Hypoactive Sexual Desire Disorder: A Review of Epidemiology, Biopsychology, Diagnosis, and Treatment

KM, Goodman JR, Razaq W, Siddique S, Borges M, Kachnic LA, Barton DL. NRG-CC004 ancillary data study-exploring the effect of bupropion on sexual desire in female cancer survivors with and without vulvovaginal symptoms

BACKGROUND

Female cancer survivors often experience estrogen-deprivation symptoms, which may lead to decreases in sexual desire, vulvovaginal health (lubrication, dryness, discomfort), and sexual satisfaction. Interventions are needed to address these concerns.

AIM

The objective of this secondary analysis was to determine if women with higher (better) scores on the Female Sexual Function Index (FSFI) lubrication and pain subscales reported higher desire scores based on treatment with bupropion vs placebo.

METHODS

Participants were part of NRG Oncology's NRG-CC004 (NCT03180294), a randomized placebo-controlled clinical trial evaluating bupropion (150 vs 300 mg) to improve sexual desire in survivors of breast or gynecologic cancer. All participants with baseline data from the FSFI lubrication, pain, and desire subscales with 5- and/or 9-week data were analyzed. The FSFI subscale scores were correlated using Spearman correlation coefficients. Logistic regression was used to determine associations between FSFI desire and other FSFI subscales while accounting for treatment arm and other covariates.

OUTCOMES

The primary outcome of NRG Oncology's NRG-CC004 (NCT03180294) randomized phase II dose-finding trial was change from baseline to 9 weeks on the FSFI desire subscale score. Similar to the parent study, the primary outcome for this ancillary data study was the FSFI desire subscale score at 5 and 9 weeks.

RESULTS

Overall, 230 participants completed the FSFI at baseline and 189 at 9 weeks. The strongest correlations were between lubrication and pain at baseline (all participants, rho = 0.77; bupropion arms, rho = 0.82), week 5 (all participants, rho = 0.71; bupropion arms, rho = 0.68), and week 9 (all participants, rho = 0.75; bupropion arms, rho = 0.78), and the weakest correlations were between desire and pain. In patients in the treatment arms there were no interactions between lubrication or pain.The impact of various covariates on the FSFI score for desire at 9 weeks demonstrated that participants of non-White race (odds ratio [OR], 0.42; 95% CI, 0.21-0.81; P = .010), with a high lubrication score (OR, 0.36; 95% CI, 0.21-0.61; P = .0002), with a high pain score (less pain) (OR, 0.50; 95% CI, 0.29-0.87; P = .014), or with prior pelvic surgery (OR, 0.38; 95% CI, 0.23-0.63; P = .0002) had lower odds of having low desire.

CLINICAL IMPLICATIONS

Acute estrogen-deprivation symptoms should be addressed prior to sexual desire intervention.

STRENGTHS AND LIMITATIONS

This secondary analysis was not powered to examine all variables.

CONCLUSION

Lubrication and pain were predictors of low desire. Therefore, vulvovaginal atrophy and associated genitourinary symptoms of menopause such as vaginal dryness and dyspareunia should be addressed prior to or in parallel with interventions for sexual desire.

Role of flibanserin in managing hypoactive sexual desire disorder in women: A systematic review and meta-analysis

BACKGROUND

Flibanserin, approved for the treatment of hypoactive sexual desire disorder (HSDD) in females, has demonstrated diverse therapeutic and adverse effect (AE) prospects in the extant randomized controlled trials (RCTs). This meta-analysis aimed to characterize the outcomes of flibanserin use in these patients comprehensively.

METHODS

RCTs involving women with HSDD receiving flibanserin in the intervention arm and placebo in the control arm were sought after throughout the electronic databases. The primary outcomes were the changes from baseline in satisfying sexual events (SSE) per month and sexual desire score per month measured using an electronic diary (eDiary).

RESULTS

From 478 initially screened articles, data from 8 RCTs involving 7906 women with HSDD were analyzed. In premenopausal women, flibanserin 100 mg was superior to placebo in improving the number of SSE per month (mean difference, MD 0.69, 95% CI [0.39, 0.99]), eDiary sexual desire score (MD 1.71, 95% CI [0.43, 2.98]), Female Sexual Function Index (FSFI) desire domain (FSFI-d) score (MD 0.30, 95% CI [0.29, 0.31]), FSFI total score (MD 2.51, 95% CI [1.47, 3.55]), Female Sexual Distress Scale-Revised (FSDS-R) Item 13 score (MD -0.30, 95% CI [-0.31, -0.29]), and FSDS-R total score (MD -3.30, 95% CI [-3.37, -3.23]). Compared to placebo, a higher number of premenopausal women using flibanserin 100 mg achieved improvements in the Patient's Global Impression of Improvement score (OR 1.93, 95% CI [1.58, 2.36], P < .00001) and responded positively at Patient Benefit Evaluation (PBE) (odds ratio, OR 1.76, 95% CI [1.34, 2.31], P < .0001). Postmenopausal women receiving flibanserin 100 mg also benefited in terms of the number of SSE per month, FSFI-d and total scores, FSDS-R Item 13 and total scores, and PBE response. Although flibanserin use was associated with higher risks of dizziness, fatigue, nausea, somnolence, and insomnia, these adverse events were mild in nature; the serious AEs and severe AEs were comparable between the flibanserin and placebo groups.

CONCLUSION

While flibanserin has demonstrated efficacy in the treatment of HSDD in both pre- and postmenopausal women, its therapeutic advantages may be overshadowed by the higher likelihood of AEs.

Female Sexual Health: Screening and Evaluation

Female sexual dysfunction is highly prevalent, affecting 30% to 50% of cisgender women globally. Low sexual desire, sexual arousal disorder, and orgasm disorder affect 10% to 20%, 6% to 20%, and 4% to 14% of women, respectively. Dyspareunia or pain with intercourse affects 8% to 22% of women. Universal screening is recommended; and a thorough medical history and physical examination are the foundations of evaluation and assessment. Laboratory tests and imaging are sometimes warranted, but referral to a sexual medicine expert is suggested if the practitioner is unfamiliar or uncomfortable with treatment.

Self-Perception of Sexual Dysfunction of Adult Brazilian Women of Reproductive Age: A Cross-Sectional Study

Introduction

Sexual dysfunction (SD) comprises disorders in sexual desire, arousal, orgasm, and lubrication. The importance of self-perceived SD relies on its relation to personal values, sex education, and partnership. We aimed to analyze the association between self-perceived SD and the Female Sexual Function Index (FSFI) in adult women of reproductive age and the correlation between age and sexual function.

Material and Methods

This analytical cross-sectional study included 285 women aged 18 to 49 years, sexually active for at least four weeks, cisgender and heterosexual, and with Internet access. Women were divided into control (CG, control group; without SD) or study group (SG, study group; with SD) and responded to a self-applicable online survey containing a sociodemographic characterization, an interview about SD knowledge, and the FSFI test. The Chi-square test of independence (χ2) analyzed the association between self-perceived SD and FSFI-assessed SD. Pearson's correlation coefficient investigated the correlation between age and FSFI.

Results

Included women had a mean age of 29.57 years ± 7.11 years. Self-perceived SD showed a moderate association (Cramer's V = 0.590) with the FSFI score (χ2 [2] = 91.500; p < 0.001). A weak, negative, and significant correlation was observed between age and the FSFI desire domain (r = -0.120; p = 0.030; r2 = 1.440).

Conclusion

Women with self-perceived SD were 68% more likely to present FSFI-assessed SD. Regarding the FSFI desire domain, sexual function decreased with age.

Prevalence, lifestyle, and risk factors of erectile dysfunction, premature ejaculation, and low libido in middle-aged men: first results of the Bavarian Men's Health-Study

BACKGROUND

Erectile dysfunction (ED), premature ejaculation (PE), and low libido (LL) are reported as the most common male sexual dysfunctions.

OBJECTIVE

To evaluate the prevalence of ED, PE, and LL and associations with lifestyle risk factors and comorbidities in middle-aged men.

