International Society for the Study of Women's Sexual Health

Scientific Program - Saturday, February 27, 2016

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Morning

07:00 a.m. - 08:00 a.m.
Breakfast & Learn - Alternative Sexual Practices
Location: Crystal Ballroom DEF
Faculty: Brooke Faught, MSN, WHNP-BC, IF & Jess Waldura, MD, MAS


08:00 a.m. - 09:00 a.m.
ISSM Journals Session
Location: Crystal Ballroom DEF
Moderator: Irwin Goldstein, MD, IF

08:00 a.m. - 08:20 a.m.
Studies in the JSM you must know about
Sharon J. Parish, MD, IF, NCMP

08:20 a.m. - 08:40 a.m.
Studies in the SMR you must know about
Stephanie S. Faubion, MD, FACP, NCMP, IF

08:40 a.m. - 09:00 a.m.
Studies in the SM you must know about
Tami Rowen, MD, MS


09:00 a.m. - 10:30 a.m.
Symposium 3 - Pregnancy, Mating & Reproduction
Location: Crystal Ballroom DEF
Moderator: Melissa A. Farmer, PhD

Sexual Function during Pregnancy
Tami Rowen, MD, MS

Hormonal Predictors of Sexual Motivation in Naturally Cycling Young Women
James R. Roney, PhD

Ovarian Steroids and Women’s Sexual Desire: A New Look at Old Issues
Kim Wallen, PhD


10:30 a.m. - 11:00 a.m.
Coffee Break - Visit Exhibitors
Location: Crystal Ballroom Foyer


11:00 a.m. - 12:00 p.m.
State of the Art 4 - Asexuality
Location: Crystal Ballroom DEF
Moderator: Sheryl A. Kingsberg, PhD, IF

Asexuality
Lori Brotto, PhD, Rpsych


Afternoon

12:00 p.m. - 01:00 p.m.
Industry Sponsored Lunch Symposium
Location: Emerald Ballroom 2+3


01:00 p.m. - 02:30 p.m.
Research Podium Session 3 - Physiology
Location: Crystal Ballroom DEF
Moderator: Noel N. Kim, PhD

01:00 p.m. - 01:10 p.m.
Sex Steroid Hormones Regulation of Relaxation and Contractile Mechanisms in Clitoris: An Experimental Model in the Rat (#019)
L. Vignozzi

019

Sex Steroid Hormones Regulation of Relaxation and Contractile Mechanisms in Clitoris: An Experimental Model in the Rat
Filippi, S1; Cellai, I1; Corno, C1; Corcetto, F1; Comeglio, P1; Maseroli, E1; Rastrelli, G1; Maggi, M1Vignozzi, L1
1: University of Florence, Italy

Objectives: Although the crucial role of tumescence of clitoris in sexual response has been established, the underlying molecular mechanisms are still poorly understood. Preclinical studies suggest that nitricoxide (NO), through the second messenger cGMP, is the main vasodilator neurotransmitter modulating the clitoral flow vessels. Aim of the present study is to investigate the effects of sexual steroid hormones on pro-erectile/relaxant (NO/cGMP mediated) and anti-erectile/contractile (RhoA/ROCK mediated) mechanism in clitoris using a validated animal model.

Material and Methods: Female Sprague Dawley rats were ovariectomized (OVX). Subgoups of OVX were treated with either estradiol (E2; 10μg/ Kg/ day), progesterone (P; 10mg /kg/ day), testosterone (T; 30mg/ kg/ week) or T+ letrozole (T; 30mg/ kg/ week; letrozole: 2,5 mg/kg/ day) for six weeks. The experimental groups were compared with a control group of intact rats.

Results: By using real-time PCR we observed that testosterone treatment upregulates the expression of NO-mediated pathway genes (eNOS, nNOS, sGC, PDE5, PKG1). Conversely, estrogen replacement regulates the expression of calcium- sensitizing RhoA/ROCK pathway. Accordingly, we also performed in vitro contractility studing, on phenylephrine pre-contracted clitoris strips. OVX was associated with a reduced responsiveness to Y-27632, a ROCK inhibitor, which was fully restored by E2 supplementation. Finally, to further examine the effect of 17β-estradiol on the RhoA/ROCK pathway, we isolated smooth muscle cells for rat clitoris and evaluated their migration capacity.

Conclusions: Collectively, our data demonstrate that T improves vascular smooth muscle cells relaxation through the NO/cGMP pathway, and that testosterone and estradiol are both necessary to mantain a functional contractile and relaxant machinery in clitoris.

Disclosure:

Work supported by industry: no.

01:10 p.m. - 01:20 p.m.
Mechanism of Action and Preliminary Clinical Experience with Zolpidem, a Non-Benzodiazepine Indirect GABA A Receptor Agonist, for Symptomatic Treatment of Persistent Genital Arousal Disorder (PGAD) (#020)
S.A. King

020

Mechanism of Action and Preliminary Clinical Experience with Zolpidem, a Non-Benzodiazepine Indirect GABA A Receptor Agonist, for Symptomatic Treatment of Persistent Genital Arousal Disorder (PGAD)
King, SA1; Goldstein, I1; Pfaus, J2
1: Alvarado Hospital, USA; 2: Concordia University, Canada

Objectives: Persistent Genital Arousal Disorder (PGAD) is characterized by persistent or recurrent, unwanted or intrusive, bothersome or distressing feelings of genital arousal or being on the verge of orgasm, genital dysesthesia, not associated with concomitant sexual interest, thoughts or fantasies. With no FDA-approved treatments, strategies to manage PGAD include: elimination of excess sensory excitation from various peripheral genital (S2, S3, S4) or central nervous system pathologies centrally misdirected to the hypothalamus and misinterpreted as genital arousal/orgasm; inhibition of central relay information to the hypothalamus.

Materials and Methods: A woman with severe unrelenting PGAD was serendipitously administered zolpidem for sleep and noted temporary but dramatic resolution of PGAD symptoms. The mechanism of action of zolpidem was reviewed and other patients with PGAD were clinically offered zolpidem for symptom reduction.

Results: Incertohypothalamic dopamine release in the medial pre-optic area is a major controller of sympathetic outflow, activated in sexual circumstances to dilate peripheral blood vessels for genital arousal and facilitate sexual desire. Zolpidem, an FDA-approved fast-acting non-benzodiazepine indirect GABA A receptor agonist, potentiates GABA release modifying the benzodiazepine binding site. Brain dopamine neurons are inhibited by GABA neurons, with small axons contacting dopamine cell bodies shutting down dopamine transmission, keeping it in check when activated. Benzodiazepines are used clinically to diminish dopamine release by activating GABA release in adjacent neurons, although the effect takes longer to produce and has more severe side effects than zolpidem. Dopamine in various regions of the hypothalamus acts to keep one awake by opposing serotonin-associated sleep induction. Zolpidem acts to knock out dopamine and release serotonin from inhibition, resulting in sleep. If PGAD is in part due to a hypofunctioning GABA system in the hypothalamus allowing dopamine to run uninhibited, then zolpidem is hypothesized to normalize GABA release, reduce dopamine and allow serotonin increase reducing PGAD symptoms. We now have preliminary successful experience with low doses of zolpidem ( 1 – 2.5 mg q 6 hours) in more than 10 PGAD patients.

Conclusions: Pharmacologic management of PGAD may be achieved by agents that lower dopamine and raise serotonin such as zolpidem, however more research is needed.

Disclosure:

Work supported by industry: no.

01:20 p.m. - 01:30 p.m.
Effect of Fractional CO2 Laser on Vulvo-Vaginal Atrophy in Post-Menopausal Women with Dyspareunia Based on FSFI Data (#022)
M. Sophocles

022

Effect of Fractional CO2 Laser on Vulvo-Vaginal Atrophy in Post-Menopausal Women with Dyspareunia Based on FSFI Data
Cohen, S1Sophocles, M2
1: Lenox Hill Hospital, USA; 2: Women’s Healthcare of Princeton, USA

Aim: To evaluate, with validated instruments, sexual function in post-menopausal women with dyspareunia secondary to vulvo-vaginal atrophy (VVA) who received 3 treatment cycles of fractional CO2 laser on vaginal tissue.

Design: Retrospective chart review.

Patients and Methods: 18 otherwise healthy post-menopausal women presenting with dyspareunia secondary to VVA, average age 59 (range: 46-71 years), were evaluated using the Female Sexual Function Index (FSFI) questionnaire before and after laser therapy. All 18 women underwent treatment in an outpatient clinic with no anesthesia. Each patient received 3 laser treatments spaced 6 weeks apart. Length of follow-up was 18 weeks - 10 months.

Results: Overall, 17/18 women (94%) who received the laser treatment reported experiencing a meaningful treatment benefit. Mean pre-laser FSFI scores were 14.41 +/- (2.7/27.9) and mean post-laser FSFI scores improved to 23.7 +/- (4.1/34.8). More specifically, mean pre-laser lubrication and orgasm scores were 1.98 +/- (0/4.8) and 2.84 +/- (0/6) and mean post-laser lubrication and orgasm scores improved to 4.56 +/- (0.9/6) and 4.11 +/- (0/6). Mean pre-laser satisfaction and pain scores were 3.13 +/- (0/6) and 1.46 +/- (0/5.6) and mean post-laser satisfaction and pain scores improved to 3.88 +/- (0/6) and 3.77 +/- (0/6).  The most common side effects reported were mild vaginal irritation and spotting for 24 hours, both of which resolved on their own without intervention.

