bluuebunny/crossref_metadata_2025_split huggingface dataset:
(029) The Effect of Nipple Neuropathy on Women’s Sexual Health
Authors: Krychman M 
Published: May 2023

Abstract

Introduction
Breast surgery (including lumpectomy, mastectomy, augmentation, and cancer surgery) is a common intervention that women of all ages may experience. In a recent research publication, it is estimated that up to 81.5% reported that stimulation of their nipples/breasts caused or enhanced their sexual arousal whereas 78.2% agreed that when sexually aroused such manipulation increased their arousal, 59.1% had asked to have their nipples stimulated during lovemaking. While breast surgery’s impact on self-esteem has been assessed, breast surgery’s impact on nipple sensation and its relationship to sexual function has often been neglected in the literature. The nipple is a sexual organ; as such, the impact of surgical intervention on sexual function should be assessed.

Objective
An in-office survey was conducted in a sexual medicine office was conducted to assess nipple sensation after a variety of different breast surgeries, and its impact on sexual function.

Methods
An in-office survey was given to a random sampling of women attending sexual medicine/obstetrician and gynecology offices. Fifty women completed the survey. A novel, non-validated, single item, nipple sensation scale, Global Assessment of Nipple Sensation Scale (GANSS), was used as an assessment tool. A Likert scale of nipple sensation was also used, where 1 was very sensitive and 7 was absent sensation. Data regarding demographics and the impact of their surgery due to changes in nipple sensation were collected

Results
Fifty female subjects, at least one year post heterogeneous type breast surgery, reporting nipple neuropathy were surveyed for the extent of neuropathy and associated sexual function changes. The average age of the subjects was 53.6 +/-10.8. The average nipple sensitivity score (Likert scale 1-7) was 5.06+/-1.39. Nipple numbness was reported by 82% of the subjects. 40% of the subjects reported that reduced sensitivity affected their sexual function as well as (sexual desire, lubrication, and arousal. 30% reported distressful impact on orgasmic strength with reports of reduced orgasm intensity. 22% of the respondents reported that the changes in nipple sensitivity had impacted their primary relationship and 32% of women reported that it had negatively impacted their overall sexual wellness.

Conclusions
Breast surgery resulting in decreased nipple sensation is perceived by patients to have impactful changes on sexual self-esteem, sexuality and overall sexual wellness. This is a poorly studied phenomenon and has implications on female sexual health. The assessment tool used in this study needs to be validated and larger clinical trials should be conducted.

Disclosure
Yes, this is sponsored by industry/sponsor: applied. iology
Clarification: Industry funding only - investigator initiated and executed study.
(033) Examining the Neuroanatomical Basis of Bremelanotide, a Drug for Low Sexual Desire in Women
Authors: Kohut-jackson A , Borland J , Meisel R 
Published: May 2023

Abstract

Introduction
Low sexual desire is a commonly reported and often distressing form of sexual dysfunction in women. Characterized by diminished interest in sex, disinclination to initiate sex, and a loss of pleasure during sex, disorders of sexual desire among women are not only poorly understood from a psychological perspective, but also in terms of their underlying neurobiology. The drug bremelanotide, trade name Vyleesi, was approved by the FDA in 2019 to treat hypoactive sexual desire disorder in women. The drug is a synthetic analogue of the melanocortin receptor (MCR) agonist alpha-MSH and thus thought to bind to the melanocortin-4 receptor (MC4R) in the brain. However, despite its FDA approval, few preclinical studies or clinical trials have been performed on the drug.

Objective
We attempted to elucidate bremelanotide’s central nervous system effects in an established rodent model of female sexual behavior.

Methods
Female Syrian hamsters underwent 0, 2 or 5 weeks of sexual conditioning in the conditioned place preference apparatus, a validated model that is designed to test the rewarding properties of sexual behavior. Some hamsters that were conditioned for 2 weeks were also given a subcutaneous injection of bremelanotide. After the sexual conditioning experiment, brains were collected for assessment of MC4R expression in the striatum. mRNA expression of dopamine-1 and 2 receptors and MC4R were carried out using Syrian hamster customized RNAscope probes.

