(011) Characterizing Sexual Dysfunction and Hormone Status in Females with Genitopelvic Pain Who Have a History of Pregnancy With or Without Lactation

Abstract Introduction Lactation substantially increases prolactin, which inhibits estrogen and androgen secretion; lactating patients may experience dysuria and dyspareunia akin to patients in other hypoestrogen states. Genitourinary Syndrome of Lactation (GSL) is a recently coined term for this constellation of symptoms, which may be mitigated by topical hormonal medication. There is limited data on later effects of lactation on pain, hormonal serologies and sexual function. Objective The objective of this study is to characterize sexual function and hormonal status in genitopelvic pain patients who have a history of pregnancy with or without lactation. Methods New female patients presenting to three vulvar pain clinics between April 2025 and September 2025 completed a questionnaire regarding number of pregnancies, year of delivery, and instances of breastfeeding as well as the female sexual function index (FSFI). Women between the ages of 18-49 were included in the study. Descriptive statistics were used to analyze differences in sexual dysfunction and hormone levels between groups according to pregnancy and lactation history. Results 270 patients were identified; 193 met inclusion criteria. Fifty-eight (30%) patients had baseline serologies measuring estradiol, testosterone, and sex hormone binding globulin measured. Average baseline serum estradiol levels were highest among patients who had at least one instance of breastfeeding (131.4 ± 71.1 pg/mL) and lowest among patients who had never been pregnant (89.92 ± 81.71 pg/mL) (Table 1). Patients who had never delivered were youngest (29.8 years +7), followed by patients who did not have a history of lactation (35.8y + 7) and patients who did lactate (37.8y + 6). Testosterone serum levels were highest among patients who had never been pregnant (34.65 ± 42.24) (Table 1). Average scaled FSFI scores were higher among patients who had never lactated (19.2 ± 5.62) versus patients who had at least one instance of lactation (18.1 ± 6.1), but all groups had scores below 26, indicating sexual dysfunction (Table 2). No statistically significant serological trends were noted among the different cohorts (never pregnant, pregnancy without lactation, and history of lactation). FSFI scores on average were lowest among patients with a history of lactation, although this did not rise to statistical significance. Conclusions Confounding variables make studying lactation in the setting of vulvovaginal disorders challenging. Age, parity, mode of delivery, history of contraception use, timing of serologic results in the cycle, and clinician motivation for obtaining serologies make it difficult to draw conclusions from this sample. The cohort is continuing to grow; detection of differences in sexual function related to lactation exposure may be possible in a larger sample size, but this remains a difficult area of study within a population with high baseline sexual dysfunction. Disclosure No.