1
|
Tetik S, Yalçinkaya Alkar Ö. Turkish women's perception of low sexual desire, its causes and consequences: an online qualitative survey. Sex Health 2024; 21:SH23185. [PMID: 38709901 DOI: 10.1071/sh23185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/08/2024] [Indexed: 05/08/2024]
Abstract
Background The nature of sexual desire is complex, and little phenomenological consensus exists about its meaning. Low sexual desire (LSD) is a commonly reported sexual difficulty among women, but it is less frequently associated with sexual distress. The aim of this qualitative study is to explore women's understanding of sexual desire, and their perceptions of factors that may contribute to LSD, its effects and their methods of seeking help. Methods The research employed a questionnaire with 12 open-ended questions, developed by the researchers based on sexual script theory. Data were collected from 165 heterosexual Turkish women who reported LSD, recruited through social media platforms between August and October 2021. The data were analysed using a contextual form of thematic analysis to identify and explore patterns. Results The ages of the participants ranged from 20 to 63years. The majority of participants held a Bachelor's degree (81.2%) and in a relationship (78.8%). Three main themes emerged from the study: (1) gendered messages concerning sex, (2) multi-level sexual desire, and (3) minimisation. The research revealed that women's sexual desire is often ignored and repressed, and has negative consequences if not expressed in socially acceptable contexts. The causes of LSD in women go beyond personal factors, and include relational and social influences. Women experiencing LSD report distressing effects on their relationships and general wellbeing, yet they tend not to seek help. Conclusions Our findings contribute to a deeper understanding of the factors impacting women's sexual desire and the barriers to seeking help.
Collapse
Affiliation(s)
- Sinan Tetik
- Psychiatry Outpatient Clinic, Ankara Etlik City Hospital, Varlik Mh., Halil Sezai Erkut Cd., Yenimahalle, Ankara, 06170, Turkey
| | - Özden Yalçinkaya Alkar
- Department of Clinical Psychology, Ankara Yildirim Beyazit University, Esenboga Campus Cubuk, Ankara, 06810, Turkey
| |
Collapse
|
2
|
Warchala A, Madej P, Kochanowicz M, Krzystanek M. Sexual Function in Women with Polycystic Ovary Syndrome Living in Stable Heterosexual Relationships: A Cross-Sectional Study. J Clin Med 2024; 13:2227. [PMID: 38673500 PMCID: PMC11050871 DOI: 10.3390/jcm13082227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Background/Objective: The prevalence and character of female sexual dysfunction (FSD) in polycystic ovary syndrome (PCOS) have not been precisely determined. The aim of this study was to assess FSD using the Changes in Sexual Functioning Questionnaire (CSFQ-14) in women with PCOS and their partners compared to a control group, as well as correlations between five subscales, the total score of the CSFQ, and seven questions of the Visual Analogue Scale (VAS). Methods: The study sample (N = 160) comprised two groups: (1) women with PCOS and their partners (n = 91) and (2) women without PCOS and their partners (control group; n = 69). Results: The total scores of the CSFQ did not reveal FSD in either group of women. Regarding all subscales and the total score, the analysis showed a statistically significant difference between women and their partners (in all cases: p < 0.001). The discrepancy in arousal between women and men in the PCOS group was large (the mean difference was -2.32; t = -11.29, p < 0.001, Cohen's d = -1.26). The importance (VAS1), the level (VAS7) of sexual satisfaction, and the intensity of sexual thoughts (VAS2) correlated with almost all domains of the CSFQ. Conclusions: In conclusion, normal sexual function in PCOS does not mean proper sexual functioning in a sexual relationship.
Collapse
Affiliation(s)
- Anna Warchala
- Department and Clinic of Psychiatric Rehabilitation, Faculty of Medical Sciences, Medical University of Silesia in Katowice, Ziołowa 45/47, 40-635 Katowice, Poland;
| | - Paweł Madej
- Department of Gynecological Endocrinology, Faculty of Health Science in Katowice, Medyków 14, Medical University of Silesia, 40-752 Katowice, Poland
| | - Marta Kochanowicz
- Clinical Department of Obstetrics, Gynecology and Gynecological Oncology in Kędzierzyn-Koźle, Roosvelta Str. 2, 47-200 Kędzierzyn-Koźle, Poland;
| | - Marek Krzystanek
- Department and Clinic of Psychiatric Rehabilitation, Faculty of Medical Sciences, Medical University of Silesia in Katowice, Ziołowa 45/47, 40-635 Katowice, Poland;
| |
Collapse
|
3
|
Barbagallo F, Cannarella R, Condorelli RA, Cucinella L, La Vignera S, Nappi RE, Calogero AE. Thyroid diseases and female sexual dysfunctions. Sex Med Rev 2024:qeae021. [PMID: 38600719 DOI: 10.1093/sxmrev/qeae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/28/2024] [Accepted: 03/24/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION Female sexual dysfunctions (FSDs) have received little attention in the context of thyroid diseases, despite the high prevalence of both conditions. OBJECTIVES This review aims to update and summarize the state of knowledge on the association between thyroid diseases and FSDs and to investigate the complex mechanisms through which thyroid hormone imbalance can impact female sexual health in the context of the biopsychosocial model. METHODS A comprehensive literature search was performed through the PubMed, MEDLINE, and Scopus databases, using the following keywords: "female sexual function," "sexual dysfunction," "hypoactive sexual desire disorder," "thyroid disease," "thyroiditis," "hypothyroidism," and "hyperthyroidism." RESULTS To date, well-designed studies that describe the relationship between FSDs and thyroid disorders are lacking. However, despite the limitations on available studies, current data indicate that sexual alterations are frequently associated with thyroid diseases in women. A complex interplay of direct and indirect hormonal and nonhormonal mechanisms has been hypothesized, including hormonal changes, neurotransmitter imbalance, reduced nitric oxide release, mood disorders, and other systemic consequences of both hypothyroidism and hyperthyroidism. Thyroid hormone receptors have also been identified in the genitourinary system. CONCLUSIONS In a clinical setting, physicians should investigate the sexuality of patients consulting for thyroid disease. At the same time, an evaluation of thyroid function should be performed in patients presenting with FSD, especially after menopause, when the risk of thyroid diseases and FSDs increases strongly.