Results
Analysis of behavior data indicated the longer (5-week) sexual conditioning period was most effective for increasing responses indicative of reward, though the shorter (2-week) period also increased reward. However, neither the low dose nor high dose of bremelanotide increased reward responding as compared to control hamsters. Further, no brain changes in MC4R expression in the striatum were detected as a function of either sexual experience or bremelanotide treatment. MC4R was not co-expressed with dopamine-1 or dopamine-2 receptors in the nucleus accumbens or dorsal striatum.

Conclusions
Bremelanotide did not increase responding indicative of reward derived from sex in the female Syrian hamster model. Given that MC4R expression was unaffected by sexual experience and/or bremelanotide, our findings did not provide evidence that the drug acts via an MC4R-related mechanism in the central nervous system. MC4R was also not co-expressed with dopamine-1 or 2 receptors, suggesting the MC4R may instead be expressed by interneurons in the striatum. Despite our lack of evidence to support bremelanotide’s efficacy in animals, limitations of the rodent model of female sex behavior include the obvious psychosocial aspects of human sexuality that cannot be replicated. Further research is warranted to clarify bremelanotide’s mechanism of action.

Disclosure
No
(047) A Thematic Analysis of Sexual Health Disparities Among Native Adolescents
Authors: Evans G 
Published: May 2023

Abstract

Introduction
Native adolescents have significantly higher rates of sexually transmitted infections and unintended pregnancies. Compared to their Non-Hispanic White counterparts, Native adolescents have 2.5 times the rate of pregnancy1, 3.7 times the rate of chlamydia, 4.6 times the rate of gonorrhea, and 2.6 times the rate of primary and secondary syphilis2. Furthermore, Native adolescents are engaging in sexual activity at younger ages and using contraceptive methods less often.3

Objective
To address and identify additional factors associated with the sexual health disparities among Native adolescents.

Methods
The study recruited a purposive sample of key stakeholders who worked in sexual health among American Indian/Alaska Native adolescents by way of an individual with the Healthy Native Youth Project. The individual was provided with information regarding the research study and asked to distribute it to their colleagues. A total of three participants were recruited and interviewed. Qualitative interviews were semi-structured, conducted individually, and recorded using the Zoom recording feature, as well as an iPhone X voice memo application for backup. Interviews lasted 23 – 40 minutes. Interviews were transcribed using Temi and Descript applications and transcripts were coded in Atlas.ti for the thematic analysis. After each transcript had been coded, they were placed into a codebook where they were defined, along with examples of each code. Codes were then grouped into categories where themes emerged.

Results
Three female identifying participants were interviewed for this study. Themes that emerged from the interviews include the overall sexuality education that Native adolescents receive, the importance of culture, and the impact of trauma. Regarding sexuality education among Native adolescents, findings show that it is imperative to acknowledge both the delivery of information, as well as confidentiality concerns. The importance and use of culture within sexual health assists in normalizing sexual health and sexuality education. Lastly, findings from interviews regarding the impact of trauma make it clear that not only is there still medical mistrust, but also that it is imperative to acknowledge it and listen to and validate concerns that the youth have on this matter.

Conclusions
The findings from this study were remarkable and each participant identified the importance of cultural relevancy and the impact that trauma continues to have and the importance of acknowledging it. Given the alarming rates of sexual health disparities among Native adolescents, it is essential to continue research and educational efforts to reduce these disparities. Future implications for this work include ensuring confidentiality, making the invisible become visible, promotion of youth councils, and translation of curricula information to healthcare.

