Introduction Radiation therapy (RT) is the gold standard for many pelvic cancers and improves overall patient survival. However, pelvic RT is associated with increased sexual dysfunction and urinary incontinence. Although the side effects of pelvic RT are well-documented, the pathological mechanisms leading to pelvic organ dysfunction are unknown, and a preclinical model has not been established. This study characterized the impact of pelvic RT at early and late timepoints on female rat bladder, vaginal, and urethral physiology and morphology. Methods Adult female Sprague-Dawley rats were divided into three groups (n = 8/group): (I) Sham, (II) four weeks RT (4wk RT), and (III) nine weeks RT (9wk RT). The RT groups received a single dose of 20 Gy external beam radiation, and experiments were conducted at 4wk and 9wk post-RT. Nerve-mediated vaginal blood flow was measured via laser Doppler. Tissue bath studies assessed vaginal contractility to electric field stimulation (EFS), adrenergic and cholinergic agonists, and relaxation to a nitric oxide donor. Bladder and urethral sphincters were evaluated for cholinergic, caffeine, and EFS-mediated contractility. Quantitative polymerase chain reaction (qPCR) measured gene expression of markers of oxidative stress. Vaginal, bladder, and urethral fibrosis were assessed with Masson\'s trichrome staining. Results At 4wk post-RT, total vaginal blood flow decreased, and at 9wk post-RT, returned to baseline levels. At 9wk post-RT, vaginal neurogenic and adrenergic-mediated contractile responses increased significantly. Vaginal epithelial thickness decreased post-RT and correlated with an acute rise in vaginal inflammatory gene expression. At 4wk post-RT, bladder neurogenic contractions decreased and remained lowered. Internal urethral contractions increased at 4wk post-RT and returned to Sham levels after 9wk post-RT. Pelvic RT increased external urethral neurogenic contractions, which remained elevated. Conclusion This novel preclinical model provides valuable insights into the temporal pathophysiology of pelvic RT-induced sexual and urinary dysfunction. The establishment of this model is crucial for understanding the underlying mechanisms involved in RT-induced pelvic injury. A reliable, clinically relevant model will allow for the testing of therapeutic strategies to prevent adverse effects with RT in pelvic cancer survivors.

BACKGROUND: Female sexual dysfunction (FSD), defined as clinically distressing problems with desire, arousal, orgasm, or pain, affects 12% of US women. Despite availability of medications for FSD, primary care physicians (PCPs) report feeling underprepared to manage it. In contrast, erectile dysfunction (ED) is frequently treated in primary care.
OBJECTIVE: To describe differences in patterns of FSD and ED diagnosis and management in primary care patients.
METHODS: Retrospective observational study.
METHODS: Primary care patients with an incident diagnosis of FSD or ED seen at a large, integrated health system between 2016 and 2022.
METHODS: Sexual dysfunction management (referral or prescription of a guideline-concordant medication within 3 days of diagnosis), patient characteristics (age, race, insurance type, marital status), and specialty of physician who diagnosed sexual dysfunction. We estimated the odds of FSD and ED management using mixed effects logistic regression in separate models.
RESULTS: The sample included 6540 female patients newly diagnosed with FSD and 16,591 male patients newly diagnosed with ED. Twenty-two percent of FSD diagnoses were made by PCPs, and 38% by OB/GYNs. Forty percent of ED diagnoses were made by PCPs and 20% by urologists. Patients with FSD were managed less frequently (33%) than ED patients (41%). The majority of FSD and ED patients who were managed received a medication (96% and 97%, respectively). In the multivariable models, compared to diagnosis by a specialist, diagnosis by a PCP was associated with lower odds of management for FSD patients (aOR, 0.59; 95% CI, 0.51-0.69) and higher odds of management (aOR, 1.52; 95% CI, 1.36-1.64) for ED patients.
CONCLUSIONS: Primary care patients with FSD are less likely to receive management if they are diagnosed by a PCP than by an OB/GYN. The opposite was true of ED patients, exposing a gap in the quality of care female patients receive.