Collapse
Affiliation(s)
- Federica Barbagallo
- Department of Clinical and Experimental Medicine, University of Catania, 95123, Catania, Italy
| | - Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, 95123, Catania, Italy
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Rosita A Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, 95123, Catania, Italy
| | - Laura Cucinella
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 2700, Pavia, Italy
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, 2700, Pavia, Italy
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, 95123, Catania, Italy
| | - Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 2700, Pavia, Italy
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, 2700, Pavia, Italy
| | - Aldo E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, 95123, Catania, Italy
| |
Collapse
|
4
|
Saltzman RG, G Campbell K, J Ripps S, Golan R, Cabreja-Castillo MA, Garzon AM, Rahman F, Caceres LV, Tovar JA, Khan A, Hare JM, Ramasamy R. The impact of cell-based therapy on female sexual dysfunction: a systematic review and meta-analysis. Sex Med Rev 2023; 11:333-341. [PMID: 37279578 DOI: 10.1093/sxmrev/qead023] [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: 01/17/2022] [Revised: 05/04/2023] [Accepted: 05/07/2023] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Female sexual dysfunction (FSD) is a complex issue affecting women of all ages; it involves several overlapping body systems and profoundly affects quality of life. The use of cell-based therapy, such as mesenchymal stem cells, has recently been investigated as a potential treatment for FSD. OBJECTIVES This systematic review and meta-analysis aim to assess FSD outcomes following cell-based therapy. METHODS We evaluated peer-reviewed articles from multiple online databases through November 2022 to identify studies that used cell-based therapy and reported sexual function outcomes in women. We performed a meta-analysis using data pooled from 3 clinical trials at our institution: CRATUS (NCT02065245), ACESO (NCT02886884), and CERES (NCT03059355). All 3 trials collected data from the Sexual Quality of Life-Female (SQOL-F) questionnaire as an exploratory outcome. RESULTS Existing literature on this topic is scarce. Five clinical studies and 1 animal study were included in the systematic review, and only 2 clinical studies were considered good quality: 1 reported significant SQOL-F improvement in women 6 months after cell therapy, and 1 reported posttherapy sexual satisfaction in all women. When individual patient data were pooled in a meta-analysis from 29 women across 3 trials at our institution, the SQOL-F was not significantly improved. CONCLUSION Despite growing interest in cell-based therapy for women's sexual health, this important issue is understudied in the literature. The optimal route, source, and dose of cell therapy to produce clinically meaningful change have yet to be determined, and further research is needed in larger randomized placebo-controlled clinical trials.
Collapse
Affiliation(s)
- Russell G Saltzman
- Interdisciplinary Stem Cell Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, United States
| | - Katherine G Campbell
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, United States
| | - Sarah J Ripps
- College of Medicine, Florida State University, Tallahassee, FL 32304, United States
| | - Roei Golan
- College of Medicine, Florida State University, Tallahassee, FL 32304, United States
| | - Maria A Cabreja-Castillo
- Interdisciplinary Stem Cell Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, United States
| | - Ana Maria Garzon
- Interdisciplinary Stem Cell Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, United States
| | - Farah Rahman
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, United States
| | - Lina V Caceres
- Interdisciplinary Stem Cell Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, United States
| | - Jairo A Tovar
- Interdisciplinary Stem Cell Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, United States
| | - Aisha Khan
- Interdisciplinary Stem Cell Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, United States
| | - Joshua M Hare
- Interdisciplinary Stem Cell Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, United States
- Division of Cardiovascular Medicine, Miller School of Medicine, University of Miami, Miami, FL 33136, 33136. United States
| | - Ranjith Ramasamy
- Interdisciplinary Stem Cell Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, United States
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, United States
| |
Collapse
|
5
|
Caruso G, Falzone L, Palermo G, Ricci D, Mazza G, Libra M, Caruso S, Gattuso G. Analysis of hsa-miR-19a-3p and hsa-miR-19b-3p modulation and phosphodiesterase type 5 expression in the vaginal epithelium of premenopausal women with genital arousal disorder. J Sex Med 2023:7143629. [PMID: 37185899 DOI: 10.1093/jsxmed/qdad057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/28/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Few studies have investigated the role of the phosphodiesterase type 5A (PDE5A) isoenzyme in female genital tissue disorders, exclusively taken from cadavers, as well as the epigenetic mechanisms responsible for the regulation of PDE5A levels. AIM The aim was to study the in vivo association between microRNA (miRNA) expression and the expression levels of PDE5A in women with female genital arousal disorder (FGAD) compared with healthy women. METHODS Premenopausal women affected by FGAD (cases) and sexually healthy women (control group) underwent microbiopsy of the periclitoral anterior vaginal wall for the collection of tissue samples. Computational analyses were preliminarily performed in order to identify miRNAs involved in the modulation of PDE5A by using miRNA-messenger RNA interaction prediction tools. Differences in the expression levels of miRNAs and PDE5A were finally investigated in cases and control subjects by using the droplet digital polymerase chain reaction amplification system and stratifying women considering their age, number of pregnancies, and body mass index. OUTCOMES Expression levels of miRNAs were able to target PDE5A and the tissue expression in women with FGAD compared with healthy women. RESULTS The experimental analyses were performed on 22 (43.1%) cases and 29 (56.9%) control subjects. Two miRNAs with the highest interaction levels with PDE5A, hsa-miR-19a-3p (miR-19a) and hsa-miR-19b-3p (miR-19b), were identified and selected for validation analyses. A reduction of the expression levels of both miRNAs was observed in women with FGAD compared with the control subjects (P < .05). Moreover, PDE5A expression levels were higher in women with FGAD and lower in women without sexual dysfunctions (P < .05). Finally, a correlation between body mass index and the expression levels of miR-19a was found (P < .01). CLINICAL IMPLICATIONS Women with FGAD had higher levels of PDE5 compared with control subjects; therefore, the administration of PDE5 inhibitors (PDE5 inhibitors) could be useful in women with FGAD. STRENGTHS AND LIMITATIONS The strength of the current study was to analyze genital tissue obtained in vivo from premenopausal women. A limitation was to not investigate other factors, including endothelial nitric oxide synthetases, nitric oxide, and cyclic guanosine monophosphate. CONCLUSION The results of the present study indicate that the modulation of selected miRNAs could influence PDE5A expression in genital tissues in healthy women or in those with FGAD. Such findings further suggest that treatment with PDE5 inhibitors, as a modulator of PDE5A expression, could be indicated for women with FGAD.
Collapse
Affiliation(s)
- Giuseppe Caruso
- Research Group for Sexology, Gynecological Clinic, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania 95123, Italy
| | - Luca Falzone
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania 95123, Italy
| | - Gaia Palermo
- Research Group for Sexology, Gynecological Clinic, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania 95123, Italy
| | - Daria Ricci
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania 95123, Italy
| | - Gabriele Mazza
- Research Group for Sexology, Gynecological Clinic, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania 95123, Italy
| | - Massimo Libra
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania 95123, Italy
| | - Salvatore Caruso
- Research Group for Sexology, Gynecological Clinic, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania 95123, Italy
| | - Giuseppe Gattuso
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania 95123, Italy
| |
Collapse
|
6
|
Symonds T, Kingsberg SA, Simon JA, Kroll R, Althof SE, Parish SJ, Cornell KA, Johnson IF, Goldstein AT. Symptoms and associated impact in pre- and postmenopausal women with sexual arousal disorder: a concept elicitation study. J Sex Med 2023; 20:277-286. [PMID: 36763961 DOI: 10.1093/jsxmed/qdac043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/31/2022] [Accepted: 12/08/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Approximately 26% of adult women in the United States suffer from female sexual arousal disorder (FSAD), yet little has been done to compare the experience of FSAD in pre- and postmenopausal women, which is critical to enhance the current understanding of FSAD and inform the development and assessment of treatment options for these patient populations. AIM To explore the experience of condition-associated symptoms and the relative importance of FSAD symptoms, including their severity, bother, and impact, on participants' health-related quality of life (HRQoL) in pre- and postmenopausal women with FSAD. METHODS In-depth, qualitative, semistructured concept elicitation interviews were conducted with premenopausal (n = 23) and postmenopausal (n = 13) women who were clinically diagnosed with FSAD by a trained sexual medicine clinician. All interviews were audio recorded and transcribed verbatim by a professional transcription company. Thematic analysis was performed with the assistance of NVivo qualitative analysis software. OUTCOMES Outcomes included qualitative interview data about FSAD symptoms and HRQoL, as well as a comparison between pre- and postmenopausal populations. RESULTS The most frequently reported symptom in both cohorts was "inability or difficulty with orgasm" (premenopausal, n = 21; postmenopausal, n = 13). The symptom that premenopausal women most desired to have treated was lubrication, and for postmenopausal women, it was a lack of lubrication or wetness and loss of feeling/sensation. In total, 21 of 23 premenopausal women and all 13 postmenopausal women reported a lack of feeling or sensation in the genitals. The most frequently reported HRQoL impact in both groups was decreased confidence. CLINICAL IMPLICATIONS Results from this study suggest that the manifestation and experience of FSAD are similar in pre- and postmenopausal women and that the unmet need for an FSAD treatment in the postmenopausal population is just as great as that of the premenopausal population. STRENGTHS AND LIMITATIONS This study involved in-depth qualitative interviews with a relatively small group of women (N = 36) recruited from only 5 study sites across the United States. CONCLUSION The analysis of qualitative data from the concept elicitation interviews revealed a substantial physical and emotional burden of FSAD, underscoring the need for Food and Drug Administration-approved treatment options for pre- and postmenopausal women with FSAD.