Disclosure
No
(052) Are Vibrators Equally Effective Among Women Engaged in Partnered Versus Solo Sexual Activity?
Authors: Dubinskaya A , Jackson F , Kohli P , Shoureshi P , Eilber K 
Published: May 2023

Abstract

Introduction
Solo sexual activity is solo stimulation of one’s genitals and other body areas for sexual pleasure. Treatment methods for Female Sexual Dysfunction (FSD), developed to date are usually assessed in the context of partnered sexual activity. There is a growing need to compare the effect of therapeutic interventions, like vibrators, among women engaged in only solo sexual activity versus partnered sexual activity.

Objective
The aim of this study was to assess the effect of routine vibrator use on sexual health among women engaged in solo only versus partnered sexual activity.

Methods
This was a prospective pilot study of sexually active women aged 18 to 99 years who presented for consultation in our urogynecology clinic with pelvic floor and/or sexual health concerns. Women were offered a bullet vibrator and instructed to use it according to the protocol. Participants’ demographics, health data, sexual practices, frequency of solo and partnered sexual activity, as well as Female Sexual Function Index (FSFI) were assessed at the initial visit and after three months of intervention. We used descriptive statistics and a paired-sample t-test to determine the effect of vibrator use on sexual function.

Results
Among 61 women enrolled in this study, 60.6% (n=37) were engaged in partnered sexual activity and 39.3% (n=24) were only solo sexually active. Participants were predominantly Caucasian (80.3%), with a mean age of 54.7 ± 16.3. There were no significant differences in demographics and pelvic floor disorders (prolapse, urinary incontinence) between the two groups. Vibrator use among women in a solo group did not show significant improvement in sexual response cycle domains (p&gt;0.05). However, the score statistical trend was noted across all the domains. Women engaged in partnered sexual activity had significant improvement in desire (p=0.03), arousal (p=0.03), orgasm (p=0.05), and the total score (p=0.03) with vibrator use. The study completion was higher among women involved in partnered sexual activity 94.6% (n=35) than women who only engaged in solo sexual activity 58.3%(n=14).

Conclusions
Vibrator therapy results in significant improvement in desire, arousal, and orgasm domains, as well as total score among women in partnered sexual activity when compared to women with only solo sexual activity. Solo sexual activity needs to be considered when recommending treatments, such as vibrators, for sexual health.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Abbvie, Coloplast.
(063) Assessing the Knowledge, Attitudes, and Practices of Graduating Medical Students Towards Sexual Health in Lebanon
Authors: El Kak F 
Published: May 2023

Abstract

Introduction
Despite the growing medical literature pertaining to the topic of SH, only a few studies have investigated the adequacy of medical training programs for graduating physicians who are able to identify, counsel, and manage SH concerns. Additionally, no studies have comprehensively assessed the knowledge, attitudes, and practices of medical students regarding SH. This gap in literature is even more evident in the Middle East and North Africa (MENA) region, which could be attributed to cultural and religious factors. These factors not only impede the exploration of SH topics in the medical field, but also manifest as lack of accessibility and availability of SH services in Arab countries.

Objective
Despite the vital role of Sexual Health (SH) in healthcare, very few studies have investigated the adequacy of training of medical students in SH matters. Our study aims to assess the knowledge, attitudes, practices, and readiness of graduating medical students to learn about SH in Lebanon, and to determine the demographic and educational factors that influence our findings.

Methods
This is a cross-sectional study. A self-designed questionnaire exploring various components of SH (contraception, STIs, IPV, sexuality, etc.) was sent to all graduating medical students in Lebanon. Knowledge, attitude, and practice scores were computed. ANOVA with subsequent post-hoc tests were used for analysis.

Results
The overall mean knowledge score was relatively low (2.61, range -13 to 10). A statistically significant difference was found in the mean knowledge score across religion (p = 0.028) and religiosity (p &lt; 0.001) categories as the mean knowledge score was higher in the atheist group when compared to the religious groups, and that of the “moderately/very religious” category was lower than that of the “not/slightly religious” (p = 0.001). The mean practice score also differed significantly across income groups (p = 0.01). No other significant associations were found between gender, sexuality, environment, primary source of SH education, or language and the mean knowledge, attitude, and practice scores.

