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Huberts AS, Vrancken Peeters NJMC, Pastoor H, Paez CG, Koppert LB. Let's talk about sex! Why should healthcare professionals address sexual distress in breast cancer patients and survivors? Eur J Oncol Nurs 2024; 71:102606. [PMID: 38909440 DOI: 10.1016/j.ejon.2024.102606] [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: 11/10/2023] [Revised: 04/26/2024] [Accepted: 05/06/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE Sexual distress impacts the quality of life (QoL) of breast cancer patients but is often overlooked in standard care pathways. This study evaluated the prevalence and factors of sexual distress among Dutch breast cancer patients, compared them to the general population, and explored how sexual distress is discussed in clinical settings from the perspectives of patients and healthcare professionals (HCPs). METHODS Questionnaires containing the Female Sexual Distress Scale (FSDS) and demographic variables were distributed to women with breast cancer. The effect of breast cancer on sexual distress was assessed with a Mann-Whitney U test. Multivariable linear regression was used to analyze variables associated with FSDS. The Sexuality Attitudes and Beliefs Survey (SABS) was sent to HCPs. RESULTS Breast cancer patients reported significantly higher sexual distress compared to a Dutch non-breast cancer cohort, respectively 16.38 (SD 11.81) and 23.35 (SD 11.39). Factors associated with higher sexual distress were psychological comorbidities, the body image scale, and being diagnosed >10 years ago. Sexual distress was not discussed as often as patients needed. Barriers to addressing sexual distress were time constraints, HCPs' confidence in their ability to address sexual distress, and uncertainty about who is responsible for initiation. CONCLUSIONS Breast cancer patients showed significantly higher sexual distress compared to the Dutch population. However, it was not frequently addressed in the consultation room. While some barriers have been identified, this study highlights the importance of further exploring obstacles to integrating discussions about sexual distress into routine care to improve QoL of breast cancer patients.
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Affiliation(s)
- Anouk S Huberts
- Department of Quality and Patientcare, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Noëlle J M C Vrancken Peeters
- Academic Breast Cancer Center, Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Hester Pastoor
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Cristina Guerrero Paez
- Dutch Breast Cancer Society (BVN), Godebaldkwartier 363, 3511 DTR, Utrecht, the Netherlands
| | - Linetta B Koppert
- Department of Quality and Patientcare, Erasmus University Medical Center, Rotterdam, the Netherlands; Academic Breast Cancer Center, Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
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Lara LADS, Pereira JMDL, de Paula SRC, de Oliveira FFL, Cunha AM, Lerner T, Villar Y, Antoniassi GPR, Benetti-Pinto CL. Challenges of prescribing testosterone for sexual dysfunction in women: Number 7 - 2024. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2024; 46:e-FPS07. [PMID: 39176198 PMCID: PMC11341187 DOI: 10.61622/rbgo/2024fps07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024] Open
Affiliation(s)
- Lucia Alves da Silva Lara
- Departamento de Ginecologia e Obstetrícia Faculdade de Medicina Universidade de São Paulo Ribeirão PretoSP Brazil Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | | | - Stany Rodrigues Campos de Paula
- Departamento de Ginecologia e Obstetrícia Faculdade de Medicina Universidade de São Paulo Ribeirão PretoSP Brazil Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | | | - André Marquez Cunha
- Universidade Federal de Goiás GoiâniaGO Brazil Universidade Federal de Goiás, Goiânia, GO, Brazil
| | - Théo Lerner
- Departamento de Ginecologia e Obstetrícia Faculdade de Medicina Universidade de São Paulo Ribeirão PretoSP Brazil Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Yara Villar
- Departamento de Ginecologia e Obstetrícia Faculdade de Medicina Universidade de São Paulo Ribeirão PretoSP Brazil Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Ertl N, Mills EG, Wall MB, Thurston L, Yang L, Suladze S, Hunjan T, Phylactou M, Patel B, Bassett PA, Howard J, Rabiner EA, Abbara A, Goldmeier D, Comninos AN, Dhillo WS. Women and men with distressing low sexual desire exhibit sexually dimorphic brain processing. Sci Rep 2024; 14:11051. [PMID: 38745001 PMCID: PMC11094107 DOI: 10.1038/s41598-024-61190-4] [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: 11/27/2023] [Accepted: 05/02/2024] [Indexed: 05/16/2024] Open
Abstract
Distressing low sexual desire, termed Hypoactive Sexual Desire Disorder (HSDD), affects approximately 10% of women and 8% of men. In women, the 'top-down' theory of HSDD describes hyperactivity in higher-level cognitive brain regions, suppressing lower-level emotional/sexual brain areas. However, it is unknown how this neurofunctional disturbance compares to HSDD in men. To investigate this, we employed task-based functional MRI in 32 women and 32 men with HSDD to measure sexual-brain processing during sexual versus non-sexual videos, as well as psychometric questionnaires to assess sexual desire/arousal. We demonstrate that women had greater activation in higher-level and lower-level brain regions, compared to men. Indeed, women who had greater hypothalamic activation in response to sexual videos, reported higher psychometric scores in the evaluative (r = 0.55, P = 0.001), motivational (r = 0.56, P = 0.003), and physiological (r = 0.57, P = 0.0006) domains of sexual desire and arousal after watching the sexual videos in the scanner. By contrast, no similar correlations were observed in men. Taken together, this is the first direct comparison of the neural correlates of distressing low sexual desire between women and men. The data supports the 'top-down' theory of HSDD in women, whereas in men HSDD appears to be associated with different neurofunctional processes.
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Affiliation(s)
- Natalie Ertl
- Invicro London, London, UK
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, UK
| | - Edouard G Mills
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, UK
| | - Matthew B Wall
- Invicro London, London, UK
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, UK
| | - Layla Thurston
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, UK
| | - Lisa Yang
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, UK
| | - Sofiya Suladze
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, UK
| | - Tia Hunjan
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, UK
| | - Maria Phylactou
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, UK
| | - Bijal Patel
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, UK
| | | | | | | | - Ali Abbara
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, UK
| | - David Goldmeier
- Jane Wadsworth Sexual Function Clinic, Imperial College Healthcare NHS Trust, London, UK
| | - Alexander N Comninos
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, UK.
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK.
| | - Waljit S Dhillo
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, UK.
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK.
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Luz do Nascimento BH, Figueira JR, Rosa-E-Silva ACJDS, Reis RM, Andrade MCR, Brito LGO, Lara LADS. Management of hypoactive sexual desire dysfunction at a specialized service in women's sexual health. JOURNAL OF SEX & MARITAL THERAPY 2024; 50:542-553. [PMID: 38482856 DOI: 10.1080/0092623x.2024.2329081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Hypoactive sexual desire dysfunction (HSDD) is prevalent among women. This retrospective cohort study aimed to verify the results of the strategies used by Gynecologists and Obstetricians (Ob-gyn) residents in the management of female HSDD. For this, we conducted a data collection of patient medical records of women with HSDD from the Human Sexuality Studies outpatient clinic of the Human Reproduction Center, Department of Gynecology and Obstetrics of FMRP-USP, from 2005 to 2019. Among the 437 women included, 361 (82.6%) answered the question concerning the effect of the protocol to which they were submitted, whereas 234 (64.8%) reported improvements in sexual desire. The univariate model showed that patients without chronic pelvic pain were 19.0% less likely to report improvements in HSDD than those with chronic pelvic pain (p = 0.03). Patients without depression and without orgasmic dysfunction were, respectively 32% and 23% more likely to show improvements in their HSDD than those who had depression or orgasmic dysfunction (respectively p = 0.001, p = 0.008). However, the multivariate model did not identify any associations. The assistance regarding HSDD by the Ob-gyn resident in training to deal with female sexual complaints may be effective in improving sexual complaints.
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Affiliation(s)
| | | | | | - Rosana Maria Reis
- Ribeirão Preto Medical School, São Paulo University, Ribeirão Preto, SP, Brazil
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Huberts AS, Peeters NJMCV, Kaplan ZLR, van Linschoten RCA, Pastoor H, van der Woude CJ, Koppert LB. Dutch normative data of the sexual distress scale and the body image scale. Qual Life Res 2023; 32:2829-2837. [PMID: 37193810 PMCID: PMC10473982 DOI: 10.1007/s11136-023-03434-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 05/18/2023]
Abstract
PURPOSE Sexual health is an important contributing factor for health-related quality of life, but research in this domain is scarce. Moreover, normative data are needed to interpret patient-reported outcome measures on sexual health. The aim of this study was to collect and describe normative scores of the Female Sexual Distress Scale (FSDS) and the Body Image Scale (BIS) from the Dutch population and assess the effect of important demographic and clinical variables on the outcome. As the FSDS is also validated in men, we refer to it as SDS. METHOD Dutch respondents completed the SDS and BIS between May and August 2022. Sexual distress was defined as a SDS score > 15. Descriptive statistics were calculated to present normative data per age group per gender after post-stratification weighting was applied. Multiple logistic and linear regression analyses were conducted to assess the effect of age, gender, education, relationship status, history of cancer and (psychological) comorbidities on SDS and BIS. RESULTS For the SDS 768 respondents were included with a weighted mean score of 14.41 (SD 10.98). Being female (OR 1.77, 95% CI [1.32; 2.39]), having a low educational level (OR 2.02, CI [1.37; 2.39]) and psychological comorbidities (OR: 4.86, 95% CI [2.17; 10.88]) were associated with sexual distress. For the BIS, 696 respondents were included. Female gender (β: 2.63, 95% CI [2.13; 3.13]), psychological comorbidities (β: 2.45, 95% CI [1.43; 3.47]), higher age (β: -0.07, 95% CI [-0.09; -0.05]), and a high educational level (β:-1.21, CI: -1.79 to -0.64) were associated with the non-disease related questions of the Body Image Scale. CONCLUSION This study provides age- and gender-dependent normative values for the SDS and the non-disease related questions of the BIS. Sexual distress and body image are influenced by gender, education level, relationship status and psychological comorbidities. Moreover, age is positively associated with Body Image.
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Affiliation(s)
- Anouk S Huberts
- Department of Quality and Patientcare, Erasmus University Medical Center, 3015 GD, Rotterdam, The Netherlands.
| | - Noëlle J M C Vrancken Peeters
- Academic Breast Cancer Center, Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Z L Rana Kaplan
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Reinier C A van Linschoten
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Gastroenterology & Hepatology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
- Department of Gastroenterology & Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - H Pastoor
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - C Janneke van der Woude
- Department of Gastroenterology & Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Linetta B Koppert
- Department of Quality and Patientcare, Erasmus University Medical Center, 3015 GD, Rotterdam, The Netherlands
- Academic Breast Cancer Center, Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
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Abstract
Most women worldwide experience menopausal symptoms during the menopause transition or postmenopause. Vasomotor symptoms are most pronounced during the first four to seven years but can persist for more than a decade, and genitourinary symptoms tend to be progressive. Although the hallmark symptoms are hot flashes, night sweats, disrupted sleep, and genitourinary discomfort, other common symptoms and conditions are mood fluctuations, cognitive changes, low sexual desire, bone loss, increase in abdominal fat, and adverse changes in metabolic health. These symptoms and signs can occur in any combination or sequence, and the link to menopause may even be elusive. Estrogen based hormonal therapies are the most effective treatments for many of the symptoms and, in the absence of contraindications to treatment, have a generally favorable benefit:risk ratio for women below age 60 and within 10 years of the onset of menopause. Non-hormonal treatment options are also available. Although a symptom driven treatment approach with individualized decision making can improve health and quality of life for midlife women, menopausal symptoms remain substantially undertreated by healthcare providers.
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Affiliation(s)
- Erin R Duralde
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Talia H Sobel
- Division of Women's Health Internal Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - JoAnn E Manson
- Harvard Medical School, Boston, MA, USA
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Luo L, Huang J, Li H. Characteristics of Chinese women in need of enhanced sexual health attention and at risk of hypoactive sexual desire disorder. BMC Womens Health 2023; 23:307. [PMID: 37312158 DOI: 10.1186/s12905-023-02357-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 04/14/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND The target population for women's sexual health services in China was unclear. To identify high-risk individuals with psychological barriers to sexual health-seeking behaviors and those at high risk of hypoactive sexual desire disorder (HSDD), we investigated correlates of Chinese women's unwillingness to communicate sexual health, the shame of sexual health-related disorders, sexual distress, and HSDD. METHODS An online survey was conducted from April to July 2020. RESULTS We received 3443 valid responses online (effective rate 82.6%). Participants were mainly Chinese urban women of childbearing age (median 26 years old, Q1-Q3 23-30). Women who knew little about sexual health knowledge (aOR 0.42, 95%CI 0.28-0.63) and were ashamed (aOR 0.32-0.57) of sexual health-related disorders were less willing to communicate sexual health. Age (aOR 4.29, 95%CI 2.26-8.17), low income (aOR 1.52-2.11), family burden (aOR 1.34-1.43), and living with friends (aOR 1.39, 95%CI 1.02-1.91) were independent correlates of women's shame about sexual health-related disorders while living with a spouse (aOR 0.66, 95%CI 0.51-0.86) or children (aOR 0.77, 95%CI 0.62-0.96) were correlated with less shame. Age (aOR 0.98, 95%CI 0.96-0.99) and a postgraduate degree (aOR 0.45, 95%CI 0.28-0.71) were linked with less sexual distress of low sexual desire while having children (aOR 1.38-2.10), intense work pressure (aOR 1.32, 95%CI 1.10-1.60) and heavy family burden (aOR 1.43, 95%CI 1.07-1.92) increased women's odds of having distress. Women with a postgraduate degree (aOR 0.42, 95%CI 0.19-0.90), more knowledge about sexual health (aOR 0.53-0.67), and decreased sexual desire caused by pregnancy, recent childbirth, or menopausal symptoms (aOR 0.60, 95%CI 0.41-0.85) were less likely to have HSDD, while they were more likely to have HSDD when their decreased sexual desire was due to other sexual issues (aOR 2.56, 95%CI 1.84-3.57) and partners' sexual problems (aOR 1.72, 95%CI 1.23-2.39). CONCLUSION Sexual health education and related services need to focus on psychological barriers of women with older age, insufficient knowledge of sexual health, intense work pressure, and poor economic conditions. The medical staff need to pay attention to the sexual health of women with intense work or life pressure and a history of gynecological disease. Low sexual desire is not equal to the sexual desire problem, which should be noticed in the future.
