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Johnson I, Thurman AR, Cornell KA, Symonds T, Hatheway J, Friend DR, Goldstein A. Comparisons and correlations of 1-month recall vs 24-hour recall in patient-reported outcomes of an exploratory, phase 2b, randomized, double-blind, placebo-controlled clinical trial of sildenafil cream, 3.6% for the treatment of female sexual arousal disorder. J Sex Med 2024; 21:787-792. [PMID: 39059373 DOI: 10.1093/jsxmed/qdae086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/11/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Efficacy assessments in clinical trials of treatments for female sexual arousal disorder (FSAD) and other female sexual dysfunction (FSD) diagnoses rely on various patient-reported outcomes (PROs). AIMS We sought to compare 1-month recall PRO measures among participants enrolled in a clinical trial who provided these data without (test population) vs with (control population) use of an at-home, 24-hour recall electronic diary (eDiary), capturing similar data. METHODS Preplanned subset analysis as performed during a phase 2b, exploratory, randomized, placebo-controlled, double-blind study of sildenafil cream, 3.6% (sildenafil cream) among healthy premenopausal women with FSAD. Preliminary product efficacy was assessed via 1-month recall and 24-hour recall questionnaires. A subset of the participants, the Evaluation of Recall Subset [ERS] provided PROs via the 1-month recall instruments but did not provide data via the 24-hour recall eDiary. OUTCOMES Responses to the 1-month recall instruments were compared among ERS (test) vs non-ERS (control) participants. Among the non-ERS population, correlations between 1-month and 24-hour recall endpoints were calculated. RESULTS There were no significant differences in the study co-primary 1-month recall efficacy endpoints, the Arousal Sensation (AS) domain of the 28-item Sexual Function Questionnaire (SFQ28) and the Female Sexual Distress Scale - Desire, Arousal, Orgasm question 14, among ERS vs non-ERS participants during the initial 1-month no-drug run-in period or the 1-month single-blind placebo run-in period (P values > .47). Scores on these 1-month recall PROs continued to be similar after randomization for sildenafil cream (P values > .30) and placebo cream (P values > .20) assigned ERS and non-ERS participants during the 3-month double-blind dosing period. There were strong correlations between the SFQ28 AS and eDiary AS scores during the no-drug run-in (R = 0.79, P < .01) and the single-blind run-in (R = 0.73 P < .001). During the double-blind dosing period, the SFQ28 AS score continued to be highly correlated with the eDiary AS score among sildenafil cream users (R = 0.83; P < .001) and placebo cream users (R = 0.8; 2 P < .001). CLINICAL IMPLICATIONS There was no evidence that 1-month recall PRO instruments introduce recall bias; assessing arousal sensations with 24-hour vs 1-month PRO instruments is similar and either method could be used to assess efficacy depending on study objectives. STRENGTHS AND LIMITATIONS This preplanned subset analysis compared efficacy of PROs based on recall duration. While the subset was preplanned, the study was powered to detect significant differences in the primary efficacy objectives, not among this subset analyses. CONCLUSION These data will be used in planning future efficacy assessments of sildenafil cream for FSAD. CLINICAL TRIAL REGISTRATION This clinical trial was registered with ClinicalTrials.gov, NCT04948151.
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Affiliation(s)
| | | | | | - Tara Symonds
- Clinical Outcomes Solutions, Kent CT19 4QJ, United Kingdom
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Spielmans GI, Ellefson EM. Small Effects, Questionable Outcomes: Bremelanotide for Hypoactive Sexual Desire Disorder. JOURNAL OF SEX RESEARCH 2024; 61:540-561. [PMID: 36809187 DOI: 10.1080/00224499.2023.2175192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Efficacy outcomes are only informative to the extent that they are validated. We examined the measurement properties of efficacy measures from the phase III ("RECONNECT") bremelanotide trials for hypoactive sexual desire disorder (HSDD) in women. Continuous efficacy outcomes, including a) the Female Sexual Function Index (FSFI) and its Desire domain (FSFI-D) and b) the Female Sexual Distress Scale-Desire/Arousal/Orgasm (FSDS-DAO) and its item assessing distress due to low desire (FSDS-DAO #13) have questionable, at best, validity evidence for women with HSDD. We found no validity evidence for previously published categorical treatment response outcomes from the RECONNECT trials. All efficacy results should be reported, but results on 8 of the 11 clinicaltrials.gov-specified efficacy outcomes were heretofore unpublished (including FSDS-DAO total score, FSFI total score, FSFI arousal domain, and items from the Female Sexual Encounter Profile-Revised). We analyzed these outcomes, upon which effect sizes ranged from nil to small. Several other continuous and categorical outcomes generated modest apparent benefits, though nearly all of these outcomes were likely derived post-hoc. Across RECONNECT trial data from two prior publications and the current study, bremelanotide's benefits are statistically modest and limited to outcomes for which scant evidence of validity among women with HSDD exists.
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Affiliation(s)
- Glen I Spielmans
- Department of Psychology, Metropolitan State University, Saint Paul, Minnesota, USA
| | - Elaine M Ellefson
- Department of Psychology, Metropolitan State University, Saint Paul, Minnesota, USA
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Symonds T, Kingsberg SA, Simon JA, Kroll R, Althof SE, Parish SJ, Cornell KA, Johnson IF, Goldstein AT. Symptoms and associated impact in pre- and postmenopausal women with sexual arousal disorder: a concept elicitation study. J Sex Med 2023; 20:277-286. [PMID: 36763961 DOI: 10.1093/jsxmed/qdac043] [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: 07/01/2022] [Revised: 10/31/2022] [Accepted: 12/08/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Approximately 26% of adult women in the United States suffer from female sexual arousal disorder (FSAD), yet little has been done to compare the experience of FSAD in pre- and postmenopausal women, which is critical to enhance the current understanding of FSAD and inform the development and assessment of treatment options for these patient populations. AIM To explore the experience of condition-associated symptoms and the relative importance of FSAD symptoms, including their severity, bother, and impact, on participants' health-related quality of life (HRQoL) in pre- and postmenopausal women with FSAD. METHODS In-depth, qualitative, semistructured concept elicitation interviews were conducted with premenopausal (n = 23) and postmenopausal (n = 13) women who were clinically diagnosed with FSAD by a trained sexual medicine clinician. All interviews were audio recorded and transcribed verbatim by a professional transcription company. Thematic analysis was performed with the assistance of NVivo qualitative analysis software. OUTCOMES Outcomes included qualitative interview data about FSAD symptoms and HRQoL, as well as a comparison between pre- and postmenopausal populations. RESULTS The most frequently reported symptom in both cohorts was "inability or difficulty with orgasm" (premenopausal, n = 21; postmenopausal, n = 13). The symptom that premenopausal women most desired to have treated was lubrication, and for postmenopausal women, it was a lack of lubrication or wetness and loss of feeling/sensation. In total, 21 of 23 premenopausal women and all 13 postmenopausal women reported a lack of feeling or sensation in the genitals. The most frequently reported HRQoL impact in both groups was decreased confidence. CLINICAL IMPLICATIONS Results from this study suggest that the manifestation and experience of FSAD are similar in pre- and postmenopausal women and that the unmet need for an FSAD treatment in the postmenopausal population is just as great as that of the premenopausal population. STRENGTHS AND LIMITATIONS This study involved in-depth qualitative interviews with a relatively small group of women (N = 36) recruited from only 5 study sites across the United States. CONCLUSION The analysis of qualitative data from the concept elicitation interviews revealed a substantial physical and emotional burden of FSAD, underscoring the need for Food and Drug Administration-approved treatment options for pre- and postmenopausal women with FSAD.