Collapse
Affiliation(s)
- Tara Symonds
- Clinical Outcomes Solutions, Folkestone, Kent, CT19 4RH, United Kingdom
| | - Sheryl A Kingsberg
- Division of Behavioral Medicine, Department of OBGYN, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, United States.,Departments of Reproductive Biology, Psychiatry, and Urology, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, United States
| | - James A Simon
- Department of OBGYN, George Washington University, Washington, DC 20052, United States.,IntimMedicine Specialists, Washington, DC 20036, United States
| | - Robin Kroll
- Seattle Clinical Research Center, Seattle, WA 98105, United States
| | - Stanley E Althof
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, United States.,Center for Marital and Sexual Health of South Florida, West Palm Beach, FL 33401, United States
| | - Sharon J Parish
- Weill Cornell Medical College, New York, NY 10021, United States
| | | | | | - Andrew T Goldstein
- Daré Bioscience, San Diego, CA 92122, United States.,Center for Vulvovaginal Disorders, Washington, DC 20037, United States
| |
Collapse
|
7
|
Espitia De La Hoz FJ. [Efficacy and safety of testosterone in the treatment of hypoactive sexual desire in women: what does the evidence say?]. Rev Int Androl 2023; 21:100328. [PMID: 36347772 DOI: 10.1016/j.androl.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/19/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the efficacy and safety of testosterone in the treatment of hypoactive sexual desire in women. MATERIALS AND METHODS A systematic review of the literature was carried out in different electronic databases (CINAHL, DynaMed, EMBASE, Lilacs, Medline, Scopus, among others), between January 1990 and May 2021; through standardized search terms. The outcomes evaluated included the efficacy and safety of testosterone in increasing sexual desire, the total number of satisfactory sexual activity, the number of orgasms and the level of distress in patients with hypoactive sexual desire and the proportion of adverse reactions. RESULTS 72 articles were included. The use of testosterone, in postmenopausal women, with hypoactive sexual desire, reports a positive effect on sexual function, with significant increases in satisfactory sexual activity, as well as improvement in all domains of sexual function (desire, arousal and orgasmic response) and a decrease in personal anguish, with an increase in the Female Sexual Function Index score. In women of childbearing age, testosterone is formulated for "off-label" use, in such a way that compounds and doses designed for treatments in men or magisterial formulas are used (which are not approved by consensus groups or endorsed by research), but has not shown any effect on sexual function. The most frequent adverse reactions are usually hirsutism and acne, although in general testosterone, at physiological doses, has a favorable safety profile. CONCLUSIONS Testosterone is an effective and safe therapy in the treatment of hypoactive sexual desire disorder in women after menopause. Currently there are no studies available to support the use of testosterone therapy in women of reproductive age, therefore, its use is not approved.
Collapse
Affiliation(s)
- Franklin José Espitia De La Hoz
- Ginecología y Obstetricia, Universidad Militar Nueva Granada, Bogotá, Colombia; Sexología Clínica, Universidad de Alcalá de Henares, Madrid, España; Uroginecología, FUCS, Hospital de San José, Unicamp, Brasil; Hathor, Clínica Sexológica, Armenia, Colombia.
| |
Collapse
|
8
|
Nappi RE, Tiranini L, Cucinella L, Martini E, Bosoni D, Righi A, Cassani C, Gardella B. Pharmacotherapy for female sexual dysfunctions (FSDs): what is on the market and where is this field heading? Expert Opin Pharmacother 2023; 24:135-143. [PMID: 35430926 DOI: 10.1080/14656566.2022.2066997] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Female sexual dysfunctions (FSDs) are common in women of any age and have a huge impact on quality of life and relationships. They have a multifaceted etiology limiting the development of pharmacotherapies with a high rate of effectiveness. Safety issues are also a concern. AREAS COVERED The authors report the most recent advances in pharmacotherapy for premenopausal and postmenopausal women with a main focus on hypoactive sexual desire disorders (HSDD) and associated sexual symptoms. Good levels of evidence have emerged for psychoactive agents, such as flibanserin and bremelanotide, as well as hormonal compounds (transdermal testosterone). The authors also report briefly on intravaginal DHEA (prasterone), local estrogen therapy (LET), and ospemifene to manage effectively vulvovaginal atrophy/genitourinary syndrome of menopause (VVA/GSM). In addition, they discuss promising therapeutic options highlighting the main reasons that hamper the availability of new labeled products. Finally, they include the importance of the multimodal approach to address FSDs. EXPERT OPINION Approved pharmacotherapies for FSD are limited. Validated multidimensional instruments and adequate objective measures of physical and mental responses to sexual external and internal incentives are mandatory to identify women suitable to chronic or on-demand treatments and to assess their pattern of response in research and practice.
Collapse
Affiliation(s)
- Rossella E Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Lara Tiranini
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Laura Cucinella
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Ellis Martini
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - David Bosoni
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Alessandra Righi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Chiara Cassani
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Unit of Obstetrics and Gynecology, IRCCS S. Matteo Foundation, Pavia, Italy
| | - Barbara Gardella
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Unit of Obstetrics and Gynecology, IRCCS S. Matteo Foundation, Pavia, Italy
| |
Collapse
|
9
|
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.
Collapse
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.
| |
Collapse
|
10
|
Baniotopoulos P, Pyrgidis N, Minopoulou I, Tishukov M, Sokolakis I, Hatzichristodoulou G, Dimitroulas T. Treatment of Sexual Dysfunction in Women with Systemic Autoimmune Rheumatic Disorders: A Systematic Review. Sex Med Rev 2022; 10:520-528. [PMID: 37051964 DOI: 10.1016/j.sxmr.2022.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/16/2022] [Accepted: 08/02/2022] [Indexed: 02/04/2023]
Abstract
Abstract
Introduction
Female sexual dysfunction (SD) is an under-recognized and undertreated problem in patients with systemic autoimmune rheumatic disorders (SARDs).
Objectives
To summarize and evaluate the existing treatment modalities for SD in females with SARDs.
Methods
A systematic review was conducted following the PRISMA guidelines. Electronic databases were searched up to April 2022 for studies that assessed the use of pharmacological and non-pharmacological treatment modalities for the management of SD in females with SARDs. Randomized and observational studies were included. (PROSPERO: CRD42022296381).
