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Gassen J, Mengelkoch S, Shanmugam D, Pearson JT, van Lamsweerde A, Benhar E, Hill SE. Longitudinal changes in sexual desire and attraction among women who started using the Natural Cycles app. Horm Behav 2024; 162:105546. [PMID: 38640590 DOI: 10.1016/j.yhbeh.2024.105546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/11/2024] [Accepted: 04/11/2024] [Indexed: 04/21/2024]
Abstract
Many women experience sexual side effects, such as decreased libido, when taking hormonal contraceptives (HCs). However, little is known about the extent to which libido recovers after discontinuing HCs, nor about the timeframe in which recovery is expected to occur. Given that HCs suppress the activities of multiple endogenous hormones that regulate both the ovulatory cycle and women's sexual function, resumption of cycles should predict libido recovery. Here, using a combination of repeated and retrospective measures, we examined changes in sexual desire and partner attraction (among partnered women) across a three-month period in a sample of Natural Cycles users (Survey 1: n = 1596; Survey 2: n = 550) who recently discontinued HCs. We also tested whether changes in these outcomes coincided with resumption of the ovulatory cycle and whether they were associated with additional factors related to HC use (e.g., duration of HC use) or relationship characteristics (e.g., relationship length). Results revealed that both sexual desire and partner attraction, on average, increased across three months after beginning to use Natural Cycles. While the prediction that changes in sexual desire would co-occur with cycle resumption was supported, there was also evidence that libido continued to increase even after cycles resumed. Together, these results offer new insights into relationships between HC discontinuation and women's sexual psychology and lay the groundwork for future research exploring the mechanisms underlying these effects.
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Affiliation(s)
- Jeffrey Gassen
- Texas Christian University, Department of Psychology, 2955 S. University Dr., Fort Worth, TX 76129, United States of America; University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, UCLA Medical Plaza 300, Los Angeles, CA 90095-7076, United States of America.
| | - Summer Mengelkoch
- Texas Christian University, Department of Psychology, 2955 S. University Dr., Fort Worth, TX 76129, United States of America; University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, UCLA Medical Plaza 300, Los Angeles, CA 90095-7076, United States of America
| | - Divya Shanmugam
- Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science, Cambridge, MA 02139, United States of America
| | - Jack T Pearson
- Natural Cycles Nordic AB, Sankt Eriksgatan 63 B, 112 34 Stockholm, Sweden
| | | | - Eleonora Benhar
- Natural Cycles Nordic AB, Sankt Eriksgatan 63 B, 112 34 Stockholm, Sweden
| | - Sarah E Hill
- Texas Christian University, Department of Psychology, 2955 S. University Dr., Fort Worth, TX 76129, United States of America
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Behn M, Kielhofner J, Panicker JN, Kaplan TB. Sexual dysfunction and commonly used drugs in neurology. Pract Neurol 2024; 24:207-214. [PMID: 38212111 DOI: 10.1136/pn-2023-003760] [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] [Accepted: 12/17/2023] [Indexed: 01/13/2024]
Abstract
Sexual dysfunction is common in men and women with neurological diseases. Medications used in neurology can cause sexual dysfunction independently of the disease process and this may adversely affect patients' quality of life. This review focuses on medications commonly prescribed to neurological patients that may contribute to altered sexual function, and discusses how they may differ in men and women.
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Affiliation(s)
- Maya Behn
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Tamara B Kaplan
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Rosato E, Sciarra F, Minnetti M, Degjoni A, Venneri MA. Clinical management of androgen excess and defect in women. Expert Rev Endocrinol Metab 2024; 19:21-35. [PMID: 37953607 DOI: 10.1080/17446651.2023.2279537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 11/01/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION Hyperandrogenism and hypoandrogenism are complex disorders involving multiple-organ systems. While androgen excess is a well-characterized condition, androgen deficiency still needs diagnostic criteria, as there are no specific cutoffs. AREAS COVERED We highlight the most recent findings on the role of androgens in female pathophysiology, investigating clinically relevant conditions of androgen insufficiency or excess throughout a woman's life, and their possible therapeutic management. EXPERT OPINION Combined oral contraceptives (COCs) should be considered as first-line therapy for the management of menstrual irregularity and/or clinical hyperandrogenism in adolescents with a clear diagnosis of polycystic ovary syndrome (PCOS). There are limited evidence-based data regarding specific types or doses of COCs for management of PCOS in women; however, the lowest effective estrogen dose should be considered for treatment. Despite evidence regarding safety, efficacy, and clinical use, testosterone therapy has not been approved for women by most regulatory agencies for treatment of hypoactive sexual desire disorder (HSDD). The long-term safety for treatments with testosterone is still to be evaluated, and this review highlights the need for more research in this area.
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Affiliation(s)
- Elena Rosato
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Francesca Sciarra
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Marianna Minnetti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Anisa Degjoni
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Mary Anna Venneri
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
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Pfender EJ, Devlin MM. What Do Social Media Influencers Say About Birth Control? A Content Analysis of YouTube Vlogs About Birth Control. HEALTH COMMUNICATION 2023; 38:3336-3345. [PMID: 36642835 DOI: 10.1080/10410236.2022.2149091] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Youth get their sexual health information from social media, often from social media influencers (SMIs) or microcelebrities with large followings. Previous research suggests that SMIs have powerful persuasive effects on attitudes and behaviors. Thus, it is important to examine the ways in which sexual health information, such as birth control, is conveyed by SMIs. Using framing theory as a theoretical framework, this study examines characteristics of SMIs and their shared experiences pertaining to birth control. A content analysis of YouTube vlogs (n = 50) posted from December 2019-2021 was conducted on SMIs who talk about their experiences using hormonal and non-hormonal birth control. SMI status was determined based on the number of people subscribed to the YouTube channels. Results suggest that SMI YouTube videos are primarily about the discontinuation of hormonal birth control and may provide inaccurate sexual health information. Reasons for discontinuation of hormonal birth control provided by the SMIs are discussed. Future research should explore the effects of influencer sexual health messaging on beliefs, attitudes, and behaviors.
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Schreuder A, Mokadem I, Smeets NJL, Spaanderman MEA, Roeleveld N, Lupattelli A, van Gelder MMHJ. Associations of periconceptional oral contraceptive use with pregnancy complications and adverse birth outcomes. Int J Epidemiol 2023; 52:1388-1399. [PMID: 37040615 PMCID: PMC10555752 DOI: 10.1093/ije/dyad045] [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: 02/14/2022] [Accepted: 03/23/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Periconceptional use of oral contraceptives (OCs) has been reported to increase risks of pregnancy complications and adverse birth outcomes, but risks are suggested to differ depending on the timing of discontinuation, amount of oestrogen and progestin content. METHODS Prospective cohort study among 6470 pregnancies included in the PRegnancy and Infant DEvelopment (PRIDE) Study in 2012-19. Exposure was defined as any reported use of OCs within 12 months pre-pregnancy or after conception. Outcomes of interest were gestational diabetes, gestational hypertension, pre-eclampsia, pre-term birth, low birthweight and small for gestational age (SGA). Multivariable Poisson regression using stabilized inverse probability weighting estimated relative risks (RRs) with 95% CIs. RESULTS Any periconceptional OC use was associated with increased risks of pre-eclampsia (RR 1.38, 95% CI 0.99-1.93), pre-term birth (RR 1.38, 95% CI 1.09-1.75) and low birthweight (RR 1.45, 95% CI 1.10-1.92), but not with gestational hypertension (RR 1.09, 95% CI 0.91-1.31), gestational diabetes (RR 1.02, 95% CI 0.77-1.36) and SGA (RR 0.96, 95% CI 0.75-1.21). Associations with pre-eclampsia were strongest for discontinuation 0-3 months pre-pregnancy, for OCs containing ≥30 µg oestrogen and for first- or second-generation OCs. Pre-term birth and low birthweight were more likely to occur when OCs were discontinued 0-3 months pre-pregnancy, when using OCs containing <30 µg oestrogen and when using third-generation OCs. Associations with SGA were observed for OCs containing <30 µg oestrogen and for third- or fourth-generation OCs. CONCLUSIONS Periconceptional OC use, particularly those containing oestrogen, was associated with increased risks of pre-eclampsia, pre-term birth, low birthweight and SGA.
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Affiliation(s)
- Anton Schreuder
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ibtissam Mokadem
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nori J L Smeets
- Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marc E A Spaanderman
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Obstetrics and Gynaecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nel Roeleveld
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Angela Lupattelli
- PharmacoEpidemiology and Drug Safety Research Group, School of Pharmacy, and PharmaTox Strategic Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
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Segarra I, Menárguez M, Roqué MV. Women's health, hormonal balance, and personal autonomy. Front Med (Lausanne) 2023; 10:1167504. [PMID: 37457571 PMCID: PMC10347535 DOI: 10.3389/fmed.2023.1167504] [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: 03/10/2023] [Accepted: 05/30/2023] [Indexed: 07/18/2023] Open
Abstract
Hormone-based contraception disrupts hormonal balance, creating artificial states of anovulation and threatening women's health. We reviewed its main adverse effects and mechanisms on accelerated ovarian aging, mental health (emotional disruptions, depression, and suicide), sexuality (reduced libido), cardiovascular (brain stroke, myocardial infarction, hypertension, and thrombosis), and oncological (breast, cervical, and endometrial cancers). Other "collateral damage" includes negative effects on communication, scientific mistrust, poor physician-patient relationships, increased patient burden, economic drain on the healthcare system, and environmental pollution. Hormone-sensitive tumors present a dilemma owing to their potential dual effects: preventing some cancers vs. higher risk for others remains controversial, with denial or dismissal as non-relevant adverse effects, information avoidance, and modification of scientific criteria. This lack of clinical assessment poses challenges to women's health and their right to autonomy. Overcoming these challenges requires an anthropological integration of sexuality, as the focus on genital bodily union alone fails to encompass the intimate relational expression of individuals, complete sexual satisfaction, and the intertwined feelings of trust, safety, tenderness, and endorsement of women's femininity.