MATERIALS AND METHODS

This study included a population-based random sample of 2500 50-year-old men who completed validated questionnaires, including the International Index of Erectile Function, the Erection Hardness Score, the Sexual Complaints Screener, and further questionnaires. Multiple logistic regression of outcomes ED, PE, and LL was used to model the association with explanatory factors.

RESULTS

The prevalence of at least one sexual dysfunction was 30%. 21%, 5.2%, and 7.2% of men had ED, PE, and LL, respectively. The risk of ED increased with PE (odds ratio [OR]: 1.94, 95% confidence interval [95%CI]: 1.22-3.08), LL (OR: 2.04, 95%CI: 1.26-3.29), higher waist circumference (OR: 2.23, 95%CI: 1.67-2.96), and lower urinary tract symptoms (LUTS) (OR: 1.88, 95%CI: 1.39-2.55), partnership was associated with a lower risk (OR: 0.57, 95%CI: 0.39-0.85). The risk of PE increased with ED (OR: 1.94, 95%CI: 1.23-3.07), partnership (OR:5.42, 95%CI: 1.30-22.60), depression (OR: 2.37, 95%CI: 1.09-5.14), and LUTS (OR: 2.42, 95%CI: 1.52-3.87), and decreased with physical activity (OR: 0.44, 95%CI: 0.21-0.93). The risk of LL increased with ED (OR: 2.09, 95%CI: 1.31-3.34) and poorer self-rated health (OR: 2.97, 95%CI: 1.54-5.71).

DISCUSSION AND CONCLUSIONS

Roughly one in three 50-year-old men experience some form of sexual dysfunction and risk factors identified in this study underline the multifactorial nature of ED, PE, and LL. Many risk factors are modifiable which underlines the role of patient education. Modifiable risk factors should be addressed in patient education and men should take active measures to remove the risk posed by these factors.

Characteristics of systemic testosterone therapy for female hypoactive sexual desire disorder-a claims database analysis

BACKGROUND

Testosterone therapy (TTh) is recommended for postmenopausal women with hypoactive sexual desire disorder (HSDD); however, there remain insufficient data to support use of TTh in premenopausal women with sexual dysfunction.

AIM

In this study, we used a large national database to evaluate prescribing trends of TTh for women with HSDD.

METHODS

We conducted a cohort analysis of information from electronic health records acquired from the data network TriNetX Diamond. The study cohort consisted of women 18-70 years of age with a diagnosis of HSDD. We analyzed trends of testosterone prescriptions, routes of testosterone administration, and coadministration of testosterone with estrogen.

OUTCOMES

Despite an increase in rates of testosterone prescriptions for HSDD, there remains a high degree of variability in the duration of treatment, route of administration, and coadministration of estrogen with significant underprescription of testosterone.

RESULTS

Our query of the TriNetX database led to the identification of 33 418 women diagnosed with HSDD at a mean age of 44.2 ± 10.8 years, among whom 850 (2.54%) women received a testosterone prescription. The testosterone prescriptions were highly variable with regard to duration and route of administration and coadministration with estrogen. For all patients until 2015, the prevalence of testosterone prescriptions for HSDD showed a positive quadratic relation was observed. Since 2015 a linear increase in prevalence was observed, with the highest rate of increase for patients aged 41-55 years.

CLINICAL IMPLICATIONS

The findings of this study reveal a significant need for further research investigating the optimal use of TTh to enhance the sexual health of women with HSDD, and further studies on the long-term effects of testosterone use must be undertaken to ensure that patients have access to safe and effective treatment.

STRENGTHS AND LIMITATIONS

Limitations to this study include patient de-identification and lack of availability of testosterone dosage data. However, this study also has many strengths, including being the first, to our knowledge, to characterize the prescribing trends of testosterone for women with HSDD.

CONCLUSION

Testosterone therapy should be considered as a potential therapy for premenopausal female patients with HSDD. Further studies on the long-term effects of testosterone use must be undertaken to address disparities in the management of HSDD and to ensure patients can access treatment.

NRG1-ErbB4 signaling in the medial amygdala controls mating motivation in adult male mice

Motivation-driven mating is a basic affair for the maintenance of species. However, the underlying molecular mechanisms that control mating motivation are not fully understood. Here, we report that NRG1-ErbB4 signaling in the medial amygdala (MeA) is pivotal in regulating mating motivation. NRG1 expression in the MeA negatively correlates with the mating motivation levels in adult male mice. Local injection and knockdown of MeA NRG1 reduce and promote mating motivation, respectively. Consistently, knockdown of MeA ErbB4, a major receptor for NRG1, and genetic inactivation of its kinase both promote mating motivation. ErbB4 deletion decreases neuronal excitability, whereas chemogenetic manipulations of ErbB4-positive neuronal activities bidirectionally modulate mating motivation. We also identify that the effects of NRG1-ErbB4 signaling on neuronal excitability and mating motivation rely on hyperpolarization-activated cyclic nucleotide-gated channel 3. This study reveals a critical molecular mechanism for regulating mating motivation in adult male mice.

Management of hypoactive sexual desire dysfunction at a specialized service in women's sexual health

Hypoactive sexual desire dysfunction (HSDD) is prevalent among women. This retrospective cohort study aimed to verify the results of the strategies used by Gynecologists and Obstetricians (Ob-gyn) residents in the management of female HSDD. For this, we conducted a data collection of patient medical records of women with HSDD from the Human Sexuality Studies outpatient clinic of the Human Reproduction Center, Department of Gynecology and Obstetrics of FMRP-USP, from 2005 to 2019. Among the 437 women included, 361 (82.6%) answered the question concerning the effect of the protocol to which they were submitted, whereas 234 (64.8%) reported improvements in sexual desire. The univariate model showed that patients without chronic pelvic pain were 19.0% less likely to report improvements in HSDD than those with chronic pelvic pain (p = 0.03). Patients without depression and without orgasmic dysfunction were, respectively 32% and 23% more likely to show improvements in their HSDD than those who had depression or orgasmic dysfunction (respectively p = 0.001, p = 0.008). However, the multivariate model did not identify any associations. The assistance regarding HSDD by the Ob-gyn resident in training to deal with female sexual complaints may be effective in improving sexual complaints.

Motivation When Desire Is Low: Associations Between Sexual Motivation and Sexual Intimacy, Sexual Satisfaction, and Sexual Distress for Men with Hypoactive Sexual Desire Disorder and Their Partners

Hypoactive sexual desire disorder (HSDD) in men, characterized by chronically low sexual desire, is associated with poor sexual well-being, such as lower sexual satisfaction and higher sexual distress. Additionally, despite their low desire, men with HSDD often report wanting sexual intimacy and validation within their sexual lives/relationships. Studies that apply self-determination theory to sexual relationships demonstrate that adopting more autonomous (e.g., engaging in sex for its inherent pleasure) and less controlled (e.g., engaging in sex for some external reward or consequence) motives for engaging in sex is associated with greater sexual well-being for both members of the couple. Given that autonomous motivation in relationships is associated with intimacy and sexual satisfaction, and lower sexual distress, having sex for autonomous reasons may allow men with HSDD and their partners to feel more sexually intimate despite their lower sexual desire, whereas having sex for controlled reasons may hinder sexual intimacy and satisfaction and augment sexual distress. In this dyadic cross-sectional study, we examined the associations between types of sexual motivation and sexual intimacy, sexual satisfaction, and sexual distress for men with HSDD and their partners (n = 64 couples). Men with HSDD who reported having sex for more autonomous reasons reported more sexual satisfaction and both partners reported more sexual intimacy. Men with HSDD who had sex for more controlled reasons had partners who felt less sexual intimacy and satisfaction, and both partners were more sexually distressed. Promoting autonomous sexual motivation and decreasing controlled motivation may help couples navigating HSDD to feel closer in their relationship, more sexually satisfied, and less sexually distressed.

