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Home , Follicular phase, Vaginal lubrication

Podium abstracts and moderated posters

S39 Podium Session 5 Overall 59.2% (2455 females)reported on . 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 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 , 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), (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 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 fluctuate throughout the 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, , 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-)in each sexually normal woman accordingly with the Objective Vulvar Vestibulitis Syndrome (VVS)is a common cause of NCCLS guidelines. . 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 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 )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 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. Conclusion In this study we have demonstrated that QST techniques, I. Gruenwald, Israel; M. Deutsch, I. Gertman, L. Lowenstein, Y. Vardi, both threshold and suprathreshold measurements are excellent tools D. Yarnitsky for diagnosis of VVS, specifically the ‘spring pressure device´ and the Objective Hysterectomy is the most frequent surgical procedure tonic heat stimulation. These tests can also be used for scaling and performed in gynecology, but little data exists regarding its effect on distinguishing the different levels of pain severity of this clinical female sexual function, specifically on genital sensation. We have syndrome. already shown that thermal and vibratory quantitative sensory tests (QST)are the basis for evaluation of neural damage of the genitalia. PS-5-7 Our aim was to prospectively evaluate the effects of hysterectomy on vaginal and clitoral sensation by QST. Female general sexual satisfaction report may hide Design and Methods 27 women aged 30–57 years (mean 46.6) hospitalized for elective hysterectomy, (5 vaginal, 22 transabdominal) specific domains of , arousal, pain and entered the study. Genital sensation was evaluated separately at the orgasmic disorders anterior and posterior vaginal walls and the . QST was S. Richter, Israel; I. Lebobich, D. Slutzker performed one day before and 3 months after surgery, using a Introduction and objectives The aim of the present study is to evaluate Thermal and Vibratory Sensory Analyzer System (Medoc, Israel). We the reported quality of sexual satisfaction at intercourse in a determined thresholds for warm, cold and vibratory sensation. Sensory population of normal sexually functioning women and to compare thresholds pre and post surgery were compared by paired t-tests. the data obtained to the known elements of the consensus classification Results All 27 females reported normal sexual function before system of different FSD domains. surgery. Post-operatively, anterior and posterior vaginal heat thresh- Materials and Methods 121 randomly selected women attending a olds became significantly worse, from 40.1c170.92 to 41c71.33 general clinic were requested to answer a sexual function (p¼0.004)and 39.4c 170.85 to 40.5c170.96 (p 0.0001)respectively. o evaluation questionnaire. Women consulting for genitourinary or Anterior and posterior vaginal cold threshold became significantly lower urinary tract pathologies were excluded. From these women no worse, 31.5c171.73 to 30.3c171.67 (p¼0.0061)and 32.2 c 171.42 to one complained overtly of sexual disorders. 114 eligible questionnaires 30.8c171.54 (p¼0.0005)respectively. Vibratory vaginal sensation were included in the analysis. Age ranged 20–70 years. The threshold was less sensitive and changed from 3.4571.23 to questionnaire integrated 10 questions, using a scale 1¼highest/ 3.7271.05 (p¼0.077). However, no significant differences were 6¼lowest, in which women were requested to rank the general degree measured in clitoral thermal or vibratory sensation pre and post of sexual satisfaction at intercourse, level of sexual desire, easiness of surgery. (39.570.88 vs. 39.470.75, and 1.98hz70.75 vs. 2.01hz70.75 sexual arousal, ability to experience orgasm and its quality, lubrication respectively). difficulties, and the occurrence and frequency of sexual pain disorders. Conclusions This is the first prospective study showing objective Results General degree of sexual satisfaction was high, moderate or evidence of vaginal sensory changes after hysterectomy. More data is poor to absent in 56%, 32.5%, 11.5%, respectively. Severe disorder of needed in order to evaluate if these changes are transient or permanent sexual desire in 34%, arousal disorder in 21% and severe lubrication and whether they are directly associated to sexual dysfunction. If a difficulties in 22%. Difficulty to reach orgasm in 24.1%, poor quality direct correlation exists- physicians will be obligated to inform patients orgasm in12.2%. Occasional dyspareunia/vaginismus in 20.4%/ on possible post-operative outcomes, and new surgical approaches 23.7%, frequent severe dyspareunia/vaginismus in 8.8%/10.5%, should be developed. respectively.

