Aetiology, diagnostic algorithms and prognosis of female sexual dysfunction

The impact of premature ovarian insufficiency on sexual function; which domain is mostly disrupted?

This study aimed to compare the sexual function (SF) and its domains between women with idiopathic premature ovarian insufficiency (POI) and healthy control. A cross-sectional study was conducted on 63 married women with idiopathic POI, referred to the reproductive endocrinology research center (Tehran, Iran), and 784 married women with regular menstrual cycles who visited for routine annual gynecological exams in 2021-2022. The Female Sexual Function Index (FSFI) questionnaire was used to assess the SF of participants. Linear regression and factor analysis were used to analyze the data. Characteristics were similar in both study groups except for body mass index, hip circumference, job status, and number of deliveries. The mean score (standard deviation) of FSFI in women with POI and control were 21.70 (9.0) and 24.30 (5.0), respectively (P < 0.001). All domains' scores of FSFI were significantly lower in POI women than in the control group (P < 0.05). After adjusting for potential confounders, these findings remained unchanged. Factor analysis demonstrated the arousal and lubrication domains as the most influential factors SF among POI women, while the desire domain played the lowest role. In addition to various health conditions threatening POI women's future lives, sexual disturbances must be addressed in their routine care.

Sexual desire, mood disorders and sleep disturbances in female BMS patients: A controlled study

BACKGROUND

Burning mouth syndrome is a chronic orofacial pain with intraoral burning and other oral dysaesthetic symptoms that significantly affects the quality of life. The aim of this study is to evaluate the sexual desire in women with BMS and to investigate the possible related factors.

METHODS

A case-control study was performed. BMS patients were enrolled according to the International Classification of OroFacial Pain criteria. Demographic variables were collected. We evaluated pain with the Numeric Rating Scale (NRS), Visual Analogue Scale (VAS) and Total Pain Rating Index (T-PRI), anxiety and depression using the Hospital Anxiety and Depression Scale (HADS-A e HADS-D), sleep disturbances with Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS), and sexual desire using Sexual Desire Inventory (SDI).

RESULTS

A total of 50 BMS women and 50 healthy controls were enrolled. Compared with the controls, the BMS patients showed higher scores in the NRS (7,81 ± 1,71 vs. 0,14 ± 0.40; p < 0.0001), TPR-I (10,50 ± 4,86 vs. 0,36 ± 1,06; p < 0.0001), HADS-A (11,86 ± 2,85 vs. 3,90 ± 2,81; p < 0.0001), HADS-D (8,04 ± 3,18 vs. 1,42 ± 1,86; p < 0.0001) and PSQI (9,04 ± 2,62 vs. 4,64 ± 3,27; p < 0.0001). The mean SDI in the study group was significantly lower compared to healthy controls (32,36 ± 14,45 vs. 69,70 ± 19,94; p < 0.0001). No correlation was found between SDI and others items explored.

CONCLUSION

In line with previous studies, anxiety, depression and sleep disturbances are more common in BMS patients than in healthy population. This pilot study demonstrates for the first time an association between BMS and low sexual desire.

Changes in sexual functioning in women of reproductive age with infertility and diminished ovarian reserve

Androgens play a key role in the physiology of the female body and the reproductive system. Androgen receptor expression in the various tissues points to the importance of androgens in the regulation of the female sexual and social functioning. The study aimed to evaluate sexual functioning in women with infertility and diminished ovarian reserve (DOR) using the Female Sexual Functioning Index questionnaire (FSFI). A cross-sectional study of 496 patients with infertility and DOR assessed the degree of sexual dysfunction in conjunction with the changes in the androgenic profiles as indicated by the androstenedione levels in the blood serum. Women with infertility and DOR were significantly more likely to report changes in sexual functioning, including a decrease in libido and in the quality and frequency of sexual relations. Furthermore, patients with normal androstenedione levels generally significantly outscored patients with decreased androstenedione levels (average questionnaire scores 21.2 ± 7.2 and 15.17 ± 3.0 respectively), indicating a lesser degree of sexual dysfunction in the former group; on the other hand, the latter group reported increased pain and decreased attraction, arousal, lubrication, orgasm, and satisfaction. Hormonal profile changes in patients with DOR, including decreased androstenedione levels, significantly impact sexual functioning, and their detection in clinical practice will allow to objectify complaints at an earlier state in order to assess the severity of sexual dysfunction and determine further personalized management tactics.

