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Kamrul-Hasan A, Hannan MA, Alam MS, Aalpona FTZ, Nagendra L, Selim S, Dutta D. Role of flibanserin in managing hypoactive sexual desire disorder in women: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e38592. [PMID: 38905407 PMCID: PMC11192006 DOI: 10.1097/md.0000000000038592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/24/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Flibanserin, approved for the treatment of hypoactive sexual desire disorder (HSDD) in females, has demonstrated diverse therapeutic and adverse effect (AE) prospects in the extant randomized controlled trials (RCTs). This meta-analysis aimed to characterize the outcomes of flibanserin use in these patients comprehensively. METHODS RCTs involving women with HSDD receiving flibanserin in the intervention arm and placebo in the control arm were sought after throughout the electronic databases. The primary outcomes were the changes from baseline in satisfying sexual events (SSE) per month and sexual desire score per month measured using an electronic diary (eDiary). RESULTS From 478 initially screened articles, data from 8 RCTs involving 7906 women with HSDD were analyzed. In premenopausal women, flibanserin 100 mg was superior to placebo in improving the number of SSE per month (mean difference, MD 0.69, 95% CI [0.39, 0.99]), eDiary sexual desire score (MD 1.71, 95% CI [0.43, 2.98]), Female Sexual Function Index (FSFI) desire domain (FSFI-d) score (MD 0.30, 95% CI [0.29, 0.31]), FSFI total score (MD 2.51, 95% CI [1.47, 3.55]), Female Sexual Distress Scale-Revised (FSDS-R) Item 13 score (MD -0.30, 95% CI [-0.31, -0.29]), and FSDS-R total score (MD -3.30, 95% CI [-3.37, -3.23]). Compared to placebo, a higher number of premenopausal women using flibanserin 100 mg achieved improvements in the Patient's Global Impression of Improvement score (OR 1.93, 95% CI [1.58, 2.36], P < .00001) and responded positively at Patient Benefit Evaluation (PBE) (odds ratio, OR 1.76, 95% CI [1.34, 2.31], P < .0001). Postmenopausal women receiving flibanserin 100 mg also benefited in terms of the number of SSE per month, FSFI-d and total scores, FSDS-R Item 13 and total scores, and PBE response. Although flibanserin use was associated with higher risks of dizziness, fatigue, nausea, somnolence, and insomnia, these adverse events were mild in nature; the serious AEs and severe AEs were comparable between the flibanserin and placebo groups. CONCLUSION While flibanserin has demonstrated efficacy in the treatment of HSDD in both pre- and postmenopausal women, its therapeutic advantages may be overshadowed by the higher likelihood of AEs.
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Affiliation(s)
- A.B.M. Kamrul-Hasan
- Department of Endocrinology, Mymensingh Medical College, Mymensingh, Bangladesh
| | - Mohammad Abdul Hannan
- Department of Endocrinology, North East Medical College and Hospital, Sylhet, Bangladesh
| | - Muhammad Shah Alam
- Department of Medicine, Army Medical College Cumilla, Cumilla, Bangladesh
| | | | - Lakshmi Nagendra
- Department of Endocrinology, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, India
| | - Shahjada Selim
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Deep Dutta
- Department of Endocrinology, CEDAR Superspeciality Healthcare, Dwarka, New Delhi, India
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Barakeh D, Mdaihly H, Karaoui LR. Pharmacotherapy of Hypoactive Sexual Desire Disorder in Premenopausal Women. Ann Pharmacother 2024:10600280241253273. [PMID: 38767282 DOI: 10.1177/10600280241253273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
OBJECTIVE This review aims to provide an overview of pharmacologic management for hypoactive sexual desire disorder (HSDD) in premenopausal women, with a focus on available agents. DATA SOURCES Through a literature search on PubMed, Google Scholar, and ClinicalTrials.gov from 1999 to 2024, studies were selected using the following MeSH search terms: hypoactive sexual desire disorder, premenopause, pharmacologic management, flibanserin, bremelanotide, buspirone, bupropion, and testosterone, excluding those involving postmenopausal women or other sexual disorders. Product monographs were also reviewed. STUDY SELECTION AND DATA EXTRACTION Relevant English-language studies or those conducted in humans were considered. DATA SYNTHESIS Hypoactive sexual desire disorder, characterized by a lack of motivation for sexual activity, predominantly affects women aged 45 years and older. Treatment involves a multimodal approach, including nonpharmacologic interventions such as psychotherapy and lifestyle adjustments, alongside pharmacologic options. Although bupropion and buspirone may be considered off-label treatments, flibanserin and bremelanotide are the sole medications approved by the Food and Drug Administration for generalized acquired HSDD in premenopausal women. However, caution is advised due to their limited efficacy, potential adverse effects, and transparency issues in reporting. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE Hypoactive sexual desire disorder, while not life-threatening, significantly impacts well-being and relationships. Pharmacotherapy, including options like flibanserin and bremelanotide, is essential within a multidisciplinary approach. Validated tools and objective measures inform tailored premenopausal HSDD care plans and aid in striking a balance between potential risks and adverse effects while maximizing meaningful clinical benefits, including for transgender individuals. CONCLUSIONS Clinicians must discern important distinctions between flibanserin, bremelanotide, and other agents when managing premenopausal HSDD. Further research with the most suitable clinical endpoints and consideration of patient factors are crucial before widespread adoption of flibanserin and bremelanotide. Pharmacists are encouraged to embrace this opportunity to provide premenopausal HSDD care in ambulatory and community practice settings.
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Affiliation(s)
| | - Hadil Mdaihly
- School of Pharmacy, Lebanese American University, Byblos, Lebanon
| | - Lamis R Karaoui
- Department of Pharmacy Practice, School of Pharmacy, Lebanese American University, Byblos, Lebanon
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Tetik S, Yalçinkaya Alkar Ö. Turkish women's perception of low sexual desire, its causes and consequences: an online qualitative survey. Sex Health 2024; 21:SH23185. [PMID: 38709901 DOI: 10.1071/sh23185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/08/2024] [Indexed: 05/08/2024]
Abstract
Background The nature of sexual desire is complex, and little phenomenological consensus exists about its meaning. Low sexual desire (LSD) is a commonly reported sexual difficulty among women, but it is less frequently associated with sexual distress. The aim of this qualitative study is to explore women's understanding of sexual desire, and their perceptions of factors that may contribute to LSD, its effects and their methods of seeking help. Methods The research employed a questionnaire with 12 open-ended questions, developed by the researchers based on sexual script theory. Data were collected from 165 heterosexual Turkish women who reported LSD, recruited through social media platforms between August and October 2021. The data were analysed using a contextual form of thematic analysis to identify and explore patterns. Results The ages of the participants ranged from 20 to 63years. The majority of participants held a Bachelor's degree (81.2%) and in a relationship (78.8%). Three main themes emerged from the study: (1) gendered messages concerning sex, (2) multi-level sexual desire, and (3) minimisation. The research revealed that women's sexual desire is often ignored and repressed, and has negative consequences if not expressed in socially acceptable contexts. The causes of LSD in women go beyond personal factors, and include relational and social influences. Women experiencing LSD report distressing effects on their relationships and general wellbeing, yet they tend not to seek help. Conclusions Our findings contribute to a deeper understanding of the factors impacting women's sexual desire and the barriers to seeking help.
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Affiliation(s)
- Sinan Tetik
- Psychiatry Outpatient Clinic, Ankara Etlik City Hospital, Varlik Mh., Halil Sezai Erkut Cd., Yenimahalle, Ankara, 06170, Turkey
| | - Özden Yalçinkaya Alkar
- Department of Clinical Psychology, Ankara Yildirim Beyazit University, Esenboga Campus Cubuk, Ankara, 06810, Turkey
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Weber M, Reis D, Friese M. Development and Validation of the Trait Sexual Motivation Scale (TSMS). J Pers Assess 2024; 106:267-282. [PMID: 37212615 DOI: 10.1080/00223891.2023.2206896] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/13/2023] [Indexed: 05/23/2023]
Abstract
Sexual motivation, the interest in sexual activity, affects people's thinking, feeling, and behavior. Common scales used to assess sexual motivation suffer from drawbacks that limit their validity and applicability. We therefore developed and validated the Trait Sexual Motivation Scale (TSMS), a brief, theory-driven self-report scale, over the course of four preregistered studies (Ntotal = 2,083). Results indicated good model fit, high internal consistency and stability of the second-order (i.e., trait sexual motivation) and first-order (i.e., cognition, affect, behavior) factor scores, and scalar measurement invariance for gender and relationship status. The TSMS correlated as expected with sexual and non-sexual constructs and predicted sexual outcomes cross-sectionally and prospectively in everyday life. Overall, the TSMS emerged as an economical, reliable, and valid measure of sexual motivation.