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Affiliation(s)
- Tara Symonds
- Clinical Outcomes Solutions, Folkestone, Kent, CT19 4RH, United Kingdom
| | - Sheryl A Kingsberg
- Division of Behavioral Medicine, Department of OBGYN, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, United States.,Departments of Reproductive Biology, Psychiatry, and Urology, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, United States
| | - James A Simon
- Department of OBGYN, George Washington University, Washington, DC 20052, United States.,IntimMedicine Specialists, Washington, DC 20036, United States
| | - Robin Kroll
- Seattle Clinical Research Center, Seattle, WA 98105, United States
| | - Stanley E Althof
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, United States.,Center for Marital and Sexual Health of South Florida, West Palm Beach, FL 33401, United States
| | - Sharon J Parish
- Weill Cornell Medical College, New York, NY 10021, United States
| | | | | | - Andrew T Goldstein
- Daré Bioscience, San Diego, CA 92122, United States.,Center for Vulvovaginal Disorders, Washington, DC 20037, United States
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Simon JA, Clayton AH, Goldstein I, Kingsberg SA, Shapiro M, Patel S, Kim NN. Response to Commentary by Spielmans. Sex Med 2022; 10:100585. [PMID: 36529480 PMCID: PMC9780765 DOI: 10.1016/j.esxm.2022.100585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- James A Simon
- IntimMedicine Specialists and George Washington University School of Medicine, Washington, DC, USA
| | - Anita H Clayton
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Irwin Goldstein
- San Diego Sexual Medicine and Alvarado Hospital, San Diego, CA, USA
| | - Sheryl A Kingsberg
- University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, OH, USA
| | | | - Sejal Patel
- Sprout Pharmaceuticals, Inc., Raleigh, NC, USA
| | - Noel N Kim
- Institute for Sexual Medicine, San Diego, CA, USA.
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5
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Spielmans GI. Pooled Analysis Confirms Flibanserin's Unimpressive Efficacy, Raises Measurement Questions: A Commentary on Simon et al. Sex Med 2022; 10:100579. [PMID: 36328924 PMCID: PMC9780768 DOI: 10.1016/j.esxm.2022.100579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Glen I. Spielmans
- Corresponding Author: Glen I. Spielmans, PhD, Metropolitan State University, Department of Psychology, Saint Paul, MN, USA. Tel: 651-999-5826; Fax: 651.999.5822
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Peixoto MM. Measurement invariance of Female Sexual Function Index: a study with heterosexual and lesbian Portuguese women. Women Health 2021; 61:811-818. [PMID: 34420497 DOI: 10.1080/03630242.2021.1970084] [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: 03/05/2021] [Revised: 07/27/2021] [Accepted: 08/13/2021] [Indexed: 10/20/2022]
Abstract
The Female Sexual Function Index is a powerful screening tool for female sexual dysfunction extensively used worldwide. Nonetheless, its factorial structure and psychometric properties have been tested almost exclusively with heterosexual samples. The current study aimed to testing the original factorial structure, reliability and temporal stability in two samples of women (heterosexual and lesbian), and to assess the measurement invariance across sexual orientation. An online sample of 752 Portuguese women (376 lesbian women and 376 heterosexual women) recruited between May 2012 and 2013 participated in the study and completed a sociodemographic questionnaire and the FSFI. For temporal stability, 30 Portuguese women were recruited online in May 2017. Confirmatory factor analysis, reliability analysis and temporal stability were assessed independently for each sample. Measurement invariance (configural, metric, and scalar) was also assessed. Main findings for both samples corroborate the six-factor structure and revealed excellent levels of temporal stability, with Cronbach alphas and McDonalds Omega of .95 for heterosexual sample, and .96 for lesbian women sample. Results corroborate measurement invariance (configural, metric, and scalar) across sample type. Overall, the FSFI revealed a good-fit for the six-factor model in both heterosexual and women sample, with excellent levels of reliability and temporal stability, and showed measurement invariance across sexual orientation. These findings support the use of the FSFI with lesbian women.
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Affiliation(s)
- Maria Manuela Peixoto
- Centro de Investigação em Psicologia para o Desenvolvimento Positivo, Instituto de Psicologia e Ciências da Educação, Universidade Lusíada-Norte, Porto, Portugal
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7
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Lim-Watson MZ, Hays RD, Kingsberg S, Kallich JD, Murimi-Worstell IB. A Systematic Literature Review of Health-related Quality of Life Measures for Women with Hypoactive Sexual Desire Disorder and Female Sexual Interest/Arousal Disorder. Sex Med Rev 2021; 10:23-41. [PMID: 34481749 DOI: 10.1016/j.sxmr.2021.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/19/2021] [Accepted: 07/23/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Hypoactive Sexual Desire Disorder (HSDD) / Female Sexual Interest/Arousal Disorder (FSIAD) impacts health-related quality of life (HRQoL) of women and their partners, yet existing measures fail to adequately capture relevant concepts (ie, what is essential to measure including symptoms/impacts) important to women with HSDD/FSIAD. OBJECTIVES To identify HRQoL tools used to assess women with HSDD/FSIAD, and to evaluate their psychometric properties (ie, reliability, validity, and responsiveness). METHODS We conducted searches in PubMed, Embase and PsychINFO from June 5, 1989 to September 30, 2020 for studies in women with HSDD/FSIAD and psychometric analyses (English only). Principles of the Preferred Reporting Items for Systematic reviews and Meta-Analyses, the COnsensus-based Standards for the selection of health Measurement INstruments Risk of Bias Checklist and other psychometric criteria were applied. Based on this search, 56 papers were evaluated including 15 randomized-controlled trials, 11 observational/single arm/open label studies, and 30 psychometric studies. RESULTS Of the 18 measures identified, the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised (FSDS-R) were included in most studies (> 50%). General HRQoL instruments were not used in any of the clinical trials; the SF-12, SF-36 and EQ-5D-5L were reported in two observational studies. No instruments achieved positive quality ratings across all psychometric criteria. The FSFI, FSDS-R, Sexual Event Diary (SED) and the Sexual Desire Relationship Distress Scale (SDRDS), were the only measures to receive a positive rating for content validity. CONCLUSION Reliable and valid HRQoL measures that include sexual desire and distress are needed to provide a more systematic and comprehensive assessment of HRQoL and treatment benefits in women with HSDD/FSIAD. While inferences about HRQoL are limited due to the lack of uniformity in concepts assessed and limited psychometric evaluation of these measures in women with HSDD/FSIAD, opportunities exist for the development of reliable and validated tools that comprehensively measure the most relevant and important concepts in women with HSDD/FSIAD. Lim-Watson MZ, Hays RD, Kingsberg S, et al. A systematic literature review of health-related quality of life measures for women with Hypoactive Sexual Desire Disorder and Female Sexual Interest/Arousal Disorder. Sex Med Rev 2021;XX:XXX-XXX.
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Affiliation(s)
- Michelle Z Lim-Watson
- Department of Pharmacoeonomics and Policy, Massachusetts College of Pharmacy and Health Sciences University, Boston, MA, USA.
| | - Ron D Hays
- Department of Health Policy and Management, School of Public Health, University of California, Los Angeles, CA, USA; Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, Los Angeles, CA, USA; RAND Corporation, Santa Monica, CA, USA
| | - Sheryl Kingsberg
- OB/GYN Behavioral Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Joel D Kallich
- Department of Pharmacoeonomics and Policy, Massachusetts College of Pharmacy and Health Sciences University, Boston, MA, USA
| | - Irene B Murimi-Worstell
- Department of Pharmacoeonomics and Policy, Massachusetts College of Pharmacy and Health Sciences University, Boston, MA, USA
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Tirado-González S, Navarro-Sánchez A, Compañ-Rosique A, Luri-Prieto P, Rodríguez-Marín J, Van-der Hofstadt-Román CJ, Berenguer Soler M, Navarro-Cremades F, Gil-Guillén VF, Navarro Ortiz R, Montejo AL, Pérez-Jover V. Validation of the Center of Applied Psychology Female Sexuality Questionnaire (CAPFS-Q). J Clin Med 2021; 10:jcm10122686. [PMID: 34207115 PMCID: PMC8235656 DOI: 10.3390/jcm10122686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 12/12/2022] Open
Abstract
Instruments for the measurement of human sexuality include self-report measures used to assess sexual functioning, but many of them have not yet been validated. The Center of Applied Psychology Female Sexual Questionnaire (CAPFS-Q) is an original self-report instrument. It has been developed for the study of sexuality in specific non-clinical populations, such as female university students of Medicine and other Health Sciences. The CAPFS-Q includes 26 items, organized as follows: sociodemographic and relevant data (four items); aspects of sexual relations with partner (five items); sexual practices (12 from 13 items); and dysfunctional aspects of sexual relations (four items). CAPFS-Q validity and reliability were examined in a sample of Spanish female university students of Health Sciences. Exploratory and confirmatory factor analysis (FA) showed a four-factor structure which explained 71.6% of the variance. This initial version of the CAPFS-Q is a reliable measure of women's sexual behavior, with a dimensionality that replicates the initial theoretical content and with adequate indicators of internal consistency, validity, and test-retest reliability. It is easy to administer and to complete.