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Affiliation(s)
- Ignacio Segarra
- Department of Pharmacy, Faculty of Pharmacy and Nutrition, Catholic University of Murcia (UCAM), Murcia, Spain
- “Pharmacokinetics, Patient Care and Translational Bioethics” Research Group, Faculty of Pharmacy and Nutrition, Catholic University of Murcia (UCAM), Murcia, Spain
| | - Micaela Menárguez
- Bioethics Chair, Faculty of Medicine, Catholic University of Murcia (UCAM), Murcia, Spain
| | - María Victoria Roqué
- “Pharmacokinetics, Patient Care and Translational Bioethics” Research Group, Faculty of Pharmacy and Nutrition, Catholic University of Murcia (UCAM), Murcia, Spain
- Bioethics Chair, Faculty of Medicine, Catholic University of Murcia (UCAM), Murcia, Spain
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Truncal Acne and Scarring: A Comprehensive Review of Current Medical and Cosmetic Approaches to Treatment and Patient Management. Am J Clin Dermatol 2023; 24:199-223. [PMID: 36539678 DOI: 10.1007/s40257-022-00746-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2022] [Indexed: 12/24/2022]
Abstract
Acne vulgaris is one of the most common skin disorders worldwide. It typically affects skin areas with a high density of sebaceous glands such as the face, upper arms, chest, and/or back. Historically, the majority of research efforts have focused on facial acne vulgaris, even though approximately half of patients with facial lesions demonstrate truncal involvement. Truncal acne vulgaris is challenging to treat and poses a significant psychosocial burden on patients. Despite these characteristics, studies specifically examining truncal acne vulgaris are limited, with treatment guidelines largely derived from facial protocols. Therefore, truncal acne remains an understudied clinical problem. Here, we provide a clinically focused review on the epidemiology, evaluation, and available treatment options for truncal acne vulgaris. In doing so, we highlight knowledge gaps with the goal of spurring further investigation into the management of truncal acne vulgaris.
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Hill SE, Mengelkoch S. Moving beyond the mean: Promising research pathways to support a precision medicine approach to hormonal contraception. Front Neuroendocrinol 2023; 68:101042. [PMID: 36332783 DOI: 10.1016/j.yfrne.2022.101042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 10/07/2022] [Accepted: 10/21/2022] [Indexed: 11/11/2022]
Abstract
Women's psychological and behavioral responses to hormonal contraceptive (HC) treatment can be highly variable. One of the great challenges to researchers seeking to improve the experiences of women who use HCs is to identify the sources of this variability to minimize unpleasant psychobehavioral side-effects. In the following, we provide recommendations for programs of research aimed at identifying sources of heterogeneity in women's experiences with HC. First, we review research demonstrating person- and prescription- based heterogeneity in women's psychobehavioral responses to HCs. Next, we identify several promising person- and prescription- based sources of this heterogeneity that warrant future research. We close with a discussion of research approaches that are particularly well-suited to address the research questions raised in article. Together, this review provides researchers with several promising research pathways to help support the development of a precision medicine approach to HC treatment.
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Takeshita RS, Edler MK, Meindl RS, Sherwood CC, Hopkins WD, Raghanti MA. Age, adrenal steroids, and cognitive functioning in captive chimpanzees ( Pan troglodytes). PeerJ 2022; 10:e14323. [PMID: 36389417 PMCID: PMC9653054 DOI: 10.7717/peerj.14323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/10/2022] [Indexed: 11/11/2022] Open
Abstract
Background Dehydroepiandrosterone-sulfate is the most abundant circulating androgen in humans and other catarrhines. It is involved in several biological functions, such as testosterone production, glucocorticoid antagonist actions, neurogenesis and neuroplasticty. Although the role of dehydroepiandrosterone-sulfate (DHEAS) in cognition remains elusive, the DHEAS/cortisol ratio has been positively associated with a slower cognitive age-decline and improved mood in humans. Whether this relationship is found in nonhuman primates remains unknown. Methods We measured DHEAS and cortisol levels in serum of 107 adult chimpanzees to investigate the relationship between DHEAS levels and age. A subset of 21 chimpanzees was used to test the potential associations between DHEAS, cortisol, and DHEAS/cortisol ratio in cognitive function, taking into account age, sex, and their interactions. We tested for cognitive function using the primate cognitive test battery (PCTB) and principal component analyses to categorize cognition into three components: spatial relationship tasks, tool use and social communication tasks, and auditory-visual sensory perception tasks. Results DHEAS levels, but not the DHEAS/cortisol ratio, declined with age in chimpanzees. Our analyses for spatial relationships tasks revealed a significant, positive correlation with the DHEAS/cortisol ratio. Tool use and social communication had a negative relationship with age. Our data show that the DHEAS/cortisol ratio, but not DHEAS individually, is a promising predictor of spatial cognition in chimpanzees.
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Affiliation(s)
- Rafaela S.C. Takeshita
- Department of Anthropology, Kent State University, Kent, OH, USA,School of Biomedical Sciences, Kent State University, Kent, OH, USA,Brain Health Research Institute, Kent State University, Kent, OH, USA
| | - Melissa K. Edler
- Department of Anthropology, Kent State University, Kent, OH, USA,School of Biomedical Sciences, Kent State University, Kent, OH, USA,Brain Health Research Institute, Kent State University, Kent, OH, USA
| | - Richard S. Meindl
- Department of Anthropology, Kent State University, Kent, OH, USA,School of Biomedical Sciences, Kent State University, Kent, OH, USA
| | - Chet C. Sherwood
- Department of Anthropology, The George Washington University, Washington, DC, USA
| | - William D. Hopkins
- Department of Comparative Medicine, The University of Texas MD Anderson Cancer Center, Bastrop, TX, USA
| | - Mary Ann Raghanti
- Department of Anthropology, Kent State University, Kent, OH, USA,School of Biomedical Sciences, Kent State University, Kent, OH, USA,Brain Health Research Institute, Kent State University, Kent, OH, USA
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A. Al-Gham M, A. Baothma O, Afzal M, I. Alzarea S, Anwar F, Shahid Nad M, Kazmi I. Levonorgestrel and Desogestrel Modulate Gut Microbiota and Blood Biochemistry of Female Wistar Rats. INT J PHARMACOL 2022. [DOI: 10.3923/ijp.2022.826.841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Trigo ACM, Maron CDC, Pinheiro MSDA, da Silva SBL, Brito MB. Female sexual function in women using LARC methods. Gynecol Endocrinol 2022; 38:68-72. [PMID: 34672861 DOI: 10.1080/09513590.2021.1993813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE This study aims to assess sexual function (SF) and quality of life (QoL) among women using copper intrauterine devices (Cu-IUD), levonorgestrel-releasing intrauterine system (LNG-IUS) or etonogestrel(ENG)-releasing subdermal implant. METHODS This is a cross-sectional study involving 213 women who are sexually active, using Cu-IUD, LNG-IUS or ENG implant for at least one year. SF assessment was carried out through the Female Sexual Function Index (FSFI) and QoL was made through The Short Form Health Research. RESULTS Frequency of sexual dysfunction score in Cu-IUD users was 33.8%; 47.2% in LNG-IUS users and 47.8% in ENG-implant users, without difference between groups. Desire domain had higher score in Cu-IUD users (Cu-IUD:4.20 ± 1.15 × LNG-IUS:3.76 ± 1.17 × ENG-implant:3.63 ± 1.15; p = .009). Between Cu-IUD and LNG-IUS users there was no difference in FSFI score. Total FSFI score was higher in Cu-IUD group when compared only to ENG-implant (Cu-IUD:27.48 ± 6.14 × Implant:25.07 ± 6.89; p = .029). Regarding the QoL score, difference was found only in general health domain (Cu-IUD:65.22 ± 14.91 × LNG-IUS:62.61 ± 19.04 × Implant:58.33 ± 16.46; p = .034), with lower score for implant group. CONCLUSION There was no difference in the SF total score between the users of Cu-IUD, LNG-IUS and ENG implant. However, the score of the FSFI desire domain and general health status were higher among users of the Cu-IUD.
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Affiliation(s)
| | | | | | | | - Milena Bastos Brito
- Bahiana School of Medicine and Public Health (BSMPH), Salvador, Brazil
- Department of Gynecology and Obstetrics, Bahia Federal University, Salvador, Brazil
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Noachtar IA, Hidalgo-Lopez E, Pletzer B. Duration of oral contraceptive use relates to cognitive performance and brain activation in current and past users. Front Endocrinol (Lausanne) 2022; 13:885617. [PMID: 36204097 PMCID: PMC9530450 DOI: 10.3389/fendo.2022.885617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Previous studies indicate effects of oral contraceptive (OC) use on spatial and verbal cognition. However, a better understanding of the OC effects is still needed, including the differential effects of androgenic or anti-androgenic OC use and whether the possible impact persists beyond the OC use. We aim to investigate the associations of OC use duration with spatial and verbal cognition, differentiating between androgenic and anti-androgenic OC. Using functional magnetic resonance imaging (MRI), we scanned a group of 94 past and current OC-users in a single session. We grouped current OC users (N=53) and past OC users with a natural cycle (N=41) into androgenic and anti-androgenic user. Effects of OC use duration were observed for current use and after discontinuation. Duration of OC use was reflected only in verbal fluency performance but not navigation: The longer the current OC use, the less words were produced in the verbal fluency task. During navigation, deactivation in the caudate and postcentral gyrus was duration-dependent in current androgenic OC users. Only during the verbal fluency task, duration of previous OC use affects several brain parameters, including activation of the left putamen and connectivity between right-hemispheric language areas (i.e., right inferior frontal gyrus and right angular gyrus). The results regarding performance and brain activation point towards stronger organizational effects of OCs on verbal rather than spatial processing. Irrespective of the task, a duration-dependent connectivity between the hippocampus and various occipital areas was observed. This could suggest a shift in strategy or processing style with long-term contraceptive use during navigation/verbal fluency. The current findings suggest a key role of the progestogenic component of OCs in both tasks. The influence of OC use on verbal fluency remains even after discontinuation which further points out the importance of future studies on OC effects and their reversibility.
