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Stock. Mount Sinai Medical Center, RMA of New York, New York, NY; Mount Sinai Medical Center, New York, NY. OBJECTIVE: Brachytherapy is a commonly employed treatment modality for localized prostate cancer. Among the perceived benefits of brachytherapy is the preservation of erectile function in previously potent men. What is less clear is how adjunctive therapies including hormonal suppression and external beam radiotherapy in combination with brachtherapy effect erectile function. We examined the effect of phosphodiesterase inhibitor use in a group of previously potent men who underwent brachytherapy. DESIGN: We searched a prospectively compiled database of 2500 men treated for clinically localized prostate cancer with brachytherapy at the Mount Sinai Medical Center since 1992. MATERIALS AND METHODS: One hundred fifty-five men were included in the analysis. Inclusion criteria were a baseline sexual health inventory for men score ⬎/⫽ 16, at least one follow-up Shim score (mean six month intervals), and use of a phsophodiesterase inhibitor. We stratified men by treatment type: brachytherapy (brachy) only (n⫽77), brachytherapy with 3 months of neo-adjuvant hormonal (brachy⫹h) suppression (n⫽27) and brachytherapy, hormonal suppression (3 months neo-adjuvant and 6 months of adjuvant) and external beam radiotherapy (brachy⫹h⫹xrt, n⫽51). The Wilcoxian rank sum test was used to compare groups. RESULTS: Mean ages of men was not significantly different. Median Gleason score was six for both the brachy alone group and the brachy⫹h group, and it was seven for the bracy⫹h⫹xrt group. All men in the brachy alone group had Gleason scores of six and under, while 3/27 and 36/51 had Gleason scores greater than six in the brachy⫹h and the brachy⫹h⫹xrt groups respectively. Mean PSA scores were 5.1, 6 and 8.86 ng/dL respectively. Baseline and follow-up Shim scores are displayed in table 1.

CONCLUSION: Brachytherapy is associated with a decline in Shim score after the procedure regardless of whether adjunctive therapy is used or not. However, Shim scores improve more rapidly in the groups where hormone suppression therapy is either not used or used in a neo-adjuvant fashion. By 36 months after brachytherapy implant, Shim scores are not significantly different even when adjuvant hormonal therapy is used. Hormonal therapy delays the return of sexual function when used in conjunction with brachytherapy. However, at three years after treatment, Shim scores are not significantly different in men treated with hormonal suppression and phosphodiesterase inhibitors. Supported by: None.

Monday, October 23, 2006 4:00 pm O-67 VALIDATION OF THE “DECREASED SEXUAL DESIRE SCREENER” (DSDS): A BRIEF DIAGNOSTIC INSTRUMENT FOR GENERALIZED, ACQUIRED HYPOACTIVE SEXUAL DESIRE DISORDER IN WOMEN. E. Onel, D. Lewis-D’agostino, R. Pyke, A. H. Clayton, E. R. Goldfischer, I. Goldstein. Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT; Univ of Virginia, Dept of Psychiatry, Charlottesville, VA; Hudson Valley Urology, Poughkeepsie, NY; The Journal of Sexual Medicine, Editor-in-Chief, Milton, MA. OBJECTIVE: It is estimated that over 40% of women worldwide have Female Sexual Dysfunction (FSD). Of the various sexual dysfunctions, the majority of women with FSD have Hypoactive Sexual Desire Disorder (HSDD). The diagnosis of HSDD relies on a time-consuming extensive interview by an expert clinician, utilizing a history that focuses on sexual activity (often incorporating instruments such as the Female Sexual Function Index, the Changes in Sexual Function Questionnaire, or others) and

FERTILITY & STERILITY威

physical exam. Many women with HSDD are consequently undiagnosed and untreated due to limited access to such experts. DESIGN: Two trials are presented in which the Decreased Sexual Desire Screener (DSDS), a brief screening instrument for the diagnosis of HSDD, was used and results compared to an extensive, standardized interview conducted by an expert clinician with specific FSD diagnostic training. MATERIALS AND METHODS: The DSDS consists of five questions: four concerning a woman’s history of sexual desire to assess symptoms of generalized, acquired HSDD according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision, and one multi-point question concerning seven medical and psychological factors to rule out items that could confound the diagnosis of HSDD. In a non-treatment validation study at 27 centers in the United States (US) & Canada, 263 women were asked to complete the DSDS at their screening visit and their answers were then reviewed with a non-expert clinician. Afterwards, a second clinician, certified as an expert in HSDD and unaware of the first clinician’s diagnosis, conducted an extensive, standardized interview and diagnosed either: i) HSDD, ii) another form of FSD, or iii) no FSD. The diagnoses of the two groups of clinicians were compared. In addition, cognitive debriefing was performed in a sub-set of 89 women and all participating clinicians. Subsequently, a treatment trial was conducted using similar diagnostic procedures in over 800 women with complaints of low sexual desire at 67 centers in the US & Canada. RESULTS: In the non-treatment trial, the DSDS had a sensitivity of 83.6%, specificity of 87.8%, and accuracy of 85.2%. Of the 150 women diagnosed with HSDD by the DSDS, 138 (92%) were also diagnosed with HSDD by the extensive, standardized interview conducted by the expert clinician. Cognitive debriefing demonstrated that each question and answer set was understood by and acceptable to the patients and clinicians. Rare misunderstandings regarding timeframes or multiple diagnoses were addressed before use in the treatment trial by two minor revisions in the clinician’s instructions. Using the DSDS and the revised clinician’s instructions in the treatment trial, the agreement between DSDS and the extensive interview was 97%. Anecdotally, the extensive, standardized interview was reported to take approximately an hour to complete while the DSDS took less than 15 minutes for the woman to complete and review with the clinician. CONCLUSION: Validation of a new diagnostic instrument is presented. While expert diagnosis of HSDD is often time-consuming, poorly accessible, and performed by few clinicians using current methodology, the Decreased Sexual Desire Screener (DSDS) enabled non-expert clinicians to quickly and accurately diagnose generalized, acquired HSDD in women. Additional research is needed in order to further support these results. Supported by: The study was funded by Boehringer Ingelheim Pharmaceuticals, Inc.

Monday, October 23, 2006 4:15 pm O-68 IMPROVING SEXUAL FUNCTION IN PATIENTS WITH ENDOMETRIOSIS VIA A PELVIC PHYSICAL THERAPY. L. J. Wurn, B. F. Wurn, C. R. King III, A. S. Roscow, E. S. Scharf, J. J. Shuster. Clear Passage Therapies, Inc., Gainesville, FL; Florida Medical Research Institute; and Southeastern Women’s Health, Gainesville, FL; None, n/a, FL; Dept of Epidemiology and Public Health Policy, Coll of Medicine, Univ of Florida, Gainesville, FL. OBJECTIVE: Among the most common symptoms experienced by the 5 million American women with endometriosis is pain during sexual intercourse. The purpose of this study was to assess the efficacy of a noninvasive manual pelvic physical therapy in reducing dyspareunia and improving overall sexual function in this population. DESIGN: Retrospective analysis. MATERIALS AND METHODS: A retrospective analysis was performed on 14 patients (mean age ⫽ 33.8) with endometriosis, confirmed by laparoscopy or laparotomy. The outcome measure was post-treatment test scores vs. pre-treatment test scores on the validated Female Sexual Function Index (FSFI) full scale and 6 individual domains (desire, arousal, lubrication, orgasm, satisfaction, and pain). After completing the pre-test, the 14 patients underwent 20 hours of a manual pelvic physical therapy designed to address restricted soft tissue mobility due to micro-adhesions and adhesions. The

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