Disfunção sexual em mulheres com câncer do colo do útero submetidas à radioterapia: análise de conceito

Resumo Objetivo analisar o conceito de disfunção sexual em mulheres com câncer do colo do útero submetidas a tratamento radioterápico. Método estudo de análise de conceito fundamentado no referencial metodológico proposto por Walker e Avant, o qual é composto por oito etapas: seleção do conceito; determinação dos objetivos da análise conceitual; identificação dos possíveis usos do conceito; determinação dos atributos críticos ou essenciais; construção de um caso modelo; construção de casos adicionais; identificação dos antecedentes e consequentes do conceito; e definição das referências empíricas. Resultados a amostra final resultou em 11 artigos, que identificaram 4 atributos críticos, 18 antecedentes e 07 consequentes do conceito, os quais permitiram a construção de uma definição conceitual e elaboração de um caso-modelo, com a finalidade de exemplificar o contexto social no qual o conceito encontra-se inserido. Conclusão e implicações para prática alterações na estrutura corporal, déficit de conhecimento, diminuição da frequência das relações sexuais, dispareunia e indiferença do parceiro são alguns dos principais antecedentes e consequentes da disfunção sexual na população estudada. Entretanto, esses fatores ainda são pouco conhecidos, o que limita a realização de ações de promoção, prevenção e reabilitação sexual, sobretudo no campo da enfermagem.

The Correlation between Severity of Overactive Bladder Symptoms with Female Sexual Dysfunction and Sexual Satisfaction of Partners

PURPOSE

Sexual dysfunction in women with overactive bladder (OAB) syndrome has been an important topic, while the sexual satisfaction of partners has not been fully investigated. Our aim was to explore the association between the severity of OAB with female sexual dysfunction and sexual satisfaction of partners.

METHODS

A total of 323 patients with OAB recruited in our hospital were included in our study from September 2017 to March 2019. Data were collected by Overactive Bladder Symptom Score (OABSS) questionnaire, self-designed questionnaire for basic characteristics; Female Sexual Function Index (FSFI); and sexual satisfaction survey for sex partners of patients. χ2 test or 1-way ANOVA was used to compare the variables among groups. Logistic regression analysis was performed to analyze the severity of OAB with female sexual dysfunction and sexual satisfaction of partners. The correlations between different OABSS domains with female sexual dysfunction and sexual satisfaction of partners were assessed.

RESULTS

All the patients were classified into mild (n = 107), moderate (n = 98), severe (n = 118) OAB group based on OABSS. Most of the basic information were similar among groups, except for BMI, highest education, occupation, fertility, and history of pelvic floor surgery. After multiple factors correction, the severity of OAB, exercise frequency, and the history of pelvic floor surgery were statistically associated with the female sexual dysfunction and sexual satisfaction of partners. Urgency score was significantly correlated with female sexual dysfunction, and the urge incontinence was most significantly associated with the sexual satisfaction of partners.

CONCLUSION

Severe OAB was closely associated with female sexual dysfunction and sexual satisfaction of partners. The urgency and urge incontinence should be focused for OAB management.