Conclusions
Our findings suggest that graduating students in Lebanese medical schools are not appropriately trained to address SH matters in clinical practice. This allows medical educators to examine the gaps in knowledge, attitude, and practice towards sexual healthcare. Pertinently incorporating, reforming, and updating SH education in medical school curricula would provide students with the appropriate skillset needed for their upcoming medical practice. Additional standardized assessment of medical students’ competencies in SH matters through diverse research models is needed. Reexamination of existing medical curricula and inclusion of more extensive SH education is necessary to improve patient care. Our study is the first study in Lebanon and the MENA to look at SH competencies of future physicians in a comprehensive approach.

Disclosure
No
(070) Treatment of Genitourinary Syndrome of Menopause is Beneficial for Lichen Sclerosus Patients
Authors: Myers A , Marino J , Pope R 
Published: May 2023

Abstract

Introduction
Postmenopausal women with Lichen Sclerosus frequently report vulvar symptoms consistent with genitourinary syndrome of menopause (GSM) including pruritus, dyspareunia, or non-provoked pain. Our data revealed not surprising vulvar itching as the most frequently reported symptom of LS, second most frequent was general irritation, followed by vaginal dryness, and vulvar burning. Distinguishing these symptoms from GSM which occurs in 27-84% of postmenopausal women can be problematic.

Objective
The purpose of this study was to understand the symptoms of postmenopausal women with LS. We specifically surveyed them regarding their symptoms and treatments they had tried including both prescription and over the counter.

Methods
We interviewed 25 women with biopsy proven LS. This was part of a larger study on the microbiome and genetics of postmenopausal women with LS.

Results
Our data revealed that while the majority of the women in our study were using standard treatments such as high or medium potency steroid ointments or calcineurin inhibitor, less than 25% reported using hormonal medicines in their vulva (4 of 17), a common treatment for postmenopausal symptoms of vulvar burning, general irritation and dryness; Our data revealed that 50% of the women reported they had used at least more than one prescription or over the counter product to manage symptoms, none of which were hormone related.

Conclusions
Our data suggests that while these women were treated for their LS, their menopausal symptoms were not addressed. These findings lead us to believe perhaps their menopausal symptoms had been undertreated and that LS symptoms may be difficult to manage exclusively with standard treatments such as steroids and/or calcineurin inhibitors in postmenopausal women. Treatment of GSM with standard recommended treatments is beneficial for LS patients.

Disclosure
No
(093) “Vagina” is Not a Bad Word: Historical and Contemporary Censorship of the Word “Vagina”
Authors: Popat S , Horwitz R , Eilber K , Lee U 
Published: May 2023

Abstract

Introduction
The first recorded use of the word “vagina” was in 1680. It is the only contemporary anatomic term for the female reproductive canal and has no anatomically accurate substitute. For the last 350 years, use of the word has been intentionally avoided in media, print, and society in general.

Objective
We sought to characterize instances of “vagina” censorship to better understand perceptions and behaviors surrounding the word “vagina.”

Methods
An internet and relevant database (PubMed, Academic OneFile, Proquest, Health Business Elite, etc.) search was conducted for “vagina, “censor,” and related wildcard terms. Search results were filtered by three independent reviewers for relevance. Related articles were summarized and reviewed for common themes.

Results
Examples of censorship of the word “vagina” were compiled in Table 1, and several themes were identified: (1) Policies surrounding censorship are unclear. Affected parties typically receive generic responses – for instance, that content “does not comply” with standards. Censoring parties oftentimes will not explicitly identify language or elements of concern. (2) Policies appear highly variable. In advertisements for similar products on the same social media platforms, some companies successfully use the word “vagina” while others are barred, highlighting puzzling inconsistencies. (3) Another related theme that emerges is differing standards between references to male and female genitalia. For example, “penis” and associated references were often allowed by the same television shows that mandated censorship or omission of “vagina.” (4) Objections often call the use of “vagina” overtly sexual, profane, or unprofessional. However, “vagina” refers to an anatomical term for which there is no suitable, biologically accurate alternative. Censorship of the word forces inaccurate, over-generalized, ambiguous references to female genitalia.