Conclusions: The most common therapy used to manage VVA currently is estrogen. Because the US Food and Drug Administration (FDA) released a “black box” warning on post-menopausal hormone use in women, providers treating these women have been waiting for a non-hormonal treatment to be approved. Fractional CO2 lasers supply energy to the vaginal wall to superficially ablate the epithelial component of atrophic mucosa, ultimately triggering the synthesis of new collagen formation. We found the use of fractional CO2 laser treatment to treat VVA in post-menopausal women resulted in clinically meaningful benefits with a low side effect profile.

Disclosure:

Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

01:30 p.m. - 01:40 p.m.
Pelvic Nerve Injury Leads to Increased Rho-Kinase Mediated Adrenergic Vasoconstriction of the Distal Vagina (#023)
S.A. Powers

023

Pelvic Nerve Injury Leads to Increased Rho-Kinase Mediated Adrenergic Vasoconstriction of the Distal Vagina
Hannan, JL1; Powers, SA1; Butner, A1; Wang, VM2; Tepper, J3; Liu, X3; Bivalacqua, TJ3
1: East Carolina University , USA; 2: Dept. Urology, Johns Hopkins Medical Institutes, Baltimore, MD, USA; 3: Dept. Urology, Johns Hopkins Medical Institutes, Baltimore, MD

Objectives: Female sexual responses rely on innervations from the pelvic plexus which may become damaged during radical hysterectomy. We demonstrated that bilateral pelvic nerve injury (BPNI) leads to increased vaginal adrenergic contractions and impaired vaginal blood flow in rats. This study examined the role of Rho-kinase (ROCK) in the elevated vaginal contractions after BPNI.

Materials and Methods: Female Sprague-Dawley rats (12 wks) were divided into sham or BPNI in which nerves from the pelvic plexus were bilaterally crushed. Animals were examined 3, 7, 14, 30 days following BPNI. Distal vaginal strips were contracted to the adrenergic agonist, norepinephrine (NE) or by electrical field stimulation (EFS) in the presence/absence of ROCK inhibitor Y-27632. Non-adrenergic, non-cholinergic (NANC) relaxation of the vaginal tissue was also assessed by EFS. ROCK1, ROCK2, RhoA, and α-smooth muscle actin (ASMA) protein and gene expression were assessed by Western blot and qPCR. Vaginal tissue was formalin fixed, paraffin embedded and sections were stained with Masson’s trichrome to assess smooth muscle and collagen. Additional sections were stained for tyrosine hydroxylase (TH) to assess sympathetic innervation of vaginal smooth muscle.

Results: An increase in vaginal contraction to NE and EFS was evident 3, 7, 14 days following BPNI (p<0.05). These increases in adrenergic mediated contractions following BPNI were significantly lower following ROCK inhibition by Y-27632 (p<0.05). NANC relaxation in the vagina was impaired 7 and 14 days post-BPNI (p<0.05). Gene expression of ROCK1, ROCK2 was increased 14 days after BPNI and its activator RhoA was also increased at 3 and 14 days compared to sham (p<0.05). Similarly, protein expression of ROCK1, ROCK2 and activated RhoA were elevated 3, 14 days after BPNI (p<0.05). A significant decrease in ASMA protein was evident at 7, 14 days after BPNI. Increased collagen and TH positive nerve terminals in the vaginal wall and a decrease in vaginal epithelium were evident14 days after BPNI.

Conclusions: Pelvic nerve injury leads to increased adrenergic, rho-kinase mediated tone, and structural changes to the vagina. These findings parallel the phenotype in the penis after cavernous nerve injury and provide us with a possible therapeutic target for neuropraxia-induced vaginal dysfunction.

Disclosure:

Work supported by industry: no.

01:40 p.m. - 01:50 p.m.
The Impact of Fiera™, a Women’s Sexual Health Consumer Product, on Premenopausal Genital Engorgement as Measured by Thermography: A Proof of Concept Study (#024)
Sue W. Goldstein, BA, IF

024

The Impact of Fiera™, a Women’s Sexual Health Consumer Product, on Premenopausal Genital Engorgement as Measured by Thermography: A Proof of Concept Study
Goldstein, S1; Goldstein, I1; Millheiser, L2
1: San Diego Sexual Medicine, USA; 2: Nuelle, Inc., USA

Objective: The primary aim of this study was to determine the degree of engorgement, as measured by temperature change in the external genitalia, produced by Fiera™, a women’s sexual health consumer product, utilizing suction and vibration technology to enhance genital blood flow. The secondary aims were to determine the time of onset of self-reported sexual arousal during use of the product as well as development of sexual desire.

Materials and Methods: A single-site, prospective, non-blinded study of Fiera™ was conducted in 14 sexually-active, premenopausal women (mean age: 37.1 + 9.0 years). Cohort-eligible women must have had a Female Sexual Function Index (FSFI) total score > 26.5, and have been sexually active in the 30 days prior to enrollment. Each subject underwent a single-visit procedure that included the establishment of baseline temperature, use of Fiera™ over the clitoris, and post-product skin temperature assessment. Temperature at the clitoris, labia and vestibule was measured using Forward Looking InfraRed Thermography. Participants self-recorded time to onset of sexual arousal during use of Fiera™. At the end of the procedure development of sexual desire was assessed using a Likert scale.

Results: A two-sided paired t-test was used to assess the statistical significance of the temperature increase from baseline to post-product use. The temperature increases for the clitoris and vestibule were statistically significant at all time points up to 10 minutes following removal of Fiera™. Temperature increase for the labia was only significant up to 8 minutes. The most significant temperature increase was observed at 0 minutes for all sites (p < 0.0001). All of the participants developed sexual arousal during use of Fiera™ with the average time to onset being 5.2 + 4.2 minutes. Forty-three percent of participants (n=6) strongly agreed that they “felt in the mood for sex” after use of the product, 50% (n=7) agreed, and 7% (n=2) somewhat agreed. None of the participants disagreed with the statement. No adverse events were reported during the study period.

Conclusion: Fiera™ produced statistically significant increases in vulvar temperatures, which is a marker of genital blood flow and engorgement. A notable finding that warrants further investigation is the congruence between genital arousal and development of sexual desire as a result of Fiera™ use in this population.

Disclosure:

Work supported by industry: yes, by Nuelle, Inc. (industry initiated, executed and funded study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

01:50 p.m. - 02:00 p.m.
A Brief Intervention to Increase Heart Rate Variability Increases Physiological Sexual Arousal in Sexually Functional Women: Results from a Pilot Study (#025)
A. Stanton

025

A Brief Intervention to Increase Heart Rate Variability Increases Physiological Sexual Arousal in Sexually Functional Women: Results from a Pilot Study
Stanton, A1; Del Rey, G1; Nichols, L1; Meston, C1
1: The University of Texas at Austin, USA

Introduction: Heart rate variability (HRV) has recently been associated with female sexual function. Specifically, below average HRV was identified as a significant risk factor for sexual arousal dysfunction and overall sexual dysfunction in women (Stanton, Lorenz, Pulverman, & Meston, 2015). Building upon this newly established relationship, the present study examined the effect of a brief intervention to increase HRV on physiological sexual arousal in sexually functional, college-aged women. Vaginal pulse amplitude (VPA), an index of genital sexual arousal, was assessed in 32 sexually functional women, aged 18-27, before and after a short session of autogenic training, which has been shown to significantly increase HRV (Miu, Heilman, & Miclea, 2009). Autogenic training is a relaxation technique that restores the balance between the activity of the sympathetic and the parasympathetic branches of the autonomic nervous system through suggestive phrases directed at certain parts of the body. We hypothesized that brief autogenic training would lead to a significant increase in both HRV and VPA.

Objectives: To assess the effect of brief autogenic training on both HRV and VPA in sexually healthy women

Materials and Methods: Vaginal photoplethysmography and electrocardiography were used to assess VPA and HRV, respectively. Both VPA and ECG were recorded using Biopac MP150 (Biopac Systems, CA, USA) at a sample rate of 200 samples/sec.

Results: Significant increases in mean HRV, post-autogenic training, were observed (p <.001). Significant increases in mean VPA, post-autogenic training, were also observed (p = .04).

Conclusions: HRV may be an important mechanism of physiological sexual arousal in women. More importantly, if replicated in women with sexual arousal dysfunction, this finding could have important implications for developing new, cost-effective treatments for sexual arousal concerns.

Disclosure:

Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

02:00 p.m. - 02:10 p.m.
Sexual Concerns for Women with Gynecologic Cancer: Does Age Make a Difference? (#026)
K. Abbott-Anderson

026

Sexual Concerns for Women with Gynecologic Cancer: Does Age Make a Difference?
Abbott-Anderson, K1; Kwekkeboom, KL2
1: Minnesota State University, USA; 2: University of Wisconsin, Madison

Objectives: The purpose of this study was to: 1) identify physical, psychological and relational sexual concerns reported by women with gynecological (GYN) cancer and 2) compare the number and intensity of physical, psychological and relational sexual concerns between younger and older women.

Material and Methods: N=260 GYN cancer survivors (mean age 59.8 [SD: 11.22]) diagnosed three months to five years prior to the study were recruited from a comprehensive cancer center. Participants completed the Sexual Concerns Questionnaire-Gynecological Cancer (SCQ-GC), a new instrument containing 34 physical, psychological and relational sexual concerns (Likert Scale: 0 [no concern]-5 [extremely concerning]) during a clinic visit. Sexual concern item wording began with the phrase “Since my cancer treatment began”.

Results: Eighty-two percent of participants with ages spanning the full sample range reported sexual concerns. Of the possible 34 sexual concerns, 15 had a mean score >1.00, meaning that participants had at least a slight level of concern for those items. Top concerns (with ≥50% of the sample reporting at least a slight concern) included “I’m not as sexually active” and “I have less interest in sex”. The most intense sexual concerns included “I’m not as sexually active’ (M=2.84 [SD=1.34]) and “I have vaginal dryness during sex” (M=2.72 [SD=1.47]). T-tests comparing younger and older women on number and intensity of physical, psychological, and relational concerns revealed statistically significant group differences for all comparisons. In each case, younger women reported more and greater intensity of sexual concerns compared to older women.

