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The Effect of Type of Delivery on Female Postpartum Sexual Functioning: A Systematic Review. Healthcare (Basel) 2022; 10:healthcare10071212. [PMID: 35885738 PMCID: PMC9322469 DOI: 10.3390/healthcare10071212] [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] [Received: 05/18/2022] [Revised: 06/18/2022] [Accepted: 06/26/2022] [Indexed: 11/22/2022] Open
Abstract
Female sexual function could be considered as multifactorial. Specific physiological structures and hormonal fluctuations postpartum, along with the psychological adjustment of women, could result in altered sexual function. The primary aim of this review was to systematically appraise the existing data on the effect of mode of delivery on female sexual function. This review was designed based on the PRISMA statement guidelines. An extensive literature search was performed in the Pubmed, Scopus, and PsycInfo databases, using prespecified inclusion/exclusion criteria, between the 20 September and 10 October 2021. Studies’ quality assessment was conducted using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies of the National Heart, Lung, and Blood Institute. The initial search involved 1592 studies. The last step of the screening procedure yielded 16 studies, including 41,441 subjects with a mean age of 29.9 years. Studies included groups with spontaneous and assisted vaginal and C-section delivery modes. No statistically significant difference between groups was found. The type of delivery appears to be irrelevant regarding this relationship. Moderating factors seemed to indirectly influence this relationship. Health professionals should educate expectant mothers and be aware of the possibility that delivery method could affect sexual function.
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van 't Hof SR, Cera N. Specific factors and methodological decisions influencing brain responses to sexual stimuli in women. Neurosci Biobehav Rev 2021; 131:164-178. [PMID: 34560132 DOI: 10.1016/j.neubiorev.2021.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 08/29/2021] [Accepted: 09/06/2021] [Indexed: 11/19/2022]
Abstract
Most of the neuroimaging studies on sexual behavior have been conducted with male participants, leading to men-based models of sexual arousal. Here, possible factors and methodological decisions that might influence brain responses to sexual stimuli, specifically for the inclusion of women, will be reviewed. Based on this review, we suggest that future studies consider the following factors: menstrual phase, hormonal contraception use, history of sexual or psychiatric disorders or diseases, and medication use. Moreover, when researching sexual arousal, we suggest future studies assess sexual orientation and preferences, that women should select visual sexual stimuli, and a longer duration than commonly used. This review is thought to represent a useful guideline for future research in sexual arousal, which hopefully will lead to a higher inclusion of women and therefore more accurate neurobiological models of sexual arousal.
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Affiliation(s)
| | - Nicoletta Cera
- Centre for Psychology at University of Porto -CPUP, Faculty of Psychology and Education Sciences, University of Porto, Portugal
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Fagundes Ferreira F, La Rosa VL, Nepomuceno Benites M, Marques Cerentini T, Machado de Souza C, Caruso S, da Silva Klahr P, Telles da Rosa LH, Della Corte L, Viana da Rosa P. Sexual function evaluation in Brazilian women accessing a public health service: an observational cross-sectional study. SEXUAL AND RELATIONSHIP THERAPY 2020. [DOI: 10.1080/14681994.2020.1817365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | | | | | | | | | - Salvatore Caruso
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
- Research Group for Sexology, University of Catania, Catania, Italy
| | | | | | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples "Federico II", Naples, Italy
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Moshfeghy Z, Tahari S, Janghorban R, Najib FS, Mani A, Sayadi M. Association of sexual function and psychological symptoms including depression, anxiety and stress in women with recurrent vulvovaginal candidiasis. J Turk Ger Gynecol Assoc 2020; 21:90-96. [PMID: 31640303 PMCID: PMC7294830 DOI: 10.4274/jtgga.galenos.2019.2019.0077] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective: Recurrent vulvovaginal candidiasis (RVVC) is a common vaginal infection which could affect the quality of life, romantic relationships, and sexual performance. There is some evidence that psychological problems result in an increased incidence of RVVC by changing the immune systems of individuals. The aim of this study was to determine the association of sexual function and psychological factors including depression, anxiety, and stress in women with RVVC. Material and Methods: Study design was case controlled. Equal numbers of women with RVVC and uninfected women referred to gynecology clinics were selected, using convenience purposive sampling. Two samples of vaginal discharge were prepared from each person. One sample was examined microscopically and the second was cultured on Sabouraud Agar. Data collection tools used for this study included demographic questionnaire, Female Sexual Function Index, Depression Anxiety Stress Scales-21. Data were analyzed using SPSS software (version 19). Results: Less sexual satisfaction [odds ratio (OR): 0.608, 95% confidence interval (CI): 0.421-0.878] and less orgasm (OR: 0.741, 95% CI: 0.530-0.998) was associated with RVVC. In patients with RVVC, the levels of depression, anxiety and stress were significantly higher compared to those of healthy individuals. Conclusion: Depression, anxiety and stress in the past four weeks are related to an increased risk of RVVC. There is an association between depression, anxiety and stress, sexual satisfaction, and orgasm with RVVC. It may be that psychological interventions and sexual counseling can be effective in improving RVVC.
