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Freitas LPG, Monaco HEMG, Pacetta AM, Nahas SC, Baracat EC, Haddad JM. Brazilian Portuguese Translation and Validation of the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-IUGA revised. Int Urogynecol J 2024:10.1007/s00192-024-05889-y. [PMID: 39153070 DOI: 10.1007/s00192-024-05889-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 07/13/2024] [Indexed: 08/19/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Condition-specific sexual questionnaires are important patient-reported outcome measures. The aim of this study was to translate and validate the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-International Urogynecology Association Revised (PISQ-IR) into Brazilian Portuguese and to clinically validate it in a Brazilian Portuguese-speaking population. METHODS Translation and validation of the PISQ-IR was performed according to the International Urogynecological Association-recommended process and guidelines. For external validity, PISQ-IR subscales were compared with the clinical measures, Pelvic Organ Prolapse Quantification system (POP-Q) stage, pelvic floor muscle tone, and Oxford Grading Scale (Pearson correlations). Descriptive statistics, internal consistency (Cronbach's alpha coefficient), and test-retest reliability (interclass correlation coefficient) were calculated for all PISQ-IR subscales. RESULTS A total of 120 sexually active and 106 not sexually active women were enrolled in the study between March 2015 and July 2019. Internal consistency was acceptable, with Cronbach's alpha values 0.60-0.80, except for the sexual arousal and orgasm, sexual arousal and partner-related issues, sexual arousal and condition-specific issues, global rating of sexual quality and condition impact subscales. PISQ-IR demonstrated good reliability (α > 0.6, CIC = 0.996). The agreement for each individual questionnaire item also individually presented substantial agreement between the assessments (κ 0.61-0.8). There was a correlation between PISQ-IR and POP, mixed, stress and fecal incontinence diagnosis and a positive correlation with pelvic floor muscle function according to the Oxford Scale in sexually active women. For sexually inactive women there was a correlation between PISQ-IR and mixed urinary symptoms. CONCLUSIONS The Brazilian Portuguese version of PISQ-IR is a reliable and valid tool that can be easily used for the identification and assessment of sexual function in Brazilian Portuguese-speaking women with pelvic floor disorders.
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Affiliation(s)
- Luciana Pistelli Gomes Freitas
- Urogynaecology Section, Department of Obstetrics and Gynecology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Isaac Krasilchik, 88. Água Branca, Sao Paulo, SP, 05036-165, Brazil.
| | - Helga Elisa Marquesini Gonzales Monaco
- Urogynaecology Section, Department of Obstetrics and Gynecology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Isaac Krasilchik, 88. Água Branca, Sao Paulo, SP, 05036-165, Brazil
| | - Aparecida Maria Pacetta
- Urogynaecology Section, Department of Obstetrics and Gynecology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Isaac Krasilchik, 88. Água Branca, Sao Paulo, SP, 05036-165, Brazil
| | - Sérgio Carlos Nahas
- Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Edmund Chada Baracat
- Urogynaecology Section, Department of Obstetrics and Gynecology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Isaac Krasilchik, 88. Água Branca, Sao Paulo, SP, 05036-165, Brazil
| | - Jorge Milhem Haddad
- Urogynaecology Section, Department of Obstetrics and Gynecology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Isaac Krasilchik, 88. Água Branca, Sao Paulo, SP, 05036-165, Brazil
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Mooney KM, Mulroy M, Park J, Pukall CF. A Prospective, Longitudinal Comparison of Sexual Distress Across Relationship Status During the COVID-19 Pandemic. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:2237-2251. [PMID: 38652408 DOI: 10.1007/s10508-024-02835-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 02/11/2024] [Accepted: 02/14/2024] [Indexed: 04/25/2024]
Abstract
Numerous studies have described declines in sexual well-being during the COVID-19 pandemic, although experiences of sexual distress during this time appear to be mixed. Previous research has relied on cross-sectional methodology and focused on individuals in relationships. Furthermore, little is known about the frequency of "COVID-safe" sexual behaviors, such as online sexual activities. These gaps in the literature were addressed using a prospective, longitudinal online study examining sexual distress, predictors of sexual distress (i.e., perceived stress), and online sexual activities over time in single and partnered individuals. Participants were single (N = 64) and partnered (N = 60) individuals who completed surveys at three timepoints over a 6-month period during the COVID-19 pandemic. Mean age across the two groups was 29 years, and approximately half were women (51.6% and 50%, respectively). Results indicated that single individuals reported significantly higher sexual distress than partnered individuals at Times 1 and 2, but not at Time 3. Sexual distress significantly decreased over time for individuals in the single group but remained stable for partnered individuals. At each timepoint, there was a conditional effect of perceived stress on sexual distress depending on one's relationship status, and the nature of these conditional effects changed throughout the course of the study. Results suggested that single individuals demonstrated improvements in sexual distress over time. Perceived stress is an important predictor of sexual distress but may operate differently depending on relationship status. Results highlight the resiliency of both single and partnered individuals during the COVID-19 pandemic.
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Affiliation(s)
- Kayla M Mooney
- Department of Psychology, Queen's University, 62 Arch Street, Humphrey Hall, Kingston, ON, K7L 3N6, Canada
| | - Maeve Mulroy
- Department of Psychology, Queen's University, 62 Arch Street, Humphrey Hall, Kingston, ON, K7L 3N6, Canada
| | - Julianna Park
- Department of Psychology, Queen's University, 62 Arch Street, Humphrey Hall, Kingston, ON, K7L 3N6, Canada
| | - Caroline F Pukall
- Department of Psychology, Queen's University, 62 Arch Street, Humphrey Hall, Kingston, ON, K7L 3N6, Canada.
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Engberg H, Strandqvist A, Berg E, Nordenskjöld A, Nordenström A, Frisén L, Hirschberg AL. Sexual Function in Women With Differences of Sex Development or Premature Loss of Gonadal Function. J Sex Med 2022; 19:249-256. [PMID: 34895859 DOI: 10.1016/j.jsxm.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous studies have suggested that sexual function may be compromised in women born with differences of sex development (DSD) or early loss of gonadal function. AIM To describe sexual function and sexual wellbeing in women with complete androgen insensitivity syndrome (CAIS), complete gonadal dysgenesis (GD) and premature ovarian insufficiency (POI) in relation to gynecological measures and in comparison with unaffected women. METHODS A cross sectional study including 20 women with CAIS, 8 women with 46,XY GD, 8 women with 46,XX GD, 21 women with POI, and 62 population-derived controls. Study participants underwent gynecological examination for anatomical measurements and evaluation of tactile sensitivity. They responded to the validated Sexual Activity Log (SAL), Profile of Female Sexual Function (PFSF), and the Personal Distress Scale (PDS). RESULTS The women with CAIS, XY GD, XX GD and POI showed overall satisfying sexual function in comparison to unaffected age-matched population female controls with a median of 1 to 2 satisfying sexual episodes per week among both the patients and the controls depending on available partner. Women with CAIS had shorter vagina and smaller clitoris and women with XY GD had a significantly shallower vagina in comparison to controls. Clitoral width was also significantly smaller among women with XX GD compared to controls. However, results showed overall good genital touch sensitivity with no significant differences between groups. CLINICAL IMPLICATIONS Women with DSD or POI can be informed on overall satisfactory sexual function and normal genital touch sensitivity. STRENGTHS & LIMITATIONS The strength is the use of age-matched population-based controls to these rare conditions of DSD and POI. Limitations are the nonresponder rate of recruited controls, as well as the small groups of women with DSD. CONCLUSION Women with differences of sex development or early loss of gonadal function show overall good sexual well-being, however clinicians have to make efforts to optimize caretaking and treatment to ensure good sexual quality of life for all patients. Engberg H, Strandqvist A, Berg E, et al., Sexual Function in Women With Differences of Sex Development or Premature Loss of Gonadal Function. J Sex Med 2022;19:249-256.
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Affiliation(s)
- Hedvig Engberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Medical unit of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden.
| | - Anna Strandqvist
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Sweden; Medical unit of Pediatric Endocrinology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Elisabeth Berg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Agneta Nordenskjöld
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden; Pediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Nordenström
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Medical unit of Pediatric Endocrinology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Louise Frisén
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Sweden; Child and Adolescent Psychiatry Research Center, Stockholm, Sweden
| | - Angelica Lindén Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Medical unit of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
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A Ismail S, E Abdel-Azim N, A Saleh M, A Mohamed A, H Yosef A, M Abbas A. A new grading system for female sexual dysfunction based on the female sexual function index in Egyptian women: a cross-sectional study. Afr Health Sci 2021; 21:835-841. [PMID: 34795742 PMCID: PMC8568215 DOI: 10.4314/ahs.v21i2.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To provide a grading system that accurately reflects the grades of female sexual dysfunction (FSD) severity. Patients and methods A cross-sectional study was conducted in Assiut University Hospital. It included 500 women who answered the Arabic version of the Female Sexual Function Index (FSFI) after getting their consent. A gradient of FSD severity was created, classifying FSD into five grades: severe, moderate, mild to moderate, mild, and no FSD. Results According to our grading system, FSD was detected in 339 women (67.8 %); Mild FSD in 20.4%, mild to moderate in 41.6%, moderate in 15.3%, and severe in 22.7%. Mean scores of desire show a linear trend of reduction from 3.8 in mild to 3.36 in mild to moderate to 2.25 in moderate and markedly reduced to 2.1 in severe grade. This difference was highly statistically significant (p= 0.002). The same was reported in arousal, orgasm, and satisfaction domains, while in lubrication and pain domains, the difference was not statistically significant. Conclusion In this study, our grading system was complementary to the FSFI. Moreover, it seems to be more practical and useful in grading the severity of FSD.