Conclusions: Women of all ages in the sample endorsed sexual concerns. Younger women endorsed higher numbers and intensity of sexual concerns compared to older women. This finding is consistent with the literature and suggests that younger women may be at particular risk for sexual concerns following GYN cancer diagnosis and treatment. Though younger women reported more sexual concerns, it is important to note that older women also endorsed sexual concerns following GYN cancer, and therefore, older women should not be excluded from future studies as has occurred in some studies. Interventions to address sexual concerns and alleviate distress related to sexual concerns may be most impactful, however, for younger GYN cancer survivors.

Disclosure:

Work supported by industry: no.

02:10 p.m. - 02:20 p.m.
Correlation of Physiologic Markers of Vulvovaginal Atrophy and Symptom Severity in Postmenopausal Women with Genitourinary Syndrome of Menopause (#021)
Michael Krychman, MD, IF

021

Correlation of Physiologic Markers of Vulvovaginal Atrophy and Symptom Severity in Postmenopausal Women with Genitourinary Syndrome of Menopause
Krychman, M1; Symons, J 2; Portman, D2
1: Southern California Center for Sexual Health and Survivorship Medicine, USA; 2: Sermonix Pharmaceuticals, USA

Objectives: Lasofoxifene, a selective estrogen receptor modulator has demonstrated significant improvement in self-reported most bothersome moderate to severe symptoms (MBS) of postmenopausal vulvovaginal atrophy (VVA) in two large, randomized, placebo controlled clinical trials. In addition to the assessment of MBS, physiological markers of VVA were also obtained, including vaginal pH, superficial and parabasal cells, and all demonstrated a significant response to lasofoxifene treatment by 12 weeks. The objective of the present analysis was to investigate a possible association between symptom severity and these various physiological measures.

Methods: Two clinical trials were conducted and randomized 444 and 445 subjects, respectively. All subjects provided informed consent and met all inclusion criteria. Prior to randomized treatment to either 0.25 mg or 0.5 mg of lasofoxifene or placebo each women identified a MBS chosen from the following: vaginal dryness, vulvar and/or vaginal itching, dysuria or dyspareunia. Vaginal pH, superficial and parabasal cells were also measured at baseline and week 12. Analyses were performed to determine whether moderate symptoms differed from severe symptom severity for each physiological measure. Parabasal cells and pH were assessed using the Wilcoxon test, while superficial cells were analyzed using chi-squared test.

Results: Generally few consistent significant differences between moderate and severe symptoms were noted for the three physiological measures. The exception to this finding was for dyspareunia, in which both studies had significant differences between moderate and severe symptom severity and percentage of parabasal cells. Subjects with moderate dyspareunia had parabasal cells percentages of 41.57 and 46.22 in the two studies, while severe subjects had an average of 56.22 and 57.14. The differences were statistically significant (p<0.01).

Conclusions: Severity of VVA symptoms in these studies could not be predicted based on physiologic assessments except for the difference for severe dyspareunia and percentage of parabasal cells. Whether parabasal cell count can be used as a biomarker for patients at risk for severe dyspareunia requires further study.

Disclosure:

Work supported by industry: yes, by Sermonix Pharmaceuticals (industry initiated, executed and funded study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

02:20 p.m. - 02:30 p.m.
VIVEVE I: VIveve Treatment of the Vaginal Introitus to Evaluate Effectiveness: An Interim Analysis (#027)
Michael Krychman, MD, IF

027

VIVEVE I: VIveve Treatment of the Vaginal Introitus to Evaluate Effectiveness: An Interim Analysis
Krychman, ML1; Wilkerson, D2
1: Southern California Center for Sexual Health and Survivorship Medicine Inc.; 2: Senior Director, Clinical Affairs, Viveve, Inc.

Introduction: Vaginal tissue laxity has often been overlooked as a contributing etiological factor to female sexual dysfunction. Vaginal looseness can lead to diminished physical sensation during intercourse. This reduction of sensation is often coupled with a reduction in sexual satisfaction, which can also impact a woman’s relationship with her sexual partner. The Viveve System is a monopolar radiofrequency system that uses surface cooling and radiofrequency (RF) energy delivery to provide a nonablative and minimally-invasive approach to creating heat deep within the layers of vaginal soft tissue, while keeping the surface cool. The Viveve procedure consists of a single, 30-minute, office-based, treatment of the vaginal introitus to improve sexual function. Interim prospective, controlled, randomized data is promising and presented here.

Methods: A prospective, longitudinal, randomized, blinded, controlled, multi-center clinical study is ongoing. This study is the first of its kind ever done for the medical condition of vaginal laxity. Over 150 subjects were randomized in a 2:1 ratio to either the active treatment group (90 J/cm2) or sham group (1 J/cm2). Subjects will be followed up at 72 hrs, 10 days, and 1, 2, 3, and 6 months post-treatment. Clinical scales for assessment include Female Sexual Function Index (FSFI), Vaginal Introitus Laxity Inventory (VALI), Female Sexual Distress Scale-Revised (FSDS-R), and the Viveve System Questionnaire (VSQ).

Results: An unblinded interim analysis was performed in July 2015 on all enrolled subjects (who did not have a major protocol deviation and in whom 3 month data was available) to reassess the sample size estimate and examine the safety profile in each treatment group. Early results suggest a positive effect of the Viveve system at 3 months, compared to placebo. Additionally, the procedure was well tolerated, with no serious adverse events reported and no topical anesthetics used or required.

Conclusion: In-office, targeted radiotherapy with cooling treatments show excellent promise for safe and effective treatment of vaginal laxity to improve sexual function.  To date over 1,000 women have been treated worldwide and no serious adverse events have been reported. Final analysis is forthcoming in the middle of 2016.

Disclosure:

Work supported by industry: yes, by Viveve, Inc.. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.


01:00 p.m. - 02:30 p.m.
Instructional Course 3 - Mindfulness Training: Learn through Participation
Location: Crystal Ballroom ABC
Faculty: Lori Brotto, PhD, Rpsych & Michael Krychman, MD, IF


02:30 p.m. - 03:00 p.m.
Coffee Break - Visit Exhibitors
Location: Crystal Ballroom Foyer


03:00 p.m. - 05:00 p.m.
Symposium 4 - Continence in Women Across the Lifespan
Location: Crystal Ballroom DEF
Moderator: Sue W. Goldstein, BA, IF

Urinary Incontinence, Sexual Dysfunction and Aging in Women
Alison J. Huang, MD, MAS, Mphil

Urinary Incontinence: Treatments and Outcomes
Kimberly S. Kenton, MD

Preventing and Treating Urinary Incontinence – The Role of Pelvic Floor Physiotherapy
Melanie Morin, PhD, MSc


05:00 p.m. - 06:30 p.m.
Poster Session (with drinks/food)
Location: Emerald Ballroom 1

Rejoice Trial: Evaluation of an Applicator-free Vaginal Estradiol Softgel Capsule for the Treatment of Postmenopausal Dyspareunia Associated with Vulvar and Vaginal Atrophy (VVA) (#018)
G. Constantine

018

Rejoice Trial: Evaluation of an Applicator-free Vaginal Estradiol Softgel Capsule for the Treatment of Postmenopausal Dyspareunia Associated with Vulvar and Vaginal Atrophy (VVA)
Constantine, G1; Bernick, B2; Kushner, H3; Mirkin, S2
1: EndoRheum Consultants LLC, Malvern, PA; 2: TherapeuticsMD Inc, Boca Raton, FL; 3: Biomedical computer Research Institute, Philadelphia, PA

Objective: TX-004HR is an investigational applicator-free vaginal softgel capsule containing 17β-Estradiol (E2) designed to provide adequate efficacy, low systemic absorption, easy insertion, complete dissolution to minimize vaginal discharge after administration. The Rejoice trial, a phase 3 clinical study, evaluated the efficacy and safety of TX-004HR in postmenopausal women with moderate-severe symptoms of vulvar and vaginal atrophy (VVA). For treatment of VVA symptoms, FDA guidance recommends demonstrating statistically significant improvement from baseline in: superficial vaginal cells, parabasal vaginal cells, vaginal pH, and the moderate to severe VVA symptom identified by the patient as the most bothersome. Dyspareunia and vaginal dryness are frequently reported VVA symptoms and often co-occur; however, of recent treatments approved for dyspareunia, none demonstrated a robust statistically significant difference over placebo for the endpoint of vaginal dryness.  

Methods: Postmenopausal women (40-75 years) with ≤ 5% superficial cells on vaginal cytological smear, vaginal pH > 5%, and moderate to severe dyspareunia enrolled in a multicenter, double-blind, placebo-controlled, phase 3 clinical trial and randomized to one of 3 doses of TX-004HR (25 μg, 10 μg, or 4 μg) or placebo. Co-primary endpoints included statistically significant improvement from baseline to Week 12 in vaginal superficial and parabasal cells, vaginal pH, and the severity of dyspareunia (as the most bothersome symptom of VVA). Planned secondary endpoints included assessments of vaginal dryness.

Results: The REJOICE trial enrolled 764 postmenopausal women (mean: 59 years) experiencing moderate to severe dyspareunia at 89 sites across the US and Canada. All 3 doses of TX-004HR demonstrated statistically significant improvement over placebo across all four co-primary endpoints (P ≤ 0.0001 for all doses and coprimary endpoints, except 4 μg dose for dyspareunia, P=0.0255). All 3 doses also demonstrated a statistically significant difference over placebo for vaginal dryness (P ≤ 0.0001 for 25 μg and 10 μg ; P = 0.025 for 4 μg). There were no clinically significant differences in AEs among patients treated with TX-004HR compared to placebo. There were no treatment-related serious AEs reported.