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Affiliation(s)
- Sonia Tirado-González
- Faculty of Psychology, Miguel Hernández University, 03202 Elche, Spain; (S.T.-G.); (A.N.-S.); (C.J.V.-d.H.-R.); (M.B.S.); (V.P.-J.)
| | - Antonio Navarro-Sánchez
- Faculty of Psychology, Miguel Hernández University, 03202 Elche, Spain; (S.T.-G.); (A.N.-S.); (C.J.V.-d.H.-R.); (M.B.S.); (V.P.-J.)
| | - Antonio Compañ-Rosique
- San Juan University Hospital, Miguel Hernández University, Ctra N-332, s/n, 03550 Sant Joan d’Alacant, Spain; (A.C.-R.); (P.L.-P.)
- School of Medicine, Miguel Hernández University, 03550 San Juan, Spain; (J.R.-M.); (F.N.-C.); (V.F.G.-G.)
| | - Paloma Luri-Prieto
- San Juan University Hospital, Miguel Hernández University, Ctra N-332, s/n, 03550 Sant Joan d’Alacant, Spain; (A.C.-R.); (P.L.-P.)
| | - Jesús Rodríguez-Marín
- School of Medicine, Miguel Hernández University, 03550 San Juan, Spain; (J.R.-M.); (F.N.-C.); (V.F.G.-G.)
| | - Carlos J. Van-der Hofstadt-Román
- Faculty of Psychology, Miguel Hernández University, 03202 Elche, Spain; (S.T.-G.); (A.N.-S.); (C.J.V.-d.H.-R.); (M.B.S.); (V.P.-J.)
| | - María Berenguer Soler
- Faculty of Psychology, Miguel Hernández University, 03202 Elche, Spain; (S.T.-G.); (A.N.-S.); (C.J.V.-d.H.-R.); (M.B.S.); (V.P.-J.)
| | - Felipe Navarro-Cremades
- School of Medicine, Miguel Hernández University, 03550 San Juan, Spain; (J.R.-M.); (F.N.-C.); (V.F.G.-G.)
| | - Vicente F. Gil-Guillén
- School of Medicine, Miguel Hernández University, 03550 San Juan, Spain; (J.R.-M.); (F.N.-C.); (V.F.G.-G.)
| | - Ramón Navarro Ortiz
- Torrevieja University Hospital, Carretera CV 95, s/n, 03186 Torrevieja, Spain;
| | - Angel L. Montejo
- Psychiatry Service, Clinical Hospital of the University of Salamanca, 37007 Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Paseo San Vicente SN, 37007 Salamanca, Spain
- Nursing School, University of Salamanca, Av. Donantes de Sangre SN, 37007 Salamanca, Spain
- Correspondence: ; Tel.: +34-63-9754-620
| | - Virtudes Pérez-Jover
- Faculty of Psychology, Miguel Hernández University, 03202 Elche, Spain; (S.T.-G.); (A.N.-S.); (C.J.V.-d.H.-R.); (M.B.S.); (V.P.-J.)
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Cieri-Hutcherson NE, Jaenecke A, Bahia A, Lucas D, Oluloro A, Stimmel L, Hutcherson TC. Systematic Review of l-Arginine for the Treatment of Hypoactive Sexual Desire Disorder and Related Conditions in Women. PHARMACY 2021; 9:pharmacy9020071. [PMID: 33801678 PMCID: PMC8103282 DOI: 10.3390/pharmacy9020071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 01/11/2023] Open
Abstract
This systematic review evaluates the efficacy and safety of l-arginine alone or in combination for the treatment of women with hypoactive sexual desire disorder (HSDD) or related conditions, such as female sexual interest/arousal disorder and female sexual arousal disorder. Medline, Embase, International Pharmaceutical Abstracts, Science Direct, and the Cumulative Index to Nursing and Allied Health Literature were searched using keywords “arginine”, “Lady Prelox”, “ArginMax”, “Stronvivo”, “Ristela”, “hypoactive sexual desire disorder”, “female sexual interest arousal disorder”, “female sexual arousal disorder”, “sexual dysfunction”, “sexual behavior”, “dyspareunia”, “libido”, and permutations thereof. Relevant records were retained if they were primary literature, conducted in women with HSDD or related conditions, and published as full text in English. Five randomized controlled trials and two nonrandomized studies met eligibility criteria. Six of the seven studies reported either an increase in the total mean Female Sexual Function Index score or significant increases in multiple domains therein. One study assessed vaginal pulse amplitude and found a statistically significant increase in a combination treatment group compared to placebo. No significant side effects were reported. Four of seven studies had potential risk-of-bias concerns per Cochrane assessments. This systematic review found that combination products containing l-arginine in the form of ArginMax or Lady Prelox may be considered for the treatment of HSDD and related conditions in women regardless of age.
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Affiliation(s)
- Nicole E. Cieri-Hutcherson
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY 14214, USA
- Correspondence: ; Tel.: +1-716-645-3635
| | - Andrea Jaenecke
- School of Pharmacy, D’Youville College, Buffalo, NY 14201, USA; (A.J.); (A.B.); (L.S.)
| | - Ajeet Bahia
- School of Pharmacy, D’Youville College, Buffalo, NY 14201, USA; (A.J.); (A.B.); (L.S.)
| | - Debra Lucas
- Montante Family Library, D’Youville College, Buffalo, NY 14201, USA;
| | - Ann Oluloro
- Department of Obstetrics and Gynecology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA;
| | - Lora Stimmel
- School of Pharmacy, D’Youville College, Buffalo, NY 14201, USA; (A.J.); (A.B.); (L.S.)
| | - Timothy C. Hutcherson
- Department of Pharmacy Practice, School of Pharmacy, D’Youville College, Buffalo, NY 14201, USA;
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Rowland DL, Kneusel JA, Bacys KR, Hamilton BD, Bhutto Z, Zadeh Z. The Role of Orgasmic Difficulty in Attributing Cause for Positive and Negative Sexual Outcomes in Women: The Importance of Cross-Cultural Analyses. JOURNAL OF SEX & MARITAL THERAPY 2021; 47:368-380. [PMID: 33555229 DOI: 10.1080/0092623x.2021.1881671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Studies investigating women's attributions for positive and negative sexual experiences have been slow to adopt a cross-cultural perspective, resulting in a perspective defined by Western experiences. This cross-cultural analysis examined such attribution processes in 88 Pakistani and 187 USA women, and identified differences related to orgasmic difficulty and country-of-origin. Pakistani and USA women differed on both self-blame and relationship blame related to negative sexual outcomes, an effect intensified in Pakistani women who reported orgasmic difficulty during partnered sex. Differences are interpreted within a cultural context and underscore the importance of addressing women's sexual experiences in a more global context.
