Female Sexual Dysfunction

Case reports: Could sexual dysfunction in women with migraine be a side effect of CGRP inhibition?

BACKGROUND

The development and approval of antibodies targeting calcitonin gene-related peptide or its receptor mark a revolutionary era for preventive migraine treatment. Real-world evidence sheds light on rare, stigmatized or overlooked side effects of these drugs. One of these potential side effects is sexual dysfunction.

CASE REPORTS

We present two cases of one 42-year-old and one 45-year-old female patient with chronic migraine who both reported sexual dysfunction as a possible side effect of treatment with galcanezumab, a monoclonal antibody targeting calcitonin gene-related peptide.

DISCUSSION

As calcitonin gene-related peptide is involved in vaginal lubrication as well as genital sensation and swelling, inhibiting the calcitonin gene-related peptide pathway may lead to sexual dysfunction as a potential side effect.

CONCLUSION

Sexual dysfunction in female migraine patients might be a rare and overlooked side effect of monoclonal antibodies targeting the calcitonin gene-related peptide pathway. Considering the discomfort and stigma surrounding both migraine and sexual dysfunction, we advocate for an open attitude and awareness among clinicians toward such side effects.

The problem of calculating the prevalence of sexual dysfunction: a meta-analysis attending gender

INTRODUCTION

Sexuality is an integral part of human health, and sexual dysfunctions are prevalent issues that affect men and women. While reviews on sexual dysfunctions in various diseases have been conducted, overall data are scarce.

OBJECTIVES

To update the overall prevalence of sexual dysfunctions from available prevalence studies on both sexes.

METHODS

We used a 2-phase selection process to include cross-sectional studies that were conducted on the adult population and published between 2017 and 2022. The extracted data were prevalence, methodology, sample size, and location. Sensitivity and subgroup analyses were conducted to assess heterogeneity.

RESULTS

This review analyzed 4407 studies. Twenty-three met the established criteria: 9 on the male population and 14 on the female population. The meta-analysis included 7 articles on males and 13 on females. The prevalence of sexual dysfunction was 31% in men and 41% in women, with significant heterogeneity among the studies. Sociocultural differences and use of varying measurement methods were identified as the main factors contributing to heterogeneity. Subgroup analysis revealed decreased heterogeneity among studies that used the Female Sexual Function Index as a diagnostic tool for females.

CONCLUSIONS

The review highlights the notable variability in results due to methodological and geographic variations. Therefore, enhancing the training of professionals and standardizing the recording of patient data-through the Female Sexual Function Index and Male Sexual Health Questionnaire or by developing new ones for this purpose-could improve the consistency of research on sexual health.

Do We Care Enough About the Presence of Sexual Problems in Diabetic Patients?

Purpose

Sexual health is not only the absence of sexual dysfunction or disability, but also the presence of physical, emotional, mental, and social well-being related to sexuality. The current study aims to determine whether all adult patients who have applied for their regular health check-ups due to diabetes mellitus had ever voluntarily expressed their sexual problems to a specialist and whether they were asked about the presence of sexual dysfunction. It also aims to determine how the physicians attach importance to the issue.

Patients and Methods

All patients aged 18-65 years with type 1 and type 2 diabetes mellitus, who applied to our hospital between the years of January 2021 and 2022, were questioned by filling out a questionnaire for the presence of sexual problems in addition to screening for chronic complications of diabetes mellitus (retinopathy, nephropathy, and neuropathy) and routine history and physical examination.

Results

The association between the presence of sexual problems and whether patients were questioned about the relevant issue in their previous controls and gender and age factors, educational background, presence of comorbidities, duration of marriage, and microvascular complications of diabetes mellitus were examined. In a population of 595 patients, 53.78% of the patients stated that they had sexual problems; however, 9.91% had been questioned about this issue by the physician. It was observed that 6.3% of female and 15.3% of male patients had previously consulted a doctor voluntarily due to their sexual problems.

Conclusion

This study presents empirical findings that shed light on the inadequacies in healthcare providers' approach to addressing sexual health concerns among individuals diagnosed with diabetes, as well as the shortcomings in patients' effective communication of these concerns.

