Cervical cancer screening for transgender and nonbinary (TNB) people should be offered in accordance with guidelines for cisgender women. Testosterone therapy has been associated with higher odds of inadequate cervical cytology and benign cervical changes, which may be difficult to differentiate from high-grade dysplasia. Patients with testosterone-related atrophy may benefit from pretreatment with topical estrogen. Growing data support self-collected HPV as an acceptable method for screening among TNB individuals for whom pelvic examination poses a barrier.

Background:While there are data showing the effects of gender-affirming hormone therapy on sexual satisfaction in transgender and gender-diverse individuals, there is no research on sexual function in patients seeking or undergoing gender-affirming hysterectomy (GAH). Aim:This project is a descriptive study of baseline characteristics (pre-hysterectomy) in patients seeking GAH. Methods:Twenty participants at a single tertiary care center were surveyed on orgasm satisfaction (Orgasm Rating Scale), and sexual function (Transmasculine Sexual Functioning Index). Results:The study sample (n = 20) was largely white, college-educated, between the ages of 21 and 35 years old. Most participants identified as transmasculine/transgender men and 75% were on testosterone therapy. No significant differences were observed in Orgasm Rating Scale subscales. The median Transmasculine Sexual Functioning Index sexual function score (20) corresponded with "moderate" sexual function. Conclusion:This study should be replicated in a larger, more diverse sample, with stratification across hormone therapy use, and longitudinal follow-up to assess for change in sexual function over time.

BACKGROUND:Several studies have suggested a decrease in sexual function after risk-reducing salpingo-oophorectomy (RRSO) that is not mitigated by hormone therapy treatment. AIMS:This is a prospective cohort study of women followed from the time of diagnosis, including those who chose whether to proceed with RRSO, and changes in sexual function. METHODS:Premenopausal women were recruited from a high-risk cancer genetics clinic at a large academic center and completed detailed demographics and validated measures regarding their physical, mental, and sexual health. OUTCOMES:Women were surveyed over the course of 60 months, using the Sexual Health Outcomes in Women Questionnaire (SHOW-Q), and results were analyzed, controlling for known confounders in sexual health, comparing women with and without RRSO. RESULTS:One hundred women completed the study, 99 of whom completed baseline SHOW-Q surveys. Forty-one women planned RRSO at the beginning of the study, and another 30 underwent an RRSO during the study period. At baseline, women who underwent RRSO had lower sexual functioning scores in terms of sexual satisfaction and pelvic problem interface. Over 60 months, there was no difference in sexual function scores between the RRSO and the no-RRSO group in multivariable models that adjusted for depression, hormone use, menopausal symptoms, or other confounders. CLINICAL IMPLICATIONS:Pre-surgery sexual function predicts post-surgery sexual function, which challenges existing dogma, and women can be reassured that surgery likely won't affect sexual function. STRENGTHS AND LIMITATIONS:This study's strength was the relatively large sample size and long-term follow-up. Limitations were a relatively homogeneous population that may not reflect the diversity of patient experiences. CONCLUSIONS:These findings can be useful to providers and patients in understanding the effects of surgery and are reassuring that sexual function may, in fact, not be worsened by surgery.

Objective: Yoga has been recommended as a complementary management strategy for women with chronic pelvic pain (CPP), but many women lack access to specialized yoga instruction for this indication, and few data are available to evaluate changes in CPP with yoga. This feasibility trial evaluated the acceptability and tolerability of a remotely delivered yoga program for CPP in women and examined data quality and interpretability for measures of pelvic pain intensity and impact with yoga instruction. Methods: Ambulatory women with CPP were recruited from northern California in 2020-2022 and randomly assigned to a 2-month program involving twice weekly group classes delivered by videoconference supplemented by individual practice of pelvic yoga techniques versus a control program involving equivalent-time instruction and practice of nonspecific skeletal muscle stretching-strengthening exercises. Diaries, questionnaires, and in-class observations assessed intervention adherence and self-efficacy as well as CPP intensity and impact. Results: Among the 36 participants randomized (aged 27-77 years), the average (±standard deviation) baseline pelvic pain intensity was 4.2 (±2.0) (0-10 scale). Thirty-one (86%) completed the 2-month intervention programs, and 27 (75%) attended more than 85% of intervention classes. Among participants completing the yoga program (N = 16), 14 (87%) reported being at least moderately confident about performing all yoga postures after 2 months. Thirty (83%) provided pain intensity data at 2 months. Average pelvic pain intensity "at its worst" and "on average" were 1.9 (±1.6) and 1.1 (±1.4) points lower, respectively, after 2 months in this yoga group. Yoga participants also reported improvements in scores in the emotional, occupational, and psychological domains of the Impact of Female Chronic Pelvic Pain Questionnaire. Conclusions: Findings demonstrate the feasibility and acceptability of a videoconference-based yoga program and collection of pain-related data among women with CPP, paving the way for future research to rigorously evaluate its specific efficacy in representative samples of women. Clinicaltrials.gov identifier: NCT04615247.