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Larsen SV, Ozenne B, Köhler-Forsberg K, Poulsen AS, Dam VH, Svarer C, Knudsen GM, Jørgensen MB, Frokjaer VG. The Impact of Hormonal Contraceptive Use on Serotonergic Neurotransmission and Antidepressant Treatment Response: Results From the NeuroPharm 1 Study. Front Endocrinol (Lausanne) 2022; 13:799675. [PMID: 35360055 PMCID: PMC8962375 DOI: 10.3389/fendo.2022.799675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/31/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Hormonal contraceptive (HC) use has been associated with an increased risk of developing a depressive episode. This might be related to HC's effect on the serotonergic brain system as suggested by recent cross-sectional data from our group, which show that healthy oral contraceptive (OC) users relative to non-users have lower cerebral serotonin 4 receptor (5-HT4R) levels. Here, we determine if cerebral 5-HT4R binding differs between HC non-users, OC users, and hormonal intrauterine device (HIUD) users among women with an untreated depressive episode. Also, we test if antidepressant drug treatment response and its association with pre-treatment 5-HT4R binding depends on HC status. METHODS [11C]-SB207145 Positron Emission Tomography imaging data from the NeuroPharm-NP1 Study (NCT02869035) were available from 59 depressed premenopausal women, of which 26 used OCs and 10 used HIUDs. The participants were treated with escitalopram. Treatment response was measured as the relative change in the Hamilton Depression Rating Scale 6 items (rΔHAMD6) from baseline to week eight. Latent variable models were used to evaluate the association between global 5-HT4R binding and OC and HIUD use as well as rΔHAMD6. RESULTS We found no evidence of a difference in global 5-HT4R binding between depressed HC users and non-users (p≥0.51). A significant crossover interaction (p=0.02) was observed between non-users and OC users in the association between baseline global 5-HT4R binding and week eight rΔHAMD6; OC users had 3-4% lower binding compared to non-users for every 10% percent less improvement in HAMD6. Within the groups, we observed a trend towards a positive association in non-users (padj=0.10) and a negative association in OC users (padj=0.07). We found no strong evidence of a difference in treatment response between the groups (p=0.13). CONCLUSIONS We found no difference in 5-HT4R binding between HC users vs. non-users in depressed women, however, it seemed that 5-HT4R settings differed qualitatively in their relation to antidepressant drug treatment response between OC users and non-users. From this we speculate that depressed OC users constitutes a special serotonin subtype of depression, which might have implications for antidepressant drug treatment response.
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Affiliation(s)
- Søren Vinther Larsen
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Brice Ozenne
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Kristin Köhler-Forsberg
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Psychiatric Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | | | - Vibeke Høyrup Dam
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Claus Svarer
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Gitte Moos Knudsen
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Martin Balslev Jørgensen
- Psychiatric Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Vibe Gedso Frokjaer
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Psychiatric Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- *Correspondence: Vibe Gedso Frokjaer,
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Wang Y. Tree nut consumption is associated with higher sex hormone-binding globulin levels in premenopausal US women. Nutr Res 2021; 93:61-68. [PMID: 34365198 DOI: 10.1016/j.nutres.2021.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/16/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
Low levels of sex hormone-binding globulin (SHBG) are associated with many diseases including hypertension, diabetes, and polycystic ovarian syndrome. Walnuts increased circulating SHBG in 31 women complicated with polycystic ovarian syndrome. However, whether tree nuts increase SHBG in women in a general population is unknown. It was hypothesized in this study that consumption of tree nuts was positively associated with SHBG levels in women in a general population. This cohort study included 2699 adult women from the 2013- to 2016 US National Health and Nutrition Examination Survey. Tree nut consumers were defined as those who consumed tree nuts on either of the 2 24-hours recall days. Associations of tree nut consumption with SHBG were assessed using least squares regression. Among the 2699 women, 234 were consuming tree nuts. The median SHBG concentrations were 67.1 and 59.3 nmol/L among tree nut consumers and non-consumers, respectively. Tree nut consumption was positively associated with circulating SHBG (β = 0.041, P = .018) but not testosterone nor estradiol after adjustment for all tested confounders. Sub-analyses showed that the positive association of tree nuts with SHBG presented in premenopausal women but not in postmenopausal women. Tree nut consumption remained independently associated with higher circulating levels of SHBG in premenopausal women when tree nut consumption was expressed as percentage of energy derived from tree nuts or when tree nut consumption was defined as a tree nut intake of ≥0.25 ounce per day. Future research will verify the effectiveness of using tree nuts to treat low SHBG in premenopausal women in the general population.
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Affiliation(s)
- Yutang Wang
- School of Science, Psychology and Sport, Federation University Australia, Ballarat, Australia.
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Taylor CM, Pritschet L, Jacobs EG. The scientific body of knowledge - Whose body does it serve? A spotlight on oral contraceptives and women's health factors in neuroimaging. Front Neuroendocrinol 2021; 60:100874. [PMID: 33002517 PMCID: PMC7882021 DOI: 10.1016/j.yfrne.2020.100874] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 12/13/2022]
Abstract
Women constitute half of the world's population, yet neuroscience research does not serve the sexes equally. Fifty years of preclinical animal evidence documents the tightly-coupled relationship between our endocrine and nervous systems, yet human neuroimaging studies rarely consider how endocrine factors shape the structural and functional architecture of the human brain. Here, we quantify several blind spots in neuroimaging research, which overlooks aspects of the human condition that impact women's health (e.g. the menstrual cycle, hormonal contraceptives, pregnancy, menopause). Next, we illuminate potential consequences of this oversight: today over 100 million women use oral hormonal contraceptives, yet relatively few investigations have systematically examined whether disrupting endogenous hormone production impacts the brain. We close by presenting a roadmap for progress, highlighting the University of California Women's Brain Initiative which is addressing unmet needs in women's health research.
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Affiliation(s)
- Caitlin M Taylor
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, United States.
| | - Laura Pritschet
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, United States
| | - Emily G Jacobs
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, United States; Neuroscience Research Institute, University of California, Santa Barbara, United States.
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Moreira IFDA, Bianchini MP, Moreira GRC, Almeida AM, Rezende BA. Sexual function and metabolic/hormonal changes in women using long-term hormonal and non-hormonal contraceptives: a pilot study. BMC WOMENS HEALTH 2020; 20:240. [PMID: 33109159 PMCID: PMC7590685 DOI: 10.1186/s12905-020-01107-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/20/2020] [Indexed: 01/28/2023]
Abstract
Background Female sexual dysfunction is a common condition that negatively impacts the emotional health and quality of life of the affected individuals. Long-acting reversible contraceptives (LARCs) are becoming increasingly popular due to their effectiveness and convenience. LARCs can be hormonal (etonogestrel releasing implant—ENG and Levonorgestrel intrauterine system—LNG) or non-hormonal (copper intrauterine device—CuIUD and copper-silver intrauterine device—SIUD). There are very few studies that assess the influence on LARCS on sexual function are lacking. This study aimed to assess changes in sexual function as well as metabolic and hormonal parameters in women after implantation with LARCs. Methods In this prospective cohort study, we assessed 80 women who visited the Military Police Hospital in Brazil for LARCs placement. The study participants were divided into 4 groups according to the type of LARC received: ENG n = 17; LNG n = 22, CuIUD n = 18 and SIUD n = 23. The four groups were evaluated twice (prior to LARC placement and approximately 3 months later) for sexual function, using the Female Sexual Function Index (FSFI) and Female Sexual Quotient (QS-F) questionnaires. Metabolic and hormonal parameters were also assessed using blood tests. Results ENG worsened sexual function according to FSFI and QS-F, across all domains. A decrease in sex hormone-binding globulin (SHBG) between stages was observed for all groups. We observed an improvement in sexual function for non-hormonal LARCs, specially SIUD. However this improvement was not statistically significant. Conclusion The use of non-hormonal LARCS improved sexual function. Etonogestrel implants, had a negative influence on sexual function, probably by blocking ovarian function, and thus reducing the production of androgens and estrogens.
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Affiliation(s)
- Igor Fernando de Aquino Moreira
- Faculdade de Ciências Médicas, Instituto de Pós-graduação, Alameda Ezequiel Dias, 275 - Centro, Belo Horizonte, MG, 30110-130, Brazil.,Hospital da Polícia Militar de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Maria Passos Bianchini
- Faculdade de Ciências Médicas, Instituto de Pós-graduação, Alameda Ezequiel Dias, 275 - Centro, Belo Horizonte, MG, 30110-130, Brazil
| | | | - Alessandra Maciel Almeida
- Faculdade de Ciências Médicas, Instituto de Pós-graduação, Alameda Ezequiel Dias, 275 - Centro, Belo Horizonte, MG, 30110-130, Brazil
| | - Bruno Almeida Rezende
- Faculdade de Ciências Médicas, Instituto de Pós-graduação, Alameda Ezequiel Dias, 275 - Centro, Belo Horizonte, MG, 30110-130, Brazil.