Conclusions: The REJOICE trial demonstrated efficacy and safety of TX-004HR for the treatment of moderate to severe dyspareunia associated with VVA in postmenopausal women. In addition, improvements in a key a priori planned secondary endpoint of vaginal dryness were also statistically significant when compared with placebo for up to 12 weeks of treatment. This investigational applicator-free E2 vaginal softgel represents a potential, new treatment for symptomatic VVA.

Disclosure:

Work supported by industry: yes, by TherapeuticsMD Inc. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

Prevalence and Motivation for Pubic Hair Removal among Women in the United States (#035)
Tami Rowen, MD, MS

035

Prevalence and Motivation for Pubic Hair Removal among Women in the United States
Rowen, TS1; Gaither, TW2; Awad, MA2; Osterberg, C2; Shindel, AW2; Breyer, BN2
1: Department of Obstetrics, Gynecology and Reproductive Sciences. University of California, San Francisco; 2: Department of Urology. University of California, San Francisco

Background: Pubic hair grooming is an increasingly prevalent trend. Several studies have sought to characterize its prevalence, associated demographics and motivations. This national study enrolled a representative sample of women to characterize current grooming practices in the United States. 

Methods: A nationally representative survey of noninstitutionalized adults aged 18–65 residing in the United States was collected. We developed a questionnaire examining grooming habits. Analysis focused on demographic characteristics and motivations associated with grooming.

Results: A total of 3316 women were included in the analysis, of which 2778(83.8%) reported genital grooming and 538 (16.2%) reported never grooming. On bivariate analysis grooming was associated with younger age, Caucasian race, higher education/income, and more sexual activity. On multivariate analysis only age, race, education and partner preference were associated with grooming. There was no association between type of relationship or sexual activity and grooming.

Conclusion: This study is the first of its kind to provide a nationally representative assessment of contemporary female genital grooming habits. We found demographic differences in grooming which may reflect cultural variations in preference related to pubic hair. Healthcare providers can use this information to better counsel patients and understand grooming practices.

Disclosure:

Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

A Review of Treatment Options for Compromise of Vaginal Tissue Integrity (Vaginal Laxity) (#036)
Michael Krychman, MD, IF

036

A Review of Treatment Options for Compromise of Vaginal Tissue Integrity (Vaginal Laxity)
Krychman, ML1; Wilkerson, D2
1: Southern California Center for Sexual Health and Survivorship Medicine, Inc.; 2: Senior Director, Clinical Affairs, Viveve, Inc.

Introduction: Vaginal tissue architecture and laxity has often been overlooked as contributing etiological factor to female sexual dysfunction. Vaginal looseness can lead to diminished physical sensation during intercourse. This reduction in sensation is often coupled with a reduction in sexual satisfaction, which can also impact a woman’s relationship with her sexual partner.

Methods: A comprehensive PubMed review was performed with key words: vagina/laxity/sexual function or vagina/loose/sexual function. A total of 15 English articles were assessed.

Results: The following treatment options were mentioned in the scientific literature and a benefit/risk assessment of each will be presented. Over-the-Counter (OTC) Vaginal Tightening Products: OTC products remain unregulated, may severely disrupt the vaginal ecosystem, and often have unsubstantiated claims. Behavioral Modification: Pelvic floor physical therapy exercises, including Kegel exercises, have often been viewed as a noninvasive mainstay treatment for vaginal laxity, however they are time consuming and have poor patient compliance and limited efficacy. Office-Based Outpatient Radiofrequency Intervention: Two published clinical studies for treatment of vaginal tissue to improve laxity and sexual satisfaction; 30 minute office-based, minimally-invasive procedure. Surgical Correction: Surgery is an invasive approach, which can include a substantial recovery period, and potential for serious adverse effects (e.g., suburethral trauma).

Conclusion: Vaginal tissue integrity can directly impact sexual function. There are limited clinically proven, safe and effective treatments. A nonablative, in-office targeted radiotherapy with cooling treatment of the vaginal introitus shows excellent promise for safe and effective treatment for this currently unmet medical need. 

Disclosure:

Work supported by industry: yes, by Viveve, Inc.. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

Effects of Physical Therapy on Female Dyspareunia in Japan (#037)
M. Shigeta

037

Effects of Physical Therapy on Female Dyspareunia in Japan
Shigeta, M1; Sekiguchi, Y1; Nakamura, R2
1: Japan; 2: , Japan

Objectives: The purpose of this study was to investigate effects of the physical therapy on female dyspareunia in Japan. Women who have dyspareunia or vaginismus have hyperactivity / hypertonia of the pelvic floor and it’s called an OVERACTIVE PELVIC FLOOR. Physical therapy reduced their chronic vulvar pain more than half on 71 % of women. 62 % improved their sexual lives and 50 % on their Quality of life. (Hartmann D. et al. 2001).And also the women with strong pelvic floor muscles were higher score of Female Sexual Function Index questionnaire (FSFI) (Lowenstein L. et al. 2010).However physical therapy hasn’t been known and done as a treatment on female dyspareunia in Japan.

Materials and Methods: Nineteen women (mean age 43.3 +/- 10.0 years) who had dyspareunia visited our clinic between April 2011 and March 2015 were evaluated by the validated Female Sexual Function Index questionnaire (FSFI), Visual Analog Scale (VAS) which is for patient’s satisfaction and Oxford Grading Scale (OS) which is for patient’s pelvic floor muscles strength. We compared the first from the last evaluations. The Patients were underwent progressive muscle relaxation method, myofascial release of pelvic floor muscles, internal soft tissue mobilization and massage treatment, pelvic floor muscles strengthening, and systematic desensitization therapy with vaginal dilators by a physical therapist. And the physical therapist suggested some home programs such as self-massage, stretching and strengthening of pelvic floor muscles with dilators or fingers of themselves.

Results: The average from all evaluations significantly improved after physical therapy (p<0.05) .Total score of the FSFI was up 8.4, desire 0.7, arousal 1.3, vaginal lubrication 1.4, orgasm 1.1, satisfaction 1.6, pain 2.3. The VAS mean first 93.2 +/- 6.7 → after 41.1 +/- 23.8, The OS mean first 2.5 +/- 1.0 → after 3.6 +/- 0.8.

Conclusions: In this study, the treatments with enough counseling, systematic desensitization and Physical therapy may contribute to improve female dyspareunia. Pelvic floor disorders of hyperactive type causally related to sexual pain disorders may affect the sexual response (Graziottin 2000). Therefore physical therapists should be part of the multidisciplinary team such as sexologists, gynecologists, urologists and psychologists involved in the center of sexual medicine.

Disclosure:

Work supported by industry: no.

Female Survivors of Sexual Abuse: Do they Differ in Sexual Behavior, Attitudes, and Perceptions towards Sexuality? Findings from a Cross-Sectional Survey Conducted among University Students in Lebanon (#038)
F. El Kak

038

Female Survivors of Sexual Abuse: Do they Differ in Sexual Behavior, Attitudes, and Perceptions towards Sexuality? Findings from a Cross-Sectional Survey Conducted among University Students in Lebanon
El Kak, F1; El Salibi, N1; Yasmine, R1; Ghandour, L1
1: American University of Beirut, Lebanon

Objectives: Myths and misconceptions about sexual abuse place an added burden on women through negative attributions and social stigmatizations. This study aims to investigate whether female university students who reported sexual abuse vary in their sexual practices, attitudes, and perceptions from those who did not (adjusting for socio-demographics).

Materials and Methods: A cross-sectional anonymous online survey was conducted between April-August 2012 among undergraduate and graduate females (aged 18-30) attending the 4th largest private university in Lebanon.

Results: One in five females (21%) reported lifetime sexual abuse. Compared to females with no history of sexual abuse, female survivors were 2-3 times as likely to report penetrative sexual experiences (p<0.0001), but were equally likely to report ever engaging in oral or anal sex to avoid hymen-breaking. Survivors of sexual abuse were more likely to report engaging in sexual activities they did not really want to (OR=7.44, p <0.0001), coercion at sexual debut (OR=3.42, p <0.0001), and ever being in a relationship where things were moving too fast physically (OR=2.57, p <0.0001). Reported reasons for engaging in sexual intercourse were similar for both groups whereby 68% would have sex if they are going to marry their partner and 87% would do so if they had a partner they loved and were comfortable with. Both female groups were also equally likely to agree that sexual intercourse is an intimate experience (94%) and that only two people who trust each other completely should have sexual relations (81%).Reasons for delaying sexual debut were also similar where the majority reported that it is against their belief or religion (75%), that their parents would disapprove (76%), or felt concerned about their reputation, losing self-respect, feeling guilty, or social repercussions (67%).

Conclusions: Contrary to social misconceptions, our findings suggest that survivors of sexual abuse do not necessarily have more open practices and views about sexuality. Understanding gender norms and breaking sex role stereotyping is crucial to prevent sexual abuse and victim blaming and enable survivors to reach out for support and counselling.

Disclosure:

Work supported by industry: yes, by Ford Foundation (industry funding only - investigator initiated and executed study).

Bringing the Body of the Iceberg to the Surface: the Female Sexual Dysfunction Index-6 (FSDI-6) in the Screening of Female Sexual Dysfunction (#039)
L. Vignozzi

039

Bringing the Body of the Iceberg to the Surface: the Female Sexual Dysfunction Index-6 (FSDI-6) in the Screening of Female Sexual Dysfunction
Maseroli, E1; Fanni, E1; Fambrini, M1; Ragghianti, B1; Limoncin, E2; Maggi, M1Vignozzi, L1
1: University of Florence, Italy; 2: University of L'Aquila, Italy

Objectives: Female Sexual Dysfunction (FSD) is a still poorly studied and underdiagnosed condition. The aim of the study was to produce an improved version of FSFI-6 (6-Item Version of the Female Sexual Function Index), entitled FSDI-6 (Female Sexual Dysfunction Index-6), and to estimate its accuracy as a screening instrument for FSD.