Results
Seven studies with 426 females with SD were included. Seven different treatment modalities belonging to 5 different classes (androgen therapy, phosphodiesterase-5 inhibitors, exercise, education and local creams) were evaluated in patients with systemic lupus erythematosus, rheumatoid arthritis and systemic sclerosis. The majority of the studies were of low methodological quality. Standardized patient education and 8-week aerobic walking programs were successful in improving female SD. Local creams improved dyspareunia in females with systemic sclerosis. Testosterone did not significantly improve SD in patients with systemic lupus erythematosus. Accordingly, tadalafil did not result in a significant improvement of SD in females with systemic sclerosis, based on the Female Sexual Function Index.
Conclusion
There is a lack of sufficient evidence to recommend a certain management strategy for SD in females with SARDs. Nonpharmacological therapy and lubricant creams may be beneficial in females with SARDs. No benefit was demonstrated after androgen therapy or tadalafil. Still, no definite conclusions can be drawn due to the important limitations of the available literature. Overall, our results may be considered preliminary and further research in the field is mandatory.
Collapse
Affiliation(s)
| | - Nikolaos Pyrgidis
- Department of Urology , Nuremberg , Germany
- ‘Martha-Maria’ Hospital Nuremberg , Nuremberg , Germany
| | - Ioanna Minopoulou
- Fourth Department of Internal Medicine , Thessaloníki , Greece
- Medical School , Thessaloníki , Greece
- Hippokration General Hospital , Thessaloníki , Greece
- Aristotle University of Thessaloniki , Thessaloníki , Greece
| | - Maksim Tishukov
- Medical School , Thessaloniki , Greece
- Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Ioannis Sokolakis
- Department of Urology , Nuremberg , Germany
- ‘Martha-Maria’ Hospital Nuremberg , Nuremberg , Germany
| | | | - Theodoros Dimitroulas
- Fourth Department of Internal Medicine , Thessaloníki , Greece
- Medical School , Thessaloníki , Greece
- Hippokration General Hospital , Thessaloníki , Greece
- Aristotle University of Thessaloniki , Thessaloníki , Greece
| |
Collapse
|
11
|
Cipriani S, Simon JA. Sexual Dysfunction as a Harbinger of Cardiovascular Disease in Postmenopausal Women: How Far Are We? J Sex Med 2022; 19:1321-1332. [DOI: 10.1016/j.jsxm.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 05/04/2022] [Accepted: 06/09/2022] [Indexed: 10/17/2022]
|
12
|
Mohammed GF, Saad HM. Severe COVID-19 has Low Testosterone, Estrogen Levels, and Impaired Sexuality. SEXOLOGIES 2022. [PMCID: PMC9061178 DOI: 10.1016/j.sexol.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
For assessing whether women with and without COVID-19 differed with regard to female genital self-image, sexual function and hormonal profile. Female genital self-image being assessed with the female genital self-image scale (FGSIS) and Female Sexual Function Index (FSFI) and laboratory investigations. The study had revealed significant differences in all domains of the FSFI except pain between the cases and the controls. The study had demonstrated significant differences in all domains of the FGSIS between the cases and the controls. The study had shown significant decline in the post-COVID-19 serum levels of total testosterone (TT), free testosterone (FT) and estradiol (E) between the two groups (P < 0.05). Positive correlations between serum TT, FT, E and FGSIS domains and total score of FGSIS in the cases were observed.
Collapse
|
13
|
Female orgasmic dysfunction and severe climacteric symptomatology in women aged 40 to 59 years. Menopause 2022; 29:654-663. [DOI: 10.1097/gme.0000000000001973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
14
|
Cucinella L, Martini E, Tiranini L, Battista F, Molinaro P, Casiraghi A, Cominotti S, Piccinino M, Rossini R, Nappi RE. Menopause and female sexual dysfunctions (FSDs). Minerva Obstet Gynecol 2022; 74:234-248. [PMID: 35107240 DOI: 10.23736/s2724-606x.22.05001-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Biological and psycho-relational factors contribute equally to the development of sexual symptoms and associated distress, a key element to diagnose female sexual dysfunctions (FSDs) in menopausal women. Consultation at midlife represents an optimal time to discuss sexual life, and healthcare providers (HCPs) have to be proactive in rising the conversation, as patients may not report their sexual concerns spontaneously. An accurate sexual history is essential to characterize the primary symptom, determine the impact on patient's quality of life and identify risk and precipitating factors. Among FSDs, hypoactive sexual desire disorder (HSDD) is very frequent at midlife together with genitourinary syndrome of menopause (GSM), a chronic condition negatively affecting the full sexual response. A multidimensional approach targeted to the patient's characteristics, goals and expectations is mandatory and should start from educative counselling and correction of modifiable risk factors. When specific treatments are required, they should include non-pharmacological and pharmacological options, often prescribed in combination to address concomitantly the biological and psychosocial components of FSDs.
Collapse
Affiliation(s)
- Laura Cucinella
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy - .,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy -
| | - Ellis Martini
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy
| | - Lara Tiranini
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Federica Battista
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Pietro Molinaro
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Arianna Casiraghi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Urogynecology Unit, Division of Gynecology and Obstetrics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Selene Cominotti
- Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Manuela Piccinino
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy
| | - Roberta Rossini
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy
| | - Rossella E Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| |
Collapse
|
15
|
Trento SRSS, Madeiro A, Rufino AC. Sexual Function and Associated Factors in Postmenopausal Women. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:522-529. [PMID: 34461662 PMCID: PMC10301848 DOI: 10.1055/s-0041-1735128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To assess the sexual function and associated factors in postmenopausal women. METHODS This a descriptive, cross-sectional study with 380 women aged 40 to 65 years, users of public health services in 2019. Questionnaires were applied on demographic characteristics, on climacteric symptoms (menopause rating scale) and on sexual function (sexual quotient, female version). Bivariate and multiple analyses by logistic regression were performed, with adjusted odds ratios (ORad) and 95% confidence intervals (95%CIs). RESULTS More than half (243/64%) of the participating women were at risk of sexual dysfunction, with lower scores in the domains of sexual desire and interest, comfort, orgasm, and satisfaction. Women with a partner (ORad 2.07; 95%CI 1.03-4.17) and those who reported sleep problems (ORad 2.72; 95%CI 1.77-4.19), depressed mood (ORad 2.03; 95%CI 1.32-3.10), sexual complaints (ORad 8.16; 95%CI 5.06-13.15), and vaginal dryness (ORad 3.44; 95%CI 2.22-5.32) showed greater chance of sexual dysfunction. CONCLUSION There was a high prevalence of sexual dysfunction, with the influence of conjugality and climacteric symptoms on sexual function.