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Affiliation(s)
- Zeinab Moshfeghy
- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Somayeh Tahari
- Student Research Committee, Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Roksana Janghorban
- Department of Midwifery, School of Nursing and Midwifery, Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Sadat Najib
- Department of Obstetrics and Gynecology, School of Medicine, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arash Mani
- Department of Psychiatry, School of Medicine, Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrab Sayadi
- Student Research Committee, Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran
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Clinical implications of directly switching antidepressants in well-treated depressed patients with treatment-emergent sexual dysfunction: a comparison between vortioxetine and escitalopram. CNS Spectr 2020; 25:50-63. [PMID: 31010445 DOI: 10.1017/s1092852919000750] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The objective of this work was to describe treatment-emergent sexual dysfunction (TESD) and tolerability following a switch from selective serotonin reuptake inhibitor (SSRI: citalopram, paroxetine, or sertraline) monotherapy to vortioxetine or escitalopram monotherapy in adults with well-treated major depressive disorder (MDD) and SSRI-induced sexual dysfunction. METHODS Data were analyzed from the primary study, an 8-week, randomized, double-blind, head-to-head study in which participants with well-treated depressive symptoms but experiencing TESD with SSRIs were directly switched to flexible doses (10/20 mg) of vortioxetine or escitalopram. Sexual functioning was assessed by the Changes in Sexual Functioning Questionnaire-14 (CSFQ-14), efficacy by the Montgomery-Åsberg Depression Rating Scale scores (MADRS) and Clinicians Global Impression of Severity/Improvement (CGI-S/CGI-I), and tolerability by adverse events. Efficacy and tolerability were assessed by pre-switch SSRI therapy where possible, and by participant characteristics. RESULTS Greater improvements in TESD were seen in the vortioxetine compared with escitalopram groups based on: participant demographics (≤45 years, women; P = 0.045), prior SSRI treatment (P = 0.044), number of prior major depressive episodes (MDEs) (1-3; P = 0.001), and duration of prior SSRI therapy (>1 year; P = 0.001). Prior SSRI treatment did not appear to influence the incidence or severity of TEAEs, except for nausea. Regardless of prior SSRI, both treatments maintained antidepressant efficacy after 8 weeks. CONCLUSION Results suggest that vortioxetine is a safe and effective switch therapy for treating SSRI-induced sexual dysfunction in adults with well-treated MDD. Also, improvement in sexual dysfunction with vortioxetine or escitalopram may be influenced by prior SSRI usage, sex, age, and history of MDEs.
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Vaishnav M, Saha G, Mukherji A, Vaishnav P. Principles of Marital Therapies and Behavior Therapy of Sexual Dysfunction. Indian J Psychiatry 2020; 62:S213-S222. [PMID: 32055064 PMCID: PMC7001355 DOI: 10.4103/psychiatry.indianjpsychiatry_19_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 01/10/2020] [Indexed: 01/23/2023] Open
Affiliation(s)
- Mrugesh Vaishnav
- Consultant Psychiatrist and Director, Samvedana Foundation, Ahmedabad, Gujarat, India.,Director, Institute of Psychological and Sexual Research, Samvedana Foundation, Ahmedabad, Gujarat, India.,National President, Indian Psychiatry Society, Kolkata, West Bengal, India.,Direct Council Member, Indian Association of Social Psychiatry, Kolkata, West Bengal, India.,Consultant, Family Planning Association of India, Consultant SECRT, Kolkata, West Bengal, India
| | - Gautam Saha
- Director, Clinic Brain Neuropsychiatric Institute and Research Centre, Kolkata, West Bengal, India.,Immediate Past General Psychiatry India Psychiatric Society, Kolkata, West Bengal, India
| | - Abir Mukherji
- Sr. Consultant Psychiatrist Medica Super Specialty Hospital, AMRI Group of Hospitals, Kolkata, West Bengal, India
| | - Parth Vaishnav
- Consultant Psychiatrist and Co-Director, Samvedana Happiness Hospital, Ahmedabad, Gujarat, India
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Abstract
Sexual arousal in women comprises two components: genital arousal and subjective arousal. Genital arousal is characterized by genital vasocongestion and other physiological changes that occur in response to sexual stimuli, whereas subjective arousal refers to mental engagement during sexual activity. For some women, genital arousal enhances subjective arousal; for others, the two types of arousal are desynchronous. However, the relationship between genital and subjective arousal might not be relevant to the diagnosis and treatment of sexual arousal dysfunction. Studies have shown that not all women who report sexual arousal problems have decreased genital arousal, and only some women with decreased genital arousal have low subjective arousal. To develop efficacious treatments for female sexual arousal dysfunction, researchers need to differentiate the women for whom genital sensations have a critical role in their subjective arousal from those who are not mentally aroused by genital cues. The mechanisms by which women become aroused and the inputs into arousal have considerable implications for treatment outcomes.