Vitamin E and ginseng supplementation to enhance female sexual function: a randomized, double-blind, placebo-controlled, clinical trial

Female sexual disorders (FSD) are a spectrum of disorders common among women, especially in their middle age, which can reduce the female quality of life substantially. We aimed to evaluate the effects of a combined vitamin E and ginseng supplement on amelioration of female sexual dysfunction. In a 6-week, double-blind, randomized, placebo-controlled clinical trial, participants, suffering from sexual dysfunction based on the female sexual function index (FSFI) questionnaire, were randomly allocated to receive the supplement (100 IU vitamin E, 67 mg Korean ginseng, and 40 mg Siberian ginseng) or placebo daily. The primary outcome in our trial was the change in the FSFI total score. Sixty-nine participants were enrolled, but only 31 in each group completed the trial. Changes in the FSFI total score and its domain scores were significant during the trial course within each group. However, the supplement only ameliorated desire and satisfaction domains superior to the placebo. In case of the total score and other domains, the changes were insignificantly different between the treatment groups. Although our study could not find additional benefits for the vitamin E and ginseng supplement over placebo in enhancing sexual function overall, the supplement worked better in enhancing sexual desire and satisfaction.

Prevalence of female sexual dysfunction in allied health workers: a cross-sectional pilot study in a tertiary hospital in Singapore

Background

Female sexual dysfunction (FSD) is increasingly being identified as a problem around the world. Women can have problems in various parts of the sexual cycle - desire, arousal, lubrication, orgasm or they may experience pain related to sexual activity. The only study involving Singapore with regard to sexual dysfunction in women, the Asian Global Studies of Sexual Attitudes and Behaviours in 2002, reported that Singapore had one of the lowest age-standardised sexual dysfunction rates of 32% compared with other Asian countries. This pilot study aims to evaluate the prevalence of female sexual dysfunction and to investigate the independent significant risk factors among allied health workers in a tertiary hospital in Singapore.

Methods

A cross-sectional study where an anonymous questionnaire which included 19 questions in the FSFI (Female Sexual Function Index) was distributed to all allied health workers in a tertiary hospital in Singapore aged between 18 to 70 years old.

Results

Three hundred thirty completed questionnaires were involved in analysis. 56.0% of women were found to have sexual dysfunction. A significant difference was found in the prevalence of FSD when comparing nurses to other allied health staff, where nurses had a decreased risk of developing FSD. Age was not found to be a significant risk factor in our study. Respondents below 40 years of age had significantly lower satisfaction scores than those above 40. Indians and Filipinos were found to have lower scores than the Chinese and Malay respondents in the lubrication (p = 0.02) and pain domains (p = 0.02).

Conclusion

A significant proportion our female allied health workers suffer from sexual dysfunction. In this study, we found that the overall prevalence was independent of age, race and marital status. Nurses had a lower risk of developing FSD. We will need further studies to assess the prevalence of female sexual dysfunction in the general population, to evaluate the independent significant risk factors for developing FSD, in addition to classical risk factors, as well as to assess the psychological impact of this condition and whether people would be willing to seek help for such problems.

Beyond the Bedroom: Cognitive, Affective, and Behavioral Responses to Partner Touch in Women With and Without Sexual Problems

Women with female sexual problems (FSP) are more likely than unaffected women to demonstrate negative appraisals, negative affect, and avoidance of sexual activity. Research suggests affected women also experience negative affect and avoidance in response to intimate partner contact for fear it will lead to sex. This online study examined whether women with FSP (N = 157) and without FSP (N = 129) exhibited different perceptions, affective reactions, and behavioral responses to hypothetical touch occurring outside sexual activity. Women (M_age = 30.70; SD = 6.66) were randomly assigned to one of three conditions representing hypothetical interactions with their partner (affectionate, sexual, or no touch), and answered questions about their perceptions of their partner's sexual intentions and their own anticipated negative affect and behavioral avoidance. Women with FSP reported higher perceptions of sexual intent, negative affect, and avoidance in the sexual touch condition, and higher negative affect in the affectionate touch condition, than women without FSP. Results highlight that women with FSP have more negative reactions to partners' hypothetical affectionate and sexual touch than women without FSP. Interventions for FSP may benefit from targeting women's perceptions, affective reactions, and behavioral reactions to partner touch when it occurs outside of explicitly sexual contexts.

Prevalence of and risk factors for sexual dysfunction in young Chinese women according to the Female Sexual Function Index: an internet-based survey

OBJECTIVES

Female sexual dysfunction (FSD) is a very common sexual health problem worldwide. The prevalence of FSD in Chinese women is, however, unknown. This is the first study to investigate a large number of young women throughout China via the internet, to determine the prevalence and types of FSD and to identify the risk factors for FSD.