Physical Activity Protects Women with Type 1 Diabetes from Sexual Dysfunctions

The aim of the study was to evaluate the relationship between physical activity and sexual function in women with type 1 diabetes mellitus (T1DM). The study group consisted of 171 women with T1DM. All the participants voluntarily filled out anonymous questionnaires. Women who were sexually inactive or had some psychological, psychiatric, or endocrine diseases were excluded from the analysis. The scores about sexual function were obtained using a Female Sexual Function Index (FSFI) questionnaire. Results equal to or below 26 points indicate clinically significant sexual dysfunction. Physical activity was measured by the International Physical Activity Questionnaire (IPAQ). Participants were divided into two groups depending on the Metabolic Equivalent of Task (MET-min/week) score with a cutoff point 3000 MET-min/week. Results above 3000 points indicate higher physical activity in woman. There were statistically significant differences in lubrication, orgasm, pain, satisfaction, and total score of FSFI. A positive correlation was revealed between results in total FSFI score and MET-min/week score (Rs = 0.18, p = 0.016). Univariate logistic regression does not show significant associations, but the multivariate logistic regression model shows an association between the MET-min/week and the total FSFI score. The higher the MET-min/week score, the higher the FSI score, and thus better sexual function.

Efficacy of Yougui pill combined with Buzhong Yiqi decoction in alleviating the sexual dysfunction in female rats through modulation of the gut microbiota

CONTEXT

Yougui pill combined with Buzhong Yiqi decoction (YPBYD) is used to relieve sexual dysfunction in clinical practice.

OBJECTIVE

To investigate changes in microbial composition caused by sexual dysfunction and identify dominant bacteria related to YPBYD treatment.

MATERIALS AND METHODS

Female Sprague-Dawley rats were randomly divided into four groups (n = 6): one group underwent Sham operation (Sham group), while three groups underwent ovariectomy (one model and two treatment groups). The ovariectomized (OVX) rats received oestradiol benzoate (250 µg/kg/week) or YPBYD (3.6 mL/d) via oral gavage for 4 weeks. Vaginal smear assay was performed; the serum levels of cyclic adenosine monophosphate (cAMP) and oestradiol (E2) were measured, followed by collection of stool samples for 16S rRNA sequencing.

RESULTS

After YPBYD treatment, the levels of E2 and cAMP in OVX rats significantly increased (E2: from 20.45 ± 1.60 ng/L to 24.38 ± 1.70 ng/L; cAMP: from 261.41 ± 9.21 pg/mL to 373.75 ± 17.37 pg/mL). OVX treatment decreased diversity of gut microbiota and YPBYD treatment restored gut microbiota composition. Compared with Sham group, the abundance of Romboutsia significantly increased, while those of Proteobacteria and Staphylococcus markedly decreased in OVX group (all p < 0.05); meanwhile, the abundance of these microbes showed an opposite trend after YPBYD treatment. These microbiotas were involved in tyrosine and tryptophan biosynthesis and fatty acid metabolism.

DISCUSSION AND CONCLUSIONS

These findings are the first to indicate YPBYD can alleviate female sexual dysfunction by modulating gut microbiota in OVX rats, which will help enhance the understanding on potential mechanism of YPBYD against sexual dysfunction.

Prevalence of sexual dysfunctions in women in their early and middle adulthood from the Pokarpackie Voivodeship

Background: Sexual dysfunctions are disorders related to the physiology of sexual responses. Aim of the study: Our study aimed to assess the prevalence of sexual dysfunctions in women in their early and middle adulthood. Material and methods: The early adulthood group consisted of 125 women aged 20–30, and out of these 100 questionnaires qualified for the final analysis. The middle adulthood group consisted of 275 women aged 45–55 in which 200 complete questionnaires were analyzed. The study was conducted in 2016 using a diagnostic survey method and the author's own survey questionnaire, the Mell-Krat Scale for Women and the Female Sexual Function Index (PL-FSFI). Results: Only 38.0% of respondents from the early adulthood group and 25.0% from the middle-adult group interviewed with a gynecologist about their sex life, possible disorders, and problems. Additionally, only 1.0% of women in the middle adulthood group benefited from the advice of a sexologist. According to the interpretation of the Mell-Krat scale, 41.0% of respondents in the early adulthood group and 76.0% of women in the middle adulthood group had a suboptimal score. These results indicate the possibility of sexual response disorders. All women in the early adulthood group and middle adulthood group scored below normal on the PL-FSFI scale indicating that the respondents are at risk for sexual disorders. Conclusions: According to the PL-FSFI scale, all women in the study may be at risk of sexual disorders. According to the Mell-Krat scale, as many as ¾ of women might suffer from sexual response disorders or are at risk of sexual disorders. Taking into account the significance of a sex life, it is necessary to take action to provide women with professional medical and psychological help to improve their intimacy sphere of life.