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Pyke RE. FDA Decisions on Measures of Hypoactive Sexual Desire Disorder in Women: A History, With Grounds to Consider Clinical Judgment. Sex Med Rev 2021; 9:186-193. [PMID: 33516742 DOI: 10.1016/j.sxmr.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/03/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION In 2000, the FDA began issuing advice about treatments for hypoactive sexual desire disorder (HSDD) in women. How its recommendations have evolved has not been reviewed. Its consistent preference for self-rating by patients over evaluation by an examining clinician has not been addressed. OBJECTIVES Recount the changes in FDA's proposals about patient-reported outcomes and diagnostics. Compare the value of patient-reported measures and clinical interviews. METHODS Historical review is based on draft guidances, publications, meetings, and prescribing information. RESULTS The FDA has avoided clinician input into diagnosis and evaluation of the severity of HSDD in women. It abandoned its initial (2000) insistence on counts of satisfying sexual events to define efficacy in favor of symptom-related scales to evaluate desire and distress with daily self-ratings. By 2015, the FDA accepted the self-rated Female Sexual Function Index-Desire Domain (FSFI-D) to measure desire and the most relevant item of the Female Sexual Distress Scale-Revised (FSDS-R) to measure distress; retrospection for both is one month. The FDA rejected the one clinician-rated broad measure of HSDD, the Sexual Interest and Desire Inventory (SIDI-F), although well-validated and treatment-sensitive. Since 2005, the FDA has accepted the Decreased Sexual Desire Screener (DSDS) to diagnose HSDD by non-expert clinicians using self-ratings and exploring them in more depth in a clinical interview. CONCLUSION FDA's decisions on how to measure HSDD in women may have stabilized on accepting 2 co-primary measures: the FSFI-D and the FSDS-R item on bother about low desire, and on accepting the DSDS for diagnosis. FDA's rejection of clinician ratings of severity through interviews in clinical trials seems unsound because interviews can give broader assessments than (brief) self-ratings, although the agency's logic was to avoid diagnostic controversies and help avoid overcommercialization. Semistructured clinical interviews for diagnosis (DSDS) and severity-rating (SIDI-F) are well validated and are recommended for clinical practice. Pyke RE. FDA Decisions on Measures of Hypoactive Sexual Desire Disorder in Women: A History, With Grounds to Consider Clinical Judgment. Sex Med Rev 2021;9:186-193.
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Zheng J, Islam RM, Bell RJ, Skiba MA, Davis SR. Prevalence of Low Sexual Desire With Associated Distress Across the Adult Life Span: An Australian Cross-Sectional Study. J Sex Med 2020; 17:1885-1895. [PMID: 32773344 DOI: 10.1016/j.jsxm.2020.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/01/2020] [Accepted: 07/03/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although hypoactive sexual desire dysfunction (HSDD; low sexual desire with personal distress) negatively impacts well-being, contemporary life-course prevalence data for HSDD are lacking. AIM To document, in an epidemiologic study, the prevalence of low sexual desire with associated distress (epidemiological HSDD [eHSDD]), and associated psychosocial factors in Australian women. METHODS A cross-sectional study of 10,554 women, aged 18-79 years, recruited from the community was performed. MAIN OUTCOME MEASURES Low desire was determined by corresponding questions in the Profile of Female Sexual Function and Female Sexual Function Index. HSDD was defined as having a low desire and Female Sexual Distress Scale-Revised score of ≥11. CLINICAL TRANSLATION Clinicians need to be aware that young women often experience sexually related distress whereas low desire with associated distress is most common in women at midlife. RESULTS The majority of the participants were partnered (66.5%) and 38.9% were recently sexually inactive. Low desire prevalence increased from age 18-24 years to 75-79 years (27.4%, 95% CI 25.5-29.3 vs 91.6%, 95% CI 88.3-94.1, P < .001). Just over half of all participants aged 25-39 years had sexually related personal distress, after which the prevalence declined with age (P < .001). 10,259 participants provided sufficient information for eHSDD classification. eHSDD increased from age 18-24 years (12.2%, 95% CI 10.8-13.7) to 40-44 years (33.4%, 95% CI 28.5-38.8), remained constant until 60-64 years (33.1%, 95% CI 28.3-38.4), and progressively declined to 7.3% (95% CI 4.8-10.9) by 75-79 years. HSDD was significantly, positively associated with being partnered (P < .001), sexually inactive (P < .001), more educated (P = .001), and psychotropic medication use (P < .001), and negatively with Asian ethnicity (P < .001). STRENGTHS & LIMITATIONS This study involved the assessment of desire using a single question derived from the Profile of Female Sexual Function or the Female Sexual Function Index. CONCLUSION eHSDD is most prevalent at midlife. Furthermore, the likelihood of eHSDD is greater for women who are partnered, sexually inactive, more educated, or taking psychotropic medications. Taken together these findings should aid health professionals in identifying women most at risk of eHSDD. Zheng J, Islam RM, Bell RJ, et al. Prevalence of Low Sexual Desire With Associated Distress Across the Adult Life Span: An Australian Cross-Sectional Study. J Sex Med 2020;17:1885-1895.
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Affiliation(s)
- Jia Zheng
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Rakibul M Islam
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Robin J Bell
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Marina A Skiba
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Susan R Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
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Zheng J, Islam RM, Skiba MA, Bell RJ, Davis SR. Associations between androgens and sexual function in premenopausal women: a cross-sectional study. Lancet Diabetes Endocrinol 2020; 8:693-702. [PMID: 32707117 DOI: 10.1016/s2213-8587(20)30239-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 04/21/2020] [Accepted: 05/21/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although clinicians often measure the serum concentration of androgens in premenopausal women presenting with sexual dysfunction, with some women given testosterone or dehydroepiandrosterone as treatment if their concentrations are low, whether androgens are determinants of sexual function in women of reproductive age is uncertain. We aimed to clarify the associations between androgens and sexual function in a community-based sample of non-health-care-seeking women. METHODS This is a substudy of the Grollo-Ruzzene cross-sectional study, which recruited women aged 18-39 years from eastern states in Australia (QLD, NSW, VIC). After providing consent, women completed an online survey that included the Profile of Female Secual Function (PFSF) questionnaire, and those who were who were not pregnant, breastfeeding, or using systemic steroids were asked to provide a blood sample. At sampling, women were asked the dates of their last menstrual bleed. Serum androgens was measured by liquid chromatography and tandem mass spectrometry and sex hormone binding globulin (SHBG) by immunoassay. Associations between androgens and domains of sexual function, assessed by the PFSF, were examined in participants with regular menstrual cycles. After univariable linear regression (model 1), age, BMI, stage of menstrual cycle, and smoking status were added to the model (model 2), and then parity, partner status, and psychotropic medication use (model 3). FINDINGS Of 6986 women who completed the online survey (surveys completed between Nov 11, 2016, and July 21, 2017), 3698 were eligible and 761 (20·6%) provided blood samples by Sept 30, 2017. Of those who provided a blood sample, 588 (77·3%) had regular menstrual cycles and were included in the analysis. Adjusting for age, BMI, cycle stage, smoking, parity, partner status, and psychoactive medication, sexual desire was positively associated with serum dehydroepiandrosterone (β-coefficient 3·39, 95% CI 0·65 to 6·03) and androstenedione (4·81, 0·16 to 9·12), and negatively with SHBG (-5.74, -9.54 to -1·90), each model explaining less than 4% of the variation in desire. Testosterone (6·00, 1·29 to 10·94) and androstenedione (6·05, 0·70 to 11·51) were significantly associated with orgasm, with the final models explaining less than 1% of the variation in orgasm. Significant associations were found between androstenedione (7·32, 0·93 to 13·08) and dehydroepiandrosterone (4·44, 0·86 to 7·95) and pleasure, and between testosterone and sexual self-image 5·87 (1·27 to 10·61), with inclusion of parity, partners status, and psychotropic drug use increasing the proportion of variation explained by each model to approximately 10%. There were no statistically significant associations between 11-oxygenated steroids and any PFSF domain, or between arousal or responsiveness and any hormone. No associations were seen between 11-oxygenated steroids and any sexual domain, or between arousal or responsiveness and any hormone. INTERPRETATION Associations between androgens and sexual function in premenopausal women are small, and their measurement offers no diagnostic use in this context. Further research to determine whether 11-ketoandrostenedione or 11-ketotestosterone are of clinical significance is warranted. FUNDING The Grollo-Ruzzene Foundation.
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Affiliation(s)
- Jia Zheng
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC Australia
| | - Rakibul M Islam
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC Australia
| | - Marina A Skiba
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC Australia
| | - Robin J Bell
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC Australia
| | - Susan R Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC Australia.
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Zheng J, Skiba MA, Bell RJ, Islam RM, Davis SR. The prevalence of sexual dysfunctions and sexually related distress in young women: a cross-sectional survey. Fertil Steril 2020; 113:426-434. [DOI: 10.1016/j.fertnstert.2019.09.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 10/24/2022]
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Islam RM, Bell RJ, Green S, Page MJ, Davis SR. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. Lancet Diabetes Endocrinol 2019; 7:754-766. [PMID: 31353194 DOI: 10.1016/s2213-8587(19)30189-5] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/22/2019] [Accepted: 05/22/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND The benefits and risks of testosterone treatment for women with diminished sexual wellbeing remain controversial. We did a systematic review and meta-analysis to assess potential benefits and risks of testosterone for women. METHODS We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science for blinded, randomised controlled trials of testosterone treatment of at least 12 weeks' duration completed between Jan 1, 1990, and Dec 10, 2018. We also searched drug registration applications to the European Medicine Agency and the US Food and Drug Administration to identify any unpublished data. Primary outcomes were the effects of testosterone on sexual function, cardiometabolic variables, cognitive measures, and musculoskeletal health. This study is registered with the International Prospective Register of Systematic Reviews (PROSPERO), number CRD42018104073. FINDINGS Our search strategy retrieved 46 reports of 36 randomised controlled trials comprising 8480 participants. Our meta-analysis showed that, compared with placebo or a comparator (eg, oestrogen, with or without progestogen), testosterone significantly increased sexual function, including satisfactory sexual event frequency (mean difference 0·85, 95% CI 0·52 to 1·18), sexual desire (standardised mean difference 0·36, 95% CI 0·22 to 0·50), pleasure (mean difference 6·86, 95% CI 5·19 to 8·52), arousal (standardised mean difference 0·28, 95% CI 0·21 to 0·35), orgasm (standardised mean difference 0·25, 95% CI 0·18 to 0·32), responsiveness (standardised mean difference 0·28, 95% CI 0·21 to 0·35), and self-image (mean difference 5·64, 95% CI 4·03 to 7·26), and reduced sexual concerns (mean difference 8·99, 95% CI 6·90 to 11·08) and distress (standardised mean difference -0·27, 95% CI -0·36 to -0·17) in postmenopausal women. A significant rise in the amount of LDL-cholesterol, and reductions in the amounts of total cholesterol, HDL-cholesterol, and triglycerides, were seen with testosterone administered orally, but not when administered non-orally (eg, by transdermal patch or cream). An overall increase in weight was recorded with testosterone treatment. No effects of testosterone were reported for body composition, musculoskeletal variables, or cognitive measures, although the number of women who contributed data for these outcomes was small. Testosterone was associated with a significantly greater likelihood of reporting acne and hair growth, but no serious adverse events were recorded. INTERPRETATION Testosterone is effective for postmenopausal women with low sexual desire causing distress, with administration via non-oral routes (eg, transdermal application) preferred because of a neutral lipid profile. The effects of testosterone on individual wellbeing and musculoskeletal and cognitive health, as well as long-term safety, warrant further investigation. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Rakibul M Islam
- Women's Health Research Program, Monash University, Melbourne, VIC, Australia
| | - Robin J Bell
- Women's Health Research Program, Monash University, Melbourne, VIC, Australia
| | - Sally Green
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Matthew J Page
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Susan R Davis
- Women's Health Research Program, Monash University, Melbourne, VIC, Australia.