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Affiliation(s)
- David L Rowland
- Department of Psychology, Valparaiso University, Valparaiso, IN, USA
| | - Julia A Kneusel
- Department of Psychology, Valparaiso University, Valparaiso, IN, USA
| | - Katelyn R Bacys
- Department of Psychology, Valparaiso University, Valparaiso, IN, USA
| | | | - Zainab Bhutto
- Institute of Professional Psychology, Bahria University, Karachi, Pakistan
| | - Zainab Zadeh
- Institute of Professional Psychology, Bahria University, Karachi, Pakistan
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Zadeh Z, Bhutto Z, McNabney SM, Kneusel JA, Rowland DL. Cross-Cultural Analysis of Sexual Response and Relationship Satisfaction in Women With and Without Orgasmic Difficulty During Partnered Sex. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2021; 33:131-143. [PMID: 38596756 PMCID: PMC10929574 DOI: 10.1080/19317611.2020.1864559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 04/11/2024]
Abstract
Objective To investigate how orgasmic difficulty may impact women's sexual/relationship quality depending upon their cultural origin. Method: We used a cross-sectional, multinational survey designed to assess orgasmic difficulty during partnered sex and other sexual/relationship factors in 88 Pakistani and 188 U.S. women. Results: Pakistani women reported less orgasmic difficulty than U.S. women, but those Pakistani women having orgasmic difficulty reported lower relationship satisfaction, less interest in sex, and greater difficulty becoming sexually aroused compared to U.S. respondents with orgasmic difficulty. Conclusions: The presence of orgasmic difficulty affected sexual and relationship factors more in Pakistani women than U.S. women.
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Affiliation(s)
- Zainab Zadeh
- Institute of Professional Psychology, Bahria University, Karachi, Pakistan
| | - Zainab Bhutto
- Institute of Professional Psychology, Bahria University, Karachi, Pakistan
| | - Sean M. McNabney
- Department of Psychology, Valparaiso University, Valparaiso, Indiana, USA
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - Julia A. Kneusel
- Department of Psychology, Valparaiso University, Valparaiso, Indiana, USA
| | - David L. Rowland
- Department of Psychology, Valparaiso University, Valparaiso, Indiana, USA
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12
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Revicki DA, Althof SE, Derogatis LR, Kingsberg SA, Wilson H, Sadiq A, Krop J, Jordan R, Lucas J. Reliability and validity of the elements of desire questionnaire in premenopausal women with hypoactive sexual desire disorder. J Patient Rep Outcomes 2020; 4:82. [PMID: 33033885 PMCID: PMC7544783 DOI: 10.1186/s41687-020-00241-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 08/24/2020] [Indexed: 12/01/2022] Open
Abstract
Background The Elements of Desire Questionnaire (EDQ) is a patient-reported outcome (PRO) measure developed to evaluate sexual desire and was included in two identically designed phase 3 clinical trials (RECONNECT) as an exploratory endpoint. The EDQ was developed based on a literature review, qualitative research with patients with hypoactive sexual desire disorder (HSDD), and input from clinical experts. This instrument is intended to be used to collect efficacy data in clinical trials evaluating potential treatments for HSDD. The objective of this study was to evaluate the measurement properties of both the monthly and daily recall versions of the EDQ during the RECONNECT trials. Methods Participants completed the EDQ daily version for 7 consecutive days prior to selected monthly clinic visits. The monthly recall version was completed at each monthly clinic visit. The analysis population consisted of all subjects with Female Sexual Function Index (FSFI) data at baseline and ≥ 1 follow-up visit. Results At baseline, 1144 and 676 subjects completed the monthly and daily recall EDQs, respectively. The EDQ scores had good internal consistency and test-retest reliability. Monthly and daily recall EDQ scores were correlated with FSFI-desire domain scores at baseline and month 3. Scores from the monthly and daily recall versions were also correlated. After 6 months, there was a significantly greater improvement for bremelanotide versus placebo in both the monthly and daily recall versions (both P < 0.0001). Conclusions The results demonstrated that EDQ exhibited good reliability, validity, and sensitivity to change. Consistent with other validated PRO measures of sexual desire, the EDQ provides additional insights into sexual desire. Trial registration NCT02338960 and NCT02333071 (RECONNECT studies).
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Affiliation(s)
- Dennis A Revicki
- Revicki Outcomes Research Consulting, 5656 Eastwind Drive, Sarasota, FL, 34233, USA.
| | - Stanley E Althof
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | | | | | - Amama Sadiq
- AMAG Pharmaceuticals, Inc., Waltham, MA, USA
| | - Julie Krop
- AMAG Pharmaceuticals, Inc., Waltham, MA, USA
| | | | - Johna Lucas
- Palatin Technologies, Inc., Cranbury, NJ, USA
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McNabney SM, Hevesi K, Rowland DL. Effects of Pornography Use and Demographic Parameters on Sexual Response during Masturbation and Partnered Sex in Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093130. [PMID: 32365874 PMCID: PMC7246896 DOI: 10.3390/ijerph17093130] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 12/13/2022]
Abstract
The effect of pornography on sexual response is understudied, particularly among women. A multinational, community-based sample of 2433 women at least 18 years of age completed a 42-item, opt-in questionnaire collecting information on demographic and sexual history characteristics, use of pornography during masturbation, frequency of pornography use, and sexual response parameters. Pornography use and average frequency were compared across demographic variables. We also examined how pornography frequency predicted differences in self-reported arousal difficulty; orgasmic difficulty, latency, and pleasure; and the percent of sexual activities ending in orgasm during both masturbation and partnered sex. On average, women using pornography were younger, and reported more interest in sex. Pornography frequency differed significantly by menopausal status, sexual orientation, anxiety/depression status, number of sexual partners, and origin of data collection. During masturbation, more frequent pornography use predicted lower arousal difficulty and orgasmic difficulty, greater pleasure, and a higher percentage of masturbatory events leading to orgasm. Frequency of pornography use predicted only lower arousal difficulty and longer orgasmic latencies during partnered sex, having no effect on the other outcome variables. Pornography use frequency did not predict overall relationship satisfaction or sexual relationship satisfaction. Overall, more frequent pornography use was generally associated with more favorable sexual response outcomes during masturbation, while not affecting most partnered sex parameters. Several demographic and relationship covariates appear to more consistently and strongly predict orgasmic problems during partnered sexual activity than pornography use.
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Affiliation(s)
- Sean M. McNabney
- Department of Psychology, Valparaiso University, Valparaiso, IN 46383, USA;
| | - Krisztina Hevesi
- Department of Psychology and Education, Eötvös Loránd University, 1075 Budapest, Hungary;
| | - David L. Rowland
- Department of Psychology, Valparaiso University, Valparaiso, IN 46383, USA;
- Correspondence: ; Tel.: +1-219-464-5446
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Derogatis LR, Revicki DA, Clayton AH. Instruments for Screening, Diagnosis, and Management of Patients with Generalized Acquired Hypoactive Sexual Desire Disorder. J Womens Health (Larchmt) 2020; 29:806-814. [PMID: 32096691 DOI: 10.1089/jwh.2019.7917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Screening, diagnosis, and management of hypoactive sexual desire disorder (HSDD) and research into the condition have been challenging due to its biopsychosocial complexity and lack of consensus on relevant measures. Although physician interviews yield much clinically valid information, self-reported questionnaires appear more acceptable to patients and physicians. Consequently, validated patient-reported outcome (PRO) tools are essential for evaluation and management of HSDD, including any therapeutic intervention. The US Food and Drug Administration (FDA) has issued guidance on the use of appropriate endpoints and associated measures for female sexual dysfunction, including HSDD. Although many of the available measures were not designed specifically for HSDD assessment, as per FDA guidelines, most clinical studies have used individual domains or items from established tools, such as the Female Sexual Function Index-desire domain and Item 13 of the revised Female Sexual Distress Scale. For clinical practice, several professional societies recommend the Decreased Sexual Desire Screener and/or a sexual history as tools to diagnose HSDD. This review discusses frequently used PRO tools as well as the newly developed and validated Elements of Desire Questionnaire, which may be appropriate for clinical trials or clinical practice.