Changes in sexual function and vaginal topography using transperineal ultrasound after vaginal laser treatment for women with stress urinary incontinence

We aim to assess the changes in sexual function and vaginal topography using 3-D transperineal ultrasound in stress-incontinent women treated with Er:YAG vaginal laser. Two hundred and twenty women with stress urinary incontinence (SUI) treated with Er:YAG laser were recruited. Assessment before and 6 months after the treatment included vaginal topography using 3-D transperineal ultrasound and sexual function using female sexual function index questionnaire (FSFI). A total of 50 women with complete data showed that the symptomatic improvement was noted in 37 (74%) women. After Er:YAG vaginal laser treatment, significantly decreased width and cross-sectional area in proximal, middle, and distal vagina were found in women with SUI. Nearly all of the domains of FSFI improved significantly after the vaginal laser treatment, except sexual desire. In conclusion, 3-D transperineal ultrasound can be used to conduct vaginal topography. After Er:YAG vaginal laser treatment, the anatomical changes of vaginal shrinkage and the improvement of female sexual function were both noted. The favorable outcome of sexual function partly related to the tightening of vagina, as evidenced by the measurements of the 3-D transperineal ultrasound.

Sexual Dysfunction Among Patients With Chronic Kidney Disease

Sexual dysfunction (SD) in patients with chronic kidney disease is common and negatively impacts quality of life. SD is often under-appreciated because of overall low awareness. Diagnosis of SD is subjective, and manifestations can be different among men and women. Causes of SD are multifactorial, including psychological disorders, hormonal imbalances, vascular disorders, neurological disorders, and medication side effects. Non-specific approaches to improving sexual function include addressing underlying psychological disorders, promoting lifestyle modifications, optimizing dialysis care, and facilitating successful kidney transplantation, whereas treatment with phosphodiesterase type 5 inhibitor, hormone replacement, and mechanical devices can be offered to patients with specific indications.

Cognitive-behavioral group therapy for women with hypoactive sexual desire: A pilot randomized study

BACKGROUND

Hypoactive Sexual Desire Disorder (HSDD) is a very prevalent sexual problem, with limited options for treatment. Given that psychological factors are major contributors to the disorder, a therapy such as Cognitive-Behavioral Therapy (CBT) may be useful to treat HSDD.

OBJECTIVE

To evaluate the effects of group CBT on women with HSDD.

METHOD

Clinical trial randomized study with 106 women diagnosed with HSDD, who were divided as follows: Group 1 (n = 53) underwent group CBT for 8-weeks, and Group 2 (n = 53), were put on a waiting list and used as a control group. Sexual function was assessed by the Female Sexual Quotient (FSQQ) at the initial interview and after 6-months. Mann Whitney test was used for group comparison.

MAIN OUTCOME MEASURES

demographics, education, sexual history, FSQQ and its domains for sexual function assessment.

RESULTS

Both groups had similar characteristics regarding sexual response, self-image, and relationship with a partner at the initial interview. Women undergoing therapy showed significant improvement in sexual function when compared with the control group. The overall FSQQ result showed an average growth of 18.08 points (95% CI 12.87‒23.28) for the therapy group against a decrease of 0.83 points (95% CI 3.43‒1.77) for controls (p < 0.001). The five domains of the questionnaire also exhibited significant improvement in the therapy group: desire and interest (p = 0.003), foreplay (p = 0.003), excitation and tuning (p < 0.001), comfort (p < 0.001), and orgasm and satisfaction (p < 0.001).

CONCLUSION

Group CBT was shown to be an effective tool for treating HSDD.

Disfunción sexual femenina: una mirada a los últimos 44 años. Análisis bibliométrico

Objetivo La disfunción sexual femenina (DSF) es un trastorno prevalente que afecta la calidad de vida de las mujeres y combina factores biológicos, psicológicos e interpersonales. Su estudio ha sido de poco interés, en campos como la investigación y el tratamiento, debido a la dificultad en la medición de las respuestas sexuales en las mujeres y otros factores, como el tabú acerca de la sexualidad femenina. Este estudio caracteriza las tendencias de publicaciones científicas acerca del tema, para que los urólogos puedan comprender la necesidad de realizar la búsqueda de este trastorno en la práctica diaria.

Métodos Se realizó una búsqueda de la literatura en las bases de datos PubMed, FABUMED y Scopus, utilizando la estrategia «((«female sexual dysfunction» [Title/Abstract])». Se realizó un análisis bibliométrico descriptivo, de corte retrospectivo, de la literatura médica obtenida en MEDLINE. A través de las herramientas estadísticas FABUMED, PubReminer y Scopus, se recopilaron los datos y se obtuvo los resultados de las variables que posteriormente fueron analizadas de forma estadística y descriptiva. Con base en esta información, elaboramos tablas y gráficas en Microsoft Office Excel 2017. Adicionalmente, realizamos un análisis de mapeo bibliométrico utilizando el programa VOSviewer. Para la obtención del factor de impacto (FI), utilizamos el Journal Citation Reports 2017/2018.