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Steinberg Weiss M, Roe AH, Allison KC, Dodson WC, Kris-Etherton PM, Kunselman AR, Stetter CM, Williams NI, Gnatuk CL, Estes SJ, Sarwer DB, Coutifaris C, Legro RS, Dokras A. Lifestyle modifications alone or combined with hormonal contraceptives improve sexual dysfunction in women with polycystic ovary syndrome. Fertil Steril 2020; 115:474-482. [PMID: 33059886 PMCID: PMC10132366 DOI: 10.1016/j.fertnstert.2020.08.1396] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To describe the prevalence of female sexual dysfunction in a well-defined polycystic ovary syndrome (PCOS) population, and to assess the impact of common PCOS treatments on sexual function. DESIGN Secondary analysis of a randomized controlled trial, oral contraceptive pills and weight loss in PCOS. SETTING Two academic medical centers. PATIENTS Women with PCOS (N = 114) defined by the Rotterdam criteria. INTERVENTIONS Continuous oral contraceptive pill (OCP) or intensive lifestyle modification (Lifestyle) or the combination (Combined) for 16 weeks. MAIN OUTCOME MEASURES Change in Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised (FSDS-R) scores after 16 weeks. RESULTS There was no change in total FSFI or FSDS-R score in any treatment group; however, an increase in the FSFI desire domain subscore was observed in the Lifestyle and Combined treatments, indicating improved sexual desire over the 16-week period. Overall, 33 participants (28.9%) met criteria for sexual dysfunction by FSFI criteria (baseline score ≤26.55). Among this group, FSFI score improved after 16 weeks of Lifestyle and Combined treatments. There was no change in prevalence of sexual dysfunction in treatment groups at 16 weeks. Use of OCPs did not alter FSFI scores. CONCLUSION(S) Female sexual dysfunction is highly prevalent among women with PCOS. Our findings suggest that common treatments for PCOS, including intensive lifestyle modification and the combination of intensive lifestyle modification and OCPs, have the potential to improve sexual function in these women; the mechanism for these improvements is likely multifactorial. CLINICAL TRIAL REGISTRATION NUMBER NCT00704912.
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Affiliation(s)
- Marissa Steinberg Weiss
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrea Hsu Roe
- Division of Family Planning, Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kelly C Allison
- Department of Psychology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - William C Dodson
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, Pennsylvania
| | - Penny M Kris-Etherton
- Department of Nutritional Sciences, Penn State College of Health and Human Development, University Park, Pennsylvania
| | - Allen R Kunselman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Christy M Stetter
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Nancy I Williams
- Department of Kinesiology, Penn State College of Health and Human Development, University Park, Pennsylvania
| | - Carol L Gnatuk
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, Pennsylvania
| | - Stepanie J Estes
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, Pennsylvania
| | - David B Sarwer
- Center for Obesity Research and Education, Temple University College of Public Health, Philadelphia, Pennsylvania
| | - Christos Coutifaris
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Richard S Legro
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, Pennsylvania; Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Anuja Dokras
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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Larsen SV, Köhler‐Forsberg K, Dam VH, Poulsen AS, Svarer C, Jensen PS, Knudsen GM, Fisher PM, Ozenne B, Frokjaer VG. Oral contraceptives and the serotonin 4 receptor: a molecular brain imaging study in healthy women. Acta Psychiatr Scand 2020; 142:294-306. [PMID: 33314049 PMCID: PMC7586815 DOI: 10.1111/acps.13211] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Sex steroid hormones potently shape brain functions, including those critical to maintain mental health such as serotonin signaling. Use of oral contraceptives (OCs) profoundly changes endogenous sex steroid hormone levels and dynamics. Recent register-based studies show that starting an OC is associated with increased risk of developing depression. Here, we investigate whether use of OCs in healthy women is associated with a marker of the serotonin system in terms of serotonin 4 receptor (5-HT4R) brain imaging. METHODS [11C]SB207145-PET imaging data on 53 healthy women, of whom 16 used OCs, were available from the Cimbi database. We evaluated global effects of OC use on 5-HT4R binding in a latent variable model based on 5-HT4R binding across cortical and subcortical regions. RESULTS We demonstrate that OC users have 9-12% lower global brain 5-HT4R binding potential compared to non-users. Univariate region-based analyses (pallidostriatum, caudate, hippocampus, amygdala, anterior cingulate cortex, and neocortex) supported the global effect of OC use with the largest difference present in the hippocampus (-12.8% (95% CI [-21.0; -3.9], Pcorrected = 0.03). CONCLUSION We show that women who use OCs have markedly lower brain 5-HT4R binding relative to non-users, which constitutes a plausible molecular link between OC use and increased risk of depressive episodes. We propose that this reflects a reduced 5-HT4R gene expression, possibly related to a blunted ovarian hormone state among OC users.
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Affiliation(s)
- S. V. Larsen
- Neurobiology Research UnitRigshospitaletCopenhagenDenmark
| | - K. Köhler‐Forsberg
- Neurobiology Research UnitRigshospitaletCopenhagenDenmark
- Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
- Mental health services in the Capital Region of DenmarkCopenhagenDenmark
| | - V. H. Dam
- Neurobiology Research UnitRigshospitaletCopenhagenDenmark
- Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - A. S. Poulsen
- Neurobiology Research UnitRigshospitaletCopenhagenDenmark
| | - C. Svarer
- Neurobiology Research UnitRigshospitaletCopenhagenDenmark
| | - P. S. Jensen
- Neurobiology Research UnitRigshospitaletCopenhagenDenmark
| | - G. M. Knudsen
- Neurobiology Research UnitRigshospitaletCopenhagenDenmark
- Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - P. M. Fisher
- Neurobiology Research UnitRigshospitaletCopenhagenDenmark
| | - B. Ozenne
- Neurobiology Research UnitRigshospitaletCopenhagenDenmark
- Department of Public HealthSection of BiostatisticsUniversity of CopenhagenCopenhagen KDenmark
| | - V. G. Frokjaer
- Neurobiology Research UnitRigshospitaletCopenhagenDenmark
- Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
- Mental health services in the Capital Region of DenmarkCopenhagenDenmark
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Guo MY, Sodhi M, Khosrow-Khavar F, Etminan M. Risk of sexual dysfunction with progestin-based contraceptives in women of child-bearing age. Eur J Clin Pharmacol 2020; 77:133-140. [PMID: 32803291 DOI: 10.1007/s00228-020-02983-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/11/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine whether there is a positive association between sexual dysfunction (SD) and different types of progestin-based contraceptives. METHODS Nested case-control study in women of child-bearing age (15-45 years) from the IQVIA® Ambulatory electronic medical record database from 2008 to 2018. Cases defined by diagnosis of sexual dysfunction identified by international classification for disease clinical modification code 9th and 10th. Each case was matched to four controls and rates of prescriptions of the following were compared: levonorgestrel intra-uterine device (IUD), progestin, and ethinyl estradiol (EE) combined oral contraceptive (COC) formulations including levonorgestrel, norgestimate, drospirenone, desogestrel, norethindrone, and norgestrel; etonogestrel vaginal ring; and medroxyprogesterone injection. RESULTS Overall, 6689 cases of patients with SD were matched to 26,756 matched controls. Compared with matched controls, more subjects with SD used levonorgestrel IUD (OR 1.24, 95% CI 1.08-1.44), EE-levonorgestrel COC (OR 1.18, 95% CI 1.00-1.41), EE-drospirenone (OR 1.28, 95% CI 1.00-1.67), and medroxyprogesterone (OR 1.38, 95% CI 1.12-1.70). The use of norgestrel exhibited a protective effect (OR 0.83, 95% CI 0.73-0.95). When using the EE-levonorgestrel COC as a comparator, norgestrel users exhibited a protective effect (OR 0.70, 95% CI 0.57-0.87) while no other contraceptives showed a statistically significant difference in association with SD. CONCLUSION Our study found an increase in the use of levonorgestrel (COC and IUD), drospirenone, and medroxyprogesterone in subjects with SD. The risk of contraceptives did not differ when compared with oral levonorgestrel. The small association size and lack of difference between drug formulations suggest a minimal impact of progestin-based contraceptives on sexual dysfunction.
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Affiliation(s)
- Michael Y Guo
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Mohit Sodhi
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, Department of Anesthesia, Pharmacology and Therapeutics, The Eye Care Center, University of British Columbia, Room 323-2550 Willow Street, Vancouver, BC, V5Z 3N9, Canada
| | - Farzin Khosrow-Khavar
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Mahyar Etminan
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, Department of Anesthesia, Pharmacology and Therapeutics, The Eye Care Center, University of British Columbia, Room 323-2550 Willow Street, Vancouver, BC, V5Z 3N9, Canada.
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20
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Evaluation of Long-Term Surgical Success and Satisfaction of Patients After Vestibulectomy. J Low Genit Tract Dis 2020; 24:399-404. [PMID: 32569021 DOI: 10.1097/lgt.0000000000000552] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Vestibulectomy is one of the only proven therapeutic treatments for provoked vulvodynia (PVD). However, little is known about long-term surgical success. METHODS Patients who underwent vestibulectomy between 1991 and 2003 were interviewed to assess frequency of intercourse and degree of pain during various activities, as well as satisfaction with and willingness to recommend the surgery. We also examined the outcome relation to PVD type being primary or secondary. Differences in pain over time were assessed using a paired-sample t test or a Wilcoxon signed-rank test. RESULTS Of 85 eligible patients, 50 (59%) were contacted and 32 (38%) participated. All underwent vestibulectomy 12-24 years prior by the same surgeon. All experienced sexual intercourse without pain at some point after surgery (median = 4 months). Penetration pain averaged 9.13 (scale = 0-10) before surgery and dropped to 0.47 at the time of follow up (p < .001). Other activities that were reported as painful before surgery also improved significantly. No patients reported worsening of pain over time; 87.5% were able to engage in sexual intercourse immediately after the recovery period, and 97% were able to do so at the time of follow up. Ninety-four percent of respondents were highly satisfied, 97% would undergo the surgery again, and 100% would recommend it to others. The type of PVD was unrelated to treatment outcome (p = .297). CONCLUSIONS Vestibulectomy is an excellent treatment for PVD and has successful long-term outcomes.