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Davis SR, Robinson PJ, Jane F, White S, White M, Bell RJ. Intravaginal Testosterone Improves Sexual Satisfaction and Vaginal Symptoms Associated With Aromatase Inhibitors. J Clin Endocrinol Metab 2018; 103:4146-4154. [PMID: 30239842 DOI: 10.1210/jc.2018-01345] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/10/2018] [Indexed: 02/13/2023]
Abstract
CONTEXT Intravaginal testosterone (IVT) is a potential treatment of vulvovaginal atrophy (VVA) associated with aromatase inhibitor (AI) use. OBJECTIVE To investigate the effects of IVT on sexual satisfaction, vaginal symptoms, and urinary incontinence (UI) associated with AI use. DESIGN Double-blind, randomized, placebo-controlled trial. SETTING Academic clinical research center. PARTICIPANTS Postmenopausal women taking an AI with VVA symptoms. INTERVENTION IVT cream (300 μg per dose) or identical placebo, self-administered daily for 2 weeks and then thrice weekly for 24 weeks. MAIN OUTCOMES AND MEASURES The primary outcome was the change in the sexual satisfaction score on the Female Sexual Function Index (FSFI). Secondary outcomes included vaginal symptoms and responses to the Profile of Female Sexual Function, the Female Sexual Distress Scale-Revised (FSDS-R), and the Questionnaire for UI Diagnosis. Serum sex steroids were measured. RESULTS A total of 44 women were randomly assigned and 37 provided evaluable data, (mean age 56.4 years, SD 8.8 years). At 26 weeks, the mean between-group difference in the baseline-adjusted change in FSFI satisfaction scores was significantly greater for the IVT group than the placebo group (mean difference 0.73 units; 95% CI, 0.02 to 1.43; P = 0.043). IVT cream resulted in significant improvements, compared with placebo, in FSDS-R scores (P = 0.02), sexual concerns (P < 0.001), sexual responsiveness (P < 0.001), vaginal dryness (P = 0.009), and dyspareunia (P = 0.014). Serum sex steroid levels did not change. Few women had UI symptoms, with no treatment effect. CONCLUSION IVT significantly improved sexual satisfaction and reduced dyspareunia in postmenopausal women on AI therapy. The low reporting of UI among women on AI therapy merits further investigation.
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Affiliation(s)
- Susan R Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Penelope J Robinson
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Fiona Jane
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Shane White
- Olivia Newton-John Cancer Centre, Austin Health, Heidelberg, Victoria, Australia
| | | | - Robin J Bell
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Assessment of Sexual Desire for Clinical Trials of Women With Hypoactive Sexual Desire Disorder: Measures, Desire-Related Behavior, and Assessment of Clinical Significance. Sex Med Rev 2018; 6:367-383. [DOI: 10.1016/j.sxmr.2017.11.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/22/2017] [Accepted: 11/26/2017] [Indexed: 01/11/2023]
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Santos-Iglesias P, Mohamed B, Walker LM. A Systematic Review of Sexual Distress Measures. J Sex Med 2018; 15:625-644. [PMID: 29576431 DOI: 10.1016/j.jsxm.2018.02.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 01/25/2018] [Accepted: 02/23/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Sexual distress is an important component of sexual dysfunction and quality of life and many different measures have been developed for its assessment. AIM To conduct a literature review of measures for assessing sexual distress and to list, compare, and highlight their characteristics and psychometric properties. METHODS A systematic review was conducted using Scopus and PubMed databases to identify studies that developed and validated measures of sexual distress. The main characteristics and psychometric properties of each measure were extracted and examined. OUTCOMES Psychometrically validated measures of sexual distress and a summary of relative strengths and limitations. RESULTS We found 17 different measures for the assessment of sexual distress. 4 were standalone questionnaires and 13 were subscales included in questionnaires that assessed broader constructs. Although 5 measures were developed to assess sexual distress in the general population, most were developed and validated in very specific clinical groups. Most followed adequate steps in the development and validation process and have strong psychometric properties; however, several limitations were identified. CLINICAL TRANSLATION This literature review offers researchers and clinicians a list of sexual distress measures and relevant characteristics that can be used to select the best assessment tool for their objectives. STRENGTHS AND LIMITATIONS A thorough search procedure was used; however, there is still a chance that relevant articles might have been missed owing to our search methodology and inclusion criteria. CONCLUSION This is a novel and state-of-the-art review of assessment tools for sexual distress that includes valuable information measure selection in the study of sexual distress and sexual dysfunction. Santos-Iglesias P, Mohamed B, Walker LM. A Systematic Review of Sexual Distress Measures. J Sex Med 2018;15:625-644.
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Affiliation(s)
| | - Bijan Mohamed
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Lauren M Walker
- Department of Oncology, University of Calgary, Calgary, AB, Canada; Department of Psychosocial Resources, Tom Baker Cancer Centre, Calgary, AB, Canada
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Abstract
SummarySexual dysfunction is one of the most common psychiatric disorders, but it is often ignored in assessment. It can be primary or secondary (a result of psychiatric disorder or medication). Success rates in managing sexual dysfunction are relatively high, with good response to psychological and medical interventions. In ICD-10 and DSM-IV-TR, sexual dysfunctions are broadly classified on the basis of the stages of sexual activity, from arousal to orgasm. There are major similarities between ICD and DSM in diagnosis and classification of sexual dysfunction, but both systems raise challenges. These include definitions of what is ‘normal’ and how abnormality is defined. In this article, we describe the role of the two systems and possible amendments that might help researchers and clinicians. We also present key principles for the assessment and treatment of people who experience sexual dysfunction. We consider problems that need to be managed in engaging and in the therapeutic alliance.
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Pyke R, Clayton A. What Sexual Behaviors Relate to Decreased Sexual Desire in Women? A Review and Proposal for End Points in Treatment Trials for Hypoactive Sexual Desire Disorder. Sex Med 2017; 5:e73-e83. [PMID: 28041924 PMCID: PMC5440628 DOI: 10.1016/j.esxm.2016.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 11/09/2016] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Counts of satisfying sexual events (SSEs) per month have been criticized as an end point in treatment trials of women with hypoactive sexual desire disorder (HSDD) but grounding improvement in sexual desire by assessing changes in sexual behavior remains of some importance. METHODS We conducted a literature review to find validated measurements that are specific sexual behavioral correlates of low sexual desire. We compared expert-proposed criteria for dysfunctional desire, expert-developed sets of scale items, and self-rated scales developed before issuance of, or in accordance with, the Food and Drug Administration's guidance on developing patient-reported outcomes. Behavioral measurements of HSDD were isolated from these sets of criteria or scales. MAIN OUTCOME MEASURES We outline a plan to evaluate such behavioral measurements of HSDD with reference to SSEs. RESULTS Eleven rating scales, four expert-originated and seven self-rated scales mainly derived from patient input were identified as well validated and relevant to HSDD. Three recent sets of diagnostic criteria for conditions such as HSDD were compared with the scales. Twenty-four different symptoms were found in the scales. Content found relevant to HSDD during development of the rating scales varied highly among measurements, including the self-rated scales developed in conformity with current recommendations for patient-reported outcome measurements. The only item on all sets was desire for sexual activity. Four other items were in approximately at least half the sets: sexual thoughts or fantasies, frequency of sexual activity, receptivity, and initiations. Sexual thoughts or fantasies were in every expert-derived set but in only three of the seven patient-derived sets. Receptivity was in five of the seven expert-derived sets vs two of the seven patient-derived sets. Frequency of sexual activity was in one of the seven expert-derived sets but in five of the patient-derived sets. Initiation was in approximately half the two sets. All other items were on one to three sets each. We identified three sexual behaviors of validated specificity for female HSDD: frequency of sexual activity, receptivity, and initiations. Six or seven items are relevant and informative. The item on frequency of sexual activity in the Changes in Sexual Functioning-Female scale is the only item that covers frequency of dyadic and solitary sexual activity. An item in the Female Sexual Desire Questionnaire (FSDQ) covers the intuitively relevant topic of frequency of sexual activity motivated by the woman's desire. Three FSDQ items on initiations and two items on receptivity reflect expert opinion on the sexual behaviors of most relevance to HSDD, but the FSDQ has not been validated in women with HSDD. CONCLUSIONS SSEs have been discredited as the primary measurement in clinical trials of women with HSDD, but it would be meaningful to include at least one sexual behavioral symptom specific to HSDD as an end point. Expert-recommended sexual behaviors specifically related to HSDD are irregularly represented in self-rating scales whether developed as in the Food and Drug Administration guidance on patient-reported outcomes or not. Six or seven items on sexual behavior in self-rated scales can be recommended for relevance to women with HSDD in clinical trials. Items on female sexual behavior should be tested in comparison with SSEs in women with HSDD for relevance and for treatment sensitivity, and responder and functional and dysfunctional cutoffs should be determined before incorporation into large-scale clinical trials. Pyke R and Clayton A. What Sexual Behaviors Relate to Decreased Sexual Desire in Women? A Review and Proposal for End Points in Treatment Trials for Hypoactive Sexual Desire Disorder. Sex Med 2017;5:e73-e83.