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Affiliation(s)
- Lan Luo
- Shanghai Jiao Tong University School of Medicine, 600, Wan Ping Nan Lu, Shanghai, 200030, China
| | - Jingjing Huang
- Shanghai mental health center, Shanghai Jiao Tong university school of medicine, 600, Wan Ping Nan Lu, Shanghai, 200030, China
- Shanghai clinical research center for mental health, 600, Wan Ping Nan Lu, Shanghai, 200030, China
| | - Huafang Li
- Shanghai mental health center, Shanghai Jiao Tong university school of medicine, 600, Wan Ping Nan Lu, Shanghai, 200030, China.
- Shanghai clinical research center for mental health, 600, Wan Ping Nan Lu, Shanghai, 200030, China.
- Shanghai key laboratory of psychotic disorders, 600, Wan Ping Nan Lu, Shanghai, 200030, China.
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Simon JA, Clayton AH, Goldstein I, Kingsberg SA, Shapiro M, Patel S, Kim NN. Effects of Flibanserin on Subdomain Scores of the Female Sexual Function Index in Women With Hypoactive Sexual Desire Disorder. Sex Med 2022; 10:100570. [PMID: 36400683 PMCID: PMC9780775 DOI: 10.1016/j.esxm.2022.100570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 07/26/2022] [Accepted: 07/30/2022] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Flibanserin treatment increases sexual desire and satisfying sexual events while decreasing distress in certain women diagnosed with acquired, generalized hypoactive sexual desire disorder (HSDD). Additional aspects of sexual function and the time course of response have not been fully characterized. AIM To evaluate changes in sexual function assessed by the subdomains of the Female Sexual Function Index (FSFI) in women with HSDD treated with flibanserin. METHODS FSFI data pooled from 3 pivotal flibanserin trials in premenopausal women (flibanserin = 1,165; placebo = 1,203) and FSFI data from one complete flibanserin trial in postmenopausal women (flibanserin = 432; placebo = 463) were subjected to post-hoc analyses. For each FSFI subdomain, least squares mean change from baseline was calculated at each assessment visit (treatment weeks 4, 8, 16, 24) and treatment groups were compared using analysis of covariance. Standardized effect size (Cohen's d) was also determined for each FSFI subdomain. MAIN OUTCOME MEASURE Changes from baseline in FSFI subdomains. RESULTS Compared to placebo, both premenopausal (P < .02) and postmenopausal (P < .045) patients in the flibanserin group reported significantly greater increases over baseline in the FSFI subdomain scores of desire, arousal, lubrication, orgasm, and satisfaction. In premenopausal patients, significant improvements were observed at the first assessment of response (week 4) and were maintained through week 24. In postmenopausal patients, significant improvements were observed at week 4 for desire and arousal, while significant improvements in lubrication, orgasm, and satisfaction were observed at week 8. At week 24, excluding the pain subdomain, standardized effect sizes ranged from 0.18 to 0.28 in the premenopausal cohort and 0.12 to 0.29 in the postmenopausal cohort. In both pre- and postmenopausal patients, improvements in pain were smaller and largely undifferentiated between treatment groups. CLINICAL IMPLICATIONS While variations in time to response should be taken into consideration, on average, the beneficial impact of flibanserin on overall sexual function occurs within the first month of treatment. The data also suggest that the response to flibanserin is sustained for the duration of treatment. STRENGTHS AND LIMITATIONS Sexual function assessments were performed in a large cohort of 2,368 premenopausal women and 895 postmenopausal women. However, the FSFI assesses changes over a 1-month period and time points earlier than 4 weeks could not be assessed. CONCLUSION These analyses suggest that assessment of benefit of flibanserin in HSDD should include improvements across all domains of sexual function, not only desire. Simon JA, Clayton AH, Goldstein I, et al. Effects of Flibanserin on Subdomain Scores of the Female Sexual Function Index in Women With Hypoactive Sexual Desire Disorder. Sex Med 2022;10:100570.
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Affiliation(s)
- James A. Simon
- IntimMedicine Specialists and George Washington University School of Medicine, Washington, DC, USA
| | - Anita H. Clayton
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Irwin Goldstein
- San Diego Sexual Medicine and Alvarado Hospital, San Diego, CA, USA
| | - Sheryl A. Kingsberg
- University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, OH, USA
| | | | - Sejal Patel
- Sprout Pharmaceuticals, Inc., Raleigh, NC, USA
| | - Noel N. Kim
- Institute for Sexual Medicine, San Diego, CA, USA,Corresponding Author: Noel N. Kim, PhD, Institute for Sexual Medicine, 6330 Nancy Ridge Drive, Suite 105, San Diego, CA 92121, USA.
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Andresen JB, Graugaard C, Andersson M, Bahnsen MK, Frisch M. Sexual Inactivity and Dysfunction in Denmark: A Project SEXUS Study. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:3669-3688. [PMID: 36127559 DOI: 10.1007/s10508-022-02348-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 04/11/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
Sexual dysfunctions are common experiences that often impact negatively on the health and well-being of affected individuals. We used baseline questionnaire data from 62,675 Danes aged 15-89 years, who participated in the cohort study Project SEXUS 2017-2018, to yield nationally representative estimates of the prevalence of sexual inactivity and dysfunction and to identify their sociodemographic correlates. Overall, we found that 23.0% of sexually experienced men and 28.8% of sexually experienced women had not been sexually active with another person within the last year. Sexual inactivity with another person was associated with both young and old age, single status, less favorable socioeconomic conditions, underweight and obesity, indicators of poor health, no use of alcohol, and physical inactivity. Among sexually active respondents, 18.0% of men had experienced any dysfunction within the last year, including erectile dysfunction (7.4%), premature ejaculation dysfunction (10.0%), orgasmic dysfunction (4.0%), and/or genital pain dysfunction (0.7%). Among women, 20.4% had experienced any dysfunction within the last year, including lubrication dysfunction (9.1%), orgasmic dysfunction (12.2%), genital pain dysfunction (5.0%), and/or vaginal cramp dysfunction (vaginismus) (0.8%). Additionally, 3.4% of men and 9.9% of women with a spouse/partner had experienced hypoactive sexual desire disorder within the last four weeks. Using the 5-item International Index of Erectile Function (IIEF-5) and the 6-item Female Sexual Function Index (FSFI-6) among respondents with a spouse/partner who had attempted sexual intercourse within the last four weeks, we found that 3.8% of men had experienced moderate or severe erectile dysfunction (IIEF-5 score ≤ 11) and 20.8% of women had experienced any sexual dysfunction (FSFI-6 score ≤ 19) during that period. Single status, difficulties paying bills and, among men, unemployment were positively associated with sexual dysfunction. In conclusion, we document several sociodemographic disparities in the prevalence of sexual inactivity and dysfunction in Denmark. In particular, both sexual inactivity and dysfunction were more common among singles and those reporting financial difficulties.
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Affiliation(s)
- Josefine Bernhard Andresen
- Department of Epidemiology Research, Statens Serum Institut, 5 Artillerivej, 2300, Copenhagen, Denmark.
- Department of Clinical Medicine, Center for Sexology Research, Aalborg University, Aalborg, Denmark.
| | - Christian Graugaard
- Department of Clinical Medicine, Center for Sexology Research, Aalborg University, Aalborg, Denmark
| | - Mikael Andersson
- Department of Epidemiology Research, Statens Serum Institut, 5 Artillerivej, 2300, Copenhagen, Denmark
| | - Mikkel Kjær Bahnsen
- Department of Epidemiology Research, Statens Serum Institut, 5 Artillerivej, 2300, Copenhagen, Denmark
| | - Morten Frisch
- Department of Epidemiology Research, Statens Serum Institut, 5 Artillerivej, 2300, Copenhagen, Denmark
- Department of Clinical Medicine, Center for Sexology Research, Aalborg University, Aalborg, Denmark
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Madaan S, Talwar D, Jaiswal A, Kumar S, Acharya N, Acharya S, Dewani D. Post-COVID-19 menstrual abnormalities and infertility: Repercussions of the pandemic. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:170. [PMID: 35847136 PMCID: PMC9277727 DOI: 10.4103/jehp.jehp_1200_21] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/19/2021] [Indexed: 05/31/2023]
Abstract
While battling the life-threatening complications of COVID-19, its effect on the menstrual cycle and infertility has been somewhat ignored. This brief review aims on highlighting the importance of menstrual abnormalities being experienced during the post-COVID period and to make the clinicians aware about what to expect in regard of menstrual abnormalities by learning from various studies that have been conducted worldwide. This review article was written with systematic literature review with the help of data search machine such as PubMed, Scopus, Web of Sciences, and Google Scholar. A search strategy leads to the extraction of 160 related articles that after the removal of inappropriate and duplicate articles, 33 articles were selected for the review. To find other potentially relevant articles, the references of the extracted articles were thoroughly examined. The search was carried out using keywords including "COVID-19," "Menstrual abnormalities," and "Infertility." Using OR and AND, the keywords mentioned above were combined and then utilized in the search box of the databases. Articles published from January 2020 to September 2021 were included in this study. It includes worldwide data ranging from studies done in China, India, Ireland, Turkey, Jordan, and Germany. During the post-COVID period, there is a significant alteration in the sex hormones of females infected by COVID-19 which may manifest as menstrual cycle abnormalities such as decreased cycle length or prolonged menstrual cycle bleeding. It may also manifest as infertility due to ovarian failure due to suppression of ovarian function COVID-19 a novel coronavirus which is presently a pandemic has affected the world in manner reminding the world of 1918 Spanish flu. However, while battling the deadly pandemic, the clinicians should also be aware of the repercussions of the effect this infection has on multiple organs such as ovarian suppression leading to infertility, oligomenorrhea, or menorrhagia.
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Affiliation(s)
- Sparsh Madaan
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| | - Dhruv Talwar
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| | - Arpita Jaiswal
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| | - Sunil Kumar
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| | - Neema Acharya
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| | - Sourya Acharya
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| | - Deepika Dewani
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
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11
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Edinoff AN, Sanders NM, Lewis KB, Apgar TL, Cornett EM, Kaye AM, Kaye AD. Bremelanotide for Treatment of Female Hypoactive Sexual Desire. Neurol Int 2022; 14:75-88. [PMID: 35076581 PMCID: PMC8788464 DOI: 10.3390/neurolint14010006] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 11/18/2022] Open
Abstract
Hypoactive sexual desire disorder (HSDD) is a persistent deficiency or absence of sexual fantasies and desire resulting in significant distress or interpersonal difficulty. Women with this disorder may display a lack of motivation for sexual activity, reduced responsiveness to erotic cues, a loss of interest during sexual activity, and avoidance of situations that could lead to sexual activity. The pathophysiology of HSDD is thought to be centered around inhibitory and excitatory hormones, neurotransmitters, and specific brain anatomy. Due to the multifactorial nature of HSDD, treatment can be complex and must attempt to target the biological and psychosocial aspects of the disorder. Bremelanotide is a melanocortin receptor agonist and has been recently approved by the FDA to treat HSDD. Bremelanotide is administered intranasally or as a subcutaneous injection. The recommended dosage of bremelanotide is 1.75 mg injected subcutaneously in the abdomen or thigh at least 45 min before sexual activity. Studies showed improvements in desire, arousal, and orgasm scores when 1.75 mg of bremelanotide was administered before sexual activity compared to a placebo. Bremelanotide is a promising way to treat HSDD.
