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Krapf JM, Goldstein AT. Combined estrogen-progestin oral contraceptives and female sexuality: an updated review. Sex Med Rev 2024; 12:307-320. [PMID: 38515302 DOI: 10.1093/sxmrev/qeae011] [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: 09/18/2023] [Revised: 01/19/2024] [Accepted: 01/28/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION Sexual side effects of combined oral contraceptives (COCs) have not been fully understood, but increasing evidence prompts broader risk/benefit evaluation and merits inclusion in counseling on contraceptive options. OBJECTIVES The study sought to explore the impact of combined estrogens-progestin oral contraceptives on components of female sexuality, including sexual desire, anatomic genitourinary changes, lubrication, orgasm, provoked vestibulodynia, well-being, body image, partner preference, and relationship stability. METHODS A literature review was performed between April 2023 and January 2024 exploring the association between combined oral contraceptive pills and sexual health. RESULTS Although COCs decrease free testosterone, it is unclear if COCs affect sexual function, including desire. Antiandrogenic COCs do seem to have a negative effect on sexual arousal, lubrication, and orgasm. Provoked vestibulodynia may be related to early onset of COC use, low-estrogen pills, and antiandrogenic progestins. Emotional and sexual side effects are strong predictors of COC discontinuation. Longitudinal data indicate that using COCs when meeting and selecting a partner has implications on sexual satisfaction and relationship length. Analysis of data is complicated by various doses and forms of estrogen and progestin in COCs, which have changed over time. CONCLUSION Lack of randomized placebo-controlled studies and heterogenicity in study design hampers generalized statements about the effects of COCs on sexual function. Despite these challenges, consideration of sexual dysfunction when presenting and prescribing hormonal contraception is essential for informed consent, shared decision making, and ensuring reliable contraceptive choices.
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Affiliation(s)
- Jill M Krapf
- Center for Vulvovaginal Disorders Florida, Tampa, FL 33609, United States
| | - Andrew T Goldstein
- Center for Vulvovaginal Disorders New York, New York, NY 10036, United States
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Blumenstock SM, Barber JS. Hormonal Contraception Use and Sexual Frequency across Young Women's Intimate Relationships. JOURNAL OF SEX RESEARCH 2023; 60:1283-1296. [PMID: 35435786 PMCID: PMC9576816 DOI: 10.1080/00224499.2022.2059649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
We examined whether hormonal contraception (HC) use predicts sexual frequency throughout and across young women's intimate relationships. From 2008-2012, the Relationships Dynamics and Social Life Study collected weekly surveys over 2.5 years, and included 893 women (aged 18-19 at baseline) who reported 2,547 intimate relationships across 32,736 weeks. Three-level logistic multilevel models assessed the weekly probability of sexual intercourse based on 1) weekly HC use (vs. nonuse) and 2) duration of HC use, both accounting for several relational and individual characteristics, including relationship duration. Women had more frequent sexual intercourse when they were using HC than when they were not (predicted probabilities .65 vs .41). The weekly probability of sexual intercourse increased sharply within the first month of HC initiation (by about 27 percentage points), remained high for several months, then began to slowly decline (yet remained above that of nonuse). When separated by method type, similar trajectories were found for the pill, ring, and IUD/implant; following the initial increase, steeper declines in intercourse frequency were found for the contraceptive injectable, eventually dropping below pre-initiation levels. Findings signify the immediate influence of reduced pregnancy fears in facilitating sexual intercourse among young women, which may decline as HC use continues long-term.
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Affiliation(s)
| | - Jennifer S. Barber
- Kinsey Institute, Indiana University, Bloomington, IN, United States
- Department of Sociology, Indiana University, Bloomington, IN, United States
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Abdollahpour S, Ashrafizaveh A, Azmoude E. Effects of the Combined Contraceptive Vaginal Ring on Female Sexual Function: A Systematic Review and Meta-analysis. Malays J Med Sci 2023; 30:21-30. [PMID: 36875197 PMCID: PMC9984104 DOI: 10.21315/mjms2023.30.1.3] [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: 07/18/2021] [Accepted: 10/29/2021] [Indexed: 03/05/2023] Open
Abstract
There are controversial debates regarding the effects of contraceptive vaginal ring devices on females' sexual function. Therefore, the meta-analysis of before-after was conducted on the intervention studies published in the past years to clarify these contradictions. The existing literature on the subject was reviewed by searching through such databases as PubMed, Scopus, ISI Web of Sciences, Embase, Cochrane Library and Google Scholar up to July 2021. Before-after intervention studies that had examined the effect of vaginal rings on females' sexual function were collected as well. In total, five studies with 369 participants were included in quantitative syntheses. Pooled results from the random-effect model showed that NuvaRing had a positive effect on females' sexual function three months after insertion (WMD: 2.48; 95% CI: 0.30, 4.67; P = 0.026); however, this effect was not significant after 6 months (WMD: 4.38; 95% CI: -4.95, 13.72; P = 0.357). Meta-regression analysis suggested that the effect of this device is associated with users' age and body mass index 3 months after insertion. No publication bias was found by Egger's test or funnel plots. Overall, the results of this meta-analysis support the view that vaginal ring use is associated with a positive effect on the sexual function of women 3 months after insertion, while the effect of this device on the sexual function of women was insignificant after 6 months. However, given the dearth of available data, it is not possible to reach a definite conclusion on the effect of vaginal rings on females' sexual function.