Female sexual desire is a complex interplay of neurotransmitters and hormones. Diagnosis is based on clinical features and sexual distress. Treatments that affect neurotransmitters and hormones that may be out of balance can help improve sexual desire in women with hypoactive sexual desire disorder.

Objectives: To assess predictors of help-seeking for sexual distress in a cohort of patients newly referred to a gynecologic oncology clinic Methods: We performed a cross-sectional study of new patients referred to a gynecologic oncology clinic for a known or suspected gynecologic malignancy. Our primary outcome was sexually related distress, classified as a score of 11 or above using the validated Female Sexual Distress Survey—Revised (FSDS-R). The PROMIS Female Sexual Function and Satisfaction Questionnaire (SexSF) is a validated instrument examining domains of sexual function over the past 30 days. We performed one-sided t-test and logistic regression statistical analyses using STATA version 17.0. Results: From May-Dec 2022, 105 of 126 (83%) eligible patients completed the survey. The median age of respondents was 60.5 years old (range 26–85). 48% of patients had a known cancer diagnosis at the time of their visit, with 71% percent having cancer confirmed on final pathology (25% ovarian, 49% uterine, and 19% cervical/vaginal/ vulvar). 50% of patients self-identified as non-Hispanic White, and 50% were non-White (Black, Asian, Pacific Islander, and Latinx), and 6% were LGBTQ. 37.5% reported being sexually active within the past 30 days. FSDS-R scores ranged from 0–32 with a median (IQR) of 2.5 (9.5). Overall, 23% of this cohort reported sexually related distress. This was not significantly associated with cancer diagnosis on arrival, final diagnosis, site of origin, or with sexual activity. 53% of patients agreed that physicians should routinely ask about sexual function. 37% of patients desired to speak with their gynecologic oncologist about sexual health, the majority (64%) of whom did not have sexual distress. Additionally, 27% desired referral to sexual health specialists, psychologists or counselor regarding sexual health concerns. Conclusions: Almost a quarter of new patients to gynecologic oncology clinic reported sexually related distress. A majority preferred to speak to their gynecologic oncologist regarding sexual health, regardless of personal report of sexual distress. Gynecologic oncology providers should incorporate screening for sexual symptoms into evaluation and treatment planning.

To quantify and identify predictors of sexual distress among gynecologic oncology patients undergoing routine surveillance to provide intervention and improve wellbeing.

