Female sexual dysfunction after pelvic surgery: the impact of surgical modifications

The relation of estradiol conditions and usage length to sexual dysfunction in progesterone acetate medroxepo acceptories at Bara-Baraya public health center of Makassar

OBJECTIVE

This study aims to determine the relationship between estradiol hormone levels and duration of the usage on sexual dysfunction in Depo Medroxy Progesterone Acetate acceptors.

METHOD

Family Planning (KB/Keluarga Berencana) Depo Medroxy Progesterone Acetate as many as 43 respondents who meet the sample criteria. The sampling technique used was accidental sampling. Data analysis was performed by using chi square.

RESULTS

The results showed that there was a significant relation between levels of the hormone estradiol and the incidence of sexual dysfunction (p=0.000), as well as the length of time using Depo Medroxy Progesterone Acetate on sexual dysfunction (p=0.000).

CONCLUSION

The result of data analysis is that the duration of Depo Medroxy Progesterone Acetate injection usage significantly reduces the level of the hormone estradiol which can cause sexual dysfunction in Depo Medroxy Progesterone Acetate acceptors.

Histologic Investigation of the Female Vesicourethral Junction and Adjacent Tissues for Nerve-sparing Radical Cystectomy

OBJECTIVE

To understand the structures around the vesicourethral junction and to improve functional outcomes after nerve-sparing radical cystectomy with orthotopic urinary diversion for female patients, we histologically elucidated the fibromuscular construction and nerve distribution around the vesicourethral junction.

METHODS

Pelvic specimens containing all the pelvic viscera were obtained from 33 donated female cadavers. Macroslices that included the urethra, the anterior wall of the vagina, and the inferomedial edge of the levator ani muscle were made and performed elastica Masson and immunohistochemical staining. The intraoperative findings were collected in 3 female patients undergoing nerve-sparing radical cystectomy.

RESULTS

In 18 out of the 33 cadavers, smooth muscle mass occupied a space between the urethra and the inferomedial edge of the levator ani muscle and covered the inferior margin of the bladder detrusor. We termed this mass the hiatal smooth muscle. The detrusor nerves entered the bladder, and the cavernous and sphincter nerves ran between the hiatal smooth muscle and vesicourethral junction. The boundary between hiatal smooth muscle and urethral smooth muscle was easily distinguished intraoperatively during dissection of the vesicourethral junction.

CONCLUSION

We found that more than half of elderly women have hiatal smooth muscle between the urethra and inferior edge of the levator ani. Autonomic nerve fibers innervating the urethral sphincter, run between the hiatal smooth muscle and vesicourethral junction in female cadavers with hiatal smooth muscle. When performing female radical cystectomy before neobladder reconstruction, nerve sparing can be reliably performed using the hiatal smooth muscle as a landmark.

Sexual and functional long-term outcomes following advanced pelvic cancer and reconstruction using vertical rectus abdominis myocutaneous and gluteal myocutaneous flap

INTRODUCTION

After extensive pelvic surgery for cancer two flap types are used at Skåne University Hospital (SUS), Sweden for perineal reconstruction: vertical rectus abdominis myocutaneous flap and gluteal flap with or without vaginal reconstruction. The objective was to study the long-term outcomes in patients treated for advanced pelvic cancer receiving a flap.

METHOD

Patients with pelvic cancer subjected to surgery including perineal reconstruction between January 2010 and August 2016 at SUS were included retrospectively. Participating patients were scheduled for an out-patient visit. Questionnaires addressing quality of life, (QLQ-C30 and EQ-5D) and sexual function (FSFI and IIEF) were filled in. Sensitivity test, using monofilaments on the gluteal/posterior thigh area, neovaginal measurements using silicon gauges and muscular functionality tests (timed stands test and stairs test) were performed.

RESULTS

Thirty-six (24 women, 12 males) out of 71 invited patients conceded participation. Patients scored a median of 85/100 regarding global health using EQ-5D. All women reported sexual dysfunction and 75% (9/12) of men reported severe erectile dysfunction. Neovaginal measurements showed adequate reconstructions. Sensitivity test implied decreased sensitivity on the operated side compared to the unoperated side in patients with gluteal flap. Both physical tests demonstrated adequate muscular functionality in everyday life activities after reconstructions using gluteal flap.

