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Introduction: The "Dual control model" of sexual response postulates that sexual desire and associated behaviors depend on the balance between excitation and inhibition. These aspects have not been evaluated in women with sexual dysfunction (FSD). Objectives: The aim of our study was to explore the psychosexual correlates of excitation and inhibition in women with FSD, according to their menopausal state. We also aimed at performing a pre-post analysis in a sub-sample of patients followed for 3-6 months, investigating the possible relationships between excitation and inhibition and the changes in questionnaires related to sexual function. Methods: In an observational, retrospective study, we recruited a consecutive series of 66 women consulting for FSD. Patients underwent a clinical evaluation, a structured interview and completed several self-administered questionnaires, including Sexual Inhibition/Sexual Excitation Scale (SIS/SES), Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), Body Uneasiness Test (BUT) and Middlesex Hospital Questionnaire (MHQ). A subgroup of patients (n=28) was evaluated at 3-6 months follow-up, using the FSFI and FSDS-R questionnaires. Results: Considering the whole sample, the SES scale was positively correlated with several psychosexual and relational parameters, including masturbation (p=0.005), number of lifetime partners (p=0.004) and histrionic personality traits (p=0.013), and negatively with the presence of a stable relationship (p=0.038) and its length (p=0.026). Sexual inhibition due to the fear of performance failure (SIS1 scale) positively correlated with conflicts within the couple (p=0.012), lack of privacy (p<0.0001), symptoms of general psychopathology (p=0.001; in particular, anxiety) and body image concerns (p=0.015). Regarding sexual parameters, the SES scale was associated with the total FSFI score (p=0.016), and the desire (p=0.011), arousal (p=0.030), lubrication (p=0.046) and orgasm domains (p=0.025), whereas the SIS1 scale was associated with the FSDS-R score (p=0.028). In premenopausal women, the SIS1 scale was associated with the diagnosis of Hypoactive Sexual Desire Disorder (HSDD), even after adjusting for confounders (p=0.047), whereas in postmenopausal women, we found an association between HSDD and the SES scale (p=0.039). Given these correlations, we developed two cut-off values for the SES and SIS1 scales, according to which a score < 49 on the SES (in postmenopausal women) and a score > 34 on the SIS1 (in premenopausal women) accurately identified patients diagnosed with HSDD. In postmenopausal women, the ROC curve for the SES scale showed an accuracy (AUC) of 0.734 +− 0.107, p=0.037, in identifying HSDD; considering a cut-off value of 49, the sensitivity and specificity for HSDD detection were 85.7% and 66.7%, respectively. In premenopausal women, the ROC curve for the SIS1 scale showed an AUC of 0.853 +− 0.081, p=0.007, in identifying HSDD; considering a cut-off value of 34, the sensitivity and specificity for HSDD detection were 78.6% and 75.0%, respectively. The mean change in FSFI total score was not correlated with the SES or SIS2 scales (p=0.214 and p=0.402, respectively), but only with the SIS1 scale (p=0.026). When comparing patients with low excitation (SES scale <49) and high inhibition (SIS1 scale >34) with the rest of the sample, they showed a significantly lower change in FSFI total score (p=0.018). Conclusions: In women consulting for FSD, sexual excitation and inhibition, which may be easily assessed by the SIS/SES questionnaire, emerge as key aspects in both the diagnostic evaluation and planning of therapeutic outcomes, in the perspective of a personalized sexual medicine approach. Disclosure: No. [ABSTRACT FROM AUTHOR]

Introduction: Research on the relationship between physical activity (PA) and female sexual dysfunction (FSD) is lacking. Objectives: To investigate the clinical, psychological, and sexual correlates of PA in women with FSD. Methods: A non-selected series of n=322 pre- and post-menopausal patients consulting for FSD was retrospectively studied. Regular involvement in PA and its frequency (<1 hour/week: sedentary, 1-3 hours/week: active, 4-6 hours/week: very active, >6 hours/week: extremely active) were investigated with a specific question. FSDs, including HSDD (Hypoactive sexual desire disorder) and FGAD (Female genital arousal disorder), were diagnosed according to a structured and clinical interview. Participants underwent a physical examination and a clitoral Doppler ultrasound, and were asked to complete the Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), Body Uneasiness Test (BUT), and Middlesex Hospital Questionnaire (MHQ). Results: At multivariate analysis, women engaging in PA (67.4%, n=217) scored significantly higher in several FSFI domains - including desire, arousal and lubrication - and showed lower sexual distress and lower resistance of clitoral arteries, as compared to sedentary women. A significant, inverse association between PA and HSDD was observed. Mediation analysis demonstrated that the negative association between PA and HSDD was partly mediated by body image concerns (BUT Global severity index), psychopathological symptoms (MHQ total score) and sexual distress (FSDS-R score). These latter two factors also partly mediated the association between PA and a reduced risk of FGAD, whilst a lower BMI was a full mediator in the relationship between PA and FGAD. Finally, extreme PA was associated with significantly worse scores in several psychosexual parameters (i.e. sexual satisfaction and histrionic/hysterical symptoms), even compared to a sedentary lifestyle. Conclusions: In women with FSD, PA was associated with better sexual function and clitoral vascularization, lower sexual distress and reduced odds of HSDD and FGAD; the benefits of PA on sexuality were mediated by both psychological and organic determinants; excessive PA was related with a poor overall sexual function and with a low sexual satisfaction. Disclosure: No. [ABSTRACT FROM AUTHOR]