BACKGROUND: Hypoactive Sexual Desire Disorder (HSDD) is a frequent sex-related problem in women; however, a specific tool to characterize HSDD subtypes based on sexual inhibitory and excitatory factors is still lacking.
OBJECTIVE: (1) To find a cutoff value in Sexual Inhibition Scale (SIS)/Sexual Excitation Scale (SES) scores predicting a diagnosis of HSDD in women consulting for sexual symptoms, (2) to explore the sexual inhibitory and excitatory profiles in women referred to a clinic for female sexual dysfunction by stratifying the sample according to the newfound cutoffs, and (3) to identify biopsychosocial factors significantly associated with the 2 profiles.
METHODS: An overall 133 women consulting for sexual symptoms were retrospectively evaluated for clinical, biochemical, and psychosexologic data collected at the first visit. A subgroup of 55 women treated with transdermal testosterone was retrospectively analyzed at baseline and the 6-month visit.
RESULTS: Patients underwent physical and laboratory examinations and completed the SIS/SES, Female Sexual Function Index, Female Sexual Distress Scale-Revised, Emotional Eating Scale, and Middlesex Hospital Questionnaire.
RESULTS: Specific cutoffs for SIS1 (≥32.5; indicating threat of performance failure) and SES (≤46.5) predicted HSDD diagnosis with an accuracy of 66.4% (P = .002) and 68.7% (P < .0001), respectively. Patients with impaired SIS1 scores showed higher distress and psychopathologic symptoms, while those with impaired SES scores demonstrated lower desire and arousal and a negative association with some metabolic and hormonal parameters. SES score also showed a significant predictive value on testosterone treatment efficacy for HSDD.
CONCLUSIONS: A better characterization of HSDD would enable individualized treatment based on the main underlying etiologies.
UNASSIGNED: Limitations of the study include the small sample size and cross-sectional retrospective design, with the choice of treatment for HSDD limited to transdermal testosterone. Strengths comprise the thorough and multifactorial evaluation of every aspect potentially affecting inhibitory and excitatory components of sexual desire.
CONCLUSIONS: Validated cutoffs of SIS/SES scores could allow deep characterization of women diagnosed with HSDD, thus ensuring better tailoring of therapy and prediction of the probability of response to specific treatments.

UNASSIGNED: Sexual dysfunction is commonly observed in patients with end-stage renal disease (ESRD). Sexual dysfunction in correlation with ESRD is associated with physiological and psychological problems resulting in low sexual desire, arousal, difficulties in achieving orgasm, and pain during intercourse. Studies on female sexual dysfunction (FSD) in correlation with renal replacement therapy are limited, and previous studies reporting contradictive results have indicated that the best modality for providing better outcomes (especially on FSD) remains unclear. Thus, this study aimed to compare the sexual function between female patients with ESRD who were on continuous ambulatory peritoneal dialysis (CAPD) and those on hemodialysis (HD).
UNASSIGNED: This study enrolled female patients who were randomly selected from the urology and renal division of the Internal Medicine Outpatient Clinic of our hospital from January 2020 to August 2021 and divided into the following groups: predialysis, HD, CAPD, and control groups. The participants were asked to fill out the Female Sexual Function Index (FSFI) questionnaires, and their data were recorded and analyzed using GraphPad Prism 9.0.0.
UNASSIGNED: Of the 280 patients, 200 female patients were included in this study. The rate of FSD (cutoff: 26.55) was 42% in the control group, 72% in the predialysis group, 62% in the CAPD group, and 66% the in HD group. The control group had a higher mean score in all parameters (p < 0.05). The total FSFI mean score indicated no significant difference (p > 0.05) between the patients on HD and those on CAPD; the mean of each point was almost identical except for satisfaction, which was higher among patients on CAPD (p < 0.05). Significant differences in the components of desire, arousal, orgasm, and satisfaction were observed between the groups.
UNASSIGNED: Patients on CAPD had better FSFI scores than the female patients with ESRD who were on HD, and the scores of both groups of patients were better than those of the predialysis group.

BACKGROUND: Female sexual dysfunction is a significant concern for many women worldwide, with chronic health conditions such as HIV infection contributing to its prevalence. However, there is a paucity of studies focusing this subject in the available literature.
OBJECTIVE: This narrative review aimed to provide a comprehensive and updated overview of the current state of knowledge regarding sexual dysfunction in women living with HIV (WLWH).
METHODS: References for this review were identified from MEDLINE, Embase, and Cochrane databases using the search terms \"sexual dysfunction\" AND \"HIV\" AND \"female\" OR \"woman.\" The final reference list was generated based on the timeline, originality, and relevance to the scope of this narrative review.
RESULTS: In the general population, female sexual function is influenced by various factors, including biological, psychological, physiological, sociocultural, and relational ones. In WLWH, the role of antiretroviral therapy in female sexual dysfunction is controversial. Although current international guidelines recommend collecting a thorough sexual life anamnesis during routine outpatient visits, sexual difficulties are often inadequately addressed.
CONCLUSIONS: A tailored clinical approach that focuses on the multidimensional domains of sexual dysfunction may improve the sexual health and quality of life in WLWH.

