Vegunta, Suneela

Abstract Introduction Sexually transmitted viruses (STVs), including Human Immunodeficiency Virus (HIV), Human Papillomavirus (HPV), Herpes Simplex Virus (HSV), and Hepatitis B Virus (HBV), present major public health challenges due to their high prevelance, chronicity, and transmission rates. Extending beyond immediate health impacts, these viruses affect sexual health and function through mechanisms including chronic inflammation, psychological stress, social stigma, and adverse effects of treatment. While the link between STVs and sexual disorders is acknowledged, it is underexplored in the literature, particularly concerning female sexual health. Current research largely focuses on male sexual dysfunction, especially erectile disorder and its treatment. This review investigates the relationship between STVs and female sexual disorders, examining physiological, psychological, and social factors contributing to sexual health concerns. Enhancing our understanding of this relationship could support clinicians in identifying sexual health concerns in female patients with STVs and providing targeted interventions to optimize sexual health outcomes. Objective This systematic review aims to examine existing literature on the relationship between STVs and female sexual disorders, identifying specific dysfunctions (e.g., pain, desire, arousal, and satisfaction) associated with each virus, underlying mechanisms, and discussing clinical and research implications. Methods A comprehensive literature search was conducted in September 2024 across four databases: Ovid MEDLINE, Ovid EMBASE, Scopus, and Web of Science. A total of 523 references were identified, with 139 duplicates removed, leaving 384 studies for screening based on inclusion and exclusion criteria. Searches combined MeSH (Medical Subject Headings) terms and keywords to capture relevant studies. MeSH terms included “Sexual Dysfunction, Physiological,” “Sexual Dysfunction, Psychological,” “Papillomavirus Infections,” “Herpesvirus 2, Human,” “Hepatitis B,” and “HIV.” Additional keywords included “sexual dysfunction,” “HSV,” “hepatitis,” “HPV,” “woman,” “women,” and “female.” The search was limited to English-language studies. Results A total of 384 studies met the inclusion criteria, with findings revealing associations between specific STVs and various types of female sexual dysfunction. HSV was notably associated with dyspareunia during outbreaks due to genital ulcers, as well as with psychosexual issues linked to concerns about transmissibility and the stigma of visible lesions, negatively affecting intimate relationships. HIV was associated with multifactorial sexual dysfunction, encompassing psychological impacts such as fear of transmission and health-related anxiety, as well as physiological effects like decreased sexual desire from antiretroviral therapy and lipodystrophy. HPV’s relationship with sexual disorders was variable, with some studies connecting it to heightened depression and anxiety following diagnosis, which diminished sexual desire. For HBV, sexual dysfunction correlated with the severity of liver dysfunction, as chronic liver disease in women impairs hormone metabolism and increases sex hormone-binding globulin (SHBG) levels, leading to suppression of the hypothalamic–pituitary-gonadal axis. Conclusions This review highlights a notable relationship between STVs and female sexual dysfunction, emphasizing the need for comprehensive care that addresses both management of the infection and sexual health concerns. Routine screening for sexual health concerns in women with STVs is recommended, along with interdisciplinary approaches to address these complex impacts. Improved recognition and management of sexual disorders in this context can enhance both sexual health outcomes and overall quality of life in affected individuals. Disclosure No.

Abstract Introduction Sexual and reproductive history taking is a fundamental yet often overlooked aspect of medical education. Most medical schools in North America do not provide adequate sexual health training to students, with 44% of schools lacking a sexual and reproductive health curriculum (1). Moreover, there are currently no national standards across medical schools for training students to take a sexual health history (2). Existing programs vary widely and often consist of limited hours or electives, leaving many medical graduates feeling unprepared (3). Objective To develop a multimodal course and standardized curriculum for first-year medical students. Methods Through a combination of video presentations, live demonstration, interactive lecture, and Group Observed Structured Clinical Experience (GOSCE) sessions with standardized patients, students were guided in learning and practicing sexual history taking skills. Post-course surveys were sent to all 52 students after completion of the course, with 46 students completing the survey (response rate 88%). Students were asked to rank their knowledge of the course topic on a scale from 1 (not at all knowledgeable) to 5 (extremely knowledgeable) both before and after participating. Results On average, there was a significant change in knowledge, regarding navigating sexual health biases and effectively obtaining a sexual history from patients, by 1.2 points after students partook in the course (p < 0.0001). The majority (80%) reported that there was the right amount of lecture and patient interactive learning. Ninety-six percent of students agreed that the course met the learning objectives and indicated they would use what they learned in the course in the future. Conclusions After participating in this multimodal sexual health course, students demonstrated an improvement in knowledge and indicated that the course met the learning objectives. These results suggest that multimodal teaching methods may address the gap in sexual health education. Disclosure No.