Collapse
Affiliation(s)
| | - Alberto Madeiro
- Programa de Pós-Graduação em Saúde e Comunidade, Universidade Federal do Piauí, Teresina, PI, Brazil
| | | |
Collapse
|
16
|
Bird ER, Piccirillo M, Garcia N, Blais R, Campbell S. Relationship Between Posttraumatic Stress Disorder and Sexual Difficulties: A Systematic Review of Veterans and Military Personnel. J Sex Med 2021; 18:1398-1426. [PMID: 37057456 DOI: 10.1016/j.jsxm.2021.05.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/26/2021] [Accepted: 05/15/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is associated with sexual difficulties but the nuances of this relationship remain elusive. Research has increased in recent years, most notably following publication of several reviews in 2015. AIM This systematic review examines the relationship between PTSD and sexual difficulties in veterans/military personnel. METHODS A systematic review was conducted using PRISMA guidelines in PsycINFO and PubMed databases for studies examining a diagnosis of PTSD or PTSD severity in relation to a range of sexual difficulties. Forty-three studies were identified that met inclusion and exclusion criteria for this review. RESULTS PTSD was associated with increased risk of experiencing at least one sexual difficulty. PTSD was most clearly associated with overall sexual function, sexual desire, sexual satisfaction, and sexual distress. Results were mixed for sexual arousal, orgasm function, erectile dysfunction, premature ejaculation, sexual pain, and frequency of sexual activity. PTSD symptom clusters of avoidance and negative alterations in cognition/mood were most commonly associated sexual difficulties. Few studies compared results by gender and trauma type. CLINICAL IMPLICATIONS Clinicians should inquire about sexual health in relation to PTSD symptoms and target avoidance and negative mood symptoms by incorporating sexual exposure assignments and sexual activation exercises when appropriate. STRENGTHS & LIMITATIONS This systematic review synthesizes an extensive literature that has grown substantially in the past 5 years and includes studies with low to moderate risk of bias. Limitations of the existing literature include challenges differentiating between PTSD and depression, inconsistent measurement of PTSD and trauma histories, inconsistent operationalization and measurement of sexual outcomes, and largely cross-sectional study designs. CONCLUSION PTSD is linked to a range of sexual outcomes. The current literature suggests that PTSD is associated with sexual difficulties related to both the sexual response cycle (ie, sexual desire) and one's emotional relationship to sexual activity (eg, sexual distress). More research is needed to increase confidence in findings. Bird ER, Piccirillo M, Garcia N, et al. Relationship Between Posttraumatic Stress Disorder and Sexual Difficulties: A Systematic Review of Veterans and Military Personnel. J Sex Med 2021;18:1398-1426.
Collapse
Affiliation(s)
- Elizabeth R Bird
- VA Puget Sound Healthcare System, Seattle Division, Seattle, WA.
| | - Marilyn Piccirillo
- VA Puget Sound Healthcare System, Seattle Division, Seattle, WA; University of Washington, Department of Psychology, Seattle, WA
| | - Natalia Garcia
- VA Puget Sound Healthcare System, Seattle Division, Seattle, WA
| | - Rebecca Blais
- Utah State University, Department of Psychology, Logan, UT
| | - Sarah Campbell
- Seattle-Denver Center of Innovation in Veteran-Centered and Value-Driven Care, Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| |
Collapse
|
17
|
Overexpressing miR-122-5p Inhibits the Relaxation of Vaginal Smooth Muscle in Female Sexual Arousal Disorder by Targeting Vasoactive Intestinal Peptide Receptor 1. Sex Med 2021; 9:100390. [PMID: 34246178 PMCID: PMC8360939 DOI: 10.1016/j.esxm.2021.100390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/07/2021] [Accepted: 05/03/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction Female sexual arousal disorder (FSAD) is a common issue causing physical and psychological pain, but it has no standard diagnostic criteria or treatment. So its pathogenesis desiderates to be explored. Aim To investigate the specific function of miR-122-5p in FSAD. Methods 18 subjects were grouped into FSAD and normal control groups according to the Chinese version of the Female Sexual Function Index, and the expression levels of miR-122-5p and vasoactive intestinal peptide receptor 1 (VIPR1) protein in their tissue were verified through real-time quantitative polymerase chain reaction (qRT-PCR) and western blot (WB) analysis. Then in vitro experiment, miR-122-5p was overexpressed or inhibited in rat vaginal smooth muscle cells (SMCs). The relaxation of rat vaginal SMCs was reflected by the cell morphology, intracellular free cytosolic calcium ion (Ca2+) levels, cell proliferation and apoptosis, together with the cyclic adenosine monophosphate (cAMP) concentration and protein kinase A (PKA) activities. Additionally, the expression levels of relaxation-related proteins, including VIPR1, stimulatory G protein (Gs), adenylate cyclase (AC), and PKA, were detected based on WB analysis. Furthermore, a rescue experiment that simultaneously overexpressed or silenced miR-122-5p and VIPR1 was conducted, and all the indicators were evaluated. Main Outcomes Measure The expression level of VIPR1 and downstream proteins, cell morphology, cell proliferation and apoptosis, and intracellular free Ca2+ levels were examined. Results We verified that women with FSAD had higher miR-122-5p and lower VIPR1 protein. Then overexpressing miR-122-5p decreased relaxation of rat vaginal SMCs, which was manifested as a contractile morphology of cells, an increased intracellular free Ca2+ concentration, and lower cAMP concentration and PKA activity. Moreover, by rescue experiments, we inferred that VIPR1 was the target of miR-122-5p and affected the relaxation function of vaginal SMCs. Conclusion miR-122-5p regulates the relaxation of vaginal SMCs in FSAD by targeting VIPR1, ulteriorly providing an underlying diagnostic and therapeutic target for FSAD. Cong S, Gui T, Shi Q, et al. Overexpressing miR-122-5p Inhibits the Relaxation of Vaginal Smooth Muscle in Female Sexual Arousal Disorder by Targeting Vasoactive Intestinal Peptide Receptor 1. Sex Med 2021;9:100390.
Collapse
|
18
|
Maseroli E, Rastrelli G, Di Stasi V, Cipriani S, Scavello I, Todisco T, Gironi V, Castellini G, Ricca V, Sorbi F, Fambrini M, Petraglia F, Maggi M, Vignozzi L. Physical Activity and Female Sexual Dysfunction: A Lot Helps, But Not Too Much. J Sex Med 2021; 18:1217-1229. [PMID: 37057426 DOI: 10.1016/j.jsxm.2021.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Research on the relationship between physical activity (PA) and female sexual dysfunction (FSD) is lacking. AIM To investigate the clinical, psychological, and sexual correlates of PA in women with FSD. METHODS A non-selected series of n = 322 pre- and post-menopausal patients consulting for FSD was retrospectively studied. Regular involvement in PA and its frequency (<1 hour/week: sedentary, 1-3 hours/week: active, 4-6 hours/week: very active, >6 hours/week: extremely active) were investigated with a specific question. OUTCOMES FSDs, including HSDD (Hypoactive sexual desire disorder) and FGAD (Female genital arousal disorder), were diagnosed according to a structured and clinical interview. Participants underwent a physical examination and a clitoral Doppler ultrasound, and were asked to complete the Female Sexual Function Index, Female Sexual Distress Scale-Revised, Body Uneasiness Test, and Middlesex Hospital Questionnaire. RESULTS At multivariate analysis, women engaging in PA (67.4%, n = 217) scored significantly higher in several Female Sexual Function Index domains - including desire, arousal and lubrication - and showed lower sexual distress and lower resistance of clitoral arteries, as compared to sedentary women. A significant, inverse association between PA and HSDD was observed. Mediation analysis demonstrated that the negative association between PA and HSDD was partly mediated by body image concerns (Body Uneasiness Test Global severity index), psychopathological symptoms (Middlesex Hospital Questionnaire total score) and sexual distress (Female Sexual Distress Scale-Revised score). These latter 2 factors also partly mediated the association between PA and a reduced risk of FGAD, whilst a lower BMI was a full mediator in the relationship between PA and FGAD. Finally, extreme PA was associated with significantly worse scores in several psychosexual parameters (i,e, sexual satisfaction and histrionic/hysterical symptoms), even compared to a sedentary lifestyle. CLINICAL IMPLICATIONS Women consulting for FSD may gain benefits on desire, arousal, lubrication and sex-related distress from regular PA; however, physicians should remain alert to the downsides of excessive exercise. STRENGTHS & LIMITATIONS The main strength lies in the novelty of the findings. The main limitations are the cross-sectional nature, the clinical setting, the small sample size of the different PA groups, and the use of self-reported instruments for the evaluation of PA. CONCLUSION In women with FSD, PA was associated with better sexual function and clitoral vascularization, lower sexual distress and reduced odds of HSDD and FGAD; the benefits of PA on sexuality were mediated by both psychological and organic determinants; excessive PA was related with a poor overall sexual function and with a low sexual satisfaction. Maseroli E, Rastrelli G, Di Stasi V, et al. Physical Activity and Female Sexual Dysfunction: A Lot Helps, But Not Too Much. J Sex Med 2021;18:1217-1229.