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Affiliation(s)
- Marcel Weber
- Department of Psychology, Saarland University, Saarbrücken, Germany
| | - Dorota Reis
- Department of Psychology, Saarland University, Saarbrücken, Germany
| | - Malte Friese
- Department of Psychology, Saarland University, Saarbrücken, Germany
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Farahi Z, HashemZadeh M, Farnam F. Sexual counseling for female sexual interest/arousal disorders: a randomized controlled trial based on the "good enough sex" model. J Sex Med 2024; 21:153-162. [PMID: 38181124 DOI: 10.1093/jsxmed/qdad168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/08/2023] [Accepted: 12/05/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Female sexual interest/arousal disorder (FSIAD) is the most common female sexual disorder with adverse effects on women's health and interpersonal relationships. AIM This survey evaluated the effects of sexual counseling based on the "good enough sex" (GES) model on the sexual health variables of women with FSIAD. METHODS A randomized clinical trial with a 1:1 allocation ratio was conducted among 80 women with FSIAD in Iran in 2021. Eligible participants were randomly assigned to group A (women) and group B (couples). Women attended 4 weekly online group sexual counseling sessions based on the GES model, each lasting 120 minutes. In group B, husbands participated in sessions 2 and 3. OUTCOMES Women's sexual health parameters-including sexual desire, sexual satisfaction, sexual function, sexual distress, sexual communication, frequency of sexual intercourse, and dysfunctional beliefs-were evaluated before and 3 months after counseling. The significance threshold considered P < .007 due to Bonferroni correction. RESULTS After the intervention, all sexual parameters except sexual dysfunctional beliefs showed significant improvement (P < .001) in both groups. During the follow-up period, the average scores for all sexual variables were slightly higher in group B vs group A. The between-group difference was significant only for frequency of sexual intercourse (P < .01). CLINICAL IMPLICATIONS This study reaffirms the impact of the GES model as biopsychosocial therapy in managing female sexual problems. Considering men's reluctance to accompany their wives to sex clinics, counseling for women alone can play a significant role in solving sexual problems, especially in the case of FSIAD. Online sexual consultation offers cost and time savings, provides a secure space for discussing sensitive topics, and facilitates group program coordination. It ensures universal access to counseling, thereby addressing gender incompatibility issues. It is a powerful, interactive, and acceptable alternative to in-person visits, providing convenience and confidentiality for clients seeking sexual health support. STRENGTHS AND LIMITATIONS The following were among the survey strengths: conducting a randomized controlled trial on women with FSIAD by applying an appropriate model and scales, involving spouses, and evaluating online group sexual counseling. However, the results of this study may not be generalizable to women without partners. CONCLUSION The GES model, emphasizing intimacy and sexual dialogue, reduces unrealistic sexual expectations and improves women's sexual desire and overall health. Our results showed that instead of insisting on the physical presence of husbands in counseling sessions, clinicians should emphasize their emotional support and companionship during the treatment process.
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Affiliation(s)
- Zahra Farahi
- Department of Reproductive Health and Midwifery, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran 1416634793, Iran
| | - Mozhgan HashemZadeh
- Department of Reproductive Health and Midwifery, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran 1416634793, Iran
| | - Farnaz Farnam
- Department of Reproductive Health and Midwifery, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran 1416634793, Iran
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Ronghe V, Pannase K, Gomase KP, Mahakalkar MG. Understanding Hypoactive Sexual Desire Disorder (HSDD) in Women: Etiology, Diagnosis, and Treatment. Cureus 2023; 15:e49690. [PMID: 38161863 PMCID: PMC10757759 DOI: 10.7759/cureus.49690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Hypoactive Sexual Desire Disorder (HSDD) is a complex and multifaceted condition that significantly impacts the sexual well-being and overall quality of life of women. This comprehensive review aims to provide a holistic understanding of HSDD by exploring its etiology, diagnostic criteria, treatment approaches, and broader societal implications. The review delves into the intricate interplay of biological factors, including hormonal changes and neurotransmitter imbalances, that contribute to HSDD. Psychological factors, such as relationship issues, body image, and stress, are examined with sociocultural factors like societal norms, cultural influences, and media portrayals of sexuality. Diagnostic criteria and assessment methods, including The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria, and self-report questionnaires, are explored to facilitate accurate identification of HSDD and differentiation from other sexual disorders. The impact of HSDD on women's quality of life and relationships is examined, highlighting the emotional strain and interpersonal challenges associated with the disorder. Societal and personal consequences of untreated HSDD underscore the need for increased awareness and support. Treatment approaches encompass non-pharmacological interventions such as cognitive-behavioral therapy, sex therapy, and couples therapy and pharmacological interventions like hormone therapy and selective serotonin reuptake inhibitors. Novel treatments like bremelanotide, flibanserin, and integrative strategies combining psychotherapy and lifestyle changes are discussed. Challenges and controversies surrounding HSDD, including the lack of consensus on diagnostic criteria, debates about the medicalization of sexuality, ethical concerns regarding pharmaceutical interventions, and cultural considerations, are addressed. Future directions in research, including advances in neurobiological understanding, personalized medicine, long-term treatment studies, and destigmatization initiatives, offer promising pathways for enhancing the management of HSDD.
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Affiliation(s)
- Vaishnavi Ronghe
- Obstetrics and Gynaecology, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Krutika Pannase
- Obstetrics and Gynaecology Nursing, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Kavita P Gomase
- Obstetrics and Gynaecology, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Manjusha G Mahakalkar
- Obstetrics and Gynaecology, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Rowland DL, Castleman JM, Bacys KR, Csonka B, Hevesi K. Do pornography use and masturbation play a role in erectile dysfunction and relationship satisfaction in men? Int J Impot Res 2023; 35:548-557. [PMID: 35840678 DOI: 10.1038/s41443-022-00596-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 06/24/2022] [Accepted: 06/29/2022] [Indexed: 11/10/2022]
Abstract
Both masturbation frequency and pornography use during masturbation have been hypothesized to interfere with sexual response during partnered sex as well as overall relationship satisfaction. However, results from prior studies have been inconsistent and frequently based on case studies, clinical reports, and simple binary analyses. The current study investigated the relationships among masturbation frequency, pornography use, and erectile functioning and dysfunction in 3586 men (mean age = 40.8 yrs, SE = 0.22) within a multivariate context that assessed sexual dysfunctions using standardized instruments and that included other covariates known to affect erectile functioning. Results indicated that frequency of pornography use was unrelated to either erectile functioning or erectile dysfunction (ED) severity in samples that included ED men with and without various sexual comorbidities or in a subset of men 30 years or younger (p = 0.28-0.79). Masturbation frequency was also only weakly and inconsistently related to erectile functioning or ED severity in the multivariate analyses (p = 0.11-0.39). In contrast, variables long known to affect erectile response emerged as the most consistent and salient predictors of erectile functioning and/or ED severity, including age (p < 0.001), having anxiety/depression (p < 0.001 except for a subset of men ≤ 30 years), having a chronic medical condition known to affect erectile functioning (p < 0.001 except for a subset of men ≤ 30 years), low sexual interest (p < 0.001), and low relationship satisfaction (p ≤ 0.04). Regarding sexual and relationship satisfaction, poorer erectile functioning (p < 0.001), lower sexual interest (p < 0.001), anxiety/depression (p < 0.001), and higher frequency of masturbation (p < 0.001) were associated with lower sexual and lower overall relationship satisfaction. In contrast, frequency of pornography use did not predict either sexual or relationship satisfaction (p ≥ 0.748). Findings of this study reiterate the relevance of long-known risk factors for understanding diminished erectile functioning while concomitantly indicating that masturbation frequency and pornography use show weak or no association with erectile functioning, ED severity, and relationship satisfaction. At the same time, although verification is needed, we do not dismiss the idea that heavy reliance on pornography use coupled with a high frequency of masturbation may represent a risk factor for diminished sexual performance during partnered sex and/or relationship satisfaction in subsets of particularly vulnerable men (e.g., younger, less experienced).
