Endocrine Aspects of Female Sexual Dysfunction

Systemic testosterone for the treatment of female sexual interest and arousal disorder (FSIAD) in the postmenopause

INTRODUCTION

Female sexual interest and arousal disorder (FSIAD) is the most prevalent female sexual dysfunction in the postmenopause.

OBJECTIVE

The aim of this review is to provide a summary of the currently available evidence on the use of testosterone in the treatment of FSIAD in postmenopausal women.

METHODS

A narrative review on the topic was performed. Only randomized controlled trials (RCTs) and systematic reviews and meta-analysis were considered. 123 articles were screened, 105 of them assessed for eligibility, and finally 9 were included in qualitative synthesis following the PRISMA declaration.

RESULTS

Current evidence recommends, with moderate therapeutic benefit, the use of systemic transdermal testosterone within the premenopausal physiological range in postmenopausal women with Hypoactive Sexual Desire Disorder (HSDD), the previous entity for low desire dysfunction, not primarily related to modifiable factors or comorbidities such as relationship or mental health problems. The available evidence is based on studies with heterogeneity on their design (different testosterone doses, routes of administration, testosterone use in combination and alone, sexual instruments of measurement). There is no data indicating severe short-term adverse effects, although long-term safety data is lacking.

CONCLUSIONS

Despite having testosterone as a valuable tool, therapeutic strategies are lacking in the pharmacological field of HSDD/FSIAD. Neuroimaging studies could provide valuable information regarding the sexual desire substrate and suggest the potential application of already approved drugs for women with a good safety profile. The use of validated instruments for HSDD in postmenopausal women, considering the level of distress, is necessary to be able to draw robust conclusions on the evaluated treatments.

The association between female sexual function and metabolic features of the polycystic ovary syndrome in Turkish women of reproductive age

OBJECTIVE

To investigate the association between female sexual function and metabolic features among women with polycystic ovary syndrome (PCOS) during reproductive age.

METHOD

This was a cross-sectional study in which 288 women with PCOS and 180 women without PCOS between the ages of 20 and 40 years were evaluated. All women had serum total testosterone, androstenedione, DHEA-S, fasting glucose, total cholesterol, HDL-C, LDL-C, and triglyceride levels analyzed. The McCoy Female Sexual Questionnaire (MFSQ) was applied to all studied women. Exploratory factor analysis and reliability analysis were done after data collection. The factor loadings of MFSQ domains were compared between women with PCOS and controls.

RESULTS

Average factor loadings of the MFSQ sexuality domain and MFSQ sexual partner domain were significantly lower in the PCOS group when compared to controls. There was no correlation between the two sexual function domains of the MFSQ and the PCOS features either in the PCOS group or the controls.

CONCLUSION

PCOS is a heterogeneous disease with different metabolic components, such as insulin resistance, obesity, and hyperandrogenism. Although sexual function among women with PCOS was lower than controls, no differences were found in metabolic features of the PCOS and non-PCOS groups with relation to sexual function determined by the MFSQ.

Sexual dysfunction and its associated factors among patients with heart failure in public hospitals in Gondar town, North and West Gondar, 2024

INTRODUCTION

Sexual dysfunction is characterized by difficulties that interfere with achieving satisfying sexual activity, affecting desire, arousal, orgasm, and overall satisfaction. A recent study in Ethiopia identified heart failure as one of the most common cardiovascular diseases in the country. Sexual dysfunction significantly affects the quality of life in individuals with heart failure, yet it often goes underdiagnosed and underreported. Understanding the prevalence of sexual dysfunction and the factors influencing sexuality in these patients is essential. Therefore, the primary objective of this study was to determine the prevalence of sexual dysfunction among patients with heart failure in Gondar City and the northern and western zones of Gondar public hospitals.

METHOD

This study included 423 participants diagnosed with heart failure, selected through simple random sampling from January 3 to February 30, 2024. Data were collected using an interviewer-administered questionnaire covering socio-demographic, behavioral, and clinical information. Sexual dysfunction in males was assessed using the International Index of Erectile Function-5, while the Female Sexual Function Index-6 was used for females. Data were entered into Epidata version 3.6 and later exported to SPSS version 25 for analysis. Binary logistic regression was employed to identify factors associated with sexual dysfunction, with a significance level set at p ≤ 0.05.

RESULT

A total of 423 heart failure patients participated in the study, achieving a 100% response rate. The results indicated a significant prevalence of sexual dysfunction, affecting 57.92% of participants (95% CI 54.76%-63.76%). Female participants reported a higher prevalence of sexual dysfunction, with 63% of the 138 female heart failure patients affected. Among the 285 male participants, 55.4% (158 patients) were identified as having erectile dysfunction. Multivariable logistic regression analysis revealed that factors such as body mass index, age, insufficient physical activity, and smoking were significantly associated with sexual dysfunction in females. In males, erectile dysfunction was significantly linked to diabetes mellitus, heart failure classification, age, and insufficient physical activity.

CONCLUSION AND RECOMMENDATION

This study identified a high prevalence of sexual dysfunction, with females being more affected than males. Additionally, the research identified several factors influencing sexual dysfunction among patients with heart failure, including BMI, age, cigarette smoking, diabetes mellitus, and the classification of heart failure. The study recommends that healthcare providers and other stakeholders take proactive measures to alleviate the burden of sexual dysfunction in patients with heart failure. Strategies should focus on controlling the severity of heart failure symptoms, effectively managing comorbidities, and addressing factors such as body weight, psychological well-being, and behavioral patterns. By targeting these areas, healthcare providers can work toward minimizing the risk of sexual dysfunction and improving the overall quality of life for patients with heart failure.