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Abstract
INTRODUCTION Hypoactive sexual desire disorder (HSDD) often has a negative impact on the health and quality of life of women; however, many women do not mention-let alone discuss-this issue with their physicians. Providers of gynecologic services have the opportunity to address this subject with their patients. AIM To review the diagnosis and evidence-based treatment of low sexual desire in women with a focus on strategies that can be used efficiently and effectively in the clinic. METHODS The Medline database was searched for clinically relevant publications on the diagnosis and management of HSDD. RESULTS HSDD screening can be accomplished during an office visit with a few brief questions to determine whether further evaluation is warranted. Because women's sexual desire encompasses biological, psychological, social, and contextual components, a biopsychosocial approach to evaluating and treating patients with HSDD is recommended. Although individualized treatment plan development for patients requires independent medical judgment, a simple algorithm can assist in the screening, diagnosis, and management of HSDD. Once a diagnosis of HSDD has been made, interventions can begin with office-based counseling and progress to psychotherapy and/or pharmacotherapy. Flibanserin, a postsynaptic 5-hydroxytryptamine 1A agonist and 2A antagonist that decreases serotonin levels and increases dopamine and norepinephrine levels, is indicated for acquired, generalized HSDD in premenopausal women and is the only agent approved in the United States for the treatment of HSDD in women. Other strategies to treat HSDD include using medications indicated for other conditions (eg, transdermal testosterone, bupropion). Bremelanotide, a melanocortin receptor agonist, is in late-stage clinical development. CONCLUSIONS Providers of gynecologic care are uniquely positioned to screen, counsel, and refer patients with HSDD. Options for pharmacotherapy of HSDD are currently limited to flibanserin, approved by the US Food and Drug Administration, and off-label use of other agents. Clayton AH, Kingsberg SA, Goldstein I. Evaluation and Management of Hypoactive Sexual Desire Disorder. Sex Med 2018;6:59-74.
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Sathyanarayana Rao TS, Tandon A, Manohar S, Mathur S. Clinical Practice Guidelines for management of Sexual Disorders in Elderly. Indian J Psychiatry 2018; 60. [PMID: 29535473 PMCID: PMC5840913 DOI: 10.4103/0019-5545.224478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
| | - Abhinav Tandon
- Neuropsychiatrist& Director, Dr AKT Neuropsychiatric Centre, Allahabad.
| | - Shivanand Manohar
- Department of Psychiatry, JSS Medical College and Hospital, JSS University, Mysore
| | - Supriya Mathur
- Department of Psychiatry, JSS Medical College and Hospital, JSS University, Mysore
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Croft HA. Understanding the Role of Serotonin in Female Hypoactive Sexual Desire Disorder and Treatment Options. J Sex Med 2018; 14:1575-1584. [PMID: 29198512 DOI: 10.1016/j.jsxm.2017.10.068] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 09/22/2017] [Accepted: 10/20/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND The neurobiology of sexual response is driven in part by dopamine and serotonin-the former modulating excitatory pathways and the latter regulating inhibitory pathways. Neurobiological underpinnings of hypoactive sexual desire disorder (HSDD) are seemingly related to overactive serotonin activity that results in underactive dopamine activity. As such, pharmacologic agents that decrease serotonin, increase dopamine, or some combination thereof, have therapeutic potential for HSDD. AIM To review the role of serotonin in female sexual function and the effects of pharmacologic interventions that target the serotonin system in the treatment of HSDD. METHODS Searches of the Medline database for articles on serotonin and female sexual function. OUTCOMES Relevant articles from the peer-reviewed literature were included. RESULTS Female sexual response is regulated not only by the sex hormones but also by several neurotransmitters. It is postulated that dopamine, norepinephrine, oxytocin, and melanocortins serve as key neuromodulators for the excitatory pathways, whereas serotonin, opioids, and endocannabinoids serve as key neuromodulators for the inhibitory pathways. Serotonin appears to be a key inhibitory modulator of sexual desire, because it decreases the ability of excitatory systems to be activated by sexual cues. Centrally acting drugs that modulate the excitatory and inhibitory pathways involved in sexual desire (eg, bremelanotide, bupropion, buspirone, flibanserin) have been investigated as treatment options for HSDD. However, only flibanserin, a multifunctional serotonin agonist and antagonist (5-hydroxytryptamine [5-HT]1A receptor agonist and 5-HT2A receptor antagonist), is currently approved for the treatment of HSDD. CLINICAL IMPLICATIONS The central serotonin system is 1 biochemical target for medications intended to treat HSDD. STRENGTHS AND LIMITATIONS This narrative review integrates findings from preclinical studies and clinical trials to elucidate neurobiological underpinnings of HSDD but is limited to 1 neurotransmitter system (serotonin). CONCLUSION Serotonin overactivity is a putative cause of sexual dysfunction in patients with HSDD. The unique pharmacologic profile of flibanserin tones down inhibitory serotonergic function and restores dopaminergic and noradrenergic function. Croft HA. Understanding the Role of Serotonin in Female Hypoactive Sexual Desire Disorder and Treatment Options. J Sex Med 2017;14:1575-1584.
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Affiliation(s)
- Harry A Croft
- CNS Studies, Clinical Trials of Texas Research Center, San Antonio, TX, USA.