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Hampson E. A brief guide to the menstrual cycle and oral contraceptive use for researchers in behavioral endocrinology. Horm Behav 2020; 119:104655. [PMID: 31843564 DOI: 10.1016/j.yhbeh.2019.104655] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 12/08/2019] [Indexed: 12/18/2022]
Abstract
There is increasing evidence that reproductive hormones exert regulatory effects in the central nervous system that can influence behavioral, cognitive, perceptual, affective, and motivational processes. These effects occur in adults and post-pubertal individuals, and can be demonstrated in humans as well as laboratory animals. Large changes in 17β-estradiol and progesterone occur over the ovarian cycle (i.e., the menstrual cycle) and afford a way for researchers to explore the central nervous system (CNS) effects of these hormones under natural physiological conditions. Increasingly, oral contraceptives are also being studied, both as another route to understanding the CNS effects of reproductive hormones and also as pharmacological agents in their own right. This mini-review will summarize the basic physiology of the menstrual cycle and essential facts about oral contraceptives to help novice researchers to use both paradigms effectively.
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Affiliation(s)
- Elizabeth Hampson
- Department of Psychology and Graduate Program in Neuroscience, University of Western Ontario, London, ON N6A 5C2, Canada.
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Kollara A, Shathasivam P, Park S, Ringuette MJ, Brown TJ. Increased androgen receptor levels and signaling in ovarian cancer cells by VEPH1 associated with suppression of SMAD3 and AKT activation. J Steroid Biochem Mol Biol 2020; 196:105498. [PMID: 31614206 DOI: 10.1016/j.jsbmb.2019.105498] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 10/08/2019] [Accepted: 10/08/2019] [Indexed: 12/11/2022]
Abstract
Studies indicate androgens contribute to initiation or progression of epithelial ovarian cancer through poorly understood mechanisms. We provide evidence that the androgen receptor (AR) interacts in a ligand-independent manner with the putative armadillo repeat domain of ventricular zone expressed PH domain-containing 1 (VEPH1). This interaction was increased by mutation of the two nuclear receptor-interacting LxxLL motifs present within the VEPH1 armadillo repeat domain. Androgen treatment did not result in nuclear co-localization of VEPH1 with AR, suggesting that VEPH1 does not function as a nuclear co-regulatory protein. VEPH1 expression decreased SMAD3 and activated AKT levels in ovarian cancer cell lines and increased AR activity and protein levels, consistent with an impact on receptor stability. Treatment of cells with dihydrotestosterone (DHT) increased AR protein levels measured 24 h after treatment, an effect augmented in VEPH1-transfected cells, and inhibited by knock-down of endogenous VEPH1. SMAD3 overexpression decreased AR protein levels and prevented the VEPH1-dependent increase in AR; however, silencing of SMAD3 paradoxically also decreased AR levels. DHT treatment led to a rapid and sustained decrease in phosphorylated AKT (pAKT) levels that was enhanced by VEPH1 expression. Inhibition of PI3K resulted in increased AR protein levels. These studies indicate that VEPH1 acts to enhance AR activity in ovarian cancer cells by decreasing SMAD3 and pAKT levels, resulting in increased levels of AR protein.
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Affiliation(s)
- Alexandra Kollara
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, M5T 3L9, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, M5S 3G5, Canada
| | - Premalatha Shathasivam
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, M5T 3L9, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, M5S 3G5, Canada
| | - Soyeon Park
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, M5T 3L9, Canada
| | - Maurice J Ringuette
- Department of Cell and Systems Biology, University of Toronto, Toronto, Ontario, M5S 3G5, Canada
| | - Theodore J Brown
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, M5T 3L9, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, M5S 3G5, Canada.
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de Castro Coelho F, Barros C. The Potential of Hormonal Contraception to Influence Female Sexuality. Int J Reprod Med 2019; 2019:9701384. [PMID: 30941356 PMCID: PMC6421036 DOI: 10.1155/2019/9701384] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 01/30/2019] [Indexed: 02/02/2023] Open
Abstract
The association between female sexual function and hormonal contraception is controversial. Recognition and management of sexual side effects in women using hormonal contraceptives are challenging. An unsatisfactory number of studies report the influence of the available contraceptives on female sexuality. This article provides an updated narrative review regarding the effect and the magnitude of the impact that hormonal contraceptives play in female sexual function.
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Affiliation(s)
- Filipa de Castro Coelho
- Department of Gynecology and Obstetrics, Hospital Dr. Nélio Mendonça, Serviço de Saúde da Região Autónoma da Madeira, E.P.E., Funchal, Portugal
| | - Cremilda Barros
- Department of Gynecology and Obstetrics, Hospital Dr. Nélio Mendonça, Serviço de Saúde da Região Autónoma da Madeira, E.P.E., Funchal, Portugal
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Traish AM. The Post-finasteride Syndrome: Clinical Manifestation of Drug-Induced Epigenetics Due to Endocrine Disruption. CURRENT SEXUAL HEALTH REPORTS 2018. [DOI: 10.1007/s11930-018-0161-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Abstract
This article reviews the history of the treatment of women's sexual problems from the Victorian era to the twenty-first century. The contextual nature of determining what constitutes female sexual psychopathology is highlighted. Conceptions of normal sexuality are subject to cultural vagaries, making it difficult to identify female sexual dysfunctions. A survey of the inclusion, removal, and collapsing of women's sexual diagnoses in the Diagnostic and Statistical Manual of Mental Disorders from 1952 to 2013 illuminates the biases in the various editions. Masters and Johnson's models of sexual response and dysfunction paved the way for the diagnosis and treatment of women's sexual dysfunctions. Their sex therapy paradigm is described. Conceptions of and treatments for anorgasmia, arousal difficulties, vaginismus, dyspareunia, and low desire are reviewed. The medicalization of human sexuality and the splintering of sex therapy are discussed, along with current trends and new directions in sexual health care for women.
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Affiliation(s)
- Peggy J. Kleinplatz
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario K1G 5Z3, Canada
- School of Psychology, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada
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Goldstein SW, Winter AG, Goldstein I. Improvements to the Vulva, Vestibule, Urethral Meatus, and Vagina in Women Treated With Ospemifene for Moderate to Severe Dyspareunia: A Prospective Vulvoscopic Pilot Study. Sex Med 2018; 6:154-161. [PMID: 29678557 PMCID: PMC5960031 DOI: 10.1016/j.esxm.2018.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 03/27/2018] [Accepted: 03/30/2018] [Indexed: 12/03/2022] Open
Abstract
Introduction Ospemifene, an oral selective estrogen receptor modulator approved for the treatment of mild to moderate dyspareunia from menopause, has been shown to moderate sexual pain and vaginal epithelial cell characteristics. However, no prospective vulvoscopic studies have been performed. Aim To examine, in menopausal women taking ospemifene 60 mg daily, changes to the vulva, vestibule, urethral meatus, and vaginal region over 20 weeks using vulvoscopy in a prospective open-label pilot study. Methods Vulvoscopic photographs taken at screening and the end of therapy assessed for changes in the appearance of the vulva, vestibule, urethral meatus, and vagina rated by a single reviewer using a 10-parameter Likert rating scale, the Vulvoscopic Genital Tissue Appearance Scale (VGTA). In addition, the cotton-tipped swab test and subject diary scores were assessed over the 20-week treatment period and compared before and after the intervention using Wilcoxon signed-rank test. Main Outcome Measure Changes in VGTA score from baseline to end of study. Results 8 subjects (age = 59 ± 4.7 years) completed all visits and were included in the analysis of vulvoscopic photographs (n = 258). There were significant changes during the study period for urethral meatal prominence, introital stenosis, vestibular pallor, vestibular erythema, mucosal moisture, vaginal rugation, and anterior wall prominence (P < .05). Total pain score during cotton-tipped swab testing decreased from 11 (interquartile range = 10–16) before the intervention to 1 (interquartile range = 0–3) at the end of the study. Quantitative diary analysis indicated an increase in the number of sexual events, decrease in rates of pain during foreplay and intercourse, and decrease in use of lubricant at study completion (P < .05). Conclusions Ospemifene 60 mg daily for 20 weeks showed improvement in physical examination findings in this prospective study of menopausal women with dyspareunia, as documented on vulvoscopic photography. These changes were consistent with improvements in subject-reported pain and sexual function. Goldstein SW, Winter AG, Goldstein I. Improvements to the Vulva, Vestibule, Urethral Meatus, and Vagina in Women Treated With Ospemifene for Moderate to Severe Dyspareunia: A Prospective Vulvoscopic Pilot Study. Sex Med 2018;6:154–161.
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AlAwlaqi A, Amor H, Hammadeh ME. Role of hormones in hypoactive sexual desire disorder and current treatment. J Turk Ger Gynecol Assoc 2017; 18:210-218. [PMID: 29278235 PMCID: PMC5776161 DOI: 10.4274/jtgga.2017.0071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Over the decades, female sexual dysfunction (FSD) has grown to be an increasingly potential problem that complicates the quality of life among women. In the current review, FSD refers to recurrent and persistent problems with sexual orgasm, desire, or response. One of the most common subtypes of FSD that has evoked increased research interest in the scientific community is hyposexuality. Today, there is a consensus that hyposexuality is a multifactorial condition that manifests with reduced sexual desire resulting in significant interpersonal distress. The objective of the current review was to examine how hormonal profile triggers propagate hypoactive sexual desire disorder (HSDD), and to highlight effective treatment interventions that can be used to manage the condition. The current review describes HSDD as a sexual dysfunction characterized by the absence or lack of sexual desire and fantasies for sexual activities. The review argues that even if the role of sexual hormones is essential in modulating HSDD through therapeutic interventions, an effective comprehension of the biologic mechanisms underlying HSDD is necessary. There is a consensus in the literature that HSDD still poses significant challenges due to the lack of properly formulated treatment regimens and absence of clear clinical guidelines. That is, a better intervention consisting of both psycho-relational and biologic aspects is compulsory if tailored management and accurate diagnosis of HSDD in clinical practice are to be realised. The review concludes that, to date, a reliable clinical intervention to manage hyposexuality is still absent and more interventions, in terms of safety and efficacy, are required. Thus, additional investigation is required to document precise hormonal or non-hormonal pharmacotherapeutic agents for individualised care among patients with HSDD.