Sexual Function in Women with Polycystic Ovary Syndrome Living in Stable Heterosexual Relationships: A Cross-Sectional Study

Background/Objective: The prevalence and character of female sexual dysfunction (FSD) in polycystic ovary syndrome (PCOS) have not been precisely determined. The aim of this study was to assess FSD using the Changes in Sexual Functioning Questionnaire (CSFQ-14) in women with PCOS and their partners compared to a control group, as well as correlations between five subscales, the total score of the CSFQ, and seven questions of the Visual Analogue Scale (VAS). Methods: The study sample (N = 160) comprised two groups: (1) women with PCOS and their partners (n = 91) and (2) women without PCOS and their partners (control group; n = 69). Results: The total scores of the CSFQ did not reveal FSD in either group of women. Regarding all subscales and the total score, the analysis showed a statistically significant difference between women and their partners (in all cases: p < 0.001). The discrepancy in arousal between women and men in the PCOS group was large (the mean difference was -2.32; t = -11.29, p < 0.001, Cohen's d = -1.26). The importance (VAS1), the level (VAS7) of sexual satisfaction, and the intensity of sexual thoughts (VAS2) correlated with almost all domains of the CSFQ. Conclusions: In conclusion, normal sexual function in PCOS does not mean proper sexual functioning in a sexual relationship.

Assessment of the Impact of SARS-CoV-2 Infection on the Sexual Function of Women, Levels of Oxytocin and Prolactin: A Prospective Cohort Study

(1) Background: There is a lack of direct evidence on whether SARS-CoV-2 affects women's sexual function through a biological-organic mechanism. Existing studies on the topic are few and have produced contradictory results. This study aims to explore the possible relationship between sex hormones and sexual function in patients who have been infected with SARS-CoV-2. Moreover, we aimed to determine whether these changes are related to the clinical course of COVID-19 and whether they are temporary or long-lasting. (2) Methods: A study was conducted on 104 women, including 64 women infected with COVID-19 and a control group of 40 healthy women, between January 2021 and August 2022. Blood samples were collected to measure prolactin and oxytocin levels, and a clinical assessment was performed 3 and 6 months later. Sexual function self-assessment was captured based on the FSFI scale. (3) Results: Our study found that patients with severe COVID-19 had better sexual satisfaction scores one month after recovery but no discernible difference after six months. High levels of serum prolactin were observed in patients with active COVID-19 but became similar to a control group after one month and remained stable over time. Higher prolactin levels were significantly associated with increased arousal and hydration. Individuals with severe COVID-19 had notably low levels of plasma oxytocin, but there was no correlation between oxytocin levels and sexual satisfaction. (4) Conclusions: The gynecologic symptoms, as well as disturbances in oxytocin and prolactin levels, might be observed in a short time after infection. However, SARS-CoV-2 infection has no lasting effect on sexual function, oxytocin, and prolactin levels among women.

Effects of long-term proton pump inhibitor use on sexual hormones and sexual and reproductive health in female patients

PURPOSE

Proton pump inhibitors (PPIs) are widely used to treat a range of gastrointestinal diseases around the world. Long-term use of PPIs has been associated to a variety of undesirable effects. Although short-term therapy has been shown to have little or no effect on endocrine hormone in women, however, its long-term safety has received little attention. We aimed at evaluating long-term use of PPIs and its effects on female reproductive hormones as well as related clinical consequences.

METHODS

A cross-sectional study was conducted in two outpatient gastroenterology clinics in the province of Khyber Pakhtunkhwa. This study included female patients who had been using PPIs on a regular basis for 3 months or more.

RESULTS

In total of 101 participants, patients with sexual complaints have significantly altered levels of prolactin (p = 0.05), estrogen (p < 0.001) and progesterone (p = 0.001) than patient without sexual complaints. The frequency of amenorrhea (p < 0.001), cyclic disturbances (p < 0.001), breast augmentation (p = 0.001) and painful breast (p = 0.004) were statistically significant in patients with raised serum prolactin values. Serum values of Sex hormone binding globulin SHBG (p < 0.001), estradiol (p = 0.002) and total testosterone (p < 0.001) were significantly altered between normal prolactin and hyperprolactinemic patients.

CONCLUSION

These findings suggest that long-term PPI use may cause endocrine hormone disturbances leading to sexual difficulties in women.

The Effects of Clove and Its Constituents on Reproductive System: a Comprehensive Review

Clove with the scientific name of Syzygium aromaticum (L.) Merr. & L.M. Perry is an evergreen tree in which its buds are used for medicinal purposes. Traditional medicine manuscripts as well as recent studies reported its effects on male and female reproductive systems. The aim of this study is to investigate the reported contradictory effects of clove and its phytochemicals on the reproductive system of both males and females. All types of in vitro, animal, and human studies of clove and its main constituents in the field of reproductive systems were collected via searching electronic databases including PubMed and Scopus from the onset till 2021. In this review, 76 articles were included, of which 25 were related to male reproduction, 32 were related to female reproduction, and 19 were related to reproductive malignancies. Analysis of the literature indicates the effects of clove and its constituents especially eugenol and β-caryophyllene on the level of sex hormones, fertility, sperm abnormalities, endometriosis, menstrual cycle, as well as gynecological infections, and reproductive tumors. The main mechanism of clove has not been understood yet but it seems that different parameters affect its pharmacological activity including the type of extract, dose, and duration of administration as well as the primary cause of the disorder. According to the effects of clove on different parts of the reproductive system, it seems that it can be a suitable candidate for related disorders, provided that more and more detailed studies are done on it.

Treatment for vaginal atrophy using microablative fractional CO2 laser: a randomized double-blinded sham-controlled trial

OBJECTIVE

The aim of this study was to evaluate the efficacy of vaginal CO2 laser for the treatment of vaginal atrophy compared to the sham procedure.