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Yildirim EA, Hacioglu Yildirim M, Carpar E, Sarac I. Clomipramine trial for treatment-resistant persistent genital arousal disorder: a case series. J Psychosom Obstet Gynaecol 2017. [PMID: 28635538 DOI: 10.1080/0167482x.2017.1296427] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Treatment of persistent genital arousal disorder (PGAD), as a chronic and disabling condition, implicates substantial compelling complexities. METHODS In this case series, seven women diagnosed with PGAD who were referred to the Sexual Dysfunction Unit of Psychotherapy Outpatient Clinic of Bakirkoy Research and Training Hospital for Psychiatry, Neurology, and Neurosurgery, Istanbul, Turkey between 2006 and 2009 were included. All patients were previously resistant to other antidepressants, antipsychotics and antiepileptics. The additional details of PGAD onset, frequency, type and duration of arousal, previous pharmacological interventions, and maximum and maintenance doses of clomipramine were recorded. RESULTS All patients achieved a substantial symptomatic improvement with clomipramine within the follow-up period of 2-9 years. DISCUSSION Based on our study results, we recommend clomipramine in combination with psychotherapy as the treatment of choice in PGAD and to be used before any invasive procedure such as electroconvulsive therapy (ECT) or surgery.
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Affiliation(s)
- Ejder Akgun Yildirim
- a Department of Psychiatry , Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Psychotherapy Outpatient Clinic , Istanbul , Turkey
| | - Munevver Hacioglu Yildirim
- a Department of Psychiatry , Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Psychotherapy Outpatient Clinic , Istanbul , Turkey
| | - Elif Carpar
- b Department of Psychiatry , Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery , Istanbul , Turkey
| | - Irmak Sarac
- c Department of Gynecology and Obstetrics , Surp Agop Hospital , Istanbul , Turkey
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Dooley EM, Miller MK, Clayton AH. Flibanserin: From Bench to Bedside. Sex Med Rev 2017; 5:461-469. [PMID: 28757356 DOI: 10.1016/j.sxmr.2017.06.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/09/2017] [Accepted: 06/17/2017] [Indexed: 01/23/2023]
Abstract
INTRODUCTION The process of approval for flibanserin (trade name Addyi) has been associated with controversy since before its approval on August 18, 2015. This argument centered on challenges to the validity of the diagnosis of hypoactive sexual desire disorder in women and the safety and efficacy of the drug. AIM To explore the process of Food and Drug Administration (FDA) approval for flibanserin and delve further into the research, concerns, and various roadblocks to its approval. METHODS A literature review was undertaken using the terms flibanserin and hypoactive sexual desire disorder and relevant commentary from supporters and critics regarding the medication and difficulties leading up to approval. MAIN OUTCOME MEASURES Review of the process of FDA approval of a medication to treat hypoactive sexual desire disorder and research published exploring the efficacy and safety of flibanserin. RESULTS Before flibanserin, there were no drugs approved to treat hypoactive sexual desire disorder, which has a reported estimated incidence of 10% of women. For studying the effectiveness of flibanserin, the FDA required satisfying sexual events as the primary end point, although this end point does not measure level of desire or the associated distress. The satisfying sexual event measurement was significant across all three flibanserin trials in premenopausal women, as was an increase in desire according to the Female Sexual Function Index desire domain and a decrease in distress as recorded with the Female Sexual Distress Scale-Revised, Item 13. Safety concerns centered on the incidence of sedation, syncope, hypotension, and the interaction of flibanserin with alcohol and CYP3A4 inhibitors. Additional targeted challenge studies were mandated by the FDA. CONCLUSION The process of approval of flibanserin was lengthy. This was due in part to it being the first drug in its class and one with no clear guidance on study design from the FDA or roadmap for development and approval. Dooley EM, Miller MK, Clayton AH. Flibanserin: From Bench to Bedside. Sex Med Rev 2017;5:461-469.
