, and Genitourinary Dysfunction in a National Database.

INTRODUCTION: Pelvic fractures are severe injuries that can drastically affect a woman's quality of life through sexual dysfunction (SD), genitourinary dysfunction (GD), and increasing the potential need for future cesarean section (C-section). Limited research has captured long-term outcomes after pelvic fractures in women of childbearing age. This study aimed to determine the association between pelvic fractures and rates of C-section, SD, and GD. METHODS: All women of childbearing age who sustained a pelvic fracture were identified in a national insurance database. A comparison group of patients with lower extremity long-bone fractures was selected. Patients who gave birth after injury were additionally identified. A minimum of 5 years of follow-up was required for inclusion. Rates of C-section, SD, and GD were compared between cohorts. Multivariate logistic regression analysis was conducted with the inclusion of diabetes, tobacco, hypertension, obesity, and advanced maternal age. RESULTS: A total of 6,174 patients with pelvic fracture and 27,154 control fracture patients were identified. 434 patients with pelvic fracture (7.0%) and 1,258 control fracture patients (4.6%) gave birth after fracture. Patients with pelvic fracture had a significantly higher rate of C-section (50.0% versus 38.8%, P < 0.001), SD diagnosis (10.9% versus 8.8%, P < 0.001), and urinary retention diagnosis (3.5% versus 2.8%, P < 0.001). No significant difference in global GD diagnosis was identified. Multivariate analyses showed that pelvic fracture was associated with C-section (odds ratio [OR]: 1.78; 95% confidence interval [95% CI]: 1.42 to 2.23, P < 0.001), SD diagnosis (OR: 1.23; 95% CI: 1.12 to 1.35, P < 0.001), and urinary retention diagnosis (OR: 1.35; 95% CI: 1.15 to 1.57, P < 0.001). DISCUSSION: Pelvic fractures confer an intrinsic level of risk of C-section, SD, and urinary retention that is elevated beyond what would be expected from a traumatic lower extremity injury alone. Treating orthopaedic surgeons should actively counsel women regarding increased risks, openly discuss postinjury sequelae, and coordinate interspecialty care beyond initial treatment of acute trauma.

Association of sexual attitudes with sexual dysfunction and sexual distress among Chinese breast cancer survivors: a cross-sectional study.

PURPOSE: Little is known about sexual dysfunction and sexual distress in Chinese female breast cancer survivors (BCSs), and their associations with physical variables, psychological factors, body image, and sexual attitudes. METHODS: A cross-sectional study of 341 BCSs was performed with the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised (FSDS-R). Associations between physical variables, psychological factors, body image, sexual attitudes, sexual dysfunction, and sexual distress were evaluated using logistic regression, adjusted for confounding factors. RESULTS: We found that 75.37% and 18.48% of BCSs reported sexual dysfunction and sexual distress during the past month, respectively. Attitudes toward sexual behavior such as "sexual activity may impede disease recovery," "sexual activity may cause cancer recurrence or metastasis," and "sexual activity may weaken treatment effects" were significantly associated with an increased likelihood of reporting sexual dysfunction and sexual distress. Body image disruption such as "felt physically less attractive as a result of your disease or treatment" was significantly associated with the experience of sexual distress. CONCLUSION: Sexual dysfunction and sexual distress are common issues in Chinese BCSs. Sexual misconception likely contributes to sexual dysfunction and sexual distress, and body image has a significantly negative association with sexual distress in BCSs. Interventions targeting sexual attitudes and body image might be important to address BCSs' sexual issues and improve their overall sexual health.

Sexual dysfunction in women with interstitial cystitis/bladder pain syndrome: Do onabotulinum toxin-A injections improve sexual function?