METHODS

Between June 2016 and May 2017, postmenopausal women with moderate to severe intensity of any vaginal atrophy symptoms (VAS) were invited to participate in the study. A total of 88 women were randomized to receive treatment with either vaginal CO2 laser or sham procedures every 4 weeks for three sessions. Both the participants and the evaluators were blinded to the treatment. Vaginal Health Index (VHI) score (primary outcome), VAS score, and the item for vaginal dryness from the International Consultation on Incontinence Modular Questionnaire-Vaginal Symptoms questionnaire were compared between the two groups by intention-to-treat analysis at 12 weeks after treatment.

RESULTS

Eighty-eight women were enrolled into the study and nine women were lost to follow-up. After 12 weeks of laser treatment, the VHI, VAS, and International Consultation on Incontinence Modular Questionnaire-Vaginal Symptoms (item for vaginal dryness) scores were significantly improved. For VHI and VAS scores the mean difference between the laser group versus the sham group was 1.37 (95% CI: 0.12-2.63), P < 0.001 and -1.52 (95% CI: -2.21 to -0.82), P = 0.03, respectively.

CONCLUSIONS

This study demonstrated that the application of microablative fractional CO2 laser was effective in treating vaginal atrophy. It could be a promising alternative treatment for postmenopausal women with vaginal atrophy. : Video Summary:http://links.lww.com/MENO/A582.

Psychiatric disorders in female psychosexual disorders-a nationwide, cohort study in Taiwan : Psychiatric disorders and female psychosexual disorders

We aimed to investigate whether females with psychosexual disorders were associated with the risk of affective and other psychiatric disorders. A total of 2240 enrolled individuals, with 560 patients with psychosexual disorders and 1680 subjects without psychosexual disorders (1:3) matched for age and index year, from the Longitudinal Health Insurance Database, retrieved from the National Health Insurance Research Database (NHIRD), between 2000 and 2015 in Taiwan. The multivariate Cox regression model was used to compare the risk of developing psychiatric disorders during the 15 years of follow-up. There were 98 in the cohort with psychosexual disorders (736.07 per 100,000 person-year) and 119 in the non-cohort without psychosexual disorders (736.07 per 100,000 person-year) that developed psychiatric disorders. The multivariate Cox regression model revealed that the adjusted hazard ratio (HR) was 9.848 (95% CI = 7.298 - 13.291, p < 0.001), after the adjustment of age, monthly income, urbanization level, geographic region, and comorbidities. Female patients with psychosexual disorders were associated with the risk of psychiatric disorders. This finding could be a reminder for clinicians about the mental health problems in patients with psychosexual disorders.

Sexual Function in Women With Polycystic Ovary Syndrome: Design of an Observational Prospective Multicenter Case Control Study

INTRODUCTION

The prevalence of polycystic ovary syndrome (PCOS) is 10-15% in women of reproductive age. Its characteristics are (i) clinical or biochemical hyperandrogenism, (ii) oligomenorrhea or amenorrhea, and (iii) polycystic ovaries on ultrasound. PCOS is associated with lower quality of life, depression, anxiety, diabetes, and cardiovascular disease. Treatment commonly entails oral contraceptive use to lower endogenous androgen levels. Androgen levels and comorbidities may affect sexual function. Previous studies have addressed a limited range of possible contributing factors. We will assess sexual function as well as genital and self-reported sexual arousal in a laboratory setting in women with PCOS compared to an age-matched healthy control group. Modulation by biopsychosocial factors mentioned will be studied.

METHODS

This is a multicenter prospective case control study. The study population includes healthy women with and without PCOS, aged 18-40 years, in a stable heterosexual relationship for at least 6 months. Power is calculated at 67 participants in each group. Anticipating a drop out of 10%, 150 participants will be recruited.

MAIN OUTCOME MEASURES

The main outcomes measured are sexual function using the Female Sexual Function Index, Sexual Desire Inventory, and Female Sexual Distress Scale-Revised; genital sexual arousal measured as vaginal pulse amplitude; and self-reported sexual arousal in response to erotic stimuli in a laboratory setting. The mediators that will be investigated include testosterone, free androgen levels, oral contraceptive use, sensitivity to androgens (using CAG repeat length), body mass index, body image, mental health, and self-esteem.

CONCLUSION

Strengths of this study are the inclusion of a broad range of biopsychosocial outcome measures including DNA analysis, a healthy control group, and standardized assessment of genital and self-reported sexual arousal in a laboratory setting. With the design of this study we aim to provide an insight into which biopsychosocial factors associated with PCOS are related to sexual function, and how sexual function may be affected by treatment. These new insights may help to improve clinical management of PCOS while improving the quality of life. Pastoor H, Both S, Timman R, et al. Sexual Function in Women With Polycystic Ovary Syndrome: Design of an Observational Prospective Multicenter Case Control Study. Sex Med 2020;8:718-729.

Female Sexual Dysfunction: ACOG Practice Bulletin Clinical Management Guidelines for Obstetrician-Gynecologists, Number 213

Female sexual dysfunction encompasses various conditions that are characterized by reported personal distress in one or more of the following areas: desire, arousal, orgasm, or pain (). Although female sexual dysfunction is relatively prevalent, women are unlikely to discuss it with their health care providers unless asked (), and many health care providers are uncomfortable asking for a variety of reasons, including a lack of adequate knowledge and training in diagnosis and management, inadequate clinical time to address the issue, and an underestimation of the prevalence (). The purpose of this document is to provide an overview of female sexual dysfunction, to outline updated criteria for diagnosis, and to discuss currently recommended management strategies based on the best available evidence.