BACKGROUND:Women diagnosed with colorectal cancer (CRC) or anal squamous cell carcinoma (ASCC) are at high risk of sexual dysfunction after treatment, yet little is known about recovery and risk factors for chronic dysfunction.AIM:We aimed to describe sexual function and sexual activity among women who underwent definitive treatment for CRC or ASCC, examine relationships between time since treatment completion and sexual function, and explore factors associated with desire and changes in sexual desire over time.METHODS:As part of a prospective cohort study of patients with gastrointestinal cancer at the University of California San Francisco, female-identifying participants who finished definitive treatment for CRC or ASCC completed the Female Sexual Function Index (FSFI) at 6- to 12-month intervals. We used multivariable linear mixed models to explore factors associated with the FSFI desire subscale.OUTCOMES:Outcomes were rates of sexual activity, proportion at risk for sexual dysfunction (FSFI score <26.55), total FSFI score, and FSFI desire subscale.RESULTS:Among the 97 cancer survivors who completed at least 1 FSFI, the median age was 59 years, the median time since treatment end was 14 months, and 87% were menopausal. Fifty-five women (57%) had a history of colon cancer; 21 (22%), rectal cancer; and 21 (22%), ASCC. An additional 13 (13%) had a current ostomy. Approximately half the women were sexually active (n = 48, 49%). Among these 48 sexually active women, 34 (71%) had FSFI scores indicating risk for sexual dysfunction. Among the 10 sexually active women who completed a FSFI ≥2 years since end of treatment, the median total score was 22.6 (IQR, 15.6-27.3). None of the evaluated characteristics were associated with desire (age, tumor site, treatment, menopause status, or ostomy status).CLINICAL IMPLICATIONS:Consistent with prior studies, we found low desire scores after treatment for CRC or ASCC, with little recovery over time, suggesting that patients should not expect an eventual rebound of sexual function.STRENGTHS AND LIMITATIONS:Strengths of our study include longitudinal data and use of the validated FSFI. Women with ASCC composed 22% of our cohort, allowing for insight into this rare disease group. Limitations of this study include the small sample size, particularly for longitudinal analyses, and the enrollment of patients at variable times since treatment end.CONCLUSION:We observed a high prevalence of sexual health concerns, including low desire, after the treatment of CRC and ASCC that persisted for years after treatment was completed.

Colorectal cancer (CRC) is the third most common cancer in the USA and worldwide. In the USA, nearly one-third of CRC cases are anatomically classified as rectal cancer. Over the past few decades, continued refinement of multimodality treatment and the introduction of new therapeutic agents have enhanced curative treatment rates and quality of life outcomes. As treatments improve and the incidence of young onset rectal cancer rises, the number of rectal cancer survivors grows each year. This trend highlights the growing importance of rectal cancer survivorship. Multimodality therapy with systemic chemotherapy, chemoradiation, and surgery can result in chronic toxicities in multiple organ systems, requiring a multi-disciplinary care model with services ranging from appropriate cancer surveillance to management of long-term toxicities and optimization of modifiable risk factors. Here, we review the evidence on these long-term toxicities and provide management considerations from consensus guidelines. Specific topics include bowel dysfunction from radiation and surgery, oxaliplatin-induced neuropathy, accelerated bone degeneration, the impact of fluoropyrimidines on long-term cardiovascular health, urinary incontinence, sexual dysfunction, and psychosocial distress. Additionally, we review modifiable risk factors to inform providers and rectal cancer survivors of various lifestyle and behavioral changes that can be made to improve their long-term health outcomes.

BACKGROUND:Clitoral adhesions are characterized by adherence of preputial tissue to the glans clitoris and can be managed using a non-surgical approach in order to relieve symptoms of sexual dysfunction. AIM:To evaluate efficacy and patient satisfaction associated with the non-surgical lysis procedure in order to determine if it is an appropriate treatment for symptomatic clitoral adhesions. METHODS:The non-surgical lysis procedure is performed by using a fine Jacobsen mosquito forceps to separate the plane between the prepuce and the glans of the clitoris, removing smegma and/or keratin pearls from underneath the adhesions and allowing for visualization of the entire glans. A chart review of 61 women that were treated for clitoral adhesions using the non-surgical lysis procedure at 1 sexual medicine practice was performed and an online survey was sent to these patients. MAIN OUTCOME MEASURES:Encrypted survey responses were used to evaluate patient satisfaction as well as self-reported improvement in sexual functioning and pain before and after the procedure. RESULTS:41 survey responses were received out of 61 eligible (67% response rate). A large majority reported improvement in pain (76%), sexual arousal (63%), and ability to achieve orgasm (64%) and no participants reported worsening in these symptoms. Of the 16 women that reported the inability to orgasm from external clitoral stimulation prior to the procedure, 6 (38%) were able to do so afterwards. Seventy-one percent of respondents reported improvement in their satisfaction with sex and 83% reported being satisfied with their decision to have the procedure. Ninety-three percent of participants reported that they would recommend this procedure to a friend with clitoral adhesions. CLINICAL IMPLICATIONS:The results of this study will help clinicians to recognize the non-surgical lysis procedure as a treatment option for clitoral adhesions. STRENGTHS & LIMITATIONS:This study is the first of its kind assessing a cohort of patients undergoing the non-surgical lysis procedure for clitoral adhesions. Its limitations include a small sample size from 1 clinic and lack of validated instrument to evaluate sexual function and pain before and after the procedure. CONCLUSION:Providers should regularly examine the clitoris of patients with symptoms of sexual dysfunction in order to determine if they have clitoral adhesions. The non-surgical lysis procedure may be a viable therapeutic option for these patients that has demonstrated both satisfaction and symptom relief. Myers MC, Romanello JP, Nico E, et al. A Retrospective Case Series on Patient Satisfaction and Efficacy of Non-Surgical Lysis of Clitoral Adhesions. J Sex Med 2022;19:1412-1420.