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Affiliation(s)
| | | | - Anita H Clayton
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
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15
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Assessment of sexual dysfunction in patients with inflammatory bowel disease. GASTROENTEROLOGY REVIEW 2019; 14:104-108. [PMID: 31616523 PMCID: PMC6791133 DOI: 10.5114/pg.2019.85893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 03/08/2019] [Indexed: 12/17/2022]
Abstract
Inflammatory bowel disease (IBD) represents a diverse variety of chronic inflammatory intestinal conditions. Sexuality is often disturbed in patients with IBD, more often affecting women than men. Many factors seem to contribute to intimacy concerns. The most popular questionnaires used in empirical research around the world are the Female Sexual Function Index (FSFI) for women and the International Index of Erectile Function (IIEF) for men. Sexual satisfaction was negatively correlated with depression, anxiety, sexual problems, and illness perceptions. When analysing the problem of IBD, disorders of sexual function should not be ignored. Patients should be screened for psychological diseases and sexual dysfunction, and necessary treatments should be given as soon as possible. By understanding what factors contribute to poor sexual functioning in patients with IBD, we may try to minimise adverse psychosocial events. Screening for sexual disorders should be a part of daily medical practice.
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Palacios S, Soler E, Ramírez M, Lilue M, Khorsandi D, Losa F. Effect of a multi-ingredient based food supplement on sexual function in women with low sexual desire. BMC WOMENS HEALTH 2019; 19:58. [PMID: 31039769 PMCID: PMC6492381 DOI: 10.1186/s12905-019-0755-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 04/11/2019] [Indexed: 12/18/2022]
Abstract
Background Studies have demonstrated that women with low desire and low excitement have negative feelings regarding their physical and emotional satisfaction, as well as their happiness. In this study, we evaluate the efficacy of Libicare® - a multi-ingredient food supplement - to improve sexual function in postmenopausal women. Methods This was an exploratory, prospective, non-controlled, observational study. Postmenopausal women aged 45–65 with a risk of sexual dysfunction (Female Sexual Function Index (FSFI) < 25.83) were included during routine clinical visits and treated with 2 tablets of Libicare® daily for 2 months. Libicare® is an oral food supplement containing Trigonella foenum graecum, Turnera diffusa, Tribulus terrestris, and Ginkgo biloba dry extracts. Primary endpoint: change vs. baseline in FSFI score. Secondary endpoints: 1) changes in testosterone and serum steroid levels of free testosterone and sex hormone-binding globulin (SHBG) levels and 2) tolerability. Results A total of 29 patients (mean age: 54.69 years) were included. FSFI mean (SD) score showed a significant increase: 20.15 (4.48) vs 25.03 (6.94), baseline vs final; p = 0.0011, paired t-test. Most patients (86.2%) increased their FSFI score. All FSFI domains, except dyspareunia, showed significant increases. The highest increase was observed in the desire domain (p = 0.0004). Testosterone and SHBG levels were assessed in 21 patients. A significant increase in testosterone level was observed: 0.41 (0.26) vs. 0.50 (0.34) pg/mL, baseline vs. final; p = 0.038, Wilcoxon test. 52.4% of patients increased their testosterone levels. Finally, a significant decrease was observed in SHBG level: 85 (32.9) vs. 73 (26.8) nmol/L, baseline vs. final; p = 0.0001; paired t-test. 95.2% of patients decreased their SHBG levels. Conclusion In this pilot study, a significant improvement in sexual function and related hormone levels was observed with Libicare®. Further studies must be conducted to confirm these exciting results. Trial registration Current Controlled Trial ISRCTN12928573. Date of registration: 28/March/2019. Retrospectively registered.
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Affiliation(s)
- S Palacios
- Gynaecology and Obstetrics Department, Palacios' Institute of Women's Health, C/Antonio Acuña 9, E-28009, Madrid, Spain.
| | - E Soler
- Gynaecology and Obstetrics Department, Palacios' Institute of Women's Health, C/Antonio Acuña 9, E-28009, Madrid, Spain
| | - M Ramírez
- Gynaecology and Obstetrics Department, Palacios' Institute of Women's Health, C/Antonio Acuña 9, E-28009, Madrid, Spain
| | - M Lilue
- Gynaecology and Obstetrics Department, Palacios' Institute of Women's Health, C/Antonio Acuña 9, E-28009, Madrid, Spain
| | - D Khorsandi
- Procare Health Iberia, Medical department, Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - F Losa
- Clínica de la Sagrada Familia, Barcelona, Spain
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Alshiek J, Jalalizadeh M, Wei Q, Chitnis P, Shobeiri SA. Ultrasongraphic age‐related changes of the pelvic floor muscles in nulliparous women and their association with pelvic floor symptoms: A pilot study. Neurourol Urodyn 2019; 38:1305-1312. [DOI: 10.1002/nau.23979] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/14/2019] [Accepted: 03/03/2019] [Indexed: 12/29/2022]
Affiliation(s)
- Jonia Alshiek
- Department of Obstetrics & GynecologyINOVA Women's HospitalFalls Church Virginia
| | - Mehrsa Jalalizadeh
- Department of Obstetrics & GynecologyINOVA Women's HospitalFalls Church Virginia
| | - Qi Wei
- Biomedical Engineering, George Mason UniversityFalls Church Virginia
| | - Parag Chitnis
- Biomedical Engineering, George Mason UniversityFalls Church Virginia
| | - S. Abbas Shobeiri
- Department of Obstetrics & GynecologyINOVA Women's HospitalFalls Church Virginia
- Biomedical Engineering, George Mason UniversityFalls Church Virginia
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Simon JA, Thorp J, Millheiser L. Flibanserin for Premenopausal Hypoactive Sexual Desire Disorder: Pooled Analysis of Clinical Trials. J Womens Health (Larchmt) 2019; 28:769-777. [PMID: 30707049 DOI: 10.1089/jwh.2018.7516] [Citation(s) in RCA: 168] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Flibanserin, a 5-hydroxytryptamine 5-HT1A agonist and 5-HT2A antagonist, is indicated for the treatment of acquired, generalized hypoactive sexual desire disorder (HSDD) in premenopausal women. This post hoc analysis assessed pooled efficacy and safety data for flibanserin in premenopausal women with HSDD. Materials and Methods: Data for flibanserin 100 mg once daily at bedtime (qhs) and placebo were pooled from three pivotal 24-week, randomized, placebo-controlled, multicenter studies (VIOLET, DAISY, and BEGONIA) of premenopausal women with HSDD. Pooled efficacy endpoints included the change from baseline to study end (i.e., 24 weeks) in the number of satisfying sexual events (SSEs) over 28 days, the Female Sexual Function Index desire domain (FSFI-d) score, and the Female Sexual Distress Scale-Revised Item 13 (FSDS-R-13) score. Results: The analysis included 2465 women (flibanserin, n = 1227; placebo, n = 1238) with a mean age of 36 years and a mean HSDD duration of 56.5 months. The mean ± standard error (SE) change from baseline to study end in SSEs over 28 days for flibanserin versus placebo was 2.1 ± 0.14 versus 1.2 ± 0.11, respectively (p < 0.0001). The least-squares mean ± SE changes from baseline to study end in FSFI desire domain score and FSDS-R-13 score were also significantly greater for flibanserin versus placebo (FSFI desire domain: 0.9 ± 0.04 vs. 0.6 ± 0.04, p < 0.0001; FSDS-R-13: -0.9 ± 0.04 vs. -0.6 ± 0.04, p < 0.0001). Patients in the flibanserin group generally had significantly greater improvements, compared with placebo, in SSEs, FSFI-d score, and FSDS-R-13 in subgroup analyses based on selected demographic and baseline clinical characteristics. Adverse events occurring in ≥10% of patients included dizziness and somnolence. Conclusions: This pooled analysis of three pivotal trials demonstrated that flibanserin 100 mg qhs was well tolerated, improved sexual desire, and reduced sexual distress associated with HSDD in premenopausal women, and these improvements were generally consistent across various subgroups based on demographic and baseline characteristics.