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Affiliation(s)
- Ahmed AlAwlaqi
- Department of Obstetrics and Gynaecology, University of Saarland, Homburg, Germany
| | - Houda Amor
- Department of Obstetrics and Gynaecology, University of Saarland, Homburg, Germany
| | - Mohamed E Hammadeh
- Department of Obstetrics and Gynaecology, University of Saarland, Homburg, Germany
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Johnson-Agbakwu C, Brown L, Yuan J, Kissling R, Greenblatt DJ. Effects of Flibanserin on the Pharmacokinetics of a Combined Ethinylestradiol/Levonorgestrel Oral Contraceptive in Healthy Premenopausal Women: A Randomized Crossover Study. Clin Ther 2017; 40:64-73. [PMID: 29198449 DOI: 10.1016/j.clinthera.2017.08.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 08/21/2017] [Accepted: 08/31/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE This study aimed to investigate the effect of steady-state exposure to flibanserin, a 5-HT1A agonist/5-HT2A antagonist approved for the treatment of hypoactive sexual desire disorder in premenopausal women, on the single-dose pharmacokinetics of the contraceptive steroids ethinylestradiol and levonorgestrel in healthy premenopausal women. METHODS Healthy female volunteers (N = 24) received 2 single doses of a combined oral contraceptive containing ethinylestradiol 30 μg and levonorgestrel 150 μg, either alone (reference) or preceded by treatment with flibanserin 100 mg once daily for 14 days (test). The 2 treatments were given in randomized order, with a 4-week washout period following the last administration of the first treatment. Plasma concentrations of ethinylestradiol and levonorgestrel were measured over 48 hours after dosing for the determination of pharmacokinetic parameters; the primary end points were Cmax and AUC0-∞ of ethinylestradiol and levonorgestrel. FINDINGS Of the 24 women enrolled (mean age, 38.0 years), 23 completed the study. Mean (SD) Cmax and AUC0-∞ values of ethinylestradiol were 66.7 (16.3) pg/mL and 693 (268) pg · h/mL, respectively, following the oral contraceptive alone, and 72.7 (25.5) pg/mL and 740 (235) pg · h/mL, respectively, when the oral contraceptive was preceded by flibanserin. In both cases, the 90% CIs of the reference/test ratios of Cmax and AUC0-∞ were within the range of 80% to 125%, indicating that flibanserin had no significant effect on the pharmacokinetic properties of ethinylestradiol. Similarly, the mean (SD) Cmax and AUC0-∞ values of levonorgestrel were 5.0 (1.6) ng/mL and 52.2 (18.7) ng · h/mL, respectively, with the oral contraceptive alone, and 5.0 (1.6) ng/mL and 53.3 (20.4) ng · h/mL, respectively, following flibanserin; again, in both cases, the 90% CIs of the reference/test ratios were within the range of 80% to 125%, indicating that flibanserin had no significant effect on the pharmacokinetic properties of levonorgestrel. All adverse events were mild to moderate in intensity (incidence: 12.5% and 70.8% with ethinylestradiol/levonorgestrel treatment alone and following administration of flibanserin, respectively). IMPLICATIONS Pretreatment with flibanserin 100 mg once daily for 2 weeks did not produce a clinically relevant change in oral contraceptive drug exposure following single-dose administration of ethinylestradiol/levonorgestrel. This finding is relevant to women with hypoactive sexual desire disorder who might prefer oral contraceptives to other forms of birth control. EudraCT No: 2006-006960-46.
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Affiliation(s)
| | - Louise Brown
- Valeant Pharmaceuticals North America LLC, Bridgewater, New Jersey
| | - James Yuan
- Valeant Pharmaceuticals North America LLC, Bridgewater, New Jersey
| | - Robert Kissling
- Valeant Pharmaceuticals North America LLC, Bridgewater, New Jersey
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Estrogenic and progestogenic effects of hormonal contraceptives in relation to sexual behavior: insights into extended sexuality. EVOL HUM BEHAV 2017. [DOI: 10.1016/j.evolhumbehav.2016.10.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Casey PM, MacLaughlin KL, Faubion SS. Impact of Contraception on Female Sexual Function. J Womens Health (Larchmt) 2017; 26:207-213. [DOI: 10.1089/jwh.2015.5703] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Petra M. Casey
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | | | - Stephanie S. Faubion
- Women's Health Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
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Guida M, Di Carlo C, Troisi J, Gallo A, Cibarelli F, Martini E, Tiranini L, Nappi RE. The sexuological impact of hormonal contraceptives based on their route of administration. Gynecol Endocrinol 2017; 33:218-222. [PMID: 27908210 DOI: 10.1080/09513590.2016.1249841] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Evidence on the effects of hormonal contraceptives on female sexuality is conflicting. We enrolled 556 women, divided into six groups: two composed of subjects using a combined hormonal contraceptive (COC) containing 0.020 ("COC20") and 0.030 ("COC30") mg of ethynyl estradiol (EE), "natural", using COC containing 1.5 mg of estradiol (E2), "ring", using a vaginal ring releasing each day 0.015 mg of EE + 0.120 of etonogestrel, "subcutaneous", using a progestin only subcutaneous contraceptive implant releasing etonogestrel and "controls", using no hormonal contraceptive methods. The subjects were required to answer to the McCoy female sexuality questionnaire and were subjected to a blood test for hormonal evaluation. An ultrasound evaluation of the dorsal clitoral artery was also performed. The higher McCoy sexological value were recorded in the subdermal group; significant differences were recorded among the groups in terms of hormone distribution, with the higher levels of androstenedione in subdermal and control groups. The ultrasound evaluation of dorsal clitoral artery shows a significative correlation between pulsatility and resistance indices and orgasm parameters of McCoy questionnaire. The recorded difference in the sexual and hormonal parameters among the studied hormonal contraceptives may guide toward the personalization of contraceptive choice.
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MESH Headings
- Adult
- Clitoris/blood supply
- Clitoris/diagnostic imaging
- Clitoris/drug effects
- Contraceptive Agents, Female/administration & dosage
- Contraceptive Agents, Female/adverse effects
- Contraceptive Agents, Female/blood
- Contraceptive Agents, Female/pharmacokinetics
- Contraceptive Devices, Female/adverse effects
- Contraceptives, Oral, Combined/administration & dosage
- Contraceptives, Oral, Combined/adverse effects
- Contraceptives, Oral, Combined/blood
- Contraceptives, Oral, Combined/pharmacokinetics
- Contraceptives, Oral, Hormonal/administration & dosage
- Contraceptives, Oral, Hormonal/adverse effects
- Contraceptives, Oral, Hormonal/blood
- Contraceptives, Oral, Hormonal/pharmacokinetics
- Delayed-Action Preparations/administration & dosage
- Delayed-Action Preparations/adverse effects
- Desogestrel/administration & dosage
- Desogestrel/adverse effects
- Desogestrel/blood
- Desogestrel/pharmacokinetics
- Dose-Response Relationship, Drug
- Drug Implants
- Estrogens/administration & dosage
- Estrogens/adverse effects
- Estrogens/blood
- Estrogens/pharmacokinetics
- Female
- Humans
- Italy
- Megestrol/administration & dosage
- Megestrol/adverse effects
- Megestrol/blood
- Megestrol/pharmacokinetics
- Norpregnadienes/administration & dosage
- Norpregnadienes/adverse effects
- Norpregnadienes/blood
- Norpregnadienes/pharmacokinetics
- Orgasm/drug effects
- Progestins/administration & dosage
- Progestins/adverse effects
- Progestins/blood
- Progestins/pharmacokinetics
- Regional Blood Flow/drug effects
- Self Report
- Sexual Behavior/drug effects
- Ultrasonography, Doppler
- Young Adult
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Affiliation(s)
- Maurizio Guida
- a Department of Medicine "Scuola Medica Salernitana" , University of Salerno , Salerno , Italy
- b Theoreo srl - spin-off of the University of Salerno , Salerno , Italy
| | - Costantino Di Carlo
- c Department of Neurosciences and Reproductive Sciences , University of Naples Federico II , Naples , Italy , and
| | - Jacopo Troisi
- a Department of Medicine "Scuola Medica Salernitana" , University of Salerno , Salerno , Italy
- b Theoreo srl - spin-off of the University of Salerno , Salerno , Italy
| | - Alessandra Gallo
- a Department of Medicine "Scuola Medica Salernitana" , University of Salerno , Salerno , Italy
| | - Francesca Cibarelli
- a Department of Medicine "Scuola Medica Salernitana" , University of Salerno , Salerno , Italy
| | - Ellis Martini
- d Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause Unit, Dept of Obstetrics and Gynecology, IRCCS "S. Matteo Foundation", University of Pavia , Pavia , Italy
| | - Lara Tiranini
- d Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause Unit, Dept of Obstetrics and Gynecology, IRCCS "S. Matteo Foundation", University of Pavia , Pavia , Italy
| | - Rossella E Nappi
- d Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause Unit, Dept of Obstetrics and Gynecology, IRCCS "S. Matteo Foundation", University of Pavia , Pavia , Italy
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Garneau-Fournier J, McBain S, Torres T, Turchik J. Sexual Dysfunction Problems in Female College Students: Sexual Victimization, Substance Use, and Personality Factors. JOURNAL OF SEX & MARITAL THERAPY 2017; 43:24-39. [PMID: 26683983 DOI: 10.1080/0092623x.2015.1113595] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Little empirical information is available on sexual dysfunction (SD) among college women even though college years represent a critical period in the development of sexuality. The current study aimed to identify factors associated with the presence, number, and type of SD problems among 547 female college students in the United States. Racial minority status, problematic drinking behaviors, and past sexual victimization were positively related to the presence of SD problems, whereas hormonal contraceptive use and past sexual victimization were associated with a greater number of SD problems. These findings highlight the importance of assessment, treatment, and prevention of sexual health issues on college campuses.