BACKGROUND: Female sexual dysfunction (FSD) is an underdiagnosed and undertreated problem. Few studies have addressed sexual distress in migraine. We aimed to perform a pilot study to determine if there is an association between migraine and sexual dysfunction/distress in premenopausal women and to identify their respective risk factors.
METHODS: Retrospective, cross-sectional pilot study, including 71 premenopausal female patients with migraine, from the headache outpatient clinic of a tertiary hospital, and 34 age-matched-controls. Female Sexual Function Index-6 (FSFI-6), Female Sexual Distress Scale-Revised (FSDS-R), Migraine Disability Assessment (MIDAS) Scale, Brief Pain Inventory (BPI), Hospital Anxiety and Depression Scale (HADS) and Sleep Health Scale (RU-SATED) were applied.
RESULTS: Of the 71 patients [40.0 (IQR = 11.00) years], only 12.7 % (n = 9) were not under migraine prophylactic treatment, and most (n = 33, 62.3 %) reported severe disability (MIDAS-IV). FSD and sexual distress were present in 50.7 % (36) patients with migraine [vs 20.6 % (7) controls]. Migraine patients showed lower FSFI-6 scores [19.0 (9.0) vs 24.0 (6.0), p = 0.005], with significantly lower levels of desire (p = 0.011), lubrication (p = 0.002), and satisfaction (p = 0.013), higher sexual distress [11.2 (25.6) vs 3.2 (9.6), p = 0.001], anxiety (p < 0.001), and depression (p < 0.001) levels, and lower sleep health scores (p = 0.005). Old age of onset, being under preventive medication, anxiety/depression, and dysfunctional sleep, were significantly associated with sexual distress. Certain domains of sexual function were associated with sociodemographic and migraine characteristics, anxiety, depression, and sleep health.
CONCLUSIONS: This pilot study highlights the possible association between migraine and elevated sexual dysfunction/distress levels among premenopausal women. It underscores the importance of sexual health assessments in these individuals, particularly those with higher levels of anxiety, depression, or poor sleep quality. It is important to exercise caution when interpreting results, as they may not be applicable to a wider context. This research paves the way for a larger study that will include a broader population of women from the community and encompass patients followed in different levels of health care.

BACKGROUND: Sexual life of pregnant women alters during pregnancy due to the physiologic,\' anatomic and hormonal changes in her body. Therefore, the aim of this study was to evaluate female sexual functioning after becoming pregnant.
METHODS: A prospective survey study including 148 pregnant women. An anonymous questionnaire including 60 inquiries concerning intimate relationship before and during pregnancy was performed. The following statistical test were used: Chi-square test of independence, Spearman\'s rank correlation coefficient and Wilcoxon test. The significance level of p = 0.05 was assumed.
RESULTS: Most of the respondents were between 31 and 40 years old (55%). Majority of them were married (86%). During pregnancy, slightly more than half of women had a moderate need for sexual intercourse (51%), a large percentage of them had a low need (32%), a high need for intercourse was declared by 17% of women. The correlation analysis showed a statistically significant relationship between women\'s education and the need for sex before pregnancy (p = 0.049). Respondents with higher degrees of education more often felt the need for intercourse before pregnancy. No correlation was found between education and the need for intercourse after pregnancy (p = 0.107). After becoming pregnant, 51% of women had less need for intercourse, 7% more, and 42% the same as before pregnancy, and these differences were statistically significant (p < 0.001). Also, a decreased satisfaction with sexual intercourse was reported during pregnancy (p < 0.001). After getting pregnant, the average number of intercourses decreased in majority (71%) of respondents, and differences in the number of intercourses before and during pregnancy were statistically significant (p < 0.001).
CONCLUSIONS: Pregnancy has significant impact on woman\'s sexuality. After becoming pregnant majority of women declare less need for sexual intercourses, decreased number of intercourses with less satisfaction.

BACKGROUND: Bladder cancer ranks 17th in prevalence of cancer types among women, and the trend is rising. The increased risk of female sexual dysfunction (FSD) after radical cystectomy (RC) underscores the need for greater focus on preserving and mitigating FSD.
OBJECTIVE: To place greater emphasis on the importance of female sexual function (FSF) in the treatment of bladder cancer and stimulate additional research to discover more effective solutions for enhancing the overall quality of life.
METHODS: This review used a narrative approach. Previous reviews on FSF after RC have provided limited and 1-sided solutions due to the lack of research. What makes this review unique is its innovative approach: it includes all available measures curing FSD as well as comparative analyses based on experimental data, thus making the findings more comprehensive. A detailed perspective of treatments for female bladder cancer is provided, including nerve- and organ-sparing RC, robot-assisted RC, and radiotherapy. We also analyze the impact of treatments for female bladder cancer on postoperative FSD. Additionally, solutions for addressing or alleviating postoperative FSD are summarized, such as urinary diversion, vaginal reconstruction, and drug and nondrug treatment.
RESULTS: Research has suggested that robot-assisted nerve- and organ-sparing RC is promising. Moreover, orthotopic neobladder among urinary diversions without a stoma helps to maintain a positive female body image. If part of the anterior vaginal wall must be removed during RC, vaginal reconstruction can restore the dimensions with synthetic grafts and biologic scaffolds. Additionally, postoperative measures, such as vaginal laser and hormone therapy, and use of vaginal dilators and lubricants have a significant role in reducing distress caused by FSD to provide maximum relief.
CONCLUSIONS: To support FSF after RC, various interventions are needed, and urologists must focus on patient recovery while minimizing treatment impact on FSF as much as possible.

