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Podium Session 5 PS-5 Women Sexual Dysfunction

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Podium Session 5 PS-5 Women Sexual Dysfunction Podium abstracts and moderated posters S39 Podium Session 5 Overall 59.2% (2455 females)reported on sexual dysfunction. We identified the well known risk-factors, as Diabetes mellitus, Hyperten- PS-5 Women sexual dysfunction sion and arterial disturbance. Interestingly we found also a strong Wednesday, November 19, 2003, correlation with mental depression. 09:00–10:30 Conclusions The prevalence of FSD in our study, defined by the criteria of Rosen et al. is extremely high, especially much higher than A. Giraldi, Denmark; I. Goldstein, USA the prevalence of ED in the male population. So we still have to evaluate if the definition of FSD is correct. On the other hand we International Journal of Impotence Research (2003) 15, Suppl where able to confirm the same risk factors for the development of 6, S39–S41. doi:10.1038/sj.ijir.3901106 FSD as for ED in the male population. To our knowledge this is one of the worldwide largest epidemiological trail on female sexuality and other age related disorders. Taking into account the repercussions of these condition on the all common health, PS-5-1 it seems to be necessary to develop, appropriate diagnostic and therapeutic tools. Immunohistochemical distribution of cAMP- and cGMP-Phosphodiesterase (PDE)isoenzymes in the PS-5-3 human vagina S. Ueckert. Germany; K.-E. Andersson, P. Hedlund, U. Jonas, M. Sexual functions in women with urinary incontinence Oelke, C. Stief G. Aslan, Turkey; A. Cihan, S. Cimen, A. Esen, H. Koseoglu, O. Sadik Objectives To date, our knowledge regarding the physiology of Objectives To date limited data exists that addresses the effect of female sexual response is only sparse. It is well known that, with sexual urinary incontinence on sexual function. We have assessed sexual stimulation, the diameter of the vagina and vaginal lubrication functions in patients with urinary incontinence and compared with age increases. Nevertheless, only little is known as to the significance of matched control subjects. cAMP- and cGMP-mediated signal transduction in the control of this Design and Methods A total of 21 pre-menopausal incontinent process. The aim of our study was to elucidate the presence of the women (3 stress incontinence,9 overactive bladder and 9 mixed phosphodiesterase (PDE)isoenzymes 3, 4, 5 and 10 in the human incontinence)were enrolled to the study. 18 healthy continent subjects vagina by means of immunofluorescence. Methods: Sections prepared served as controls. All subjects were asked to complete Female Sexual from formaldehyde-fixated vaginal wall segments were incubated for Function Index (FSFI)questionnaire and each FSFI domain scores; 48 h with primary antibodies directed against PDE isoenzymes 3, 4, 5 desire (1.2–6), arousal (0–6), lubrication (0–6), orgasm (0–6), satisfac- and 10. Then, sections were incubated with fluorescein isothiocyanate- tion (0–6), pain (0–6) were calculated. Mean scores in each domain (FITC)or Texas Red- (TR)labeled secondary antibodies for 2 h. were compared between groups. Visualization was commenced by means of a confocal laser micro- Results Mean age of subjects with urinary incontinence and controls scope. Results: Immunostaining indicating the presence of PDE4 were 39.576.6 and 32.679.1 years respectively. Each domain scores (cAMP-PDE)and 5 (cGMP-PDE)was abundantly observed in the are tabulated in table 1. All domain scores were significantly lower in vaginal smooth musculature and arterial vessels interspersing the incontinent women except for pain. tissue. In addition, staining for PDE4 was also observed in the vaginal Conclusions Urinary incontinence significantly reduces sexual func- epithelium. Immunoactivity indicating the expression of PDE10 (Dual tions in women. Substrate PDE)was seen in the smooth muscle portion and, to a minor Figure 81.gif: degree, in the epithelial layer. No significant amounts of immunoac- tivity for PDE3 (cGMP-inhibited PDE)were detected. Conclusion Our results demonstrate the presence of cAMP- and cGMP-PDEs in the human vagina and may indicate a function of these enzymes in the control of smooth muscle tone and lubrica- tion. These findings might be of significance with regard to the pharmacological treatment of disorders connected with female sexual arousal and orgasm, e.g. reduced vaginal lubrication or sensitivity. PS-5-2 The ‘‘Cologne 20.000 community survey‘‘ - Prevalence of female sexual dysfunction M. Braun, Germany; M. Abel, U. Engelmann, B. Korda, F. Sommer Objectives Epidemiological studies on male sexual disorders have PS-5-4 shown, that sexuality presents an important factor on quality of life also in the aging population. From other studies, we learned that Androgens fluctuate throughout the menstrual cycle in sexuality in older women seems to be an underestimated part of the quality of life. Up to now the prevalence of female sexual disorders is healthy fertile