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Affiliation(s)
- Jade Garneau-Fournier
- a Pacific Graduate School of Psychology at Palo Alto University and Center of Innovation to Implementation, VA Palo Alto Health Care System , Palo Alto , California , USA
| | - Sacha McBain
- a Pacific Graduate School of Psychology at Palo Alto University and Center of Innovation to Implementation, VA Palo Alto Health Care System , Palo Alto , California , USA
| | - Tammy Torres
- b Pacific Graduate School of Psychology-Stanford Consortium Psy.D. Program and Center of Innovation to Implementation, VA Palo Alto Health Care System , Palo Alto , California , USA
| | - Jessica Turchik
- c Center of Innovation to Implementation, VA Palo Alto Health Care System, National Center for PTSD , VA Palo Alto Health Care System, Palo Alto , California , USA
- d Department of Psychiatry and Behavioral Sciences , Stanford University , Menlo Park , California , USA
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Heijboer AC, Savelkoul E, Kruit A, Endert E, Blankenstein MA. Inaccurate First-Generation Testosterone Assays Are Influenced by Sex Hormone–Binding Globulin Concentrations. ACTA ACUST UNITED AC 2016; 1:194-201. [DOI: 10.1373/jalm.2016.020065] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 05/27/2016] [Indexed: 11/06/2022]
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Lynn DD, Umari T, Dunnick CA, Dellavalle RP. The epidemiology of acne vulgaris in late adolescence. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2016; 7:13-25. [PMID: 26955297 PMCID: PMC4769025 DOI: 10.2147/ahmt.s55832] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Acne vulgaris is the most common skin condition affecting late adolescents across the globe. Although prior studies have evaluated epidemiologic patterns of acne vulgaris in various ethnicities and regions, adequate understanding of the worldwide burden of the disease associated with patients in their late adolescence (15–19-year olds) remains lacking. Objective To assess the global burden of the disease associated with acne vulgaris for late adolescents (15–19-year olds) and provide an overview of the epidemiology, pathophysiology, and treatment options for acne in this population. Design Database summary study. Setting Global Burden of Disease Study 2010 database. Participants Global Burden of Disease regions comprised countries with prevalence of acne vulgaris between the ages of 15 and 19 years. Main outcomes and measures Geographic region-level disability-adjusted life year rates (per 100,000 persons) associated with acne vulgaris in years 1990 through 2010. Median percentage change in disability-adjusted life year rates was estimated for each region across the specified study period. Conclusion and relevance Acne vulgaris-associated disease burden exhibits global distribution and has continued to grow in prevalence over time within this population. This continued growth suggests an unmet dermatologic need worldwide for this disorder and potential opportunities for improved access and delivery of dermatologic care. Our analysis of the literature reveals numerous opportunities for enhanced patient care. To that end, we highlight some of the effective and promising treatments currently available and address important factors, such as sex, nationality, genetics, pathophysiology, and diet, as they relate to acne vulgaris in late adolescence.
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Affiliation(s)
- Darren D Lynn
- Department of Dermatology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Tamara Umari
- Department of Dermatology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Dermatology Service, US Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, CO, USA
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Dermatology Service, US Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, CO, USA; Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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McCullough LE, Miller EE, Wang Q, Li JY, Liu L, Li H, Zhang J, Smith JS. Cross-Sectional Associations between Body Size, Circulating Sex-Steroid Hormones and IGF Components among Healthy Chinese Women. PLoS One 2015; 10:e0137686. [PMID: 26352264 PMCID: PMC4564271 DOI: 10.1371/journal.pone.0137686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 08/19/2015] [Indexed: 01/03/2023] Open
Abstract
The incidence of breast cancer has increased in Asian countries and rates of hormone receptor (HR) negative breast cancer exceed those of Western countries. Epidemiologic data suggest that the association between body size and BC risk may vary by HR status, and could differ geographically. While body size may influence BC risk by moderating the synthesis and metabolism of circulating sex-steroid hormones, insulin-like growth factor (IGF)-1 and related binding proteins, there is a dearth of literature among Asian women. We aimed to examine these specific associations in a sample of Chinese women. In Sichuan Province 143 women aged ≥40 years were recruited through outpatient services (2011–2012). Questionnaires, anthropometric measurements, and blood samples were utilized for data collection and linear regression was applied in data analyses. Among women <50 years we observed a non-monotonic positive association between body mass index (BMI) and 17β-estradiol, and a reversed J-shaped association between BMI and IGF-1 (p ≤0.05). We observed similar associations between waist-to-hip ratio and these markers. Our finding of augmented IGF-1 among women with low body mass may have implications for understanding breast tumor heterogeneity in diverse populations and should be evaluated in larger prospective studies with cancer outcomes.
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Affiliation(s)
- Lauren E. McCullough
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, 135 Dauer Drive, Chapel Hill, North Carolina, 27599, United States of America
- Lineberger Comprehensive Cancer Center, 101 Manning Drive, Chapel Hill, North Carolina, 27514, United States of America
| | - Erline E. Miller
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, 135 Dauer Drive, Chapel Hill, North Carolina, 27599, United States of America
| | - Qiong Wang
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, 16 Ren Min Nan Lu, Chengdu, 610041, P.R. China
| | - Jia-yuan Li
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, 135 Dauer Drive, Chapel Hill, North Carolina, 27599, United States of America
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, 16 Ren Min Nan Lu, Chengdu, 610041, P.R. China
- * E-mail:
| | - Li Liu
- The Comprehensive Guidance Center of Women's Health, Chengdu Women’s and Children’s Central Hospital, Shi Ye Street, Qingyang District, Chengdu, 610015, P.R. China
| | - Hui Li
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, 16 Ren Min Nan Lu, Chengdu, 610041, P.R. China
| | - Jing Zhang
- The Comprehensive Guidance Center of Women's Health, Chengdu Women’s and Children’s Central Hospital, Shi Ye Street, Qingyang District, Chengdu, 610015, P.R. China
| | - Jennifer S. Smith
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, 135 Dauer Drive, Chapel Hill, North Carolina, 27599, United States of America
- Lineberger Comprehensive Cancer Center, 101 Manning Drive, Chapel Hill, North Carolina, 27514, United States of America
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Pre-gravid oral contraceptive use in relation to birth weight: a prospective cohort study. Eur J Epidemiol 2015; 30:1199-208. [PMID: 26076921 DOI: 10.1007/s10654-015-0053-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 05/30/2015] [Indexed: 01/19/2023]
Abstract
Few studies have evaluated the association between pregravid oral contraceptive (OC) use and birth weight, and findings have been conflicting. We conducted a prospective cohort study of 5921 pregnancy planners in Denmark to evaluate recency, duration, and type of OC used before conception in relation to infant birth weight. Participants completed online questionnaires and reported detailed information on contraceptive history and covariates at baseline. Participants completed bimonthly follow-up questionnaires to update their pregnancy status for up to 12 months or until conception occurred. Birth weight data were ascertained from the Danish Medical Birth Registry for 4046 live births delivered by study participants between 2008 and 2010. We used multivariable linear and log-binomial regression analyses to control for confounding. Mean birth weight was higher among women who had used OCs within 0-1 months (mean difference = 97 g, CI 26, 168) or 2-6 months (mean difference = 40 g, CI -5, 85) before conception, compared with more than 12 months before conception. Mean birth weight was lower among women who had used OCs for long durations (mean difference comparing ≥12 with <4 years of OC use = -85 g, CI -158, -11). Our findings indicate that pregravid OC use within 6 months of conception may be associated with a small increase in birth weight, but that long duration of use may have the opposite effect. Results were stronger among male infants, among 2nd and 4th generation OC users, and among users of OCs with a higher estrogen dose.
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Wallwiener CW, Wallwiener LM, Seeger H, Schönfisch B, Mueck AO, Bitzer J, Zipfel S, Brucker SY, Taran FA, Wallwiener M. Are hormonal components of oral contraceptives associated with impaired female sexual function? A questionnaire-based online survey of medical students in Germany, Austria, and Switzerland. Arch Gynecol Obstet 2015; 292:883-90. [DOI: 10.1007/s00404-015-3726-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 04/16/2015] [Indexed: 01/02/2023]
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Lello S, Cavani A. Ethynilestradiol 20 mcg plus Levonorgestrel 100 mcg: Clinical Pharmacology. Int J Endocrinol 2014; 2014:102184. [PMID: 25477960 PMCID: PMC4247926 DOI: 10.1155/2014/102184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 10/27/2014] [Indexed: 11/17/2022] Open
Abstract
Estroprogestins (EPs) are combinations of estrogen and progestin with several actions on women's health. The different pharmacological composition of EPs is responsible for different clinical effects. One of the most used low-dose EP associations is ethinylestradiol 20 mcg plus levonorgestrel 100 mcg in monophasic regimen (EE20/LNG100). This review summarizes clinical pharmacology, cycle control, and effects on lipid and glucose metabolism, coagulation, body weight/body composition, acne, and sexuality of EE20/LNG100. Overall, EE20/LNG100 combination is safe and well tolerated, and in several studies the incidence of adverse events in the treated group was comparable to that of the placebo group. Cycle control was effective and body weight/body composition did not vary among treated and untreated groups in most studies. The EE20/LNG100 combination shows mild or no effect on lipid and glucose metabolism. Lastly, EE20/LNG100 is associated with a low risk of venous thromboembolism (VTE). In conclusion, in the process of decision making for the individualization of EPs choice, EE20/LNG100 should be considered for its favorable clinical profile.