Abstract Introduction Sexual well-being is an important quality of life component to women throughout life, and during menopausal transition and beyond. Female sexual response cycle includes desire, arousal, orgasm, and resolution phases. Female sexual dysfunction (FSD) encompasses all phases of sexual response cycle and can lead to distress for both the woman and her partner and warrant further investigation. Research has indicated both positive and negative associations between alcohol consumption and sexual health, our review goal is to further explore the relationship between alcohol consumption and sexual function in perimenopausal women. Objective We aim to review the current literature regarding the influence of alcohol use on sexual health during the menopausal transition and beyond. Methods The examination of alcohol consumption and its effects on sexual health in menopausal women was performed through reviewing existing literature. The literature search was completed in the Ovid MEDLINE database (1946- Present) in August 2023. 16 articles were identified in the initial search. 12 articles met our inclusion criteria and were independently reviewed by the authors. Results from these articles were summarized. The search was limited to the English language and the last 20 years (2003-current). Keywords included: menopause, pre-menopause, post menopause, perimenopause, alcohol use, alcohol related disorder, and sexual function. Results Seven out of 16 articles reviewed linked a negative association between alcohol consumption and female sexual function. Seven indicated a positive association between alcohol use and sexual function and 2 articles did not reveal an association. The findings of our review indicate a complex relationship of alcohol on women's sexual function. Studies indicating a positive association between mild alcohol consumption (equal or less than 0.21 FL oz. alcohol/day) and improved sexual function. This effect was theorized due to alcohol increasing endogenous estrogen or due to behavioral changes such as disinhibition, influencing sexual activities influenced by alcohol or subjective arousal due to drinking. Additionally, a positive association was seen between increased alcohol consumption and Female Sexual Function Index (FSFI) scores. However no significant influence on Female Sexual Distress Scale scoring was identified which is a key component to FSD. Other studies showed that excessive or prolonged alcohol consumption (more than 1.00 FL oz. alcohol per day) found to be associated with worsening sexual function and can impact all 6 domains on the FSFI (which include: desire, arousal, lubrication, orgasm, satisfaction, and pain) even after abstinence. These findings were reflected in another study that showed women (however not exclusively menopausal) who were seeking treatment for alcohol dependency diagnosis experienced low sexual desire, inability to achieve orgasm and less satisfaction. Initiating alcohol consumption at a younger age, along with an extended and more intense period of dependency, was correlated with a higher likelihood of experiencing increased sexual dysfunction. A meta-Analysis of 7 studies showed increased odds of sexual dysfunction with alcohol consumption. Another study showed that moderate alcohol consumption was found to be an independent risk factor for FSD and Genitourinary syndrome of menopause (GSM) which can lead to FSD. Conclusions The impact of alcohol on sexual health in postmenopausal women is multifaceted, based on varying levels of consumption influencing various aspects of sexual function. This relationship can also be influenced by other factors such as pre-existing sexual problems and the utilization of alcohol as a coping mechanism to reduce anxiety, release stress or to increase sexual behavior through enhancing arousal. A study indicated that menopausal symptoms may trigger a craving for alcohol, leading to increased alcohol consumption. Further research is essential to elucidate the direct and indirect effects of alcohol consumption on sexual dysfunction. In addition, the impact of abstinence from alcohol on sexual dysfunction in postmenopausal women needs to be further explored. Understanding the impact of alcohol consumption on sexual function of postmenopausal women is critical for healthcare professionals, to provide appropriate guidance and interventions. These findings highlight the need for further research and increased awareness regarding the impact of alcohol use on sexual health during in pre-menopausal, peri and postmenopausal women. Disclosure No.

Abstract Introduction Sexual pain has a profound impact on individuals, regardless of their sexual orientation or gender identity, and affects women more often than men. It adversely affects both sexual function and interpersonal relationships. Despite its prevalence, sexual pain in women often remains unaddressed and untreated. Various underlying causes contribute to sexual pain, sometimes involving multiple factors. We explore treatment options and offer clinical insights into the evaluation and management of 4 common conditions which cause sexual pain in women. In this article, we use the term “women” to indicate cisgender women. Objectives Our aim is to highlight the most common clinical scenarios of sexual pain and provide comprehensive discussions on each, to improve patient care and outcomes in the management of sexual pain. Methods We conducted a comprehensive review of literature and clinical cases to explore the various causes and management strategies for sexual pain in women. We systematically searched databases such as PubMed, Google Scholar, and relevant medical journals. We included peer-reviewed articles, case studies, and clinical trials published between 2000 and 2023. Additionally, we analyzed real-life cases from our clinical practice at our academic institution. Results Our review identified various factors contributing to sexual pain in women, ranging from hormonal imbalances to neuroproliferative and inflammatory conditions affecting the genitourinary system. Each case should be approached individually to offer optimal management strategies accordingly. Conclusion The management of sexual pain in women requires a comprehensive approach that addresses the multifactorial nature of the condition. Patient education and counseling play a crucial role in the management of sexual pain, empowering individuals to advocate for their own health and well-being. The collaboration between healthcare providers and patients can improve our understanding and management of this complex condition.