Androgen-based therapies in women

Androgens play a key biological role in libido and sexual arousal in women, and knowledge about their complex role in other systems remains ambiguous and incomplete. This narrative review examines the role of endogenous androgens in women's health throughout the life span before focusing on evidence surrounding the use of androgen-based therapies to treat postmenopausal women. The role of testosterone as a therapeutic agent in women continues to attract controversy as approved preparations are rare, and use of off-label and compounded formulations is widespread. Despite this androgen therapy has been used for decades in oral, injectable, and transdermal formulations. Responses to androgen therapy have been demonstrated to improve aspects of female sexual dysfunction, notably hypoactive sexual desire disorder, in a dose related manner. Substantial research has also been conducted into the role of androgens in treating aspects of the genitourinary syndrome of menopause (GSM). Evidence for benefits beyond these is mixed and more research is required regarding long-term safety. However, It remains biologically plausible that androgens will be effective in treating hypoestrogenic symptoms related to menopause, either through direct physiological effects or following aromatization to estradiol throughout the body.

Comparing Responses to Sexual Rejection and Sexual and Relationship Well-Being in Couples Coping with Sexual Interest/Arousal Disorder and Community Couples

Four distinct partner responses to sexual rejection - sexual advances that are declined by a partner - have been identified. This study assessed the frequency of these responses between and within North American couples coping with Sexual Interest/Arousal Disorder (SIAD) and community couples and - in line with the Interpersonal Emotion Regulation Model - compared the associations between responses to sexual rejection and sexual and relationship well-being across the two samples. Individuals with SIAD and their partners (n = 241) and community couples (n = 105) completed online measures of sexual rejection responses, sexual satisfaction, sexual desire, sexual distress, sexual frequency, and relationship satisfaction. Results showed that after accounting for sexual rejection frequency, individuals with SIAD and their partners reported greater resentful and insecure partner responses to sexual rejection than individuals in the community sample, and individuals with SIAD perceived less understanding responses than their own partners reported. For both groups, more understanding and less resentful and insecure responses were associated with greater sexual and relationship well-being. Clinicians might encourage couples to reflect on their rejection responses and to shift to more helpful ways of responding to sexual rejection.

Interpersonal Experiences with Persistent Genital Arousal: Connections between Symptom Disclosure, Partner Responses, and Catastrophizing on Relationship Adjustment and Symptom Severity

Increased research attention to interpersonal factors in genitopelvic pain conditions, such as vulvodynia, have led to more comprehensive understanding of couple dynamics in pain, sexual, and relationship outcomes. There has been very little examination of interpersonal factors in Persistent Genital Arousal Disorder/Genitopelvic Dysesthesia (PGAD/GPD), a distressing condition involving persistent sensations of arousal and often pain. The aims of the present study were to examine whether individuals disclose their symptoms to intimate partners and whether interpersonal variables (e.g., partner responses, symptom disclosure, and catastrophizing) are related to relationship adjustment and symptom severity. Seventy-six individuals with symptoms of PGAD/GPD participated in a one-time anonymous online survey. Over three-quarters (85.5%) of the sample disclosed their symptoms to their partners in some way. Greater supportive partner responses and lower symptom catastrophizing were related to better relationship adjustment among participants with PGAD/GPD symptoms. Greater symptom catastrophizing also predicted greater PGAD/GPD symptom severity. Partner responses were not related to PGAD/GPD symptom severity. Although interpersonal factors have been linked to symptom severity in chronic pain and genitopelvic pain conditions, the results of the current study suggest that interpersonal factors may play a slightly different role in PGAD/GPD symptom experiences and in the conceptualization of PGAD/GPD more broadly.

Barriers to sexual health-seeking behaviors for Chinese women

PURPOSE

Cognitive barriers to Chinese women's sexual health-seeking behaviours remained unclear. Therefore, we conducted this study to investigate the characteristics of the sexual health beliefs of Chinese women to clarify why they were reluctant to seek help for sexual issues.

METHODS

An online survey was undertaken from April to July 2020.

RESULTS

A total of 3443 valid responses were gleaned (the effective rate was 82.6%), the participants of which were mainly Chinese urban women of childbearing age. Up to 66.0% (n=2271, the standardized rate was 66.8%~73.4%) felt ashamed of sexual health-related disorders. Most women (49.4%, n=1700) were strongly motivated to seek help for sexual issues but also had a great psychological impediment. Women with low motivation and a great psychological impediment were rare (6.4%, n= 219).

CONCLUSIONS

The shame of sexual health-related disorders was the main barrier to sexual health-seeking behaviours for Chinese women, which should be given enough attention in related health services and sexual education.

Incidence and Predictors of Low Sexual Desire and Hypoactive Sexual Desire Disorder in Women: A Systematic Review and Meta-Analysis

Determining the true incidence and identifying the risk factors of low sexual desire (LSD) and hypoactive sexual desire disorder (HSDD) are essential to prevent sexual dysfunctions and provide adequate treatment resources. This systematic review and meta-analysis were performed on research articles reporting women with LSD and HSDD in PsycArticles, Scopus, MEDLINE, Web of Science databases, and reference lists till October 2021. All cross-sectional studies published in English that assessed both sexual desire and sexual distress were included. Of 891 full-text articles identified, 24 were eligible, all of which had a low risk of overall bias. We did separate random-effects meta-analyses for LSD and HSDD outcomes. The incidence of LSD and HSDD were 29% and 12%, respectively. Studies that used the convenience sampling method reported a higher incidence of HSDD than studies that used the probability sampling method. No differences were found between the assessment method and across cultures in LSD and HSDD. A majority of studies reviewed addressed demographic (e.g. age, education), physiological (e. g. menopausal status, body mass index), psychological (e.g. depression, daily internal stress), relational (e.g. relationship length, relationship satisfaction), and sexual predictors (e.g. sexual activity, sexual pleasure) between LSD and HSDD. This systematic review may inform researchers, guideline developers, and policy-makers about LSD associated with distress and help health professionals to identify women most at risk.

Sexual Desire and Erotic Fantasies Questionnaire: The Development and Validation of the Erotic Fantasy Use Scale (SDEF2) on Experience, Attitudes, and Sharing Issues

BACKGROUND

The investigation of sexual fantasies is a delicate issue within sex research. Most studies have focused on the content of these fantasies, rather than on use, experiences, attitudes, and sharing issues, which are fundamental aspects within sexual therapy. The main aim of the present study was to develop and validate the "Sexual Desire and Erotic Fantasies questionnaire-Part 2. Use of Erotic Fantasies (SDEF2)".

METHODS

The SDEF2 was completed by 1773 Italian participants (1105 women, 645 men, and 23 other genders).

RESULTS

The final 21-item version presented a five-factor structure (fantasies frequency, fantasies normality, fantasies importance, negative emotions, and sharing and experiencing). The SDEF2 showed good psychometric properties, internal reliability, construct, and discriminant validity, appearing to be able to differentiate between sexually clinical and functional women and men (based on the FSFI and IIEF cut-off scores).

CONCLUSIONS

The possibility of assessing fantasies frequency, attitudes, and emotions may be extremely useful both for research and clinical purposes. The current study seems to validate that the SDEF2 is a useful measure of assessing the different aspects related to a fantasizing activity, which was shown to be associated with sexual functioning and satisfaction.

Sexual Desire and Erotic Fantasies Questionnaire: Validation of the Erotic Fantasy Inventory Scale (SDEF3) in Italian Adults

Background: Erotic fantasies are the most common sexual experiences and provide valuable clinical material for understanding individual and relational emotional dynamics. The primary objective of this study is to validate the Sexual Desire and Erotic Fantasies questionnaire (SDEF) Part 3–Inventory of Erotic Fantasies. This questionnaire was designed to be a sex-positive and inclusive measure of the content of erotic fantasies, accessible to individuals of all gender identities, sexual orientations, relationship/romantic status, and sexual behaviors. Methods: The SDEF3 was completed by 1773 Italian participants (1105 women, 645 men, and 23 participants identifying as other genders). Two factorial structures were presented and discussed: a 20-dimension structure for clinical and explorative use and a 6-dimension structure for research purposes. Results: The six-factor version was preferred due to its robust statistical properties and its ability to differentiate between sexually clinical and functional men and women, based on cut-off scores from the Female Sexual Function Index (FSFI) and the International Index of Erectile Function (IIEF). Differences in the frequency of themes in fantasies between gender and sexual orientation were reported and discussed. Conclusions: The current study indicates that the SDEF3 is a valuable and comprehensive measure for assessing various scenarios related to fantasizing activity. It has potential applications in both clinical practice and scientific research.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Hypo- or hyperfunction? Differential relationships between compulsive sexual behavior disorder facets and sexual health

BACKGROUND

Previous studies linking compulsive sexual behavior disorder (CSBD) and sexual health have shown mixed results, which could be due to the fact that different CSBD facets may have differential relationships with sexual functioning.