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Affiliation(s)
- Robert Pyke
- S1 Biopharma, Inc, Medical, New Fairfield, CT, USA.
| | - Anita Clayton
- Psychiatry and Behavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
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Zethraeus N, Dreber A, Ranehill E, Blomberg L, Labrie F, von Schoultz B, Johannesson M, Hirschberg AL. Combined Oral Contraceptives and Sexual Function in Women-a Double-Blind, Randomized, Placebo-Controlled Trial. J Clin Endocrinol Metab 2016; 101:4046-4053. [PMID: 27525531 DOI: 10.1210/jc.2016-2032] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
CONTEXT There is a lack of knowledge about how oral contraceptives may affect sexual function. OBJECTIVE To determine whether there is a causal effect of oral contraceptives on sexuality. We hypothesized that a widely used pill impairs sexuality. DESIGN A double-blind, randomized, placebo-controlled trial. Enrollment began in February 2012 and was completed in August 2015. SETTING Karolinska University Hospital, Stockholm, Sweden. PARTICIPANTS A total of 340 healthy women, aged 18-35 years, were randomized to treatment, and 332 completed the study. INTERVENTIONS A combined oral contraceptive (150 μg levonorgestrel and 30 μg ethinylestradiol) or placebo for 3 months of treatment. MAIN OUTCOME MEASURES The primary outcome was the aggregate score on the Profile of Female Sexual Function (PFSF). Secondary outcomes were the seven domains of the PFSF, the Sexual Activity Log, and the Personal Distress Scale. RESULTS Overall sexual function was similar in women in the oral contraceptive and placebo groups. The PFSF domains desire (-4.4; 95% confidence interval [CI], -8.49 to -0.38; P = .032), arousal (-5.1; 95% CI, -9.63 to -0.48; P = .030), and pleasure (-5.1; 95% CI, -9.97 to -0.32; P = .036) were significantly reduced in comparison to placebo, whereas orgasm, concern, responsiveness, and self-image were similar between groups. The mean frequency of satisfying sexual episodes and personal distress were also similar between groups. CONCLUSIONS This study shows no negative impact of a levonorgestrel-containing oral contraceptive on overall sexual function, although three of seven sexual function domains were adversely affected.
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Affiliation(s)
- Niklas Zethraeus
- Department of Learning, Informatics, Management and Ethics (N.Z.), Karolinska Institutet, 171 77 Stockholm, Sweden; Department of Economics (A.D., M.J.), Stockholm School of Economics, 113 83 Stockholm, Sweden; Department of Economics (E.R.), University of Zurich, 8006 Zurich, Switzerland; Department of Women's and Children's Health (L.B., B.v.S., A.L.H), Karolinska Institutet, and Department of Obstetrics and Gynecology, Karolinska University Hospital, 171 76 Stockholm, Sweden; and Laval University (F.L.), Quebec City G1V 0A6, Canada
| | - Anna Dreber
- Department of Learning, Informatics, Management and Ethics (N.Z.), Karolinska Institutet, 171 77 Stockholm, Sweden; Department of Economics (A.D., M.J.), Stockholm School of Economics, 113 83 Stockholm, Sweden; Department of Economics (E.R.), University of Zurich, 8006 Zurich, Switzerland; Department of Women's and Children's Health (L.B., B.v.S., A.L.H), Karolinska Institutet, and Department of Obstetrics and Gynecology, Karolinska University Hospital, 171 76 Stockholm, Sweden; and Laval University (F.L.), Quebec City G1V 0A6, Canada
| | - Eva Ranehill
- Department of Learning, Informatics, Management and Ethics (N.Z.), Karolinska Institutet, 171 77 Stockholm, Sweden; Department of Economics (A.D., M.J.), Stockholm School of Economics, 113 83 Stockholm, Sweden; Department of Economics (E.R.), University of Zurich, 8006 Zurich, Switzerland; Department of Women's and Children's Health (L.B., B.v.S., A.L.H), Karolinska Institutet, and Department of Obstetrics and Gynecology, Karolinska University Hospital, 171 76 Stockholm, Sweden; and Laval University (F.L.), Quebec City G1V 0A6, Canada
| | - Liselott Blomberg
- Department of Learning, Informatics, Management and Ethics (N.Z.), Karolinska Institutet, 171 77 Stockholm, Sweden; Department of Economics (A.D., M.J.), Stockholm School of Economics, 113 83 Stockholm, Sweden; Department of Economics (E.R.), University of Zurich, 8006 Zurich, Switzerland; Department of Women's and Children's Health (L.B., B.v.S., A.L.H), Karolinska Institutet, and Department of Obstetrics and Gynecology, Karolinska University Hospital, 171 76 Stockholm, Sweden; and Laval University (F.L.), Quebec City G1V 0A6, Canada
| | - Fernand Labrie
- Department of Learning, Informatics, Management and Ethics (N.Z.), Karolinska Institutet, 171 77 Stockholm, Sweden; Department of Economics (A.D., M.J.), Stockholm School of Economics, 113 83 Stockholm, Sweden; Department of Economics (E.R.), University of Zurich, 8006 Zurich, Switzerland; Department of Women's and Children's Health (L.B., B.v.S., A.L.H), Karolinska Institutet, and Department of Obstetrics and Gynecology, Karolinska University Hospital, 171 76 Stockholm, Sweden; and Laval University (F.L.), Quebec City G1V 0A6, Canada
| | - Bo von Schoultz
- Department of Learning, Informatics, Management and Ethics (N.Z.), Karolinska Institutet, 171 77 Stockholm, Sweden; Department of Economics (A.D., M.J.), Stockholm School of Economics, 113 83 Stockholm, Sweden; Department of Economics (E.R.), University of Zurich, 8006 Zurich, Switzerland; Department of Women's and Children's Health (L.B., B.v.S., A.L.H), Karolinska Institutet, and Department of Obstetrics and Gynecology, Karolinska University Hospital, 171 76 Stockholm, Sweden; and Laval University (F.L.), Quebec City G1V 0A6, Canada
| | - Magnus Johannesson
- Department of Learning, Informatics, Management and Ethics (N.Z.), Karolinska Institutet, 171 77 Stockholm, Sweden; Department of Economics (A.D., M.J.), Stockholm School of Economics, 113 83 Stockholm, Sweden; Department of Economics (E.R.), University of Zurich, 8006 Zurich, Switzerland; Department of Women's and Children's Health (L.B., B.v.S., A.L.H), Karolinska Institutet, and Department of Obstetrics and Gynecology, Karolinska University Hospital, 171 76 Stockholm, Sweden; and Laval University (F.L.), Quebec City G1V 0A6, Canada
| | - Angelica Lindén Hirschberg
- Department of Learning, Informatics, Management and Ethics (N.Z.), Karolinska Institutet, 171 77 Stockholm, Sweden; Department of Economics (A.D., M.J.), Stockholm School of Economics, 113 83 Stockholm, Sweden; Department of Economics (E.R.), University of Zurich, 8006 Zurich, Switzerland; Department of Women's and Children's Health (L.B., B.v.S., A.L.H), Karolinska Institutet, and Department of Obstetrics and Gynecology, Karolinska University Hospital, 171 76 Stockholm, Sweden; and Laval University (F.L.), Quebec City G1V 0A6, Canada
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Davis SR, Worsley R, Miller KK, Parish SJ, Santoro N. Androgens and Female Sexual Function and Dysfunction--Findings From the Fourth International Consultation of Sexual Medicine. J Sex Med 2016; 13:168-78. [PMID: 26953831 DOI: 10.1016/j.jsxm.2015.12.033] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 12/20/2015] [Accepted: 12/22/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Androgens have been implicated as important for female sexual function and dysfunction. AIM To review the role of androgens in the physiology and pathophysiology of female sexual functioning and the evidence for efficacy of androgen therapy for female sexual dysfunction (FSD). METHODS We searched the literature using online databases for studies pertaining to androgens and female sexual function. Major reviews were included and their findings were summarized to avoid replicating their content. MAIN OUTCOME MEASURES Quality of data published in the literature and recommendations were based on the GRADES system. RESULTS The literature supports an important role for androgens in female sexual function. There is no blood androgen level below which women can be classified as having androgen deficiency. Clinical trials have consistently demonstrated that transdermal testosterone (T) therapy improves sexual function and sexual satisfaction in women who have been assessed as having hypoactive sexual desire disorder. The use of T therapy is limited by the lack of approved formulations for women and long-term safety data. Most studies do not support the use of systemic dehydroepiandrosterone therapy for the treatment of FSD in women with normally functioning adrenals or adrenal insufficiency. Studies evaluating the efficacy and safety of vaginal testosterone and dehydroepiandrosterone for the treatment of vulvovaginal atrophy are ongoing. CONCLUSION Available data support an important role of androgens in female sexual function and dysfunction and efficacy of transdermal T therapy for the treatment of some women with FSD. Approved T formulations for women are generally unavailable. In consequence, the prescribing of T mostly involves off-label use of T products formulated for men and individually compounded T formulations. Long-term studies to determine the safety of T therapy for women and possible benefits beyond that of sexual function are greatly needed.
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Affiliation(s)
- Susan R Davis
- The Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University Melbourne, VIC, Australia.
| | - Roisin Worsley
- The Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University Melbourne, VIC, Australia
| | - Karen K Miller
- Neuroendocrine Research Program in Women's Health and Neuroendocrine and Pituitary Clinical Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Thomas HN, Thurston RC. A biopsychosocial approach to women's sexual function and dysfunction at midlife: A narrative review. Maturitas 2016; 87:49-60. [PMID: 27013288 PMCID: PMC4808247 DOI: 10.1016/j.maturitas.2016.02.009] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/15/2016] [Indexed: 01/21/2023]
Abstract
A satisfying sex life is an important component of overall well-being, but sexual dysfunction is common, especially in midlife women. The aim of this review is (a) to define sexual function and dysfunction, (b) to present theoretical models of female sexual response, (c) to examine longitudinal studies of how sexual function changes during midlife, and (d) to review treatment options. Four types of female sexual dysfunction are currently recognized: Female Orgasmic Disorder, Female Sexual Interest/Arousal Disorder, Genito-Pelvic Pain/Penetration Disorder, and Substance/Medication-Induced Sexual Dysfunction. However, optimal sexual function transcends the simple absence of dysfunction. A biopsychosocial approach that simultaneously considers physical, psychological, sociocultural, and interpersonal factors is necessary to guide research and clinical care regarding women's sexual function. Most longitudinal studies reveal an association between advancing menopause status and worsening sexual function. Psychosocial variables, such as availability of a partner, relationship quality, and psychological functioning, also play an integral role. Future directions for research should include deepening our understanding of how sexual function changes with aging and developing safe and effective approaches to optimizing women's sexual function with aging. Overall, holistic, biopsychosocial approaches to women's sexual function are necessary to fully understand and treat this key component of midlife women's well-being.