Human papillomavirus (HPV) infections cause more than 35,900 cancers annually in the United States. Although cervical cancer is the most prevalent HPV-related malignancy in women, the virus is also responsible for a significant percentage of anal, vaginal, and vulvar cancers. A comprehensive approach to mitigating cervical cancer includes HPV vaccination (primary prevention), screening and treatment of precancerous lesions (secondary prevention), and diagnosis and treatment of invasive cancer (tertiary prevention). Although a successful strategy, there are opportunities to innovate and increase access that can also be adapted to address the unique clinical care gaps that exist with the other anogenital cancers. The Society for Women's Health Research held a series of interdisciplinary meetings and events, during which expert researchers, clinicians, patient advocates, and health care policy leaders evaluated the current landscape of HPV-related cancers and their effects on women's health. This report summarizes the discussions of this working group and areas it identified in which to address gaps in primary and secondary prevention approaches to improve access and health outcomes for women with HPV-related anogenital cancers.

You have accessJournal of UrologyGlobal Health/Humanitarian (MP67)1 Sep 2021MP67-23 EVALUATING THE AWARENESS, CLINICAL EXPERIENCE AND KNOWLEDGE OF FEMALE GENITAL MUTILATION/CUTTING AMONG FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY SPECIALISTS IN THE UNITED STATES Hannah S. Thomas, Nnenaya A. Mmonu, Gregory Amend, Crista Johnson-Agbakwu, Tami Rowen, Jennifer T. Anger, and Benjamin N. Breyer Hannah S. ThomasHannah S. Thomas More articles by this author , Nnenaya A. MmonuNnenaya A. Mmonu More articles by this author , Gregory AmendGregory Amend More articles by this author , Crista Johnson-AgbakwuCrista Johnson-Agbakwu More articles by this author , Tami RowenTami Rowen More articles by this author , Jennifer T. AngerJennifer T. Anger More articles by this author , and Benjamin N. BreyerBenjamin N. Breyer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002028.23AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Female genital mutilation/cutting (FGM/C) is a cultural practice whereby there is partial or total removal of external female genitalia for non-therapeutic reasons. Despite the high prevalence of urologic complications, there is a paucity of literature discussing FGM/C in the context of clinical Female Pelvic Medicine and Reconstructive Surgery (FPMRS) practice. This study aimed to evaluate the awareness, clinical experience, and knowledge of FGM/C among US FPMRS specialists with the ultimate goal of strengthening the recognition and care of patients with FGM/C. METHODS: We distributed a 27-item survey via email to members of the Society of Urodynamics, Female Pelvic Medicine and Reconstructive Surgery. We collected variables pertaining to previous education of FGM/C, confidence in a clinical environment, cultural and medical knowledge, and future education. RESULTS: A total of 54 US-based FPMRS specialists completed the survey. All providers had heard of FGM/C before; however only 13% received formal education during medical training. Over half of respondents had encountered a patient with FGM/C in clinical practice; however, only 19% and 13% felt completely confident recognising and discussing FGM/C, respectively (Table 1). 70% believed religious doctrine informed the practice of FGM/C and 24% correctly identified the type of FGM/C on clinical representation. Only 17% of respondents were aware of FGM/C guidelines and providers expressed a desire for future, multimodal educational resources on the topic. Finally, 80% of FPMRS specialists correctly identified that FGM/C is illegal in the US. CONCLUSIONS: Education regarding FGM/C remains sparse and variable for US FPMRS specialists, and cultural and clinical knowledge is lacking. With increasing globalization, there is an imperative for both urologists and gynecologists to be aware of FGM/C. Future work seeks to focus on formal provider education and investigation of the perspectives of patients with FGM/C, in order to translate findings into meaningful education and patient-centered care. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e518-e519 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hannah S. Thomas More articles by this author Nnenaya A. Mmonu More articles by this author Gregory Amend More articles by this author Crista Johnson-Agbakwu More articles by this author Tami Rowen More articles by this author Jennifer T. Anger More articles by this author Benjamin N. Breyer More articles by this author Expand All Advertisement PDF downloadLoading ...