Analysis of low sexual desire in Chinese women: a national population-based epidemiological survey in mainland China

Background Low sexual desire is the most prevalent female sexual health problem; however, national epidemiologic data on female sexual desire in China are absent. Understanding factors related to low sexual desire are essential in preparing educational and consultative programs and policies to improve women's sexual health.

METHODS

A national epidemiological survey on female sexual function was conducted from February 2014 to January 2016 in mainland China. Women were randomly selected using multistage, stratified, cluster sampling. The sexual functioning was assessed by using the Chinese version of the 19-item Female Sexual Function Index (FSFI) questionnaire.

RESULTS

The questionnaire on sexual dysfunction was completed by 25446 women who were aged 20-70 years. The prevalence of low sexual desire was 21.6% (domain score ≤4.28), and the declines in sexual desire started as early as 25-29 years. Sexual arousal was most closely related to sexual desire (Pearson's correlation = 0.760). Higher educational attainment was associated with a decreased risk of low sexual desire. Diabetes, non-gynaecological cancer, pelvic inflammatory disease and pelvic pain had negative effects on sexual desire (OR = 1.44, 99% CI = 1.11-1.87; OR = 1.92, 99% CI = 1.18-3.13; OR = 1.32, 99% CI = 1.07-1.63; OR = 1.77, 99% CI = 1.13-2.76 respectively).

CONCLUSIONS

The prevalence of low sexual desire in females in China was modest. Low sexual desire is correlated with sexual arousal disorder. Biopsychosocial factors have overlapping effects on sexual desire.

Effect of a multi-ingredient based food supplement on sexual function in women with low sexual desire

Background

Studies have demonstrated that women with low desire and low excitement have negative feelings regarding their physical and emotional satisfaction, as well as their happiness. In this study, we evaluate the efficacy of Libicare® - a multi-ingredient food supplement - to improve sexual function in postmenopausal women.

Methods

This was an exploratory, prospective, non-controlled, observational study. Postmenopausal women aged 45–65 with a risk of sexual dysfunction (Female Sexual Function Index (FSFI) < 25.83) were included during routine clinical visits and treated with 2 tablets of Libicare® daily for 2 months. Libicare® is an oral food supplement containing Trigonella foenum graecum, Turnera diffusa, Tribulus terrestris, and Ginkgo biloba dry extracts. Primary endpoint: change vs. baseline in FSFI score. Secondary endpoints: 1) changes in testosterone and serum steroid levels of free testosterone and sex hormone-binding globulin (SHBG) levels and 2) tolerability.

Results

A total of 29 patients (mean age: 54.69 years) were included. FSFI mean (SD) score showed a significant increase: 20.15 (4.48) vs 25.03 (6.94), baseline vs final; p = 0.0011, paired t-test. Most patients (86.2%) increased their FSFI score. All FSFI domains, except dyspareunia, showed significant increases. The highest increase was observed in the desire domain (p = 0.0004). Testosterone and SHBG levels were assessed in 21 patients. A significant increase in testosterone level was observed: 0.41 (0.26) vs. 0.50 (0.34) pg/mL, baseline vs. final; p = 0.038, Wilcoxon test. 52.4% of patients increased their testosterone levels. Finally, a significant decrease was observed in SHBG level: 85 (32.9) vs. 73 (26.8) nmol/L, baseline vs. final; p = 0.0001; paired t-test. 95.2% of patients decreased their SHBG levels.

Conclusion

In this pilot study, a significant improvement in sexual function and related hormone levels was observed with Libicare®. Further studies must be conducted to confirm these exciting results.

Trial registration

Current Controlled Trial ISRCTN12928573. Date of registration: 28/March/2019. Retrospectively registered.

Pornography and women’s sexual pleasure: Accounts from young women in Australia

Understanding how young women experience pornography is a modern imperative in promoting sexual health. There has been, until now, no Australian research exploring what pornography means to women in relation to sexual pleasure. We conducted in-depth interviews with 27 women from around Australia. A thematic analysis of their accounts, supported by narrative theory, revealed that pornography both enhanced and interfered with pleasure. Women described pornography’s contributions to the enhancement of pleasure through solo pleasure, shared viewing with partners, discovering new sexual preferences, and reassurance about body appearance. Pornography was constructed as interfering with pleasure through its misrepresentation (of bodies, sexual acts, and expression of pleasure), women’s concern for actors’ wellbeing, and its disruption of intimacy. Accounts were consistent with women’s place in a culture that subordinates female pleasure to male pleasure. It was evident in women’s accounts that pornography plays complex, dynamic roles in the production of pleasure, acting in the domains of physiology, psychology, relationships, ethics, society, and culture.

Prevalence and Predictors of Female Sexual Dysfunction in Migraine

Background:

Migraine is a common cause of primary headache, with women being affected thrice as common as men. Very few studies are available on sexual dysfunction in female migraineurs. There are no published studies done on the same in India till now. This study was done to look for the prevalence and predictors of sexual dysfunction disorder in females suffering from migraine.

Materials and Methods:

This is a cross-sectional study done to look for the prevalence and predictors of female sexual dysfunction in migraine. Sixty female patients with migraine were studied. The International Headache Society's International Classification of Headache Disorders, 3^rd Edition, was followed to diagnose migraine with or without aura. Migraine disability assessment scale was used to assess migraine-related disability, and Female Sexual Function Index (FSFI) score was used to assess female sexual function.

Results:

Sexual dysfunction was found in 78.3% migraineurs. The mean FSFI score was 23.1 ± 4.76. The FSFI scores in all the domains were lower in the individuals studied. Acute headaches resulted in loss of sexual desire among all the migraineurs.

Conclusion:

Sexual dysfunction is common in migraine with all domains of sexual function being affected. There is a significant negative correlation of sexual function with duration of acute episodes of headache and increasing frequency of migraine attacks per month.