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Affiliation(s)
- Holly N Thomas
- University of Pittsburgh, Department of Medicine, United States.
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Cappelletti M, Wallen K. Increasing women's sexual desire: The comparative effectiveness of estrogens and androgens. Horm Behav 2016; 78:178-93. [PMID: 26589379 PMCID: PMC4720522 DOI: 10.1016/j.yhbeh.2015.11.003] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 10/21/2015] [Accepted: 11/13/2015] [Indexed: 11/24/2022]
Abstract
Both estradiol and testosterone have been implicated as the steroid critical for modulating women's sexual desire. By contrast, in all other female mammals only estradiol has been shown to be critical for female sexual motivation and behavior. Pharmaceutical companies have invested heavily in the development of androgen therapies for female sexual desire disorders, but today there are still no FDA approved androgen therapies for women. Nonetheless, testosterone is currently, and frequently, prescribed off-label for the treatment of low sexual desire in women, and the idea of testosterone as a possible cure-all for female sexual dysfunction remains popular. This paper places the ongoing debate concerning the hormonal modulation of women's sexual desire within a historical context, and reviews controlled trials of estrogen and/or androgen therapies for low sexual desire in postmenopausal women. These studies demonstrate that estrogen-only therapies that produce periovulatory levels of circulating estradiol increase sexual desire in postmenopausal women. Testosterone at supraphysiological, but not at physiological, levels enhances the effectiveness of low-dose estrogen therapies at increasing women's sexual desire; however, the mechanism by which supraphysiological testosterone increases women's sexual desire in combination with an estrogen remains unknown. Because effective therapies require supraphysiological amounts of testosterone, it remains unclear whether endogenous testosterone contributes to the modulation of women's sexual desire. The likelihood that an androgen-only clinical treatment will meaningfully increase women's sexual desire is minimal, and the focus of pharmaceutical companies on the development of androgen therapies for the treatment of female sexual desire disorders is likely misplaced.
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Affiliation(s)
- Maurand Cappelletti
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA 30322, USA.
| | - Kim Wallen
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA 30322, USA
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Labrie F, Derogatis L, Archer DF, Koltun W, Vachon A, Young D, Frenette L, Portman D, Montesino M, Côté I, Parent J, Lavoie L, Beauregard A, Martel C, Vaillancourt M, Balser J, Moyneur É. Effect of Intravaginal Prasterone on Sexual Dysfunction in Postmenopausal Women with Vulvovaginal Atrophy. J Sex Med 2015; 12:2401-12. [PMID: 26597311 DOI: 10.1111/jsm.13045] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Previous data have shown that intravaginal dehydroepiandrosterone (DHEA, prasterone) improved all the domains of sexual function, an effect most likely related to the local formation of androgens from DHEA. AIMS To confirm in a placebo-controlled, prospective, double-blind and randomized study the benefits of daily intravaginal DHEA for 12 weeks on sexual function using the Female Sexual Function Index (FSFI) questionnaire. METHODS Placebo was administered daily to 157 women while 325 women received 0.50% (6.5 mg) DHEA daily for 12 weeks. All women were postmenopausal meeting the criteria of vulvovaginal atrophy (VVA), namely moderate to severe dyspareunia as their most bothersome symptom of VVA in addition to having ≤5% of vaginal superficial cells and vaginal pH > 5.0. The FSFI questionnaire was filled at baseline (screening and day 1), 6 weeks and 12 weeks. Comparison between DHEA and placebo of the changes from baseline to 12 weeks was made using the analysis of covariance test, with treatment group as the main factor and baseline value as the covariate. MAIN OUTCOME MEASURES The six domains and total score of the FSFI questionnaire were evaluated. RESULTS The FSFI domain desire increased over placebo by 0.24 unit (+49.0%, P = 0.0105), arousal by 0.42 unit (+56.8%, P = 0.0022), lubrication by 0.57 unit (+36.1%, P = 0.0005), orgasm by 0.32 unit (+33.0%, P = 0.047), satisfaction by 0.44 unit (+48.3%, P = 0.0012), and pain at sexual activity by 0.62 unit (+39.2%, P = 0.001). The total FSFI score, on the other hand, has shown a superiority of 2.59 units in the DHEA group over placebo or a 41.3% greater change than placebo (P = 0.0006 over placebo). CONCLUSION The present data show that all the six domains of the FSFI are improved over placebo (from P = 0.047 to 0.0005), thus confirming the previously observed benefits of intravaginal DHEA on female sexual dysfunction by an action exerted exclusively at the level of the vagina, in the absence of biologically significant changes of serum steroids levels.
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Affiliation(s)
| | | | | | - William Koltun
- Medical Center for Clinical Research, San Diego, CA, USA
| | - Andrée Vachon
- Clinique Médicale St-Louis (recherche) Inc, Quebec City, QC, Canada
| | | | | | - David Portman
- Columbus Center for Women's Health Research, Columbus, OH, USA
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Seav SM, Dominick SA, Stepanyuk B, Gorman JR, Chingos DT, Ehren JL, Krychman ML, Su HI. Management of sexual dysfunction in breast cancer survivors: a systematic review. Womens Midlife Health 2015; 1:9. [PMID: 30766696 PMCID: PMC6297963 DOI: 10.1186/s40695-015-0009-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 09/02/2015] [Indexed: 01/01/2023] Open
Abstract
Female sexual dysfunction occurs frequently in midlife breast cancer survivors (BCS) and encompasses problems with sexual desire, interest, arousal, orgasm and genitopelvic pain. Although common, sexual problems are under-diagnosed and under-treated in BCS. The objective of this review was to assess primary studies that intervene on sexual dysfunction in BCS. In February 2015, PubMed, SCOPUS, CINAHL, COCHRANE and Web of Science databases were systematically searched for randomized controlled clinical trials (RCTs) of vaginal (lubricants, moisturizers, estrogens, dehydroepiandrosterone [DHEA], testosterone, vibrators, dilators), systemic (androgens, anti-depressants, flibanserin, ospemifene), physical therapy (physical activity, pelvic floor training), counseling and educational interventions on sexual function in BCS. Observational studies of vaginal interventions were also included due to the paucity of RCTs. The search yielded 1414 studies, 34 of which met inclusion criteria. Both interventions and outcomes, measured by 31 different sexual function scales, were heterogeneous, and therefore data were not pooled. The review found that regular and prolonged use of vaginal moisturizers was effective in improving vaginal dryness, dyspareunia, and sexual satisfaction. Educational and counseling interventions targeting sexual dysfunction showed consistent improvement in various aspects of sexual health. No consistent improvements in sexual health were observed with physical activity, transdermal testosterone or hot flash interventions. There was a lack of BCS-specific data on vaginal lubricants, vibrators, dilators, pelvic floor therapy, flibanserin or ospemifene. Overall, the quality of evidence for these studies was moderate to very low. Because each of the interventions with BCS data had limited efficacy, clinical trials to test novel interventions are needed to provide evidence-based clinical recommendations and improve sexual function in BCS.
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Affiliation(s)
- Susan M. Seav
- Department of Reproductive Medicine and Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Dive #0901, La Jolla, CA 92093 USA
| | - Sally A. Dominick
- Department of Reproductive Medicine and Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Dive #0901, La Jolla, CA 92093 USA
| | - Boris Stepanyuk
- Department of Reproductive Medicine and Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Dive #0901, La Jolla, CA 92093 USA
| | - Jessica R. Gorman
- Department of Reproductive Medicine and Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Dive #0901, La Jolla, CA 92093 USA
- Young Survival Coalition, 80 Broad Street, New York, NY 10004 USA
| | - Diana T. Chingos
- Young Survival Coalition, 80 Broad Street, New York, NY 10004 USA
| | - Jennifer L. Ehren
- University of California, Irvine, Beckman Laser Institute, 1002 Health Sciences Road, Irvine, CA 92612 USA
| | - Michael L. Krychman
- Southern California Center for Sexual Health and Survivorship Medicine, 1501 Superior Avenue, Newport Beach, CA 92663 USA
| | - H. Irene Su
- Department of Reproductive Medicine and Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Dive #0901, La Jolla, CA 92093 USA
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Kalmbach DA, Pillai V, Kingsberg SA, Ciesla JA. The Transaction Between Depression and Anxiety Symptoms and Sexual Functioning: A Prospective Study of Premenopausal, Healthy Women. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:1635-1649. [PMID: 25403320 DOI: 10.1007/s10508-014-0381-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 04/01/2014] [Accepted: 05/13/2014] [Indexed: 06/04/2023]
Abstract
A number of studies have called attention to the problematic interplay between depression and anxiety symptoms and sexual difficulties. However, despite the bidirectional conceptualization of the association between affective and sexual problems, few studies have adequately examined temporal precedence or state-level fluctuations between these two constructs. Using Clark and Watson's (1991) tripartite model of anxiety and depression, the current study employed a repeated measures design to examine how weekly changes in affective symptoms were related to weekly changes in sexual functioning in a non-clinical sample of premenopausal women. First, we examined how general distress, anxious arousal, and anhedonia were concurrently related to various indices of sexual functioning. Next, we examined lagged effects of mood and anxiety symptoms predicting later levels of sexual functioning. Finally, we tested sexual functioning's influence on later reports of affective symptoms. Hierarchical linear modeling analyses revealed that, of the three symptom types tested, anhedonic depression was the most consistently related to sexual problems, and that these relations were more proximal than distal. The preponderance of data suggested temporal precedence of mood on sexual symptoms. These findings emphasize the importance of prospective studies in the investigation of mental and sexual health.