women with normal sexual function: limited. Preliminary results Material & Methods We used an validated questionnaire for A. Salonia, Italy; F. Fabio, V. G. Fantini, M. Francesco, M. Pontillo, assessment of female sexual function. The ‘‘Female Sexual Function N. Rossella, G. Zanni Index’’ (FSFI)was published by Rosen and coworkers in the year 2000. It represents a suitable instrument for epidemiological investiga- Objectives The aim of this study was to evaluate androgens values tions. In addition treatment modalities and other risk factors were throughout the menstrual cycle, accordingly to the National Commit- evaluated. The questionnaire has been sent three times to 20.000 tee for Clinical Laboratory Standards (NCCLS)approved guidelines, people (30–80 years, age standardised, 10.000 males, 10.000 females)in in normal cycling healthy fertile women with a fully normal sexual the Cologne area. function. Results Response rate for the female population was 41% (4150 Design & Methods 85 women (mean age: 33,6 yrs; range: 21–49)were females). The prevalence of female sexual dysfunction was age related. evaluated with: a general and sexual history; Female Sexual Function International Journal of Impotence Research Podium abstracts and moderated posters S40 Index (FSFI); Beck inventory for depression (BDI); Female Sexual PS-5-6 Distress Scale (FSDS)and preliminary lab test to exclude any metabolic abnormalities and entered this still ongoing study. A Vulvar vestibulitis severity - Assessment by sensory and detailed hormonal profile (including FSH, LH, E2, progesterone, pain testing modalities prolactin, SHBG, total and free testosterone (T), DHEAS, delta4- I. Gruenwald, Israel; M. Deutsch, M. Friedman, L. Lowenstein, Y. androstenedione, cortisol, HGH)was evaluated throughout the Vardi, D. Yarnitsky menstrual cycle (namely: mid-follicular phase, ovulatory phase and mid-luteal phase)in each sexually normal woman accordingly with the Objective Vulvar Vestibulitis Syndrome (VVS)is a common cause of NCCLS guidelines. dyspareunia. To date, no objective diagnostic tool for determining the Results Androgens profile throughout the menstrual cycle severity of VVS is available. Our aims were to evaluate the diagnostic (mean7SE; range): follicular phase: total-T (ng/ml): 0.4270.02 value of several pain threshold tests for VVS patients (vs. healthy (0.14–1.1); free-T (pg/ml): 0.9670.06 (0.14–2.71); SHBG (nmol/L): subjects)and to examine if any could be used for determining severity 77.275.5 (13.2–229.0); Free Androgen Index (FAI): 2.8870.29 (0.94– of the condition. 6.57); delta4-androstenedione (ng/ml): 1.870.07 (0.5–3.6); DHEAS Design and Methods Thirty-five vestibulitis patients, 17 with moder- (ng/ml): 1900.37108.3 (468–5800); prolactin (ng/ml): 11.170.7 (2.7– ate (severe pain during sexual intercourse)and 18 with severe disorder 42.5); cortisol (ng/ml): 121.575.8 (32.5–207.8); ovulatory phase: total- (constant, non-provoked pain or pain preventing sexual intercourse) T: 0.5070.02 (0.17–1.04); free-T: 1.0270.06 (0.20–3.01); SHBG: were compared to 22 age-matched control, normal, sexually active 81.077.01 (16.0–257.0); FAI: 3.4370.36 (1.30–6.91); delta 4-andros- females. Tactile and pain thresholds, induced by mechanical pressure tenedione: 1.970.09 (0.30–3.64); DHEAS: 1882.07141.02 (180–8001); and thermal stimuli were measured at the posterior fourcette. prolactin: 11.570.7 (4.0–34.8); cortisol: 115.277.1 (66.1–194.4); luteal Magnitude estimations of painful suprathresholds (MEPS)were phase: total-T: 0.5070.01 (0.13–0.94); free-T: 1.170.1 (0.24–3.06); obtained for mechanical and thermal tonic & phasic stimuli. Ordinal SHBG: 93.177,0 (7.2–257.0); FAI: 3.170.52 (1.17–8.09); delta4- logistic regression analysis between each of the pain measures and androstenedione: 2.070.1 (0.3–3.9); DHEAS: 2059.57148.1 (250– diagnostic category was performed. Separate analysis for each pain test 6080); prolactin: 12.270.90 (2.9–60.7). cortisol: 115.579.8 (50–256). between the diagnostic groups was done. Cut-off points were defined Conclusions These preliminary data represent the steroids hormones for each test, discriminating between moderate, severe VVS and profile throughout the menstrual cycle in normal cycling healthy healthy controls. women fully screened for a normal sexual function. A larger amount of Results The groups were comparable for age and medical back- women with normal sexual activity should be enclosed in this still ground. Pain thresholds were lower and MEPS were higher in VVS ongoing study to obtain normatives values accordingly with the patients, in agreement with disease severity. The best discriminative NCCLS guidelines. test was mechanical pain threshold obtained by a ‘spring pressure device´ (kappa 0.82), predicting correctly 100% of severe and 88% of all VVS cases. MEPS for tonic heat stimulation also had a high kappa PS-5-5 value (0.73)predicting correctly 82% overall with a 100% correct Does hysterectomy affect genital sensation? diagnosis of the control group.
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