CONCLUSION

This long-term follow up after extensive surgery treating pelvic cancer with perineal flap reconstruction implies high quality of life, good muscular functionality and adequate neovaginal measurements. However sexual function is impaired among both sexes and sensitivity in the surgical area of the gluteal flap is decreased.

Radical Cystectomy in Female Patients - Improving Outcomes

PURPOSE OF REVIEW

To review the methods of improving surgical, oncological, and functional outcomes in women with bladder cancer treated with radical cystectomy.

RECENT FINDINGS

Οrthotopic urinary diversion (ONB) is a safe option for well-selected women as it combines high rates of daytime and nighttime continence with exceptional oncologic outcomes. It is considered safe even for patients with limited lymph node disease and trigone involvement, as long as a preoperative biopsy of the bladder neck or an intraoperative frozen section analysis of distal urethral margin rules out malignant disease. Nerve-sparing techniques have shown promising results. For well-selected patients with early invasive disease, sparing of internal genitalia has proven to be oncologically safe. Yet, generally accepted and evidence-based oncological and functional follow-up schemes for women after radical cystectomy are still lacking. Properly designed prospective studies are needed with adequate number of participants in order to safely conclude about a broader use of pelvic organ-sparing cystectomy.

Orthotopic Urinary Diversion for Women

Orthotopic neobladder is a viable option for women undergoing cystectomy for bladder cancer, with excellent oncologic outcomes and a low incidence of urethral recurrence. Careful patient selection is important, as is developing a clear understanding by the patient and her family in what to expect with an orthotopic diversion. Surgical technique is also important in optimizing functional outcomes, such as continence, sexual function, and decreased rate of vaginal fistula formation, and urinary retention.

Survey of the prevalence of sexual dysfunctions in Kurdish women

This study evaluates the prevalence of female sexual dysfunctions among Kurdish women. Participants in the study were 196 women between 15 and 55 years of age who attended the gynecological clinic of Be'sat Hospital in Sanandaj Province, Iran. The authors collected relevant data using the Female Sexual Function Index. The mean score was 22.71 (SD = 5). Using a cutoff score of 26.55, the authors found that 151 women (77%) had some sexual dysfunction. Scores declined as patients' age increased; further, an older age at marriage was associated with a higher score. This study, the first about sexual dysfunctions in Kurdish society, shows that sexual dysfunctions are prevalent among women of this ethnicity. Clinicians should complete further studies to assess the factors contributing to this phenomenon.

Ileal neobladder in women with bladder cancer: cancer control and functional aspects

PURPOSE OF REVIEW

Radical cystectomy and urinary diversion is the accepted standard of care for invasive bladder cancer. Although orthotopic neobladder is the preferred method of urinary diversion in men, less experience is available for women. Recent studies and reports on this subject are summarized and reviewed.

RECENT FINDINGS

Urethra-sparing cystectomy in women and orthotopic urinary diversion can be performed safely in appropriately selected women with invasive bladder cancer. Excellent oncological outcomes can be expected with a minimal risk of urethral recurrence in case of negative frozen section of the proximal urethra. Orthotopic neobladder diversion offers excellent clinical and functional results, and should be the diversion of choice in most women following cystectomy. Female sexual dysfunction can be avoided in patients who received neurovascular preservation, although quality of life declined in women who had undergone non-nerve-sparing radical cystectomy.

SUMMARY

Urethra-sparing cystectomy does not compromise the oncologic outcome in women with bladder cancer. The excellent functional outcome and voiding pattern with orthotopic urinary diversion argues in favor of this technique as the preferred method for lower urinary tract reconstruction after radical cystectomy. Nerve-sparing radical cystectomy preserves female sexual function and improves quality of life.

Female sexual function after abdominoperineal resection for squamous cell carcinoma of the anus and the specific influence of colpectomy and vertical rectus abdominis myocutaneous flap

AIM

Abdominoperineal resection (APR) is the only curative treatment for recurrent or persisting squamous cell carcinoma of the anus after radiochemotherapy. A vertical rectus abdominis myocutaneous (VRAM) flap reduces perineal morbidity. The sexual life (SL) of women after APR is unknown. Aims of this study were to evaluate SF of women after APR.

