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Pelvic symptoms improved in all subjects after vaginal reconstructive surgery. Whereas PFPT did not result in detectable subjective differences in this short-term study, superior muscular function suggested benefit from the intervention.

Vaginal laxity is common and may impact sexual function and quality of life. Expanding our knowledge regarding pathophysiology and treatment would be of benefit to these patients.

Introduction Considering the prevalence of female sexual dysfunction, the lack of education and training in female sexual function and dysfunction (FSF&D) during and obstetrics and gynecology residency highlights a need for greater focus on this topic. Aim To assess understanding and confidence among third and fourth year Ob/Gyn residents with respect to FSF&D. Methods An Internet-based survey was constructed to evaluate third and fourth year residents in American Council for Graduate Medical Education-approved Ob/Gyn programs. Residents were asked about familiarity, knowledge, and confidence in treating various aspects of FSF&D, based on the Council on Resident Education in Obstetrics and Gynecology (CREOG) Educational Objectives for Ob/Gyn training. They were also queried regarding areas of improvement for their education. Main Outcome Measure Responses to survey instrument. Results Two hundred thirty-four residents responded. The majority (91.5%) reported attending ≤5 didactic activities on FSF&D. Only 19.6% reported often or always screening women for sexual function problems; most had very little or no knowledge in administering or interpreting screening questionnaires. While many (82.8%) felt confident about obtaining a complete sexual history, only 54.7% felt able to perform a targeted physical exam. Although most residents had cared for women with dyspareunia (55.1%), a minority had managed many women with low desire (18.4%), arousal problems (8.1%), anorgasmia (5.6%), or vaginismus (16.7%). In treating patients, 34–56% reported rarely or never suggesting ancillary therapy such as counseling and medications. However, the majority believed that their confidence would increase through FSF&D lectures (97.9%), FSF&D patient observations (97.4%), rotating with a urogynecologist (94.4%), and online modules (90.6%). Conclusion Despite CREOG requirements for Ob/Gyn training in female sexuality, most residents feel ill-equipped to address these problems. Additional evidence-based educational and didactic activities would enhance residents’ knowledge and confidence in treating these common, quality-of-life issues.

Introduction The female sexual response is dynamic; anatomic mechanisms may ease or enhance the intensity of orgasm. Aim The aim of this study is to evaluate the clitoral size and location with regard to female sexual function. Methods This cross-sectional TriHealth Institutional Board Review approved study compared 10 sexually active women with anorgasmia to 20 orgasmic women matched by age and body mass index (BMI). Data included demographics, sexual history, serum hormone levels, Prolapse/Incontinence Sexual Questionnaire-12 (PISQ-12), Female Sexual Function Index (FSFI), Body Exposure during Sexual Activity Questionnaire (BESAQ), and Short Form Health Survey-12. All subjects underwent pelvic magnetic resonance imaging (MRI) without contrast; measurements of the clitoris were calculated. Main Outcome Measures Our primary outcomes were clitoral size and location as measured by noncontrast MRI imaging in sagittal, coronal, and axial planes. Results Thirty premenopausal women completed the study. The mean age was 32 years (standard deviation [SD] 7), mean BMI 25 (SD 4). The majority was white (90%) and married (61%). Total PISQ-12 (P < 0.001) and total FSFI (P < 0.001) were higher for orgasmic subjects, indicating better sexual function. On MRI, the area of the clitoral glans in coronal view was significantly smaller for the anorgasmic group (P= 0.005). A larger distance from the clitoral glans (51 vs. 45 mm, P= 0.049) and body (29 vs. 21 mm, P= 0.008) to the vaginal lumen was found in the anorgasmic subjects. For the entire sample, larger distance between the clitoris and the vagina correlated with poorer scores on the PISQ-12 (r = −0.44, P= 0.02), FSFI (r = −0.43, P= 0.02), and BESAQ (r = −0.37, P= 0.04). Conclusion Women with anorgasmia possessed a smaller clitoral glans and clitoral components farther from the vaginal lumen than women with normal orgasmic function.