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Affiliation(s)
- David L Rowland
- Department of Psychology, Valparaiso University, Valparaiso, IN, USA.
| | | | - Katelyn R Bacys
- Department of Mathematics and Statistics, Valparaiso University, Valparaiso, IN, USA
| | - Balazs Csonka
- Department of Psychology, University of Debrecen, Debrecen, Hungary
| | - Krisztina Hevesi
- Institute of Psychology, ELTE Eotvos Lorand University, Budapest, Hungary
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Taiwo OA, Dosumu OA, James AS, Ugwor EI, Ojo OA, Dedeke GA, Ademuyiwa O. Pre-puberty cannabichromene exposure modulates reproductive function via alteration of spermatogenesis, steroidogenesis, and eNOS pathway metabolites. Toxicol Rep 2023; 10:690-705. [PMID: 37396845 PMCID: PMC10313885 DOI: 10.1016/j.toxrep.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/19/2023] [Accepted: 06/02/2023] [Indexed: 07/04/2023] Open
Abstract
Background Cannabis and cannabinoids affect almost every system of the body and exert systemic effects such as alterations in memory and cognitive functions, neurotransmission impediment, as well as obstruction of endocrine and reproductive system functions. Reproduction is a complicated phenomenon that integrates biological, psychological and behavioural aspects, hence susceptible to intracellular and extracellular modulations by numerous chemicals and toxicants like cannabis. Aim The effects of early-life exposure to cannabis on reproductive function biomarkers and genes were investigated in male and female Wistar rats in this study. Method An initial computational analysis (molecular docking and induced fit docking) of some cannabinoids with reproductive enzymes; androgen and follicle stimulating hormone receptors was conducted. Overall, cannabichromene (CBC) had the best IFD scores and binding free energies for the two proteins studied and it interacted with notable amino acids within their active sites. Subsequently, forty (40) Wistar rats, 20 male and 20 female (24-28 days old, weighing 20-28 ± 2 g) were divided into two groups each and orally administered CBC for 21 days. Penile tissues, testes and ovaries, were collected for biochemical analysis (hormonal assays, enzyme activities, and metabolite concentrations), gene expressions, and histological evaluations. Results Activities of arginase and phosphodiesterase-5 in the penile tissue were significantly increased, while nitric oxide and calcium levels were significantly (p < 0.05) decreased in the CBC-exposed groups relative to the control group. Semen analysis showed significantly more abnormalities and decreased concentration of spermatozoa in the CBC-exposed group compared to the control. Activities of 17β-hydroxysteroid dehydrogenase and cholesterol level were decreased in both testes and ovaries of CBC-exposed groups. Furthermore, levels of testosterone, progesterone, luteinizing, and follicle-stimulating hormones were reduced in the serum of CBC rats. Moreover, relative expressions of androgen receptor and follicle-stimulating hormone receptor genes were significantly downregulated in the CBC-exposed groups. Histological evaluations revealed lesions, tubular necrosis, and cellular congestions in both the testes and ovaries. Conclusion This study suggests that pre-puberty exposure to cannabis modulates reproductive functions via cannabichromene inhibition of steroidogenesis, stimulation of erectile dysfunction (modulation of intermediates and enzymes of the endothelial nitric oxide synthase (eNOS) pathway in the penile tissue), and downregulation of the expressions of genes associated with reproduction.
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Affiliation(s)
- Odunayo Anthonia Taiwo
- Department of Biochemistry, College of Natural and Applied Sciences, Chrisland University, Ajebo Abeokuta, Ogun-state, Nigeria
- Department of Biochemistry, College of Biosciences, Federal University of Agriculture Abeokuta, Nigeria
| | - Oluwatosin Adebisi Dosumu
- Department of Biochemistry, College of Biosciences, Federal University of Agriculture Abeokuta, Nigeria
| | - Adewale Segun James
- Faculty of Science, Department of Chemical Sciences (Biochemistry Programme), Augustine University, Ilara-Epe, Nigeria
| | | | - Oluwafemi Adeleke Ojo
- Phytomedicine, Molecular Toxicology, and Computational Biochemistry Research Laboratory (PMTCB-RL) Department of Biochemistry, Bowen University, 232101 Iwo, Nigeria
| | - Gabriel Adewunmi Dedeke
- Department of Pure and Applied Zoology, College of Biosciences, Federal University of Agriculture Abeokuta, Nigeria
| | - Oladipo Ademuyiwa
- Department of Biochemistry, College of Biosciences, Federal University of Agriculture Abeokuta, Nigeria
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Khan DY, Behaeddin BC, Uhlyar S, Parker JM. Bupropion Treatment for Stimulant Withdrawal in a Patient With Substance Use Disorder and Unspecified Bipolar Disorder. Cureus 2023; 15:e37700. [PMID: 37206494 PMCID: PMC10191240 DOI: 10.7759/cureus.37700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
Patients presenting with comorbid stimulant use disorder is a common occurrence in nearly all medical specialties. New clinical strategies to care for patients experiencing stimulant withdrawal should be considered as an effort to improve clinical outcomes. Our patient, a woman in her early 20s with a history of substance use disorder and unspecified bipolar and related disorder, presented with acute psychosis with symptoms including agitation, auditory hallucinations, and delusions in the context of chronic mental illness and cocaine abuse. She was subsequently admitted to the inpatient psychiatry unit. Notable symptoms included mood swings, erratic behavior, anger, and agitation. Mood and psychotic symptoms were treated with olanzapine. She also received medications, including haloperidol, lorazepam, and diphenhydramine, as needed for agitation, which were given as an emergency treat option (ETO) injection. The patient continuously exhibited irritability and endorsed that she was undergoing cocaine withdrawal symptoms, for which she was started on bupropion. Within days of taking this medication, she reported significant improvement in her psychotic and mood symptoms. The patient continued this treatment during the remainder of her stay until the resolution of her symptoms and was discharged with both bupropion and olanzapine to continue while awaiting an outpatient psychiatry appointment in one week.
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Affiliation(s)
- Daanish Y Khan
- Psychiatry and Behavioral Sciences, St. George's University School of Medicine, Miami, USA
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10
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Kasano JPM, Crespo HFG, Arias RAR, Alamo I. Genitourinary syndrome in menopause: Impact of vaginal symptoms. Turk J Obstet Gynecol 2023; 20:38-45. [PMID: 36908063 PMCID: PMC10013085 DOI: 10.4274/tjod.galenos.2023.50449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Objective To describe the impact of genitourinary syndrome symptoms on daily activities and well-being in peri- and postmenopausal women living in an urban area. Materials and Methods Observational, prospective, and cross-sectional research in a population of peri- and postmenopausal women living in the Lima region. A non-probabilistic sample was used. The instrument used is "The Day-to-Day Impact of Vaginal Aging" questionnaire. It consists of four domains and its internal reliability is between 0.82 and 0.93. The questions were answered using a Likert scale. High values indicate a more severe impact. Statistical procedures were performed using SPSS version 26. Results One thousand seventy women participated; the mean age was 54±7.5 years. The results about the activities of daily living showed that 35% of women reported regular vaginal symptoms and 14.7% major symptoms. In the emotional well-being domain, 90% had minor symptoms. In the sexual function domain, 57.6% reported minor vaginal symptoms, and in the self-concept and body image domain, 60.9% reported minor symptoms and 20.7% major symptoms. According to the global score, 60.9% reported minor discomfort, 36.3% regular discomfort, and 2.8% major discomfort. The sexually active women declared an impact of severity in terms of their daily activities and sexual function (p<0.05). Conclusion There is a relationship between activities of daily living, sexual function, and women with sexual activity, causing a negative impact on social life and quality of life.
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Affiliation(s)
- Juan Pedro Matzumura Kasano
- Department of Obstetrician and Gynecologist, Faculty of Medicine of the Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Hugo F Gutiérrez Crespo
- Department of Obstetrician and Gynecologist, Faculty of Medicine of the Universidad Nacional Mayor de San Marcos, Lima, Peru
| | | | - Isabel Alamo
- Department of Health Services Management, Faculty of Medicine of the Universidad Ricardo Palma, Santiago de Surco, Peru
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Nappi RE, Tiranini L, Cucinella L, Martini E, Bosoni D, Righi A, Cassani C, Gardella B. Pharmacotherapy for female sexual dysfunctions (FSDs): what is on the market and where is this field heading? Expert Opin Pharmacother 2023; 24:135-143. [PMID: 35430926 DOI: 10.1080/14656566.2022.2066997] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Female sexual dysfunctions (FSDs) are common in women of any age and have a huge impact on quality of life and relationships. They have a multifaceted etiology limiting the development of pharmacotherapies with a high rate of effectiveness. Safety issues are also a concern. AREAS COVERED The authors report the most recent advances in pharmacotherapy for premenopausal and postmenopausal women with a main focus on hypoactive sexual desire disorders (HSDD) and associated sexual symptoms. Good levels of evidence have emerged for psychoactive agents, such as flibanserin and bremelanotide, as well as hormonal compounds (transdermal testosterone). The authors also report briefly on intravaginal DHEA (prasterone), local estrogen therapy (LET), and ospemifene to manage effectively vulvovaginal atrophy/genitourinary syndrome of menopause (VVA/GSM). In addition, they discuss promising therapeutic options highlighting the main reasons that hamper the availability of new labeled products. Finally, they include the importance of the multimodal approach to address FSDs. EXPERT OPINION Approved pharmacotherapies for FSD are limited. Validated multidimensional instruments and adequate objective measures of physical and mental responses to sexual external and internal incentives are mandatory to identify women suitable to chronic or on-demand treatments and to assess their pattern of response in research and practice.
