ABSTRACT
Objectives: We aimed to investigate the difference in perceived intensity of orgasm among women experiencing clitoral or vaginally activated orgasm (VAO). Method(s): We reviewed data from the Sex@COVID online survey (Mollaioli et al, J Sex Med. 2021 Jan;18(1):35-49) to retrieve a sample of heterosexual Italian sexually active female subjects. Several validated questionnaires and inventories were used to investigate sexual and psychological health (GAD-7, Lowe et al, Med Care 2008;46:266-274;PHQ-9, Kroenke et al, J Gen Intern Med 2001;16:606-613;FSFI, Rosen et al, J Sex Marital Ther 2000;26:191-208). Result(s): 1207 women were included in analysis: 346 were in a non-cohabiting relationship (Group A, 28.7%), 581 were in a cohabiting relationship (Group B, 48.1%) and 280 were married (Group C, 23.2%). 40.9% of the study population reported being able to orgasm through both clitoral stimulation and vaginal penetration (n = 494), 35.4% through clitoral stimulation (n = 427) and 20.1% through vaginal stimulation (n = 243). Additionally, 3.6% (n = 43) reported being unable to reach orgasm at all. By analysis of variance, following adjustment for FSFI, PHQ-9, GAD-7 and age, women experiencing no orgasm had lower orgasmometer scores (beta = -0.75, p <0.001), and VAO were associated with higher orgasmic intensity compared to clitoral orgasms (beta = 0.10, p = 0.008). Experiencing both orgasms had no effect compared to VAO (beta = 0.03, p = 0.545). Women who preferred reaching orgasm through masturbation to partnered sexual activity had lower orgasmic intensity (beta = -0.28, p = 0.002). Groups B and C had better orgasmic intensity compared to group A (beta = 0.08, p = 0.009). Conclusion(s): Orgasmic intensity differs between VAO and clitoral orgasms, independently of other confounding factors. This finding provides additional insight on the role of the clitourethrovaginal complex in female sexual function. Conflicts of Interest: None of the authors report any competing interests for the present study. Copyright © 2022
ABSTRACT
CASE: A 22-year-old woman with h/o asthma initially presented to the hospital with lip swelling and sore throat. She tested positive for COVID-19 and received a casirivimab-imdevimab (monoclonal antibody) infusion. She returned a week later with worsening lip swelling, dysphagia and conjunctivitis. Physical exam revealed edematous lips with vesicular lesions, no tongue swelling, tonsillar exudate, 4+ conjunctival injection bilaterally with purulent discharge, and shallow clean based clitoral ulceration. She reports no history of allergic reactions, angioedema or exposure to new medications. Nasopharyngolaryngoscopy showed no laryngeal edema but visualized exudates throughout the supraglottis and glottis. C4, ANA, CMV, EBV, throat and blood cultures were negative. STI testing was trichomonas positive and gonorrhea/chlamydia negative. Respiratory virus panel remained positive for COVID-19. HSV swab of lip lesion, HSV 1/2 IgG and IgM were negative. Mycoplasma pneumoniae IgG was elevated (0.60, negative is ≤0.09), IgM equivocal (0.85, negative is ≤0.76), and nasopharyngeal PCR negative. Conjunctival culture showed rare bacteria (S. Aureus) and no leukocytes. She initially received methylprednisolone IV due to concern for angioedema, acyclovir for empiric HSV treatment and empiric antibacterial moxifloxacin eye drops. Given lack of infectious trigger, her presentation was concerning for reactive infectious mucocutaneous eruption (RIME) associated with SARSCoV-2 or Mycoplasma. Prednisone 1mg/kg daily was initiated followed by improvement in oral mucositis and conjunctivitis within days. IMPACT/DISCUSSION: A broad differential is important when evaluating oral swelling and mucositis. Her lack of cutaneous involvement, medication exposure or family history and negative infectious, autoimmune and inflammatory workup make other causes including Stevens-Johnson syndrome, erythema multiforme, angioedema, and HSV less likely. Our final diagnosis of RIME describes mucocutaneous eruptions likely due to an immune response triggered by bacterial or viral infection. Our patient's RIME may be due to COVID-19 or Mycoplasma given her equivocal Mycoplasma IgM. Eruptions generally involve two or more mucosal sites and occur mostly in children and adolescents. Common presentations include oral erosions and ulcers, purulent bilateral conjunctivitis, or urogenital lesions, which were all seen in our patient. As this is a relatively rare and new condition, no standard of care treatment exists for RIME but systemic steroids have been effective in case reports for initial treatment and subsequent flares. CONCLUSION: RIME is a rare, newly described condition in young patients who develop postinfectious mucocutaneous eruptions of two or more mucosal sites. It has been recently reported in association with COVID-19 and its association with Mycoplasma infection is important to evaluate. This condition is important to recognize and treat given the requirement for higher dose steroids than that used for angioedema.