1. Nasrin Changizi FPFD Fellowship

2. ANORGASMIA
PELVIC
FLOOR
UNCTION
DysF
Nasrin Changizi FPFD Fellowship

3. NASRIN CHANGIZI FEMALE PELVIC FLOOR DYSFUNCTION FELLOWSHIP
Nasrin Changizi FPFD Fellowship

4. ANORGASMIA Female Orgasmic Disorder may be : LIFELONG /ACQUIRED
GENERALIZED/SITUATIONAL
PRIMARY /SECONDARY
Nasrin Changizi FPFD Fellowship

5. Prevalence
A recent meta-analysis of studies (limited to English language publications published between 2000 and 2014)
Overall female orgasmic disorder prevalence of 20.9%, -25.7%
Nasrin Changizi FPFD Fellowship

6. Prevalence of female orgasmic disorder in Africa was highest, followed by Asia and the Middle East, with the lowest nominal prevalence in Europe and the non-European West.
Nasrin Changizi FPFD Fellowship

7. Other Mental Disorders
RISK FACTORS
Lower Education
Lower
Income
Poorer Health
Status
Deppression
Other Mental Disorders
Comorbid Disorders
Nasrin Changizi FPFD Fellowship

8. Pelvic Floor Dysfunction
Sexual Dysfunction
Nasrin Changizi FPFD Fellowship

9. Significance
Avoidance of Intercourse has been in 11-45% of Women with UI.
Women with symptomatic POP are less likely to engage in sexual relations(POOR BODY IMAGE)
Nasrin Changizi FPFD Fellowship

10. Clinical Findings Vaginal Bulging Pelvic Pressure Splinting/Digitation
UI/FI
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11. Assessment Are you Sexually Active Any Problem Any Pain
Nasrin Changizi FPFD Fellowship

12. Research Tools Validated questionnaires :PISQ 12 –question short form
Limitations :
Include only Heterosexuals
Sexually Active in last 6 months
Not validated for Anal Incontinence
PISQ-IR
Nasrin Changizi FPFD Fellowship

13. IMPACT OF PROLAPSE
Sexual Function generally worsen with increasing severity of POP.
Sexual Function domain affected by symptomatic POP are :Arousal,Orgasm,Pain
Nasrin Changizi FPFD Fellowship

14. Impact of Prolapse Treatment
Nasrin Changizi FPFD Fellowship

15. Non Surgical May improve sexual Dysfunction in some,and have no Hartm.
Pessary
PFMT(not specifically studied)
Nasrin Changizi FPFD Fellowship

16. Surgical
Regardless of type of Prolapse and Methods of Surgical Repair :this approach is generally associated with improvements.
Improvement may be related to improve Body Image as well as reversal of Physical Symptoms.
Nasrin Changizi FPFD Fellowship

17. De novo Dyspareunia(1-28%)
Nerve Injury
Narrowing
Vaginal Mesh
Shortened Vag.Length
Nasrin Changizi FPFD Fellowship

18. Impact Of SUI /OAB Decreased Libido Increased Vag.Dryness
Increased Dyspareunia
Nasrin Changizi FPFD Fellowship

19. Impact Of Treatment
All kinds of Treatment is associated with betterment of Sexual Function
Nasrin Changizi FPFD Fellowship

20. Non surgical PFMT (Desire-Orgasm-Less Dyspareuia )
Pessary (Alone/Combined )
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21. PFMT
Nasrin Changizi FPFD Fellowship

22. Nasrin Changizi FPFD Fellowship

23. Surgical Treatment
The Impact Varies But Mostly reperted Unchanged or Improved
In those who reported worsened sexual Function it Had been mainly due to De no Vo Dyspareunia
Nasrin Changizi FPFD Fellowship

24. ANAL Incontinence Less Desire Less Satisfaction
Nasrin Changizi FPFD Fellowship

25. Impact Of Treatment
Several Studies of women treated with Sphincteroplasty reported no improvements in Sexual Funtion Scores .
Post Operative Counselling
Nasrin Changizi FPFD Fellowship

26. Sexual function measured improved following surgery.
Can sex survive pelvic floor surgery? Sushma Srikrishna & Dudley Robinson & Linda Cardozo & Juan Gonzalez
Sexual function measured improved following surgery.
A better supported pelvic floor (POP-Q) was associated with significantly improved GRISS scores.
Conclusions These findings aid in pre-operative counselling of women with POP and SUI about potential improvement in sexual function post-operatively.
Nasrin Changizi FPFD Fellowship

27. Impact of urinary incontinence on female sexual health in women during midlife
Overall, though studies are lacking and of poor quality, treatment of incontinence has been shown to improve sexual function. Both pelvic muscle training and midurethral slings have been shown to improve sexual function in those with stress urinary incontinence. In urgency urinary incontinence, evidence indicates improvement in sexual function after treatment with anti-muscarinic medications. Coital incontinence commonly improves with treatment of the underlying incontinence subtype. Although problems related to sexual health are complex and involve both psychological and physical factors, it is important to consider treatment of urinary incontinence as part of management of sexual dysfunction.
Nasrin Changizi FPFD Fellowship

28. The effect of mode of delivery on postpartum sexual functioning in primiparous women
C/S
Mediolateral/Median
Nasrin Changizi FPFD Fellowship

29. Nasrin Changizi FPFD Fellowship