There has been an increase in genital cosmentic surgeries over the past decade, with the most common procedure being labiaplasty. This trend has many origins, but a significant motivator is genital self image, which has been shown to be very culturally influenced. Furthermore genital self modification, by way of grooming also is felt to play a role in the desire to surgically alter one's genital appearance. Given the cultural aspect of these practices, sexual health proivders should be aware of the role of self image and self modification in the drive towards persuing surgical changes to the genitals. Schmidt CN, Rowen TS. Female Genital Self-Image and Modification. J Sex Med 2021;18:1945-1949.

Many well-meaning researchers and clinicians have spent excess time and money to study very important topics related to sexual health. While prospective studies are the most well regarded and therefore more likely to make an academic and clinical impact, these studies are very challenging to complete. The first step to any study is recruitment, and nearly all researchers have not struggled with the challenges of enrolling the appropriate participants in a clinical study.

Introduction: Testosterone has been studied for its benefits on sexual health for decades. The research regarding testosterone in women has produced evidence that this is a potential treatment for women suffering from female sexual dysfunction. There are several limitations of the testosterone trials that can affect their interpretation and challenges posed by some regulatory agencies that have prevented approval of any testosterone treatment for women in several countries. Aim: To summarize the challenges of testosterone trials in terms of study populations, patient-reported outcomes, validated instruments in research, confounders, and regulatory barriers. Methods: A thorough review of published data on testosterone for the treatment of women's sexual health problems was undertaken. A detailed evaluation of the limitations of these trials was conducted and incorporated with the published evidence on the regulatory processes involved in moving testosterone from clinical research to drug approval. Main Outcome Measure: Main outcome measures are assessment of clinical trial populations, survey tools, confounders, and regulatory barriers. Results: There is some heterogeneity of study populations included in testosterone trials in women. Similarly, there have been differences in instruments used to assess patient-reported outcomes and often minimal control for potential confounders. The regulatory agency had posed a challenge to approve any testosterone treatment for women based on unproven concerns and a lack of regulatory guidance for drug developers. Clinical Implications: There is strong evidence that shows testosterone is effective for treating sexual health concerns in the women included in clinical trials. Strength & Limitations: Strengths include thorough review of published literature and trial design for sexual health concerns. Limitations include being restricted to English Language publications and not having access to unpublished clinical trial data. Conclusions: Testosterone trials in women have been limited by homogeneity in the study populations and outcomes measured. Drug development has been hampered by inconsistent regulatory barriers. Copyright (C) 2020, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