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Karadag H, Oner O, Karaoglan A, Orsel S, Demir AU, Firat H, Karadeniz D, Aksu M, Ardic S, Ucar ZZ, Sevim S, Yilmaz H, Itil O. Body Mass Index and Sexual Dysfunction in Males and Females in a Population Study. ACTA ACUST UNITED AC 2016. [DOI: 10.5455/bcp.20130925023705] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Hasan Karadag
- Diskapi Yildirim Beyazit Training and Research Hospital, Department of Psychiatry, Ankara - Turkey
| | - Ozgur Oner
- Ankara University School of Medicine, Department of Child and Adolescent Psychiatry, Ankara - Turkey
| | | | - Sibel Orsel
- Diskapi Yildirim Beyazit Training and Research Hospital, Department of Psychiatry, Ankara - Turkey
| | - Ahmet Ugur Demir
- Hacettepe University, Faculty of Medicine, Department of Chest Diseases, Ankara - Turkey
| | - Hikmet Firat
- Diskapi Yildirim Beyazit Training and Research Hospital, Department of Chest Diseases, Ankara - Turkey
| | - Derya Karadeniz
- Istanbul University, Cerrahpasa Faculty of Medicine, Department of Neurology, Istanbul - Turkey
| | - Murat Aksu
- Erciyes University, Department of Neurology, Kayseri - Turkey
| | - Sadik Ardic
- Diskapi Yildirim Beyazit Training and Research Hospital, Department of Chest Diseases, Ankara - Turkey
| | - Zeynep Zeren Ucar
- Izmir Dr. Suat Seren Training and Research Hospital, Department of Chest Diseases, Izmir - Turkey
| | - Serhan Sevim
- Mersin University, Department of Neurology, Mersin - Turkey
| | - Hikmet Yilmaz
- Celal Bayar University, Faculty of Medicine, Department of Neurology, Manisa - Turkey
| | - Oya Itil
- Dokuz Eylul University, School of Medicine, Department of Neurology, Izmir - Turkey
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Converse AK, Aubert Y, Allers KA, Sommer B, Abbott DH. Flibanserin-Stimulated Partner Grooming Reflects Brain Metabolism Changes in Female Marmosets. J Sex Med 2015; 12:2256-66. [PMID: 26635207 PMCID: PMC5681869 DOI: 10.1111/jsm.13068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Female sexual interest and arousal disorder is personally distressing for women. To better understand the mechanism of the candidate therapeutic, flibanserin, we determined its effects on an index of brain glucose metabolism. AIM We hypothesized that chronic treatment with flibanserin would alter metabolism in brain regions associated with serotonergic function and female sexual behavior. METHODS In a crossover design, eight adult female common marmosets (Calithrix jacchus) received daily flibanserin or vehicle. After 7-12 weeks of treatment, the glucose metabolism radiotracer [(18) F]fluorodeoxyglucose (FDG) was administered to each female immediately prior to 30 minutes of interaction with her male pairmate, after which females were anesthetized and imaged by positron emission tomography. Whole-brain normalized images were analyzed with anatomically defined regions of interest. Whole-brain voxelwise mapping was used to explore treatment effects. Correlations were examined between alterations in metabolism and pairmate social grooming. MAIN OUTCOME MEASURES Changes in metabolism associated with flibanserin were determined for dorsal raphe, medial prefrontal cortex (mPFC), medial preoptic area of hypothalamus (mPOA), ventromedial nucleus of hypothalamus, and field cornu ammonis 1 (CA1) of the hippocampus. RESULTS In response to chronic flibanserin, metabolism in mPOA declined, and this reduction correlated with increases in pairmate grooming. A cluster of voxels in frontal cortico-limbic regions exhibited reduced metabolism in response to flibanserin and overlapped with a voxel cluster in which reductions in metabolism correlated with increases in pairmate grooming. Finally, reductions in mPOA metabolism correlated with increases in metabolism in a cluster of voxels in somatosensory cortex. CONCLUSIONS Taken together, these results suggest that flibanserin-induced reductions in female mPOA neural activity increase intimate affiliative behavior with male pairmates.
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Affiliation(s)
| | - Yves Aubert
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, US
- Department of Biological and Medical Psychology, University of Bergen, NO
| | - Kelly A. Allers
- Department of CNS Diseases, Boehringer Ingelheim, Biberach, DE
| | - Bernd Sommer
- Department of CNS Diseases, Boehringer Ingelheim, Biberach, DE
| | - David H. Abbott
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, US
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison, US
- Endocrinology-Reproductive Physiology Training Program, University of Wisconsin-Madison, US
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Sathyanarayana Rao TS, Ismail S, Darshan MS, Tandon A. Sexual disorders among elderly: An epidemiological study in south Indian rural population. Indian J Psychiatry 2015; 57:236-41. [PMID: 26600575 PMCID: PMC4623640 DOI: 10.4103/0019-5545.166618] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Realizing a dearth of data on this topic, especially in the Indian context, an epidemiological study was conducted in a south Indian rural population to identify the sexual activity patterns and sexual problems among the population above 60 years of age. OBJECTIVES (1) Assessment of sexual activity patterns among individuals above 60 years. (2) Assessment of the prevalence of sexual disorders among individuals above 60 years. MATERIALS AND METHODS The study sample consisted of 259 participants, which included both males and females above 60 years of age. Subjects who were sexually active and fulfilled the study criteria were administered Arizona Sexual Experience Scale as a screening tool, for the presence of sexual problems. Those who were found to have sexual problems were interviewed further using appropriate questionnaires. RESULTS Only 27.4% of the individuals above 60 years were sexually active, and it progressively dropped as age advanced and none were sexually active after 75 years of age. Among the sexually active males, erectile dysfunction (ED) was prevalent in 43.5%, premature ejaculation in 10.9%, hypoactive sexual desire disorder (HSSD) in 0.77% and anorgasmia in 0.38% of the subjects. Among females, arousal disorder was prevalent in 28%, HSSD in 16%, anorgasmia in 20% and dyspareunia in 8% of the subjects. CONCLUSION The study gives us an insight into the sexual problems of the elderly and brings home the point that sexual problems are very much common among both men and women in the older population. Among elderly males, ED is the most common sexual disorder whereas in elderly females, arousal disorder is the most prevalent female sexual dysfunction, implicating biology plays an important role in men, whereas psychology plays an important role in women sexual functioning.