AIM

As CSBD is a multidimensional disorder, we wanted to investigate whether distinct CSBD domains are differentially related to sexual health.

METHODS

Two online studies were conducted-the first on a convenience sample (812 Polish participants; mean [SD] age, 22.07 [5.91] years) and a replication study on a representative sample of Polish adults (n = 1526; 43.02 [14.37]). Hierarchical regression was employed with sexual functioning as a predicted variable and CSBD symptoms as predictors.

OUTCOMES

The Compulsive Sexual Behavior Disorder Scale was used to assess CSBD symptoms, and the Arizona Sexual Experience Scale was used to measure sexual dysfunction.

RESULTS

In study 1, CSBD salience (β = -.20, P < .001) predicted hyperfunction (ie, stronger sex drive, easier sexual arousal, easier vaginal lubrication/penile erection, easier ability to reach an orgasm, and more satisfying orgasms). Yet, CSBD negative consequences (β = .15, P = .001) and dissatisfaction (β = .22, P < .001) predicted hypofunction (ie, weaker sex drive, more difficulties in sexual arousal, greater difficulties in vaginal lubrication/penile erection, less ability to reach an orgasm, and less satisfying orgasms). Similar results were found in study 2: salience (β = -.26, P < .001) and relapse (β = -.11, P = .004) predicted hyperfunction, while negative consequences (β = .12, P < .001) and dissatisfaction (β = .12, P < .001) predicted hypofunction.

CLINICAL IMPLICATIONS

Our results stress the importance of assessing the severity of each group of symptoms in patients with CSBD to better understand possible difficulties in their sexual functioning.

STRENGTHS AND LIMITATIONS

Our studies are the first to evaluate the effects of each CSBD domain on sexual health. We also replicated results obtained from a convenience sample on a representative sample. The cross-sectional design of the current studies does not allow causal relations to be tested, so future longitudinal research should be carried out. We also gathered data from a general population-thus, it is important to replicate these results on patients diagnosed with CSBD.

CONCLUSION

Our research points out the differential impact of CSBD domains on sexual health: salience and relapse are related to sexual hyperfunction, while negative consequences and dissatisfaction to hypofunction.

The prevalence of sexual dysfunctions in pregnant women and the correlated factors: a systematic review and meta-analysis

BACKGROUND

Sexual functions are negatively affected during pregnancy with the emergence of physical, hormonal, mental, emotional, and behavioral changes; however, there is no cumulative knowledge about the global prevalence of sexual dysfunction (SD) in pregnant women and the correlated factors in SD.

AIM

The study aimed to determine the prevalence of SD among pregnant women and the factors correlated with their SD scores.

METHODS

A systematic review and meta-analysis of studies focusing on SD in pregnant women were conducted in the PubMed, EBSCOhost, Web of Science, Turkish Medline, Scopus, Google Scholar, and Ovid databases by using the following combination of keywords: "pregnant" OR "pregnancy" AND "sexual dysfunction."

OUTCOMES

Nearly 70% of pregnant women were at risk for SD. The age of the pregnant woman, the spouse's age, and the duration of marriage were negatively correlated with the SD score, while the education level was positively correlated with it.

RESULTS

Initially, 5644 studies were identified: 693 studies were evaluated for eligibility and 668 were removed following the exclusion criteria. A total of 25 studies involving 6871 pregnant women were included in the meta-analysis. The pooled SD prevalence in pregnant women was 69.7% (95% CI, 59.9%-77.9%).

CLINICAL IMPLICATIONS

The results of this study can be used in the organization of prenatal care, especially for pregnant women at high risk for SD.

STRENGTHS AND LIMITATIONS

This meta-analysis is the first to reveal the global prevalence of SD and the factors correlated with SD scores in pregnant women. The most important limitation of this study is that it analyzes documents showing pregnant women at risk for SD according to an unconfirmed measurement tool for pregnant women.

CONCLUSION

Most pregnant women experience SD symptoms. More research is needed, specifically on validated tools that assess pregnancy-specific SD symptoms.

An evaluation of bremelanotide injection for the treatment of hypoactive sexual desire disorder

INTRODUCTION

Female sexual response implies a deep intertwining between psychosocial and neurobiological mediators. Regulation of central melanocortin signaling may enhance sexual desire. In premenopausal women with hypoactive sexual desire disorder (HSDD), melanocortin receptor agonist bremelanotide (Vyleesi) has been hypothesized to trigger excitatory brain pathways.

AREAS COVERED

Hereby we summarize bremelanotide's proposed mechanism of action, pharmacokinetics, efficacy and safety data derived from clinical trials. A literature search of peer-reviewed publications on the current evidence on the pharmacotherapy with bremelanotide was performed using the PubMed database.

EXPERT OPINION

Bremelanotide appears to be moderately safe and well-tolerated; the most common adverse reaction is nausea (40%). Although data from clinical trials demonstrated a significant change in validated questionnaires, the overall clinical benefit appears to be modest. However, these results should be interpreted in the light of the dramatic challenges in conducting well-designed clinical trials for female sexual dysfunction, due to the significant placebo effect of pharmacotherapy, and the frequent use of outcome measures that are likely to be highly susceptible to expectation biases, such as long periods of recall of sexual and emotional response.

Sexuality and Quality of Life in Eastern Taiwan People With Schizophrenia

OBJECTIVE

Patients with schizophrenia are living at the border of society and their sexuality is often neglected. The aim of the study is to explore the association among The Brief Psychiatric Rating Scale (BPRS), quality of life (QoL), Taiwanese Depression Questionnaire, and Sexual Desire Inventory in people with schizophrenia (PwS).

METHODS

This study used a cross-sectional design with 277 psychiatric inpatients. A descriptive analysis, difference analysis, and logistic regression model were presented to identify relevant variables that may affect the probability of good QoL.

RESULTS

The study showed that male PwS had higher scores of standard deviation (SD) than females in PwS. The study also showed that smoking, early illness onset age, and shorter illness duration demonstrated a significantly higher SD. The logistic regression analysis showed that BPRS, depression, and SD significantly affected the probability of QoL. By structural equation model, SD would be positively correlated with mental status and SD would indirectly influence QoL.

CONCLUSION

Our results showed psychological and sociological factors interactions may contribute to the QoL and SD for PwS. This study also demonstrated a close relationship between SD, depression, and BPRS. These factors may predict the probability of good life quality for the PwS.

Sexual Inactivity and Dysfunction in Denmark: A Project SEXUS Study

Sexual dysfunctions are common experiences that often impact negatively on the health and well-being of affected individuals. We used baseline questionnaire data from 62,675 Danes aged 15-89 years, who participated in the cohort study Project SEXUS 2017-2018, to yield nationally representative estimates of the prevalence of sexual inactivity and dysfunction and to identify their sociodemographic correlates. Overall, we found that 23.0% of sexually experienced men and 28.8% of sexually experienced women had not been sexually active with another person within the last year. Sexual inactivity with another person was associated with both young and old age, single status, less favorable socioeconomic conditions, underweight and obesity, indicators of poor health, no use of alcohol, and physical inactivity. Among sexually active respondents, 18.0% of men had experienced any dysfunction within the last year, including erectile dysfunction (7.4%), premature ejaculation dysfunction (10.0%), orgasmic dysfunction (4.0%), and/or genital pain dysfunction (0.7%). Among women, 20.4% had experienced any dysfunction within the last year, including lubrication dysfunction (9.1%), orgasmic dysfunction (12.2%), genital pain dysfunction (5.0%), and/or vaginal cramp dysfunction (vaginismus) (0.8%). Additionally, 3.4% of men and 9.9% of women with a spouse/partner had experienced hypoactive sexual desire disorder within the last four weeks. Using the 5-item International Index of Erectile Function (IIEF-5) and the 6-item Female Sexual Function Index (FSFI-6) among respondents with a spouse/partner who had attempted sexual intercourse within the last four weeks, we found that 3.8% of men had experienced moderate or severe erectile dysfunction (IIEF-5 score ≤ 11) and 20.8% of women had experienced any sexual dysfunction (FSFI-6 score ≤ 19) during that period. Single status, difficulties paying bills and, among men, unemployment were positively associated with sexual dysfunction. In conclusion, we document several sociodemographic disparities in the prevalence of sexual inactivity and dysfunction in Denmark. In particular, both sexual inactivity and dysfunction were more common among singles and those reporting financial difficulties.