INTRODUCTION:Sexual pain is common among women but little is known about associations with exercise and physical activity. AIM:To determine the prevalence of sexual pain among physically active women and to evaluate cycling and other potential risk factors. METHODS:This is a secondary data analysis of a study on the urinary and sexual wellness of physically active women recruited through sporting clubs and targeted social media advertising. We used multivariable logistic regression to assess the role of cycling and exercise in reporting any, frequent, or severe sexual pain, controlling for demographic, relationship, and health risk factors. MAIN OUTCOME MEASURE:Sexual pain, including frequency and severity, was measured using the Female Sexual Function Index. RESULTS:A total of 2,039 women were included, with 1,097 (54%) reporting any level of sexual pain, 364 (18%) experiencing frequent pain, and 378 (19%) reporting severe pain. Less than 5% of women reported diabetes or hypertension, and the cohort had a median body mass index of 23.3 (interquartile range 21.4-25.7). Increasing age and body mass index were protective against any sexual pain, as was cycling (odds ratio [OR] 0.73 [95% CI 0.59-0.90]). Participants who reported being "moderately satisfied" (OR 0.53 [95% CI 0.31-0.91]) or "very satisfied" (OR 0.33 [95% CI 0.19-0.56]) with their emotional closeness to a sexual partner had decreased odds of any sexual pain. CONCLUSION:Experiencing any sexual pain is common in physically active women, with a prevalence of over 50%; however, weekly energy expenditure from exercise was not associated with sexual pain. Cycling participation and higher levels of emotional closeness and intimacy were associated with less pain. Patients between the ages of 18 and 30 years who were normal or underweight incurred the highest risk of sexual pain. Fergus KB, Cohen AJ, Cedars BE, et al. Risk Factors for Sexual Pain Among Physically Active Women. Sex Med 2020;8:501-509.

Study ObjectiveTo evaluate opioid use after benign gynecologic surgery after implementation of Enhanced Recovery After Surgery (ERAS) opioid prescribing recommendations.DesignA prospective cohort study.SettingAn academic tertiary care hospital.PatientsAll patients undergoing elective benign gynecologic surgery at a large academic institution between August 2017 and December 2017, 1 year after ERAS postoperative opioid prescribing recommendations were implemented for the benign gynecologic surgery department.InterventionsA chart review determining opioid prescription quantity and a patient telephone survey 7 days after surgery were both performed. Total opioid use was calculated. Physician adherence to the institution's ERAS postoperative opioid prescribing recommendations after benign gynecologic surgery was then determined. Patients were classified as either in the physician adherent to ERAS group or the physician nonadherent to ERAS group. After this stratification, patients’ total opioid use within each group was then compared.Measurements and Main ResultsA total of 241 consecutive benign gynecologic surgical procedures were reviewed. Opioids were prescribed for outpatient postoperative pain management in 186 (77.2%) of these procedures. Physician adherence to the ERAS postoperative opioid prescribing recommendations occurred in 150 (62.2%) of all surgical cases. The telephone survey was completed by 144 (59.8%) patients 7 days after their surgery. Among survey participants, a total of 13 783.5 morphine milligram equivalents (MMEs) or 64.7% of all opioids prescribed were unused 7 days after surgery. This is equivalent to 1838 oxycodone 5-mg tablets unused by the end of the study period. For all surgical procedure types, the ERAS-nonadherent group was prescribed statistically significantly more opioids per patient than the ERAS-adherent group (246.2 ± 22.8 MME vs 81.1 ± 6.2 MME, p < .005), resulting in more opioids unused among the ERAS-nonadherent group. Consequently, the ERAS-nonadherent group contributed 63.5% (8747.5 MMEs) of the total unused opioids by the end of the study period despite only making up 39.6% of the completed patient surveys.ConclusionPatients require significantly less opioids after benign gynecologic surgery than they are being prescribed. Physician adherence to the ERAS postoperative opioid recommendations is suboptimal and contributes significantly to the quantity of unused opioids after surgery for benign gynecologic indications. Almost two thirds of all opioids prescribed are not used by 1 week after benign gynecologic surgery.

Following definitive chemoradiation for anal squamous cell carcinoma (ASCC), patients face a variety of chronic issues including: bowel dysfunction, accelerated bone loss, sexual dysfunction, and psychosocial distress. The increasing incidence of this disease, high cure rates, and significant long-term sequelae warrant increased focus on optimal survivorship care following definitive chemoradiation. In order to establish our survivorship care model for ASCC patients, a multi-disciplinary team of experts performed a comprehensive literature review and summarized best practices for the multi-disciplinary management of this unique patient population. We reviewed principle domains of our survivorship approach: (1) management of chronic toxicities; (2) sexual health; (3) HIV management in affected patients; (4) psychosocial wellbeing; and (5) surveillance for disease recurrence and survivorship care delivery. We provide recommendations for the optimization of survivorship care for ASCC patients can through a multi-disciplinary approach that supports physical and psychological wellness.