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Affiliation(s)
- James A Simon
- 1 Department of Obstetrics and Gynecology, George Washington University School of Medicine, Washington, District of Columbia
| | - John Thorp
- 2 Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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19
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Genito Pelvic Vaginal Laxity: Classification, Etiology, Symptomatology, and Treatment Considerations. CURRENT SEXUAL HEALTH REPORTS 2018. [DOI: 10.1007/s11930-018-0168-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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20
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Vallejo-Medina P, Pérez-Durán C, Saavedra-Roa A. Translation, Adaptation, and Preliminary Validation of the Female Sexual Function Index into Spanish (Colombia). ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:797-810. [PMID: 28567567 DOI: 10.1007/s10508-017-0976-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 02/27/2017] [Accepted: 03/15/2017] [Indexed: 06/07/2023]
Abstract
The Female Sexual Function Index (FSFI) subjectively explores the dimensions of female sexual functioning. This research undertook to adapt and validate the FSFI to Spanish language in a Colombian sample. To this effect, this study was conducted in two steps, namely: (1) cultural adaptation of the scale with the collaboration of seven experts; and (2) preliminary validation of the scale in a sample of 925 participants. Reliability indices were appropriate in this sample, and external validity in relation to other measures showed significant relationships. Findings suggest that the FSFI is reliable and valid in Spanish for a Colombian population. Further research is needed to establish the test-retest reliability and discriminant validity of this Spanish version.
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Affiliation(s)
- Pablo Vallejo-Medina
- SexLab KL, School of Psychology, Fundación Universitaria Konrad Lorenz, Bogotá D.C., 110221, Colombia.
| | - Claudia Pérez-Durán
- SexLab KL, School of Psychology, Fundación Universitaria Konrad Lorenz, Bogotá D.C., 110221, Colombia
| | - Alejandro Saavedra-Roa
- SexLab KL, School of Psychology, Fundación Universitaria Konrad Lorenz, Bogotá D.C., 110221, Colombia
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Pyke R, Clayton A. What Sexual Behaviors Relate to Decreased Sexual Desire in Women? A Review and Proposal for End Points in Treatment Trials for Hypoactive Sexual Desire Disorder. Sex Med 2017; 5:e73-e83. [PMID: 28041924 PMCID: PMC5440628 DOI: 10.1016/j.esxm.2016.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 11/09/2016] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Counts of satisfying sexual events (SSEs) per month have been criticized as an end point in treatment trials of women with hypoactive sexual desire disorder (HSDD) but grounding improvement in sexual desire by assessing changes in sexual behavior remains of some importance. METHODS We conducted a literature review to find validated measurements that are specific sexual behavioral correlates of low sexual desire. We compared expert-proposed criteria for dysfunctional desire, expert-developed sets of scale items, and self-rated scales developed before issuance of, or in accordance with, the Food and Drug Administration's guidance on developing patient-reported outcomes. Behavioral measurements of HSDD were isolated from these sets of criteria or scales. MAIN OUTCOME MEASURES We outline a plan to evaluate such behavioral measurements of HSDD with reference to SSEs. RESULTS Eleven rating scales, four expert-originated and seven self-rated scales mainly derived from patient input were identified as well validated and relevant to HSDD. Three recent sets of diagnostic criteria for conditions such as HSDD were compared with the scales. Twenty-four different symptoms were found in the scales. Content found relevant to HSDD during development of the rating scales varied highly among measurements, including the self-rated scales developed in conformity with current recommendations for patient-reported outcome measurements. The only item on all sets was desire for sexual activity. Four other items were in approximately at least half the sets: sexual thoughts or fantasies, frequency of sexual activity, receptivity, and initiations. Sexual thoughts or fantasies were in every expert-derived set but in only three of the seven patient-derived sets. Receptivity was in five of the seven expert-derived sets vs two of the seven patient-derived sets. Frequency of sexual activity was in one of the seven expert-derived sets but in five of the patient-derived sets. Initiation was in approximately half the two sets. All other items were on one to three sets each. We identified three sexual behaviors of validated specificity for female HSDD: frequency of sexual activity, receptivity, and initiations. Six or seven items are relevant and informative. The item on frequency of sexual activity in the Changes in Sexual Functioning-Female scale is the only item that covers frequency of dyadic and solitary sexual activity. An item in the Female Sexual Desire Questionnaire (FSDQ) covers the intuitively relevant topic of frequency of sexual activity motivated by the woman's desire. Three FSDQ items on initiations and two items on receptivity reflect expert opinion on the sexual behaviors of most relevance to HSDD, but the FSDQ has not been validated in women with HSDD. CONCLUSIONS SSEs have been discredited as the primary measurement in clinical trials of women with HSDD, but it would be meaningful to include at least one sexual behavioral symptom specific to HSDD as an end point. Expert-recommended sexual behaviors specifically related to HSDD are irregularly represented in self-rating scales whether developed as in the Food and Drug Administration guidance on patient-reported outcomes or not. Six or seven items on sexual behavior in self-rated scales can be recommended for relevance to women with HSDD in clinical trials. Items on female sexual behavior should be tested in comparison with SSEs in women with HSDD for relevance and for treatment sensitivity, and responder and functional and dysfunctional cutoffs should be determined before incorporation into large-scale clinical trials. Pyke R and Clayton A. What Sexual Behaviors Relate to Decreased Sexual Desire in Women? A Review and Proposal for End Points in Treatment Trials for Hypoactive Sexual Desire Disorder. Sex Med 2017;5:e73-e83.
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Affiliation(s)
- Robert Pyke
- S1 Biopharma, Inc, Medical, New Fairfield, CT, USA.
| | - Anita Clayton
- Psychiatry and Behavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
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22
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Cornell LF, Mussallem DM, Gibson TC, Diehl NN, Bagaria SP, McLaughlin SA. Trends in Sexual Function After Breast Cancer Surgery. Ann Surg Oncol 2017; 24:2526-2538. [PMID: 28560595 DOI: 10.1245/s10434-017-5894-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE Sexual dysfunction is assumed to be common, but understudied, in breast cancer patients. Herein, we use the validated female sexual functioning index (FSFI) to evaluate changes in female sexual function after breast cancer surgery. METHODS The FSFI assesses sexual function in six domains (desire, arousal, lubrication, orgasm, satisfaction, pain) on a 36-point scale, with scores >26.6 indicating better sexual function. We identified 226 women with unilateral breast cancer undergoing surgery at our institution from June 2010-January 2015. All completed the FSFI preoperatively and at a median of 13 months postoperatively. We quantified declines in FSFI scores and considered p-values <0.05 statistically significant. RESULTS Overall, 119 women had breast-conserving surgery (BCS), 40 had unilateral mastectomy (UM), and 67 had UM plus contralateral prophylactic mastectomy (CPM). All women had similar baseline FSFI scores (medians: BCS, 26.3; UM, 25.2; UM+CPM, 23.7; p = 0.23). At follow-up, sexual function had declined significantly in BCS (23.5; p < 0.001) and UM (17.4; p = 0.010), but was unchanged in UM+CPM (22.8; p = 0.74) women. Interestingly, all women maintained their desire for sex (p = 0.17). BCS and UM women demonstrated significant declines in all other subscale domains (all p < 0.045). UM+CPM women demonstrated no decline in any subscale domain, yet did not exhibit superior sexual function to those having UM or BCS (medians: BCS, 23.5; UM, 17.4; UM+CPM, 22.8; p = 0.21). CONCLUSIONS Baseline sexual dysfunction exists in women diagnosed with breast cancer. Surgery negatively impacts sexual function. Patients who choose mastectomy do not exhibit superior sexual function over those having BCS at 13 months following surgery.
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Affiliation(s)
- Lauren F Cornell
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Dawn M Mussallem
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Tammeza C Gibson
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL, USA.,Division of General Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Nancy N Diehl
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - Sanjay P Bagaria
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL, USA.,Division of General Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Sarah A McLaughlin
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL, USA. .,Division of General Surgery, Mayo Clinic, Jacksonville, FL, USA.
