Assessing the Efficacy of Amniotic Bladder Therapy for Female Sexual Dysfunction in Patients with Radiation Cystitis

Introduction and Objectives: Female sexual dysfunction (FSD) and radiation cystitis (RC) are complications of pelvic radiation with limited treatment options. Both conditions result from radiation-induced inflammation and scarring of pelvic organs, leading to symptoms such as dysuria in RC and dyspareunia in FSD, with significant impacts on quality of life. Amniotic Bladder Therapy (ABT), which we have previously demonstrated improves symptoms of RC through immunomodulatory and anti-fibrotic effects, may also offer therapeutic potential for FSD. In this study, we assessed the efficacy of intra-detrusor micronized amniotic membrane (AM) injections on FSD symptoms in patients with concomitant RC, using the Female Sexual Function Index (FSFI) and a pain visual analog scale (VAS). Methods: Five females (mean age: 64.4 ± 20.1 years) with FSD recalcitrant to multiple therapies received intra-detrusor injections under general anesthesia of reconstituted 100 mg micronized AM. The FSFI questionnaire and pain VAS were obtained preoperatively and at 4, 8, 12, 16, 20, and 24 weeks post-injection. Results: All five patients exhibited an improvement in FSFI scores from baseline to 16 weeks, with this improvement diminishing at 20 and 24 weeks. Pain (VAS) associated with intercourse decreased from 8.9±1.0 at baseline to 5.4±1.1 at 16 weeks, with an increase to 6.1±0.9 at 24 weeks. No adverse events arose during the study. Conclusion: ABT in female RC patients with severe FSD symptoms demonstrated an improvement in sexual function and pain up to 16 weeks with a diminishing response at 20 to 24 weeks post-injection. Further studies are needed to correlate these results and elucidate the mechanism through which patients relapse in FSD symptoms following ABT.