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Affiliation(s)
| | - Shajahan Ismail
- Consultant Psychiatrist Argyll House, Sheffield Health and Social Care NHS Trust, # 9 Williamson Road, Sheffield, UK
| | - M. S. Darshan
- Founding Director & Consultant Neuropsychiatrist, Prerana Hospital for Neurocare, Psychiatry and Deaddiction, Mysore, India
| | - Abhinav Tandon
- Director and Consulatant (Neuro) Psychiatrist, Dr. AK Tandon Neuropsychiatric Centre, Allahabad, India
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Gama CR, Lasmar R, Gama GF, Abreu CS, Nunes CP, Geller M, Oliveira L, Santos A. Clinical Assessment of Tribulus terrestris Extract in the Treatment of Female Sexual Dysfunction. CLINICAL MEDICINE INSIGHTS. WOMEN'S HEALTH 2014; 7:45-50. [PMID: 25574150 PMCID: PMC4275110 DOI: 10.4137/cmwh.s17853] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 08/21/2014] [Accepted: 11/19/2014] [Indexed: 01/04/2023]
Abstract
This is a qualitative–quantitative study based on hospital records of female patients of reproductive age, presenting sexual dysfunction, and treated with 250 mg Tribulus terrestris extract (1 tablet thrice daily for 90 days). Safety monitoring included vital signs, physical examination, laboratory tests, and occurrence of adverse events. Efficacy analysis included results of the Female Sexual Function Index (FSFI), dehydroepiandrosterone (DHEA) levels together with total and free testosterone, and the patient and physician assessments. There was a statistically significant improvement in total FSFI scores (P < 0.0001) post-treatment, with improvement among 106 (88.33%) subjects. There was a statistically significant (P < 0.0001) increase in the level of DHEA, while the levels of both serum testosterone (P = 0.284) and free testosterone decreased (P < 0.0001). Most adverse events recorded were related to the gastrointestinal tract. Physical examination showed no significant changes post-treatment. Based on the results, it is concluded that the T. terrestris extract is safe and effective in the treatment of female sexual dysfunction.
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Affiliation(s)
- Carlos Rb Gama
- Department of Gynecology-Universidade Estadual Paulista (UNESP) São Paulo-SP, Brazil. ; Department of Gynecology-Fundação Educacional Serra dos Órgãos (UNIFESO) Teresópolis-RJ, Brazil. ; Colégio Brasileiro de Cirurgiões-Rio de Janeiro-RJ, Brazil. ; Department of Gynecologic Endoscopy-UNIFESO Teresópolis-RJ, Brazil
| | - Ricardo Lasmar
- Department of Gynecology-Universidade Estadual Paulista (UNESP) São Paulo-SP, Brazil. ; Department of Gynecology-Universidade Federal Fluminense (UFF) Rio de Janeiro, RJ, Brazil
| | - Gustavo F Gama
- Department of Gynecologic Endoscopy-UNIFESO Teresópolis-RJ, Brazil. ; Department of Gynecology & Obstetrics Service-Hospital das Clínicas-UNIFESO Teresópolis-RJ, Brazil
| | - Camila S Abreu
- Department of Pharmaceutics-Universidade Federal do Rio de Janeiro (UFRJ) Rio de Janeiro-RJ, Brazil
| | - Carlos P Nunes
- Department of Internal Medicine-UNIFESO Teresópolis-RJ, Brazil. ; Department of Clinical Immunology-Instituto de Pós-Graduação Médica Carlos Chagas (IPGMCC) Rio de Janeiro-RJ, Brazil
| | - Mauro Geller
- Department of Clinical Immunology-Instituto de Pós-Graduação Médica Carlos Chagas (IPGMCC) Rio de Janeiro-RJ, Brazil. ; Department of Immunology-UNIFESO Teresópolis-RJ, Brazil
| | - Lisa Oliveira
- Researcher in Immunology and Microbiology-UNIFESO Teresópolis-RJ, Brazil
| | - Alessandra Santos
- Department of Clinical Immunology-Instituto de Pós-Graduação Médica Carlos Chagas (IPGMCC) Rio de Janeiro-RJ, Brazil. ; Department of Clinical Genetics-UFRJ Rio de Janeiro-RJ, Brazil
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Clayton AH, Reddy S, Focht K, Musgnung J, Fayyad R. An Evaluation of Sexual Functioning in Employed Outpatients with Major Depressive Disorder Treated with Desvenlafaxine 50mg or Placebo. J Sex Med 2013; 10:768-76. [DOI: 10.1111/j.1743-6109.2012.02899.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Aubert Y, Gustison ML, Gardner LA, Bohl MA, Lange JR, Allers KA, Sommer B, Datson NA, Abbott DH. Flibanserin and 8-OH-DPAT implicate serotonin in association between female marmoset monkey sexual behavior and changes in pair-bond quality. J Sex Med 2012; 9:694-707. [PMID: 22304661 DOI: 10.1111/j.1743-6109.2011.02616.