Resultados Desde 1975 hasta 2019, se publicaron 1.292 estudios, y la tasa anual de publicación permaneció estable entre 1975 y 2000. Pero, a partir del año 2000, se evidenció un aumento en el número de publicaciones, con un crecimiento del 92,1%. De las veinte revistas con más publicaciones, sólo cuatro son de urología. Los países con más publicaciones fueron: Estados Unidos (31,4%), Reino Unido (12,9%), Italia (8,9%), Turquía (5,9%), y Australia (4%). Estos datos son muy diferentes a los de los países de América Latina, en los que se encontraron muy pocas publicaciones, como Colombia, con tan sólo tres estudios.

Conclusiones Este análisis bibliométrico mostró las diferentes tendencias y tasas de publicación de estudios sobre DSF, y evidenció una baja tasa de producción con relación a otras temáticas, sobre todo en las revistas urológicas, con predominio de mujeres como autores, aunque en los últimos años se ha identificado un crecimiento importante y sostenido. Se hace evidente la necesidad de desarrollar estrategias para mejorar la formación tanto en los niveles de posgrado como de pregrado y, así, generar más adhesión a este tema en una especialidad quirúrgica como la nuestra.

Sexuality, Contraception, and Pregnancy in Kidney Transplantation

Sexual dysfunction is defined as any abnormality in sexual arousal, libido, intercourse, orgasm, or satisfaction. It is prevalent in patients with chronic and end-stage kidney disease, with 70% to 84% of men and 30% to 60% of women reporting some form of sexual dysfunction. Although kidney transplantation improves the overall quality of life for patients receiving dialysis, it can have unexpected effects on sexual function owing to the use of immunosuppressive medications and comorbid illnesses. It is important to recognize these adverse effects and pre-emptively discuss them with patients to help mitigate consequent psychosocial discontent. Women of reproductive age will often recover fertility after kidney transplantation and therefore need to be empowered to prevent unwanted pregnancies and plan for a safe pregnancy if desired. Complications such as preeclampsia, pregnancy-induced hypertension, gestational diabetes, ectopic pregnancy, still birth, low birth weight, and preterm birth are more common in pregnant women with a kidney transplant. Careful monitoring for infection, rejection, and immunosuppressive dose adjustment along with comanagement by a high-risk obstetrician is of utmost importance. Breast-feeding is safe with most immunosuppressive medications and should be encouraged.

Sexual dysfunction in Thai gynecologic malignancies survivors: A single-institutional cross-sectional observational survey

OBJECTIVE

To examine the prevalence of female sexual dysfunction (FSD) in gynecologic cancer survivors.

METHODS

A cross-sectional observation survey recruited women aged 18-65 years old who were diagnosed with gynecologic cancers and underwent surgery, radiation, chemotherapy, or combined modalities. Data were collected from September 2019 to March 2020 by the Thai version of the female sexual function index questionnaire to define FSD. The survey contained six domains: desire, arousal, lubrication, orgasm, satisfaction, and pain.

RESULTS

Of the 98 women included in the study, the mean age was 48.7 ± 10.6 years old. Two-third (67.3%) of the participants was premenopausal, had been diagnosed with ovarian cancer, and had early-stage gynecologic cancers. Fifty-eight of 98 (59.2%) participants were sexually active in the past 4 weeks before the survey. Among those, 89.6% had FSD. The median scores in the FSD group were significantly lower than those in the non-FSD group in all six domains, namely, desire, arousal, lubrication, orgasm, satisfaction, and pain (p < 0.05). There was no statistically significant difference observed between participants with and without FSD in terms of age group, cancer-related data, or sexual behavior data, except participants who had good/excellent relationships with their partners, which impacted FSD (p = 0.01).

CONCLUSIONS

This study discovered the high prevalence (89.6%) of hidden issue of "female sexual dysfunction" in Thai gynecologic cancer survivors. The good/excellent relationships with their partners affected the FSD who were sexually active in the past 4 weeks before the survey.

What is the "weight" of body mass index on sexual functioning in women? A mediation model

PURPOSE

It is well known that body mass index (BMI) affects how individuals perceive their well-being and that obese individuals tend to report poorer levels of subjective health status. The aim of this study was to compare subjects with and without FSD and to examine the direct and indirect impact of BMI on female sexual dysfunction (FSD) in overweight/obese and normal-weight women.