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Affiliation(s)
- Rossella E Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Lara Tiranini
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Laura Cucinella
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Ellis Martini
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - David Bosoni
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Alessandra Righi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Chiara Cassani
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Unit of Obstetrics and Gynecology, IRCCS S. Matteo Foundation, Pavia, Italy
| | - Barbara Gardella
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Unit of Obstetrics and Gynecology, IRCCS S. Matteo Foundation, Pavia, Italy
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12
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Thurston L, Hunjan T, Mills EG, Wall MB, Ertl N, Phylactou M, Muzi B, Patel B, Alexander EC, Suladze S, Modi M, Eng PC, Bassett PA, Abbara A, Goldmeier D, Comninos AN, Dhillo WS. Melanocortin 4 receptor agonism enhances sexual brain processing in women with hypoactive sexual desire disorder. J Clin Invest 2022; 132:152341. [PMID: 36189794 PMCID: PMC9525110 DOI: 10.1172/jci152341] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/09/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Hypoactive sexual desire disorder (HSDD) is characterized by a persistent deficiency of sexual fantasies and desire for sexual activity, causing marked distress and interpersonal difficulty. It is the most prevalent female sexual health problem globally, affecting approximately 10% of women, but has limited treatment options. Melanocortin 4 receptor (MC4R) agonists have emerged as a promising therapy for women with HSDD, through unknown mechanisms. Studying the pathways involved is crucial for our understanding of normal and abnormal sexual behavior. METHODS Using psychometric, functional neuroimaging, and hormonal analyses, we conducted a randomized, double-blinded, placebo-controlled, crossover clinical study to assess the effects of MC4R agonism compared with placebo on sexual brain processing in 31 premenopausal heterosexual women with HSDD. RESULTS MC4R agonism significantly increased sexual desire for up to 24 hours after administration compared with placebo. During functional neuroimaging, MC4R agonism enhanced cerebellar and supplementary motor area activity and deactivated the secondary somatosensory cortex, specifically in response to visual erotic stimuli, compared with placebo. In addition, MC4R agonism enhanced functional connectivity between the amygdala and the insula during visual erotic stimuli compared with placebo. CONCLUSION These data suggest that MC4R agonism enhanced sexual brain processing by reducing self-consciousness, increasing sexual imagery, and sensitizing women with HSDD to erotic stimuli. These findings provide mechanistic insight into the action of MC4R agonism in sexual behavior and are relevant to the ongoing development of HSDD therapies and MC4R agonist development more widely. TRIAL REGISTRATION ClinicalTrials.gov NCT04179734. FUNDING This is an investigator-sponsored study funded by AMAG Pharmaceuticals Inc., the Medical Research Council (MRC) (MR/T006242/1), and the National Institute for Health Research (NIHR) (CS-2018-18-ST2-002 and RP-2014-05-001).
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Affiliation(s)
- Layla Thurston
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, United Kingdom
| | - Tia Hunjan
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, United Kingdom
| | - Edouard G Mills
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, United Kingdom
| | - Matthew B Wall
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, United Kingdom.,Invicro, a Konica Minolta Company, London, United Kingdom
| | - Natalie Ertl
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, United Kingdom.,Invicro, a Konica Minolta Company, London, United Kingdom
| | - Maria Phylactou
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, United Kingdom
| | - Beatrice Muzi
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, United Kingdom
| | - Bijal Patel
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, United Kingdom
| | - Emma C Alexander
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, United Kingdom
| | - Sofiya Suladze
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, United Kingdom
| | - Manish Modi
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, United Kingdom
| | - Pei C Eng
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, United Kingdom
| | | | - Ali Abbara
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, United Kingdom
| | - David Goldmeier
- Jane Wadsworth Sexual Function Clinic, St. Mary's Hospital and
| | - Alexander N Comninos
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, United Kingdom.,Department of Endocrinology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Waljit S Dhillo
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, United Kingdom.,Department of Endocrinology, Imperial College Healthcare NHS Trust, London, United Kingdom
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13
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Limoncin E, Ciocca G, Castellini G, Sansone A, Cavalieri F, Cavallo F, Cocchiaro T, Ricca V, di Lorenzo G, Rossi A, Fisher AD, Rochira V, Corona G, Jannini EA. Hypersexuality as a tip of the iceberg of a primary psychopathology: a joined position statement of the Italian Society of Andrology and Sexual Medicine (SIAMS) and of the Italian Society of Psychopathology (SOPSI). J Endocrinol Invest 2022; 45:1787-1799. [PMID: 35527295 DOI: 10.1007/s40618-022-01798-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/28/2022] [Indexed: 10/18/2022]
Abstract
In the last years, hypersexual behavior has been broadly scientifically studied. The interest in this topic, belonging to psycho-sexology and sexual medicine, has been due to its still unclear aetiology, nature, and its manifestation in relationship with several organic and psychopathological conditions. So, the specialist (the psychologist, psychiatrist, endocrinologist, neurologist) may encounter some difficulties in diagnosing and managing this symptom. The first main objective of this position statement, which has been developed in collaboration between the Italian Society of Andrology and Sexual Medicine (SIAMS) and the Italian Society of Psychopathology (SOPSI) is to give to the reader evidence about the necessity to consider hypersexuality as a symptom related to another underlying condition. Following this consideration, the second main objective is to give specific statements, for the biopsychosocial assessment and the diagnosis of hypersexual behavior, developed on the basis of the most recent literature evidence. To develop a psycho-pharmacological treatment tailored on patients' needs, our suggestion is to assess the presence of specific comorbid psychopathological and organic conditions, and the impact of pharmacological treatments on the presence of an excess of sexual behavior. Finally, a suggestion of a standardized psychometric evaluation of hypersexuality will be given.
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Affiliation(s)
- E Limoncin
- Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University Tor Vergata, E Tower South. Floor 4, Room E413, Via Montpellier 1, 00133, Rome, Italy
- Department of Dynamic, Clinical Psychology and Health, University Sapienza, Rome, Italy
| | - G Ciocca
- Department of Dynamic, Clinical Psychology and Health, University Sapienza, Rome, Italy
| | - G Castellini
- Psychiatric Unit, Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - A Sansone
- Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University Tor Vergata, E Tower South. Floor 4, Room E413, Via Montpellier 1, 00133, Rome, Italy
| | - F Cavalieri
- Department of Medicine, Unit of Andrology and Reproduction Medicine, University of Padova, Padua, Italy
| | - F Cavallo
- Spinal Unit, San Raffaele Institute of Sulmona, Sulmona, Italy
| | - T Cocchiaro
- Department of Gender, Parenting, Child and Adolescent Medicine, Unit of Reproductive Pathophysiology and Andrology, "Sandro Pertini" Hospital, Rome, Italy
| | - V Ricca
- Psychiatric Unit, Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - G di Lorenzo
- Laboratory of Psychophysiology and Cognitive Neuroscience, Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Psychiatry and Clinical Psychology Unit, Section of Psychiatry, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - A Rossi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - A D Fisher
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - V Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - G Corona
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Bologna, Italy
| | - E A Jannini
- Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University Tor Vergata, E Tower South. Floor 4, Room E413, Via Montpellier 1, 00133, Rome, Italy.
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14
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Razali NA, Sidi H, Choy CL, Che Roos NA, Baharudin A, Das S. The Role of Bupropion in the Treatment of Women with Sexual Desire Disorder: A Systematic Review and Meta-Analysis. Curr Neuropharmacol 2022; 20:1941-1955. [PMID: 35193485 PMCID: PMC9886814 DOI: 10.2174/1570159x20666220222145735] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/05/2021] [Accepted: 02/18/2022] [Indexed: 11/22/2022] Open
Abstract
Although few clinical trials examined the efficacy of bupropion to treat sexual dysfunction among female patients, a comprehensive and objective synthesis of the best available evidence is still lacking. To date, to the best of our knowledge, there are no published systematic reviews or meta-analyses specifically focusing on the role of bupropion in the treatment of female sexual dysfunction. The main objective of the present study was to evaluate the efficacy of bupropion in the treatment of female sexual dysfunction, and we hypothesized that bupropion is efficient in treating female patients with sexual dysfunction. This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search for published literature was performed using Ovid, Medline, Scopus, Cochrane Library, Science Direct, and PubMed databases. In our study, we found that bupropion was almost three-fold more favorable in improving problems with sexual desire (pool estimate 2.845, 95% CI: 0.215 to 5.475, I2= 95.6%, p=0.034). A meta-regression was performed to explore heterogeneity and we found that only the dosage of bupropion was statistically significant in explaining the variance, i.e., the lower the dosage (150 mg vs. 300 mg), the better the improvement in the sexual desire of women with hypoactive sexual desire disorder (HSDD). Based on the results of this systematic review and metaanalysis, there is a potential role of bupropion as an effective treatment for women with HSDD.