International Journal of Impotence Research Podium abstracts and moderated posters

S41 Conclusions High degree of sexual satisfaction was paradoxically associated with reported severe lubrication difficulties and sexual Podium Session 6 desire, arousal, orgasmic and pain disorders. PS-6 Epidemiology It seems that reported quality of sexual satisfaction and objective Wednesday, November 19, 2003 female sexual function do not necessarily correlate. 09:00 - 10:30 A. Martin Morales, Spain; F. Simsek, Turkey PS-5-8 Effects of various treatment modalities for female sexual International Journal of Impotence Research (2003) 15, Suppl dysfunction: The early report 6, S41–S44. doi:10.1038/sj.ijir.3901107 K. Min, Republic of Korea; C. Choi, S. Choi, D. Kang, K. Moon Objectives The aim of this study was to evaluate the usefulness of various medical treatments for the women with sexual dysfunction and PS-6-1 the improvement of the sexual function. Designs & Methods Forty two who complained desire disorder and The men’s attitude to life events and sexuality (MALES) arousal disorder was tried with androgen replacement, local admin- study-II: Correlates of self-reported disease severity istration of PGE1, administration of Viagra and Uprima, and among men with application of vacuum suction device. If a treatment option was failed R. Rosen, USA; I. Eardley, W. Fisher, C. Niederberger, M. Sand in a case, other treatment modalities were applied in same case. The improvement of sexual function was evaluated in respect of sexual Objectives The MALES Study–II is aimed at understanding and desire, sexual sensation, sexual excitement, vaginal lubrication, validating self-reports of severity of erectile dysfunction (ED)among orgasm, sexual satisfaction with Female Sexual Function Index and men with this disorder. subjective assessment during . Methods 3,775 men from 8 countries (US, UK, Germany, France, Results Androgen (or androgen plus )replacement increased Italy, Spain, Mexico, and Brazil), aged 20–75 years and with some 35.7% (5/14)in sexual desire and 21.4% (3/14)in sexual arousal degree of self-reported ED, were recruited through participation in response without any side effect. Local application of PGE1 (Muse) MALES–I and booster methods. We examined the relationship increased 42.8% (3/7)in vaginal lubrication only. Uprima increased between self-reported severity of ED and self-reports of relevant 12.5% (2/16)in vaginal lubrication. Viagra improved sexual excite- characteristics of sexual function including: I get no at all; I ment and vaginal lubrication in 26.3% (5/19). Clitoral suction device have difficulty getting a sufficiently good erection; I get satisfactory improved the sexual sensation in 62.5% (25/40)and vaginal lubrication but they don’t last long enough; percent reduction in sexual in 45.0% (18/40). Each treatment modalities were more effective in activities of any kind; temporal duration of ED; and perceived secondary female sexual dysfunction than primary one. All of these temporary or permanent nature of ED. modalities were demonstrated the improvement of a part of sexual Results The severity of self-reported ED strongly correlated with response, but not general sexual satisfaction. perceptions of ED sufferers that their ED is permanent and associated Conclusions Although not improved sexual satisfaction, it is needed with reduction in sexual activity (Po0.0001). Self-reported ED severity to continue studies to develop indications of these armamentarium didn’t correlate with disease duration. In addition, men with mild ED tried in this study, because of partial effectiveness. Female sexual were more likely to describe their problem as one of maintaining an dysfunction may be not solved with simple treatment, various erection; men with moderate ED were more likely to cite difficulties treatment modalities may be applied for a long time. achieving a sufficiently good erection; men with severe ED were more likely to report getting no erection at all. Conclusion These data validate a simple self-reported measure of ED PS-5-9 severity, and provide an insight into perceptions of ED sufferers that may be valuable to clinicians treating men with ED, and to Efficacy of functional electrical stimulation (FES)- understanding treatment-seeking behavior of men with ED. biofeedback with cognitive behavioral therapy as a treatment of vaginismus J. T. Seo, Republic of Korea; K.-H. Kim, J.-S. Lee, W. S. Lee Objectives Vaginismus is involuntary vaginal muscle contraction that leads to difficult or impossible sexual intercourse. Various therapeutic approaches have been considered physiologically and psychologically. We report twelve cases of vaginismus which were successfully treated with FES-biofeedback with cognitive behavioral therapy. Our objective was to determine the efficacy of FES-biofeedback with cognitive behavioral therapy as a standard therapy for vaginismus. Design and Methods Twelve women with vaginismus waiting for a clinical checkup participated in this study. Patients enrolled in this study had vaginismus with the criteria of DSM-IV and ICD-10. The patients were assessed at pretreatment and posttreatment follow-up via gynecological examination and structured interviews pertaining to sexual function and psychological adjustment. After the diagnosis of vaginismus, we conducted a pelvic floor muscle relaxation by FES- biofeedback once a week. When the patients became tolerable to vaginal manipulation, the 8-staged gradual desensitization using PS-6-2 vaginal self-dilation with fingers and vaginal probe insertion were added for 8 weeks. Sexual activity, attitudes and problems in european Results At 8 weeks of treatment, all 12 women who completed the program became tolerable to vaginal insertion of larger size probes and adults aged 40 to 80 years: Results of an international could achieve satisfactory vaginal intercourse. survey Conclusions FES-biofeedback with behavioral cognitive therapy is an C. Gingell, United Kingdom; J. Buvat, D. Glasser, U. Hartmann, effective aid to learning the muscle control in patients with vaginismus. A. Nicolosi, F. Simsek Therefore, it may increase the success rate of treatment of vaginismus.

International Journal of Impotence Research