title: Sexual activity and function after surgical treatment in patients with (pre)invasive vulvar lesions.
abstract: OBJECTIVE
  Sexual activity (SA) and sexual function (SF) are central outcome measures in women affected by preinvasive (vulvar intraepithelial neoplasia, VIN) and invasive (vulvar cancer, VC) vulvar lesions. Data on sexuality after treatment are scarce.
  
  
  METHODS
  Validated questionnaires including the female sexual function index (FSFI-d) were provided to 166 women with a history of VIN and VC who attended the colposcopy units of the University Medical Center Hamburg-Eppendorf and Asklepios Medical Clinic Altona for follow-up between March 2011 and June 2012. Additional patients (n = 14) assessed the questionnaires online through the website of the German Vulvar Cancer Support Group (VulvaKarzinom SHG e.V.) during the same time period.
  
  
  RESULTS
  Twenty-four patients with VIN and 34 with VC were evaluable. Median age was 51.5 years, with 34 (58.6%) of the patients being postmenopausal. Median time since completion of treatment was 17 months. All women had undergone vulvar surgery (laser/cold knife/combination). Overall, 14 (24.1%) women reported no SA during the last 4 weeks. SF was clearly impaired compared with previously described normal cohorts. SA and SF of active patients did not differ significantly between those with VIN and VC. Analyses contrasting surgical treatment methods yielded no significant associations; likewise, time since diagnosis did not affect SA and SF significantly. Increasing age was negatively associated with most dimensions of the FSFI-d [desire (p = 0.011), arousal (p = 0.004), lubrication (p = 0.003), orgasm (p = 0.013), satisfaction (p = 0.345), pain (p < 0.001)].
  
  
  CONCLUSIONS
  Women with VIN and VC after surgical treatment are at high risk to suffer from persistent sexual dysfunction especially at higher age.
authors.affiliation: Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
authors.forename: Donata
authors.initials: D
authors.lastname: Grimm
authors.affiliation: Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Eulenburg
authors.affiliation: Department of Gynecology and Gynecologic Oncology, Medical Center Asklepios Altona, Hamburg, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Brummer
authors.affiliation: Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
authors.forename: Anna-Katharina
authors.initials: AK
authors.lastname: Schliedermann
authors.affiliation: Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
authors.forename: Fabian
authors.initials: F
authors.lastname: Trillsch
authors.affiliation: Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Prieske
authors.affiliation: Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
authors.forename: Friederike
authors.initials: F
authors.lastname: Gieseking
authors.affiliation: Vulvar Cancer Support Group (VulvaKarzinom SHG e.V.), Wilhelmshaven, Germany.
authors.forename: Enzia
authors.initials: E
authors.lastname: Selka
authors.affiliation: Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Mahner
authors.affiliation: Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany. lwoelber@uke.de.
authors.forename: Linn
authors.initials: L
authors.lastname: Woelber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001143:Arousal / Q000502:physiology; D002278:Carcinoma in Situ / Q000503:physiopathology / Q000523:psychology* / Q000601:surgery; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000523:psychology; D007989:Libido / Q000502:physiology; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009948:Orgasm / Q000502:physiology; D010549:Personal Satisfaction; D012725:Sexual Behavior; D011795:Surveys and Questionnaires; D014846:Vulvar Neoplasms / Q000503:physiopathology / Q000523:psychology* / Q000601:surgery
keywords: FSFI; Sexuality; VIN; Vulvar cancer; Vulvar intraepithelial neoplasia