Sexual function in women with polycystic ovary syndrome: a systematic review and meta-analysis

We present the first systematic review and meta-analysis of sexual function in women with polycystic ovary syndrome (PCOS) compared with women without PCOS. Data on this topic are limited and often contradicting. Sexual function is influenced by endocrine, mental and social factors, which are often compromised in women with PCOS. The main outcome measures were validated sexual function questionnaires and visual analogue scales (VAS). We identified and assessed 1925 original articles; 18 articles were included. Significant small effect sizes were found on sexual function subscales (total score: P = 0.006; arousal: P = 0.019; lubrication: P = 0.023; satisfaction: P = 0.015; orgasm: P = 0.028), indicating impaired sexual function in women with PCOS. Large effect sizes for the effect of body hair on sex were shown on VAS (P = 0.006); social effect of appearance (P = 0.007); sexual attractiveness (P < 0.001). Satisfaction with sex life was impaired (P < 0.001), but sexual satisfaction was rated equally important in women with PCOS and controls. We conclude that a satisfying sex life is important for women with PCOS; however, sexual function and feelings of sexual attractiveness are impaired. The findings imply that sexual function, sexual satisfaction and psychosocial functioning need to be part of every clinical assessment of women with PCOS.

Evidence-based treatments for low sexual desire in women

Low sexual desire is the most common sexual complaint in women, with multinational studies finding that at least a third of women experience low sexual desire. No single etiology for the development of Female Sexual Interest/Arousal Disorder, the diagnosis laid out by the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, has been established. There has been considerable interest in pharmacological approaches to improving low desire, and agents targeting a range of neurotransmitters have been examined. To date, only flibanserin, a centrally acting medication targeting the serotonin, dopamine, and norepinephrine systems, has been approved by the Food and Drug Administration (FDA). Despite statistically significant effects on sexual desire, sexual distress, and sexually satisfying events, side-effects are significant, and flibanserin is completely contraindicated with alcohol. As such, there has been renewed interest in advancing the science of psychological approaches to low desire, including cognitive behavioral and mindfulness therapies.

Ligand- and Structure-Based Drug Design of Non-Steroidal Aromatase Inhibitors (NSAIs) in Breast Cancer

Aromatase is a multienzyme complex overexpressed in breast cancer and responsible for estrogen production. It is the potential target for designing anti-breast cancer drugs. Ligand and Structure-Based Drug Designing approaches (LBDD and SBDD) are involved in development of active and more specific Nonsteroidal Aromatase Inhibitors (NSAIs). Different LBDD and SBDD approaches are presented here to understand their utility in designing novel NSAIs. It is observed that molecules should possess a five or six membered heterocyclic nitrogen containing ring to coordinate with heme portion of aromatase for inhibition. Moreover, one or two hydrogen bond acceptor features, hydrophobicity, and steric factors may play crucial roles for anti-aromatase activity. Electrostatic, van der Waals, and p-p interactions are other important factors that determine binding affinity of inhibitors. HQSAR, LDA-QSAR, GQSAR, CoMFA, and CoMSIA approaches, pharmacophore mapping followed by virtual screening, docking, and dynamic simulation may be effective approaches for designing new potent anti-aromatase molecules.

Vitamin D3 deficiency is associated with female sexual dysfunction in premenopausal women

PURPOSE

To assess female sexual functions in women who were affected by vitamin D₃ deficiency.

METHODS

A total of 50 women with FSD and 58 healthy women controls were included in the study, according to the Female Sexual Function Index (FSFI) questionnaire using a 26.55 cutoff value. Detailed medical histories were obtained from all sexual active women, and all women were evaluated in terms of possible presence of depression with the Beck Depression Inventory (BDI). Serum 25-hydroxyvitamin D₃, follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, total and free testosterone, estradiol, dehydroepiandrosterone-SO₄ (DHEA-SO₄), sex hormone-binding globulin (SHBG), free thyroxine (fT4), and thyroid-stimulating hormone (TSH) levels were measured.

RESULTS

Mean age of premenopausal women was 34.9 ± 6.3 years. The level of serum 25-hydroxyvitamin D₃ was significantly lower in women with FSD compared with the controls (15.9 ± 8.4 and 26.3 ± 11.7 nmol/L, respectively). Desire (p = 0.0001), arousal (p = 0.0001), lubrication (p = 0.002), orgasm (p = 0.0001), satisfaction (p = 0.018), and pain (p = 0.010) domain scores were also correlated with the levels of serum 25-hydroxyvitamin D₃. The BDI score showed a significant negative correlation with the total FSFI score (r = -0.492, p = 0.0001). The FSFI score not showed a significant correlation with the hormones (p > 0.05).

CONCLUSION

There is a relationship with FSD and deficiency of vitamin D₃. Also, increased depressive symptoms were associated with FSD.

Ligand- and Structure-Based Drug Design of Non-Steroidal Aromatase Inhibitors (NSAIs) in Breast Cancer

Aromatase is a multienzyme complex overexpressed in breast cancer and responsible for estrogen production. It is the potential target for designing anti-breast cancer drugs. Ligand and Structure-Based Drug Designing approaches (LBDD and SBDD) are involved in development of active and more specific Nonsteroidal Aromatase Inhibitors (NSAIs). Different LBDD and SBDD approaches are presented here to understand their utility in designing novel NSAIs. It is observed that molecules should possess a five or six membered heterocyclic nitrogen containing ring to coordinate with heme portion of aromatase for inhibition. Moreover, one or two hydrogen bond acceptor features, hydrophobicity, and steric factors may play crucial roles for anti-aromatase activity. Electrostatic, van der Waals, and p-p interactions are other important factors that determine binding affinity of inhibitors. HQSAR, LDA-QSAR, GQSAR, CoMFA, and CoMSIA approaches, pharmacophore mapping followed by virtual screening, docking, and dynamic simulation may be effective approaches for designing new potent anti-aromatase molecules.