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Affiliation(s)
- Amber N. Edinoff
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA 71103, USA
- Correspondence: ; Tel.: +1-(318)-675-8969
| | - Nicole M. Sanders
- Shreveport School of Medicine, Louisiana State University, Shreveport, LA 71103, USA; (N.M.S.); (K.B.L.)
| | - Kyle B. Lewis
- Shreveport School of Medicine, Louisiana State University, Shreveport, LA 71103, USA; (N.M.S.); (K.B.L.)
| | - Tucker L. Apgar
- Department of Chemical Biology and Biochemistry, Vanderbilt University, Nashville, TN 37235, USA;
| | - Elyse M. Cornett
- Department of Anesthesiology, Louisiana State University Health Science Center Shreveport, Shreveport, LA 71103, USA; (E.M.C.); (A.D.K.)
| | - Adam M. Kaye
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA 95211, USA;
| | - Alan D. Kaye
- Department of Anesthesiology, Louisiana State University Health Science Center Shreveport, Shreveport, LA 71103, USA; (E.M.C.); (A.D.K.)
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12
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Testosterone Therapy in Women: A Clinical Challenge. Obstet Gynecol 2021; 138:809-812. [PMID: 34619691 DOI: 10.1097/aog.0000000000004566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/05/2021] [Indexed: 11/26/2022]
Abstract
The physiology of testosterone as a normal female hormone in reproductive years and beyond is poorly taught and understood. This has led to unregulated and dangerous prescribing practices by physicians and other health care professionals. There are data for safe use, and as women's health care practitioners, we owe it to our patients to follow these guidelines and practices, as well as advocate for more research and safer, regulated products to prescribe.
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13
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Pettigrew JA, Novick AM. Hypoactive Sexual Desire Disorder in Women: Physiology, Assessment, Diagnosis, and Treatment. J Midwifery Womens Health 2021; 66:740-748. [PMID: 34510696 DOI: 10.1111/jmwh.13283] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 08/02/2021] [Accepted: 08/07/2021] [Indexed: 11/29/2022]
Abstract
Nearly half of women in the United States report problems with sexual function. Many health care providers do not ask about sexual concerns during routine clinical encounters because of personal discomfort, lack of familiarity with treatment, or the belief that they lack adequate time to address this complex issue. This may be especially true for hypoactive sexual desire disorder (HSDD), the most commonly identified sexual problem among women. HSDD is characterized by a deficiency of sexual thoughts, feelings, or receptiveness to sexual stimulation that has been present for at least 6 months, causes personal distress, and is not due to another medical condition. This is an up-to-date overview of HSDD for clinicians, discussing its physiology, assessment, diagnosis, and treatment strategies. Although a definitive physiology of HSDD is still unknown, multiple hormones and neurotransmitters likely participate in a dual-control model to balance excitation and inhibition of sexual desire. For assessment and diagnosis, validated screening tools are discussed, and the importance of a biopsychosocial assessment is emphasized, with guidance on how this can be implemented in clinical encounters. The 2 recently approved medications for HSDD, flibanserin and bremelanotide, are reviewed as well as off-label treatments. Overall, HSDD represents a common yet likely underrecognized disorder that midwives and other health care providers who care for women across the life span are in a unique position to address.
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Affiliation(s)
- Jessica A Pettigrew
- Department of Obstetrics & Gynecology, University of Colorado School of Medicine-Anschutz Medical Campus, Aurora, Colorado
| | - Andrew M Novick
- Department of Psychiatry, University of Colorado School of Medicine-Anschutz Medical Campus, Aurora, Colorado
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14
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Parish SJ, Simon JA, Davis SR, Giraldi A, Goldstein I, Goldstein SW, Kim NN, Kingsberg SA, Morgentaler A, Nappi RE, Park K, Stuenkel CA, Traish AM, Vignozzi L. International Society for the Study of Women's Sexual Health Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women. Climacteric 2021; 24:533-550. [PMID: 33792440 DOI: 10.1080/13697137.2021.1891773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM To provide a clinical practice guideline for the use of testosterone including identification of patients, laboratory testing, dosing, post-treatment monitoring, and follow-up care in women with hypoactive sexual desire disorder (HSDD). METHODS The International Society for the Study of Women's Sexual Health appointed a multidisciplinary panel of experts who performed a literature review of original research, meta-analyses, review papers, and consensus guidelines regarding testosterone use in women. Consensus was reached using a modified Delphi method. OUTCOMES A clinically useful guideline following a biopsychosocial assessment and treatment approach for the safe and efficacious use of testosterone in women with HSDD was developed including measurement, indications, formulations, prescribing, dosing, monitoring, and follow-up. RESULTS Although the Global Position Statement endorses testosterone therapy for only postmenopausal women, limited data also support the use in late reproductive age premenopausal women, consistent with the International Society for the Study of Women's Sexual Health Process of Care for the Management of HSDD. Systemic transdermal testosterone is recommended for women with HSDD not primarily related to modifiable factors or comorbidities such as relationship or mental health problems. Current available research supports a moderate therapeutic benefit. Safety data show no serious adverse events with physiologic testosterone use, but long-term safety has not been established. Before initiation of therapy, clinicians should provide an informed consent. Shared decision-making involves a comprehensive discussion of off-label use, as well as benefits and risks. A total testosterone level should not be used to diagnose HSDD, but as a baseline for monitoring. Government-approved transdermal male formulations can be used cautiously with dosing appropriate for women. Patients should be assessed for signs of androgen excess and total testosterone levels monitored to maintain concentrations in the physiologic premenopausal range. Compounded products cannot be recommended because of the lack of efficacy and safety data. CLINICAL IMPLICATIONS This clinical practice guideline provides standards for safely prescribing testosterone to women with HSDD, including identification of appropriate patients, dosing, and monitoring. STRENGTHS AND LIMITATIONS This evidence-based guideline builds on a recently published comprehensive meta-analysis and the Global Position Statement endorsed by numerous societies. The limitation is that testosterone therapy is not approved for women by most regulatory agencies, thereby making prescribing and proper dosing challenging. CONCLUSION Despite substantial evidence regarding safety, efficacy, and clinical use, access to testosterone therapy for the treatment of HSDD in women remains a significant unmet need.
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Affiliation(s)
- Sharon J Parish
- Department of Psychiatry & Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - James A Simon
- IntimMedicine Specialists, George Washington University School of Medicine, Washington, DC, USA
| | - Susan R Davis
- Women's Health Research Program, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Annamaria Giraldi
- Sexological Clinic, Psychiatric Center, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Irwin Goldstein
- Sexual Medicine, Alvarado Hospital, San Diego, CA, USA.,San Diego Sexual Medicine, San Diego, CA, USA
| | | | - Noel N Kim
- Institute for Sexual Medicine, San Diego, CA, USA
| | - Sheryl A Kingsberg
- University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Abraham Morgentaler
- Men's Health Boston, Beth Israel Deaconess Medical Center, Harvard Medical School, Chestnut Hill, MA, USA
| | - Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, Obstetrics and Gynecology Unit, IRCCS S. Matteo Foundation, University of Pavia, Pavia, Italy
| | - Kwangsung Park
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Cynthia A Stuenkel
- Department of Medicine, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Abdulmaged M Traish
- Departments of Biochemistry and Urology, Boston University School of Medicine, Boston, MA, USA
| | - Linda Vignozzi
- Andrology, Women's Endocrinology & Gender Incongruence Unit, Department of "Excellence" Experimental and Clinical Biomedical Sciences "Mario Serio", Careggi Hospital-University of Florence, Florence, Italy.,Consorzio Interuniversitario I.N.B.B., Rome, Italy
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15
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Parish SJ, Simon JA, Davis SR, Giraldi A, Goldstein I, Goldstein SW, Kim NN, Kingsberg SA, Morgentaler A, Nappi RE, Park K, Stuenkel CA, Traish AM, Vignozzi L. International Society for the Study of Women's Sexual Health Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women. J Sex Med 2021; 18:849-867. [PMID: 33814355 DOI: 10.1016/j.jsxm.2020.10.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/12/2020] [Accepted: 10/19/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Global Consensus Position Statement on the Use of Testosterone Therapy for Women (Global Position Statement) recommended testosterone therapy for postmenopausal women with hypoactive sexual desire disorder (HSDD). AIM To provide a clinical practice guideline for the use of testosterone including identification of patients, laboratory testing, dosing, post-treatment monitoring, and follow-up care in women with HSDD. METHODS The International Society for the Study of Women's Sexual Health appointed a multidisciplinary panel of experts who performed a literature review of original research, meta-analyses, review papers, and consensus guidelines regarding testosterone use in women. Consensus was reached using a modified Delphi method. OUTCOMES A clinically useful guideline following a biopsychosocial assessment and treatment approach for the safe and efficacious use of testosterone in women with HSDD was developed including measurement, indications, formulations, prescribing, dosing, monitoring, and follow-up. RESULTS Although the Global Position Statement endorses testosterone therapy for only postmenopausal women, limited data also support the use in late reproductive age premenopausal women, consistent with the International Society for the Study of Women's Sexual Health Process of Care for the Management of HSDD. Systemic transdermal testosterone is recommended for women with HSDD not primarily related to modifiable factors or comorbidities such as relationship or mental health problems. Current available research supports a moderate therapeutic benefit. Safety data show no serious adverse events with physiologic testosterone use, but long-term safety has not been established. Before initiation of therapy, clinicians should provide an informed consent. Shared decision-making involves a comprehensive discussion of off-label use, as well as benefits and risks. A total testosterone level should not be used to diagnose HSDD, but as a baseline for monitoring. Government-approved transdermal male formulations can be used cautiously with dosing appropriate for women. Patients should be assessed for signs of androgen excess and total testosterone levels monitored to maintain concentrations in the physiologic premenopausal range. Compounded products cannot be recommended because of the lack of efficacy and safety data. CLINICAL IMPLICATIONS This clinical practice guideline provides standards for safely prescribing testosterone to women with HSDD, including identification of appropriate patients, dosing, and monitoring. STRENGTHS & LIMITATIONS This evidence-based guideline builds on a recently published comprehensive meta-analysis and the Global Position Statement endorsed by numerous societies. The limitation is that testosterone therapy is not approved for women by most regulatory agencies, thereby making prescribing and proper dosing challenging. CONCLUSION Despite substantial evidence regarding safety, efficacy, and clinical use, access to testosterone therapy for the treatment of HSDD in women remains a significant unmet need. Parish SJ, Simon JA, Davis SR, et al. International Society for the Study of Women's Sexual Health Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women. J Sex Med 2021;18:849-867.
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Affiliation(s)
- Sharon J Parish
- Department of Psychiatry & Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - James A Simon
- IntimMedicine Specialists, George Washington University School of Medicine, Washington, DC, USA
| | - Susan R Davis
- Women's Health Research Program, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Annamaria Giraldi
- Sexological Clinic, Psychiatric Center, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Irwin Goldstein
- Sexual Medicine, Alvarado Hospital, San Diego, CA, USA; San Diego Sexual Medicine, San Diego, CA, USA
| | | | - Noel N Kim
- Institute for Sexual Medicine, San Diego, CA, USA
| | - Sheryl A Kingsberg
- University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Abraham Morgentaler
- Men's Health Boston, Beth Israel Deaconess Medical Center, Harvard Medical School, Chestnut Hill, MA, USA
| | - Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, Obstetrics and Gynecology Unit, IRCCS S. Matteo Foundation, University of Pavia, Pavia, Italy
| | - Kwangsung Park
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Cynthia A Stuenkel
- Department of Medicine, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Abdulmaged M Traish
- Departments of Biochemistry and Urology, Boston University School of Medicine, Boston, MA, USA
| | - Linda Vignozzi
- Andrology, Women's Endocrinology & Gender Incongruence Unit, Department of "Excellence" Experimental and Clinical Biomedical Sciences "Mario Serio"-Careggi Hospital-University of Florence, Florence, Italy; Consorzio Interuniversitario I.N.B.B., Rome, Italy
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16
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Parish SJ, Simon JA, Davis SR, Giraldi A, Goldstein I, Goldstein SW, Kim NN, Kingsberg SA, Morgentaler A, Nappi RE, Park K, Stuenkel CA, Traish AM, Vignozzi L. International Society for the Study of Women's Sexual Health Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women. J Womens Health (Larchmt) 2021; 30:474-491. [PMID: 33797277 PMCID: PMC8064950 DOI: 10.1089/jwh.2021.29037] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background: The Global Consensus Position Statement on the Use of Testosterone Therapy for Women (Global Position Statement) recommended testosterone therapy for postmenopausal women with hypoactive sexual desire disorder (HSDD). Aim: To provide a clinical practice guideline for the use of testosterone including identification of patients, laboratory testing, dosing, post-treatment monitoring, and follow-up care in women with HSDD. Methods: The International Society for the Study of Women's Sexual Health appointed a multidisciplinary panel of experts who performed a literature review of original research, meta-analyses, review papers, and consensus guidelines regarding testosterone use in women. Consensus was reached using a modified Delphi method. Outcomes: A clinically useful guideline following a biopsychosocial assessment and treatment approach for the safe and efficacious use of testosterone in women with HSDD was developed including measurement, indications, formulations, prescribing, dosing, monitoring, and follow-up. Results: Although the Global Position Statement endorses testosterone therapy for only postmenopausal women, limited data also support the use in late reproductive age premenopausal women, consistent with the International Society for the Study of Women's Sexual Health Process of Care for the Management of HSDD. Systemic transdermal testosterone is recommended for women with HSDD not primarily related to modifiable factors or comorbidities such as relationship or mental health problems. Current available research supports a moderate therapeutic benefit. Safety data show no serious adverse events with physiologic testosterone use, but long-term safety has not been established. Before initiation of therapy, clinicians should provide an informed consent. Shared decision-making involves a comprehensive discussion of off-label use, as well as benefits and risks. A total testosterone level should not be used to diagnose HSDD, but as a baseline for monitoring. Government-approved transdermal male formulations can be used cautiously with dosing appropriate for women. Patients should be assessed for signs of androgen excess and total testosterone levels monitored to maintain concentrations in the physiologic premenopausal range. Compounded products cannot be recommended because of the lack of efficacy and safety data. Clinical Implications: This clinical practice guideline provides standards for safely prescribing testosterone to women with HSDD, including identification of appropriate patients, dosing, and monitoring. Strengths & Limitations: This evidence-based guideline builds on a recently published comprehensive meta-analysis and the Global Position Statement endorsed by numerous societies. The limitation is that testosterone therapy is not approved for women by most regulatory agencies, thereby making prescribing and proper dosing challenging. Conclusion: Despite substantial evidence regarding safety, efficacy, and clinical use, access to testosterone therapy for the treatment of HSDD in women remains a significant unmet need.