METHODS

A cross-sectional study was conducted on 186 overweight/obese and 233 normal-weight women. FSD assessed with the Female Sexual Function Index (FSFI) was investigated in relation to body satisfaction assessed with the Body Uneasiness Test (BUT-A) and self-esteem assessed with the Rosenberg Self-Esteem scale (RSE).

RESULTS

No difference in the prevalence of FSD was found between overweight/obese (44.4%) and normal-weight women (55.6%), even though significant between-group differences in body image were found. Structural Equation Modelling (SEM) showed that BMI contribute to FSD only through the mediating role of body dissatisfaction and self-esteem.

CONCLUSIONS

The present results support the notion that sexual functioning is not related directly to BMI in women but to a more complex interactions of body weight, satisfaction with one's own body image, and levels of self-esteem. Clinicians should take into account that for women having a good sexual life seems not related to body weight but to the way their body weight is perceived within the context of self-image.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

Relationship of the type of breastfeeding in the sexual function of women

Objective:

to relate the type of breastfeeding in the women’s sexual function.

Method:

a cross-sectional study conducted with 150 women in the postpartum period registered in the Family Health Strategy of a large Brazilian municipality. Two instruments were used: one for characterizing sociodemographic, obstetric and breastfeeding variables, and the Female Sexual Function Index for the sexual function. Descriptive data analysis was performed, comparing the variables of interest using the Analysis of Variance, Brown-Forsythe and Tukey tests.

Results:

there was statistical significance between the groups that practiced different types of breastfeeding in the vaginal lubrication domain (p = 0.015), with the mothers in mixed or partial breastfeeding presenting a higher score for this domain (3.8).

Conclusion:

there is a difference in the female sexual function between different types of breastfeeding. Women who presented better vaginal lubrication belonged to the mixed breastfeeding group.

Overexpressing miR-122-5p Inhibits the Relaxation of Vaginal Smooth Muscle in Female Sexual Arousal Disorder by Targeting Vasoactive Intestinal Peptide Receptor 1

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.

A Systematic Review of Clinical Trials Assessing Sexuality in Hysterectomized Patients

In hysterectomized patients, even though there is still controversy, evidence indicates that in the short term, the vaginal approach shows benefits over the laparoscopic approach, as it is less invasive, faster and less costly. However, the quality of sexual life has not been systematically reviewed in terms of the approach adopted. Through a systematic review, we analyzed (CRD42020158465 in PROSPERO) the impact of hysterectomy on sexual quality and whether there are differences according to the surgical procedure (abdominal or vaginal) for noncancer patients. MEDLINE (through PubMed), Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and Scopus were reviewed to find randomized clinical trials assessing sexuality in noncancer patients undergoing total hysterectomy, comparing vaginal and abdominal (laparoscopic and/or open) surgery. Three studies that assessed the issue under study were finally included. Two of these had a low risk of bias (Cochrane risk of bias tool); one was unclear. There was significant variability in how sexuality was measured, with no differences between the two approaches considered in the review. In conclusion, no evidence was found to support one procedure (abdominal or vaginal) over another for non-oncological hysterectomized patients regarding benefits in terms of sexuality.

Association between Psychopathological Dimensions and Sexual Functioning/Sexual Arousal in Young Adults

Psychological-psychiatric factors have a different effect on sexual functioning in men and women. This research aimed to examine the association between psychopathological dimensions and dimensions of sexual functioning in Spanish young adults in two studies. Study 1 examined sexual functioning and psychopathological dimensions in 700 women and 516 men. Study 2 conducted an experimental laboratory task to evaluate subjective sexual arousal and genital sensations when watching visual sexual stimuli in a subsample of participants from Study 1 (143 women and 123 men). As a result, the first study showed that depression and anxiety-related symptoms had a negative effect, both in men and women, and having a partner had a positive influence on the dimensions of sexual functioning. The second study showed that anxiety symptoms were positively associated with subjective sexual arousal in both men and women, and anxiety was associated with the assessment of genital sensations in men. The differences between the results of anxiety may be explained because sexual arousal was evaluated in general terms in Study 1, whereas it was evaluated as a state in Study 2. These findings confirm that the presence of psychopathological symptoms contributes to sexual functioning, as well as the necessity of strengthening mental illness prevention programs that include sexual health components.

Priapism following a juvenile Russell's viper bite: An unusual case report

Following a bite from a juvenile Russell's viper (Daboia russelii), a priapism (painful erection) developed rapidly in a 16-year-old male and only subsided after administration of antivenom 3 hours later. Potential mechanisms for this snakebite-induced priapism are unclear but likely due to venom toxins causing nitric oxide (NO) release and subsequent vasodilation of endothelium in the corpus cavernosum, although the possible involvement of other mechanisms cannot be ruled out. We strongly believe that this unusual case report may lead to further scientific research in order to improve the clinical understanding of the pathophysiology of envenomation due to Russell's viper bites. Although it is too early to speculate, further research may also discover the possibilities of developing venom-based candidate molecules to treat sexual dysfunction in males and females.