Collapse
Affiliation(s)
- Elisa Maseroli
- Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, , Florence, Italy
| | - Giulia Rastrelli
- Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, , Florence, Italy
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Azienda Ospedaliero-Universitaria Careggi, , Florence, Italy
| | - Vincenza Di Stasi
- Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, , Florence, Italy
| | - Sarah Cipriani
- Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, , Florence, Italy
| | - Irene Scavello
- Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, , Florence, Italy
| | - Tommaso Todisco
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Azienda Ospedaliero-Universitaria Careggi, , Florence, Italy
| | - Veronica Gironi
- Psychiatric Unit, Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, , Florence, Italy
| | - Giovanni Castellini
- Psychiatric Unit, Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, , Florence, Italy
| | - Valdo Ricca
- Psychiatric Unit, Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, , Florence, Italy
| | - Flavia Sorbi
- Gynecology Unit, Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, , Florence, Italy
| | - Massimiliano Fambrini
- Gynecology Unit, Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, , Florence, Italy
| | - Felice Petraglia
- Gynecology Unit, Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, , Florence, Italy
| | - Mario Maggi
- Endocrinology Unit, Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, , Florence, Italy
- I.N.B.B. (Istituto Nazionale Biostrutture e Biosistemi), Rome, Italy
| | - Linda Vignozzi
- Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, , Florence, Italy
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Azienda Ospedaliero-Universitaria Careggi, , Florence, Italy
- I.N.B.B. (Istituto Nazionale Biostrutture e Biosistemi), Rome, Italy
| |
Collapse
|
19
|
Pyrgidis N, Mykoniatis I, Tishukov M, Sokolakis I, Nigdelis MP, Sountoulides P, Hatzichristodoulou G, Hatzichristou D. Sexual Dysfunction in Women With End-Stage Renal Disease: A Systematic Review and Meta-Analysis. J Sex Med 2021; 18:936-945. [PMID: 33903042 DOI: 10.1016/j.jsxm.2021.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/07/2021] [Accepted: 02/18/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND In women with end-stage renal disease (ESRD), female sexual dysfunction (SD) remains underestimated. AIM To explore the prevalence, correlates, diagnostic approach and treatment modalities of sexual symptoms in females with ESRD. METHODS We performed a systematic review and meta-analysis to estimate both the prevalence of SD and the pooled Female Sexual Function Index (FSFI) scores in ESRD females. Similarly, for studies reporting the FSFI score before and after renal transplantation (RT), we estimated the effect of RT on sexual function. Further assessment of heterogeneity was conducted via subgroup and sensitivity analyses, cumulative meta-analysis and univariate meta-regression of important correlates. Records were identified through searching PubMed, Cochrane Library and Scopus databases as well as sources of grey literature until November 2020 (PROSPERO ID: CRD42020215178). OUTCOMES We included 47 studies with 61 patient group entries and 3490 ESRD female individuals (median age: 45.2 years, ΙQR: 40.4-50.6). RESULTS The SD prevalence in all females with ESRD was 74% (95%CI: 67%-80%, I2 = 92%) and the FSFI total score 16.1 points (95%CI: 14.3-17.8, I2 = 98%). The female SD prevalence was 63% (95%CI: 43%-81%, I2 = 92%) in renal transplant recipients, 80% (95%CI: 72%-87%, I2 = 91%) in hemodialysis patients and 67% (95%CI: 46%-84%, I2 = 90%) in peritoneal dialysis patients. The total FSFI score improved by 7.5 points (95%CI: 3.9-11.1, I2 = 92%) after RT. Older age and menopause were associated with higher SD prevalence. CLINICAL TRANSLATION Female SD is highly prevalent in all ESRD women, but renal transplant recipients reported improved sexual function. STRENGTHS & LIMITATIONS We provide the first study about SD in females and assessed the role of RT on sexual function. Contrary, none of the included studies evaluated the concomitant presence of distress with SD. The levels of heterogeneity were substantially high for all outcomes and we could not adjust for further correlates, which might have affected our measures. CONCLUSIONS Sexual symptoms negatively affect the quality of life and warrants appropriate clinical attention, as they are an underdetermined and undertreated clinical entity in females with ESRD. Studies on treatment modalities of female SD in patients with ESRD are mandatory, as currently no relevant studies or clinical recommendations exist. Pyrgidis N, Mykoniatis I, Tishukov M, et al. Sexual Dysfunction in Women With End-Stage Renal Disease: A Systematic Review and Meta-Analysis. Sex Med Rev 2021;18:936-945.
Collapse
Affiliation(s)
- Nikolaos Pyrgidis
- Urology Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece; Department of Urology, 'Martha-Maria' Hospital Nuremberg, Nuremberg, Germany.
| | - Ioannis Mykoniatis
- Urology Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maksim Tishukov
- Urology Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Sokolakis
- Department of Urology, 'Martha-Maria' Hospital Nuremberg, Nuremberg, Germany
| | - Meletios P Nigdelis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Petros Sountoulides
- Urology Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Dimitrios Hatzichristou
- Urology Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
20
|
Jang C, Boyle JA, Vincent A. Global consensus statement on testosterone therapy for women: an Australian perspective. Med J Aust 2020; 213:449-452.e1. [PMID: 33131104 DOI: 10.5694/mja2.50837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Christina Jang
- Mater Health Services, Brisbane, QLD.,University of Queensland, Brisbane, QLD
| | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC.,Monash Health, Melbourne, VIC
| | - Amanda Vincent
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC.,Monash Health, Melbourne, VIC
| |
Collapse
|
21
|
Barbagallo F, Mongioì L, Cannarella R, La Vignera S, Condorelli R, Calogero A. Sexual Dysfunction in Diabetic Women: An Update on Current Knowledge. DIABETOLOGY 2020; 1:11-21. [DOI: 10.3390/diabetology1010002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Diabetes mellitus (DM) is one of the most common chronic diseases worldwide and its prevalence is expected to increase in the coming years. Therefore, updated knowledge of all diabetic complications and their management is essential for the proper treatment of these patients. Sexual dysfunctions are one of the long-term complications of DM in both genders. However, female sexuality is still a taboo and sexual concerns are often overlooked, underdiagnosed, and untreated. The aim of this review is to summarize the current knowledge on the relationship between sexual function and DM in women. In particular, we evaluated the prevalence, etiology, diagnostic approaches, and current treatment options of female sexual dysfunction (FSD) in diabetic patients.