INTRODUCTION: Interstitial cystitis/bladder pain syndrome (IC/BPS) has a negative impact on female sexual function. We aimed to evaluate the effect of intravesical botulinum toxin-A (BTX-A) injection on the improvement of sexual dysfunction and urinary symptoms using the multi-domain female sexual function Index (FSFI), interstitial cystitis symptom index (ICSI), and interstitial cystitis problem index (ICPI). MATERIAL AND METHOD: The data of the 23 patients (study group) who received intravesical BTX-A with the diagnosis of IC/BPS were reviewed. Twenty-three age-matched healthy, sexually active women were determined as the control group. Patients received 100 U BTX-A submucosally injections, including the trigone. One hundred units of BTX-A were diluted to 20 cc 0.9% saline, and 1 cc was then applied submucosally on 20 different points of the bladder wall (5 U/1 mL per site). The study group was asked to fill out FSFI, ICSI, and ICPI, as well as the visual analog scale (VAS) and bladder diary before and 3 months after the treatment. Patients in the control group completed the same questionnaires once. The pre- and post-treatment questionnaire scores were compared in the study group. The study group's data were also compared to the control group. RESULTS: Compared to the pretreatment period, the study group showed statistically significant improvement in the total FSFI score and each domain of the FSFI after BTX-A injection. The mean total FSFI score and three domains of FSFI (desire, lubrication, pain) reached to the score of the control group following BTX-A injection. Statistically significant improvements were also shown in scores of ICSI, ICPI, and VAS. (p < 0.05). CONCLUSION: IC/BPS is associated with a very high incidence of sexual dysfunction. Intravesical BTX-A injection may provide significant improvement in sexual dysfunction in women with IC/BPS.

Transsphenoidal surgery for prolactinomas in male patients: a retrospective study.

Male patients with prolactinomas usually present with typical hyperprolactinemia symptoms, including sexual dysfunction and infertility. However, clinical factors related to sexual dysfunction and surgical outcomes in these patients remain unclear. This study aimed to investigate the outcomes of male patients with prolactinomas after transsphenoidal surgery and the risk factors affecting sexual dysfunction. This study was conducted on 58 male patients who underwent transsphenoidal surgery for prolactinomas between May 2014 and December 2020 at the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. We evaluated the sexual function of patients before and after surgery through International Index of Erectile Function-5 scores, libido, and frequency of morning erection. Of the 58 patients, 48 (82.8%) patients had sexual intercourse preoperatively. Among those 48 patients, 41 (85.4%) patients presented with erectile dysfunction. The preoperative International Index of Erectile Function-5 scores in patients with macroprolactinomas were significantly higher than those in patients with giant prolactinomas (17.63 ± 0.91 vs 13.28 ± 1.43; P = 0.01). Postoperatively, the incidence of erectile dysfunction was 47.9%, which was significantly lower than that preoperatively (85.4%; P = 0.01). Twenty-eight (68.3%) patients demonstrated an improvement in erectile dysfunction. Tumor size and invasiveness were significantly correlated with the improvement of erectile dysfunction. Preoperative testosterone <2.3 ng ml-1 was an independent predictor of improvement in erectile dysfunction. In conclusion, our results indicated that tumor size and invasiveness were important factors affecting the improvement of sexual dysfunction in male patients with prolactinoma. The preoperative testosterone level was an independent predictor related to the improvement of erectile dysfunction.

Pre and Postoperative Sexual Dysfunction in Patients with Leriche Syndrome-A Prospective Pilot Study.

Background: Recovery of normal arterial inflow in the lower limbs after Leriche's syndrome surgery does not always improve erection. This study assesses the effects of Leriche syndrome on erectile and ejaculatory dysfunction in patients awaiting surgical treatment and the impact of treatment used on sexual dysfunctions. Methods: 35 men with Leriche syndrome aged 61.3 years (SD = 7.74) were assessed for erectile dysfunction. The patients were classified into three groups: aortofemoral bypass (group 1); stenting of the iliac artery (group 2) and aortobifemoral bypass (group 3). The patients were qualified for surgery based on the TASC II guidelines. Follow-up was done 3 months after treatment. Results: The mean preoperative IIEF-5 score was 14. 69 (+/- 5.30), with better preoperative scores obtained by 54.3% of patients. A total of 51.4% and 48.6% of patients, respectively, reported normal erection enabling satisfactory penetration and normal ejaculation before treatment. After surgical treatment, satisfactory erection was reported by 60% of all surgically treated patients, whereas the presence of ejaculation was reported by only 14.2% of patients. Conclusions: The IIEF-5 score is a tool for careful assessment of vascular erectile dysfunctions, it allows for the evaluation of erectile dysfunctions in relation to atherosclerosis risk factors. The treatment strategy used allowed for slight improvement as evidenced to erection but decreasing normal ejaculation.

Interstitial Cystitis/Bladder Pain Syndrome Treatment: A Systematic Review of Sexual Health Outcomes.