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Affiliation(s)
- Sharon J Parish
- Department of Psychiatry, New York Presbyterian Hospital/Westchester Behavioral Health Center, White Plains, New York, USA.,Department of Medicine, New York Presbyterian Hospital/Westchester Behavioral Health Center, White Plains, New York, USA
| | - James A Simon
- IntimMedicine Specialists, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Susan R Davis
- Women's Health Research Program, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Annamaria Giraldi
- Sexological Clinic, Psychiatric Center, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Irwin Goldstein
- Sexual Medicine, Alvarado Hospital, San Diego, California, USA.,San Diego Sexual Medicine, San Diego, California, USA
| | | | - Noel N Kim
- Institute for Sexual Medicine, San Diego, California, USA
| | - Sheryl A Kingsberg
- University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Abraham Morgentaler
- Men's Health Boston, Beth Israel Deaconess Medical Center, Harvard Medical School, Chestnut Hill, Massachusetts, USA
| | - Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, Obstetrics and Gynecology Unit, IRCCS S. Matteo Foundation, University of Pavia, Pavia, Italy
| | - Kwangsung Park
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Cynthia A Stuenkel
- Department of Medicine, UC San Diego School of Medicine, La Jolla, California, USA
| | - Abdulmaged M Traish
- Departments of Biochemistry and Urology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Linda Vignozzi
- Andrology, Women's Endocrinology & Gender Incongruence Unit, Department of "Excellence" Experimental and Clinical Biomedical Sciences "Mario Serio"-Careggi Hospital-University of Florence, Florence, Italy.,Consorzio Interuniversitario I.N.B.B., Rome, Italy
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17
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Espitia De La Hoz FJ. One-year incidence of low libido in women using levonorgestrel subdermal implant as contraception. Cohort study. Armenia, Colombia, 2014-2019. ACTA ACUST UNITED AC 2021; 72:33-42. [PMID: 33878812 PMCID: PMC8372765 DOI: 10.18597/rcog.3520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 02/04/2021] [Indexed: 11/22/2022]
Abstract
Objetivo: Definir la incidencia de deseo sexual hipoactivo (DSH) en mujeres que planifican con el implante subdérmico de levonorgestrel (LNG) después de 12 meses, y conocer otros efectos adversos. Materiales y métodos: Estudio de cohorte, cuyas participantes fueron mujeres mayores de 18 años sin hijos ni embarazos previos y con pareja estable, a quienes se les había insertado el implante de LNG al menos tres meses previos en una clínica privada de carácter universitario en Armenia (Quindío), Colombia, entre 2014 y 2019. Se excluyeron mujeres con antecedentes de disfunción sexual, infecciones de transmisión sexual en los últimos 6 meses, peso mayor a 89 Kg y dificultades para el seguimiento. El muestreo fue consecutivo. Se describieron las características de la población estudiada, se estimó la incidencia acumulada de DSH y efectos adversos relacionados con el implante subdérmico de LNG Resultados: Participaron 238 mujeres cuya edad media fue de 24,69 (DE ± 5,82) años. Se determinó una incidencia de deseo sexual hipoactivo del 18,82%. El 60,25% de las mujeres fueron diagnosticadas con DHS en los primeros 6 meses de seguimiento. Los efectos adversos se hicieron presentes desde los primeros 3 meses de la inserción del implante, el sangrado irregular (62,34%) fue el más frecuente, seguido de la amenorrea (38,91%) y el aumento de peso (33,89%). Conclusiones: Es importante que los médicos y las usuarias se informen sobre la presencia del trastorno de deseo sexual hipoactivo y los efectos adversos que pueden surgir con el uso del implante subdérmico de levonorgestrel. Las futuras investigaciones deben confirmar estos hallazgos, así como su eventual base fisiológica.
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18
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Davis SR. Use of Testosterone in Postmenopausal Women. Endocrinol Metab Clin North Am 2021; 50:113-124. [PMID: 33518180 DOI: 10.1016/j.ecl.2020.11.002] [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] [Indexed: 11/22/2022]
Abstract
The role of testosterone in women and its potential as a therapeutic agent continue to attract controversy. The clinical trials of testosterone therapy for women primarily have focused on treatment of female sexual dysfunction, with the largest placebo-controlled studies being of transdermal testosterone in postmenopausal women. Based on the cumulative data from these studies, loss of sexual desire with associated personal distress currently is the only agreed-on indication for judicious testosterone supplementation for postmenopausal women. This article reviews the physiology of testosterone in women, summarizes the findings from observational studies and clinical trials, and considers indications for testosterone use.
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Affiliation(s)
- Susan R Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia.
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19
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Wijaya M, Lee G, Fischer G. Quality of life of women with untreated vulval lichen sclerosus assessed with vulval quality of life index (VQLI). Australas J Dermatol 2021; 62:177-182. [PMID: 33508152 DOI: 10.1111/ajd.13530] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/03/2020] [Accepted: 11/07/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND/OBJECTIVE The diagnosis of vulval lichen sclerosus (VLS) is often delayed, and little is known about quality of life (QoL) of women with it prior to receiving diagnosis and treatment. This study aimed to investigate the impact on QoL on patients with previously untreated VLS using the Vulval Quality of Life Index (VQLI). METHODS A prospective cross-sectional survey of patients attending a dermato-gynaecology practice in Sydney, Australia from March 2018 to November 2019. Patients with a new biopsy-proven diagnosis of VLS not previously commenced on topical corticosteroid treatment were invited to complete the VQLI. RESULTS A total of 68 participants with median age of 58 (interquartile range, IQR 48-67) years. Median symptom duration was 24 (IQR 11-60) months. Scarring was present in 53% of participants. The median total score was 13.5 (IQR 7.5-22.0), global score 1.0 (IQR 1.0-2.0). Twelve per cent had nil to minimal effect on QoL, 38% had a mild effect on QoL, 28% had a moderate effect on QoL, 22% had a severe effect on QoL, and none had a very severe effect on QoL. The highest-scoring domains were symptoms, followed by sexuality, anxiety and activities of daily living. CONCLUSION There was significant impairment in all QoL areas of women with untreated VLS. Most experienced moderate-to-severe impairment as a result of the disease and approximately half had already developed scarring at the time of diagnosis. The findings emphasise the importance of improved awareness, early diagnosis and early commencement of treatment in VLS.
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Affiliation(s)
- Marlene Wijaya
- Faculty of Medicine, Northern Clinical School, University of Sydney, Australia.,Department of Dermatology, Royal North Shore Hospital, Australia
| | - Geoffrey Lee
- Faculty of Medicine, Northern Clinical School, University of Sydney, Australia
| | - Gayle Fischer
- Faculty of Medicine, Northern Clinical School, University of Sydney, Australia.,Department of Dermatology, Royal North Shore Hospital, Australia.,North Shore Private Hospital, St Leonards, New South Wales, Australia
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20
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Phelan N, Behan LA, Owens L. The Impact of the COVID-19 Pandemic on Women's Reproductive Health. Front Endocrinol (Lausanne) 2021; 12:642755. [PMID: 33841334 PMCID: PMC8030584 DOI: 10.3389/fendo.2021.642755] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/15/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has profoundly affected the lives of the global population. It is known that periods of stress and psychological distress can affect women's menstrual cycles. We therefore performed an observational study of women's reproductive health over the course of the pandemic thus far. MATERIALS AND METHODS An anonymous digital survey was shared by the authors via social media in September 2020. All women of reproductive age were invited to complete the survey. RESULTS 1031 women completed the survey. Mean age was 36.7 ± 6.6 years (range, 15-54). 693/70% reported recording their cycles using an app or diary. 233/23% were using hormonal contraception. 441/46% reported a change in their menstrual cycle since the beginning of the pandemic. 483/53% reported worsening premenstrual symptoms, 100/18% reported new menorrhagia (p = 0.003) and 173/30% new dysmenorrhea (p < 0.0001) compared to before the pandemic. 72/9% reported missed periods who not previously missed periods (p = 0.003) and the median number of missed periods was 2 (1-3). 17/21% of those who "occasionally" missed periods pre-pandemic missed periods "often" during pandemic. 467/45% reported a reduced libido. There was no change in the median cycle length (28 days) or days of bleeding (5) but there was a wider variability of cycle length (p = 0.01) and a 1 day median decrease in the minimum (p < 0.0001) and maximum (p = 0.009) cycle length. Women reported a median 2 kg increase in self-reported weight and a 30-min increase in median weekly exercise. 517/50% of women stated that their diet was worse and 232/23% that it was better than before the pandemic. 407/40% reported working more and 169/16% were working less. Women related a significant increase in low mood (p < 0.0001), poor appetite (p < 0.0001), binge eating (p < 0.0001), poor concentration (p < 0.0001), anxiety (p < 0.0001), poor sleep (p < 0.0001), loneliness (p < 0.0001) and excess alcohol use (p < 0.0001). Specific stressors reported included work stress (499/48%), difficulty accessing healthcare (254/25%), change in financial (201/19%) situation, difficulties with home schooling (191/19%) or childcare (99/10%), family or partner conflict (170/16%), family illness or bereavement (156/15%). CONCLUSIONS The COVID-19 pandemic has significantly impacted the reproductive health of women. The long term health implications of this are yet to be determined and future studies should address this.
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Affiliation(s)
- Niamh Phelan
- Faculty of Health Sciences, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Department of Endocrinology, St. James’s Hospital, Dublin, Ireland
| | - Lucy Ann Behan
- Faculty of Health Sciences, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Department of Endocrinology, Tallaght University Hospital, Dublin, Ireland
| | - Lisa Owens
- Faculty of Health Sciences, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Department of Endocrinology, St. James’s Hospital, Dublin, Ireland
- *Correspondence: Lisa Owens,
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Hamzehgardeshi Z, Malary M, Moosazadeh M, Khani S, Pourasghar M, Alianmoghaddam N. Socio-demographic determinants of low sexual desire and hypoactive sexual desire disorder: a population-based study in Iran. BMC WOMENS HEALTH 2020; 20:233. [PMID: 33054812 PMCID: PMC7556956 DOI: 10.1186/s12905-020-01097-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 10/07/2020] [Indexed: 12/23/2022]
Abstract
Background Various socio-demographic factors have been introduced as the determinants of Low Sexual Desire (LSD), but whether these variables can also contribute to the Hypoactive Sexual Desire Disorder (HSDD), remains uncertain. In this study, we sought to identify the socio-demographic determinants of LSD and HSDD in Iranian women of reproductive age. Methods This was a population-based, cross-sectional study of 1000 married Iranian women of reproductive age (16–49 years) who met the inclusion criteria. The participants were chosen using the systematic random sampling method from all the healthcare centres in the city of Sari, Iran. LSD was defined as a score no higher than 33 on the Sexual Interest and Desire Inventory-Female (SIDI-F). The sexually-related personal distress was considered as a score of at least 11.0 on the Female Sexual Distress Scale-Revised (FSDS-R), and HSDD was determined based on the sum of those scores. Descriptive statistics were used to describe the socio-demographic characteristics and a chi-square test was run for data analysis using grouping variables. Multivariate logistic regression test was also employed to adjust the effect of confounding variables. Results The mean score of sexual interest/desire among women was 30.6 ± 10.5. After adjusting the effect of confounding variables, logistic regression showed that socio-demographic variables including age at first intercourse, length of marriage and the level of satisfaction with income were significantly associated with both LSD and HSDD (P < 0.01). While advancing age (P < 0.001) and body mass index (P < 0.01) were just predictors of LSD. Conclusion Some socio-demographic factors could predict LSD in women, while they were not associated with HSDD. In other words, some factors associated with LSD do not instigate sexually-related personal distress, which is one of the criteria necessary for the diagnosis of HSDD.