Collapse
|
22
|
Mechanosensitive Vaginal Epithelial Adenosine Triphosphate Release and Pannexin 1 Channels in Healthy, in Type 1 Diabetic, and in Surgically Castrated Female Mice. J Sex Med 2020; 17:870-880. [PMID: 32241676 DOI: 10.1016/j.jsxm.2020.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 01/15/2020] [Accepted: 02/09/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Distension of hollow organs is known to release adenosine triphosphate (ATP) from the lining epithelium, which triggers local responses and activates sensory nerves to convey information to the central nervous system. However, little is known regarding participation of ATP and mediators of ATP release, such as Pannexin 1 (Panx1) channels, in mechanisms of vaginal mechanosensory transduction and of changes imposed by diabetes and menopause, conditions associated with vaginal dysfunction and risk for impaired genital arousal. AIM To investigate if intravaginal mechanical stimulation triggers vaginal ATP release and if (a) this response involves Panx1 channels and (b) this response is altered in animal models of diabetes and menopause. METHODS Diabetic Akita female mice were used as a type 1 diabetes (T1D) model and surgical castration (ovariectomy [OVX]) as a menopause model. Panx1-null mice were used to evaluate Panx1 participation in mechanosensitive vaginal ATP release. Vaginal washes were collected from anesthetized mice at baseline (non-stimulated) and at 5 minutes after intravaginal stimulation. For the OVX and Sham groups, samples were collected before surgery and at 4, 12, 22, 24, and 28 weeks after surgery. ATP levels in vaginal washes were measured using the luciferin-luciferase assay. Panx1 mRNA levels in vaginal epithelium were quantified by quantitative polymerase chain reaction. OUTCOMES The main outcome measures are quantification of mechanosensitive vaginal ATP release and evaluation of impact of Panx1 deletion, OVX, and T1D on this response. RESULTS Intravaginal mechanical stimulation-induced vaginal ATP release was 84% lower in Panx1-null (P < .001) and 76% lower in diabetic (P < .0001) mice compared with controls and was reduced in a progressive and significant manner in OVX mice when compared with Sham. Panx1 mRNA expression in vaginal epithelium was 44% lower in diabetics than that in controls (P < .05) and 40% lower in OVX than that in the Sham (P < .05) group. CLINICAL TRANSLATION Panx1 downregulation and consequent attenuation of mechanosensitive vaginal responses may be implicated in mechanisms of female genital arousal disorder, thereby providing potential targets for novel therapies to manage this condition. STRENGTHS & LIMITATIONS Using animal models, we demonstrated Panx1 involvement in mechanosensitive vaginal ATP release and effects of T1D and menopause on this response and on Panx1 expression. A limitation is that sex steroid hormone levels were not measured, precluding correlations and insights into mechanisms that may regulate Panx1 expression in the vaginal epithelium. CONCLUSIONS Panx1 channel is a component of the vaginal epithelial mechanosensory transduction system that is essential for proper vaginal response to mechanical stimulation and is targeted in T1D and menopause. Harroche J, Urban-Maldonado M, Thi MM, et al. Mechanosensitive Vaginal Epithelial Adenosine Triphosphate Release and Pannexin 1 Channels in Healthy, in Type 1 Diabetic, and in Surgically Castrated Female Mice. J Sex Med 2020;17:870-880.
Collapse
|
23
|
Sharan P, Purnima S, Rao R, Kedia S, Khoury B, Reed GM. Field Testing of ICD-11 Proposals for Female Sexual Dysfunctions in India: Cognitive Interviews with Patients. Arch Med Res 2020; 50:567-576. [PMID: 32062429 DOI: 10.1016/j.arcmed.2020.01.002] [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] [Received: 08/02/2019] [Revised: 01/10/2020] [Accepted: 01/14/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Women's experiences of female sexual difficulties are shaped by cultural expectations. AIM OF THE STUDY To investigate the cultural validity and clinical utility of the classification of female sexual dysfunctions (FSD) in the International Classification of Diseases - 11th Revision (ICD-11) among Indian Women. METHODS A purposive sample of 22 married women with probable sexual problems underwent cognitive interviews that were conducted using a semi-structured guide. The interviews were transcribed and analyzed qualitatively to help establish the content and cultural validity of the ICD-11 classification of FSD. RESULTS Most participants had limited knowledge of the sexual act, felt unskilled in sex, and were led by their husbands in sexual matters. Many participants reported problems related to sexual dysfunction and sexual pain-penetration. Many participants with sexual pain-penetration issues and some with low sexual desire considered these symptoms to be problematic; however, this was rarely the case with the absence or lack of sexual arousal and orgasm. The application of the 'independent focus of clinical attention' requirement for diagnosis reduced cases by half for Hypoactive Sexual Desire Disorder (HSDD) and almost eliminated all cases of Female Sexual Arousal Dysfunction (FSAD) and Anorgasmia. Hence, this requirement was moved from essential (required) features to 'additional features' of the final ICD-11 sexual dysfunction guidelines. CONCLUSION Advancement toward a more precise nomenclature and classification system of FSD will facilitate better diagnosis which will ultimately lead to improved care for women with sexual dysfunction.
Collapse
Affiliation(s)
- Pratap Sharan
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
| | - Shivani Purnima
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Ravindra Rao
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Swati Kedia
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Brigitte Khoury
- Associate Professor, Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
| | - Geoffrey M Reed
- Department of Psychiatry and Global Mental Health Program, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| |
Collapse
|
24
|
Davis SR, Baber R, Panay N, Bitzer J, Perez SC, Islam RM, Kaunitz AM, Kingsberg SA, Lambrinoudaki I, Liu J, Parish SJ, Pinkerton J, Rymer J, Simon JA, Vignozzi L, Wierman ME. Global Consensus Position Statement on the use of Testosterone Therapy for Women. Maturitas 2019; 128:89-93. [DOI: 10.1016/j.maturitas.2019.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
25
|
Davis SR, Baber R, Panay N, Bitzer J, Perez SC, Islam RM, Kaunitz AM, Kingsberg SA, Lambrinoudaki I, Liu J, Parish SJ, Pinkerton J, Rymer J, Simon JA, Vignozzi L, Wierman ME. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab 2019; 104:4660-4666. [PMID: 31498871 PMCID: PMC6821450 DOI: 10.1210/jc.2019-01603] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 01/22/2023]
Abstract
This Position Statement has been endorsed by the International Menopause Society, The Endocrine Society, The European Menopause and Andropause Society, The International Society for Sexual Medicine, The International Society for the Study of Women's Sexual Health, The North American Menopause Society, The Federacion Latinoamericana de Sociedades de Climaterio y Menopausia, The Royal College of Obstetricians and Gynecologists, The International Society of Endocrinology, The Endocrine Society of Australia, and The Royal Australian and New Zealand College of Obstetricians and Gynecologists.