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Affiliation(s)
| | - Hatta Sidi
- Address correspondence to this author at the Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, 56000 Cheras, Kuala Lumpur, Malaysia; Tel: +6016-3112070; E-mail:
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15
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Simon JA, Athavale A, Ravindranath R, Hadker N, Sadiq A, Lim-Watson M, Williams L, Krop J. Assessing the Burden of Illness Associated with Acquired Generalized Hypoactive Sexual Desire Disorder. J Womens Health (Larchmt) 2022; 31:715-725. [PMID: 35475708 PMCID: PMC9133974 DOI: 10.1089/jwh.2021.0255] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Hypoactive sexual desire disorder (HSDD), which affects ∼10% of women in the United States, is defined as the persistent or recurrent deficiency/absence of sexual desire accompanied by personal distress. Although HSDD impacts patient quality of life and interpersonal relationships, the disorder often goes unaddressed or untreated. Recent studies of the burden of illness in women with HSDD, especially premenopausal women, are limited. Materials and Methods: A 45-minute web-based survey was designed to investigate the experience of women seeking treatment for HSDD and the impact of this disorder on several psychosocial aspects of women's lives. Women were recruited from an online panel of patients who participated in research studies for compensation. Validated questionnaires assessed sexual function (Female Sexual Function Index) and health-related quality of life (12-Item Short Form Survey [SF-12]), including mental and physical component scores. Results: A total of 530 women, aged ≥18 years, diagnosed with acquired generalized HSDD were included in the study. Premenopausal women indicated greater overall HSDD symptom burden compared with postmenopausal women. Patients with HSDD reported lower SF-12 scores compared with the general population. A multivariable regression analysis demonstrated that psychosocial factors influencing the burden of HSDD, including interference with their relationship with their partner (β = −0.18; p < 0.005), mental and emotional well-being (β = −0.23; p < 0.005), and household and personal activities (β = −0.23; p = 0.02), negatively affected SF-12 mental component scores. Conclusions: HSDD symptom burden was found to be negatively and statistically significantly associated with patients' mental health; the impact was greater among premenopausal women compared with postmenopausal women.
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Affiliation(s)
- James A Simon
- Department of Obstetrics and Gynecology, George Washington University and IntimMedicine™ Specialists, Washington, District of Columbia, USA
| | | | | | | | - Amama Sadiq
- AMAG Pharmaceuticals, Inc., Waltham, Massachusetts, USA
| | | | | | - Julie Krop
- AMAG Pharmaceuticals, Inc., Waltham, Massachusetts, USA
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16
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Nimbi FM, Simonelli C. The Sex Therapists' Approach to the Evaluation and Management of Low Sex Drive in Men. J Sex Med 2022; 19:546-552. [DOI: 10.1016/j.jsxm.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 01/28/2022] [Accepted: 02/02/2022] [Indexed: 11/26/2022]
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17
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Clayton AH, Kingsberg SA, Portman D, Sadiq A, Krop J, Jordan R, Lucas J, Simon JA. Safety Profile of Bremelanotide Across the Clinical Development Program. J Womens Health (Larchmt) 2022; 31:171-182. [PMID: 35147466 DOI: 10.1089/jwh.2021.0191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Bremelanotide, a melanocortin receptor agonist, is Food and Drug Administration (FDA)-approved for the treatment of premenopausal women with acquired, generalized hypoactive sexual desire disorder. Methods: Review of bremelanotide's safety profile from the clinical development program (phases 1 through 3). Results: The clinical development program comprised 3500 subjects in 43 completed studies. In the phase 3 studies, subjects took bremelanotide for up to 18 months. The most common adverse events (AEs) were nausea (40.0% vs. 1.3%), flushing (20.3% vs. 1.3%), headache (11.3% vs. 1.9%), and injection site reactions (5.4 vs. 0.5), bremelanotide versus placebo groups, respectively, in the integrated double-blind portion of the phase 3 studies (N = 1247). Nausea was the most common reason for bremelanotide discontinuation. There were no deaths; a few subjects experienced serious AEs. Focal hyperpigmentation was rare when bremelanotide was dosed in accordance with label recommendations, but it occurred in more than one-third of subjects following up to 16 consecutive daily dosings. Small and transient but statistically significant blood pressure increases were observed during ambulatory blood pressure monitoring. Most drug-drug interactions were not clinically significant, except for interactions that lowered plasma concentrations of indomethacin and naltrexone. In the double-blind portion of the integrated phase 3 studies, 70% of the bremelanotide group proceeded to the open-label phase of the studies versus 87% of those on placebo. Conclusions: The AEs associated with bremelanotide are mostly mild to moderate. Although not deemed clinically important, bremelanotide should be used with caution in patients at risk of cardiovascular disease, and blood pressure should be well controlled during treatment. Clinical Trial Registration number: NCT02333071 [Study 301] and NCT02338960 [Study 302].
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Affiliation(s)
- Anita H Clayton
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Sheryl A Kingsberg
- Department of Reproductive Biology and Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | | | - Amama Sadiq
- AMAG Pharmaceuticals, Inc., Waltham, Massachusetts, USA
| | - Julie Krop
- AMAG Pharmaceuticals, Inc., Waltham, Massachusetts, USA
| | - Robert Jordan
- Palatin Technologies, Inc., Cranbury, New Jersey, USA
| | - Johna Lucas
- Palatin Technologies, Inc., Cranbury, New Jersey, USA
| | - James A Simon
- George Washington University and IntimMedicine™ Specialists, Washington, District of Columbia, USA
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18
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Cucinella L, Martini E, Tiranini L, Battista F, Molinaro P, Casiraghi A, Cominotti S, Piccinino M, Rossini R, Nappi RE. Menopause and female sexual dysfunctions (FSDs). Minerva Obstet Gynecol 2022; 74:234-248. [PMID: 35107240 DOI: 10.23736/s2724-606x.22.05001-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Biological and psycho-relational factors contribute equally to the development of sexual symptoms and associated distress, a key element to diagnose female sexual dysfunctions (FSDs) in menopausal women. Consultation at midlife represents an optimal time to discuss sexual life, and healthcare providers (HCPs) have to be proactive in rising the conversation, as patients may not report their sexual concerns spontaneously. An accurate sexual history is essential to characterize the primary symptom, determine the impact on patient's quality of life and identify risk and precipitating factors. Among FSDs, hypoactive sexual desire disorder (HSDD) is very frequent at midlife together with genitourinary syndrome of menopause (GSM), a chronic condition negatively affecting the full sexual response. A multidimensional approach targeted to the patient's characteristics, goals and expectations is mandatory and should start from educative counselling and correction of modifiable risk factors. When specific treatments are required, they should include non-pharmacological and pharmacological options, often prescribed in combination to address concomitantly the biological and psychosocial components of FSDs.
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Affiliation(s)
- Laura Cucinella
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy - .,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy -
| | - Ellis Martini
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy
| | - Lara Tiranini
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Federica Battista
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Pietro Molinaro
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Arianna Casiraghi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Urogynecology Unit, Division of Gynecology and Obstetrics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Selene Cominotti
- Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Manuela Piccinino
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy
| | - Roberta Rossini
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy
| | - Rossella E Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
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19
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Lerner T, Bagnoli VR, de Pereyra EAG, Fonteles LP, Sorpreso ICE, Júnior JMS, Baracat EC. Cognitive-behavioral group therapy for women with hypoactive sexual desire: A pilot randomized study. Clinics (Sao Paulo) 2022; 77:100054. [PMID: 35905577 PMCID: PMC9334335 DOI: 10.1016/j.clinsp.2022.100054] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/13/2022] [Accepted: 05/20/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Hypoactive Sexual Desire Disorder (HSDD) is a very prevalent sexual problem, with limited options for treatment. Given that psychological factors are major contributors to the disorder, a therapy such as Cognitive-Behavioral Therapy (CBT) may be useful to treat HSDD. OBJECTIVE To evaluate the effects of group CBT on women with HSDD. METHOD Clinical trial randomized study with 106 women diagnosed with HSDD, who were divided as follows: Group 1 (n = 53) underwent group CBT for 8-weeks, and Group 2 (n = 53), were put on a waiting list and used as a control group. Sexual function was assessed by the Female Sexual Quotient (FSQQ) at the initial interview and after 6-months. Mann Whitney test was used for group comparison. MAIN OUTCOME MEASURES demographics, education, sexual history, FSQQ and its domains for sexual function assessment. RESULTS Both groups had similar characteristics regarding sexual response, self-image, and relationship with a partner at the initial interview. Women undergoing therapy showed significant improvement in sexual function when compared with the control group. The overall FSQQ result showed an average growth of 18.08 points (95% CI 12.87‒23.28) for the therapy group against a decrease of 0.83 points (95% CI 3.43‒1.77) for controls (p < 0.001). The five domains of the questionnaire also exhibited significant improvement in the therapy group: desire and interest (p = 0.003), foreplay (p = 0.003), excitation and tuning (p < 0.001), comfort (p < 0.001), and orgasm and satisfaction (p < 0.001). CONCLUSION Group CBT was shown to be an effective tool for treating HSDD.