INTRODUCTION: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic condition with highly prevalent negative consequences on sexual health and quality of life. However, there is a lack of consensus regarding treatment options that improve sexual function in this population. This study aims to review the current literature on sexual health outcomes in patients treated for IC/BPS. METHODS: We conducted a systematic review of the literature on sexual health outcomes after treatment of IC/BPS. PubMed, MEDLINE, EMBASE, CINHAL, and Google Scholar were queried, and results were screened using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria for this review were: IC/BPS was clearly defined in the cohort, sexual health outcomes were measured as the primary or a secondary outcome, manuscript was written in English from January 2000 to April 2020. Studies on cystectomy were excluded as radical surgery is a confounding factor for sexual dysfunction. RESULTS: We identified 1611 items with our search algorithm and determined that 10 studies ultimately met inclusion criteria. 4 of 10 studies reported improved sexual function after treatment. 4 of 10 studies were randomized control trials and reported no improvement in sexual function in each of the therapies that were investigated. Data were conflicting regarding the effect of intravesical hyaluronic acid. CONCLUSION: This systematic review demonstrates the lack of focus on sexual health outcomes in studies of the IC/BPS. There was no strong evidence that any modality used to treat IC/BPS also improves sexual function despite the higher prevalence in this population. Chen A, Shahiyan RH, Anger J. Interstitial Cystitis/Bladder Pain Syndrome Treatment: A Systematic Review of Sexual Health Outcomes. Sex Med Rev 2022;10:71-76.

Association Between Ejaculatory Dysfunction and Post-Void Dribbling After Urethroplasty.

OBJECTIVE: To determine whether ejaculatory dysfunction (EjD) and post-void dribbling (PVD) after urethroplasty are associated, providing evidence for a common etiology. METHODS: We reviewed a prospectively maintained database for first-time, anterior urethroplasties. One item from the Male Sexual Health Questionnaire (MSHQ) assessed EjD: "How would you rate the strength or force of your ejaculation". One item from the Urethral Stricture Surgery Patient-Reported Outcome Measure (USS-PROM) assessed PVD: "How often have you had slight wetting of your pants after you had finished urinating?". The frequency of symptoms was compared after penile vs. bulbar repairs, and anastomotic versus augmentation bulbar repairs. Associations were assessed with chi-square. RESULTS: A total of 728 men were included. Overall, postoperative EjD and PVD were common; 67% and 66%, respectively. There was a significant association between EjD and PVD for the whole cohort (p<0.0001); this association remained significant after penile repairs (p=0.01), bulbar repairs (p<0.0007), and bulbar anastomotic repairs (p=0.002), but not after bulbar augmentation repairs (p=0.052). EjD and PVD occurred at similar rates after penile and bulbar urethroplasty. The rate of EjD was similar after bulbar augmentation and bulbar anastomotic urethroplasties, but PVD was more common after bulbar augmentation (70% vs. 52%) (p = 0.0001). CONCLUSION: EjD and PVD after anterior urethroplasty are significantly associated with one another, supporting the theory of a common etiology. High rates after penile repairs argue against a bulbospongiosus muscle damage etiology, and high rates after anastomotic repairs argue against graft sacculation. More work is needed to better understand and prevent symptoms.

SHBG as a Marker of NAFLD and Metabolic Impairments in Women Referred for Oligomenorrhea and/or Hirsutism and in Women With Sexual Dysfunction.

