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BACKGROUND: Several surgical techniques have been described for the treatment of patients with vaginal agenesis. The simplest intervention that gives good sexual results should be the surgical technique of choice. METHODS: We report anatomic and functional outcome in 28 women after vaginoplasty using laparoscopic Davydov operation. This surgery includes three steps: two laparoscopic and one perineal. The patient then has to use a mould or a vaginal dilatator for 1 month. The functional outcome was assessed by a brief and valid self-report questionnaire evaluating female sexual life (Female Sexual Function Index, FSFI). A control group was recruited to compare the results. RESULTS: Two intra-operative bladder and ureteric injuries were repaired without sequels. Two post-operative complications were observed: one abdominal migration of the mould, which was treated successfully with the laparoscope, and one vesico-vaginal fistula. No patient was lost to follow-up. The anatomical result was judged to be satisfactory (>6 cm) in 26 of the 28 patients: the mean vaginal length was 7.2 ± 1.5 cm. Among the 28 operated women, 19 had a good or very good result. No statistical difference was found between our operated patients and French controls in all six domains of the FSFI. CONCLUSIONS: Laparoscopic Davydov may be considered a good option for the surgical treatment of women presenting vaginal agenesis. This technique offers advantages such as: short operating time and hospital stay, no particular instrumentation required and no external scars. Sexuality approaches so-called ‘normal sexuality’. [ABSTRACT FROM AUTHOR]

Objective: To investigate the functional and sexual outcome of sigmoid vaginoplasty in patients with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome., Design: Prospective study., Setting: University hospital., Patient(s): Fifty-nine consecutive patients with MRKH syndrome., Intervention(s): Forty-eight patients underwent sigmoid vaginoplasty, and 11 were treated using the Frank method of dilatation., Main Outcome Measure(s): Functional results and sexuality were evaluated with the use of two standardized questionnaires: the Female Sexual Function Index (FSFI) and the revised Female Sexual Distress Scale (FSDS-R). Questions were added to analyze depression, body image perception, and desire of motherhood., Result(s): Out of the 68% of patients who answered the questionnaire, 73% had regular sexual intercourse. The mean total FSFI score was 28 ± 3.1 in the operated group and 30 ± 5.3 in the group treated with the Frank method. Their mean FSDS-R scores were 21 ± 12.1 and 18 ± 13.8, respectively., Conclusion(s): Sigmoid vaginoplasty is an effective technique providing a nearly normal sexual function to patients with vaginal aplasia. Despite this, psychologic distress related to sexuality persists in most patients, demonstrating the need for a multidisciplinary support., (Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Introduction: There are limited outcome data on the etiology and efficacy of psychological interventions for male and female sexual dysfunction as well as the role of innovative combined treatment paradigms., Aim: This study aimed to highlight the salient psychological and interpersonal issues contributing to sexual health and dysfunction, to offer an etiological model for understanding the evolution and maintenance of sexual symptoms, and to offer recommendations for clinical management and research., Methods: This study reviewed the current literature on the psychological and interpersonal issues contributing to male and female sexual dysfunction., Main Outcome Measure: This study provides expert opinion based on a comprehensive review of the medical and psychological literature, widespread internal committee discussion, public presentation, and debate., Results: Medical and psychological therapies for sexual dysfunctions should address the intricate biopsychosocial influences of the patient, the partner, and the couple. The biopsychosocial model provides an integrated paradigm for understanding and treating sexual dysfunction., Conclusions: There is need for collaboration between healthcare practitioners from different disciplines in the evaluation, treatment, and education issues surrounding sexual dysfunction. In many cases, neither psychotherapy alone nor medical intervention alone is sufficient for the lasting resolution of sexual problems. The assessment of male, female, and couples' sexual dysfunction should ideally include inquiry about predisposing, precipitating, maintaining, and contextual factors. Research is needed to identify efficacious combined and/or integrated treatments for sexual dysfunction.

Introduction: There are limited outcome data on the efficacy of psychological interventions for male and female sexual dysfunction and the role of innovative combined treatment paradigms., Aim: To highlight the salient psychological and interpersonal issues contributing to sexual health and dysfunction; to offer a four-tiered paradigm for understanding the evolution and maintenance of sexual symptoms; and to offer recommendations for clinical management and research., Methods: An International Consultation assembled over 200 multidisciplinary experts from 60 countries into 17 committees. The recommendations of committee members represent state-of-the-art knowledge and opinions of experts from five continents were developed in a process over a 2-year period. Concerning the Psychological and Interpersonal Committee of Sexual Function and Dysfunction, there were nine experts from five countries., Main Outcome Measure: Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate., Results: Medical and psychological therapies for sexual dysfunctions should address the intricate biopsychosocial influences of the patient, the partner, and the couple. The biopsychosocial model provides a compelling reason for skepticism that any single intervention (i.e., a phosphodiesterase type 5 inhibitor, supraphysiological doses of a hormone, processing of childhood victimization, marital therapy, pharmacotherapy of depression, etc.) will be sufficient for most patients or couples experiencing sexual dysfunction., Conclusions: There is need for collaboration between healthcare practitioners from different disciplines in evaluation, treatment, and education issues surrounding sexual dysfunction. In many cases, neither psychotherapy alone nor medical intervention alone is sufficient for the lasting resolution of sexual problems. Assessment of male, female, and couples' sexual dysfunction should ideally include inquiry about: predisposing, precipitating, maintaining, and contextual factors. Treatment of lifelong and/or chronic dysfunction will be different from acquired or recent dysfunction. Research is needed to identify efficacious combined and/or integrated treatments for sexual dysfunction.