Sexual Desire in Women: Paradoxical and Nonlinear Associations with Anxiety and Depressed Mood

The aim of the present study was to expand previous findings regarding paradoxical effects of negative mood on sexual desire. This was done by considering the full range of depressed mood and anxiety symptoms and using methods that are unaffected by recall bias and that don't require participants to infer causal associations between their mood and sexual desire. A convenience sample of 213 university students completed daily questionnaires for approximately two months. Multilevel random-effects models were used to estimate average effects for the entire sample and to test for variability across participants in the associations between negative mood and sexual desire, controlling also for potential influences of the menstrual cycle. Previous findings showing that some women report decreased sexual desire and others increased sexual desire when depressed or anxious were confirmed. More importantly, for both depressed mood and anxiety, results demonstrated the presence of within-person paradoxical associations, whereby there were some women for whom both low and high levels of negative mood were associated with the same change (an increase or a decrease) in sexual desire. Related to these diverse response patterns, paradoxical associations between negative mood and sexual desire were also present at low levels of negative mood. The discussion underlines the importance of considering individual variability and multifactorial nonlinear models when studying sexual desire.

Melanocortin 4 receptor agonism enhances sexual brain processing in women with hypoactive sexual desire disorder

BACKGROUND

Hypoactive sexual desire disorder (HSDD) is characterized by a persistent deficiency of sexual fantasies and desire for sexual activity, causing marked distress and interpersonal difficulty. It is the most prevalent female sexual health problem globally, affecting approximately 10% of women, but has limited treatment options. Melanocortin 4 receptor (MC4R) agonists have emerged as a promising therapy for women with HSDD, through unknown mechanisms. Studying the pathways involved is crucial for our understanding of normal and abnormal sexual behavior.

METHODS

Using psychometric, functional neuroimaging, and hormonal analyses, we conducted a randomized, double-blinded, placebo-controlled, crossover clinical study to assess the effects of MC4R agonism compared with placebo on sexual brain processing in 31 premenopausal heterosexual women with HSDD.

RESULTS

MC4R agonism significantly increased sexual desire for up to 24 hours after administration compared with placebo. During functional neuroimaging, MC4R agonism enhanced cerebellar and supplementary motor area activity and deactivated the secondary somatosensory cortex, specifically in response to visual erotic stimuli, compared with placebo. In addition, MC4R agonism enhanced functional connectivity between the amygdala and the insula during visual erotic stimuli compared with placebo.

CONCLUSION

These data suggest that MC4R agonism enhanced sexual brain processing by reducing self-consciousness, increasing sexual imagery, and sensitizing women with HSDD to erotic stimuli. These findings provide mechanistic insight into the action of MC4R agonism in sexual behavior and are relevant to the ongoing development of HSDD therapies and MC4R agonist development more widely.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04179734.

FUNDING

This is an investigator-sponsored study funded by AMAG Pharmaceuticals Inc., the Medical Research Council (MRC) (MR/T006242/1), and the National Institute for Health Research (NIHR) (CS-2018-18-ST2-002 and RP-2014-05-001).

Evaluation of male sexual parameters in infertile couples with a history of abortion

INTRODUCTION

It is thought that both individuals are affected psychologically and sexually in couples experiencing abortion. In addition to the stress caused by infertility, sexual life may also be negatively affected in couples who experience psychogenic wear, such as abortion and curettage. The aim of this study is to evaluate male sexual functions in infertile couples with a history of abortion and male infertility component.

METHODS

Five hundred forty-seven male patients' data were evaluated retrospectively. Group 1 was the included the males of the couples without abortion history and the rest with abortion history was group 2. In addition to demographic data, abortion history, libido level, presence of morning erection and intercourse frequency were evaluated. Hormone levels of all patients were evaluated. After that we created sub-group 1 and sub-group 2 from these groups, respectively, due to whether the patients fulfilled the international index of erectile function (IIEF), Beck anxiety inventory (BAI) and Beck depression inventory (BDI).

RESULTS

There were not any significant differences between the groups regarding psychiatric scale scores, hormone levels, libido, intercourse frequency and IIEF scores. Only orgasmic dysfunction was significant in the males of the couples with abortion history.

CONCLUSION

Man is not affected from abortion process in which woman get involved. Men only have orgasmic dysfunction when there is one or more abortion history in couples.

Assessing the Burden of Illness Associated with Acquired Generalized Hypoactive Sexual Desire Disorder

Background:

Hypoactive sexual desire disorder (HSDD), which affects ∼10% of women in the United States, is defined as the persistent or recurrent deficiency/absence of sexual desire accompanied by personal distress. Although HSDD impacts patient quality of life and interpersonal relationships, the disorder often goes unaddressed or untreated. Recent studies of the burden of illness in women with HSDD, especially premenopausal women, are limited.

Materials and Methods:

A 45-minute web-based survey was designed to investigate the experience of women seeking treatment for HSDD and the impact of this disorder on several psychosocial aspects of women's lives. Women were recruited from an online panel of patients who participated in research studies for compensation. Validated questionnaires assessed sexual function (Female Sexual Function Index) and health-related quality of life (12-Item Short Form Survey [SF-12]), including mental and physical component scores.

Results:

A total of 530 women, aged ≥18 years, diagnosed with acquired generalized HSDD were included in the study. Premenopausal women indicated greater overall HSDD symptom burden compared with postmenopausal women. Patients with HSDD reported lower SF-12 scores compared with the general population. A multivariable regression analysis demonstrated that psychosocial factors influencing the burden of HSDD, including interference with their relationship with their partner (β = −0.18; p < 0.005), mental and emotional well-being (β = −0.23; p < 0.005), and household and personal activities (β = −0.23; p = 0.02), negatively affected SF-12 mental component scores.

Conclusions:

HSDD symptom burden was found to be negatively and statistically significantly associated with patients' mental health; the impact was greater among premenopausal women compared with postmenopausal women.

Management strategies of sexual dysfunctions in Parkinson's disease

Sexual dysfunctions (SD) are frequent and highly disabling nonmotor manifestations of Parkinson's disease (PD) but are also potentially treatable. Neurologists should actively discuss, recognize and treat sexual health issues as an integral part of the management of the disease. In this chapter, we provide recommendations for managing and treating both primary and secondary SD in PD. Many sexual problems can be, at least partially, improved by adjusting the treatment of motor, nonmotor symptoms and comorbidities. Although some treatments of primary SD are evidence-based, many therapeutic options have not been yet systematically studied in patients with PD. The development of new treatments and repurposing of existing remedies in patients with PD remain an unmet need.

Bremelanotide for Treatment of Female Hypoactive Sexual Desire

Hypoactive sexual desire disorder (HSDD) is a persistent deficiency or absence of sexual fantasies and desire resulting in significant distress or interpersonal difficulty. Women with this disorder may display a lack of motivation for sexual activity, reduced responsiveness to erotic cues, a loss of interest during sexual activity, and avoidance of situations that could lead to sexual activity. The pathophysiology of HSDD is thought to be centered around inhibitory and excitatory hormones, neurotransmitters, and specific brain anatomy. Due to the multifactorial nature of HSDD, treatment can be complex and must attempt to target the biological and psychosocial aspects of the disorder. Bremelanotide is a melanocortin receptor agonist and has been recently approved by the FDA to treat HSDD. Bremelanotide is administered intranasally or as a subcutaneous injection. The recommended dosage of bremelanotide is 1.75 mg injected subcutaneously in the abdomen or thigh at least 45 min before sexual activity. Studies showed improvements in desire, arousal, and orgasm scores when 1.75 mg of bremelanotide was administered before sexual activity compared to a placebo. Bremelanotide is a promising way to treat HSDD.