Conclusions
The word “vagina” is censored across multiple platforms: print, film and television, social media, politics, education, and more. It has been censored for centuries and continues to be today. This erects barriers to care for women. Patients increasingly turn to the internet and other media platforms as accessible sources of high-quality health information about their bodies. Pervasive censorship of the word “vagina” perpetuates a culture of ignorance and shame about women’s bodies. Until we normalize the term “vagina,” we cannot make progress on women’s pelvic health.

Disclosure
No
(102) Basic Research for Determination of Normal Levels of Sex Hormones (Testosterone, Free Testosterone, DHEA-S, Estradiol, IGF-1) in Middle-aged and Elderly Japanese Women
Authors: Sekiguchi Y 
Published: May 2023

Abstract

Introduction
Testosterone, the hormone that also keeps women motivated to live with sexual desire, is important in maintaining the health of women of all ages. However, it remains difficult to judge whether testosterone levels in female patients are normal or not, based on test results in general clinical practice.

Objective
From October 2020 to February 2021, 160 healthy volunteer women who visited 5 clinics were collected blood, tested, and free testosterone. Testosterone, DHEA-S, were measured. At same time, estradiol and IGF-1 which suggested the level of growth hormone were measured.

Methods
The measurement was outsourced to LSI Medience Biomedical Blood Test Department, and male hormone levels were collectively measured by the CLIA method. Age of the female volunteers was mean 45 years, median 41 years, maximum 87 years, minimum 20 years. The population distribution was 16 in their 20s, 52 in their 30s, 43 in their 40s, 17 in their 50s, 15 in their 60s, 10 in their 70s, and 7 in their 80s.

Results
See Table 1

Conclusions
DHEA, free testosterone and IGF-1 declined with age, but the level of decline of testosterone was smaller than the others. Moreover estradiol was maintained as 10∼20pg/ml so called therapeutic window.

Disclosure
No
(121) Female Sexual Dysfunction: Can it be Addressed During Infertility Treatment?
Authors: Schaub A , Dubinskaya A , Eilber K , Pisarska M 
Published: May 2023

Abstract

Introduction
Female sexual dysfunction (FSD) is a highly prevalent and distressing condition in the general population. Women undergoing fertility treatments are at higher risk of developing sexual dysfunction due to associated stress, sense of sexual activity as being routine, and demanding treatment regimens. Despite the known association between FSD and infertility, the optimal FSD treatment regimen for the infertility patient has not been described.

Objective
Our objective was to determine the optimal FSD treatment strategy for women with infertility.

Methods
We conducted a systematic review on the current approaches to treat FSD while undergoing fertility treatments. PubMed, PMC and Google Scholar were queried, and results were screened using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria for this review were: 1) Subjects were women presenting for infertility treatment, 2) Sexual health was described and measured, 3) Interventions were performed or recommended to the subjects with measured outcomes and 4) The manuscript was written in English between January 2000 to June 2022. Case reports and studies that did not address conditions of interest were excluded from analysis.

Results
Queries identified 2,341 studies of which title and summary were screened. 15 articles were identified for full text review, and only 1 article met inclusion criteria. The single article identified was a prospective cohort study including 35 women with infertility in each arm. The intervention arm underwent 2 sessions of sexual counseling following the BETTER method, and at a 3 month follow up period FSFI scores were significantly improved in the intervention arm compared to the control arm.

Conclusions
Given the significant risk for FSD in this population, the fact that only one study could be identified on this topic is a huge gap in the medical knowledge that requires more investigation. The single study identified suggests counseling may be a successful treatment option for women with FSD and infertility, but more studies are needed to determine what other options are available and effective for FSD in this population.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Ferrring pharmaceuticals