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Kalmbach DA, Ciesla JA, Janata JW, Kingsberg SA. The Validation of the Female Sexual Function Index, Male Sexual Function Index, and Profile of Female Sexual Function for Use in Healthy Young Adults. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:1651-1662. [PMID: 25091215 DOI: 10.1007/s10508-014-0334-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 01/22/2014] [Accepted: 03/25/2014] [Indexed: 06/03/2023]
Abstract
Past research has typically used clinical samples to evaluate the validity of sexual function measures. As normal variations in sexually healthy individuals are of important research and clinical interest, evaluating the applicability of common sexual function measures to these populations is important. Factor structures of the Female Sexual Function Index (FSFI), Male Sexual Function Index (MSFI) (adapted for this investigation), and Profile of Female Sexual Function (PFSF) were examined in young, healthy men and women. We predicted the factor structures to be consistent with past evaluations. In a cross-sectional study, 1,258 participants (M age = 19.56 years; 59 % women) completed these measures. Confirmatory factor analyses did not initially support the factor structures. However, factor loadings showed marked differences between positively and negatively worded items. As such, each measure's factor structure was tested using multi-trait multi-method confirmatory factor analysis which accounted for variance due to item valence. These models supported the predicted structures of the FSFI and MSFI, whereas the PFSF's Responsiveness scale required modification, resulting in an Avoidance scale for both genders. This study was one of few to validate the FSFI in young, healthy adults and the first to examine the MSFI and PFSF in these populations. Additionally, this investigation was the first to propose a reconceptualization of the PFSF Responsiveness scale into an Avoidance scale. Lastly, our study highlights the significant impact of item valence on how individuals respond to questions regarding their sexual functioning.
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Derogatis LR. Review of Patient-Reported Outcome Measures for Sexual Dysfunction. CURRENT SEXUAL HEALTH REPORTS 2015. [DOI: 10.1007/s11930-015-0052-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Kalmbach DA, Arnedt JT, Pillai V, Ciesla JA. The impact of sleep on female sexual response and behavior: a pilot study. J Sex Med 2015; 12:1221-32. [PMID: 25772315 DOI: 10.1111/jsm.12858] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The etiological role of sleep disturbance in sexual difficulties has been largely overlooked. Research suggests that short sleep duration and poor sleep quality lead to poor female sexual response. However, prior research consists of cross-sectional studies, and the influence of sleep on sexual functioning and behavior has not been prospectively examined. AIM We sought to examine the influence of nightly sleep duration, sleep quality, and sleep onset latency on daily female sexual response and activity. METHODS This study used a longitudinal design to study 171 women free of antidepressants and with reliable Internet access who were recruited from a university setting in the United States. Participants first completed baseline measures in a laboratory, and then completed web-delivered surveys at their habitual wake time for 14 consecutive days. MAIN OUTCOME MEASURES All outcome measures were modified for daily recall. Participants completed the Profile of Female Sexual Function's desire, subjective arousal, and orgasmic functioning scales and the Female Sexual Function Index's genital arousal scale, and indicated whether they engaged in partnered sexual activity or self-stimulation in response to dichotomous items. RESULTS Analyses revealed that longer sleep duration was related to greater next-day sexual desire (b = 0.32, P = 0.02), and that a 1-hour increase in sleep length corresponded to a 14% increase in odds of engaging in partnered sexual activity (odds ratio = 1.14, P < 0.05). In contrast, sleeping longer predicted poorer next-day genital arousal (b = -0.19, P < 0.01). However, results showed that women with longer average sleep duration reported better genital arousal than women with shorter average sleep length (b = 0.54, P = 0.03). CONCLUSIONS Obtaining sufficient sleep is important to the promotion of healthy sexual desire and genital response, as well as the likelihood of engaging in partnered sexual activity. These relationships were independent of daytime affect and fatigue. Future directions may investigate sleep disorders as risk factors for sexual dysfunction.
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Affiliation(s)
- David A Kalmbach
- Sleep and Circadian Research Laboratory, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - J Todd Arnedt
- Sleep and Circadian Research Laboratory, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Vivek Pillai
- Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MI, USA
| | - Jeffrey A Ciesla
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
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Abstract
INTRODUCTION The specific affective experiences related to changes in various aspects of female sexual function have received little attention as most prior studies have focused instead on the role of clinical mood and anxiety disorders and their influence on sexual dysfunction. AIM We sought to understand the transaction between daily affect and female sexual function in effort to provide a more nuanced understanding of the interplay between affective and sexual experiences. METHODS The present study used a 2-week daily diary approach to examine same-day and temporal relations between positive and negative affect states and sexual function in young women. MAIN OUTCOME MEASURES We examined the unique relations between positive (i.e., joviality, serenity, self-assurance) and negative (i.e., fear, sadness, hostility) affects and female sexual response (i.e., desire, subjective arousal, vaginal lubrication, orgasmic function, and sexual pain) while controlling for higher order sexual distress, depression, and anxiety, as well as age effects and daily menstruation. RESULTS Analyses revealed different aspects of both positive and negative affects to be independently related to sexual response indices. Specifically, results indicated that joviality was related to same-day sexual desire and predicted increased desire the following day. This latter relation was partially mediated by sexual activity. Further, greater sexual desire predicted next-day calmness, which was partially mediated by sexual activity. Notably, fear was related to same-day subjective arousal, lubrication, orgasmic function, and vaginal pain, whereas poorer orgasmic function predicted greater next-day sadness. CONCLUSIONS These findings describe the manner in which changes in affect correspond to variations in female sexual function, thus highlighting the inextricability of mental and sexual health. Further, these findings may offer insight into the progression of normative levels of affect and sexual function as they develop into comorbid depression, anxiety, and sexual dysfunction.
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Affiliation(s)
- David A Kalmbach
- Department of Psychiatry, Sleep and Chronophysiology Laboratory, University of Michigan, Ann Arbor, MI, USA; Department of Psychology, Kent State University, Kent, OH, USA
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Kalmbach DA, Kingsberg SA, Ciesla JA. How changes in depression and anxiety symptoms correspond to variations in female sexual response in a nonclinical sample of young women: a daily diary study. J Sex Med 2014; 11:2915-27. [PMID: 25200390 DOI: 10.1111/jsm.12692] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION A large body of literature supports the co-occurrence of depression, anxiety, and sexual dysfunction. However, the manner in which affective symptoms map onto specific female sexual response indices is not well understood. AIMS The present study aimed to examine changes in depression and anxiety symptoms and their correspondence to fluctuations in desire, subjective arousal, genital response, orgasmic function, and vaginal pain. METHODS The study used a 2-week daily diary approach to examine same-day and temporal relations between affective symptoms and sexual function. MAIN OUTCOME MEASURES The unique relations between shared and disorder-specific symptoms of depression and anxiety (i.e., general distress, anhedonia, and anxious arousal) and female sexual response (i.e., desire, subjective arousal, vaginal lubrication, orgasmic function, and sexual pain) were examined, controlling for baseline levels of sexual distress, depression, and anxiety, as well as age effects and menstruation. RESULTS Analyses revealed that changes in depression and anxiety severity corresponded to same-day variations in sexual response. Specifically, anhedonia (depression-specific symptom) was related to poorer same-day sexual desire, whereas greater anxious arousal (anxiety-specific symptom) was independently related to simultaneous increases in subjective sexual arousal, vaginal lubrication, and sexual pain. Increases in general distress (i.e., shared symptoms) were associated with greater same-day difficulties achieving orgasm. Notably, only one temporal relation was found; it indicated that higher levels of anhedonia predicted a next-day decrease in sexual desire. CONCLUSIONS It is proposed that the simultaneous changes in affective symptoms and sexual function may indicate that they are products of shared underlying mechanisms. That is, in response to stress, the processes manifesting as feelings of weak positive affect and amotivation are the very same processes responsible for diminished capacity for sexual desire. In contrast, the physiological hyperarousal associated with anxiety also gives rise to sexual arousal difficulties and vaginal pain.
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Affiliation(s)
- David A Kalmbach
- Sleep and Chronophysiology Laboratory, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Department of Psychology, Kent State University, Kent, OH, USA
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Alexander JL, Dennerstein L, Burger H, Graziottin A. Testosterone and libido in surgically and naturally menopausal women. ACTA ACUST UNITED AC 2012; 2:459-77. [PMID: 19803917 DOI: 10.2217/17455057.2.3.459] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The assessment and then treatment of a change in libido, or a change in the desire to partake in sexual activity, during the menopausal transition and beyond has been a challenging and elusive area of clinical research. This is partly due to the multidimensional nature of female sexuality, the difficulties of measuring testosterone in women in a reliable and accurate manner, and the complexity of the neurobiology and neurobehavior of female sexual desire. In addition, there is a lack of evidence for diagnostic specificity of low free testosterone levels for the symptom of low libido in women for whom there are no confounding interpersonal or psychological factors; although, in the symptomatic population of surgically or naturally menopausal women, a low level of free testosterone often accompanies a complaint of reduced desire/libido. The randomized clinical trial research on testosterone replacement for naturally and/or surgically menopausal women with sexual dysfunction has been criticized for a high placebo response rate, supraphysiological replacement levels of testosterone, the perception of modest clinical outcome when measuring objective data such as the frequency of sexual intercourse relative to placebo, and the unknown safety of long-term testosterone replacement in the estrogen-replete surgically or naturally menopausal woman. A careful review of current evidence from randomized, controlled trials lends support to the value of the replacement of testosterone in the estrogen-replete menopausal woman for whom libido and desire has declined. The issue of long-term safety remains to be answered.
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Affiliation(s)
- Jeanne L Alexander
- Kaiser Permanente Medical Group of Northern California Psychiatry Women's Health, Kaiser Permanente Medical Group, 1700 Shattuck Avenue, Suite 329, Berkeley, CA 94709, USA.