METHODS

The primary endpoint was the Female Sexual Function Index (FSFI) score, with additional questions on contraception, sexual activity, relationship stability, pregnancy and other factors which may influence sexual function. The online questionnaire was completed by women from 31 of the 34 Chinese provinces.

RESULTS

A total of 1618 completed questionnaires were received, and 1010 were included in the analyses after screening (62.4%). The mean age of the respondents was 25.1 ± 4.5 years. The mean total FSFI score was 24.99 ± 4.60. According to FSFI definitions (cut-off score 26.55), 60.2% of women were at risk of FSD. Based on domain scores, 52 were considered at high risk of dysfunction for pain (5.1%), 35 for orgasm (3.5%), 33 for desire (3.3%), 20 for arousal (2.0%), 6 for satisfaction (0.6%) and 2 for lubrication (0.2%).

CONCLUSIONS

The prevalence of FSFI scores indicating risk of sexual dysfunction was about 60% in Chinese women. An unstable relationship, pressure to become pregnant, non-use of contraception, negative self-evaluation of appearance and increasing age were significantly associated with FSD in young Chinese women.

Sexuality in menopausal women

PURPOSE OF REVIEW

Sexuality is an essential part of a healthy life. It can contribute significantly to the physical, psychological and social wellbeing of menopausal women, therefore, to their quality of life. This study is an overview of the most recent findings in the literature retrieved from searches of computerized databases. We extracted all notable information concerning definition, epidemiology, symptoms, diagnostic evaluation and management.

RECENT FINDINGS

The experience of sexuality in menopause is fundamentally shaped by the biological and psychological changes that occur on a substrate of modifications linked to the ageing process. Moreover, several additional factors, including effects of illness, medications and psychosocial stressors can contribute to sexual dysfunction. Patients should be educated about the causes of sexual dysfunction and available treatment.

SUMMARY

In recent years, the field of research in sexual dysfunctions has made great progress in many areas of investigation, from epidemiology to pathophysiology providing a better understanding of causes and promoting better care. However, the multifactorial nature of human sexuality still makes our ability to comprehensively treat sexual dysfunction quite difficult. An integrated approach is needed to recognize different aspects involved and to identify the proper intervention strategies for early prevention and promotion of a healthy sexuality in menopause.

The Association Between Female Sexual Dysfunction and the Husband's Erectile Dysfunction: Evidence from Married Couples in Hong Kong

Little is known about the association between the sexual functioning of each partner in a heterosexual married couple. By using a community-based survey of Hong Kong Chinese couples in 2012, this study attempted to examine the relation between female sexual dysfunction and their husbands' erectile dysfunction. Among the 1,518 female and 1,059 male respondents, 944 sexually active couples were eligible for the analysis, with mean age of 39.3 ± 6.8 years (range = 21-50) for the wives and 43.6 ± 8.6 years (range = 18-80) for the husbands. Of the wives, 27.0% reported at least one form of female sexual dysfunction and 5.0% of the husbands reported erectile dysfunction. After adjusting for the female's age and other risk factors, the total and domain scores of female sexual dysfunction were not associated with her husband's erectile dysfunction except for physical pain during sexual intercourse. Therefore, whether to screen the partner's sexual function depends on the age of the female clients.

Sexual dysfunction among reproductive-aged Chinese married women in Hong Kong: prevalence, risk factors, and associated consequences

INTRODUCTION

Although female sexual dysfunction (FSD) is a serious public health issue endangering women's well-being, systematic research on FSD among reproductive-aged Chinese women in Hong Kong is quite scarce.

AIM

This study aims to estimate the prevalence, risk factors, and associated consequences of FSD among reproductive-aged Chinese married women in Hong Kong.

METHODS

This study was based on a community-based survey across Hong Kong conducted by the Family Planning Association of Hong Kong in 2012 with 1,518 married women aged 21-49 years.