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Affiliation(s)
- Théo Lerner
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Vicente Renato Bagnoli
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Elsa Aida Gay de Pereyra
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Lucivanda Pontes Fonteles
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Isabel Cristina Esposito Sorpreso
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - José Maria Soares Júnior
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Edmund Chada Baracat
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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20
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Hoeppner CG, Cigna ST, Perkins J, Gaba ND. Sexual Health. Clin Geriatr Med 2021; 37:553-577. [PMID: 34600722 DOI: 10.1016/j.cger.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Women's sexual health is a frequently ignored area of geriatric medicine. There are clearly defined criteria for sexual dysfunction that are organized by phase of sexual function, including desire, arousal, orgasm, and pain. The menopause transition and comorbid medical conditions (as well as their treatments) can contribute to alterations in sexual function. The partner must be included and involved in the evaluation and management to achieve a better intimate relationship in an established couple. A variety of effective and evidence-based treatments are available to women for sexual concerns in the geriatric population.
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Affiliation(s)
- Catherine G Hoeppner
- The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue Northwest, Suite 6A-427, Washington, DC 20037, USA.
| | - Sarah T Cigna
- The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue Northwest, Suite 6A-427, Washington, DC 20037, USA
| | - Jenna Perkins
- The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue Northwest, Suite 6A-427, Washington, DC 20037, USA
| | - Nancy D Gaba
- The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue Northwest, Suite 6A-427, Washington, DC 20037, USA
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21
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Pérez-López FR, Vieira-Baptista P, Phillips N, Cohen-Sacher B, Fialho SCAV, Stockdale CK. Clinical manifestations and evaluation of postmenopausal vulvovaginal atrophy. Gynecol Endocrinol 2021; 37:740-745. [PMID: 34036849 DOI: 10.1080/09513590.2021.1931100] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION It is estimated that 50% of women will suffer a severe form of vulvovaginal atrophy (VVA) related to menopause. Equally, young women may temporarily present this clinical problem while receiving various pharmacological or endocrine treatments or radiotherapy. AIM To determine clinical and diagnostic exams required to confirm the presence of VVA (also referred to as atrophic vaginitis, urogenital atrophy, or genitourinary syndrome of menopause) and rule out other genital or pelvic clinical conditions. MATERIALS AND METHODS Literature review searches were carried out on the main scientific article search engines (PubMed, SciELO, Cochrane) using different clinical terms, treatments or interventions and comorbidity related to VVA. RESULTS The development and severity of VVA depend mainly on the duration of hypoestrogenism. Hypoestrogenism causes changes in the urogenital tissue, generating signs and symptoms, such as dryness, burning, soreness, itching, and irritation of the genital skin. The diagnosis can be made through anamnesis (patient history), questionnaires, physical exam, and, sometimes, complementary exams. Objective vaginal assessment is essential and can be completed with the Vaginal Health Index, the Vaginal Maturation Index, or vaginal pH in the absence of infection or semen. The exclusion of other vulvovaginal organic pathology is essential to reach an accurate diagnosis and provide adequate treatment. CONCLUSIONS The specialist should be able to identify VVA, rule out other pathologies that make a differential diagnosis and conduct proper management.
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Affiliation(s)
- Faustino R Pérez-López
- Department of Obstetrics and Gynecology, University of Zaragoza Faculty of Medicine, Zaragoza, Spain
| | - Pedro Vieira-Baptista
- Hospital Lusíadas Porto, Porto, Portugal
- LAP, Unilabs, Porto, Portugal
- Lower Genital Tract Unit, Centro Hospitalar de São João, Porto, Portugal
| | - Nancy Phillips
- Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Bina Cohen-Sacher
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
| | - Susana C A V Fialho
- Department of Obstetrics and Gynecology, Universidade Federal Fluminense Niterói, Rio de Janeiro, Brazil
| | - Colleen K Stockdale
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Naguib MJ, Makhlouf AIA. Scalable flibanserin nanocrystal-based novel sublingual platform for female hypoactive sexual desire disorder: engineering, optimization adopting the desirability function approach and in vivo pharmacokinetic study. Drug Deliv 2021; 28:1301-1311. [PMID: 34176378 PMCID: PMC8238064 DOI: 10.1080/10717544.2021.1938755] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Flibanserin (FLB) was approved by FDA for the treatment of pre-menopausal female hypoactive sexual desire disorder (HSDD). FLB suffers from low oral bioavailability (33%) which might be due to hepatic first-pass metabolism in addition to its poor aqueous solubility. The sublingual route could be a promising alternative for FLB due to the avoidance of enterohepatic circulation. However, the drug needs to dissolve in the small volume of saliva in order to be absorbed through the sublingual mucosa. Therefore, FLB nanocrystals were prepared by sono-precipitation technique according to 23 full factorial design. FLB-nanocrystals were formulated using two surfactants (PVP K30 and PL F127) in two different amounts (200 and 400 mg) and the volume of ethanol was either 3 or 5 mL. Nanocrystal formulation was optimized according to the desirability function to have a minimum particle size, zeta potential, polydispersity index, and maximum saturated solubility. The optimized formula had a particle size of 443.12 ± 14.91 nm and a saturated solubility of 23.27 ± 4.62 mg/L which is five times the saturated solubility of FLB. Nanocrystal dispersion of the optimized formula was solidified by freeze-drying and used to prepare rapidly disintegrating sublingual tablets containing Pharmaburst® as superdisintegrant. Sublingual tablet formulation with the shortest disintegration time (36 s) was selected for the in vivo study. FLB nanocrystal-based sublingual tablets exhibited a two-fold increase in bioavailability with a faster onset of action compared to the commercially available oral formulation. These findings prove the potential application of FLB nanocrystal-based sublingual tablets in the treatment of HSDD.
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Affiliation(s)
- Marianne J Naguib
- Faculty of Pharmacy, Department of Pharmaceutics and Industrial Pharmacy, Cairo University, Cairo, Egypt
| | - Amal I A Makhlouf
- Faculty of Pharmacy, Department of Pharmaceutics and Industrial Pharmacy, Cairo University, Cairo, Egypt
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Thomas EJ, Gurevich M. Difference or dysfunction?: Deconstructing desire in the DSM-5 diagnosis of Female Sexual Interest/Arousal Disorder. FEMINISM & PSYCHOLOGY 2021. [DOI: 10.1177/0959353521989536] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This article answers ongoing calls within critical sexuality scholarship to explore how constructions of women’s bodies influence and are influenced by broader sociocultural contexts. Specifically, this article offers a conceptual analysis of female sexual desire, highlighting the deeply political nature of its pathologization. We briefly explore dominant definitions and models of sexual desire to highlight the erasure of embodied desire as an important part of healthy female sexuality. The DSM-5 diagnosis of Female Sexual Interest/Arousal Disorder is critically analyzed to highlight how desire differences are framed as gendered, individual problems which sidelines relational, contextual, and sociopolitical factors contributing to individual distress. When the language of desire is displaced by the language of interest (particularly when framed as receptivity), the capacity to theorize wanting and entitlement is undermined. We argue that the pathologization of diverse desires obscures possibilities for embodied wanting and neglects the consideration that all types of desire (absent, frequent, physical, emotional) may represent normal sexual variations.
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El-Behairy MF, Ahmed RM, Fayed MAA, Mowafy S, Abdallah IA. Insights into flibanserin oxidative stress degradation pathway: in silico – in vitro toxicity assessment of its degradates. NEW J CHEM 2021. [DOI: 10.1039/d0nj05548d] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Characterization of the degradation products of pharmaceutical drugs is essential to assess their safety.