Urogynecological effects of menopause

The menopause signifies a period after significant hormonal change that affects all estrogen-sensitive tissues. This change may result in symptoms affecting any part of the urogenital system. These changes can significantly affect women's health and quality of life. The menopause is associated with lower urinary tract symptoms, vulvovaginal symptoms and pelvic organ prolapse. In this article, we have aimed to describe the symptomatology along with pathophysiology of the effects of menopause on urogynecological problems affecting women's health. Other factors apart from menopause add to these symptoms, like parity, mode of delivery, obesity, smoking and poor psychological health.

A prospective study on sexual function and mood in female-to-male transsexuals during testosterone administration and after sex reassignment surgery

Testosterone administration in female-to-male transsexual subjects aims to develop and maintain the characteristics of the desired sex. Very little data exists on its effects on sexuality of female-to-male transsexuals. The aim of this study was to evaluate sexual function and mood of female-to-male transsexuals from their first visit, throughout testosterone administration and after sex reassignment surgery. Participants were 50 female-to-male transsexual subjects who completed questionnaires assessing sexual parameters and mood. The authors measured reproductive hormones and hematological parameters. The results suggest a positive effect of testosterone treatment on sexual function and mood in female-to-male transsexual subjects.

Remission of female sexual dysfunction in morbidly obese female patients with the Scopinaro procedure

BACKGROUND

The prevalence of obesity has increased in Spain in recent years. Obese women are at increased risk for sexual dysfunction, and important remission of this condition has been previously reported with bariatric surgery.

OBJECTIVES

The major aim of this study was to assess the effects of the Scopinaro biliopancreatic diversion on female sexual dysfunction (FSD) using a validated Female Sexual Function Index (FSFI).

METHODS

Eighty sexually active women with morbid obesity and with FSD underwent surgery. All patients completed the FSFI before surgery, as well as 6 and 12 months after surgery. The FSFI evaluates the sexual function using 6 items: desire, arousal, lubrication, orgasm, satisfaction, and pain. We used a<26.5 cut-point to assess the presence of FSD. This cut-point is used as a standard for the investigation.

RESULTS

Before surgery, all patients had FSD (mean 19.9±1.6). Six months after surgery, the FSD improved (mean 25.4±4.1; P<.001), and 12 months after surgery FSD resolved in most of the patients (mean 30.4±3.5; P<.001). All of the parameters evaluated by the FSFI (P<.001) improved significantly in all patients.

CONCLUSION

FSD improved significantly 6 months after biliopancreatic diversion among obese women with preoperative sexual dysfunction and continued improving up to 12 months later.

Hypoactive sexual desire disorder

PURPOSE OF REVIEW

Hypoactive sexual desire disorder (HSDD) is the most prevalent female sexual dysfunction, with estimates of prevalence approximating 10%. By definition it is a deficiency of sexual desire that causes distress. HSDD has no single cause, but physiological, psychological and socio-cultural factors underpinning female sexual desire may all be important in its development.

RECENT FINDINGS

Medical therapeutic strategies to date have concentrated on modulation of hormone levels, particularly androgen administration, yet few products have been approved for the treatment of HSDD in developed countries. More recent medical targets have included agents with 5-hydroxytryptamine agonist activity. Psychological therapeutic approaches have been infrequently studied but concentrate on cognitive behavioural therapy.

SUMMARY

HSDD is an evolving diagnosis, the existence of which has been questioned by some critics. Whilst HSDD remains the subject of ongoing research, its title and definition are under debate as a new edition of the Diagnostic and Statistical Manual of the American Psychiatric Association approaches publication in 2012.

The 2012 hormone therapy position statement of: The North American Menopause Society

OBJECTIVE

This position statement aimed to update the evidence-based position statement published by The North American Menopause Society (NAMS) in 2010 regarding recommendations for hormone therapy (HT) for postmenopausal women. This updated position statement further distinguishes the emerging differences in the therapeutic benefit-risk ratio between estrogen therapy (ET) and combined estrogen-progestogen therapy (EPT) at various ages and time intervals since menopause onset.

METHODS

An Advisory Panel of expert clinicians and researchers in the field of women's health was enlisted to review the 2010 NAMS position statement, evaluate new evidence, and reach consensus on recommendations. The Panel's recommendations were reviewed and approved by the NAMS Board of Trustees as an official NAMS position statement.

RESULTS

Current evidence supports the use of HT for perimenopausal and postmenopausal women when the balance of potential benefits and risks is favorable for the individual woman. This position statement reviews the effects of ET and EPT on many aspects of women's health and recognizes the greater safety profile associated with ET.

CONCLUSIONS

Recent data support the initiation of HT around the time of menopause to treat menopause-related symptoms and to prevent osteoporosis in women at high risk of fracture. The more favorable benefit-risk ratio for ET allows more flexibility in extending the duration of use compared with EPT, where the earlier appearance of increased breast cancer risk precludes a recommendation for use beyond 3 to 5 years.

