(115) Sexual Dysfunction in the Context of hEDS, MCAS, and POTS: A Cross-Sectional Analysis in a Community-Based Population

Abstract Introduction Unexplained sexual dysfunction is a frequently reported concern in urology, gynecology, and sexual medicine clinics. While psychosocial, hormonal, and local genitourinary factors are commonly investigated as causes of sexual dysfunction, systemic contributors are often overlooked. Hypermobile Ehlers–Danlos syndrome (hEDS), mast cell activation syndrome (MCAS), and Postural orthostatic tachycardia syndrome (POTS) are chronic disorders associated with urogynecologic complaints and may plausibly increase the risk of sexual dysfunction through overlapping pathophysiological mechanisms. Each affects key domains relevant to sexual health, including autonomic regulation, connective tissue integrity, vascular dynamics, and inflammatory signaling. Understanding these associations is essential to improving comprehensive evaluation and care for patients presenting with sexual concerns. Objective This study examines the prevalence of hypermobility/MCAS/dysautonomia symptom burden amongst people with sexual dysfunction in community-based populations. Methods This study is a cross-sectional survey design, and study participants will be patients with known sexual dysfunction who will be recruited from sexual medicine clinics to complete an online REDCap survey. The survey includes intake questions, sociodemographic information, and a series of questionnaires, including: 1) Female Sexual Function Index (FSFI-6) or International Index of Erectile Function (IIEF-5) to determine sexual function, as chosen by participants based on their personal anatomy; 2) Composite Autonomic Symptom Score (COMPASS-31) to measure autonomic symptoms, 3) Mast Cell Mediator Release Syndrome Questionnaire (MCMRS) to measure potential MCAS symptom burden, and; 4) 5PQ Hypermobility Questionnaire to screen for hypermobility. We also included the Beck Depression Inventory Questionnaire (BDI-II) to study the correlation of depressive symptoms. Analyses will include group comparisons and multivariable logistic regression adjusted for age, sex, hormone use, and depression. Results Although our results are pending, we expect to see a higher prevalence of hypermobility, MCAS, and dysautonomic symptoms amongst patients with sexual dysfunction, and be able to show that these three conditions may be triadic in occurrence. Preliminary results will be available in February. Conclusions Evidence suggests that hEDS, MCAS, and POTS often co-occur, suggesting shared pathophysiological pathways that may exacerbate sexual symptoms. We anticipate significant associations between hEDS, MCAS, and POTS with sexual dysfunction across multiple domains. These findings would highlight systemic factors that contribute to sexual dysfunction often overlooked in clinical practice, and expose a gap in sexual medicine research and clinical practice. Greater awareness could enable earlier identification of systemic contributors to sexual dysfunction, promote interdisciplinary collaboration, and support the development of more therapeutic strategies. Practicing more holistic diagnostics may include screening for hypermobility, MCAS, and dysautonomic symptoms disorders in sexual medicine clinics. Future investigations should define prevalence, predictors, and mechanistic underpinnings of these conditions in sexual medicine populations to improve patient care and quality of life. Disclosure No.