FEMALE SEXUAL DYSFUNCTION AFTER RADICAL CYSTECTOMY: A NEW OUTCOME MEASURE CRAIG D. ZIPPE, RUPESH RAINA, ASHA D. SHAH, ERIC Z. MASSANYI, ASHOK AGARWAL, JAMES ULCHAKER, STEPHEN JONES, AND ERIC KLEIN ABSTRACT Objectives. To assess, in our contemporary radical cystectomy (RC) series, female sexual dysfunction and whether the type of diversion affected the occurrence of sexual dysfunction. Outcome data after RC with and without orthotopic diversion has focused primarily on cure, urethral recurrence, and continence. Methods. The baseline and follow-up data from 27 sexually active female patients (mean age 54.79  12.7 years) who underwent RC from 1997 to 2002 for transitional cell carcinoma of the bladder (16 with Stage T1-T2 and 11 with Stage T3-T4) were obtained. Thirteen patients were premenopausal before RC. Of the 27 patients, 10 (37%) underwent Studor orthotopic diversion, 7 (26%) Indiana cutaneous diversion, and 10 (37%) ileal conduit diversion. A 10-item version of the self-administered Index of Female Sexual Function questionnaire was used to assess sexual dysfunction. The specific domains analyzed in the Index of Female Sexual Function include the degree of vaginal lubrication, ability to achieve orgasm, degree of pain during intercourse, overall sexual desire and interest, and overall sexual satisfaction, with responses graded on a scale of 1 (almost never, never) to 5 (almost always, always). Results. With a mean follow-up of 24.2 months (range 15 to 65.1), the total mean baseline Index of Female Sexual Function score decreased from 17.4  7.23 to 10.6  6.62 after RC (P 0.05). The most common symptoms reported by the patients included diminished ability or inability to achieve orgasm in 12 (45%), decreased lubrication in 11 (41%), decreased sexual desire in 10 (37%), and dyspareunia in 6 patients (22%). Only 13 (48%) of the 27 patients were able to have successful vaginal intercourse, with 14 (52%) reporting decreased satisfaction in overall sexual life after RC. Eight partners (30%) had a decrease in desire for sexual activity owing to apprehension after cancer diagnosis and treatment. Although the numbers were small, the preliminary data suggested no differences in sexual function between patients undergoing Studor orthotopic diversions and those undergoing Indiana cutaneous diversions. Conclusions. Sexual dysfunction is a prevalent problem after female RC. The nature of the dysfunction involves multiple domains, including decreased orgasm, decreased lubrication, lack of sexual desire, and dyspareunia. Our early results suggest that the type of continent diversion does not affect sexual function. Surgical modifications such as urethral and vaginal sparing, neurovascular preservation, and tubular vaginal reconstruction sparing may improve female sexual function after RC. UROLOGY 63: 1153–1157, 2004. © 2004 Elsevier Inc. O utcome measures after radical cystectomy (RC), with or without orthotopic diversion, has focused primarily on cure, urethral recurrence, and continence. 1–4 However, sexual dysfunction is a major concern and side effect in many of our younger female patients. 2,5 During RC, the neuro- vascular bundles (located on the lateral walls of the vagina) are usually removed or damaged by re- moval of the bladder, urethra, and anterior vaginal wall. 5–8 In addition, significant devascularization of the clitoris often occurs with removal of the dis- tal urethra, affecting subsequent sexual arousal and desire. 5,6,8 Therefore, we conducted this clinical study to address sexual dysfunction in a subset of sexually active women undergoing RC. Using a modified Index of Female Sexual Function (IFSF) question- C. D. Zippe is a member of the speaker’s bureau for Pfizer. From the Glickman Urological Institute and Center for Ad- vanced Research in Human Reproduction, Infertility and Sexual Function, Cleveland Clinic Foundation, Cleveland, Ohio Reprint requests: Craig D. Zippe, M.D., Glickman Urological Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk A100, Cleveland, OH 44195 Submitted: August 11, 2003, accepted (with revisions): December 29, 2003 ADULT UROLOGY © 2004 ELSEVIER INC. 0090-4295/04/$30.00 ALL RIGHTS RESERVED doi:10.1016/j.urology.2003.12.034 1153