Sexual function in pre- and post-menopausal women with obstructive sleep apnea syndrome

The objective of this study was to evaluate the female sexual function in relation to hormonal status in pre- and postmenopausal women with obstructive sleep apnea (OSA). A total of 43 premenopausal (mean age 42.1±4.9) and 58 postmenopausal (mean age 59.9±4.8) women were included in the study. All women filled out the Epworth sleepiness scale (ESS), the Beck Depression Inventory (BDI) and the Female Sexual Function Index (FSFI). Testosterone, estradiol and progesterone were measured. After polysomnography, women were allocated to a not-severe OSA group (Apnea-Hypopnea Index (AHI) 10-30) and a severe OSA group (AHI >30). Healthy subjects comprised the control group. Severe OSA women in both pre- and post-menopausal group were found to have significantly lower mean FSFI score (16.5±4.0 and 16.9±4.7, respectively) compared with not-severe OSA (23.4±5.5, P<0.01 and 21.8±7.5, P<0.05) and control subjects (27.0±5.5, P<0.01 and 24.0±6.7, P<0.01). Progesterone, which was significantly lower in severe OSA premenopausal women (0.26±0.2) compared with not-severe OSA (0.55±0.14, P<0.01) and control group (0.62±0.16, P<0.01), correlated significantly with FSFI (r=0.39, P<0.01). Our study demonstrated that OSA is associated with sexual dysfunction in both premenopausal and postmenopausal women in a dose-related fashion. Regarding premenopausal women, our results indicated that progesterone may play a role in the association between OSA and female sexual dysfunction.

Effects of hyperthyroidism, hypothyroidism, and thyroid autoimmunity on female sexual function

INTRODUCTION

Thyroid hormones affect male and female sexual functions, but data in hypo- and hyperthyroid women are scanty.

AIM

To investigate sexual function in hypo- and hyperthyroid women before and immediately after restoration of euthyroidism and in women with euthyroid Hashimoto's thyroiditis (HT).

PATIENTS AND CONTROLS

Fifty-six women with thyroid diseases (age 19-50 yr; 22 with hyperthyroidism, 17 with hypothyroidism, and 17 with euthyroid HT) and 30 age-matched healthy women.

MAIN OUTCOME MEASURES

Hypoactive sexual desire, disorders of sexual arousal, vaginal lubrication, orgasm, satisfaction, and sexual pain (SPD) were assessed by Female Sexual Function Index. Serum TSH, free T4 (FT4) and thyroid autoantibodies (anti-thyroglobulin, anti-thyroperoxidase, and TSH-receptor antibodies) were assessed at the diagnosis; FT4 and TSH were repeated after treatment to confirm normalization of thyroid function.

RESULTS

All sexual domains scores were significantly reduced (p ranging <0.0001-<0.05) in both hypo- and hyperthyroid women. Correction of hypothyroidism was associated to normalization of desire, satisfaction, and pain, while arousal and orgasm remained unchanged. In hyperthyroid women therapy normalized sexual desire, arousal/lubrication, satisfaction, and pain, while orgasm remained significantly impaired. Interestingly, euthyroid HT women displayed a significant decrease in sexual desire (p<0.0005), with no changes in the other sexual domains.

CONCLUSIONS

Both hypo- and hyperthyroidism markedly impair female sexual function. A rapid improvement is observed with the restoration of euthyroidism, although a longer period of time may be needed for full normalization. Preliminary data suggest that thyroid autoimmunity may selectively impair sexual desire, independently from thyroid function.

Disorders in sexual desire and sexual arousal in women, a 2010 state of the art

In this contribution, female sexual desire and arousal disorders are viewed from the perspective of incentive motivation and information processing models of sexual response. The effects of hormones, somatic disease, and medication on sexual arousability are discussed, as well as the influence of psychological factors, such as stimulus meaning, mood and cognition, and relational context on female sexual desire and arousal. Specific topics to attend to during the anamnesis of sexual desire and arousal problems, and empirically evaluated psychological and pharmacological treatments for these problems are discussed.

The effects of dehydroepiandrosterone (DHEA)/DHEA-sulfate (DHEAS) on the contraction responses of the clitoral cavernous smooth muscle from female rabbits

INTRODUCTION

Dehydroepiandrosterone (DHEA) is a multifunctional steroid that is increasingly available as a supplement aimed at improving libido and well-being in postmenopausal women in the recent times. Together with its sulfate version, DHEA-sulfate (DHEAS), it is the most abundant steroid in humans. The clitoris is an important component of the female sexual response, with its increased vascular response during sexual arousal that results in erection.

AIMS

To elucidate the direct effects of DHEA/DHEAS on the vasomotor reactivity of the rabbit clitoral cavernosum.

METHODS

Twenty New Zealand white female rabbits weighing approximately 2.5-3 kg were used in the study.

MAIN OUTCOME MEASURES

The contractile response of clitoral cavernous smooth muscle strips in response to phenylephrine (PE; 10(-9)-10(-4) M) were observed in rabbits. Additionally, DHEA/DHEAS effects on phenylephrine-induced contraction and/or acetylcholine-induced relaxation of phenylephrine-induced contraction were measured.

RESULTS

DHEA/DHEAS did not elicit any remarkable response in the resting state. However, both DHEA and DHEAS evoked dose-dependent relaxations of PE-induced contraction. The contractile responses to high potassium were significantly decreased in the DHEA/DHEAS-pretreated strips, compared with the DHEA/DHEAS-nontreated strips. Additionally, contractions by Bay K 8644 (10(-7)-10(-6) M) treatment were also significantly inhibited by DHEA/DHEAS. DHEA-induced relaxation responses were stronger than DHEAS-induced relaxation responses. Various K channel blockers, tetraethylammonium (TEA; 1 mM, 10 mM), 4-aminopyridine (10 microM) and glibenclamide (10 microM) did not affect the DHEA/DHEAS-induced relaxation on muscle strips contracted by PE. Relaxation responses by acetylcholine or sodium nitroprusside (SNP) were not changed after DHEA/DHEAS pretreatment.

CONCLUSIONS

DHEA/DHEAS was found to induce a relaxation response in rabbit clitoral cavernosal smooth muscle, and this is thought to be mediated by direct inhibition of a voltage-dependent calcium channel.