Material and Methods: In the new version, an item related to the personal interest in having a satisfying sex life was added, while the item rating the entity of sexual arousal was removed. We administered FSDI-6 in a consecutive series of female adult patients not consulting for sexual problems (n=120, Cohort 1), and in another series of patients specifically consulting for sexual problems, which were considered as the control group (n=160, Cohort 2).

Results: FSDI-6 score was significantly higher in patients in Cohort 2 (p<0.0001). Cronbach’s alpha for FSDI-6 was 0.784, indicating a high level of reliability. The estimated area under the ROC curve for FSDI-6 was 0.657 (p< 0.0001, 95% CI 0.584- 0.730). The proportion of subjects with a pathological FSDI-6 score (≥16.5) was 29.9

(n=32) and 59.4% (n=95) in Cohort 1 and 2, respectively (p<0.0001). Among subjects with a pathological FSDI-6 (score≥16.5), those consulting for FSD had been postmenopausal for fewer years, had a higher level of education, a lower BMI and a lower prevalence of chronic diseases than those not consulting for FSD (p<0.05).

Conclusions: Although a lower educational level, overweight/obesity, menopause and chronic diseases are risk factors for FSD, they are often associated with the failure in medical consultation for FSD. We propose that FSDI-6 should be performed by health care providers in non-specialist settings in order to detect potential FSD, which otherwise could remain under-diagnosed.

Disclosure:

Work supported by industry: no.

Social Media's Impact on PGAD Patients (#040)
L. Cataldo

040

Social Media's Impact on PGAD Patients
Cataldo, L1; Ramsey, K1
1: PGAD Support for Men and Women - Facebook, USA

Objective: Due to the sensitive and embarrassing symptoms of Persistent Genital Arousal Disorder (PGAD), isolation of PGAD patients is a concern. At present, social media provides much needed information and support for people living with this rare disorder, both nationally and internationally.

Method: Social media on this topic was examined, including PGAD Support for Men and Women, a secret Facebook group, a Yahoo PGAD group- PSAS-support.com, and a recently added YouTube information site. All websites are available for patients seeking in-depth knowledge and support for symptoms of PGAD. We assessed screening procedures for membership, kinds of members and content.

Results: On the Facebook and Yahoo site, potential group members are screened to exclude non-PGAD patients, press and sexual predators. Once members have cleared the screening and are accepted, they are welcomed to a safe, nonjudgmental online space where they have access to a variety of resources. Some healthcare providers are also involved including doctors familiar with treating PGAD, qualified physical therapists, and therapists who are PGAD friendly. Site content includes research articles, member observations/experiences, and alternative treatments that have been successful in symptom management for those who eschew traditional medicine. Most importantly, members are part of a growing, informed and supportive PGAD community.

Conclusions: Online support sites for PGAD sufferers allow willing members to share experiences and support newer members as they navigate lives made even more stressful by PGAD. Additional information is needed for both healthcare providers and PGAD sufferers to better understand and treat the condition, as well as advocacy for it to be recognized.

Disclosure:

Work supported by industry: no.

Self-Reported Sexual Problems Predicts Higher Levels of Depression, Anxiety and Distress in Female Cancer Patients (#041)
M. Hughes

041

Self-Reported Sexual Problems Predicts Higher Levels of Depression, Anxiety and Distress in Female Cancer Patients
Hughes, M1; De La Garza, R1
1: UT MD Anderson Cancer Center, USA

Objective: The current study was designed to evaluate the prevalence of sexual problems and the extent to which this impacted mood symptoms in cancer patients.

Methods: Only adult female patients seen from July 2014-September 2015 in the MDACC outpatient psychiatry oncology clinic who provided informed consent were included (N=733). Assessment tools include the Patient Health Questionnaire-9 (PHQ-9) to measure depression, the Generalized Anxiety Disorder scale (GAD-7) to measure anxiety, and the NCCN Distress Management Thermometer (DT) and Checklist to measure distress. Demographic variables included age, race/ethnicity, and marital status. Additional categorical variables included cancer diagnosis and psychiatric diagnosis. Data are presented as percentages or Mean ± S.E.M.

Results: In this cohort, 25.3% (186/733) female patients endorsed (Yes vs. No) “sexual problems” on the DT checklist. Patients who endorsed sexual problems were significantly younger (48.9±.8 vs. 53.2±.5, F1,730=17.7, p<.0001), but there were no differences according to race/ethnicity (χ2=1.4, p=.51). Patients in a committed relationship (married or life partner) were more likely to endorse sexual problems as compared to those who were single, separated, divorced or widowed (31.6% vs. 21.9%; χ2=12.1, p=.0005). Of interest, there were no differences in prevalence of sexual problems according to psychiatric diagnosis (χ2=1.4, p=.51). Importantly, patients who endorsed sexual problems had significantly higher levels of depression (13.1±.4 vs. 10.3±.2, F1,730=33.1, p<.0001), anxiety (11.6±.4 vs. 9.0±.2, F1,730=29.3, p<.0001) and distress (6.5±.2 vs. 5.5±.1, F1,730=17.0, p<.0001).

Discussion: The data indicate that one quarter of all female patients seen at the MDACC Psychiatric Oncology Clinic endorsed sexual problems and that these individuals exhibit significantly greater levels of depression, anxiety and distress. Patients who reported sexual problems tended to be younger and in a committed relationship.

Women who are being treated for cancer are often not evaluated for sexual changes during or after their treatment since the oncologist focuses on treating cancer. Since sexuality is a quality of life issue, it often does not surface until treatments are complete and the patient is in the survivorship stage of her cancer. If a woman complains of depression or anxiety, it is important to also assess for sexual dysfunction. Conversely, if a woman reports sexual problems, she should be assessed for depression and anxiety.

Disclosure:

Work supported by industry: no.

Vagal Activity During Physiological Sexual Arousal in Women With and Without Sexual Dysfunction (#042)
A. Stanton

042

Vagal Activity During Physiological Sexual Arousal in Women With and Without Sexual Dysfunction
Stanton, A1; Pulverman, C2; Meston, C1
1: The University of Texas at Austin, USA; 2: The University of Texas at Austin, USA

Introduction: Changes in the high frequency band of heart rate variability (HRV) are due to respiratory sinus arrhythmia (RSA), the cyclical increase and decrease in heart rate that occurs with respiration. RSA is mediated by the parasympathetic nervous system (PNS) through the vagus nerve (Berntson, Cacioppo, & Quigley, 1993). High frequency HRV, indexed by RSA, has been used as a measure of overall PNS activity and the strength of vagal influence on the heart (Berntson et al., 1997; Malik et al., 1996). Recently, HRV has also been associated with female sexual function (Stanton, Lorenz, Pulverman, & Meston, 2015). Low HRV was a significant predictor of female sexual arousal dysfunction and overall sexual dysfunction. Building upon this established relationship between HRV and female sexual function, the present study examined the hypothesis that differences in vagal activity between sexually functional and sexually dysfunctional women may be driving the association between low HRV and female sexual dysfunction.

Objective: To assess vagal activity, indexed by RSA, before, during, and after physiological sexual arousal and to examine potential differences in RSA between sexually functional and sexually dysfunctional women.

Materials and Methods: Sexual function was assessed in 84 women, aged 18-47, with the Female Sexual Function Index (FSFI; Rosen et al., 2000), an empirically validated, 19-item questionnaire. ECG was recorded using Biopac MP150 (Biopac Systems, CA, USA) at a sample rate of 200 samples/sec. Power spectral densities of the beat-to-beat interval variability were determined via the Fast Fourier Transform using Kubios HRV Analysis Software (Biosignal Analysis and Medical Imagine Group, University of Kuopio, Kuopio, Finland).

Results: Significant differences in vagal activity, specifically differences in vagal activity from baseline to the presentation of the erotic stimulus, between sexually functional women and sexually dysfunctional women were observed (p = .02).

Conclusions: Vagal activity, indexed by RSA, during physiological sexual arousal may provide additional specificity to the recently established relationship between HRV and female sexual function while also offering a potential mechanism to target during treatment for sexual dysfunction.

Disclosure:

Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

Hormonal and Psychosocial Characteristics of Female Sexual Dysfunction (#043)
S. Wåhlin-Jacobsen

043

Hormonal and Psychosocial Characteristics of Female Sexual Dysfunction
Wåhlin-Jacobsen, S1; Pedersen, AT2; Kristensen, E1; Læssøe, NC1; Lundqvist, M3; Cohen, AS3; Hougaard, DM3; Giraldi, A1
1: Psychiatric Center Copenhagen, Denmark; 2: Copenhagen University Hospital, Denmark; 3: Statens Serum Institute, Denmark

Objective: Women’s sexual response is influenced by several inhibitory and excitatory neurophysiological and psychological mechanisms interacting with social and cultural factors. Both neurotransmitters and sex hormones are thought to modulate women’s sexual response and desire. Low levels of testosterone (T) are seen as a risk factor of impaired sexual function, but larger studies investigating the effect of T are missing.

The aim of this study was to investigate how androgen levels and psychosocial factors are associated to Female Sexual Dysfunction (FSD) including Hypoactive Sexual Desire Disorder (HSDD).