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Psychopathological origins of personally distressing, hypoactive sexual desire disorder (HSDD) in women are unknown, but are generally attributed to an inhibitory neural regulator, serotonin (5-HT). Flibanserin, a 5-HT(1A) agonist and 5-HT(2A) antagonist, shows promise as a treatment for HSDD. AIM To test the hypothesis that female marmoset sexual behavior is enhanced by flibanserin and diminished by 8-OH-DPAT, in order to evaluate the efficacy of serotonergic modulation of female sexual behavior in a pairmate social setting comparable to humans. METHODS Sexual and social behavior were examined in eight female marmoset monkeys receiving daily flibanserin (15 mg/kg), 8-OH-DPAT (0.1 mg/kg), or corresponding vehicle for 15-16 weeks in a counterbalanced, within-subject design, while housed in long-term, stable male-female pairs. MAIN OUTCOME MEASURES Marmoset pairmate interactions, including sexual and social behavior, were scored during weeks 5-6 of daily flibanserin, 8-OH-DPAT or vehicle treatment. 24-hour pharmacokinetic profiles of the drugs and their metabolites, as well as drug-induced acute symptoms of the 5-HT behavioral syndrome were also assessed. RESULTS Two-way analysis of variance reveals that flibanserin-treated females attract more male sexual interest (P=0.020) and trigger increased grooming (P=0.001) between partners. In contrast, 8-OH-DPAT-treated females show increased rejection of male sexual advances (P=0.024), a tendency for decreased male sexual interest (P=0.080), and increased aggression with their male pairmates (P=0.049). CONCLUSIONS While 8-OH-DPAT-treated female marmosets display decreased sexual receptivity and increased aggressive interactions with their male pairmates, flibanserin-treated female marmosets demonstrate increased affiliative behavior with their male pairmates. Such pro-affiliation attributes may underlie flibanserin's effectiveness in treating HSDD in women.
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Affiliation(s)
- Yves Aubert
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, USA.
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Converse AK, Aubert Y, Farhoud M, Weichert JP, Rowland IJ, Ingrisano NM, Allers KA, Sommer B, Abbott DH. Positron emission tomography assessment of 8-OH-DPAT-mediated changes in an index of cerebral glucose metabolism in female marmosets. Neuroimage 2012; 60:447-55. [PMID: 22233732 DOI: 10.1016/j.neuroimage.2011.12.065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 12/21/2011] [Accepted: 12/22/2011] [Indexed: 01/23/2023] Open
Abstract
As part of a larger experiment investigating serotonergic regulation of female marmoset sexual behavior, this study was designed to (1) advance methods for PET imaging of common marmoset monkey brain, (2) measure normalized FDG uptake as an index of local cerebral metabolic rates for glucose, and (3) study changes induced in this index of cerebral glucose metabolism by chronic treatment of female marmosets with a serotonin 1A receptor (5-HT(1A)) agonist. We hypothesized that chronic treatment with the 5-HT(1A) agonist 8-OH-DPAT would alter the glucose metabolism index in dorsal raphe (DR), medial prefrontal cortex (mPFC), medial preoptic area of hypothalamus (mPOA), ventromedial nucleus of hypothalamus (VMH), and field CA1 of hippocampus. Eight adult ovariectomized female common marmosets (Callithrix jacchus) were studied with and without estradiol replacement. In a crossover design, each subject was treated daily with 8-OH-DPAT (0.1mg/kg SC daily) or saline. After 42-49 days of treatment, the glucose metabolism radiotracer FDG was administered to each female immediately prior to 30 min of interaction with her male pairmate, after which the subject was anesthetized and imaged by PET. Whole brain normalized PET images were analyzed with anatomically defined regions of interest (ROI). Whole brain voxelwise mapping was also used to explore treatment effects and correlations between alterations in the glucose metabolism index and pairmate interactions. The rank order of normalized FDG uptake was VMH/mPOA>DR>mPFC/CA1 in both conditions. 8-OH-DPAT did not induce alterations in the glucose metabolism index in ROIs. Voxelwise mapping showed a significant reduction in normalized FDG uptake in response to 8-OH-DPAT in a cluster in medial occipital cortex as well as a significant correlation between increased rejection of mount attempts and reduced normalized FDG uptake in an overlapping cluster. In conclusion, PET imaging has been used to measure FDG uptake relative to whole brain in marmoset monkeys. Voxelwise mapping shows that 8-OH-DPAT reduces this index of glucose metabolism in medial occipital cortex, consistent with alterations in female sexual behavior.