MAIN OUTCOME MEASURE

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition classification was adopted to assess FSD.

RESULTS

It was found that 25.6% of the married women surveyed reported at least one form of sexual dysfunction and that the prevalence of six domains of sexual dysfunction was as follows: 10.6% for lack of interest in sex, 10.5% for not finding sex pleasurable, 9.3% for lubrication difficulties, 8.8% for inability to achieve orgasm, 8.8% for orgasm delay, and 8.4% for physical pain during sex. Multivariate analyses showed that low education and income, average or poor health, lower frequency of sex, abortion history, traditional attitudes toward sex, and marital dissatisfaction are all significant risk factors for different components of FSD. It was also been found that four domains of FSD (the exceptions being orgasm delay and physical pain during sex) have severe consequences for married women's life satisfaction and sexual satisfaction.

CONCLUSION

The prevalence of FSD is lower among reproductive-aged Chinese married women in Hong Kong than among women in the United States and some Asian countries. The risk factors associated with FSD include sociodemographic factors, physical health, sexual experience and attitudes, and relationship factors. FSD has significant consequences for married women's life quality. These findings have great implications for FSD prevention and relevant service delivery.

Sexual function of women practicing sex in nonconventional settings

The quality of sexual intercourse in the context of conjugal visits by women to their jailed partners is unknown. This study aimed to assess the quality of the sex lives and psychological conditions of women attending conjugal visits with their jailed inmate partners. This controlled study involved 124 women between the ages of 18 to 40 years who engaged in sexual relations with their inmate partners (conjugal visit group) or with their partners at home (control group). Sexual function was assessed using a semi-structured questionnaire and the Female Sexual Function Index, and psychological parameters were evaluated using the Hospital Anxiety and Depression scale. The total Female Sexual Function Index scores was similar in the 2 groups. The percentage of women reporting good quality of the relationship was significantly higher in the conjugal visit group. Also, the Hospital Anxiety and Depression scale scores were higher in the conjugal visit group. Depression was a risk factor for sexual dysfunction and had a negative effect on scores in the desire, excitement, lubrication, and sexual satisfaction domains, whereas anxiety was associated with lower sexual desire scores. A regular + poor quality of the relationship and being religious were factors associated with sexual dysfunction. Sexual practices in jail were not a risk for sexual dysfunction in this sample.

Psychometric properties of the Iranian version of the female sexual distress scale-revised in women

INTRODUCTION

Several tools for the assessment of sexuality-related distress are now available. The Female Sexual Distress Scale (FSDS) and its revised version (FSDS-R) are extensively validated and among the most widely used tools to measure sexually related personal distress.

AIM

The aim of the study was to determine the psychometric properties of the Iranian version of the FSDS-R in a population sample of Iranian women.

METHODS

A total of 2,400 married and potentially sexually active women were recruited and categorized into three groups including (i) a healthy control group; (ii) a group of women with hypoactive sexual desire disorder (HSDD); and (iii) a group of women suffering from other female sexual dysfunction (FSD). Participants were asked to complete a set of questionnaires including the Iranian version of the Female Sexual Function Index (FSFI-IV), the FSDS-R, and the Hospital Anxiety and Depression Scale.

MAIN OUTCOME MEASURES

Sexuality-related distress and FSD as assessed by the Iranian version of the FSDS-R and the FSFI-IV are the main outcome measures.

RESULTS

Internal consistencies and test-retest reliability of the FSDS-R across the three assessments points for the three groups were >0.70. The FSDS-R correlated significantly with anxiety, depression, and the FSFI total score. Significant differences in the FSDS-R scores were found between healthy women, women with HSDD, and women with other types of FSD. Factor analysis of the FSDS-R yielded a single-factor model with an acceptable fit.

CONCLUSIONS

The Persian version of the FSDS-R is a valid and reliable instrument for the assessment of sexuality-related distress in Iranian women and can be used to screen patients with HSDD.

Prevalence and risk factors of female sexual dysfunction among healthcare personnel in Malaysia

OBJECTIVE

To determine the prevalence and risk factors of female sexual dysfunction (FSD) among healthcare personnel in selected healthcare facilities in Malaysia.