Material and Methods: 529 women aged 19-65 years were included in this cross-sectional study. All women filled out a questionnaire including data on psychosocial factors and had a blood test taken on a standardized time in their menstrual cycle. FSD, sexual distress and HSDD was investigated using the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale (FSDS). Serum levels of T and dehydroepiandrosterone sulphate (DHEAS) were analyzed using mass spectrometry. Logistic regression models were built to test the association between hormone levels and psychosocial factors (explanatory factors) and FSD or HSDD, respectively, and to adjust for relevant confounders. P levels < 0.05 were considered as statistically significant.

Results: DHEAS was associated (p = 0.011) to FSD after adjustment. Relationship length above two years (p = 0.004), and impaired well-being (p < 0.001) were also associated to FSD. T (p = 0.004) and DHEAS (p = 0.028) were associated to HSDD in primary analysis, however after adjustment, only age (p = 0.038), relationship length above two years (p = 0.004), and impaired well-being (p < 0.001) stayed associated to HSDD.

Conclusion: In this large cross-sectional study a statistically significant association between DHEAS and FSD was found, and age was found to associate to HSDD. Relationship length above two years and impaired quality of life were found to associate to both FSD and HSDD.

Disclosure:

Work supported by industry: no.

E-Recruitment for Clinical Trials in Sexual Medicine – A Rising Method for a Modern World (#044)
M.S. Carroll

044

E-Recruitment for Clinical Trials in Sexual Medicine – A Rising Method for a Modern World
Carroll, MS1; Morin, M1; Dumoulin, C2; Mayrand, MH2; Waddell, G1; Khalifé, S3; Bergeron, S2; Dubois, MF1
1: University of Sherbrooke, Canada; 2: University of Montreal, Canada; 3: McGill University

Objective: Efficient recruitment of participants plays a crucial role in clinical trials and investigators are increasingly tempted toward new e-recruitment initiatives. The aim of this study was to compare the number of patients enrolled, the retention rate and the baseline characteristics of participants recruited using three recruitment methods (E-recruitment, professional referrals and conventional methods)

Material and Methods: The comparison data were collected as part of a bi-centric, parallel group randomized controlled trial evaluating the efficacy of physiotherapy in comparison to topical lidocaine in 212 women suffering from provoked vestibulodynia. The three recruitment methods included: 1) E-recruitment (Facebook ads and Web pages), 2) Health professional referrals (physicians, gynecologists and physiotherapists) and 3) Conventional methods (ads in local newspapers, word of mouth, posters and leaflets in clinics, university, professional schools, restaurants, gyms, etc.). Women interested in participating were screened verbally by telephone and were assessed by one of our gynecologist to confirm their diagnosis. Structured interviews were undertaken to describe their baseline characteristics (age, pain intensity, duration of symptoms, frequency of intercourse, pain at first intercourse and use of oral contraceptive). Chi-square and one-way analysis of variances were used to compare the participants according to their recruitment methods.

Results: Most of the participants were recruited using conventional methods (56.1%) followed by the E-recruitment methods (28.3%) and health professional referrals (15.6%). The retention rate (91-97%) was found to be similar between the three groups (p=0.351). As regards to baseline characteristics, no significant differences were found between the three groups (p≥0.141).

Conclusion: Multiplication of recruitment methods appears beneficial in promoting clinical trial recruitment. Given that the recruitment methods influenced neither retention rate nor patient baseline characteristics, the use of E-recruitment is promising in sexual health trials. An economic analysis is planned to compare cost implication for the different methods.

Disclosure:

Work supported by industry: no.

An Examination of a Continuous Measure of Subjective Sexual Arousal in Arousal Specificity for Abused and Non-Abused Women (#045)
C. Kilimnik

045

An Examination of a Continuous Measure of Subjective Sexual Arousal in Arousal Specificity for Abused and Non-Abused Women
Kilimnik, C1; Pulverman, C1; Handy, A1; Meston, C1
1: University of Texas at Austin, USA

Objective: Subjective sexual arousal is typically measured via recall using a self-report Likert scale after the presentation of sexual stimuli. This methodology may miss variations in arousal across time during the presentation of different sexual stimuli. The current study examined subjective sexual arousal differences between women with and without a history of childhood sexual abuse (CSA) using both a self-report Likert scale and a continuous measure of arousal. The aim was to examine whether a continuous measure of sexual arousal provides information on the specificity of arousal not detectable using recall self-report measures.

Methods/Materials: Women with a history of CSA that included penetration (n = 38), did not include penetration (n = 20), and with no history of CSA (n = 68) watched erotic film clips (2 minutes of foreplay, 2 minutes of oral sex, and 2 minutes of penetrative intercourse) while continuously reporting on their state sexual arousal using a device that that electronically records changes in arousal as it is slid across intervals (0-7). They then completed a 3-item self-report Likert measure of subjective sexual arousal (Heiman & Rowland, 1983).

Results: There were no observed differences between women in the NSA and CSA groups overall in their subjective arousal across film types using either continuous or Likert Scale measures of subjective sexual arousal. However, differences emerged between groups in subjective arousal specificity across film content. Women who had experienced non-penetrative CSA (M = .62, SD = .30) reported significantly higher subjective arousal to the oral sex film clip than did both the NSA group (M = 55, SD = .29), and the CSA penetration group (M = .45, SD = .29; F(2, 120) = 6.41, p = .002, ηp2 = .10).

Conclusions: The use of a continuous measure of arousal during the presentation of sexual stimuli provides more information than retrospective self-report, particularly for arousal specificity. The differences in subjective arousal within the CSA group supports previous findings that characteristics of the CSA events may influence different sexual outcomes (Lemieux & Byers, 2008). The higher arousal of the non-penetrative CSA group may be reflective of the hyper- and hyposexual behaviors reported in women with a history of CSA (Rellini, 2008). Research should explore differences in cognitive, affective, and physiological differences within women with CSA history dependent on the penetrative status of the CSA.

Disclosure:

Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

Differences in why Women with and without Sexual Dysfunction have Sex (#046)
A.B. Handy

046

Differences in why Women with and without Sexual Dysfunction have Sex
Handy, AB1; Stanton, AM1; Kilimnik, C1; Meston, C1
1: University of Texas at Austin, USA

Objective: The aim of the current study was to examine whether sexually functional and dysfunctional women differ in the number and reasons for engaging in sex. Based on past research showing sexually healthy women use significantly more cues for engaging in sex than do women with sexual dysfunction (McCall & Meston, 2006), we hypothesized sexually functional women would also have a greater number of reasons for having sex than would sexually dysfunctional women. We also hypothesized there would be differences between sexually functional and dysfunctional women in the reasons they endorsed for having sex. Specifically, sexually functional women would endorse a greater number of Physical reasons for having sex, and sexually dysfunctional women would endorse more reasons pertaining to Insecurity.

Materials/Methods: One hundred and fifty-five sexually functional and dysfunctional women completed the Reasons for Having Sex Questionnaire (YSEX; Meston & Buss, 2007) and the Female Sexual Function Index (FSFI; Rosen et al., 2000). The YSEX assess sexual motivations across four factors (Physical, Goal Attainment, Emotional, and Insecurity), each of which has two to four subscales. Because sexually functional women were significantly younger than dysfunctional women, age was controlled for in subsequent analyses.

Results: Sexually functional women had significantly greater FSFI scores (M = 31.31, SD = 3.47) than did dysfunctional (M = 23.92, SD = 5.55) women (p < .001). There was no difference in total number of reasons between the two groups of women, nor were there differences in number of reasons endorsed on the Physical, Goal Attainment, or Emotional factors. Women with sexual dysfunction endorsed significantly more reasons for engaging in sex on the Insecurity factor, F(1, 151) = 3.929, p = .049. Specifically, we found the Duty/Pressure subscale to be driving this difference, F(1, 151) = 6.928, p = .009. Sexually dysfunctional women also endorsed using Duty/Pressure reasons more frequently than did sexually functional women, F(1, 151) = 8.725, p = .004.

Conclusion: The results speak to the cycle of dysfunction that is often seen in clinical settings, in which the pressure and feelings of duty to have sex lead women to engage in sex that they may not enjoy. These findings suggest that clinicians may need to target this sense of duty to alleviate pressure and encourage enjoyable sex.

Disclosure:

Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

Review of the Evidence of the Female Prostate as a Functional Gland (#047)
N. Szell

047

Review of the Evidence of the Female Prostate as a Functional Gland
Szell, N1; Goldstein, S2; Komisaruk, B3; Goldstein, I2
1: St. John Providence Health System, USA; 2: San Diego Sexual Medicine, USA; 3: Rutgers Universtiy, USA

Introduction: We have observed women with new-onset internal vaginal orgasmic dysfunction following mid-urethral sling surgery for stress urinary incontinence. We have also reported a meta-analysis of 2350 women in whom there was a large discrepancy noted in orgasm satisfaction versus overall sexual satisfaction following mid-urethral sling placement. We thus propose that mid-urethral slings cause injury to neural pathways to the “female prostate”, as the existence and function of the female prostate is fully supported by extensive reliable contemporary evidence.

Methods: A literature search was performed using "female prostate", "Skene's glands", "paraurethral glands", and "G-spot". Over 200 publications were found, narrowed down based on relevance and analyzed in comparison to the male prostate. Categories included anatomy, physiology, embryology, pathology, neural innervation, adenomatous and cancerous changes, orgasmic potential. Anatomical depictions and imaging studies were included when relevant.

Results: More than 60 publications were included for review and analysis, including critical historic data from Zaviacic, Skene, Grafenberg, and others. Since the time of Kama Sutra, 400 BCE, scholars have proposed the existence of sexually sensitive homologous "female prostate" adjacent to the anterior vaginal wall. Contemporary researchers, however, have characterized “female prostate” exhibiting glandular and secretive elements identical to male prostate via immunohistochemical studies with prostate specific antigen (PSA), prostate specific acid phosphatase, androgen receptors, three dimensional modelling, and waxy casts.