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Simon JA. Identifying and Treating Sexual Dysfunction in Postmenopausal Women: The Role of Estrogen. J Womens Health (Larchmt) 2011; 20:1453-65. [DOI: 10.1089/jwh.2010.2151] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- James A. Simon
- George Washington University and Women's Health & Research Consultants, Washington, District of Columbia
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Normandin JJ, Murphy AZ. Excitotoxic lesions of the nucleus paragigantocellularis facilitate male sexual behavior but attenuate female sexual behavior in rats. Neuroscience 2010; 175:212-23. [PMID: 21144886 DOI: 10.1016/j.neuroscience.2010.11.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 11/11/2010] [Accepted: 11/13/2010] [Indexed: 01/23/2023]
Abstract
Little is known regarding the descending inhibitory control of genital reflexes such as ejaculation and vaginal contractions. The brainstem nucleus paragigantocellularis (nPGi) projects bilaterally to the lumbosacral motoneuron pools that innervate the genital musculature of both male and female rats. Electrolytic nPGi lesions facilitate ejaculation in males, leading to the hypothesis that the nPGi is the source of descending inhibition to genital reflexes. However, the function of the nPGi in female sexual behavior remains to be elucidated. To this end, male and female rats received bilateral excitotoxic fiber-sparing lesions of the nPGi, and sexual behavior and sexual behavior-induced Fos expression were examined. In males, nPGi lesions facilitated copulation, supporting the hypothesis that the nPGi, and not fibers-of-passage, is the source of descending inhibition of genital reflexes in male rats. nPGi lesions in males did not alter sexual behavior-induced Fos expression in any brain region examined. nPGi-lesioned females spent significantly less time mating with stimulus males and had significantly longer ejaculation-return latencies compared to baseline. These results did not significantly differ from control females, but this trend warranted further analysis of the reinforcing value of sexual behavior. Both lesioned and non-lesioned females formed a conditioned place preference (CPP) for artificial vaginocervical stimulation (aVCS). However, post-reinforcement, nPGi-lesioned females did not differ in the percentage of time spent in the non-reinforced chamber versus the reinforced chamber, suggesting a weakened CPP for aVCS. nPGi lesions in females reduced sexual behavior-induced Fos expression throughout the hypothalamus and amygdala. Taken together, these results suggest that while nPGi lesions in males facilitate copulation, such lesions in females attenuate several aspects of sexual behavior resulting in a reduction in the rewarding value of copulation that may be mediated by nPGi control of genital reflexes. This work has important implications for the understanding and treatment of sexual dysfunction in people including delayed/premature ejaculation, involuntary vaginal spasms, and pain during intercourse.
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Affiliation(s)
- J J Normandin
- Department of Biology, Center for Behavioral Neuroscience, Georgia State University, Atlanta, GA 30302-4010, USA
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Abstract
Painful bladder syndrome or urologic chronic pelvic pain syndrome is a chronic condition that presents with lower urinary tract symptoms that include dysuria, urgency, frequent urination, and chronic pelvic pain. Diagnoses included in the painful bladder syndrome are interstitial cystitis and prostatodynia. The history, physical examination, and laboratory evaluation of patients with lower urinary tract symptoms are important in ruling out other diagnoses. Treatment options that are US Food and Drug Administration approved and evidence based are limited; however, many symptom-based treatment options can reduce symptoms and improve quality of life.
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Affiliation(s)
- Viviana Martinez-Bianchi
- Duke Family Medicine Residency Program, Division of Family Medicine, Department of Community and Family Medicine, Duke University, DUMC 3886, Durham, NC 27710, USA.
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Moskovic DJ, Mohamed O, Sathyamoorthy K, Miles BJ, Link RE, Lipshultz LI, Khera M. The female factor: predicting compliance with a post-prostatectomy erectile preservation program. J Sex Med 2010; 7:3659-65. [PMID: 20819141 DOI: 10.1111/j.1743-6109.2010.02014.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Early post-radical prostatectomy (RP) erectile preservation (EP) therapy may be critical to preserve erections after surgery. AIM To assess if pre-RP female sexual function predicts of partner compliance with an EP protocol. MAIN OUTCOME MEASURES Compliance, defined as use of localized penile EP therapy (intracavernosal injections [ICIs], vacuum erection device [VED], or alprostadil) at 3 and 6 months after RP. METHODS Records of patients enrolled in our EP program from April 2007 to June 2008 were reviewed. Before surgery, patients completed the Sexual Health Inventory for Men (SHIM) and their female partners completed the Female Sexual Function Index (FSFI) questionnaire. Prior to surgery, patients were advised to take sildenafil 25 mg every nightly and use a 250-µg alprostadil suppository three times/week. At 1 month, additional daily use of a VED was encouraged. All patients unable to achieve erections sufficient for penetration were encouraged to initiate ICI of Trimix (phentolamine, papaverine, and PGE1) twice weekly after 3 months following surgery. Data were analyzed using binary logistic regression analysis holding all input variables constant. RESULTS Twenty-nine patients had preoperative SHIM>7 and pre-RP partner FSFI data available. After a 4-week follow-up, compliance with alprostadil suppository declined and both ICI and VED usage increased. At 6 months, six (25.0%) patients had return of natural erectile function and 22 (91.7%) were achieving assisted erections. Higher preoperative partner FSFI scores were associated with greater compliance to the localized penile therapy component of our EP protocol (risk ratio 3.8, P=0.05). CONCLUSIONS Preoperative female sexual function correlated with greater partner compliance with the localized component of our EP protocol. Consideration of a female partner's preoperative sexual function in predicting patient erectile function recovery after RP is warranted. Future studies are necessary to determine the clinical significance of this factor.
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Affiliation(s)
- Daniel J Moskovic
- Baylor College of Medicine-Scott Department of Urology, Houston, TX, USA
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