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Affiliation(s)
- Zeinab Hamzehgardeshi
- Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Reproductive Health and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mina Malary
- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Haft-e Tir Square, Po Box 7394736147, Shahroud, Iran.
| | - Mahmood Moosazadeh
- Health Sciences Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran.,Gastrointestinal Cancer Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Soghra Khani
- Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Reproductive Health and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran.,Research Center of Diabetes, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mehdi Pourasghar
- Department of Psychiatry, Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
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Meyers M, Margraf J, Velten J. Psychological Treatment of Low Sexual Desire in Women: Protocol for a Randomized, Waitlist-Controlled Trial of Internet-Based Cognitive Behavioral and Mindfulness-Based Treatments. JMIR Res Protoc 2020; 9:e20326. [PMID: 32990248 PMCID: PMC7556380 DOI: 10.2196/20326] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/16/2020] [Accepted: 08/16/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Psychological therapies are effective treatments for hypoactive sexual desire dysfunction (HSDD; formerly hypoactive sexual desire disorder), a common sexual dysfunction among women. Access to evidence-based treatments, however, remains difficult. Internet-based interventions are effective for a variety of psychological disorders and may be a promising means to close the treatment gap for HSDD. OBJECTIVE This article describes the treatment protocol and study design of a randomized controlled trial, aiming to study the efficacy of cognitive behavioral and mindfulness-based interventions delivered via the internet for women with HSDD to a waitlist control group. Outcomes are sexual desire (primary) and sexual distress (secondary). Additional variables (eg, depression, mindfulness, rumination) will be assessed as potential moderators or mediators of treatment success. METHODS A cognitive behavioral and a mindfulness-based self-help intervention for HSDD will be provided online. Overall, 266 women with HSDD will be recruited and assigned either to one of the intervention groups, or to a waitlist control group (2:2:1). Outcome data will be assessed at baseline, at 12 weeks, and at 6 and 12 months after randomization. Intention-to-treat and completer analyses will be conducted. RESULTS We expect improvements in sexual desire and sexuality-related distress in both intervention groups compared to the waitlist control. Recruitment has begun in January 2019 and is expected to be completed in August 2021. Results will be published in 2022. CONCLUSIONS This study aims to contribute to the improvement and dissemination of psychological treatments for women with HSDD and to clarify whether cognitive behavioral and/or mindfulness-based treatments for HSDD are feasible and effective when delivered via the internet. TRIAL REGISTRATION ClinicalTrials.gov NCT03780751; https://clinicaltrials.gov/ct2/show/NCT03780751. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/20326.
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Affiliation(s)
- Milena Meyers
- Clinical Psychology and Psychotherapy, Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Jürgen Margraf
- Clinical Psychology and Psychotherapy, Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Julia Velten
- Clinical Psychology and Psychotherapy, Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
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Zheng J, Islam RM, Bell RJ, Skiba MA, Davis SR. Prevalence of Low Sexual Desire With Associated Distress Across the Adult Life Span: An Australian Cross-Sectional Study. J Sex Med 2020; 17:1885-1895. [PMID: 32773344 DOI: 10.1016/j.jsxm.2020.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/01/2020] [Accepted: 07/03/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although hypoactive sexual desire dysfunction (HSDD; low sexual desire with personal distress) negatively impacts well-being, contemporary life-course prevalence data for HSDD are lacking. AIM To document, in an epidemiologic study, the prevalence of low sexual desire with associated distress (epidemiological HSDD [eHSDD]), and associated psychosocial factors in Australian women. METHODS A cross-sectional study of 10,554 women, aged 18-79 years, recruited from the community was performed. MAIN OUTCOME MEASURES Low desire was determined by corresponding questions in the Profile of Female Sexual Function and Female Sexual Function Index. HSDD was defined as having a low desire and Female Sexual Distress Scale-Revised score of ≥11. CLINICAL TRANSLATION Clinicians need to be aware that young women often experience sexually related distress whereas low desire with associated distress is most common in women at midlife. RESULTS The majority of the participants were partnered (66.5%) and 38.9% were recently sexually inactive. Low desire prevalence increased from age 18-24 years to 75-79 years (27.4%, 95% CI 25.5-29.3 vs 91.6%, 95% CI 88.3-94.1, P < .001). Just over half of all participants aged 25-39 years had sexually related personal distress, after which the prevalence declined with age (P < .001). 10,259 participants provided sufficient information for eHSDD classification. eHSDD increased from age 18-24 years (12.2%, 95% CI 10.8-13.7) to 40-44 years (33.4%, 95% CI 28.5-38.8), remained constant until 60-64 years (33.1%, 95% CI 28.3-38.4), and progressively declined to 7.3% (95% CI 4.8-10.9) by 75-79 years. HSDD was significantly, positively associated with being partnered (P < .001), sexually inactive (P < .001), more educated (P = .001), and psychotropic medication use (P < .001), and negatively with Asian ethnicity (P < .001). STRENGTHS & LIMITATIONS This study involved the assessment of desire using a single question derived from the Profile of Female Sexual Function or the Female Sexual Function Index. CONCLUSION eHSDD is most prevalent at midlife. Furthermore, the likelihood of eHSDD is greater for women who are partnered, sexually inactive, more educated, or taking psychotropic medications. Taken together these findings should aid health professionals in identifying women most at risk of eHSDD. Zheng J, Islam RM, Bell RJ, et al. Prevalence of Low Sexual Desire With Associated Distress Across the Adult Life Span: An Australian Cross-Sectional Study. J Sex Med 2020;17:1885-1895.
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Affiliation(s)
- Jia Zheng
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Rakibul M Islam
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Robin J Bell
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Marina A Skiba
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Susan R Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
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Abstract
Introduction: Hypoactive sexual desire disorder (HSDD) is the most prevalent sexual dysfunction in women, previously managed with off-label therapies. Indicated for premenopausal women, flibanserin is the first FDA-approved medication to treat HSDD.Areas covered: This review summarizes flibanserin's pharmacokinetics, proposed mechanism of action, and safety data in clinical trials with a focus on sedation- and hypotension-related adverse events, and drug interactions with alcohol and antidepressants. Sources included peer-reviewed publications and internal data from the manufacturer.Expert opinion: Flibanserin is a well-tolerated and effective treatment that decreases distress and restores sexual desire to a level that is normative for the individual patient with HSDD. Simplification of a risk mitigation program for flibanserin in the US is likely to increase the number of prescribing clinicians if accompanied with educational efforts to clarify flibanserin's risk-benefit profile. As flibanserin is dosed daily and may be used for a decade or more in the typical premenopausal patient, long-term pharmacovigilance data will be essential. Over time, HSDD will be treated by more nonspecialist health care professionals and flibanserin will likely become established as a significant treatment option along with other medications approved for this indication in the context of a holistic biopsychosocial treatment paradigm.
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Affiliation(s)
- Anita H Clayton
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, USA
| | | | - Noel N Kim
- Institute for Sexual Medicine, San Diego, CA, USA
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Rubin JD, Conley TD, Klein V, Liu J, Lehane CM, Dammeyer J. A cross-national examination of sexual desire: The roles of ‘gendered cultural scripts’ and ‘sexual pleasure’ in predicting heterosexual women's desire for sex. PERSONALITY AND INDIVIDUAL DIFFERENCES 2019. [DOI: 10.1016/j.paid.2019.07.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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López-Rodríguez MM, Fernández AP, Hernández-Padilla JM, Fernández-Sola C, Fernández-Medina IM, Granero-Molina J. Dyadic and Solitary Sexual Desire in Patients With Fibromyalgia: A Controlled Study. J Sex Med 2019; 16:1518-1528. [DOI: 10.1016/j.jsxm.2019.07.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 07/22/2019] [Accepted: 07/28/2019] [Indexed: 10/26/2022]
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Nimbi FM, Tripodi F, Rossi R, Navarro-Cremades F, Simonelli C. Male Sexual Desire: An Overview of Biological, Psychological, Sexual, Relational, and Cultural Factors Influencing Desire. Sex Med Rev 2019; 8:59-91. [PMID: 30803921 DOI: 10.1016/j.sxmr.2018.12.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 12/15/2018] [Accepted: 12/16/2018] [Indexed: 01/10/2023]
Abstract
INTRODUCTION The literature showed the need for a better understanding of the male sexual response, which has historically been considered as simpler and more mechanistic compared with that in women. AIM To examine the literature on biopsychosocial factors associated with the level of sexual desire in men and discuss some interesting directions for future research. METHODS A systematic literature review was conducted. MAIN OUTCOME MEASURES 169 articles published in Google Scholar, Web of Science, Scopus, EBSCO, and Cochrane Library about male sexual desire and related biopsychosocial factors. RESULTS We found a lack of multidimensional studies on male sexual desire. Most existing research has focused on hypoactive sexual desire disorder in coupled heterosexual men. Biological factors play important roles in the level of sexual desire, but they are insufficient to explain the male sexual response. Psychological, relational, and sexual factors (eg depression, anxiety, emotions, attraction, conflicts, communication, sexual functioning, distress, satisfaction) are involved in the development/maintenance of lack of sexual interest in men. Cultural influence is also relevant, with cognitive factors linked to gender roles and sexual scripts of masculinity identified as important predictors of low sexual desire. CONCLUSION Male sexual desire is characterized by an interplay among biological, psychological, sexual, relational, and cultural elements. This interplay merits further study to better understand how sexual desire works and how treatments for low sexual interest could be improved. Nimbi FM,Tripodi F, Rossi R, et al. Male Sexual Desire: An Overview of Biological, Psychological, Sexual, Relational, and Cultural Factors Influencing Desire. Sex Med Rev 2020;8:59-91.
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Affiliation(s)
- Filippo Maria Nimbi
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy; Institute of Clinical Sexology, Rome, Italy.
| | | | | | | | - Chiara Simonelli
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy; Institute of Clinical Sexology, Rome, Italy
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Which psychosocial variables affect drive the most? Analysis of sexual desire in a group of Italian men. Int J Impot Res 2019; 31:410-423. [DOI: 10.1038/s41443-018-0105-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/08/2018] [Accepted: 11/26/2018] [Indexed: 12/25/2022]
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Zhang H, Liu T, Zhou Z, Zhang A, Zhu Y, Zhang J, Pan L, Ma J. miR-137 Affects Vaginal Lubrication in Female Sexual Dysfunction by Targeting Aquaporin-2. Sex Med 2018; 6:339-347. [PMID: 30454615 PMCID: PMC6302129 DOI: 10.1016/j.esxm.2018.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/26/2018] [Accepted: 09/26/2018] [Indexed: 11/30/2022] Open
Abstract
Introduction Female sexual dysfunction (FSD) is a common disease with serious potential hazards, but it has not received much attention. The pathogenesis of FSD is urgently needed for the diagnosis and treatment of FSD. Aim To investigate the role of microribonucleic acid (mRNA, miR)-137 in FSD. Methods Vaginal epithelium tissues from 15 women with lubrication disorder and 15 women with normal function were collected for this study. The expression level of miR-137 in lubrication disorder and normal function women were measured by microarray analysis and Real-time Quantitative Polymerase Chain Reaction (PCR, qPCR). miR-137 was overexpressed in vaginal epithelial cells VK2/E6E7 by lentivirus infection. The cell water permeability was measured using the calcein-quenching method. Cell apoptosis was analyzed by flow cytometry. The potential target of miR-137 was predicted by bioinformatic analysis, then verified by luciferase reporter assays. Main Outcome Measure The expression level of miR-137 and aquaporin-2 (AQP2), cell water permeability, cell apoptosis, and luciferase reporter assays were examined. Results miR-137 was found to be highly expressed in vaginal epithelial tissues of women with lubrication disorder. Additionally, functional in vitro studies suggested that overexpression of miR-137 leads to a decrease in cell permeability. By combining target prediction and examination, we identified AQP2 as the direct mechanistic target of miR-137 that affected the water permeability of vaginal epithelial cells. Conclusion Our results point to a novel role for miR-137 and its downstream effector AQP2 in vaginal lubrication, which can be manipulated as therapeutic targets against lubrication disorder and its related disorders. Zhang H, Liu T, Zhou Z. miR-137 affects vaginal lubrication in female sexual dysfunction by targeting Aquaporin-2. Sex Med 2018;6:339–347.
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Affiliation(s)
- Hepeng Zhang
- Department of Urology, The People's Hospital of Yuyao, Zhejiang, China
| | - Tianjiao Liu
- Department of Women Health Care, Nanjing Maternal and Child Health Care Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Ziyun Zhou
- Department of Children Health Care, Wuxi Children's Hospital, Wuxi, China
| | - Aixia Zhang
- The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China
| | - Yuan Zhu
- The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China
| | - Jing Zhang
- Jiangsu Health Vocational College, Nanjing, China
| | - Lianjun Pan
- The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China
| | - Jiehua Ma
- The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China.