Conclusion: “Female prostate” is embryologically and physiologically identical to male prostate. In some women, stimulation of “female prostate” via the anterior wall of the vagina results in ejaculation and orgasm. This is analogous to stimulation of the rectum resulting in ejaculation and orgasm in some men. The female prostate is not simply a vestigial organ. .

Disclosure:

Work supported by industry: no.

"Partner Prosthesis Panic": Management of Female Sexual Dysfunction in Partners of Men Undergoing Penile Prosthesis Implantation (#048)
Irwin Goldstein, MD, IF

048

"Partner Prosthesis Panic": Management of Female Sexual Dysfunction in Partners of Men Undergoing Penile Prosthesis Implantation
Hartzell, R1; King, SA2Goldstein, I2
1: San Diego Sexual Medicine, USA; 2: Alvarado Hospital, USA

Objectives: About 30,000 penile implants are placed annually in the US. In our practice, several female partners in monogamous relationships with men with ED considering implant surgery have expressed significant concern over the re-introduction of an erect penis into their sexual lives. We define "Partner Prosthesis Panic” as the concerns of the female sexual partner who described issues such as: her low sexual desire, reduced arousal, muted orgasm, and bothersome pain during penetration. These conditions may negatively influence post-op outcome and frequency of implant use. We examined prevalence of “Partner Prosthesis Panic” and management strategies of distressed female sexual partners of men undergoing penile prosthesis implantation.

Materials and Methods: In the last fifty consecutive penile implant surgeries in men in monogamous relationships, we identified 11 (22%) female sexual partners (mean age 57 +/- 11 years) who expressed “Partner Prosthesis Panic” and underwent management in our facility.

Results: Contemporary management of women with sexual dysfunction is biopsychosocial including judicious use of FDA-approved and non-approved treatment options. 82% were menopausal, 18% were peri-menopausal. All had sexual dysfunction for >5 years prior to the implant. FSFI (mean 18 +/- 4) and FSDS (21 +/- 6) scores were abnormal in all. Psychologic interviews revealed findings consistent with a history of sexual trauma/abuse (27%) and mood issues: anxiety, depression, panic, use of mood-related medications (45%). Pelvic floor exams were abnormal in 73%. Vulvoscopy revealed abnormalities such as clitoral atrophy, resorption of labia minora, erythema/tenderness of minor vestibular glands, limited robust peri-urethral tissue, urethral prolapse, limited gavial rugae, abnormal vaginal pH in all 11 patients. Hormonal assessments of sex steroids were abnormal in all 11 patients. Following sex therapy, physical therapy, and biologic management, 8 of 11 experienced markedly improved sexual function that significantly facilitated couple satisfaction post-penile implantation.

Conclusions: Now that the FDA has approved treatments for women with sexual health concerns, management of women with sexual dysfunction, especially in monogamous relationships with men with ED considering penile implant surgery will become more commonplace. To maximize satisfaction following penile implant insertion, sexual medicine care to both individual members of the couple should be offered and provided.

Disclosure:

Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

Changes in the Sexual Self-Schema of Women with a History of Childhood Sexual Abuse Following Expressive Writing Treatment (#049)
C. Pulverman

049

Changes in the Sexual Self-Schema of Women with a History of Childhood Sexual Abuse Following Expressive Writing Treatment
Pulverman, C1; Boyd, R1; Stanton, A1; Meston, C2
1: University of Texas at Austin, USA; 2: Universtiy of Texas at Austin, USA

Objective: Sexual self-schema are cognitive generalizations about the sexual self that influence the processing of sexually pertinent information and guide sexual behavior. Until recently sexual self-schema were exclusively assessed with self-report instruments. Novel research using the Meaning Extraction Method (MEM), an inductive method of topic modeling, identified seven unique themes of sexual self-schema: family and development, virginity, abuse, relationship, sexual activity, attraction, and existentialism from the sexually-focused essays of 239 (Stanton, Boyd, Pulverman, & Meston, 2015). In the current study, these themes were used to examine changes in theme prominence for women with a history of childhood sexual abuse (CSA) and sexual dysfunction who completed an expressive writing treatment targeted towards improving sexual function.

Materials and Methods: Women (N = 138) with a history of CSA completed a five-session expressive writing treatment. Essays on sexual self-schema written at the pre-treatment intake session and at four post-treatment follow-up sessions were examined for changes in theme prominence.

Results: Women showed a reduction in the prominence of the abuse, family and development, virginity, and attraction themes, and an increase in the existentialism theme.

Conclusions: This study supports the validity of the seven sexual self-schema themes identified by Stanton and colleagues (2105). Specifically, women showed a decrease in their use of the abuse schema after treatment suggesting that expressive writing may aid women with a history of sexual abuse to process their abuse history such that it becomes a less salient aspect of their sexual self-schema. The only schema that increased in prominence after treatment was the existentialism schema, which invokes concepts associated with meaning-making and reflection, and may indicate that the treatment helped women to further reflect on their abuse history.

Disclosure:

Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

Lifetime Persistent Genital Arousal Disorder: Management of PGAD in an Adolescent (#050)
S.A. King

050

Lifetime Persistent Genital Arousal Disorder: Management of PGAD in an Adolescent
King, SA1; Espenschied, C2; Gagnon, C2; Minton, J3; Goldstein, I1
1: Alvarado Hospital, USA; 2: San Diego Sexual Medicine, USA; 3: San Diego Sexual Medicine, USA

Introduction: Persistent Genital Arousal Disorder (PGAD) is characterized by persistent or recurrent, unwanted or intrusive, bothersome or distressing feelings of genital arousal or being in the verge of orgasm (genital dysesthesia) not associated with concomitant sexual interest, thoughts or fantasies. PGAD most commonly occurs in sexually active adults, mostly women, who have already experienced sexual desire, arousal and orgasm. PGAD has not been previously reported in an adolescent, naïve to sexual activity, who describes her PGAD as “feelings”. This adolescent has despair, bother, emotional lability and difficulty attending school.

Methods: A 13 year old female, accompanied by her mother, presented with unwanted and unrelenting "feelings" lasting up to an hour at a time, recurring up to 6 times a day, that worsened with anxiety and stress and after swim team, and were unrelated to any known direct injuries to her genital area. She began having "feelings" around age 6 and by age 9 she needed to cross her legs to help relieve symptoms.

Results: MRI of the sacral spine S2-4 ruled out Tarlov cyst. No evidence of genital arousal: lubrication, swelling of clitoris or labia, was noted. She had a significant pain/grimacing response to umbilical hypersensitivity testing. Vulvoscopy revealed pubic hair consistent with Tanner Stage 3. Clitoris and hood were normal, both labia minora met at the posterior fourchette. Minor vulvar vestibular glands at 1, 3, 5, 6, 7, 9 and 11:00 oclock revealed moderate erythema with 8-9, 10, 10, 10, 10, 10 and 10/10 discomfort to cotton swab testing consistent with provoked vestibulodynia. Testosterone was low (9 ng/dl), SHBG 48 nmol/L, calcu-lated free testosterone was low (0.126 ng/dl), dihydrotestosterone was <5 ng/dl, LH was 2.1, FSH was 4.9, estradiol was 37 pg/ml and progesterone was absent. A vestibular anesthesia test (VAT) was performed with topical bupivicaine, lidocaine, tetracaine between Hart’s line and intact hymen. She experienced loss of her “feeling” for the first time and there was a dramatic shift in mood and affect, going from tearful to giddy, happy, joking, and ambulating in the office halls. Local vestibular testosterone 0.1% and estradiol 0.02% cream x 6 months was not successful. Her current diagnosis is congenital neuro-proliferative vestibulodynia. Current management includes tramadol 2.5 mg TID and zolpidem 0.5 mg prn. She is considering complete vestibulectomy in 5 years when she is 18 years.

Conclusion: PGAD in adolescents is a significant clinical challenge.

Disclosure:

Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

The Use of Ilioinguinal Nerve Block for Treatment of Chronic Pelvic Pain (#051)
S. Bahlani-Khanna

051

The Use of Ilioinguinal Nerve Block for Treatment of Chronic Pelvic Pain
Bahlani-Khanna, S1; King, A2; Moldwin, R1
1: The Arthur Smith Institute- North Shore LIJ System, USA; 2: Hofstra- North Shore LIJ School of Medicine

Objectives: Ilioinguinal nerve blockade with administration of local anesthetic has been shown helpful in postoperative analgesia after inguinal surgery and in post-surgical pelvic pain. These blocks are particularly effective in visceral pain states and in sympathetically maintained pain. Ilioinguinal nerve blockade, therefore, has great potential to be an effective element of the management of patients with chronic pelvic pain. The objective of this study was to evaluate the role of ilioinguinal nerve blockade in treatment of chronic pelvic pain (CPP).

Materials and Methods: 37 patients with CPP receiving ilioinguinal nerve block therapy were identified via medical record review. In these patients, ilioinguinal nerve blockade was performed via ultrasound-guided injections of a lidocaine and marcaine cocktail in a 7:3 ratio. Medical records with access to ilioinguinal nerve block procedures and specific questions regarding post procedural symptomatology were reviewed. Results were recorded in a database. Categoric data were compared with the chi-square test. No data was considered censored. All analyses were performed using SPSS version 22.0. 

Results: 37 patients with CPP were included. Median age of patients was 33 years [32.75-54.25]. 22 (59%) of these patients were female and 15 (41%) were male. 19 patients received more than one ilioinguinal nerve block during their treatment course. Average latency to repeat treatment was 53 days, median latency 36 days. 27 (73%) patients were receiving additional concurrent trigger point injections to the pelvic floor. 25 (67.6%) patients reported improvement in pain with ilioinguinal nerve blockade.