UNASSIGNED: Sexual health is a major concern in women with endometriosis, however only a few controlled studies have examined this with validated instruments. The effect of hormonal treatments on sexual function in endometriosis is also an underrated topic. The aim of this study was to investigate sexual function of patients with endometriosis by a specific tool to better evaluate their sexual function (including different domains), and the influence of hormonal treatment or surgery on these parameters.
UNASSIGNED: An observational, cross-sectional, multicentre study was conducted in a group (n=194) of sexually active, women aged 25-45 years old, with surgical or ultrasonographic diagnosis of endometriosis, referred to the Endometriosis Center of Careggi University Hospital or Negrar di Valpolicella. Sexual function was assessed by administering the Female Sexual Function Index (FSFI), which assesses the domains of desire, arousal, lubrication, orgasm, satisfaction and pain. FSFI scores were compared to those of a control group (n=58) and according to the treatment received by patients with endometriosis.
UNASSIGNED: Ovarian endometriosis was present in 50 patients (25.8%), deep infiltrating endometriosis in 65 patients (33.5%) and both in 79 patients (40.7%). Adenomyosis coexisted in 102 patients (52.6%). Women with endometriosis reported a mean total FSFI score of 18.3 [4.2-25.8] (< 26.55), indicating female sexual dysfunction (FSD) in all patients. At multivariate analysis, after adjusting for confounders (BMI and hormonal therapy), women with endometriosis presented significantly lower scores than controls in all the FSFI (p<0.001). Patients with endometriosis under hormonal treatments (n=124; 64%), regardless of the type, had significantly lower scores in all FSFI subscales and total score, even after adjusting for confounders-age, BMI and history of surgery.
UNASSIGNED: Patients with endometriosis are at risk for FSD, encompassing not only dyspareunia, but all domains of sexual function. Hormonal treatments do not result in improvement in sexual symptoms.

UNASSIGNED: The 6-item Female Sexual Function Index (FSFI-6) is the shortened version of the widely used 19-item FSFI-19, designed for efficient screening of female sexual dysfunction in outpatient settings. However, this shorter FSFI-6 tool has not yet been validated for use in Bangladesh.
UNASSIGNED: The purpose of this study was to culturally adapt and validate the FSFI-6 in Bangla.
UNASSIGNED: The FSFI-6 was translated into Bangla using standard adaptation protocols. We interviewed 100 married, sexually active women aged 18 years and over from the outpatient and psychiatric sex clinic of a psychiatry department. Of these women, 50 were clinically diagnosed with sexual disorders based on the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, criteria. After obtaining written informed consent, participants completed a semi-structured questionnaire to provide sociodemographic information and the Bangla-adapted version of the FSFI-6. We assessed reliability and construct validity using the Statistical Package for Social Sciences, version 25, along with Classical and Bayesian Instrument Development software.
UNASSIGNED: Study outcomes were internal consistency, factor structure, and sensitivity and specificity.
UNASSIGNED: The study involved 100 participants with a mean ± SD age of 30 ± 5.4 years, ranging from 18 to 48 years. The majority of respondents (54.34%) reported issues related to sexual desire. The overall mean score on the Bangla-adapted FSFI-6 was 18.4 ± 5.4. Reliability analysis showed a high internal consistency, with a Cronbach\'s alpha of 0.887 indicating robust reliability. Both inter-item correlations and item-total correlations were within the acceptable range. A cutoff value of 19 for the FSFI-6 demonstrated high discriminative power, effectively distinguishing between individuals with sexual disorders and those without sexual disorders or with other psychiatric conditions. The sensitivity at this cutoff was 96%, with a specificity of 100%.
UNASSIGNED: The FSFI-6 Bangla version can be used to screen patients for female sexual dysfunction in an outpatient setting.
UNASSIGNED: The internal consistency of this study, indicated by a Cronbach\'s alpha of 0.887, was robust. The instrument is time efficient, user friendly, and well suited for outpatient settings. However, the sampling technique utilized was nonrandomized, confined to a single institution, and did not incorporate assessments for concurrent validity or test-retest reliability.
UNASSIGNED: The FSFI-6 Bangla version showed good reliability and validity in this study, supporting its usability as a valuable tool for screening sexual dysfunction in female.