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Affiliation(s)
- Sedigheh Abdollahpour
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Akram Ashrafizaveh
- Department of Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Elham Azmoude
- Department of Midwifery, Neyshabur University of Medical Sciences, Neyshabur, Iran
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Delvaux T, Jespers V, Benova L, van de Wijgert J. Acceptability and Satisfaction of Contraceptive Vaginal Rings in Clinical Studies: A Systematic Review and Narrative Synthesis. Front Glob Womens Health 2022; 2:799963. [PMID: 34970653 PMCID: PMC8712726 DOI: 10.3389/fgwh.2021.799963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 11/11/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Acceptability of and satisfaction with contraceptive methods are paramount for uptake and continuation. In the current context of multipurpose prevention of pregnancy and sexually transmitted diseases/HIV development, it is critical to have a better understanding of acceptability of and satisfaction with the contraceptive vaginal ring (CVR) including sexual satisfaction. The objective of this study was to review the evidence about acceptability of CVRs and general and sexual satisfaction of users. Methods: We searched PubMed, CINAHL, and Web of Science (until December 31, 2020) and selected original studies documenting actual use of hormonal CVR and explicitly addressing any of the 3 outcomes. Results: Of a total of 1,129 records screened, 46 studies were included. Most studies (n = 43, 93%) were prospective, conducted in high-income settings (n = 35), and reported on NuvaRing® use (n = 31). Overall, 27 (59%) studies included a comparison group, 38 (82%) studies used exclusively quantitative questionnaires, with qualitative only (n = 4, 9%), or mixed methods (n = 4, 9%) studies being less common. Ease of CVR insertion/removal/reinsertion was high in all the settings and improved with time of use, with qualitative studies supporting these findings. When mentioned, ring-related events were associated with discontinuation, and results on continuation of use were mixed. Among NuvaRing® studies, general satisfaction (being satisfied or very satisfied) was between 80 and 90% and tended to mirror continuation. Sexual satisfaction was less commonly reported and results were mixed. Overall, limited information was provided on actual CVR experiences of women (and men) and cultural norms that may affect sexuality and CVR use. Conclusion: Positive aspects of acceptability of and satisfaction with CVRs were reported, but ring-related events and factors, which may affect long-term CVR use, deserve further study. More information is needed on actual experiences of women using CVRs, relationship aspects, male partner opinions, and contextual norms to better understand the acceptability of and satisfaction with CVRs.
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Affiliation(s)
| | - Vicky Jespers
- Belgian Health Care Knowledge Centre, Brussels, Belgium
| | - Lenka Benova
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Janneke van de Wijgert
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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5
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TOPSAKAL Ö, YANIKKEREM E. Evaluation of Sexual Functions in Women Who Used Hormonal or Nonhormonal Contraceptives. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.769735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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6
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de Wit AE, de Vries YA, de Boer MK, Scheper C, Fokkema AA, Schoevers RA, Giltay EJ. Hormonal contraceptive use and depressive symptoms: systematic review and network meta-analysis of randomised trials. BJPsych Open 2021; 7:e110. [PMID: 34099098 PMCID: PMC8220855 DOI: 10.1192/bjo.2021.64] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/24/2021] [Accepted: 04/17/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Observational studies suggest that hormonal contraceptive use may increase depressive symptoms in women, but it is unclear whether the effect is causal. AIMS To quantitatively examine the evidence from randomised clinical trials for the link between hormonal contraceptive use and depressive symptoms. METHOD We performed a systematic review and network meta-analysis of randomised clinical trials comparing women randomised to any form of a hormonal contraceptive with women randomised to any other form of a (non-)hormonal contraceptive or placebo. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Web of Science, PsycINFO, EMCare and EMBASE, from inception to 1 May 2020. Certainty of the evidence was assessed with the Grading of Recommendations Assessment, Development and Evaluation approach. A random-effect Bayesian network meta-analysis was conducted, with change in depressive symptoms between baseline and three cycles as outcome. RESULTS This review identified 3492 records, of which 14 trials were eligible and 12 could be included in the network meta-analysis. These trials included 5833 participants (mean age per study range: 16.8-32.4 years) and compared 10 different interventions. Compared with placebo, hormonal contraceptive use did not cause worsening of depressive symptoms (standardised mean difference: median, -0.04; range, -0.17 [95% credible interval -0.46 to 0.13] to 0.13 [95% credible interval -0.28 to 0.56]). CONCLUSIONS This study suggests that hormonal contraceptive use does not lead to an increase in depressive symptoms in adult women. Future studies should include first-time users, to confirm the results in young women.