Collapse
Affiliation(s)
- Susan R Davis
- Women’s Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- The International Menopause Society
- Correspondence and Reprint Requests: Susan R. Davis, MBBS, PhD, Women’s Health Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St. Kilda Road, Melbourne, Victoria 3004, Australia. E-mail:
| | - Rodney Baber
- University of Sydney, Sydney, Australia
- The International Menopause Society
- Royal Australian and New Zealand College of Obstetricians and Gynaecologists
| | - Nicholas Panay
- Queen Charlotte’s & Chelsea and Westminster Hospitals and Imperial College, London, United Kingdom
- The International Menopause Society
| | - Johannes Bitzer
- University Hospital Basel, Basel, Switzerland
- The International Society for Sexual Medicine
| | - Sonia Cerdas Perez
- Endocrinology Department, Hospital Cima and University of Costa Rica, San Jose, Costa Rica
- The Federacion Latinoamericana de Sociedades de Climaterio y Menopausia
| | - Rakibul M Islam
- Women’s Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- The International Menopause Society
| | - Andrew M Kaunitz
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville, Florida
- The American College of Obstetricians and Gynecologists
| | - Sheryl A Kingsberg
- Behavioral Medicine, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio
- The North American Menopause Society
| | - Irene Lambrinoudaki
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
- The European Menopause and Andropause Society
| | - James Liu
- Department of Obstetrics and Gynecology, University Hospitals Cleveland and Case Western Reserve University School of Medicine, Cleveland, Ohio
- The American College of Obstetricians and Gynecologists
| | - Sharon J Parish
- Weill Cornell Medical College, New York, New York
- The International Society for the Study of Women’s Sexual Health
| | - JoAnn Pinkerton
- Department of Obstetrics and Gynecology, the University of Virginia Health System, Charlottesville, Virginia
- The North American Menopause Society
| | - Janice Rymer
- King’s College London, Guy’s and St. Thomas’ Foundation Hospital Trust, London, United Kingdom
- The Royal College of Obstetricians and Gynaecologists
| | - James A Simon
- George Washington University, Washington, DC
- IntimMedicine Specialists, Washington, DC
- The International Society for the Study of Women’s Sexual Health
| | - Linda Vignozzi
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio,” University of Florence, Florence, Italy
- Careggi Hospital, Florence, Italy
- The International Society for Sexual Medicine
| | - Margaret E Wierman
- Department of Medicine, Integrative Physiology and Obstetrics and Gynecology, University of Colorado, Anschutz Medical Campus, Colorado
- The Endocrine Society
| |
Collapse
|
26
|
Davis SR, Baber R, Panay N, Bitzer J, Cerdas Perez S, Islam RM, Kaunitz AM, Kingsberg SA, Lambrinoudaki I, Liu J, Parish SJ, Pinkerton J, Rymer J, Simon JA, Vignozzi L, Wierman ME. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. Climacteric 2019; 22:429-434. [DOI: 10.1080/13697137.2019.1637079] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Susan R. Davis
- Author institutional affiliations: Women’s Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Author society affiliations: The International Menopause Society, London, UK
| | - Rodney Baber
- University of Sydney, Sydney, Australia
- Author society affiliations: The International Menopause Society, London, UK
- Royal Australian and New Zealand College of Obstetricians and Gynaecologists
| | - Nicholas Panay
- Queen Charlotte’s & Chelsea and Westminster Hospitals and Imperial College, London, UK
- Author society affiliations: The International Menopause Society, London, UK
| | - Johannes Bitzer
- University Hospital Basel, Switzerland
- The International Society for Sexual Medicine
| | - Sonia Cerdas Perez
- Endocrinology Department, Hospital Cima and University of Costa Rica, San José, Costa Rica
- The Federacion Latinoamericana de Sociedades de Climaterio y Menopausia
| | - Rakibul M. Islam
- Author institutional affiliations: Women’s Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Author society affiliations: The International Menopause Society, London, UK
| | - Andrew M. Kaunitz
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville, USA
- The American College of Obstetricians and Gynecologists, USA
| | - Sheryl A. Kingsberg
- Behavioral Medicine, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA
- The North American Menopause Society, Cleveland, OH, USA
| | - Irene Lambrinoudaki
- Medical School, National and Kapodistrian University of Athens, Greece
- The European Menopause and Andropause Society
| | - James Liu
- Department of Obstetrics and Gynecology, University Hospitals Cleveland and Case Western Reserve University School of Medicine, Cleveland, USA
- The American College of Obstetricians and Gynecologists, USA
| | - Sharon J. Parish
- Weill Cornell Medical College, New York, USA
- The International Society for the Study of Women’s Sexual Health, USA
| | - JoAnn Pinkerton
- Department of Obstetrics and Gynecology, the University of Virginia Health System, Charlottesville, VA, USA
- The North American Menopause Society, Cleveland, OH, USA
| | - Janice Rymer
- King’s College London, and Guy’s and St. Thomas’ Foundation Hospital Trust, London, UK
- The Royal College of Obstetricians and Gynaecologists, London, UK
| | - James A. Simon
- George Washington University, Washington, DC, and IntimMedicine Specialists, Washington, DC, USA
- The International Society for the Study of Women’s Sexual Health, USA
| | - Linda Vignozzi
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, University of Florence, and Careggi Hospital, Florence, Italy
- The International Society for Sexual Medicine
| | - Margaret E. Wierman
- Department of Medicine, Integrative Physiology and Obstetrics and Gynecology, University of Colorado, Anschutz Medical Campus, Colorado, USA
- The Endocrine Society, Bethesda, MD, USA
| |
Collapse
|
27
|
Parish SJ, Hahn SR, Goldstein SW, Giraldi A, Kingsberg SA, Larkin L, Minkin MJ, Brown V, Christiansen K, Hartzell-Cushanick R, Kelly-Jones A, Rullo J, Sadovsky R, Faubion SS. The International Society for the Study of Women's Sexual Health Process of Care for the Identification of Sexual Concerns and Problems in Women. Mayo Clin Proc 2019; 94:842-856. [PMID: 30954288 DOI: 10.1016/j.mayocp.2019.01.009] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/10/2018] [Accepted: 01/16/2019] [Indexed: 12/20/2022]
Abstract
Sexual problems are common in women of all ages. Despite their frequency and impact, female sexual dysfunctions (FSDs) are often unrecognized and untreated in clinical settings. In response, the International Society for the Study of Women's Sexual Health convened a multidisciplinary, international expert panel to develop a process of care (POC) that outlines recommendations for identification of sexual problems in women. This POC describes core and advanced competencies in FSD for clinicians who are not sexual medicine specialists and serve as caregivers of women and, therefore, is useful for clinicians with any level of competence in sexual medicine. The POC begins with the expectation of universal screening for sexual concerns, proceeds with a 4-step model (eliciting the story, naming/reframing attention to the problem, empathic witnessing of the patient's distress and the problem's impact, and referral or assessment and treatment) that accommodates all levels of engagement, and delineates a process for referral when patients' needs exceed clinician expertise. Distressing problems related to desire, arousal, and orgasm affect 12% of women across the lifespan. Low desire is the most common sexual problem, but sexual pain and other less common disorders of arousal and orgasm are also seen in clinical practice. Screening is best initiated by a ubiquity statement that assures the patient that sexual concerns are common and can be revealed. Patient-centered communication skills facilitate and optimize the discussion. The goal of the POC is to provide guidance to clinicians regarding screening, education, management, and referral for women with sexual problems.
Collapse
Affiliation(s)
- Sharon J Parish
- Department of Medicine and Department of Psychiatry, Weill Cornell Medical College, New York, NY.
| | - Steven R Hahn
- Department of OB/GYN, Albert Einstein College of Medicine, Bronx, NY
| | | | - Annamaria Giraldi
- Department of Clinical Medicine and Department of Family and Community Medicine, Sexological Clinic, Psychiatric Center Copenhagen, University of Copenhagen, Denmark
| | - Sheryl A Kingsberg
- Department of OB/GYN, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, OH
| | - Lisa Larkin
- Lisa Larkin MD and Associates, Cincinnati, OH
| | - Mary Jane Minkin
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | | | | | | | | | - Jordan Rullo
- Department of Psychology and Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Richard Sadovsky
- Department of Family Medicine, SUNY-Downstate Medical Center, Brooklyn, NY
| | - Stephanie S Faubion
- Center for Women's Health and Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| |
Collapse
|