Does sexual functioning improve with migraine improvements and/or weight loss?-A post hoc analysis in the Women's Health and Migraine (WHAM) trial

BACKGROUND

Despite plausibility of migraine headaches contributing to impaired sexual function among women, data are inconsistent and point to obesity as a potential confounder. Prospective studies that assess the relative importance of migraine improvements and weight loss in relation to sexual function could help elucidate associations among migraine, obesity and female sexual dysfunction (FSD).

OBJECTIVE

To evaluate sexual function changes and predictors of improvement after behavioural weight loss (BWL) intervention for migraine or migraine education (ME).

METHODS

Women with migraine and overweight/obesity were randomized to 16 weeks of BWL (n = 54) or ME (n = 56). Participants completed a 4-week smartphone headache diary and the Female Sexual Function Index (FSFI) at pre- and post-treatment. A validated FSFI total cut-off score defined FSD. We compared changes in FSFI scores and FSD rates between conditions and evaluated migraine improvements and weight loss as predictors of sexual functioning in the full sample.

RESULTS

Among treatment completers (n = 85), 56 (65.9%) participants who reported sexual activity at pre- and post-treatment were analysed. Migraine improvements were similar between conditions, whereas BWL had greater weight losses compared with ME. FSD rates did not change overall (48.2% to 44.6%, p = .66) or by condition (BWL: 56.0% to 40.0% vs. ME: 41.9% to 48.4%, p = .17). Similar patterns were observed for changes in FSFI total and subscale scores. Across conditions, larger weight losses predicted greater improvements in FSFI total and arousal subscale scores, whereas larger migraine headache frequency reductions predicted greater improvements in FSFI satisfaction subscale scores.

CONCLUSION

Sexual functioning did not improve with either BWL or ME despite migraine headache improvements in both conditions and weight loss after BWL. However, weight loss related to improvements in physiological components of the sexual response (i.e., arousal) and overall sexual functioning, whereas reduced headache frequency related to improved sexual satisfaction. Additional research with larger samples is needed.

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.

Hypoactive sexual desire disorder (HSDD) is not "female erectile dysfunction (ED)": challenges with the characterization of HSDD in women based on a systematic literature review

Objective: Hypoactive sexual desire disorder (HSDD) in women has been viewed inaccurately by some in the medical and payer community as analogous to erectile dysfunction (ED) in men. This literature review aims to highlight the distinctions between HSDD and ED.Methods: Two systematic literature searches were conducted on the epidemiology, symptomatology and biopsychosocial outcomes of HSDD and ED. Studies published since 2007 were considered for HSDD; studies published since 2012 were considered for ED.Results: HSDD in women is primarily a central nervous system condition related to neuroendocrine factors, whereby neural pathways that regulate sexual excitation and/or inhibition appear to be involved. A combination of organic and psychogenic factors often contributes to ED. HSDD and ED are associated with similar psychological and interpersonal consequences, but affect different phases of the sexual response model (desire versus arousal) and have different pathophysiologies, therefore requiring different treatment and outcome paradigms. ED is measured by objective, physiological responses (erection and sexual function), but quantitative assessments for HSDD are more difficult because loss of desire with associated distress has to be assessed. Outcome measures used to assess ED, such as the number of satisfying sexual events, are far less informative as an endpoint for randomized clinical trials of treatments for HSDD.Conclusions: HSDD and ED are distinct conditions affecting different phases of the sexual response model, and thus require clear and unique clinical characterization and adequate communication between the health care professional and patient for appropriate diagnosis, management and treatment.