Conclusion: The use of ultrasound-guided ilioinguinal nerve block therapy is associated with an overall improvement in pain measures in patients with CPP. It should be considered a safe, valuable, and effective treatment option for this patient population both as stand alone therapy or as adjuvant treatment in patients currently receiving trigger point injections. 

Disclosure:

Work supported by industry: no.

Development of a Harmonized Multi-Site, Prospective Research Registry to Accelerate Evidence-Based Treatment of Sexual Disorders in Women and Girls with Cancer (#052)
Stacy Lindau, MD

052

Development of a Harmonized Multi-Site, Prospective Research Registry to Accelerate Evidence-Based Treatment of Sexual Disorders in Women and Girls with Cancer
Lindau, ST1; Abramsohn, EM1; Carpenter, K2; Carter, J3; Faubion, S4; Feltmate, C5; Flynn, K 6; Haseotes, D7; Jeffery, D8; Jhingran, A9; Joslin, I1; Kennedy, V10; Kushner, D11; Lynn, M12; Mumby, P12
1: University of Chicago, USA; 2: Ohio State University, USA; 3: Memorial Sloan-Kettering Cancer Center, USA; 4: Mayo Clinic, USA; 5: Dana Farber Cancer Institute, USA; 6: Medical College of Wisconsin, USA; 7: Brown University, USA; 8: Department of Defense, USA; 9: MD Anderson Cancer Center, USA; 10: University of California, Davis, USA; 11: University of Wisconsin, Madison, USA; 12: Loyola University Medical Center, USA

Objectives: To accelerate evidence-based treatment of sexual disorders in women and girls with cancer by creating a harmonized multi-site, prospective research registry.

Material and Methods: A multidisciplinary group of investigators and clinicians affiliated with several NCI-funded and other cancer centers organized at the 4th meeting of the Scientific Network on Female Sexual Health and Cancer to collaborate on building a harmonized, multi-site prospective registry. Data were collected about the characteristics of existing registries, including self-report measures for assessing sexual function.

Results: As of October 2015, 12 investigators from 10 states and 11 institutions, including 9 NCI-funded cancer centers, were participating in the registry harmonization project. Four institutions had an active registry. Mean registry duration was 2.3 years (range 3 months – 7 years). Total number of registrants affected by cancer (diagnosed with cancer or at elevated risk) was 263 (range 22-148). The oldest registry, established in 2008, was at the University of Chicago (UC). Two sites, UC and University of Wisconsin-Madison, were already harmonized using a REDCap database and protocol developed by UC. The established registries were led by investigators from gynecology (n=2), internal medicine (n=1), and medical oncology (n=1). Six institutions joined the collaborative in order to launch a registry at their site. Thus far, a total of 13 patients at 6 sites have been identified who are interested in a research advocate role. Three investigators with expertise on the PROMIS SexFS and other validated self-report measures have also joined. The four active registries have been administering 15 unique sexuality instruments (including nine PROMIS subscales) evaluating 8 unique domains.

Conclusions: Coordinated research is needed to inform best practices and treatment for a diverse national population of women and girls with cancer and sexual function concerns. A multidisciplinary group is activated to form the first harmonized, multi-site registry in the field. Researchers will convene in December 2015 to align on a core set of domains and measures that all sites will adopt to address the most pressing questions in the field.

Disclosure:

Work supported by industry: no.

Painful Sex, Why Women Do or Don't Seek Treatment (#053)
Sheryl A. Kingsberg, PhD, IF

053

Painful Sex, Why Women Do or Don't Seek Treatment
Kingsberg, S1; Amadio, J2; Graham, S2
1: U Hospitals Case Medical Ctr, USA; 2: TherapeuticsMD, USA

Objectives: To further understand the reasons why postmenopausal women do or do not use prescription therapy for vulvovaginal atrophy (VVA) and specifically dyspareunia.

Material and Methods: Six in-person focus groups of women diagnosed with VVA and specifically dyspareunia, were held in Tampa, Philadelphia and Chicago from Feb to Mar, 2015. Thirty-eight women participated with a mean age of 62.9 years; 58% were over 60 years of age. The 6 groups were comprised of:a) women currently taking Rx therapy (Rx user = FG=1, n=6); b) women not taking Rx therapy (Rx non-user, FG=3, n=20), and c) a mix of Rx users and non-users (FG=2, n=12).

Results: Women who were not using Rx therapy reported significant pain, loss of sexual function, emotional trauma, lower self-esteem and damage to marital and partner relationships. Statements regarding dyspareunia included: “it felt like someone was stabbing me with a knife”; “it’s sharp – on a 10 point scale, it’s a 10”. Women also reported that the pain can be enduring: “soreness lasts for days after intercourse”; “can’t wipe, it’s irritated and not natural”. Most non-Rx users reported that the experience of sex itself is frustrating with a loss of spontaneity and pleasure.

Attitudes were very different between Rx-users and Rx non-users:

Rx Users: - Recognize physical and emotional benefits of estrogen VVA therapy; - Strong anti-aging beliefs; - Search-out medical advice (switch doctors); - Empowered personality; - Optimistic and sexually active

Rx Non-Users: - Accepting aging as inevitable; - Less likely to talk with healthcare provider, embarrassed;       - Lack of knowledge, fears and confusion dominate thinking; - Depressed about the future; - Not in an active sexual relationship

Conclusions: Based on this sampling of VVA patients, there is a segment of highly motivated patients interested in solutions to the problem of postmenopausal pain with penetration and the underlying condition. However, many of the non-treating women do not understand VVA causes and are not motivated to take action to find help. When they do ask, they are not being heard by practitioners. Women’s perceptions of estrogen are both a barrier to treatment and opportunity for education of the syndrome and options for treatment.

Disclosure:

Work supported by industry: yes, by TherapeuticsMD, Inc. (industry initiated, executed and funded study).

The Efficacy of Trigger Point Injections in the Treatment of Sexual Pain (#054)
S. Bahlani-Khanna

054

The Efficacy of Trigger Point Injections in the Treatment of Sexual Pain
Bahlani-Khanna, S1; King, A2; Moldwin, R1
1: The Arthur Smith Institute- North Shore LIJ System, USA; 2: Hofstra- North Shore LIJ School of Medicine

Objective: Chronic pelvic pain (CPP), including pelvic floor dysfunction (PFD) and Category III B prostatitis/ chronic pelvic pain (CP/CPPS), affects up to 40% of patients age 18-45 years. Patients often present with a combination of lower urinary tract symptoms with pelvic pain and sexual dysfunction. Sexual pain is found in up to 42% of women with CPP. No uniform treatment strategy exists for treating these patients.

Often patients with PFD and CP/CPPS will have trigger points. These hyperirritable muscular foci can give rise to pain. Trigger points can be involved in the etiology of sexual pain in women and ejaculatory pain in men. Trigger point injections involve infiltration of the musculature with anesthetic solution (consisting of lidocaine and marcaine), which can be both diagnostic and therapeutic for patients. These injections have been shown to be effective in treating patients with PFD and associated pain. The objective of this study was to further evaluate the role of trigger point injections in treatment of PFD and CP/CPPS, specifically in regards to sexual pain.

Material and Methods: 48 patients with PFD and CP/CPPS were identified via medical record review. Medical records with access to trigger point procedures and data regarding post-procedural symptomatology were reviewed. Results were recorded in a database. Categoric data were compared with the chi-square test; binary data were compared with McNemar’s test. No data was censored. All analyses performed with SPSS v22.0

Results: 48 patients with PFD and CP/CPPS were included. Median age of patients was 47 years [43.1-52.5]. 36 (75%) of these patients are female and 12 (25%) patients are male. 31 patients (64.6%) that received trigger point injections reported improvement in quality of life measures, such as decreases in hesitancy, nocturia, and constipation (all p<0.0001). In total, 22/48 patients reported sexual pain. 12 of 19 female patients with sexual pain reported improvement in sexual pain, including dyspareunia post procedure (p<0.0001). 3 of 3 of male patients (100 %) with ejaculatory pain felt improvement in symptoms post-procedure (p=.25).15/22 patients reported improvement in sexual pain including dyspareunia and ejaculatory pain (p<.0001).

Conclusions: The use of trigger point injections is associated with an overall improvement in quality of life measures and sexual pain in patients diagnosed with PFD and CP/CPPS. This is the first study to evaluate sexual pain in patients after trigger point injections.

Disclosure:

Work supported by industry: no.

Pelvic Floor Treatment in a Female Transsexual Patient (#055)
O. Freundlich

055

Pelvic Floor Treatment in a Female Transsexual Patient
Freundlich, O1
1: Centro Miintimidad, Chile

Objective: Demonstrate the importance of including a pelvic floor physical therapist in the treatment of Sex reassignment surgery 

Material and Method: Female Transsexual patient consulting for impossibility of vaginal penetration after 3 years of Sex reassignment surgery.

The method used for treatment, was pelvic floor muscle exercise to keep normal strength, tone and learn muscle control.

Anatomical education and genitals self exploration to integrate her new vagina to her body scheme

Systematic desenzitation, to normalize genitals sensation.

Vaginal miofascial massage, to keep vaginal elasticity.

Dilators therapy, to avoid vaginal compression and keep the elasticity and learn coital ability.

Results: After 10 sessions of pelvic floor treatment, patient was able to connect with her vagina, localize the pelvic floor muscles, and learn how to relax them, loose the fear of vaginal penetration, and have intercourse without pain, without fear and with pleasure.

Conclusion: Pelvic floor treatment done by a trained pelvic floor physical therapist, can be very useful and helpful to include in the treatment of the female transsexual patients

Disclosure:

Work supported by industry: no.


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ISSWSH Annual Meeting 2018

  February 8-11, 2018  195 days left
  Hilton San Diego on Mission Bay
San Diego, CA, USA

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