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Introduction In the United States, medical education on sexual medicine varies throughout the country and between institutions. With limited standardization, medical students and subsequent trainees have little to no training in how to approach a patient with concerns surrounding their sexual health. In 2018, half of the medical institutions in the United States required formal instruction in sexual medicine. Of those institutions that do include didactic material on sexual medicine, most of the material is dedicated to anatomy, physiology, and sexually transmitted infections, with limited or no information on sexual dysfunction and sexual history taking. Therefore, we identified a need to determine which components of sexual medicine, particularly female sexual medicine, are currently being covered in undergraduate medical education with the goal of proposing and developing standardized curriculum materials to be utilized by medical students during their preclinical education. Objective The aim of this study is to examine current preclinical curricula at all seven medical schools, including six allopathic and one osteopathic institution, in the Chicago, Illinois area to investigate which aspects of female sexual anatomy, physiology, pathology and pharmacology are being taught to medical students. Methods Curriculum materials on female sexual anatomy, physiology and pathology were collected from all seven medical schools in Chicago, Illinois. Courses covering topics on female sexual medicine varied between institutions due to differences in preclinical curriculum and coursework. To standardize our needs assessment, we utilized previous literature to identify specific components of anatomy, physiology, pathology, pharmacology, social sciences, and history and physical exam skills. Upon reviewing each institution's preclinical educational materials, we assessed curriculum content for saturation of specific concepts within each of the above areas. Results Curriculum materials were collected from seven (n=7) total medical schools in the surrounding Chicago, Illinois area. Out of the 7 institutions, 4/7 discussed clitoral anatomy, with 6/7 mentioning the glans, 1/7 mentioning the corona, 2/7 mentioning the clitoral hood, 6/7 mentioning the corpora cavernosa, 4/7 mentioning the corpus spongiosum, 6/7 mentioning the crus, 6/7 mentioning the bulb and 5/7 detailing the clitoral neurovasculature. In addition to the anatomy, 4/7 discussed the physiology of the female orgasm, 3/7 highlighted the rate and epidemiology of female sexual dysfunction (FSD), 3/7 included information on treatment for FSD, 1/7 taught a genitourinary physical exam specific to assessing FSD (external exam, internal exam, pelvic floor assessment), and 6/7 institutions included information on how to take a sexual history asking about sexual function, pleasure, and satisfaction. Conclusion Overall, our focused needs assessment of both allopathic and osteopathic medical schools in the Chicago, Illinois area highlights the need for restructuring of curriculum as it pertains to female sexual medicine and FSD in undergraduate medical education. Next steps include proposing individual curricular recommendations to institutions, due to the variation in current curriculum design, as to how they can better teach on areas surrounding FSD, while also aiming to standardize what medical students are learning during their preclinical years. Disclosure Work supported by industry: no.
Introduction Clitoral adhesions (CA) occur when preputial skin that normally moves over the glans clitoris to expose the corona becomes adhered, creating a closed compartment that is vulnerable to irritation, erythema, and infection. CAs can be associated with persistent genital arousal disorder (PGAD), which is characterized by persistent or recurrent, distressing feelings of genital arousal that are not associated with sexual interest or thoughts. One treatment option for CA is a non-surgical lysis procedure that is minimally invasive and stretches the preputial tissue open, but this procedure has not been specifically studied in women with PGAD. Objective To determine if women with PGAD treated for CA with the non-surgical lysis procedure reported satisfaction and outcomes that were different from women without PGAD. Methods 61 women who have been treated for CA using the non-surgical lysis procedure at one sexual medicine practice between the years of 2017 and 2021 were identified using a chart review and an online survey was sent to patients to evaluate patient satisfaction and the efficacy of the procedure in patients with and without PGAD. Results 41 survey responses were received (67% response rate) and 4 women had a PGAD diagnosis. There was no difference in the procedure's ability to improve pain (50% vs 81%), ability to orgasm (75% vs. 63%), or sexual satisfaction (50% vs. 73%) between women with and without PGAD. 65% of all respondents (n=40) reported being “extremely satisfied” with their decision to have the lysis procedure; however, significantly fewer patients with PGAD reported being “extremely satisfied” as compared to the control group (25% vs. 69%; p=0.04). In addition, while only 27% of all participants reported that the procedure was painful, women with PGAD were significantly more likely to report pain than women without PGAD (75% vs. 22%; p=0.01). Lastly, 51% of respondents (n=37) reported recurrence of CA after the procedure, but the incidence of readherence was significantly higher in patients with PGAD compared to patients without PGAD (100% vs. 45%; p=0.02). The increased readherence in women with PGAD was not attributable to differences in post-procedural care (use of hormone cream, yeast cream, vaseline, or retraction of the clitoral hood) or risk factors for CA (history of yeast infections and urinary tract infections, use of hormonal-based contraceptives, blunt perineal or genital trauma, lichen sclerosus, or history of sexual pain) as these were not significantly different between study groups. Conclusions These results indicate that the non-surgical lysis procedure has similar efficacy in improving pain and sexual function in women with and without PGAD. However, this procedure may be a less favorable treatment for CA in women with PGAD as evidenced by lower reported satisfaction with the procedure, increased reports that the procedure was painful, and higher rates of readherence in this group. As only 4 women in our study had PGAD, future studies with more patients with both PGAD and CA may be necessary to provide insight into additional treatment options that may offer these patients more satisfaction and improved outcomes. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Sprout (Raleigh, NC), Absorption Pharmaceuticals
Introduction Clitoral adhesions occur when the prepuce adheres to the glans. These adhesions have been found in up to 22% of women seeking evaluation for sexual dysfunction. The etiology of clitoral adhesions remains largely unclear. Studies published to date on the presentation and management of clitoral adhesions are relatively recent and raise questions for future research. Objectives We sought to provide a background of existing knowledge on the prevalence, presentation, etiology, associated conditions, and management of clitoral adhesions and to identify areas for future research. Methods A review of literature was performed for studies that investigate clitoral adhesions. Results Conditions associated with chronic clitoral scarring appear to have a role in the development of clitoral adhesions. Symptoms include clitoral pain (clitorodynia), discomfort, hypersensitivity, hyposensitivity, difficulty with arousal, and muted or absent orgasm. Complications include inflammation, infection, and the development of keratin pearls and smegmatic pseudocysts. There are surgical and nonsurgical interventions to manage clitoral adhesions. Additionally, topical agents can be included in conservative and/or postprocedural management. Although many studies on clitoral adhesions are limited to patients with lichen sclerosus (LS), clitoral adhesions are not confined to this population. Conclusion Areas for future research include etiologies of clitoral adhesion; such knowledge is imperative to improve prevention and management. Also, in previous studies, patients were instructed to apply various topical agents and manually retract the prepuce for conservative management or postlysis care. However, the efficacy of these interventions has not been investigated. Surgical and nonsurgical lysis procedures have been described for the management of pain and difficulties with arousal and orgasm that are causes of the sexual dysfunction associated with clitoral adhesion. Although previous studies have assessed efficacy and patient satisfaction, many of these studies were limited to small sample sizes and focused solely on patients with LS. Future studies are needed to inform a standard of care for the management of clitoral adhesions.
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