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Symonds T, Abraham L, Bushmakin AG, Williams K, Martin M, Cappelleri JC. Sexual Function Questionnaire: Further Refinement and Validation. J Sex Med 2012; 9:2609-16. [DOI: 10.1111/j.1743-6109.2011.02627.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kalmbach DA, Ciesla JA, Janata JW, Kingsberg SA. Specificity of anhedonic depression and anxious arousal with sexual problems among sexually healthy young adults. J Sex Med 2011; 9:505-13. [PMID: 22024317 DOI: 10.1111/j.1743-6109.2011.02533.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Past research has suggested that depression and anxiety are similarly associated with sexual problems. However, methodological limitations may have hindered the ability of prior studies to detect potential specificity between depression and anxiety with distinct sexual problems. Specifically, previous studies have frequently used measures that confound depression and anxiety, focused exclusively on populations with medical complications, and failed to account for the iatrogenic effects of antidepressants. AIM Clark and Watson's tripartite model was used to differentiate anxious and depressive symptoms and examine their associations with indices of sexual functioning. Specifically, we examined how general distress, anxious arousal, and anhedonia are differentially related to sexual desire, arousal, erection and lubrication difficulties, orgasm achievement, pain, satisfaction, avoidance, pleasure, concerns, and sexual self-image. METHODS In a cross-sectional study, 1,258 young men and women completed the Female Sexual Function Index, Male Sexual Function Index (adapted for the current investigation), Profile of Female Sexual Function, and Mood and Anxiety Symptom Questionnaire. RESULTS Zero-order correlations revealed some specificity between the three affective constructs, as they were associated with sexual problems. However, multiple regression analyses revealed clearer patterns, showing that anhedonic depression was more uniquely related to most sexual problems among women, whereas the relations of anxiety and depression with male sexual problems were more mixed. DISCUSSION This study of young subjects not identified to have affective or sexual disorders suggests that specificity exists between depression and anxiety as they relate to sexual functioning, and that this specificity varies between genders. Such findings highlight the importance of considering the unique influences of anxiety and depression in the conceptualization and treatment of sexual dysfunction.
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Affiliation(s)
- David A Kalmbach
- Department of Psychology, Kent State University in Kent, OH 44242, USA
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Giraldi A, Rellini A, Pfaus JG, Bitzer J, Laan E, Jannini EA, Fugl‐Meyer AR. Questionnaires for Assessment of Female Sexual Dysfunction: A Review and Proposal for a Standardized Screener. J Sex Med 2011; 8:2681-706. [DOI: 10.1111/j.1743-6109.2011.02395.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Maclaran K, Panay N. Managing Low Sexual Desire in Women. WOMENS HEALTH 2011; 7:571-81; quiz 582-3. [DOI: 10.2217/whe.11.54] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Low sexual desire is a prevalent symptom, but not one frequently volunteered by women. When accompanied by distress, loss of libido is known as hypoactive sexual desire disorder, which can have a significant impact on a woman's wellbeing. The etiology of hypoactive sexual desire disorder is multifactorial and its management requires a combination of psychosocial and pharmacological interventions. This article outlines the assessment of patients presenting with the symptom of low sexual desire and discusses the evidence for pharmacological management.
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Affiliation(s)
- Kate Maclaran
- Queen Charlotte's & Chelsea, & Chelsea & Westminster Hospitals, West London Menopause & PMS Centre, Du Cane Road, London, W12 0HS, UK
- Imperial College London, London, UK
| | - Nick Panay
- Queen Charlotte's & Chelsea, & Chelsea & Westminster Hospitals, West London Menopause & PMS Centre, Du Cane Road, London, W12 0HS, UK
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Goldhammer DL, McCabe MP. Development and psychometric properties of the Female Sexual Desire Questionnaire (FSDQ). J Sex Med 2011; 8:2512-21. [PMID: 21676180 DOI: 10.1111/j.1743-6109.2011.02334.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Sexual desire is often evaluated as part of a global assessment of female sexual function, which may not comprehensively evaluate the various facets of this experience. There currently exists a need to develop a psychometrically robust desire-specific measure for women. AIM The aim of this study was to develop and validate a desire-specific, self-administered instrument that evaluates the multiple facets of sexual desire and factors influencing this experience for partnered heterosexual women, with or without sexual dysfunction. METHODS Preliminary items for inclusion in the Female Sexual Desire Questionnaire (FSDQ) were identified through a literature review and individual interviews with partnered heterosexual women, mostly from Australia. The resulting instrument was completed by a validation sample of 741 women, aged between 18 and 71 years, who were involved in a heterosexual relationship of between 3 months' and 49 years' duration. MAIN OUTCOME MEASURES Exploratory factor analysis was used to refine the FSDQ item content and identify the underlying domain structure. The reliability (internal consistency) and validity (convergent validity) of the FSDQ were also evaluated. RESULTS The final version of the FSDQ consisted of 50 items organized into six domains that characterized the experience of, and factors influencing, sexual desire for heterosexual partnered women: Dyadic Desire, Solitary Desire, Resistance, Positive Relationship, Sexual Self-Image, and Concern. Each domain demonstrated high reliability, as did the overall measure. Evidence of construct validity was ascertained through convergence with the Sexual Desire Inventory and the Hurlbert Index of Sexual Desire. A short-form of the FSDQ, consisting of six items, was also developed. CONCLUSIONS The FSDQ is a new reliable and valid multidimensional measure designed specifically for evaluating the facets of, and factors influencing, sexual desire among sexually functional and dysfunctional women who are involved in a heterosexual relationship.
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Biglia N, Peano E, Sgandurra P, Moggio G, Panuccio E, Migliardi M, Ravarino N, Ponzone R, Sismondi P. Low-dose vaginal estrogens or vaginal moisturizer in breast cancer survivors with urogenital atrophy: a preliminary study. Gynecol Endocrinol 2010; 26:404-12. [PMID: 20196634 DOI: 10.3109/09513591003632258] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The study aim is to evaluate the efficacy and safety of two low-dose vaginal estrogen treatments (ETs) and of a non-hormonal vaginal moisturizer in postmenopausal breast cancer survivors with urogenital atrophy. Eighteen patients receiving estriol cream 0.25 mg (n = 10) or estradiol tablets 12.5 microg (n = 8) twice/week for 12 weeks were evaluated and compared with eight patients treated with polycarbophil-based moisturizer 2.5 g twice/week. Severity of vaginal atrophy was assessed using subjective [Vaginal Symptoms Score (VSS), Profile of Female Sexual Function (PFSF)] and objective [Vaginal Health Index (VHI), Karyopycnotic Index (KI)] evaluations, while safety by measuring endometrial thickness and serum sex hormones levels. After 4 weeks, VSS and VHI were significantly improved by both vaginal ETs, with further improvement after 12 weeks. PFSF improved significantly only in estriol group (p = 0.02). Safety measurements did not significantly change. Vaginal moisturizer improved VSS at week 4 (p = 0.01), but score returned to pre-treatment values at week 12; no significant modification of VHI, KI, PFSF was recorded. Both low-dose vaginal ET are effective for relieving urogenital atrophy, while non-hormonal moisturizer only provides transient benefit. The increase of serum estrogens levels during treatment with vaginal estrogen at these dosages is minimal.
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Affiliation(s)
- Nicoletta Biglia
- Department of Oncological Gynaecology, University of Turin, Institute for Cancer Research and Treatment of Candiolo (IRCC), Turin, Italy.
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Panay N, Al-Azzawi F, Bouchard C, Davis SR, Eden J, Lodhi I, Rees M, Rodenberg CA, Rymer J, Schwenkhagen A, Sturdee DW. Testosterone treatment of HSDD in naturally menopausal women: the ADORE study. Climacteric 2010; 13:121-31. [DOI: 10.3109/13697131003675922] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hassanin IM, Helmy YA, Fathalla MM, Shahin AY. Prevalence and characteristics of female sexual dysfunction in a sample of women from Upper Egypt. Int J Gynaecol Obstet 2009; 108:219-23. [DOI: 10.1016/j.ijgo.2009.09.031] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Revised: 09/22/2009] [Accepted: 11/11/2009] [Indexed: 01/23/2023]
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Castelo-Branco C, Palacios S, Combalia J, Ferrer M, Traveria G. Risk of hypoactive sexual desire disorder and associated factors in a cohort of oophorectomized women. Climacteric 2009; 12:525-32. [DOI: 10.3109/13697130903075345] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Effect of intravaginal dehydroepiandrosterone (Prasterone) on libido and sexual dysfunction in postmenopausal women. Menopause 2009; 16:923-31. [DOI: 10.1097/gme.0b013e31819e85c6] [Citation(s) in RCA: 154] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Sexual function in middle-aged Latin American women as determined by the Female Sexual Function Index: improving global acceptance of the use of validated measures of sexual function. Menopause 2009; 16:1089-91. [PMID: 19696687 DOI: 10.1097/gme.0b013e3181b8b54a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Graziottin A, Koochaki PE, Rodenberg CA, Dennerstein L. The Prevalence of Hypoactive Sexual Desire Disorder in Surgically Menopausal Women: An Epidemiological Study of Women in Four European Countries. J Sex Med 2009; 6:2143-53. [DOI: 10.1111/j.1743-6109.2009.01319.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
Sexuality is a critical issue at menopause for many women. Several biological, psychological and socio-relational factors are related to women's sexual health and they may negatively affect the entire sexual response cycle, inducing significant changes in desire, arousal, orgasm and satisfaction. Age- and menopause-related events may impair the integrity of multiple biological systems involved in the normal sexual response of women, including hormonal environment, neuromuscular substrates and vascular supplies. Sex hormones, namely low levels of estradiol, physical and mental well-being and, very importantly, feelings for partner are extremely relevant for women's sexuality in natural menopause. Even a significant lack of androgens, as more frequently occurs in surgical menopause, has a negative impact on women's desire and sexual responsiveness. Sexual history and clinical evaluation may help doctors to accurately diagnose sexual symptoms causing personal and relational distress and to identify the best therapeutic approach.