METHODS

This was a cross-sectional study carried out at three large healthcare facilities that were selected by convenience sampling. Within each facility, stratified random sampling was used to select suitable candidates to participate in the study (n=201). Validated questionnaires were used to assess depression, anxiety, sexual function in women and erectile dysfunction (ED) in their partners.

RESULTS

The prevalence of FSD was 5.5%. Women with sexual dysfunction were more likely to be married longer (OR=4.08; 95% CI; 1.15-4.50), had lower frequency of sexual intercourse (OR=5.00; 95% C; 1.05-23.76) and had a spouse with ED (OR=24.35; 95% CI; 4.55-130.37). Multivariate analysis showed that ED was the strongest predictor for FSD (AOR=27.30; 95% CI; 4.706-159.08).

CONCLUSION

One in eighteen female healthcare personnel suffered from FSD and presence of ED in the partner strongly impacted her sexual function, negatively. The findings highlight the importance of including the male partner in clinical assessment of FSD.

Anxiety and female sexual functioning: an empirical study

Previous research regarding anxiety and female sexual functioning has yielded conflicting conclusions. This study examined the effect of state/trait anxiety and anxiety sensitivity on sexual responding and the propensity toward sexual inhibition/excitation in women without an anxiety disorder (n = 100, M age = 28.8 years) compared with women with an anxiety disorder (panic disorder or generalized anxiety disorder, n = 30, M age = 30.2 years). Participants completed self-report measures of state and trait anxiety, anxiety sensitivity, sexual functioning, and sexual inhibition/excitation. Women with an anxiety disorder reported worse sexual functioning compared with those without an anxiety disorder (except for desire, lubrication, and pain) and a greater propensity toward sexual inhibition, because of the threat of performance failure and its consequences. Dispositional anxiety and related worries significantly predicted various types of sexual dysfunctions. Findings suggested the importance of considering the relation between anxiety and sexual functioning to design optimal prevention and therapeutic interventions for women with anxiety disorders.

Should questionnaires of female sexual dysfunction be used in routine clinical practice?

AIMS

The aim of this paper is to explore the potential value of questionnaires in routine clinical practice to assess female sexual dysfunction (FSD), and to identify if this could increase the competence of a physician in the initial management of women with these problems. The rationale to encourage Health Care Professionals (HCPs) to engage women in dialogue about their sexual health is that it may enhance a woman's quality of life (which may lead to improved general health) and might lead to timely interventions and possible preventative measures for certain diseases.

METHOD

A short literature review of the most relevant publications was undertaken evaluating current practice.

RESULTS

FSD can have a negative impact on women's well-being and can also be an early symptom of underlying disease. Many HCPs do not broach the subject, consequently women do not get the opportunity either to voice their sexual concerns or access appropriate services. Review of currently available FSD questionnaires suggests that many but not all are generally inappropriate for use in routine clinical practice. Kriston et al.'s STEFFI-2 may be an appropriate starting point. Evidence suggests that this would facilitate discussion of sexual matters between the HCP and the women, and increase the likelihood of FSD being diagnosed.

CONCLUSIONS

Following this review of the literature, the authors strongly recommend that HCPs include FSD questionnaires as part of their routine engagement with women. However, the questionnaire would need to be used as part of the overall assessment and cannot replace a detailed case history and examination, which should lead to effective treatment and management of FSD. The authors recommend further research in the following areas: • Effective training for HCPs. • FSD as an early presentation of sub-clinical disease. • The cost-benefit of early treatment of FSD. • A standardised, validated FSD screening tool. • Benefits of using FSD screener in routine clinical practice.

Sexual function of women with premature ovarian failure

OBJECTIVE

The aim of this study was to evaluate the sexual function of women with premature ovarian failure (POF).

METHODS

A cross-sectional study was performed to evaluate 58 women with a diagnosis of POF compared with a control group composed of 58 women of reproductive age with normal ovarian function, paired for age (±2 y). Sexual function was evaluated in the two groups using the Female Sexual Function Index (FSFI).

