(018) Is Female Sexual Dysfunction an Important Factor in Physician Process of Care and Decision-Making for Common Gynecologic Procedures: An Interview Study
Authors: Tomalty D , Giovannetti O , Kment B , Adams M 
Published: June 2023

Abstract

Introduction
The mid-urethral sling (MUS) and cervical conization are two common gynecologic procedures performed to correct symptoms of stress urinary incontinence, and to treat cervical dysplasia respectively. There is limited literature surrounding the decision-making process, and process of care physicians follow when performing these procedures. Additionally, current evidence suggests that sexual dysfunction (SD) can result in some women following the MUS procedure and cervical conization, specifically the loop electrosurgical excision procedure (LEEP). Despite this, it is unclear in the literature how physicians performing these procedures perceive this evidence, and if it has an influence on their process of care and decision-making.

Objectives
The objective of this study was to understand the factors that impact physician decision-making surrounding MUS and cervical conization procedures. A specific interest of this research was determining if and how the recent evidence regarding the potential for post-operative complications of SD is incorporated into the decision-making process and process of care of physicians performing MUS/LEEP.

Methods
A qualitative semi-structured interview protocol was developed that explored three general areas: pre- and post-operative patient counseling, physicians’ decision making intra-operatively, and physicians’ approach to and perceptions of SD and sexual health counseling. Six Canadian staff physicians with specializations in relevant fields were recruited and interviewed as a pilot study. Thematic content analysis of the recorded and transcribed interviews was completed using NVivo 12.

Results
All participants indicated a preferred surgical approach (transobturator; LEEP). Factors that influenced this choice included reported risk data, procedure efficacy, and training. A commonly identified theme was the importance of minimizing damage to surrounding tissues (MUS) and minimizing the amount of tissue excised (conization) to mitigate post-operative complications. Most participants acknowledged that these procedures could have a negative impact on female sexual functioning (FSF). However, individual definitions of SD and the perceived type, degree, and potential of impact on these procedures on FSF were highly variable. Most of the participants indicated that they assessed some aspect of their patient’s sexual functioning post-operatively, however none specified a compete assessment of FSF or the use of a validated instrument or questionnaire. None of the MUS physicians reported discussing the evidence-based risk of the possible negative impact of the MUS procedure on orgasm function with their patients.

Conclusions
The results from this pilot study provide emerging evidence that physicians’ definitions of SD, and the perceived impact of LEEP and MUS on FSF are highly variable and do not fully reflect current evidence. The degree to which the physicians incorporated the reported post-operative risk of SD as a part of their process of care within the context of these procedures was also inconsistent. These results suggest the need for a standardized process of care with regard to counseling patients of the risk of post-operative SD, in addition to the assessment of female sexual health within the context of these two procedures. Further validation of these results is needed in a larger cohort, with an extension of this study that includes American physicians currently underway.

Disclosure
No.