(028) A Comparison of Genital Self-Image and Sexual Functioning among Women with Vulvar and Non-Vulvar Dermatologic Disease
Authors: Rivera S , Flood A , DeMaria A 
Published: June 2023

Abstract

Introduction
Inflammatory dermatologic diseases of the vulva represent a significant morbidity burden for affected women. Genital itching, pain, and skin changes have a profound impact on sexual function. Research also suggests women with generalized, non-vulvar dermatologic diseases have impaired sexual function. The Female Genital Self-Image Scale (FGSIS) was developed and validated in a large sample of American women a decade ago. Despite developers’ suggestion that the FGSIS could be used to further understand the burden of genital disease, there remains a paucity of research in this area. Both vulvar and non-vulvar inflammatory skin disease have yet to be fully characterized with regards to impact on genital self-image (GSI), a key mediator in sexual health and behavior.

Objectives
The present study describes GSI, sexual function, and sexual behaviors among women with vulvar and non-vulvar inflammatory dermatoses.

Methods
A 20-minute Qualtrics survey was distributed between September and November 2020 through three primary means: 1) targeted social media ads, 2) relevant social media support groups, and 3) online research volunteer recruitment services. Women in the US over age 18 who have ever been diagnosed with an inflammatory dermatosis persisting longer than one month were eligible to participate. The present data were collected as part of a larger study examining sexual health, quality of life, and health care experiences of women with skin disease. Survey items analyzed included the FGSIS, the Female Sexual Function Index (FSFI), and sexual behavior histories.

Results
The sample consisted of 320 women with a mean age of 42.7±15.5 (Range=19-81). Most participants were pre-menopausal (n=200; 62.5%), Caucasian (n=278; 86.9%), and heterosexual (n=263; 82.2%). Nearly one-third of women (n=98; 30.6%) reported inflammatory dermatologic disease isolated to the vulva, while 150 (46.9%) had strictly non-vulvar disease, and 72 (22.5%) experienced both vulvar and non-vulvar manifestations. The average FGSIS score among women with any vulvar disease was 16.9±4.1 (range=7-28) and was significantly (p&lt;.01) lower than that of women with non-vulvar disease (M=21.2±4.3; range=9-28), with a higher score indicating a more positive FGSIS. A similar trend was seen with the FSFI, which was significantly (p&lt;.01) different among women with vulvar disease (M=15.4±9.7, range=2.0-35.1) compared to women with non-vulvar disease (M=21.2±10.1, range=2.0-35.1), with higher scores indicating better functioning. When stratified by category, FSFI remained significant for desire (p=.04) and pain (p&lt;.01), but not for arousal, lubrication, orgasm, or satisfaction. Women with vulvar disease were significantly less likely to receive (p=.02) or give (p=.04) oral sex or to engage in vaginal intercourse (p&lt;.01) during the last four weeks.

Conclusions
This study demonstrates severe sexual health morbidity associated with inflammatory vulvar dermatoses, characterized by very low FGSIS and FSFI scores. Pain and desire shaped sexual function for women with vulvar disease, despite non-significant differences in other domains including satisfaction. Results also indicated low FSFI scores in women with non-vulvar disease, with FGSIS scores similar to previously-described healthy controls. A more precise understanding of the role of GSI in both vulvar and non-vulvar disease will provide opportunities for improved patient-centered disease management in the realm of sexual health.

Disclosure
No.