METHOD

47 women alive after APR performed between 1996 and 2007 were included. SL was evaluated using the female sexual function index (FSFI) score.

RESULTS

29 (62%) women answered the questionnaire: 15 (52%) had a VRAM and 16 (55%) a colpectomy. Among the 21 patients with SL before surgery, 16 (76%) still had intercourse with a mean FSFI score of 19.5 ± 10.9 [4.8-36]. Main difficulties reported were troubles of lubrication, orgasm, and dyspareunia. Confection of a VRAM did not influence the recovery of SL (P = 0.717). Colpectomy reduced return of SL (P = 0.026).

CONCLUSION

Among women who had SL before APR, 76% still had sexual intercourse after. Colpectomy seems to reduce SL.

Sexual and urinary dysfunction after proctectomy for rectal cancer

Sexual and urinary dysfunction occur frequently after rectal surgery. Total mesorectal excision (TME) is currently the optimal technique for resection of rectal cancer, providing superior carcinological and functional outcomes. Age, pre-operative radiation therapy, abdominoperineal resection, and surgery which fails to respect the "sacred planes" of TME are the four major risk factors for post-operative sexual and urinary sequelae. In the era of TME, postoperative sexual dysfunction ranges from 10-35%, depending on the scores used to assess it, while urinary sequelae have decreased to less than 5%. The place of laparoscopic surgery remains to be defined, particularly with respect to these complications. It is essential to inform the patient pre-operatively about the possibility of such disorders not only for patient informed consent but also to help with correct post-operative management of the problem. Management is multifaceted, and includes psychological, pharmacological, and sometimes surgical therapy.

Female sexual function and activity following cystectomy and continent urinary tract diversion for benign indications: a clinical pilot study and review of literature

INTRODUCTION

There are limited data on female sexual function after cystectomy for benign indications.

AIMS

To evaluate postoperative sexual items following cystectomy and continent urinary diversion for benign indications (e.g., severe incontinence, interstitial cystitis) in female patients. Furthermore, to review the studies investigating changes in women's sexual function after cystectomy.

METHODS

In a retrospective study, 21 out of 23 patients (91%) who underwent a cystectomy for a benign indication completed a questionnaire. These women had a median age at the date of operation of 47.3 years (range 25-66 years) and a mean follow-up of 11.9 years. Questions on preoperative and postoperative sexuality, postoperative sexual activity, sexual appreciation, and the Female Sexual Function Index (FSFI) in patients at present were evaluated. Electronic databases were searched for the published studies investigating female sexual function after cystectomy.

MAIN OUTCOME MEASURES

Female sexual function was evaluated by the FSFI domain scores and postoperative sexual appreciation questions.

RESULTS

Sexual complaints before operation were present in 48% of the patients. The most common complaints reported were incontinence during intercourse, pain, and loss of libido. Seventeen out of 21 patients (81%) were sexually active preoperatively, 14 were still active postoperatively, and two preoperative inactive patients became active. Sexual inactivity postoperatively is mainly due to patient-related or combination of patient- and partner-related issues (70%), such as with pain during intercourse, loss of libido, and impaired body image. In the sexually active group, the majority (62.5%) showed improved or unchanged intercourse postoperatively. In the FSFI in 11 sexually active patients (52%) at present, domains of desire, arousal, lubrication, orgasm, and pain scored above average. The domain of satisfaction scored below average.

CONCLUSIONS

Despite extensive surgery, female sexuality may remain unchanged or even improve, following cystectomy and continent diversion for benign indication. Sexual inactivity postoperatively needs more attention in respect to sexual counseling. Overall, the results are reassuring.

Neurovascular preservation in female orthotopic radical cystectomy significantly improves sexual function

Radical cystectomy has emerged as a standard treatment option for patients with muscle invasive bladder cancer. The impact of nerve-sparing cystectomy with urethra and vaginal sparing has not been quantified with validated questionnaires. We report our experience with nerve-sparing orthotopic radical cystectomy and the impact on postoperative sexual function.