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Tuiten A, Michiels F, Böcker KB, Höhle D, van Honk J, de Lange RP, van Rooij K, Kessels R, Bloemers J, Gerritsen J, Janssen P, de Leede L, Meyer JJ, Everaerd W, Frijlink HW, Koppeschaar HP, Olivier B, Pfaus JG. Genotype scores predict drug efficacy in subtypes of female sexual interest/arousal disorder: A double-blind, randomized, placebo-controlled cross-over trial. ACTA ACUST UNITED AC 2018; 14:1745506518788970. [PMID: 30016917 PMCID: PMC6052493 DOI: 10.1177/1745506518788970] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Attempts to develop a drug treatment for female sexual interest/arousal disorder
have so far been guided by the principle of ‘one size fits all’, and have failed
to acknowledge the complexity of female sexuality. Guided by personalized
medicine, we designed two on-demand drugs targeting two distinct hypothesized
causal mechanisms for this sexual disorder. The objective of this study was to
design and test a novel procedure, based on genotyping, that predicts which of
the two on-demand drugs will yield a positive treatment response. In a
double-blind, randomized, placebo-controlled cross-over experiment, 139 women
with female sexual interest/arousal disorder received three different on-demand
drug-combination treatments during three 2-week periods: testosterone
0.5 mg + sildenafil 50 mg, testosterone 0.5 mg + buspirone 10 mg, and matching
placebo. The primary endpoint was change in satisfactory sexual events.
Subjects’ genetic profile was assessed using a microarray chip that measures
300,000 single-nucleotide polymorphisms. A preselection of single-nucleotide
polymorphisms associated with genes that are shown to be involved in sexual
behaviour were combined into a Phenotype Prediction Score. The Phenotype
Prediction Score demarcation formula was developed and subsequently validated on
separate data sets. Prediction of drug-responders with the Phenotype Prediction
Score demarcation formula gave large effect sizes (d = 0.66 through 1.06) in the
true drug-responders, and medium effect sizes (d = 0.51 and d = 0.47) in all
patients (including identified double, and non-responders). Accuracy,
sensitivity, specificity, positive predictive value, and negative predictive
value of the Phenotype Prediction Score demarcation formula were all between
0.78 and 0.79, and thus sufficient. The resulting Phenotype Prediction Score was
validated and shown to effectively and reliably predict which women would
benefit from which on-demand drug, and could therefore also be useful in
clinical practice, as a companion diagnostic establishing the way to a true
personalized medicine approach.
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Affiliation(s)
| | - Frits Michiels
- 2 Chemistry and Life Sciences, V.O. Patients & Trademarks, Amsterdam, The Netherlands
| | | | - Daniël Höhle
- 3 Alan Turing Institute Almere, Almere, The Netherlands
| | - Jack van Honk
- 4 Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands.,5 Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa.,6 Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Kim van Rooij
- 1 Emotional Brain BV, Almere, The Netherlands.,7 Utrecht Institute for Pharmaceutical Sciences and Rudolf Magnus Institute of Neuroscience, Utrecht University, Utrecht, The Netherlands
| | - Rob Kessels
- 1 Emotional Brain BV, Almere, The Netherlands
| | - Jos Bloemers
- 1 Emotional Brain BV, Almere, The Netherlands.,7 Utrecht Institute for Pharmaceutical Sciences and Rudolf Magnus Institute of Neuroscience, Utrecht University, Utrecht, The Netherlands
| | - Jeroen Gerritsen
- 1 Emotional Brain BV, Almere, The Netherlands.,7 Utrecht Institute for Pharmaceutical Sciences and Rudolf Magnus Institute of Neuroscience, Utrecht University, Utrecht, The Netherlands
| | - Paddy Janssen
- 8 Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,9 Department of Central Hospital Pharmacy, Viecuri Hospital, Venlo, The Netherlands
| | - Leo de Leede
- 10 Exelion Bio-Pharmaceutical Consultancy B.V., Waddinxveen, The Netherlands
| | - John-Jules Meyer
- 3 Alan Turing Institute Almere, Almere, The Netherlands.,11 Department of Information and Computing Sciences, Utrecht University, Utrecht, The Netherlands
| | - Walter Everaerd
- 12 Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Henderik W Frijlink
- 13 Research Group of Pharmaceutical Technology and Biopharmacy, University of Groningen, Groningen, The Netherland
| | | | - Berend Olivier
- 7 Utrecht Institute for Pharmaceutical Sciences and Rudolf Magnus Institute of Neuroscience, Utrecht University, Utrecht, The Netherlands.,14 Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.,15 Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, The Netherlands
| | - James G Pfaus
- 16 Department of Psychology, Centre for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada
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Birke H, Ekholm O, Højsted J, Sjøgren P, Kurita GP. Chronic Pain, Opioid Therapy, Sexual Desire, and Satisfaction in Sexual Life: A Population-Based Survey. PAIN MEDICINE 2018; 20:1132-1140. [DOI: 10.1093/pm/pny122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jette Højsted
- Multidisciplinary Pain Centre, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Per Sjøgren
- Department of Oncology
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Geana Paula Kurita
- Department of Oncology
- Multidisciplinary Pain Centre, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
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McCool-Myers M, Theurich M, Zuelke A, Knuettel H, Apfelbacher C. Predictors of female sexual dysfunction: a systematic review and qualitative analysis through gender inequality paradigms. BMC WOMENS HEALTH 2018; 18:108. [PMID: 29929499 PMCID: PMC6013982 DOI: 10.1186/s12905-018-0602-4] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 06/07/2018] [Indexed: 11/10/2022]
Abstract
Background Female sexual dysfunction affects 41% of reproductive-age women worldwide, making it a highly prevalent medical issue. Predictors of female sexual dysfunction are multifaceted and vary from country to country. A synthesis of potential risk factors and protective factors may aid healthcare practitioners in identifying populations at risk, in addition to revealing modifiable factors to prevent sexual dysfunction among reproductive-age women. Methods Observational studies which assessed the prevalence and predictors of female sexual dysfunction in reproductive-age women were systematically sought in relevant databases (2000–2014). Significant predictors were extracted from each included publication. A qualitative analysis of predictors was performed with a focus on types of sexual regimes and level of human development. Results One hundred thirty-five studies from 41 countries were included in the systematic review. The types of predictors varied according to the location of the study, the type of sexual regime and the level of gender inequality in that country/region. Consistently significant risk factors of female sexual dysfunction were: poor physical health, poor mental health, stress, abortion, genitourinary problems, female genital mutilation, relationship dissatisfaction, sexual abuse, and being religious. Consistently significant protective factors included: older age at marriage, exercising, daily affection, intimate communication, having a positive body image, and sex education. Some factors however had an unclear effect: age, education, employment, parity, being in a relationship, frequency of sexual intercourse, race, alcohol consumption, smoking and masturbation. Conclusions The sexual and reproductive lives of women are highly impacted by female sexual dysfunction, and a number of biological, psychological and social factors play a role in the prevalence of sexual dysfunction. Healthcare professionals who work with women should be aware of the many risk factors for reproductive-age women. Future prevention strategies should aim to address modifiable factors, e.g. physical activity and access to sex education; international efforts in empowering women should continue. Electronic supplementary material The online version of this article (10.1186/s12905-018-0602-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Megan McCool-Myers
- Medical Sociology, Department of Epidemiology and Preventive Medicine, University of Regensburg, Dr. Gessler Strasse 17, 93051, Regensburg, Germany.
| | - Melissa Theurich
- LMU - Ludwig-Maximilians-Universität Munich, Div Metabolic and Nutritional Medicine, Dr von Hauner Children's Hospital, Univ. of Munich Medical Center, Lindwurmstr. 4, 80337, Munich, Germany
| | - Andrea Zuelke
- Institute of Sociology, Friedrich-Schiller-University of Jena, Fürstengraben 1, 07737, Jena, Germany
| | - Helge Knuettel
- University Library of Regensburg, Universitaetsstrasse 3, 93053, Regensburg, Germany
| | - Christian Apfelbacher
- Medical Sociology, Department of Epidemiology and Preventive Medicine, University of Regensburg, Dr. Gessler Strasse 17, 93051, Regensburg, Germany
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Costa TJ, Ceravolo GS, Echem C, Hashimoto CM, Costa BP, Santos-Eichler RA, Oliveira MA, Jiménez-Altayó F, Akamine EH, Dantas AP, Carvalho MHC. Detrimental Effects of Testosterone Addition to Estrogen Therapy Involve Cytochrome P-450-Induced 20-HETE Synthesis in Aorta of Ovariectomized Spontaneously Hypertensive Rat (SHR), a Model of Postmenopausal Hypertension. Front Physiol 2018; 9:490. [PMID: 29867542 PMCID: PMC5952044 DOI: 10.3389/fphys.2018.00490] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 04/17/2018] [Indexed: 12/02/2022] Open
Abstract
Postmenopausal period has been associated to different symptoms such as hot flashes, vulvovaginal atrophy, hypoactive sexual desire disorder (HSDD) and others. Clinical studies have described postmenopausal women presenting HSDD can benefit from the association of testosterone to conventional hormonal therapy. Testosterone has been linked to development of cardiovascular diseases including hypertension and it also increases cytochrome P-450-induced 20-HETE synthesis which in turn results in vascular dysfunction. However, the effect of testosterone plus estrogen in the cardiovascular system is still very poorly studied. The aim of the present study is to evaluate the role of cytochrome P-450 pathway in a postmenopausal hypertensive female treated with testosterone plus estrogen. For that, hypertensive ovariectomized rats (OVX-SHR) were used as a model of postmenopausal hypertension and four groups were created: SHAM-operated (SHAM), ovariectomized SHR (OVX), OVX treated for 15 days with conjugated equine estrogens [(CEE) 9.6 μg/Kg/day/po] or CEE associated to testosterone [(CEE+T) 2.85 mg/kg/weekly/im]. Phenylephrine-induced contraction and generation of reactive oxygen species (ROS) were markedly increased in aortic rings from OVX-SHR compared to SHAM rats which were restored by CEE treatment. On the other hand, CEE+T abolished vascular effects by CEE and augmented both systolic and diastolic blood pressure of SHR. Treatment of aortic rings with the CYP/20-HETE synthesis inhibitor HET0016 (1 μM) reduced phenylephrine hyperreactivity and the augmented ROS generation in the CEE+T group. These results are paralleled by the increased CYP4F3 protein expression and activity in aortas of CEE+T. In conclusion, we showed that association of testosterone to estrogen therapy produces detrimental effects in cardiovascular system of ovariectomized hypertensive females via CYP4F3/20-HETE pathway. Therefore, our findings support the standpoint that the CYP/20-HETE pathway is an important therapeutic target for the prevention of cardiovascular disease in menopausal women in the presence of high levels of testosterone.
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Affiliation(s)
- Tiago J Costa
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.,Facultat de Medicina, Departament de Farmacologia, Terapèutica i Toxicologia, Institut de Neurociències, Universitat Autònoma de Barcelona, Bellaterra, Spain.,Group of Atherosclerosis and Coronary Disease, Institut Clinic del Torax, Institut d'Investigacions Biomédiques August Pi I Sunyer, Barcelona, Spain
| | - Graziela S Ceravolo
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.,Department of Physiological Sciences, State University of Londrina, Londrina, Brazil
| | - Cinthya Echem
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Carolina M Hashimoto
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Beatriz P Costa
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Rosangela A Santos-Eichler
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Maria Aparecida Oliveira
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Francesc Jiménez-Altayó
- Facultat de Medicina, Departament de Farmacologia, Terapèutica i Toxicologia, Institut de Neurociències, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Eliana H Akamine
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Ana Paula Dantas
- Group of Atherosclerosis and Coronary Disease, Institut Clinic del Torax, Institut d'Investigacions Biomédiques August Pi I Sunyer, Barcelona, Spain
| | - Maria Helena C Carvalho
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
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Abstract
INTRODUCTION Hypoactive sexual desire disorder (HSDD) often has a negative impact on the health and quality of life of women; however, many women do not mention-let alone discuss-this issue with their physicians. Providers of gynecologic services have the opportunity to address this subject with their patients. AIM To review the diagnosis and evidence-based treatment of low sexual desire in women with a focus on strategies that can be used efficiently and effectively in the clinic. METHODS The Medline database was searched for clinically relevant publications on the diagnosis and management of HSDD. RESULTS HSDD screening can be accomplished during an office visit with a few brief questions to determine whether further evaluation is warranted. Because women's sexual desire encompasses biological, psychological, social, and contextual components, a biopsychosocial approach to evaluating and treating patients with HSDD is recommended. Although individualized treatment plan development for patients requires independent medical judgment, a simple algorithm can assist in the screening, diagnosis, and management of HSDD. Once a diagnosis of HSDD has been made, interventions can begin with office-based counseling and progress to psychotherapy and/or pharmacotherapy. Flibanserin, a postsynaptic 5-hydroxytryptamine 1A agonist and 2A antagonist that decreases serotonin levels and increases dopamine and norepinephrine levels, is indicated for acquired, generalized HSDD in premenopausal women and is the only agent approved in the United States for the treatment of HSDD in women. Other strategies to treat HSDD include using medications indicated for other conditions (eg, transdermal testosterone, bupropion). Bremelanotide, a melanocortin receptor agonist, is in late-stage clinical development. CONCLUSIONS Providers of gynecologic care are uniquely positioned to screen, counsel, and refer patients with HSDD. Options for pharmacotherapy of HSDD are currently limited to flibanserin, approved by the US Food and Drug Administration, and off-label use of other agents. Clayton AH, Kingsberg SA, Goldstein I. Evaluation and Management of Hypoactive Sexual Desire Disorder. Sex Med 2018;6:59-74.