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23
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Derogatis LR. Review of Patient-Reported Outcome Measures for Sexual Dysfunction. CURRENT SEXUAL HEALTH REPORTS 2015. [DOI: 10.1007/s11930-015-0052-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Efficacy and safety of flibanserin in postmenopausal women with hypoactive sexual desire disorder: results of the SNOWDROP trial. Menopause 2015; 21:633-40. [PMID: 24281236 DOI: 10.1097/gme.0000000000000134] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to assess the efficacy and safety of flibanserin, a serotonin receptor 1A agonist/serotonin receptor 2A antagonist, in postmenopausal women with hypoactive sexual desire disorder (HSDD). METHODS Naturally postmenopausal women with HSDD received flibanserin 100 mg once daily at bedtime (n = 468) or placebo (n = 481) for 24 weeks. Co-primary endpoints were changes from baseline to week 24 in the number of satisfying sexual events (SSEs) across 28 days and in the Female Sexual Function Index (FSFI) desire domain score. Secondary endpoints included change from baseline in Female Sexual Distress Scale-Revised (FSDS-R) Item 13 score (which assesses distress due to low sexual desire), FSDS-R total score, and FSFI total score. The Patient Benefit Evaluation was asked on treatment discontinuation. RESULTS There were significant improvements with flibanserin versus placebo in the mean (SE) changes in the number of SSEs (1.0 [0.1] vs 0.6 [0.1]), FSFI desire domain score (0.7 [0.1] vs 0.4 [0.1]), FSDS-R Item 13 score (-0.8 [0.1] vs -0.6 [0.1]), FSDS-R total score (-8.3 [0.6] vs -6.3 [0.6]), and FSFI total score (4.2 [0.4] vs 2.7 [0.4]; all P < 0.01). More women on flibanserin (37.6%) than women on placebo (28.0%) reported experiencing meaningful benefits from the study medication on treatment discontinuation. The most frequent adverse events associated with flibanserin were dizziness, somnolence, nausea, and headache. CONCLUSIONS In naturally postmenopausal women with HSDD, flibanserin, compared with placebo, has been associated with improvement in sexual desire, improvement in the number of SSEs, and reduced distress associated with low sexual desire, and is well tolerated.
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Gao Z, Yang D, Yu L, Cui Y. Efficacy and Safety of Flibanserin in Women with Hypoactive Sexual Desire Disorder: A Systematic Review and Meta-Analysis. J Sex Med 2015; 12:2095-104. [DOI: 10.1111/jsm.13037] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Forbes MK. Response to Rosen et al. ( 2014 ) "Commentary on 'Critical flaws in the FSFI and IIEF'". JOURNAL OF SEX RESEARCH 2014; 51:498-502. [PMID: 24826878 DOI: 10.1080/00224499.2014.895795] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This is a response to the commentary by Rosen, Revicki, and Sand ( 2014 ) on our original article titled "Critical Flaws in the Female Sexual Function Index and the International Index of Erectile Function" (Forbes, Baillie, & Schniering, 2014 ). We address his criticisms and clarify our points further using existing research. We conclude that there are a number of evident limitations to these popular measures, and suggest that researchers and clinicians familiarize themselves with the aim and scope of each measure before use.
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Affiliation(s)
- Miriam K Forbes
- a Centre for Emotional Health, Department of Psychology , Macquarie University
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Rosen RC, Revicki DA, Sand M. Commentary on "Critical flaws in the FSFI and IIEF". JOURNAL OF SEX RESEARCH 2014; 51:492-7. [PMID: 24826877 DOI: 10.1080/00224499.2014.894491] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
This invited commentary responds to recent criticisms of two validated and widely used sexual function questionnaires, the Female Sexual Function Index (FSFI) and the International Index of Erectile Function (IIEF) (Forbes, Baillie, & Schniering, 2014 ). We take issue with the conceptual arguments presented, selective review of published literature on both instruments, and conclusions drawn from methodologically flawed findings from an Internet-based study in a nonrepresentative group of Australian men and women. Alternative perspectives on the IIEF and FSFI are presented.
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Affiliation(s)
- Raymond C Rosen
- a New England Research Institutes, Inc. , Watertown , Massachusetts
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Katz M, DeRogatis LR, Ackerman R, Hedges P, Lesko L, Garcia M, Sand M. Efficacy of flibanserin in women with hypoactive sexual desire disorder: results from the BEGONIA trial. J Sex Med 2013; 10:1807-15. [PMID: 23672269 DOI: 10.1111/jsm.12189] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Hypoactive Sexual Desire Disorder (HSDD) is characterized by low sexual desire that causes marked distress or interpersonal difficulty. AIM The aim of this study was to assess the efficacy and safety of the 5-HT1A agonist/5-HT2A antagonist flibanserin in premenopausal women with HSDD. METHODS This was a randomized, placebo-controlled trial in which premenopausal women with HSDD (mean age: 36.6 years) were treated with flibanserin 100 mg once daily at bedtime (qhs) (n = 542) or placebo (n = 545) for 24 weeks. MAIN OUTCOME MEASURES Coprimary end points were the change from baseline to study end in Female Sexual Function Index (FSFI) desire domain score and in number of satisfying sexual events (SSE) over 28 days. Secondary end points included the change from baseline in FSFI total score, Female Sexual Distress Scale-Revised (FSDS-R) total score, and FSDS-R Item 13 score. RESULTS Compared with placebo, flibanserin led to increases in mean (standard deviation) SSE of 2.5 (4.6) vs. 1.5 (4.5), mean (standard error [SE]) FSFI desire domain score of 1.0 (0.1) vs. 0.7 (0.1), and mean (SE) FSFI total score of 5.3 (0.3) vs. 3.5 (0.3); and decreases in mean (SE) FSDS-R Item 13 score of -1.0 (0.1) vs. -0.7 (0.1) and mean (SE) FSDS-R total score of -9.4 (0.6) vs. -6.1 (0.6); all P ≤ 0.0001. The most frequently reported adverse events in the flibanserin group were somnolence, dizziness, and nausea, with adverse events leading to discontinuation in 9.6% of women receiving flibanserin vs. 3.7% on placebo. CONCLUSION In premenopausal women with HSDD, flibanserin 100 mg qhs resulted in significant improvements in the number of SSE and sexual desire (FSFI desire domain score) vs. placebo. Flibanserin was associated with significant reductions in distress associated with sexual dysfunction (FSDS-R total score) and distress associated with low sexual desire (FSDS-R Item 13) vs. placebo. There were no significant safety concerns associated with the use of flibanserin for 24 weeks.
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Affiliation(s)
- Molly Katz
- Katz and Kade, Cincinnati, OH 45219, USA.
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Nowosielski K, Wróbel B, Sioma-Markowska U, Poręba R. Development and validation of the Polish version of the Female Sexual Function Index in the Polish population of females. J Sex Med 2012; 10:386-95. [PMID: 23211010 DOI: 10.1111/jsm.12012] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Unlike male sexual function, which is relatively easy to assess, female sexual function is still a diagnostic challenge. Although numerous new measurements for female sexual dysfunction (FSD) have recently been developed, the Female Sexual Function Index (FSFI) remains the gold standard for screening. It has been validated in more than 30 countries. The FSFI has been used in several studies conducted in Poland, but it has never been standardized for Polish women. AIM The aim of this study was to develop a Polish version of the FSFI (PL-FSFI). MATERIALS AND METHODS In total, 189 women aged 18-55 years were included in the study. Eighty-five were diagnosed with FSD as per the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM IV-TR) criteria; 104 women did not have FSD. All subjects completed the PL-FSFI at baseline (day 0), day 7, and day 28. MAIN OUTCOME MEASURES Test-retest reliability was determined by Pearson's product-moment correlations. Reliability was tested using Cronbach's α coefficient. Construct validity was evaluated by principal component analysis using varimax rotation and factor analysis. Discriminant validity was assessed with between-groups analysis of variance. RESULTS All domains of the PL-FSFI demonstrated satisfactory internal consistencies, with Cronbach's α value of >0.70 for the entire sample. The test-retest reliability demonstrated good-to-excellent agreement between the assessment points. Based on principal component analysis, a 5-factor model was established that explained 83.62% of the total variance. Domain intercorrelations of the PL-FSFI ranged from 0.37-0.77. The optimal PL-FSFI cutoff score was 27.50, with 87.1% sensitivity and 83.1% specificity. CONCLUSION The PL-FSFI is a reliable questionnaire with good psychometric and discriminative validity. Therefore, it can be used as a tool for preliminary screening for FSD among Polish women.