The clinical management of testosterone replacement therapy in postmenopausal women with hypoactive sexual desire disorder: a review

As women age, there is an overall decrease in androgen production due to decline of ovarian and adrenal function during menopause. Androgens have been demonstrated to play an important role in sexual motivation in women. As a result, many postmenopausal women experience Female Sexual Dysfunction (FSD) which are a group of disorders that pertain to sexual arousal, desire, orgasm, and pain. A prevalent manifestation of FSD is Hypoactive Sexual Desire Disorder (HSDD) or the absence of sexual fantasies, thoughts, and/or desire for or receptivity to sexual activity. There is gaining interest in the use of Testosterone Replacement Therapy (TRT) for the treatment of HSDD in postmenopausal women. This article reviews the literature on the relationship of androgen decline and HSDD, describes our methodology for evaluation, diagnosis of HSDD, and the use of TRT in treating postmenopausal women with HSDD. Our results conclude that testosterone is a vital hormone in women in maintaining sexual health and function. TRT is an effective treatment option for postmenopausal people with HSDD. There is still limited data on the effectiveness in premenopausal people with HSDD. Further research in the strengths and weaknesses for the long-term effect of TRT in women of all ages is needed.

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.

The Effect of Mindfulness-Based Cognitive-Behavioral Sex Therapy on Improving Sexual Desire Disorder, Sexual Distress, Sexual Self-Disclosure and Sexual Function in Women: A Randomized Controlled Clinical Trial

Sexual desire disorder is the most common form of sexual dysfunction among women and is associated with problems like sexual distress and reduced sexual self-disclosure. As a result, this RCT study was conducted with 70 reproductive-age women in the form of 4 weekly group educational sessions. Compared to the control group, the mindfulness-based cognitive-behavioral sex therapy (MBCST) intervention significantly improved sexual -desire, -distress, self-disclosure and -function immediately, 4 and 12 weeks after the educational sessions were completed in the intervention group (p < 0.001). Overall, our findings underscore the significance of the MBCST intervention on improving sexual dysfunction among women.Trial registration number: Iranian registry of clinical trials. IRCT Id: IRCT20160808029255N4.Trial registration date: 17th September 2018.Date of first patient's enrollment: 19th September 2018.Supplemental data for this article is available online at https://doi.org/10.1080/0092623X.2021.2008075.

Do Women Need Androgens Like a Fish Needs a Bicycle? A Review of the Literature and Clinical Guidelines

Biopotent androgens such as testosterone circulate in low levels in women. However, androgen precursors, such as dehyroepiandrosterone, are among the most abundant hormones produced in both men and women. While testosterone exerts obvious phenotypic effects in men and is essential for male sexual function, considerable debate and controversy abounds over the role of androgens in women and whether androgens exert an analogous role in women as they do in men. This piece reviews androgen economy in women and the clinical case for and against androgen treatment for women for specific indications.

Navigating Women's Low Desire: Sexual Growth and Destiny Beliefs and Couples' Well-Being

People's beliefs about how to maintain sexual satisfaction have been associated with how they navigate sexual differences, but research has yet to explore the consequences of these beliefs for couples facing a distressing sexual issue. The current research extends past work on sexual growth beliefs (i.e., the view that sexual satisfaction requires continuous effort to maintain) and sexual destiny beliefs (i.e., the view that sexual satisfaction is the result of natural sexual compatibility with a partner) to couples for whom these beliefs might be especially consequential - those coping with sexual dysfunction. In a dyadic longitudinal study of 97 couples coping with women's clinically significant low desire and arousal, we tested how sexual growth and destiny beliefs are associated with sexual, relationship, and personal well-being. We found that endorsing greater sexual growth beliefs was associated with higher sexual desire for both partners, whereas, with some exceptions, endorsing greater sexual destiny beliefs was linked to lower sexual desire and relationship satisfaction, more conflict, and more depressive and anxious symptoms. However, these effects did not persist one year later. Our findings highlight the implications of sexual growth and destiny beliefs for both couple members when navigating a chronic sexual difficulty.

Incorporating the Principles of Sex Therapy into Urologic Care

Urologic conditions and their treatments can have a significant impact on patients' sexual functioning and sexual health. Although urologists address sexual dysfunction within their scope of practice, sexual health conversations occur rarely and focus narrowly on physiologic sexual function. The sex therapy perspective considers biologic, psychological, relationship, and cultural aspects of sexuality. We propose that urologists benefit from taking this perspective when performing sexual health assessment. Urologists are not required to provide sex therapy but can optimize their patient's sexual well-being by taking a holistic perspective on sex and offering informational resources and referral to colleagues with complementary sexual health expertise.

A Systematic Literature Review of Health-related Quality of Life Measures for Women with Hypoactive Sexual Desire Disorder and Female Sexual Interest/Arousal Disorder

INTRODUCTION

Hypoactive Sexual Desire Disorder (HSDD) / Female Sexual Interest/Arousal Disorder (FSIAD) impacts health-related quality of life (HRQoL) of women and their partners, yet existing measures fail to adequately capture relevant concepts (ie, what is essential to measure including symptoms/impacts) important to women with HSDD/FSIAD.

OBJECTIVES

To identify HRQoL tools used to assess women with HSDD/FSIAD, and to evaluate their psychometric properties (ie, reliability, validity, and responsiveness).

METHODS

We conducted searches in PubMed, Embase and PsychINFO from June 5, 1989 to September 30, 2020 for studies in women with HSDD/FSIAD and psychometric analyses (English only). Principles of the Preferred Reporting Items for Systematic reviews and Meta-Analyses, the COnsensus-based Standards for the selection of health Measurement INstruments Risk of Bias Checklist and other psychometric criteria were applied. Based on this search, 56 papers were evaluated including 15 randomized-controlled trials, 11 observational/single arm/open label studies, and 30 psychometric studies.

RESULTS

Of the 18 measures identified, the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised (FSDS-R) were included in most studies (> 50%). General HRQoL instruments were not used in any of the clinical trials; the SF-12, SF-36 and EQ-5D-5L were reported in two observational studies. No instruments achieved positive quality ratings across all psychometric criteria. The FSFI, FSDS-R, Sexual Event Diary (SED) and the Sexual Desire Relationship Distress Scale (SDRDS), were the only measures to receive a positive rating for content validity.

CONCLUSION

Reliable and valid HRQoL measures that include sexual desire and distress are needed to provide a more systematic and comprehensive assessment of HRQoL and treatment benefits in women with HSDD/FSIAD. While inferences about HRQoL are limited due to the lack of uniformity in concepts assessed and limited psychometric evaluation of these measures in women with HSDD/FSIAD, opportunities exist for the development of reliable and validated tools that comprehensively measure the most relevant and important concepts in women with HSDD/FSIAD. Lim-Watson MZ, Hays RD, Kingsberg S, et al. A systematic literature review of health-related quality of life measures for women with Hypoactive Sexual Desire Disorder and Female Sexual Interest/Arousal Disorder. Sex Med Rev 2021;XX:XXX-XXX.