Objective: To assess the functional outcome and sexuality of patients after creation of a sigmoid neovagina., Design: Clinical study performed between 1992 and 2002, with a mean follow-up of 3.3 years (range, 6 months to 9 years)., Setting: Tertiary care center., Patient(s): Sixteen consecutive patients with Rokitansky syndrome., Intervention(s): Creation of a neovagina with an antiperistaltic (n = 13) or isoperistaltic (n = 3) sigmoid graft and colovestibular anastomosis by interrupted suture (n = 11) or PCEEA forceps (n = 5). All patients had a neovaginal vault suspension (n = 16)., Main Outcome Measure(s): Functional results were evaluated in patients 6 or more months after the operation (n = 12) by using the standardized Female Sexual Function Index (FSFI). This index assesses four domains of sexual dysfunction: desire disorder, arousal disorder, orgasm disorder, and sexual pain disorder. Lubrification and "sexual" quality of life was also evaluated. Normal patients had a mean full FSFI score of 30 +/- 5 of 36., Result(s): The mean full FSFI score was 28 +/- 5 (range: 22-34). Seventy-two percent of patients had vaginal intercourse at least once a week; in this subset, the mean full FSFI score was 30 +/- 3 (range: 25-34)., Conclusion(s): Sigmoid neovagina allowed a normal sexual life in patients who had sexual relations.

Objective: Several recent studies have reported prevalence rates for erectile dysfunction (ED) displaying considerable variation from country to country. We report here the results of a survey carried out in France in 2001., Methods: This study was carried out by means of telephone interviews, on a representative sample of 1004 men aged 40 years or over. The prevalence of ED was determined from the patient's self-evaluation and International Index of Erectile Dysfunction 5 (IIEF-5) score., Results: We found that in France in men aged 40 years and over, one man in three (31.6%) presented ED, of essentially mild or moderate severity (according to IIEF-5 score). We also found that the majority of men suffering from ED expressed dissatisfaction with their relations with their partner. Finally, a large proportion of men stated that they were ready to consult a doctor., Conclusion: This survey confirms that the prevalence of ED is high in France. This condition, which represents a source of distress that remains difficult to express and to assess, should be evaluated more effectively by rigorous and standardised methods, particularly as oral and effective treatments are now available., (Copyright 2002 Elsevier Science B.V.)

Objective: Several studies have recently reported the prevalence rates of erectile dysfunction (ED) that vary according to the country. The authors report the results of a survey conducted in France in 2001., Material and Methods: This study was conducted by telephone conversation with a representative sample of 1,004 men over the age of 40. The prevalence of ED was measured by the patient's self-assessment and by the IIEF-5 index., Results: The results show that about 1 man in 3 (31.6%) suffers from ED in France, which is essentially mild to moderate (according to IIEF-5). The majority of men reporting ED declared to be dissatisfied with their relationship with their partner. Finally, a large proportion of men declared that they would be willing to consult a practitioner., Conclusion: This survey confirms the high prevalence of erectile dysfunction in France. It is responsible for a distress that is still difficult to express and assess. This disease needs to be more accurately evaluated by rigorous and standardized methods, especially as simple and effective treatments are now available.

Objective: The prevalence of urinary symptoms, their impact on quality of life and sexuality and the man's attitude in relation to these problem were studied by a self-administered questionnaire (including I-PSS, 6 questions of DAN-PSS-1, BPHQL9 and IIEF)., Material and Methods: This questionnaire was sent by mail to a national representative sample of 3,500 French men aged 50 to 80 years. Of the 2,372 men who returned an interpretable questionnaire, 21%, 33% and 42% belonged to the severe or moderate category for symptoms, tolerance of symptoms, and alteration of quality of life, respectively., Results: 81% of men reported sexual activity during the last 4 weeks. 8.3% of men were treated with "antiprostate" medical treatments, and 8% had been operated (16% of them were treated medically after the operation). Only 29% and 17% of men had talked about their sexual and urinary problems, respectively., Conclusion: Alteration of functional and perceived sexuality was correlated with age and the severity of symptoms in non-operated patients, but the poor correlations between scales evaluating sexuality and symptoms indicate that sexuality is a difficult aspect to investigate.