Bremelanotide: New Drug Approved for Treating Hypoactive Sexual Desire Disorder

Objective: To review data regarding bremelanotide, a recently approved therapy for hypoactive sexual desire disorder (HSDD). Data Sources: Literature search of Medline, SCOPUS, and EMBASE was performed using the search terms bremelanotide, bremelanotide injection, Vyleesi, and melanocortin 4 receptor agonist between January 1, 1996, and December 15, 2019. Reference lists from included articles were also reviewed for pertinent citations. Study Selection/Data Extraction: We included phase 2 and 3 trials of bremelanotide. There were 2 reports of phase 3 trials and 2 reports of phase 2 trials. Additional information from supplementary analyses was also referenced. Data Synthesis: Bremelanotide demonstrates significant improvement in desire and a significant decrease in distress related to lack of desire. The most common adverse effects include nausea (39.9%), facial flushing (20.4%), and headache (11%). Relevance to Patient Care and Clinical Practice: Bremelanotide is the second Food and Drug Administration–approved medication for the treatment of HSDD. Bremelanotide’s place in therapy is unknown, as the HSDD guidelines were last updated in 2017. Although the trials met statistical significance for change in sexual desire elements and distress related to sexual desire, the clinical benefit may only be modest. Conclusion: Bremelanotide is a subcutaneous injection that can be administered as needed approximately 45 minutes prior to sexual activity. Bremelanotide is safe and has limited drug-drug interactions, including no clinically significant interactions with ethanol. Prescribing guidelines recommend no more than 1 dose in 24 hours and no more than 8 doses per month. Individuals should discontinue use after 8 weeks without benefit.

Sensory processing of women diagnosed with genito-pelvic pain/penetration disorder: a research proposal

Objectives

The study objectives are to describe the sensory processing patterns of women diagnosed with genito-pelvic pain/penetration disorder (GPPPD), to explore the level of anxiety when both GPPPD and sensory processing disorder (SPD) are present and to investigate participants’ experience of participating in a sensory-based home programme.

Methods

A descriptive two-phased study design will be used. Phase one is a quantitative, cross sectional non-experimental descriptive study, using the Adolescent/Adult Sensory History (ASH) and Hospital Anxiety and Depression Scales (HADS) to obtain data from purposive sampling. Phase two is an exploratory qualitative study involving participants who were identified with SPD in phase one. They will participate in a sensory-based home programme and their experience thereof will be established during semi-structured interviews.

Outcomes

Descriptive studies are known to be useful in planning health services and to develop hypotheses for future testing. This study could improve practitioners’ understanding of GPPPD and SPD and make alternative, non-invasive, non-pharmacological treatment options available to better assist these patients. The study could further clarify the role of the occupational therapist in sexuality. Exploring participants’ anxiety has important implications for treatment protocols in occupational therapy and assisting in describing the signs and symptoms of GPPPD.

Influence of Genotype and Hyperandrogenism on Sexual Function in Women With Congenital Adrenal Hyperplasia

BACKGROUND

Depending on CYP21A2 genotype, congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency leads to biochemical alterations (including hyperandrogenism, hypocortisolism, and hypoaldosteronism) and a wide spectrum of phenotypic disease manifestation. The latter include life-threatening salt-wasting crises, prenatal virilization of genitalia in women (classic CAH [C-CAH]) as well as milder forms of the disease exclusively presenting with hirsutism, acne or reduced fertility (nonclassic CAH [NC-CAH]), and could influence sexual function and identity.

AIM

The present study evaluated sexual function, gender identification, and partner preference in women with C-CAH and NC-CAH.

METHODS

In a cross-sectional cohort analysis, 35 female patients with CAH were divided into 2 groups: C-CAH (salt-wasting/simple virilizing; n = 17) and NC-CAH (n = 18) according to genotype and phenotype. Sexual function and sexual distress were assessed using established questionnaires, including the Female Sexual Function Index. Phenotype (defined by signs of hyperandrogenism) was assessed clinically (Ferriman-Gallwey score) and with the ovulatory function index. CYP21A2 genotype was determined by Sanger sequencing and multiplex ligation-dependent probe amplification. Sexual function was also separately analyzed in the context of clinical signs of androgenization in women with (n = 13) and without acne (n = 22).

OUTCOMES

The study outcomes were sexual function and sexual distress in relation to genotype, clinical signs of androgenization, and biochemical parameters.

RESULTS

Women with NC-CAH had significantly lower orgasm scores, a trend toward lower sexual function with higher sexual distress, as well as biochemical evidence of hyperandrogenism (higher dehydroepiandrosterone sulfate and lower SHBG) and a trend toward more clinical signs of hyperandrogenism (hirsutism). Indicators of in utero and childhood androgen excess as well as the presence of acne in all patients were related to lower sexual function and higher sexual distress. Clinical signs of hyperandrogenism correlated well with cardiovascular and metabolic risk factors.

CLINICAL TRANSLATION

Women with NC-CAH and women with clinical signs of hyperandrogenism demonstrated higher distress compared to women with C-CAH and women without clinical signs of hyperandrogenism, respectively, regarding different aspects of sexual function.

CONCLUSIONS

These data underline the importance of early diagnosis and therapy initiation, especially in patients with NC-CAH. Schernthaner-Reiter MH, Baumgartner-Parzer S, Egarter HC, et al. Influence of Genotype and Hyperandrogenism on Sexual Function in Women With Congenital Adrenal Hyperplasia. J Sex Med 2019;16:1529-1540.