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Affiliation(s)
- Krzysztof Nowosielski
- Department of Gynecology and Obstetrics, Specialist Teaching Hospital in Tychy, Tychy, Poland.
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Jayne C, Simon JA, Taylor LV, Kimura T, Lesko LM. Open‐Label Extension Study of Flibanserin in Women with Hypoactive Sexual Desire Disorder. J Sex Med 2012; 9:3180-8. [DOI: 10.1111/j.1743-6109.2012.02942.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Goldey KL, van Anders SM. Sexual Arousal and Desire: Interrelations and Responses to Three Modalities of Sexual Stimuli. J Sex Med 2012; 9:2315-29. [DOI: 10.1111/j.1743-6109.2012.02845.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Current World Literature. Curr Opin Obstet Gynecol 2012; 24:265-72. [DOI: 10.1097/gco.0b013e3283564f02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Revicki DA, Margolis MK, Fisher W, Rosen RC, Kuppermann M, Hanes V, Sand M. Evaluation of the Sexual Desire Relationship Distress Scale (SDRDS) in Women with Hypoactive Sexual Desire Disorder. J Sex Med 2012; 9:1344-54. [DOI: 10.1111/j.1743-6109.2012.02679.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Derogatis LR, Komer L, Katz M, Moreau M, Kimura T, Garcia M, Wunderlich G, Pyke R. Treatment of hypoactive sexual desire disorder in premenopausal women: efficacy of flibanserin in the VIOLET Study. J Sex Med 2012; 9:1074-85. [PMID: 22248038 DOI: 10.1111/j.1743-6109.2011.02626.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Hypoactive sexual desire disorder (HSDD) is the most common form of female sexual dysfunction and is characterized by low sexual desire that causes distress. AIM The aim of this study was to assess the efficacy and safety of flibanserin, a postsynaptic 5-HT(1A) agonist/5-HT(2A) antagonist, in premenopausal women with HSDD. METHODS North American premenopausal women with HSDD were randomized to 24 weeks' treatment with placebo (N = 295), flibanserin 50 mg (N = 295), or flibanserin 100 mg (N = 290), once daily at bedtime. MAIN OUTCOME MEASURES Coprimary endpoints were change from baseline to study end in number of satisfying sexual events (SSE) and sexual desire score measured daily using an electronic diary (eDiary). Secondary endpoints included change from baseline to study end in female sexual function index (FSFI) desire domain and total scores, female sexual distress scale-revised (FSDS-R) Item 13 and total scores, and patient's global impression of improvement. RESULTS Flibanserin 50 mg and 100 mg led to increases in SSE (P < 0.05 and P < 0.01 vs. placebo, respectively). There was a numerical trend toward improvement in eDiary desire score on flibanserin 100 mg, but statistical significance was not reached (P = 0.07 vs. placebo). FSFI desire domain and total scores increased with both flibanserin regimens (P < 0.05). FSDS-R total and Item 13 scores decreased with flibanserin 100 mg (P < 0.001), indicating reduced sexual distress. More women receiving flibanserin 50 mg and 100 mg considered their HSDD to have improved than women receiving placebo (39.6% and 50.0% vs. 30.3%, respectively) (P < 0.05). CONCLUSION In premenopausal women with HSDD, flibanserin 50 mg and 100 mg once daily at bedtime were well tolerated and associated with statistically significant improvements in SSE, sexual desire (FSFI desire domain score but not eDiary desire score) and overall sexual function, and reduction of sexual distress, vs. placebo.
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Affiliation(s)
- Leonard R Derogatis
- The Center for Sexual Medicine at Sheppard Pratt, Johns Hopkins Department of Psychiatry and Behavioural Sciences, Baltimore, MD 21285-6815, USA.
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Thorp J, Simon J, Dattani D, Taylor L, Kimura T, Garcia M, Lesko L, Pyke R. Treatment of hypoactive sexual desire disorder in premenopausal women: efficacy of flibanserin in the DAISY study. J Sex Med 2012; 9:793-804. [PMID: 22239862 DOI: 10.1111/j.1743-6109.2011.02595.x] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Hypoactive Sexual Desire Disorder (HSDD) is characterized by low sexual desire that causes marked distress or interpersonal difficulty. AIM To assess the efficacy and tolerability of flibanserin, a postsynaptic 5-HT1A agonist/5-HT2A antagonist, in the treatment of premenopausal women with HSDD. METHODS North American premenopausal women with HSDD (mean age 35 years) were randomized to 24 weeks' treatment with flibanserin 25 mg twice daily (N=396), 50 mg twice daily (N=392), 100 mg once daily at bedtime (N=395), or placebo (N=398). MAIN OUTCOME MEASURES Co-primary endpoints were changed from baseline to study end in number of satisfying sexual events (SSE) and sexual desire score, measured daily using an eDiary. Secondary endpoints included change in Female Sexual Distress Scale-Revised (FSDS-R) total score and Item 13 score (distress due to low sexual desire), Female Sexual Function Index (FSFI) total and desire domain scores, and Patient's Global Impression of Improvement. RESULTS Flibanserin 100 mg once daily was associated with an increase in SSE (P<0.01 vs. placebo) but the 25 mg and 50 mg twice daily doses were not. No group showed a significant increase in eDiary desire score vs. placebo. All flibanserin regimens improved FSDS-R total, FSDS-R Item 13, FSFI total, and FSFI desire domain scores vs. placebo (P<0.05, for all). More women receiving flibanserin 50 mg twice daily and 100 mg once daily considered their HSDD to have improved than women receiving placebo (44.1% and 47.0% vs. 30.3%, respectively) (P<0.000, 1 vs. placebo). The most frequently reported adverse events in women receiving flibanserin were somnolence (11.8%), dizziness (10.5%), and fatigue (10.3%). CONCLUSION In premenopausal women with HSDD, flibanserin 100 mg once daily was well tolerated and associated with statistically significant improvements in SSE, sexual desire (FSFI desire domain score but not eDiary desire score), sexual function, and decrease in sexual distress vs. placebo.
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Affiliation(s)
- John Thorp
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7570, USA.
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Kingsberg SA, Althof SE. Satisfying Sexual Events as Outcome Measures in Clinical Trial of Female Sexual Dysfunction. J Sex Med 2011; 8:3262-70. [DOI: 10.1111/j.1743-6109.2011.02447.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Goldfischer ER, Breaux J, Katz M, Kaufman J, Smith WB, Kimura T, Sand M, Pyke R. Continued Efficacy and Safety of Flibanserin in Premenopausal Women with Hypoactive Sexual Desire Disorder (HSDD): Results from a Randomized Withdrawal Trial. J Sex Med 2011; 8:3160-72. [DOI: 10.1111/j.1743-6109.2011.02458.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Choice of recall period for patient-reported outcome (PRO) measures: criteria for consideration. Qual Life Res 2011; 21:1013-20. [PMID: 21909804 DOI: 10.1007/s11136-011-0003-8] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2011] [Indexed: 12/17/2022]
Abstract
PURPOSE Understand the choice of recall period for PRO measures based on intended use, characteristics of the disease, treatment, and attributes of studies. METHODS Current practice and considerations were reviewed within several disease areas (overactive bladder, menopausal hot flashes, niacin-induced flushing, osteoarthritis pain, irritable bowel symptoms, benign prostatic hyperplasia, and alopecia). RESULTS Rationales were identified for using different recall periods, including event-driven (immediate), daily, up to weekly, and longer than weekly. This work demonstrates that (1) recall depends on what the PRO measure captures, its intended use, and attributes of the disease and study; (2) within the same disease area, recall can vary depending on the concept or phenomenon of interest; (3) recall must consider patient burden and their ability to easily and accurately recall the information requested; and (4) recall must be consistent with the duration of the trial and the scheduled clinic visits. CONCLUSIONS Shorter recall periods may underestimate symptom burden when symptoms have diurnal or day-to-day fluctuation and may place undue burden on patients. On the other hand, recall intervals that are too long may either over- or underestimate the health state. Therefore, appropriate criteria should be considered given attributes of the disease when selecting an adequate recall period.
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