Evaluation of sexual dysfunction prevalence in infertile couples

INTRODUCTION

The physical health and emotional well-being of many individuals and couples of reproductive age are significantly affected by infertility. Sexual function is one of the important components of health and overall quality of life.

AIMS

To determine the prevalence of sexual dysfunction in infertile couples.

METHODS

In a cross-sectional study, in a tertiary university hospital, sexual dysfunction was assessed in 100 infertile couples. Sexual Function Questionnaire (SFQ) and International Index of Erectile Function (IIEF) questionnaire were administered.

MAIN OUTCOME MEASURES

Prevalence of sexual dysfunction in infertile couples based on the score of the domains of SFQ and IIEF.

RESULT(S)

The SFQ score was within the normal range in all five domains in only 7% of women. The prevalence of female sexual dysfunction was highest and lowest in arousal-sensation (80.2%) and orgasm (22.8%) domains, respectively. Only 2% of male participants have had severe erectile dysfunction (ED).

CONCLUSIONS

The prevalence of dysfunction in arousal-sensation and arousal-lubrication in our study was found to be higher than the results reported from Iranian normal population. The prevalence of any degree of ED in our study was higher than the prevalence reported for normal population and infertile men. The role of demographic factors, relationship parameters, and infertility per se in the prevalence of sexual dysfunction in infertile couples remains to be determined.

Management of sexual dysfunction in postmenopausal breast cancer patients taking adjuvant aromatase inhibitor therapy

Treatment with aromatase inhibitors for postmenopausal women with breast cancer has been shown to reduce or obviate invasive procedures such as hysteroscopy or curettage associated with tamoxifen-induced endometrial abnormalities. The side effect of upfront aromatase inhibitors, diminished estrogen synthesis, is similar to that seen with the natural events of aging. The consequences often include vasomotor symptoms (hot flushes) and vaginal dryness and atrophy, which in turn may result in cystitis and vaginitis. Not surprisingly, painful intercourse (dyspareunia) and loss of sexual interest (decreased libido) frequently occur as well. Various interventions, both non-hormonal and hormonal, are currently available to manage these problems. The purpose of the present review is to provide the practitioner with a wide array of management options to assist in treating the sexual consequences of aromatase inhibitors. The suggestions in this review are based on recent literature and on the recommendations set forth both by the North American Menopause Association and in the clinical practice guidelines of the Society of Gynaecologists and Obstetricians of Canada. The complexity of female sexual dysfunction necessitates a biopsychosocial approach to assessment and management alike, with interventions ranging from education and lifestyle changes to sexual counselling, pelvic floor therapies, sexual aids, medications, and dietary supplements-all of which have been reported to have a variable, but often successful, effect on symptom amelioration. Although the use of specific hormone replacement-most commonly local estrogen, and less commonly, systemic estrogen with or without an androgen, progesterone, or the additional of an androgen in an estrogenized woman (or a combination)-may be highly effective, the concern remains that in patients with estrogen-dependent breast cancer, including those receiving anti-estrogenic adjuvant therapies, the use of these hormones may be attended with potential risk. Therefore, non-hormonal alternatives should in all cases be initially tried with the expectation that symptomatic relief can often be achieved.First-line therapy for urogenital symptoms, notably vaginal dryness and dyspareunia, should be the non-hormonal group of preparations such as moisturizers and precoital vaginal lubricants. In patients with estrogen-dependent breast cancer (notably those receiving anti-estrogenic adjuvant therapies) and severely symptomatic vaginal atrophy that fails to respond to non-hormonal options, menopausal hormone replacement or prescription vaginal estrogen therapy may considered. Systemic estrogen may be associated with risk and thus is best avoided. Judicious use of hormones may be appropriate in the well-informed patient who gives informed consent, but given the potential risk, these agents should be prescribed only after mutual agreement of the patient and her oncologist.

Sexual Function in Female Patients with Unstable Angina or Non-ST-Elevation Myocardial Infarction

INTRODUCTION

Coronary artery disease is the leading cause of death and disability for both women and men. The psychological impact of acute myocardial infarction, as well as the physiological effects of the illness and its medications, can have a major effect on a patient's ability to resume sexual activity.

AIM

To assess sexual activity in female patients with unstable angina or non-ST-elevation myocardial infarction (NSTEMI), and to study the impact of cardiovascular rehabilitation (CR) on resumption of sexual activity.

MAIN OUTCOME MEASURES

Doppler-echocardiographic study, exercise tolerance test (ETT), and assessment of sexual activity.

METHODS

This study was conducted in the Riyadh National Hospital and included 35 female patients admitted to the intensive care unit for management of unstable angina or NSTEMI. All patients were enrolled into a CR program. All of them were interviewed for assessment of sexual activity, 12 weeks post discharge. The Arizona Sexual Experience Scale (ASEX) was used for the assessment of the severity of sexual dysfunction for patients who resumed their sexual activity.

RESULTS

Results indicate that 48.57% of the patients resumed their sexual activity at the time of the interview. However, most of them were either not satisfied at all with their sexual activity or mostly dissatisfied. The remaining patients (51.43%) had not resumed sex yet. CR was completed by 70.59% of those resuming sex, and 38.89% of those not resuming sex. We estimated that rehabilitated patients were 3.77 times more likely to resume sexual activity than those who did not receive rehabilitation. ASEX score ranged from 19 to 30, with a mean of 24.118 +/- 3.42.

CONCLUSION

Unstable angina and NSTEMI have a negative impact on frequency of, and satisfaction with, sexual activity, and lead to sexual dysfunction within a large number of female patients. Accurate and complete sexual instructions for both partners with specific attention paid to the woman's concerns and needs should be part of CR programs.