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Affiliation(s)
- Mohammed F. El-Behairy
- Department of Organic and Medicinal Chemistry
- Faculty of Pharmacy
- University of Sadat City
- Sadat City 32897
- Egypt
| | - Rasha M. Ahmed
- Department of Pharmaceutical Chemistry
- Faculty of Pharmacy
- Misr International University
- Cairo 11341
- Egypt
| | - Marwa A. A. Fayed
- Department of Pharmacognosy
- Faculty of Pharmacy
- University of Sadat City
- Sadat City 32897
- Egypt
| | - Samar Mowafy
- Department of Pharmaceutical Chemistry
- Faculty of Pharmacy
- Misr International University
- Cairo 11341
- Egypt
| | - Inas A. Abdallah
- Department of Analytical Chemistry
- Faculty of Pharmacy
- University of Sadat City
- Sadat City 32897
- Egypt
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Sadeghi S, Bahrami R, Raisi F, Rampisheh Z, Ghobadi A, Akhtari E. Evaluation of the effect of carrot seed (Daucus Carota) in women of fertile age with hypoactive sexual desire disorder: A randomized double-blind clinical trial. Complement Ther Med 2020; 54:102543. [PMID: 33183662 DOI: 10.1016/j.ctim.2020.102543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/15/2020] [Accepted: 08/17/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hypoactive Sexual Desire Disorder (HSDD) is a common sexual problem of women which has negative impacts on their health and quality of life. Given the side effects of pharmacologic interventions, it would be beneficial to patients trying to find new options based on herbal medicine. OBJECTIVES To evaluate efficacy of carrot seed on sexual dysfunction of women with HSDD compared with placebo. METHODS In this randomized double-blind clinical trial, 68 participants randomly assigned to the intervention group which took 500 mg carrot seed three times a day for 12 weeks versus placebo. Participants in two groups filled Female Sexual Function Index (FSFI) questionnaire at baseline, week six and 12. Repeated measure analysis of variance (ANOVA) test was used for statistical analysis. RESULTS Thirty women in carrot seed group and thirty women in placebo group completed 12 weeks of the study. In general, carrot seed compared to placebo improved the total score of FSFI 7.329 ± 0.830 (p < 0.001), desire 4.1±0.7 (p < 0.001), lubrication 4.7±0.4 (p = 0.019), arousal 4.1±0.08 (p < 0.001), satisfaction 4.8±1.1 (p < 0.001), orgasm 3.9±0.9 (p < 0.001) and pain 5.4±1(p < 0.001). No adverse event was reported in this study. CONCLUSIONS Women with HSDD may benefit from six weeks' treatment with carrot seed for improvement of sexual dysfunction. Further large clinical studies are warranted to confirm efficacy of this herbal drug.
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Affiliation(s)
- Sajjad Sadeghi
- Iranian Traditional Medicine Clinic, Amiralmomenin Hospital, Semnan University of Medical Sciences, Semnan, Iran
| | - Rosita Bahrami
- Research Institute for Islamic and Complementary Medicine, School of Persian Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Firoozeh Raisi
- Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Rampisheh
- Preventive Medicine and Public Health Research Center, Department of Community Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Ghobadi
- Research Institute for Islamic and Complementary Medicine, School of Persian Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Elham Akhtari
- Research Institute for Islamic and Complementary Medicine, School of Persian Medicine, Iran University of Medical Sciences, Tehran, Iran.
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Development and Greenness Evaluation of Spectrofluorometric Methods for Flibanserin Determination in Dosage Form and Human Urine Samples. Molecules 2020; 25:molecules25214932. [PMID: 33113816 PMCID: PMC7663165 DOI: 10.3390/molecules25214932] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 10/23/2020] [Indexed: 11/16/2022] Open
Abstract
Green, economic and sensitive two spectrofluorometric methods were developed for the quantitation of flibanserin (FB) in different matrices, which are based on FB native fluorescence properties. The first technique depends on measuring the relative fluorescence intensity of FB directly at emission and excitation wavelengths(λem/λex) (371 nm/247 nm), while the second technique is a first derivative (D1) spectrofluorometric method, which depends on measuring the peak amplitudes at 351 nm. Linear regressions were observed in the range of 0.1–1.5 μg/mL for both methods. Moreover, both methods were efficiently extended to analyze FB in human urine, indicating the ultra-sensitivity of the methods, and linear regression was found within a range 0.05–0.7 μg/mL for both methods. Excellent selectivity of the proposed methods and good recoveries were obtained upon the analysis of FB in pharmaceutical dosage form and human urine samples without interference from matrix components with acceptable ranges, from 98.86 to 101.46% and from 98.08 to 102.37%, respectively. Greenness of the developed methods was assessed using the national environmental method index (NEMI) and Analytical Eco-scale and Green Analytical Procedure Index (GAPI). The three approaches confirmed that the developed methods are green, safe and environment-friendly.
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II. Antidepressants and sexual behavior: Acute fluoxetine, but not ketamine, disrupts paced mating behavior in sexually experienced female rats. Pharmacol Biochem Behav 2020; 199:173040. [PMID: 32931803 DOI: 10.1016/j.pbb.2020.173040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/02/2020] [Accepted: 09/07/2020] [Indexed: 11/20/2022]
Abstract
Female sexual dysfunction is both a symptom of depression and exacerbated by treatments for depression. Ketamine, a novel treatment for depression, has been shown to enhance, whereas fluoxetine has been shown to impair sexual motivation. Sexual experience leads to more robust partner preference and paced mating behavior in female rats. Whether acute ketamine and fluoxetine similarly affect sexual motivation and mating behavior in sexually experienced female rats is unknown. Sexually experienced female rats received 10 mg/kg i.p. of ketamine or saline vehicle (Experiment 1) or 10 mg/kg i.p. of fluoxetine or water vehicle (Experiment 2) 30 min before a 10-min no-contact partner preference test followed immediately by a 15-intromission paced mating test. Partner preference and paced mating behavior did not differ between ketamine- and saline-treated rats. In contrast, rats treated with fluoxetine spent significantly less time with either stimulus animal and were less active during the partner preference test than water-treated rats. Additionally, contact-return latency to ejaculation was significantly longer in fluoxetine-treated rats and they spent less time with the male during paced mating in comparison to water-treated rats. Thus, even with sexual experience, fluoxetine disrupts sexual function whereas ketamine has no detrimental effects on sexual behavior in female rats. A growing body of evidence suggests that ketamine is an encouraging new approach to treat depression particularly because it is not associated with sexual dysfunction.
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Kingsberg SA, Simon JA. Female Hypoactive Sexual Desire Disorder: A Practical Guide to Causes, Clinical Diagnosis, and Treatment. J Womens Health (Larchmt) 2020; 29:1101-1112. [PMID: 32460605 DOI: 10.1089/jwh.2019.7865] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Hypoactive sexual desire disorder (HSDD) in women is defined as the persistent or recurrent absence of sexual thoughts or fantasies and/or lack of desire for sexual activity that is associated with marked personal distress and/or interpersonal difficulties, and cannot be better attributed to another primary disorder, medication, or general medical condition. Notably, HSDD shares some similarity with depression, as its etiology can be explained using a biopsychosocial model that includes biological, psychological, and sociocultural factors, as well as interpersonal influences. Due to its high prevalence and negative impact on the overall health and well-being of women, primary care health professionals and women's health practitioners need to be actively aware of HSDD, particularly because patients may be reluctant or unwilling to initiate a discussion about their sexual concerns during routine visits. HSDD is well established as a valid and treatable clinical entity. Even for those inexperienced in treating sexual problems, there are simple and validated screening tools such as the Decreased Sexual Desire Screener that can help identify HSDD and a need for further evaluation and treatment. There have been few established pharmacologic treatments for HSDD. Flibanserin was the first drug approved for the treatment of HSDD by the U.S. Food and Drug Administration (FDA). Bremelanotide, a novel melanocortin receptor agonist, was recently approved by the FDA for the treatment of acquired, generalized HSDD in premenopausal women. Increased awareness and recognition of HSDD as a medical condition should provide an incentive for further clinical development of effective treatments for HSDD.