Sexual Dysfunction Is a More Common Problem in Young Women with Type 1 Diabetes than in Healthy Women

The aim of the study was to analyze the relationship between the presence of type 1 diabetes and sexual dysfunction among young women. The study group consisted of 230 women, including 70 healthy and 160 with diabetes mellitus type 1 (DM1). All the participants voluntarily filled anonymous questionnaire. The results regarding sexual function were obtained using a Female Sexual Function Index (FSFI) questionnaire. Statistical analysis was performed for sexually active people. In the study group, 180 women declared sexual activity: 62 healthy (88%) and 118 with DM1 (82.5%). Women with DM1 in comparison with healthy women were older, had higher BMI, weight, and had more pack-years of cigarette smoking. Women with DM1 had lower results in FSFI and more often achieved scores below the clinical cutoff point. In a multiple linear regression model, the presence of diabetes predicted lower FSFI results. DM1 is independently associated with the presence of impaired sexual function. Sexual dysfunctions are more common among young women with DM1 than in healthy controls. The relationship is significant despite of the age, duration of diabetes, body weight, and presence of angiopathy.

Transcutaneous Electrical Nerve Stimulation to Improve Female Sexual Dysfunction Symptoms: A Pilot Study

OBJECTIVES

To perform a pilot study using transcutaneous electrical nerve stimulation (TENS) on the dorsal genital nerve and the posterior tibial nerve for improving symptoms of female sexual dysfunction (FSD) in women without bladder problems. We hypothesize that this therapy will be effective at improving genital arousal deficits.

MATERIALS AND METHODS

Nine women with general FSD completed the study. Subjects received 12 sessions of transcutaneous dorsal genital nerve stimulation (DGNS; n = 6) or posterior tibial nerve stimulation (PTNS; n = 3). Stimulation was delivered for 30 min at 20 Hz. Sexual functioning was evaluated with the female sexual functioning index (FSFI), and surveys were also given on general health, urological functioning, and the Patients' Global Impression of Change (PGIC) after treatment. Surveys were given before treatment (baseline), after 6 and 12 weeks of treatment, and 6 weeks after the completion of stimulation sessions.

RESULTS

The average total FSFI score across all subjects significantly increased from 15.3 ± 4.8 at baseline to 20.3 ± 7.8 after six sessions, 21.7 ± 7.5 after 12 sessions, and 21.3 ± 7.1 at study completion (p < 0.05 for all time points). Increases were observed in both DGNS and PTNS subjects. Significant FSFI increases were seen in the subdomains of lubrication, arousal, and orgasm, each of which is related to genital arousal. Bladder and general health surveys did not change across the study. PGIC had a significant increase.

CONCLUSIONS

This study provides evidence that transcutaneous stimulation of peripheral nerves has the potential to be a valuable therapeutic tool for women with FSD.

Adult Profiles of Child Sexual Abuse Survivors: Attachment Insecurity, Sexual Compulsivity, and Sexual Avoidance

The present study examined the possibility of different groups of child sexual abuse (CSA) survivors based on their different patterns of attachment and sexual problems. A sample of 324 CSA survivors and 484 participants who did not report any child maltreatment experiences completed online questionnaires. A cluster analysis on attachment and sexual outcomes revealed that CSA survivors formed two distinct profiles. The first profile included CSA survivors with elevated attachment anxiety and low to moderate scores on attachment avoidance, sexual compulsion, and sexual avoidance. The second profile comprised CSA survivors with high scores on attachment anxiety, attachment avoidance, sexual compulsion, and sexual avoidance. These groups were then compared on CSA severity, gender differences, and other child maltreatment experiences. As compared to CSA survivors of the first profile, survivors from the second profile reported more intrusive and extrafamilial CSA, higher rates of psychological maltreatment and witnessed parental violence, and experienced more personal and couple distress. These results suggest that CSA survivors form a heterogeneous population and that sexual abuse is differentially associated with the complex unfolding of the attachment and sexual systems within two distinct subgroups.

Lifestyle Choices Can Augment Female Sexual Well-Being

Female sexual wellbeing is complex and it's an important part of a comprehensive approach to women's health. Unfortunately, this aspect of health often is not discussed during medical appointments which can be isolating for female patients. Low libido is the most common female sexual dysfunction. There are multiple causes of low libido that may be physical, cultural, emotional, medical psychological or due to her relationship with her partner. A healthy lifestyle is one way to help women overcome low libido and a few examples include exercise, mindfulness and yoga. Ultimately, these lifestyle approaches can enhance sexual satisfaction.