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Gass M, Larson J, Cochrane B, Manson JE, Lane D, Barnabei V, Ockene J, Stefanick ML, Mouton C. Sexual activity and vaginal symptoms in the postintervention phase of the Women's Health Initiative Hormone Therapy Trials. Menopause 2018; 25:252-264. [PMID: 29112594 PMCID: PMC5821577 DOI: 10.1097/gme.0000000000000994] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the impact of discontinuing oral hormone therapy (HT) on sexual activity, vaginal symptoms, and sexual activity components among participants in the estrogen-progestin therapy (EPT) and estrogen therapy (ET) trial of the Women's Health Initiative. METHODS Surveys were sent postintervention to those who were still taking study pills and agreed to continue in the study when the trials were stopped. Comparisons between former HT and placebo users were accomplished with chi-square tests for categorical variables and t tests for continuous variables. RESULTS In all, 13,902 women with mean age at survey 69.9 years (EPT trial, women with intact uterus) and 71.7 years (ET trial, women with history of hysterectomy) responded. Prevalence of sexual activity postintervention was not significantly different between former EPT and placebo users (36.0% vs 34.2%; P = 0.37). Sexual activity of former ET users was 5.6% higher than placebo users (27.6% vs 22.0%; P = 0.001). The majority of sexually active women overall maintained orgasmic capacity and sexual satisfaction. Former EPT users were 10% to 12% more likely than former placebo users to report decreased desire, arousal, intercourse, climax, and satisfaction with sexual activity, and also increased dryness and dyspareunia upon discontinuing study drugs (P < 0.001). Former ET users were more likely than placebo users to report rare to no desire or arousal postintervention (P < 0.001). CONCLUSIONS Postintervention ET trial participants formerly assigned to ET were significantly more likely to report sexual activity than those formerly assigned to placebo. Women who discontinued EPT were significantly more likely to report negative vaginal and sex-related effects.
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Affiliation(s)
| | | | - Barbara Cochrane
- Fred Hutchinson Cancer Research Center, Seattle, WA
- University of Washington School of Nursing, Seattle, WA
| | - JoAnn E. Manson
- Division of Preventive Medicine, Brigham and Women’s
Hospital, Harvard Medical School, Boston, MA
| | - Dorothy Lane
- Department of Preventive Medicine, Stony Brook University School of
Medicine, Stony Brook, NY
| | - Vanessa Barnabei
- Department of Obstetrics and Gynecology, School of Medicine and
Biomedical Sciences, University at Buffalo, New York, NY
| | - Judith Ockene
- Division of Preventive and Behavioral Medicine at the University of
Massachusetts
| | - Marcia L. Stefanick
- Stanford Prevention Research Center, Stanford University School of
Medicine, Stanford, CA
| | - Charles Mouton
- Office of Academic Affairs and Department of Family Medicine,
University of Texas Medical Branch, Galveston, Texas
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Yun HJ, Cho HH. The characteristics of hypoactive sexual desire disorder in Korean women who visited a community-based gynaecology hospital for sexual dysfunction. J OBSTET GYNAECOL 2018; 38:663-667. [PMID: 29433404 DOI: 10.1080/01443615.2017.1389866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This cross-sectional study analysed the characteristics of HSDD (hypoactive sexual desire disorder) in Korean women. Two hundred and seventeen women seen for sexual dysfunction were assessed using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised (DMS IV-TR) and the Female Sexual Function Index (FSFI). A diagnosis of HSDD was more common in women in their 40 s (56%), who had previously undergone surgery for a feeling of 'wide vagina'. Both too much or too little sexual activity caused HSDD. Longer physical contact and sexual foreplay duration lessened the prevalence of HSDD. We concluded that special attention should be paid to women in their 40 s, particularly those with a history of vaginal surgery as they are at risk of HSDD. Potential treatment options should include couple counselling about the optimal frequency and duration of sexual activity, as well as treatment specific to the disorders identified by the FSFI. Impact statement What is already known on this subject: Many socio-medical factors affect the prevalence of HSDD (Hypoactive sexual desire disorder). Age, cultural factors, relationship status, education, religion, employment, mental distress, depression, medications, menopausal status, multiple psychiatric disorders and a variety of medical conditions impact on sexual function. What do the results of this study add: A history of wide vaginal surgery (perineoplasty, vaginal rogation rejuvenation, or anterior vaginal introitoplasty) affects the incidence of HSDD (and have not been evaluated before). Both too much or too little sexual activity were found to have caused HSDD. A longer physical contact and duration of sexual foreplay lessened the prevalence of HSDD. What are the implications of these findings for clinical practice and/or further research: We concluded that special attention should be paid to women in their 40 s; particularly those with a history of wide vaginal surgery, as they are at risk of HSDD. Potential treatment options should include couple counselling about the optimal frequency and duration of sexual activity, as well as treatment specific to the disorders identified by the FSFI.
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Affiliation(s)
- Ho Ju Yun
- a Best Skilled Gynecology Hospital , Seoul , Korea
| | - Hyun Hee Cho
- b Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital , Catholic University Medical College , Seoul , Korea
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Nimbi FM, Tripodi F, Rossi R, Simonelli C. Expanding the Analysis of Psychosocial Factors of Sexual Desire in Men. J Sex Med 2017; 15:230-244. [PMID: 29292060 DOI: 10.1016/j.jsxm.2017.11.227] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 10/23/2017] [Accepted: 11/29/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The literature lacks studies of the male sex drive. Most existing studies have focused on hypoactive sexual desire disorder in coupled heterosexual men, highlighting some of the main related biological, psychological, and social factors. AIM To evaluate the role of selected psychological and social variables affecting male sexual desire such as quality of life, sexual function, distress, satisfaction, psychological symptoms, emotions, alexithymia, couple adjustment, sexism, cognitive schemas activated in a sexual context, sexual dysfunctional beliefs, and different classes of cognitions triggered during sexual activity about failure anticipation, erection concerns, age- and body-related thoughts, erotic fantasies, and negative attitudes toward sexuality. METHODS A wide self-administered survey used snowball sampling to reach 298 heterosexual Italian men (age = 32.66 ± 11.52 years) from the general population. OUTCOMES 13 questionnaires exploring psychological and social elements involved in sexual response were administrated: International Index of Erectile Function, Short Form 36 for Quality of Life, Beck Depression Inventory-II, Symptom Check List-90-Revised, Toronto Alexithymia Scale, Premature Ejaculation Severity Index, Sexual Distress Scale, Sexual Satisfaction Scale, Dyadic Adjustment Scale, Ambivalent Sexism Inventory, Sexual Modes Questionnaire, Sexual Dysfunctional Belief Questionnaire, and Questionnaire of Cognitive Schema Activation in Sexual Context. RESULTS Results showed lack of erotic thoughts (β = -0.328), fear (β = -0.259) and desire to have a baby (β = -0.259) as the main predictors of the level of sexual desire in this group. Energy-fatigue, depression, premature ejaculation severity, sexual distress, compatibility, subjective sexual response, and sexual conservatism had a weaker effect on sexual desire. Sexual functioning (13.80%), emotional response (12.70%), dysfunctional sexual beliefs (12.10%), and negative automatic thoughts (12.00%) had more variable effects on sexual drive. CLINICAL TRANSLATION Analyzed variables could represent important factors that should be considered in the assessment of desire concerns and discussed in therapy. STRENGTHS AND LIMITATIONS The strength of this study is the analysis of novel psychological and social factors on male sexual desire. Recruitment and sample size do not allow generalization of the results, but some crucial points for future research and clinical practice are discussed. CONCLUSION Our findings showed that male sexual desire could be affected by many psychological and social elements. Other factors remain to be explored, in their direct and interactive effects, aiming to better explain male sexual desire functioning. Nimbi FM, Tripodi F, Rossi R, Simonelli C. Expanding the Analysis of Psychosocial Factors of Sexual Desire in Men. J Sex Med 2018;15:230-244.
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Affiliation(s)
- Filippo Maria Nimbi
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy; Institute of Clinical Sexology, Rome, Italy.
| | | | | | - Chiara Simonelli
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy; Institute of Clinical Sexology, Rome, Italy
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Atarodi-Kashani Z, Kariman N, Ebadi A, Alavi Majd H, Beladi-Moghadam N. Sexual function and related factors in Iranian woman with epilepsy. Seizure 2017; 52:147-153. [DOI: 10.1016/j.seizure.2017.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 08/30/2017] [Accepted: 10/02/2017] [Indexed: 11/08/2022] Open
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Graham CA, Mercer CH, Tanton C, Jones KG, Johnson AM, Wellings K, Mitchell KR. What factors are associated with reporting lacking interest in sex and how do these vary by gender? Findings from the third British national survey of sexual attitudes and lifestyles. BMJ Open 2017; 7:e016942. [PMID: 28903968 PMCID: PMC5722087 DOI: 10.1136/bmjopen-2017-016942] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES To investigate factors associated with reporting lacking interest in sex and how these vary by gender. SETTING British general population. DESIGN Complex survey analyses of data collected for a cross-sectional probability sample survey, undertaken 2010-2012, specifically logistic regression to calculate age-adjusted OR (AOR) to identify associated factors. PARTICIPANTS 4839 men and 6669 women aged 16-74 years who reported ≥1 sexual partner (opposite-sex or same-sex) in the past year for the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). MAIN OUTCOME MEASURE Lacking interest in sex for ≥3 months in the past year. RESULTS Overall, 15.0% (13.9-16.2) of men and 34.2% (32.8-35.5) of women reported lacking interest in sex. This was associated with age and physical and mental health for both men and women, including self-reported general health and current depression. Lacking interest in sex was more prevalent among men and women reporting sexually transmitted infection diagnoses (ever), non-volitional sex (ever) and holding sexual attitudes related to normative expectations about sex. Some gender similarities in associated relationship and family-related factors were evident, including partner having had sexual difficulties in the last year (men: AOR 1.41 (1.07-1.86); women: AOR 1.60 (1.32-1.94)), not feeling emotionally close to partner during sex (men: 3.74 (1.76-7.93); women: 4.80 (2.99-7.69) and ease of talking about sex (men: 1.53 (1.23-1.90);women: 2.06 (1.77-2.39)). Among women only, lack of interest in sex was higher among those in a relationship of >1 year in duration and those not sharing the same level of interest (4.57 (3.87-5.38)) or preferences (2.91 (2.22-3.83)) with a partner. CONCLUSIONS Both gender similarities and differences were found in factors associated with lacking interest in sex, with the most marked differences in relation to some relationship variables. Findings highlight the need to assess, and if appropriate, treat lacking interest in sex in a holistic and relationship-specific way.
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Affiliation(s)
- Cynthia A Graham
- Department of Psychology, Centre for Sexual Health Research, University of Southampton, Southampton, UK
| | - Catherine H Mercer
- Centre for Sexual Health and HIV Research, Research Department of Infection & Population Health, University College London, London, UK
| | - Clare Tanton
- Centre for Sexual Health and HIV Research, Research Department of Infection & Population Health, University College London, London, UK
| | - Kyle G Jones
- Centre for Sexual Health and HIV Research, Research Department of Infection & Population Health, University College London, London, UK
| | - Anne M Johnson
- Centre for Sexual Health and HIV Research, Research Department of Infection & Population Health, University College London, London, UK
| | - Kaye Wellings
- Centre for Sexual and Reproductive Health Research, Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Kirstin R Mitchell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, London, UK
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Vonzun L. Die Lustpille für die Frau. GYNAKOLOGISCHE ENDOKRINOLOGIE 2017. [DOI: 10.1007/s10304-017-0141-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Andac T, Aslan E. Sexual life of women in the climacterium: A community-based study. Health Care Women Int 2017; 38:1344-1355. [DOI: 10.1080/07399332.2017.1352588] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Tugba Andac
- Kemal Haciyüzbaşıoğlu Aile Sağlığı Merkezi Kartal, Istanbul, Turkey
| | - Ergul Aslan
- Istanbul University Florence Nightingale Faculty of Nursing Abide-i Hurriyet Cad. 34381 Sisli, Istanbul, Turkey
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Fisher WA, Gruenwald I, Jannini EA, Lev-Sagie A, Lowenstein L, Pyke RE, Reisman Y, Revicki DA, Rubio-Aurioles E. Standards for Clinical Trials in Male and Female Sexual Dysfunction: II. Patient-Reported Outcome Measures. J Sex Med 2017; 13:1818-1827. [PMID: 27914562 DOI: 10.1016/j.jsxm.2016.08.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 08/13/2016] [Accepted: 08/18/2016] [Indexed: 11/27/2022]
Abstract
The second article in this series, Standards for Clinical Trials in Male and Female Sexual Dysfunction, focuses on measurement of patient-reported outcomes (PROs). Together with the design of appropriate phase I to phase IV clinical trials, the development, validation, choice, and implementation of valid PRO measurements-the focus of the present article-form the foundation of research on treatments for male and female sexual dysfunctions. PRO measurements are assessments of any aspect of a patient's health status that come directly from the patient (ie, without the interpretation of the patient's responses by a physician or anyone else). PROs are essential for assessing male and female sexual dysfunction and treatment response, including symptom frequency and severity, personal distress, satisfaction, and other measurements of sexual and general health-related quality of life. Although there are some relatively objective measurements of sexual dysfunction (ie, intravaginal ejaculatory latency time, frequency of sexual activity, etc), these measurements do not comprehensively assess the occurrence and extent of sexual dysfunction or treatment on the patient's symptoms, functioning, and well-being. Data generated by a PRO instrument can provide evidence of a treatment benefit from the patient's perspective.