Systematic Review of l-Arginine for the Treatment of Hypoactive Sexual Desire Disorder and Related Conditions in Women

This systematic review evaluates the efficacy and safety of l-arginine alone or in combination for the treatment of women with hypoactive sexual desire disorder (HSDD) or related conditions, such as female sexual interest/arousal disorder and female sexual arousal disorder. Medline, Embase, International Pharmaceutical Abstracts, Science Direct, and the Cumulative Index to Nursing and Allied Health Literature were searched using keywords “arginine”, “Lady Prelox”, “ArginMax”, “Stronvivo”, “Ristela”, “hypoactive sexual desire disorder”, “female sexual interest arousal disorder”, “female sexual arousal disorder”, “sexual dysfunction”, “sexual behavior”, “dyspareunia”, “libido”, and permutations thereof. Relevant records were retained if they were primary literature, conducted in women with HSDD or related conditions, and published as full text in English. Five randomized controlled trials and two nonrandomized studies met eligibility criteria. Six of the seven studies reported either an increase in the total mean Female Sexual Function Index score or significant increases in multiple domains therein. One study assessed vaginal pulse amplitude and found a statistically significant increase in a combination treatment group compared to placebo. No significant side effects were reported. Four of seven studies had potential risk-of-bias concerns per Cochrane assessments. This systematic review found that combination products containing l-arginine in the form of ArginMax or Lady Prelox may be considered for the treatment of HSDD and related conditions in women regardless of age.

Body Image and Hypoactive Sexual Desire Disorder Relationship in a Representative Sample of Iranian Women

Objective: Hypoactive Sexual Desire Disorder (HSDD) among women is a complicated one which is created by various factors playing roles. One of the potential concerns related to Body Image (BI) is lack of sexual appeal in women. Body Image is often described as what a person perceives of their body encompassing the biological, psychological and social factors. The present research pursues the goal to investigate the association between BI and HSDD among the reproductive age women in Iran. Materials and methods: The current study is a cross-sectional (descriptive -analytical) research done on 1000 reproductive age included woman (15-49 years), performed by systematic random sampling method. The data collection tool includes the socio-demographics and the sexual desire scale in addition to the revised sexual distress scale to measure HSDD completed as self-report by the samples. Univariate and multivariate regression tests have been used in order to analyze the data. Results: The mean ± SD age of the women participating in the study was 32.09 ± 7.33. Having adjusted the confounder variables' effect by logistic regression multivariate analysis; the odd ratio for HSDD has been analyzed. The findings suggested that the odd ratio for HSDD in those not satisfied or slightly feeling fulfilled with their BI has been OR: 4.2 (95% CI: 1.98-9.05) and OR: 3.9 (95% CI: 2.29-6.65), respectively, times more than the ones highly satisfied with their body image. Conclusion: The present study results indicate that being dissatisfied with BI is a determinant factor of HSDD that is more probable in the people with negative image of their body structure and feeling lack of bodily appeal. Thus it is imperative to pay attention to this factor when analyzing HSDD.

Difference or dysfunction?: Deconstructing desire in the DSM-5 diagnosis of Female Sexual Interest/Arousal Disorder

This article answers ongoing calls within critical sexuality scholarship to explore how constructions of women’s bodies influence and are influenced by broader sociocultural contexts. Specifically, this article offers a conceptual analysis of female sexual desire, highlighting the deeply political nature of its pathologization. We briefly explore dominant definitions and models of sexual desire to highlight the erasure of embodied desire as an important part of healthy female sexuality. The DSM-5 diagnosis of Female Sexual Interest/Arousal Disorder is critically analyzed to highlight how desire differences are framed as gendered, individual problems which sidelines relational, contextual, and sociopolitical factors contributing to individual distress. When the language of desire is displaced by the language of interest (particularly when framed as receptivity), the capacity to theorize wanting and entitlement is undermined. We argue that the pathologization of diverse desires obscures possibilities for embodied wanting and neglects the consideration that all types of desire (absent, frequent, physical, emotional) may represent normal sexual variations.

Sexual Health in the Elderly Population

PURPOSE OF REVIEW

Among the growing elderly population, sexual health remains an important concern for individuals and couples. An understanding of the expected changes with aging and taking care of aging men and women is important for treating sexual dysfunction. Sexual health issues related to aging can be both linked between men and women and independent. The aim of this study is to determine the most important considerations that contribute to sexual satisfaction in men and women in this population.

RECENT FINDINGS

Many factors contribute to the overall sexual health of men and women. Hypogonadism and erectile dysfunction both warrant thorough evaluation and consideration of treatment to improve sexual satisfaction. Underlying cardiovascular issues may be present in men presenting with these concerns. In addition to hormone replacement and traditional therapy for erectile dysfunction, therapeutic stem cell injection has shown some promise. Menopause, vaginal dryness, and dyspareunia play important roles in sexual satisfaction in women. Vaginal moisturizers, topical estrogen, and MonaLisa Touch laser therapy all may aid in improving these symptoms and ultimately sex lives. Studies have also demonstrated some benefit in populations with arousal disorders, which can be present in the elderly.

SUMMARY

Male patients often describe issues related to erectile dysfunction and hypogonadism, and issues with sexual drive. The pathophysiology is linked between these conditions and treatment of one component can provide symptom relief on a larger scale. A combination of testosterone therapy, lifestyle modifications, and therapy for erectile dysfunction relates to sexual satisfaction in men. In women, an understanding of the physiological process of menopause and offering therapy when indicated can improve the quality of sexual health and provide satisfaction to both patient and partner. While aging can diminish drive and desire, proper counseling and treatment may significantly benefit some patients. A multimodal approach involving the physician, patient, and partner will optimize care and may improve the quality of life in the elderly. This review outlines some normal changes due to aging and identifies some current treatment options for a population in which sexual health can be often ignored or dismissed. By understanding the available tools, a more comprehensive approach can be taken to achieve satisfaction in couples and individuals alike.

Socio-demographic determinants of low sexual desire and hypoactive sexual desire disorder: a population-based study in Iran

Background

Various socio-demographic factors have been introduced as the determinants of Low Sexual Desire (LSD), but whether these variables can also contribute to the Hypoactive Sexual Desire Disorder (HSDD), remains uncertain. In this study, we sought to identify the socio-demographic determinants of LSD and HSDD in Iranian women of reproductive age.

Methods

This was a population-based, cross-sectional study of 1000 married Iranian women of reproductive age (16–49 years) who met the inclusion criteria. The participants were chosen using the systematic random sampling method from all the healthcare centres in the city of Sari, Iran. LSD was defined as a score no higher than 33 on the Sexual Interest and Desire Inventory-Female (SIDI-F). The sexually-related personal distress was considered as a score of at least 11.0 on the Female Sexual Distress Scale-Revised (FSDS-R), and HSDD was determined based on the sum of those scores. Descriptive statistics were used to describe the socio-demographic characteristics and a chi-square test was run for data analysis using grouping variables. Multivariate logistic regression test was also employed to adjust the effect of confounding variables.

Results

The mean score of sexual interest/desire among women was 30.6 ± 10.5. After adjusting the effect of confounding variables, logistic regression showed that socio-demographic variables including age at first intercourse, length of marriage and the level of satisfaction with income were significantly associated with both LSD and HSDD (P < 0.01). While advancing age (P < 0.001) and body mass index (P < 0.01) were just predictors of LSD.

Conclusion

Some socio-demographic factors could predict LSD in women, while they were not associated with HSDD. In other words, some factors associated with LSD do not instigate sexually-related personal distress, which is one of the criteria necessary for the diagnosis of HSDD.

Psychological Treatment of Low Sexual Desire in Women: Protocol for a Randomized, Waitlist-Controlled Trial of Internet-Based Cognitive Behavioral and Mindfulness-Based Treatments

BACKGROUND

Psychological therapies are effective treatments for hypoactive sexual desire dysfunction (HSDD; formerly hypoactive sexual desire disorder), a common sexual dysfunction among women. Access to evidence-based treatments, however, remains difficult. Internet-based interventions are effective for a variety of psychological disorders and may be a promising means to close the treatment gap for HSDD.

OBJECTIVE

This article describes the treatment protocol and study design of a randomized controlled trial, aiming to study the efficacy of cognitive behavioral and mindfulness-based interventions delivered via the internet for women with HSDD to a waitlist control group. Outcomes are sexual desire (primary) and sexual distress (secondary). Additional variables (eg, depression, mindfulness, rumination) will be assessed as potential moderators or mediators of treatment success.