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Affiliation(s)
- Sheryl A Kingsberg
- Division of Behavioral Medicine, University Hospitals Cleveland Medical Center, MacDonald Women's Hospital, Cleveland, Ohio, USA.,Departments of Reproductive Biology and Psychiatry, Case Western Reserve University School of Medicine, MacDonald Women's Hospital, Cleveland, Ohio, USA
| | - James A Simon
- IntimMedicine™ Specialists, George Washington University School of Medicine, Washington, District of Columbia, USA
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Prescott H, Khan I. Medicinal plants/herbal supplements as female aphrodisiacs: Does any evidence exist to support their inclusion or potential in the treatment of FSD? JOURNAL OF ETHNOPHARMACOLOGY 2020; 251:112464. [PMID: 31881322 DOI: 10.1016/j.jep.2019.112464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/15/2019] [Accepted: 11/18/2019] [Indexed: 06/10/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Female Sexual Dysfunction is a complex condition with biopsychosocial origins. Plants traditionally used as aphrodisiacs may be promising as routes to develop therapeutic options which are lacking. AIM To distinguish the plants commonly used in (AP) on the market in the United States, and to evaluate their ethnobotanical and clinical evidence as a basis for their inclusion. METHODS This study is a narrative review of 53 species commonly found in AP on the market in the United States. Most species listed have anecdotal use as aphrodisiacs throughout history; therefore, a systematic search was done for clinical evidence. The primary outcome assessed is the clinical efficacy of plants in the treatment of libido desire disorders. RESULTS There is little to no evidence from the literature to substantiate claims of plants currently on the market as AP for female libido desire disorders. CONCLUSIONS The biggest problem in the literature is the lack of botanical verification and consistency in material across studies. Any botanical, commercial or otherwise must be tested for chemical markers exhibited by individual species; however, if no markers exist, work must first be done to determine these. Appropriate analytical techniques for this would include high pressure liquid chromatography, and mass spectroscopy. It would also be sufficient to taxonomically authenticate species provided the plant material. Further research should aim to standardize plant material and extraction methods utilized in order to compare studies effectively and allow for reproducibility to draw conclusions. While clear interest into investigation the aphrodisiac potential of plants exists, a translatable in vivo animal model does not. Clinical trials rely on patient reported outcomes to determine efficacy but cost and length of such trials deem a necessity for development of an animal model to first screen botanicals. We suggest development of screening tools utilizing the evident neurobiological underpinnings of FSD as the first step. In general, studies of plants currently used as ingredients for AP are severely lacking, and even so the evidence that exists is weak.
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Affiliation(s)
- Hayley Prescott
- The University of Mississippi, School of Pharmacy, 1558 University Circle, P.O. Box 1848, University, MS, 38677, United States.
| | - Ikhlas Khan
- The University of Mississippi, School of Pharmacy, 1558 University Circle, P.O. Box 1848, University, MS, 38677, United States.
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Methodological Challenges in Studying Testosterone Therapies for Hypoactive Sexual Desire Disorder in Women. J Sex Med 2020; 17:585-594. [DOI: 10.1016/j.jsxm.2019.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/04/2019] [Accepted: 12/07/2019] [Indexed: 11/19/2022]
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Ahmed RM, Abdallah IA. Determination of flibanserin in the presence of confirmed degradation products by a third derivative emission spectrofluorometric method: Application to pharmaceutical formulation. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2020; 225:117491. [PMID: 31476647 DOI: 10.1016/j.saa.2019.117491] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/19/2019] [Accepted: 08/25/2019] [Indexed: 06/10/2023]
Abstract
Flibanserin is a new drug used for the treatment of hypoactive sexual desire disorder. This work is considered the first study concerning the fluorimetric behaviour of flibanserin and its new florescent degradation products. A fast, cost-effective, stability-indicating spectrofluorometric method was developed and validated for the determination of flibanserin in the presence of oxidative degradation products. Stability studies are performed to predict the behaviour of substances under various harsh conditions. Thus, flibanserin was subjected to degradation using hydrogen peroxide. The stability-indicating method was developed and validated per ICH guidelines; it was linear in the range of 0.1-3 μg/mL. The method was accurate and precise as it showed good recoveries between 98.50 and 100.90% and relative standard deviation less than 2%, respectively, and no significant differences were found after statistical comparison with the in-house HPLC method. In addition, the structures of the oxidative degradation products were confirmed using infrared spectroscopy and mass spectrometry, and the proposed degradation pathway was predicted.
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Affiliation(s)
- Rasha M Ahmed
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Misr International University, Cairo, Egypt
| | - Inas A Abdallah
- Department of Analytical Chemistry, Faculty of Pharmacy, University of Sadat City, Sadat City, Egypt.
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32
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Evolutionary Perspectives on Hypoactive Sexual Desire Disorder in Women. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00223-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Montejo AL. Sexuality and Mental Health: The Need for Mutual Development and Research. J Clin Med 2019; 8:jcm8111794. [PMID: 31717765 PMCID: PMC6912629 DOI: 10.3390/jcm8111794] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 01/25/2023] Open
Abstract
Research in the field of sexuality has shown growing scientific development in recent years, although there’s a lack of well-trained professionals who could contribute to increasing its benefits. Sexuality continues to be a taboo with different interpretations and difficult delimitation of either normal or pathological behavior. More resources are needed for the understanding of new emerging pathologies, and to increase the research in new models of sexual behavior. All psychiatric diseases include symptoms affecting sexual life, such as impaired desire, arousal, or sexual satisfaction that need to be properly addressed. Health providers and prescribers must detect and prevent iatrogenic sexual dysfunction that can highly deteriorate a patient’s sexual life and satisfaction, leading to frequent drop-outs of medication. Approaching and researching aspects of sexual intimacy, life desires, frustrations, and fears undoubtedly constitutes the best mental health care.
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Affiliation(s)
- Angel L Montejo
- University of Salamanca, Psychiatry Service, Clinical Hospital, Faculty of Nursing and Institute of Biomedical Research of Salamanca (IBSAL), Avenue of Donantes de Sangre SN, 37007 Salamanca, Spain
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Simon JA, Clayton AH, Kingsberg SA, Parish SJ, Kim NN, Millheiser L. Effects of Timing of Flibanserin Administration Relative to Alcohol Intake in Healthy Premenopausal Women: A Randomized, Double-Blind, Crossover Study. J Sex Med 2019; 16:1779-1786. [PMID: 31522985 DOI: 10.1016/j.jsxm.2019.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Flibanserin is approved in the United States and Canada for the treatment of acquired, generalized, hypoactive sexual desire disorder in premenopausal women. Sedation-related side effects are among the most prevalent adverse events. Although infrequent, hypotension and syncope remain safety concerns because of possible interaction of flibanserin with alcohol. AIM To evaluate the impact of the timing of alcohol consumption on flibanserin safety and tolerability. METHODS In this single-center, randomized, double-blind, placebo-controlled, 4-treatment crossover study, 64 healthy premenopausal women (mean age 32.5 ± 8.7 years; range 20‒52 years) received once-daily flibanserin 100 mg or placebo during each of two 10-day treatment periods. Study medication was administered on days 1-3 to achieve steady state. On days 4, 6, 8, and 10, after a standard breakfast, participants consumed 0.4 g/kg ethanol (approximately equivalent to two 5-oz glasses of wine) administered with orange juice 2, 4, or 6 hours before taking study medication or orange juice alone (no ethanol) 2 hours before taking study medication. OUTCOMES The primary endpoint was percentage of participants experiencing syncope or orthostatic hypotension-associated adverse events requiring medical intervention. Secondary endpoints included the incidence of hypotension, the incidence of orthostatic hypotension, and rates of adverse events of special interest (syncope, orthostatic hypotension, dizziness, and somnolence). RESULTS 1 participant experienced a primary endpoint event (syncope) during treatment with placebo taken 4 hours after ethanol consumption. Within each ethanol dose-timing treatment, there were no statistically significant differences for flibanserin compared with placebo. Rates of hypotension were 53.3-66.7% after flibanserin dosing and 57.4-63.3% after placebo dosing. Rates for orthostatic hypotension were 0.0-5.0% after flibanserin dosing and 1.7-6.6% after placebo dosing. CLINICAL IMPLICATIONS Ethanol interaction with flibanserin was not observed in this study. STRENGTHS & LIMITATIONS This study provides information regarding the use of flibanserin after the consumption of moderate amounts of ethanol (0.4 g/kg). However, daytime administration of flibanserin is not consistent with the drug's indicated bedtime dosing. CONCLUSION Flibanserin, at steady state taken 2, 4, or 6 hours after 0.4 g/kg of ethanol intake did not increase the incidence of hypotension, orthostatic hypotension, or syncope compared with either flibanserin alone or ethanol alone. Simon JA, Clayton AH, Kingsberg SA, et al. Effects of Timing of Flibanserin Administration Relative to Alcohol Intake in Healthy Premenopausal Women: A Randomized, Double-Blind, Crossover Study. J Sex Med 2019;16:1779-1786.
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Affiliation(s)
- James A Simon
- George Washington University School of Medicine and IntimMedicine Specialists, Washington, DC, USA
| | - Anita H Clayton
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Sheryl A Kingsberg
- University Hospitals Cleveland Medical Center, MacDonald Women's Hospital, Cleveland, OH, USA
| | | | - Noel N Kim
- Institute for Sexual Medicine, San Diego, CA, USA.
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Meissner VH, Schroeter L, Köhn FM, Kron M, Zitzmann M, Arsov C, Imkamp F, Hadaschik B, Gschwend JE, Herkommer K. Factors Associated with Low Sexual Desire in 45-Year-Old Men: Findings from the German Male Sex-Study. J Sex Med 2019; 16:981-991. [DOI: 10.1016/j.jsxm.2019.04.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/26/2019] [Accepted: 04/29/2019] [Indexed: 12/11/2022]
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