PCOS is one of the most common endocrine disorders and NAFLD is one of its most dangerous metabolic consequences. The diagnosis of NAFLD is not a practical task and the condition is at risk of being overlooked. The use of simpler but still reliable surrogate markers is necessary to identify women with a high likelihood of NAFLD. The aim of this study was to evaluate the clinical correlates of NAFLD Liver Fat Score (NAFLD-LFS) in women with oligomenorrhea and/or hirsutism. Furthermore, the study aimed to evaluate whether, among the hormonal parameters evaluated in such women, possible hallmarks of NAFLD may be identified. To this purpose, 66 women who attended our Outpatient Clinic for oligomenorrhea and/or hyperandrogenism were included in the study. In order to validate the results obtained in the first cohort, a second independent sample of 233 women evaluated for female sexual dysfunction (FSD) was analyzed. In cohort 1, NAFLD-LFS positively correlated with metabolic and inflammatory parameters. Among the hormone parameters, NAFLD-LFS showed no significant relationships with androgens but a significant negative correlation with SHBG (p<0.0001) that therefore appeared as a candidate hallmark for pathologic NAFLD-LFS. The ROC analysis showed a significant accuracy (81.1%, C.I.69.1-93.0, p <0.0001) for SHBG in identifying women with a pathological NAFLD-LFS. In particular, a SHBG 33.4 nmol/l was recognized as the best threshold, with a sensitivity of 73.3% and a specificity of 70.7%. In order to validate this SHBG as a marker of metabolic impairment possible related with the presence of NAFLD, we tested this threshold in cohort 2. FSD women with SHBG <33.4 nmol/l had worse metabolic parameters than women with SHBG ≥33.4 nmol/l and a significantly higher NAFLD-LFS even after adjusting for confounders (B=4.18 [2.05; 6.31], p=0.001). In conclusion, this study provides a new evidence in the diagnostic process of NAFLD, showing that the measurement of SHBG, which is routinely assessed in the workup of women referred for possible PCOS, could identify women at higher metabolic risk, thus detecting those who may deserve further targeted diagnostic assessment.

The Correlation between Severity of Overactive Bladder Symptoms with Female Sexual Dysfunction and Sexual Satisfaction of Partners.

PURPOSE: Sexual dysfunction in women with overactive bladder (OAB) syndrome has been an important topic, while the sexual satisfaction of partners has not been fully investigated. Our aim was to explore the association between the severity of OAB with female sexual dysfunction and sexual satisfaction of partners. METHODS: A total of 323 patients with OAB recruited in our hospital were included in our study from September 2017 to March 2019. Data were collected by Overactive Bladder Symptom Score (OABSS) questionnaire, self-designed questionnaire for basic characteristics; Female Sexual Function Index (FSFI); and sexual satisfaction survey for sex partners of patients. χ2 test or 1-way ANOVA was used to compare the variables among groups. Logistic regression analysis was performed to analyze the severity of OAB with female sexual dysfunction and sexual satisfaction of partners. The correlations between different OABSS domains with female sexual dysfunction and sexual satisfaction of partners were assessed. RESULTS: All the patients were classified into mild (n = 107), moderate (n = 98), severe (n = 118) OAB group based on OABSS. Most of the basic information were similar among groups, except for BMI, highest education, occupation, fertility, and history of pelvic floor surgery. After multiple factors correction, the severity of OAB, exercise frequency, and the history of pelvic floor surgery were statistically associated with the female sexual dysfunction and sexual satisfaction of partners. Urgency score was significantly correlated with female sexual dysfunction, and the urge incontinence was most significantly associated with the sexual satisfaction of partners. CONCLUSION: Severe OAB was closely associated with female sexual dysfunction and sexual satisfaction of partners. The urgency and urge incontinence should be focused for OAB management.

Disfunção sexual em mulheres com câncer do colo do útero submetidas à radioterapia: análise de conceito / Disfunción sexual en mujeres con cáncer de cuello uterino sometidas a radioterapia: análisis de concepto / Sexual dysfunction in women with cervical cancer undergoing radiotherapy: concept analysis

Resumo Objetivo analisar o conceito de disfunção sexual em mulheres com câncer do colo do útero submetidas a tratamento radioterápico. Método estudo de análise de conceito fundamentado no referencial metodológico proposto por Walker e Avant, o qual é composto por oito etapas: seleção do conceito; determinação dos objetivos da análise conceitual; identificação dos possíveis usos do conceito; determinação dos atributos críticos ou essenciais; construção de um caso modelo; construção de casos adicionais; identificação dos antecedentes e consequentes do conceito; e definição das referências empíricas. Resultados a amostra final resultou em 11 artigos, que identificaram 4 atributos críticos, 18 antecedentes e 07 consequentes do conceito, os quais permitiram a construção de uma definição conceitual e elaboração de um caso-modelo, com a finalidade de exemplificar o contexto social no qual o conceito encontra-se inserido. Conclusão e implicações para prática alterações na estrutura corporal, déficit de conhecimento, diminuição da frequência das relações sexuais, dispareunia e indiferença do parceiro são alguns dos principais antecedentes e consequentes da disfunção sexual na população estudada. Entretanto, esses fatores ainda são pouco conhecidos, o que limita a realização de ações de promoção, prevenção e reabilitação sexual, sobretudo no campo da enfermagem.

