P-055 - Female Sexual Function in Small Fiber Neuropathy

Abstract Title: Female Sexual Function in Small Fiber Neuropathy

Background: Small fiber neuropathy (SFN) can result in a variety of pain and autonomic symptoms due to its impact on small-diameter somatic and autonomic unmyelinated C-fibers and/or thinly myelinated A-delta (Aδ) fibers. It has been identified in 66% of patients with complex (refractory or multisystem) pelvic pain. Like pain pathways, sexual function involves complex interactions between the somatic and autonomic nervous systems. SFN is known to be associated with sexual dysfunction, including erectile dysfunction in men. However, its effects specifically on female sexual function have not been well studied. We hypothesized that SFN has a negative impact on female sexual function.

Purpose/Objectives: The objective of this study was to characterize the differences between sexual symptoms in female patients with and without SFN.

Methods: This was a retrospective case control study. Patients were initially screened via a comprehensive multispecialty pelvic questionnaire. Those with pelvic pain were then seen in combined evaluation with Neurology-Based Pain Management, Urology-Based Urogynecology in a Multispecialty Pelvic Pain Clinic between January 2023 and October 2023. All patients presenting for evaluation were offered an electronic pre-visit intake form inclusive of the PISQ-IR (evaluation tool validated by the IUGA for sexual symptoms). The primary outcome measure was self-reported quality of sexual function, represented by the PISQ-IR score. Secondary outcomes included comparisons of subscores for arousal, orgasm, and dyspareunia between SFN and non-SFN patients.

Results: A total of 89 patients were analyzed, 11 with definitive SFN and 78 without SFN. Results were compared between these two groups using chi-square tests and Mann-Whitney U tests. PISQ-IR scores were significantly different between SFN and non-SFN patients. Mean scores of 2.9 (SD 0.6) and 3.5 (SD 0.6) were calculated, respectively, indicating worse overall sexual function in SFN patients. This corresponds with a difference of 0.64 (95% CI 0.19 – 1.09, p = 0.01). Secondary outcomes analyzed were significant for lower orgasm intensity scores in SFN patients (median of 2 vs 3 in non-SFN patients, p = 0.02 Mann-Whitney test). Arousal scores and pain scores were not significantly different between the 2 patient populations.

Conclusions/Implications for future research and/or clinical care: SFN is associated with poorer sexual function and decreased orgasm intensity in the female subspecialty pelvic health population.

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