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Affiliation(s)
- Stefano Lello
- Gynecological Endocrinology, Pathophysiology of Menopause and Osteoporosis, IDI-IRCCS, Via Monti di Creta 104, 00167 Rome, Italy
| | - Andrea Cavani
- Laboratory of Experimental Immunology, IDI-IRCCS, 00167 Rome, Italy
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Abstract
Introduction Combined hormonal contraceptives (CHCs) use is becoming an increasingly recognized causes of vestibulodynia. Aim This study aims to describe pre- and posttreatment vestibular pain, sex hormone binding globulin (SHBG), and calculated free testosterone levels in women undergoing treatment for vestibulodynia. Methods This was a chart review of 50 premenopausal women who presented with vestibular pain while currently using CHCs. Pre- and posttreatment vestibular pain, SHBG, and calculated free testosterone levels were assessed. Results There was a statistically significant improvement in posttreatment vestibular pain scores (P = 0.001), SHBG (P = 0.001), and calculated free testosterone (P = 0.001) levels from baseline. Conclusion Women with vestibulodynia that began while on CHC may effectively be treated by discontinuing the CHC combined with the application topical hormone therapy. Symptomatic improvement is accompanied by normalization of calculated free testosterone and SHBG values. Burrows LJ and Goldstein AT. The treatment of vestibulodynia with topical estradiol and testosterone. Sex Med 2013;1:30–33.
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Affiliation(s)
- Lara J Burrows
- Obstetrics and Gynecology, The Center for Vulvovaginal Disorders Washington, DC, USA
| | - Andrew T Goldstein
- Obstetrics and Gynecology, The Center for Vulvovaginal Disorders Washington, DC, USA
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Stanczyk FZ, Archer DF. Gestodene: a review of its pharmacology, potency and tolerability in combined contraceptive preparations. Contraception 2013; 89:242-52. [PMID: 24485094 DOI: 10.1016/j.contraception.2013.12.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 11/28/2013] [Accepted: 12/05/2013] [Indexed: 11/15/2022]
Abstract
Combined progestin-estrogen pills are an established and reliable contraceptive option used by women worldwide. Combined oral contraceptives (COCs) containing the progestins--gestodene, desogestrel or norgestimate--were developed to minimize androgenic side effects and are considered an effective, well-tolerated contraceptive option. Gestodene achieves contraceptive efficacy with the lowest dose of any progestin in a COC, and has an established and favorable short- and long-term tolerability profile. In this review we present an overview of the pharmacology, potency and tolerability of gestodene.
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Affiliation(s)
- Frank Z Stanczyk
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
| | - David F Archer
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
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Davis SR, Bitzer J, Giraldi A, Palacios S, Parke S, Serrani M, Mellinger U, Nappi RE. Change to Either a Nonandrogenic or Androgenic Progestin‐Containing Oral Contraceptive Preparation is Associated with Improved Sexual Function in Women with Oral Contraceptive‐Associated Sexual Dysfunction. J Sex Med 2013; 10:3069-79. [DOI: 10.1111/jsm.12310] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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43
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44
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Goldstein I. Prevention, Not Cure. J Sex Med 2013; 10:2613-5. [DOI: 10.1111/jsm.12338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Roberts SC, Cobey KD, Klapilová K, Havlíček J. An evolutionary approach offers a fresh perspective on the relationship between oral contraception and sexual desire. ARCHIVES OF SEXUAL BEHAVIOR 2013; 42:1369-1375. [PMID: 23733157 DOI: 10.1007/s10508-013-0126-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- S Craig Roberts
- School of Natural Sciences, University of Stirling, Stirling, FK9 4LA, UK,
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Pastor Z, Holla K, Chmel R. The influence of combined oral contraceptives on female sexual desire: a systematic review. EUR J CONTRACEP REPR 2013; 18:27-43. [PMID: 23320933 DOI: 10.3109/13625187.2012.728643] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To determine the relationship between the use of combined oral contraceptives (COCs) and sexual desire based on a systematic review of the literature. METHODS MEDLINE Complete, Google Scholar and the Cochrane Library were searched for articles published between 1975 and 2011, reporting the effects of oral contraceptives on sexual desire. Reports fully meeting all the predefined criteria were analysed and included in a final reference list. In addition, a review of the reference list of selected articles was carried out. RESULTS We evaluated 36 studies (1978-2011; 13,673 women). Of the COC users (n = 8,422), 85% reported an increase (n = 1,826) or no change (n = 5,358) in libido and 15% reported a decrease (n = 1,238). We found no significant difference in sexual desire in the case of COCs with 20-35 μg ethinylestradiol; libido decreased only with pills containing 15 μg ethinylestradiol. CONCLUSIONS The majority of COC users report no significant change in libido although in most studies a decline in plasma levels of free testosterone and an increase in those of sex hormone binding globulin were observed.
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Affiliation(s)
- Zlatko Pastor
- Obstetrics and Gynaecology Department, 2nd Medical Faculty, Teaching Hospital Motol, Charles University, Prague, Czech Republic.
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Genuis SJ, Lipp C. Ethical diversity and the role of conscience in clinical medicine. INTERNATIONAL JOURNAL OF FAMILY MEDICINE 2013; 2013:587541. [PMID: 24455248 PMCID: PMC3876678 DOI: 10.1155/2013/587541] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 10/09/2013] [Indexed: 05/09/2023]
Abstract
In a climate of plurality about the concept of what is "good," one of the most daunting challenges facing contemporary medicine is the provision of medical care within the mosaic of ethical diversity. Juxtaposed with escalating scientific knowledge and clinical prowess has been the concomitant erosion of unity of thought in medical ethics. With innumerable technologies now available in the armamentarium of healthcare, combined with escalating realities of financial constraints, cultural differences, moral divergence, and ideological divides among stakeholders, medical professionals and their patients are increasingly faced with ethical quandaries when making medical decisions. Amidst the plurality of values, ethical collision arises when the values of individual health professionals are dissonant with the expressed requests of patients, the common practice amongst colleagues, or the directives from regulatory and political authorities. In addition, concern is increasing among some medical practitioners due to mounting attempts by certain groups to curtail freedom of independent conscience-by preventing medical professionals from doing what to them is apparently good, or by compelling practitioners to do what they, in conscience, deem to be evil. This paper and the case study presented will explore issues related to freedom of conscience and consider practical approaches to ethical collision in clinical medicine.
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Affiliation(s)
- Stephen J. Genuis
- University of Alberta, 2935-66 Street, Edmonton, AB, Canada T6K 4C1
- *Stephen J. Genuis:
| | - Chris Lipp
- University of British Columbia, 2329 W Mall, Vancouver, BC, Canada V6T 1Z4
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Burrows LJ, Basha M, Goldstein AT. The Effects of Hormonal Contraceptives on Female Sexuality: A Review. J Sex Med 2012; 9:2213-23. [DOI: 10.1111/j.1743-6109.2012.02848.x] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Gambineri A, Patton L, Altieri P, Pagotto U, Pizzi C, Manzoli L, Pasquali R. Polycystic ovary syndrome is a risk factor for type 2 diabetes: results from a long-term prospective study. Diabetes 2012; 61:2369-74. [PMID: 22698921 PMCID: PMC3425413 DOI: 10.2337/db11-1360] [Citation(s) in RCA: 158] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 03/24/2012] [Indexed: 02/06/2023]
Abstract
Polycystic ovary syndrome (PCOS) recently has been identified as a risk factor associated with type 2 diabetes. However, the evidence derives from cross-sectional observational studies, retrospective studies, or short-term prospective studies. This long-term prospective study of a large cohort of women with PCOS, followed from youth to middle age, aimed at estimating, for the first time, the incidence and potential predictors of type 2 diabetes in this population. A total of 255 women with PCOS were followed for at least 10 years (mean follow-up 16.9 years). Six women were patients with diabetes at baseline, and another 42 women developed type 2 diabetes during the follow-up. The incidence rate of type 2 diabetes in the study population was 1.05 per 100 person-years. The age-standardized prevalence of diabetes at the end of follow-up was 39.3%, which is significantly higher with respect to that of the general Italian female population of a similar age (5.8%). The likelihood of developing type 2 diabetes significantly increased as BMI, fasting glucose, and glucose area under the curve at baseline increased and significantly decreased as sex hormone-binding globulin (SHBG) levels at follow-up increased. This study demonstrates that the risk of type 2 diabetes is markedly elevated in middle-aged women with PCOS and suggests including BMI, glucose, and SHBG-circulating levels in the risk stratification.
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Affiliation(s)
- Alessandra Gambineri
- From the Endocrinology Unit, Department of Clinical Medicine, St. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy; the
| | - Laura Patton
- From the Endocrinology Unit, Department of Clinical Medicine, St. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy; the
| | - Paola Altieri
- From the Endocrinology Unit, Department of Clinical Medicine, St. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy; the
| | - Uberto Pagotto
- From the Endocrinology Unit, Department of Clinical Medicine, St. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy; the
| | - Carmine Pizzi
- Department of Internal Medicine, Aging and Nephrologic Diseases, St. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy; and the
| | - Lamberto Manzoli
- Section of Hygiene, Epidemiology, Pharmacology and Legal Medicine, University of Chieti, Chieti, Italy
| | - Renato Pasquali
- From the Endocrinology Unit, Department of Clinical Medicine, St. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy; the
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