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Affiliation(s)
- R E Nappi
- Research Center for Reproductive Medicine, Department of Morphological, Eidological and Clinical Sciences, & Unit of Gynecological Endocrinology and Menopause, IRCCS Maugeri Foundation, University of Pavia, Italy
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Biddle AK, West SL, D'Aloisio AA, Wheeler SB, Borisov NN, Thorp J. Hypoactive sexual desire disorder in postmenopausal women: quality of life and health burden. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2009; 12:763-72. [PMID: 19192259 DOI: 10.1111/j.1524-4733.2008.00483.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES To describe the health-related quality of life (HRQOL) implications of hypoactive sexual desire disorder (HSDD) in a national sample of postmenopausal women ages 30–70. METHODS The Nationwide Survey of Female Sexual Health, a random-digit telephone survey of US households, collected information on female sexual function, demographic characteristics, HRQOL, and the presence of specific medical disorders from 1189 naturally or surgically postmenopausal women in stable relationships of ≥3 months duration. HSDD was defined as <40 on the Profile of Female Sexual Function© scale and <60 on the Personal Distress Scale©. Short Form-12 Health Survey (SF-12) summary and domain scores, and EuroQol (EQ-5D) index score and dimensions were compared with population-based norms for healthy individuals and selected chronic conditions. RESULTS HSDD was associated with significant HRQOL decrements, with the largest SF-12 score differences in mental health (HSDD: 45.4 [standard error 1.9] vs. no HSDD: 51.0 [0.6], P < 0.01), vitality (HSDD: 47.7 [1.3] vs. no HSDD: 52.0 [0.7], P < 0.01), social function (HSDD: 47.3 [1.4] vs. no HSDD: 50.9 [0.7], P < 0.05), and bodily pain (HSDD: 41.4 [2.2] vs. no HSDD: 46.7 [0.9], P < 0.05). EQ-5D index was 0.08 points lower (HSDD: 0.76 [0.03] vs. no HSDD: 0.84 [0.02], P < 0.05) for those with HSDD compared with those without. HSDD was associated with a 0.1-point decrement in naturally menopausal women (HSDD: 0.78 [0.03] vs. no HSDD 0.88 [0.01], P < 0.01). Women with HSDD showed more HRQOL impairment than healthy population norms but were similar to adults with other chronic conditions such as diabetes and back pain. CONCLUSIONS Women with HSDD showed substantial impairment in HRQOL. Given a prevalence of 6.6% to 12.5% among US women, HSDD represents an important burden on quality of life.
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Affiliation(s)
- Andrea K Biddle
- Department of Health Policy and Management, Gillings, School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Graziottin A, Serafini A, Palacios S. Aetiology, diagnostic algorithms and prognosis of female sexual dysfunction. Maturitas 2009; 63:128-34. [DOI: 10.1016/j.maturitas.2009.04.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Kingsberg S, Althof SE. Evaluation and treatment of female sexual disorders. Int Urogynecol J 2009; 20 Suppl 1:S33-43. [DOI: 10.1007/s00192-009-0833-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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DeRogatis LR, Graziottin A, Bitzer J, Schmitt S, Koochaki PE, Rodenberg C. ORIGINAL RESEARCH–WOMEN'S SEXUAL HEALTH: Clinically Relevant Changes in Sexual Desire, Satisfying Sexual Activity and Personal Distress as Measured by the Profile of Female Sexual Function, Sexual Activity Log, and Personal Distress Scale in Postmenopausal Women with Hypoactive Sexual Desire Disorder. J Sex Med 2009; 6:175-83. [DOI: 10.1111/j.1743-6109.2008.01058.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Sexuality is innate within all women to a greater or lesser extent, and is affected by a number of extrinsic factors that occur in the menopausal transition. Assessing hormone status is difficult as evidence exists that sex hormones may differ between ethnic groups, and that bio-assays may be insensitive at lower testosterone levels. Data are available on the prevalence of female sexual dysfunction, but results from cross-sectional studies differ from those of longitudinal studies. The original traditional models of human sexual response have been challenged, and new models have been defined which show more complex interaction between intrinsic and extrinsic factors. Definitions of sexual dysfunction have been redefined. There are a limited number of randomized, placebo-controlled trials of drugs to improve sexual function. These include sildenafil citrate, tibolone and hormone replacement therapy. Randomized controlled trials on testosterone replacement in naturally and/or surgically menopausal patients with female sexual dysfunction have been criticized for a high placebo response rate and short duration. This chapter seeks to put sexuality into perspective and to define both function and dysfunction.
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Affiliation(s)
- Joan Pitkin
- Northwick Park; St Marks Hospital, N.W. London Hospitals, NHS Trust, Watford Road, HA1 3UJ, UK.
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Davis SR, Moreau M, Kroll R, Bouchard C, Panay N, Gass M, Braunstein GD, Hirschberg AL, Rodenberg C, Pack S, Koch H, Moufarege A, Studd J. Testosterone for low libido in postmenopausal women not taking estrogen. N Engl J Med 2008; 359:2005-17. [PMID: 18987368 DOI: 10.1056/nejmoa0707302] [Citation(s) in RCA: 285] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The efficacy and safety of testosterone treatment for hypoactive sexual desire disorder in postmenopausal women not receiving estrogen therapy are unknown. METHODS We conducted a double-blind, placebo-controlled, 52-week trial in which 814 women with hypoactive sexual desire disorder were randomly assigned to receive a patch delivering 150 or 300 microg of testosterone per day or placebo. Efficacy was measured to week 24; safety was evaluated over a period of 52 weeks, with a subgroup of participants followed for an additional year. The primary end point was the change from baseline to week 24 in the 4-week frequency of satisfying sexual episodes. RESULTS At 24 weeks, the increase in the 4-week frequency of satisfying sexual episodes was significantly greater in the group receiving 300 microg of testosterone per day than in the placebo group (an increase of 2.1 episodes vs. 0.7, P<0.001) but not in the group receiving 150 microg per day (1.2 episodes, P=0.11). As compared with placebo, both doses of testosterone were associated with significant increases in desire (300 microg per day, P<0.001; 150 microg per day, P=0.04) and decreases in distress (300 microg per day, P<0.001; 150 microg per day, P=0.04). The rate of androgenic adverse events - primarily unwanted hair growth - was higher in the group receiving 300 microg of testosterone per day than in the placebo group (30.0% vs. 23.1%). Breast cancer was diagnosed in four women who received testosterone (as compared with none who received placebo); one of the four received the diagnosis in the first 4 months of the study period, and one, in retrospect, had symptoms before undergoing randomization. CONCLUSIONS In postmenopausal women not receiving estrogen therapy, treatment with a patch delivering 300 microg of testosterone per day resulted in a modest but meaningful improvement in sexual function. The long-term effects of testosterone, including effects on the breast, remain uncertain. (ClinicalTrials.gov number, NCT00131495.)
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Affiliation(s)
- Susan R Davis
- Women's Health Program, Monash University, Alfred Hospital, Prahran, Australia.
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Ahmed N, Bestall JC, Payne SA, Noble B, Ahmedzai SH. The use of cognitive interviewing methodology in the design and testing of a screening tool for supportive and palliative care needs. Support Care Cancer 2008; 17:665-73. [PMID: 18982363 DOI: 10.1007/s00520-008-0521-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Accepted: 10/01/2008] [Indexed: 10/21/2022]
Abstract
GOALS OF WORK The authors describe the use of cognitive interviewing methodology in the development of a new supportive and palliative care screening measure to identify the specialist supportive and palliative care needs of patients with an advanced illness. MATERIALS AND METHODS A draft screening measure was developed by literature reviewing and consultation with patients, carers and health and social care professionals. Using this draft, cognitive interviews were conducted with six professionals and one consumer using the 'thinking aloud technique' to assess the perception, usefulness and interpretation of each question on the measure. The focus of these interviews was to identify unclear words or phrases and to explore how the questions worked in eliciting a response. A content analysis of the interviews was used to identify problems with the text, phrasing and format of the questions and accompanying responses. MAIN RESULTS The authors found the technique to be useful in identifying jargon or confusing questions. A number of perspectives were taken into account by speaking to health and social care professionals in primary care and secondary care who would be offering the measure to future patients. CONCLUSIONS The most sensitive questions were highlighted, and this enabled the researchers to consider how these should be asked and responded to in subsequent versions of the measure. The measure was re-drafted in light of these comments.
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Affiliation(s)
- Nisar Ahmed
- Academic Unit of Supportive Care, School of Medicine and Biomedical Sciences, University of Sheffield, Sykes House Little Common Lane, Sheffield S11 9NE, UK.
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Davison SL, Bell RJ, La China M, Holden SL, Davis SR. ORIGINAL RESEARCH—OUTCOMES ASSESSMENT: Assessing Sexual Function in Well Women: Validity and Reliability of the Monash Women's Health Program Female Sexual Satisfaction Questionnaire. J Sex Med 2008; 5:2575-86. [DOI: 10.1111/j.1743-6109.2008.00967.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Sidi H, Midin M, Sharifah Ezat Wan Puteh, Abdullah N. Orgasmic Dysfunction Among Women at a Primary Care Setting in Malaysia. Asia Pac J Public Health 2008; 20:298-306. [DOI: 10.1177/1010539508322810] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Aim. The aim of this study was to investigate the prevalence of orgasmic dysfunction and the potential risk factors that may be associated with orgasmic dysfunction among women at a primary care setting in Malaysia. Methods. A validated questionnaire for sexual function was used to assess orgasmic function. A total of 230 married women aged 18 to 70 years participated in this study. Their sociodemographic and marital profiles were compared between those who had orgasmic dysfunction and those who did not, and the risk factors were examined. Results. The prevalence of orgasmic dysfunction in the primary care population was 51.9%. Women with orgasmic dysfunction were found to be significantly higher in the following groups: age >45 years, being non-Malay, having lower academic status, married longer, having more children, married to an older husband, and being at menopausal state. Conclusion. Women with infrequent sexual intercourse are less likely to be orgasmic (odds ratio = 0.29, 95% confidence interval = 0.11-0.74).
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Affiliation(s)
- Hatta Sidi
- Department of Psychiatry, Faculty of Medicine, Universiti
Kebangsaan, Kuala Lumpur,
| | - Marhani Midin
- Department of Psychiatry, Faculty of Medicine, Universiti
Kebangsaan, Kuala Lumpur
| | | | - Norni Abdullah
- Department of Psychiatry, Hospital Tengku Ampuan Rahimah,
Klang Malaysia
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Kingsberg SA, Simon JA, Goldstein I. ORIGINAL ARTICLE: The Current Outlook for Testosterone in the Management of Hypoactive Sexual Desire Disorder in Postmenopausal Women. J Sex Med 2008; 5 Suppl 4:182-93; quiz 193. [PMID: 18783534 DOI: 10.1111/j.1743-6109.2008.00961.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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