METHODS

A cognitive behavioral and a mindfulness-based self-help intervention for HSDD will be provided online. Overall, 266 women with HSDD will be recruited and assigned either to one of the intervention groups, or to a waitlist control group (2:2:1). Outcome data will be assessed at baseline, at 12 weeks, and at 6 and 12 months after randomization. Intention-to-treat and completer analyses will be conducted.

RESULTS

We expect improvements in sexual desire and sexuality-related distress in both intervention groups compared to the waitlist control. Recruitment has begun in January 2019 and is expected to be completed in August 2021. Results will be published in 2022.

CONCLUSIONS

This study aims to contribute to the improvement and dissemination of psychological treatments for women with HSDD and to clarify whether cognitive behavioral and/or mindfulness-based treatments for HSDD are feasible and effective when delivered via the internet.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03780751; https://clinicaltrials.gov/ct2/show/NCT03780751.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/20326.

Reed G, Dekker A. Estimating the Prevalence of Sexual Dysfunction Using the New ICD-11 Guidelines

BACKGROUND

The 11th edition of the International Statistical Classification of Diseases (ICD-11) is due to come into force in 2022. The goal of the present partial evaluation of the GeSiD study findings is to provide the first ever estimate of the prevalence of different types of sexual dysfunction in Germany as defined by the diagnostic guidelines that are soon to take effect.

METHODS

The representative GeSiD study was carried out in 4955 men and women who belonged to a doubly stratified random sample of data from residence registration offices across Germany. The participation rate was 30.2%. Various types of sexual dysfunction were ascertained for the first time by means of a screening instrument based on the new ICD-11 guidelines.

RESULTS

The reported prevalence of one or more sexual problems, including mild distress, in the previous 12 months was 33.4% in men (95% confidence interval [31.0; 35.9]) and 45.7% in women [43.0; 48.4]. Some 80.4% of men and 72.1% of women stated that they had had at least one sexual contact in the past year. Sexual dysfunction causing marked distress, as per the ICD-11 guidelines, was reported by 13.3% [11.6; 15.1] of the sexually active men (most commonly, erectile dysfunction in 6.6% and early ejaculation in 4.5%), and by 17.5% [15.6; 19.6] of the sexually active women (most commonly, hypoactive sexual desire in 6.9% and orgasmic dysfunction in 5.8%). Orgasmic dysfunction was approximately twice as common in women as delayed ejaculation was in men. The prevalence of erectile dysfunction increased with age, while that of early ejaculation decreased. Women felt particularly impaired by pain associated with sexual activity.

CONCLUSION

The findings of this study indicate the importance of sexual dysfunction as an obstacle to sexual health. The study provides the first prevalence estimates for the new ICD-11 guidelines and simultaneously offers a screening instrument for sexual dysfunction that can be used economically in routine practice.

The Evolution of the Female Sexual Disorder/Dysfunction Definitions, Nomenclature, and Classifications: A Review of DSM, ICSM, ISSWSH, and ICD

INTRODUCTION

The 2 most well-known classification systems that include sexual medicine diagnoses are the International Classification of Diseases and Statistics (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM). Sexual medicine experts from international societies representing an array of disciplines have revised and redefined female sexual dysfunctions (FSDs) to reflect current scientific evidence and the state of the art.

AIM

To summarize the evidence and interactive and chronological process by which sexual medicine societies' consensus groups developed the current nomenclature, classifications, and definitions for FSDs.

METHODS

We review the contributions and collaborations of the Fourth International Consultation in Sexual Medicine (ICSM), the International Society for the Study of Women's Sexual Health (ISSWSH), and the World Association of Sexual Health in conjunction with the World Health Organization.

MAIN OUTCOME MEASURES

The ICSM and ISSWSH diagnostic systems are contrasted with the DSM classification. We discuss innovations and strengths; relevant evidence regarding epidemiology, etiology, and risk factors; and key differences. We describe how sexual medicine expertise informed FSD codes in the ICD-11 classification.

RESULTS

ICSM and ISSWSH published evidence-based guidelines on the definitions, nomenclature, and diagnostic criteria for FSD that diverge from the DSM psychiatric compendia. These definitions and nomenclature recommend the separation of female sexual desire and arousal disorders, elaborate on subtypes of arousal problems, broaden the scope of sexual pain definitions, and provide a greater understanding of etiologies and risk factors for FSDs.

CONCLUSIONS

These collaborations among sexual medicine experts and their role in the ICD-11 development process provide confidence that the ICD-11 Sexual Dysfunction codes are based on current scientific evidence for diagnosing and coding FSDs in clinical settings worldwide, can serve as endpoints in clinical trials, and will provide specificity for treatment outcomes for FSD therapies. Parish SJ, Cottler-Casanova S, Clayton AH, et al. The Evolution of the Female Sexual Disorder/Dysfunction Definitions, Nomenclature, and Classifications: A Review of DSM, ICSM, ISSWSH, and ICD. Sex Med 2021;9:36-56.

Sexual Desire and Fantasies in the LGBT+ Community: a Focus on Bisexuals, Transgender, and Other Shades of the Rainbow

Purpose of Review

The purpose of this review is to summarize the current knowledge on sexual desire expressions, sexual orientation, and identity in understudied groups inside the LGBT+ community.

Recent Findings

Sexual desire and related problems have unique expressions in LGBT+ people which influence their sexual health. Emerging sex-positive approaches might be powerful and prominent tools to provide support and education on behalf of safer sex practices and marginalized sexualities. The importance of deepening LGBT+ sexualities and relationships, not only in lesbian women and gay men but also in all the other shades of the rainbow (bisexual, transgender, asexual, fluid, and non-binary/genderqueer identities), is strongly highlighted.

Summary

A lack of literature regarding sexual desire in LGBT+ people is reported. Results are controversial and research is still limited on this topic, with little information available about sexual and health needs of sexual minorities beyond gay and lesbian people.

Impulsivity and the Experience of Desire in the Choice of Erotic Stimuli

(1) Background: the relationship between erotic desire and personality factors is still relatively understudied. (2) Objective: to study the influence of the experience of desire, as well as impulsivity in the choice of videos, as the behavioral variable in the experimental trial. (2) Method: the sample consisted of 48 adult subjects, who took part in an experimental study that involved watching videos. (3) Results: the linear regression analysis revealed that the behavior involved in choosing videos is predicted by the sexual desire felt at the time of the trial, and not by stable personality factors, such as impulsivity or general self-report levels of sexual desire. (4) Conclusion: it is observed that the specific moment or situation and the behavior have a bigger impact on the erotic desire experienced at the time of the test than certain personality traits, as well as the previous and habitual levels of erotic desire of which an individual reports.

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.

Female Hypoactive Sexual Desire Disorder: A Practical Guide to Causes, Clinical Diagnosis, and Treatment

Hypoactive sexual desire disorder (HSDD) in women is defined as the persistent or recurrent absence of sexual thoughts or fantasies and/or lack of desire for sexual activity that is associated with marked personal distress and/or interpersonal difficulties, and cannot be better attributed to another primary disorder, medication, or general medical condition. Notably, HSDD shares some similarity with depression, as its etiology can be explained using a biopsychosocial model that includes biological, psychological, and sociocultural factors, as well as interpersonal influences. Due to its high prevalence and negative impact on the overall health and well-being of women, primary care health professionals and women's health practitioners need to be actively aware of HSDD, particularly because patients may be reluctant or unwilling to initiate a discussion about their sexual concerns during routine visits. HSDD is well established as a valid and treatable clinical entity. Even for those inexperienced in treating sexual problems, there are simple and validated screening tools such as the Decreased Sexual Desire Screener that can help identify HSDD and a need for further evaluation and treatment. There have been few established pharmacologic treatments for HSDD. Flibanserin was the first drug approved for the treatment of HSDD by the U.S. Food and Drug Administration (FDA). Bremelanotide, a novel melanocortin receptor agonist, was recently approved by the FDA for the treatment of acquired, generalized HSDD in premenopausal women. Increased awareness and recognition of HSDD as a medical condition should provide an incentive for further clinical development of effective treatments for HSDD.