Resumen Objetivo analizar el concepto de disfunción sexual en mujeres con cáncer de cuello uterino sometidas a tratamiento radioterápico. Método estudio de análisis de concepto basado en el marco metodológico de Walker y Avant, compuesto por ocho etapas: selección del concepto; determinación de los objetivos del análisis conceptual; identificación de posibles usos del concepto; determinación de atributos críticos o esenciales; construcción de un caso modelo; construcción de casos adicionales; identificación de antecedentes y consecuentes del concepto; y definición de referencias empíricas. Resultados La muestra final resultó en 11 artículos: 04 críticos, 18 antecedentes y 07 consecuentes del concepto, lo que permitió la construcción de una definición conceptual y la elaboración de un caso modelo con el fin de ejemplificar el contexto social en que se inserta el concepto. Conclusión e implicaciones para la práctica Cambios en la estructura corporal, déficit de conocimiento, disminución de la frecuencia de las relaciones sexuales, dispareunia y la indiferencia de la pareja son algunos de los principales antecedentes y consecuentes de la disfunción sexual en la población estudiada. Sin embargo, estos factores aún son poco conocidos, lo que limita la realización de acciones de promoción, prevención y rehabilitación sexual, especialmente en el campo de la enfermería.

Abstract Objective to analyze the concept of sexual dysfunction in women with cervical cancer undergoing radiotherapy. Method a concept analysis study based on the methodological framework proposed by Walker and Avant, which consists of eight stages: concept selection; determination of the objectives of the conceptual analysis; identification of possible uses of the concept; determination of critical or essential attributes; construction of a model case; construction of additional cases; identification of the antecedents and consequences of the concept; and definition of empirical references. Results the final sample resulted in 11 articles, which identified 4 critical attributes, 18 antecedents and 07 consequences of the concept, which allowed the construction of a conceptual definition and the elaboration of a model case in order to exemplify the social context in which the concept is inserted. Conclusion and implications for practice changes in body structure, lack of knowledge, decreased frequency of sexual intercourse, dyspareunia, and partner's indifference are some of the main antecedents and consequences of sexual dysfunction in the studied population. However, these factors are still little known, which limits the performance of actions of promotion, prevention and sexual rehabilitation, especially in the field of nursing.

Sexual function and depression in polycystic ovary syndrome: Is it associated with inflammation and neuromodulators?

Numerous studies have been carried out on depression and sexual dysfunction concomitant with polycystic ovary syndrome (PCOS). Increasing evidence has revealed the importance of inflammation in the etiology of PCOS. In addition, it has been known that some neuromodulators affect depression and sexual function. However, their effects on PCOS are not known. This study aimed to evaluate the relationship of depression and sexual function with cytokines and neuromodulators in PCOS patients. The present study included 20 fertile and 30 infertile patients diagnosed with PCOS and 30 healthy volunteers. Metabolic and endocrine parameters, interleukin (IL)-1ß, IL-6, TNFα, γ-aminobutyric acid (GABA), Glutamate, Brain-derived neurotrophic factor (BDNF) serum levels, Beck Depression Index (BDI) and Female Sexual Function Index (FSFI) scores of the patients were compared between the groups. TNFα, IL-1ß, IL-6, glutamate, GABA, and BDI scores were found to be significantly higher (p < 0.05) in the PCOS group (p < 0.05). Glutamate, TNFα, IL-1ß, and IL-6 values were higher whereas GABA and BDNF values were lower in pateints with moderate and severe depression (p < 0.05). There were no statistically significant relationships between these parameters and the FSFI scores (p > 0.05). Multivariate logistic regression analysis was conducted with potential factors that may affect sexual dysfunction. The results indicated that high waist-to-hip ratio (WHR) (> 0.80) with an odds ratio of 1.81 in PCOS patients, and body mass index (BMI) with an odds ratio of 2.3 and high WHR (> 0.80) with an odds ratio of 1.97 in all patients were found to be independent risk factors affecting sexual dysfunction. The results of the present study suggested that chronic low-dose inflammation seen in PCOS may interact with some neuromodulators, leading to the development of depression. However, no relationship was found between these parameters and sexual function.