RESULTS

The mean ± SD age of the women in the POF and control groups was 39.4 ± 6.5 and 39.0 ± 6.8 years, respectively. Mean ± SD FSFI score was 24.0 ± 6.0 and 27.3 ± 4.8 in the POF and control groups, respectively. The prevalence of sexual dysfunction (total FSFI score ≤ 26.55) in the POF group was 62.1% (n = 36) compared with 37.8% (n = 22) in the control group (P = 0.0093). In the analysis of domains, the only domain in which no statistically significant difference was found between the two groups was desire. For the domains of arousal, lubrication, orgasm, satisfaction, and pain, scores were significantly lower, hence poorer, in the group of women with POF compared with the control group. Belonging to the POF group increased a woman's likelihood of having sexual dysfunction by 2.8-fold (OR = 2.78, IC 1.29 to 5.98, P < 0.05).

CONCLUSIONS

Women with POF had a higher prevalence of sexual dysfunction compared with women with normal gonadal function and more difficulties in relation to satisfaction, lubrication, orgasm, pain, and arousal; however, there were no differences between the two groups with respect to desire.

Patient compliance with the use of vaginal dilators following pelvic radiotherapy for a gynaecological cancer

Background: In July 2005 the national forum of gynaecological oncology nurses published the first UK best practice guidelines for the use of vaginal dilators after pelvic radiotherapy. It was written following a Cochrane review by Denton and Maher suggesting that vaginal dilators minimised vaginal stenosis and improved sexual function. Women within the author’s large cancer centre are advised to use vaginal dilators in accordance with the national recommendations.

Primary outcome measure: To evaluate compliance with the use of vaginal dilators in women who have received radiotherapy for either cervix or endometrial cancer. Compliance was defined as the use of vaginal dilators two or more times a week, at 6 months.

Design: One hundred and sixty-four women were posted questionnaires. Potential participants had received pelvic radiotherapy for cancer of the cervix or endometrium, were 6 months to 5 years post-treatment and disease free. The 18-point questionnaire consisted of 11 points assessing demographics and dilator use, while points 12–18 related to vaginal symptoms. Simple descriptive statistics were used to describe demographics. Mann–Whitney U and Fisher’s exact tests were used for one-at-a-time analysis of compliance against age, vaginal symptoms, treatment modality and cancer type.

Results: Seventy-five completed questionnaires were returned (response rate 45.7%). Seventy-four out of the 75 respondents had been offered vaginal dilators during treatment. 89.2% (66/74) were compliant with vaginal dilation (95% confidence interval 80.1% to 94.4%).

Conclusion: The compliance rate in this study was greater than seen in previously published studies. This could be due to the intervention by practitioners within the author’s cancer centre. Further prospective evaluation studies are required to explore the potential benefits of intervention at 6 months post-treatment to improve long-term compliance.

Management of hypoactive sexual desire disorder in women: current and emerging therapies

Hypoactive sexual desire disorder (HSDD) is a common multifactorial condition which is characterized by a decrease in sexual desire that causes marked personal distress and/or interpersonal difficulty. The general idea that HSDD is a sexual dysfunction difficult to treat is due to the large number of potential causes and contributing factors. Indeed, a balanced approach comprising both biological and psycho-relational factors is mandatory for accurate diagnosis and tailored management in clinical practice. There are currently no approved pharmacological treatments for premenopausal women with HSDD, while transdermal testosterone is approved in Europe for postmenopausal women who experience HSDD as a result of a bilateral oophorectomy. Even though the role of sex hormones in modulating the sexual response during the entire reproductive life span of women is crucial, a better understanding of the neurobiological basis of sexual desire supports the idea that selective psychoactive agents may be proposed as nonhormonal treatments to restore the balance between excitatory and inhibitory stimuli leading to a normal sexual response cycle. We conclude that the ideal clinical approach to HSDD remains to be established in term of efficacy and safety, and further research is needed to develop specific hormonal and nonhormonal pharmacotherapies for individualized care in women.