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Affiliation(s)
- William A Fisher
- Department of Psychology and Department of Obstetrics and Gynaecology, Western University, London, ON, Canada.
| | - Ilan Gruenwald
- Department of Urology, Director, Neuro-urology Unit, Rambam Medical Center, Haifa, Israel
| | - Emmanuele A Jannini
- Endocrinology and Medical Sexology, Department of Systems Medicine, University of Rome, Tor Vergata, Italy
| | - Ahinoam Lev-Sagie
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
| | | | - Yakov Reisman
- Medical Director Sexuality Clinics, Amstelland Hospital, Amstelveen, The Netherlands
| | | | - Eusebio Rubio-Aurioles
- Asociación Mexicana para la Salud Sexual, AC, and Universidad Nacional Autónoma de México, Mexico City, Mexico
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Korse NS, Veldman AB, Peul WC, Vleggeert-Lankamp CLA. The long term outcome of micturition, defecation and sexual function after spinal surgery for cauda equina syndrome. PLoS One 2017; 12:e0175987. [PMID: 28423044 PMCID: PMC5397048 DOI: 10.1371/journal.pone.0175987] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 04/03/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cauda equina syndrome (CES) is a rare neurologic complication of lumbar herniated disc for which emergency surgical decompression should be undertaken. Despite the common belief that the restoration of functions that are affected by CES can take several years postoperatively, follow up seldom exceeds the first year after surgery. Long term outcome of especially micturition, defecation and sexual function-which are by definition affected in CES-are unknown. The aim of this study is to evaluate 1) postoperative long term outcome of micturition, defecation and sexual function in CES patients 2) attitude of patients towards received hospital care with regard to (recovery of) these functions. METHODS CES patients were selected by screening the records of all patients operated on lumbar herniated disc in our university hospital between 1995-2010. A questionnaire was sent to the selected CES patients evaluating current complaints of micturition, defecation and sexual function and attitude towards delivered care with focus on micturition, defecation and sexual function. RESULTS Thirty-seven of 66 eligible CES patients were included (response rate 71%, inclusion rate 56%). Median time after surgery was 13.8 years (range 5.8-21.8 years). Dysfunction at follow up was highly prevalent: 38% micturition dysfunction, 43% defecation dysfunction and 54% sexual dysfunction. Younger age at presentation was associated with sexual dysfunction at follow up: for every year younger at presentation, odds ratio for sexual dysfunction at follow up was 1.11 (p = 0.035). Other associations with outcome were not identified. Two-third of the CES patients wished their neurosurgeon had given them more prognostic information about micturition, defecation and sexual function. CONCLUSION The presented data demonstrate that dysfunction of micturition, defecation and sexual function are still highly prevalent in a large number of CES patients even years postoperatively. These alarming follow up data probably have a devastating effect on personal perceived quality of life, which should be studied in more detail. CES patients communicate a clear demand for more prognostic information. The presented figures enable clinicians to inform their CES patients more realistically about long term postoperative outcome of micturition, defecation and sexual function after surgical intervention.
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Affiliation(s)
- Nina S. Korse
- Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Anna B. Veldman
- Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Wilco C. Peul
- Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands
- Department of Neurosurgery, Haaglanden Medical Center, the Hague, the Netherlands
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Wåhlin-Jacobsen S, Kristensen E, Pedersen AT, Laessøe NC, Cohen AS, Hougaard DM, Lundqvist M, Giraldi A. Androgens and Psychosocial Factors Related to Sexual Dysfunctions in Premenopausal Women ∗: ∗2016 ISSM Female Sexual Dysfunction Prize. J Sex Med 2017; 14:366-379. [PMID: 28117267 DOI: 10.1016/j.jsxm.2016.12.237] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 12/14/2016] [Accepted: 12/23/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The female sexual response is complex and influenced by several biological, psychological, and social factors. Testosterone is believed to modulate a woman's sexual response and desire, because low levels are considered a risk factor for impaired sexual function, but previous studies have been inconclusive. AIM To investigate how androgen levels and psychosocial factors are associated with female sexual dysfunction (FSD), including hypoactive sexual desire disorder (HSDD). METHODS The cross-sectional study included 428 premenopausal women 19 to 58 years old who completed a questionnaire on psychosocial factors and had blood sampled at days 6 to 10 in their menstrual cycle. Logistic regression models were built to test the association among hormone levels, psychosocial factors, and sexual end points. MAIN OUTCOME MEASURES Five different sexual end points were measured using the Female Sexual Function Index and the Female Sexual Distress Scale: impaired sexual function, sexual distress, FSD, low sexual desire, and HSDD. Serum levels of total and free testosterone, androstenedione, dehydroepiandrosterone sulfate, and androsterone glucuronide were analyzed using mass spectrometry. RESULTS After adjusting for psychosocial factors, women with low sexual desire had significantly lower mean levels of free testosterone and androstenedione compared with women without low sexual desire. None of the androgens were associated with FSD in general or with HSDD in particular. Relationship duration longer than 2 years and mild depressive symptoms increased the risk of having all the sexual end points, including FSD in general and HSDD in particular in multivariate analyses. CONCLUSION In this large cross-sectional study, low sexual desire was significantly associated with levels of free testosterone and androstenedione, but FSD in general and HSDD in particular were not associated with androgen levels. Length of relationship and depression were associated with FSD including HSDD. Wåhlin-Jacobsen S, Kristensen E, Tønnes Pedersen A, et al. Androgens and Psychosocial Factors Related to Sexual Dysfunctions in Premenopausal Women. J Sex Med 2017;14:366-379.
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Affiliation(s)
- Sarah Wåhlin-Jacobsen
- Department of Sexological Research, Psychiatric Center Copenhagen, Copenhagen, Denmark.
| | - Ellids Kristensen
- Department of Sexological Research, Psychiatric Center Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anette Tønnes Pedersen
- Department of Gynecology and Fertility Clinic, JMC Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Arieh S Cohen
- Department for Congenital Disorders, Statens Serum Institute, Copenhagen, Denmark
| | - David M Hougaard
- Department for Congenital Disorders, Statens Serum Institute, Copenhagen, Denmark
| | - Marika Lundqvist
- Department for Congenital Disorders, Statens Serum Institute, Copenhagen, Denmark
| | - Annamaria Giraldi
- Department of Sexological Research, Psychiatric Center Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Goldstein I, Kim NN, Clayton AH, DeRogatis LR, Giraldi A, Parish SJ, Pfaus J, Simon JA, Kingsberg SA, Meston C, Stahl SM, Wallen K, Worsley R. Hypoactive Sexual Desire Disorder: International Society for the Study of Women's Sexual Health (ISSWSH) Expert Consensus Panel Review. Mayo Clin Proc 2017; 92:114-128. [PMID: 27916394 DOI: 10.1016/j.mayocp.2016.09.018] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 09/16/2016] [Accepted: 09/29/2016] [Indexed: 12/17/2022]
Abstract
The objective of the International Society for the Study of Women's Sexual Health expert consensus panel was to develop a concise, clinically relevant, evidence-based review of the epidemiology, physiology, pathogenesis, diagnosis, and treatment of hypoactive sexual desire disorder (HSDD), a sexual dysfunction affecting approximately 10% of adult women. Etiologic factors include conditions or drugs that decrease brain dopamine, melanocortin, oxytocin, and norepinephrine levels and augment brain serotonin, endocannabinoid, prolactin, and opioid levels. Symptoms include lack or loss of motivation to participate in sexual activity due to absent or decreased spontaneous desire, sexual desire in response to erotic cues or stimulation, or ability to maintain desire or interest through sexual activity for at least 6 months, with accompanying distress. Treatment follows a biopsychosocial model and is guided by history and assessment of symptoms. Sex therapy has been the standard treatment, although there is a paucity of studies assessing efficacy, except for mindfulness-based cognitive behavior therapy. Bupropion and buspirone may be considered off-label treatments for HSDD, despite limited safety and efficacy data. Menopausal women with HSDD may benefit from off-label testosterone treatment, as evidenced by multiple clinical trials reporting some efficacy and short-term safety. Currently, flibanserin is the only Food and Drug Administration-approved medication to treat premenopausal women with generalized acquired HSDD. Based on existing data, we hypothesize that all these therapies alter central inhibitory and excitatory pathways. In conclusion, HSDD significantly affects quality of life in women and can effectively be managed by health care providers with appropriate assessments and individualized treatments.
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Affiliation(s)
- Irwin Goldstein
- Department of Sexual Medicine, Alvarado Hospital, San Diego, CA.
| | - Noel N Kim
- Institute for Sexual Medicine, San Diego, CA
| | - Anita H Clayton
- Department of Psychiatry and Neurobehavioral Sciences and Obstetrics and Gynecology, University of Virginia, Charlottesville
| | - Leonard R DeRogatis
- Maryland Center for Sexual Health, Johns Hopkins University School of Medicine, Baltimore
| | - Annamaria Giraldi
- Sexological Clinic, Psychiatric Center Copenhagen, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - James Pfaus
- Center for Studies in Behavioral Neurobiology, Department of Psychology, Concordia University, Montréal, QC, Canada
| | | | - Sheryl A Kingsberg
- Division of Behavioral Medicine, Department of Obstetrics/Gynecology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH
| | - Cindy Meston
- Department of Psychology, University of Texas at Austin
| | - Stephen M Stahl
- Department of Psychiatry, University of California San Diego, and the Neuroscience Education Institute, San Diego
| | - Kim Wallen
- Department of Psychology and Yerkes National Primate Research Center, Emory University, Atlanta, GA
| | - Roisin Worsley
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
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Efficacy and safety of transdermal testosterone in postmenopausal women with hypoactive sexual desire disorder: a systematic review and meta-analysis. Fertil Steril 2016; 107:475-482.e15. [PMID: 27916205 DOI: 10.1016/j.fertnstert.2016.10.028] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 10/18/2016] [Accepted: 10/18/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To systematically review and summarize the existing evidence related to the efficacy and safety of transdermal T in postmenopausal women for the treatment of hypoactive sexual desire disorder (HSDD). DESIGN Systematic reviews and meta-analysis. SETTING Not applicable. PATIENT(S) Seven randomized controlled trials enrolled 3,035 participants; 1,350 women were randomized to treatment with T patch, and 1,379 women were randomized to placebo. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Primary outcome: satisfying sexual episodes. SECONDARY OUTCOMES sexual activity, orgasm, Profile of Female Sexual Function domains (desire), personal distress score, adverse events, acne, increased hair growth, facial hair, alopecia, voice deepening, urinary symptoms, breast pain, headache, site reaction, total adverse events, serious adverse events, withdrawal from study, and follow-up rate. RESULT(S) The T group had significantly more satisfying sexual episodes, sexual activity, orgasms, desire, significant change in Personal Distress Scale score, androgenic adverse events, acne, and hair growth compared with the placebo group. There was no significant difference between the two groups in increase in facial hair, alopecia, voice deepening, urinary symptoms, breast pain, headache, site reaction to the patch, total adverse events, serious adverse events, reasons for withdrawal from the study, and the number of women who completed the study. CONCLUSION(S) The short-term efficacy in terms of improvement of sexual function and safety of transdermal T in naturally and surgically menopausal women affected by HSDD either on or not on estrogen progestin hormone therapy is evident from this systematic review. The use of transdermal T is associated with increase in androgenic adverse events such as acne but is not associated with any serious adverse events.
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What kind of sexual dysfunction is most common among overweight and obese women in reproductive age? Int J Impot Res 2016; 29:61-64. [DOI: 10.1038/ijir.2016.46] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 08/08/2016] [Accepted: 10/03/2016] [Indexed: 11/08/2022]
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