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Affiliation(s)
- Anouk E. de Wit
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Ymkje Anna de Vries
- Department of Developmental Psychology, University of Groningen, The Netherlands
| | - Marrit K. de Boer
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Celeste Scheper
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Ante A. Fokkema
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Robert A. Schoevers
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Erik J. Giltay
- Department of Psychiatry, University Medical Center Leiden, The Netherlands
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Runyan A, Welch RA, Kramer KJ, Cortez S, Roberts LJ, Asamoah C, Ottum S, Sanders J, Shafi A, Recanati MA. Long-Acting Reversible Contraception: Placement, Continuation, and Removal Rates at an Inner-City Academic Medical Center Clinic. J Clin Med 2021; 10:jcm10091918. [PMID: 33925203 PMCID: PMC8125758 DOI: 10.3390/jcm10091918] [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: 02/28/2021] [Revised: 04/21/2021] [Accepted: 04/21/2021] [Indexed: 11/16/2022] Open
Abstract
Long-Acting Reversible Contraception (LARCs) has the potential to decrease unintended pregnancies but only if women can easily access a requested method. Retrospective electronic chart review identified women desiring LARC placement over a one-year period ending 31 December 2016. Most of the 311 insertions were for family planning, with 220 new insertions and 60 replacements. Delays occurred in 38% (n = 118) of patients, averaged 5 ± 5 weeks, and 47% received interval contraception. Reasons included absence of qualified provider (n = 44, 37%), pending cultures (n = 31, 26%), and Mirena availability. Teenage LARC use favored Nexplanon whereas older women preferred Mirena (p < 0.01). Of the 11% choosing early LARC removal, a significant number were African Americans (p = 0.040) or teenagers (p = 0.048). Retention time varied by device type; most patients switched to other contraceptives. No patients experienced IUD expulsion. Understanding barriers, attempting to remedy them, and addressing the side effects associated with LARC use is of importance in this inner-city patient population in the United States.
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Affiliation(s)
- Aliye Runyan
- Department of Obstetrics and Gynecology, Westchester Medical Center, Valhalla, NY 10595, USA;
| | - Robert A. Welch
- Department of Obstetrics and Gynecology, Hurley Medical Center, Flint, MI 48503, USA;
| | - Katherine J. Kramer
- Department of Obstetrics and Gynecology, St. Vincent’s Catholic Medical Centers, New York, NY 10011, USA;
| | - Sarah Cortez
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48202, USA; (S.C.); (L.J.R.); (C.A.)
| | - LeAnne J. Roberts
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48202, USA; (S.C.); (L.J.R.); (C.A.)
| | - Clementina Asamoah
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48202, USA; (S.C.); (L.J.R.); (C.A.)
| | - Sarah Ottum
- Department of Surgery, Wayne State University, Detroit, MI 48202, USA;
| | - Jessica Sanders
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT 84132, USA;
| | - Adib Shafi
- Department of Computer Science, Wayne State University, Detroit, MI 48202, USA;
| | - Maurice-Andre Recanati
- NIH-Women’s Reproductive Health Research (WRHR) Scholar, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48202, USA
- Correspondence:
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Di Stasi V, Maseroli E, Rastrelli G, Scavello I, Cipriani S, Todisco T, Marchiani S, Sorbi F, Fambrini M, Petraglia F, Maggi M, Vignozzi L. SHBG as a Marker of NAFLD and Metabolic Impairments in Women Referred for Oligomenorrhea and/or Hirsutism and in Women With Sexual Dysfunction. Front Endocrinol (Lausanne) 2021; 12:641446. [PMID: 33854482 PMCID: PMC8040974 DOI: 10.3389/fendo.2021.641446] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/17/2021] [Indexed: 12/20/2022] Open
Abstract
PCOS is one of the most common endocrine disorders and NAFLD is one of its most dangerous metabolic consequences. The diagnosis of NAFLD is not a practical task and the condition is at risk of being overlooked. The use of simpler but still reliable surrogate markers is necessary to identify women with a high likelihood of NAFLD. The aim of this study was to evaluate the clinical correlates of NAFLD Liver Fat Score (NAFLD-LFS) in women with oligomenorrhea and/or hirsutism. Furthermore, the study aimed to evaluate whether, among the hormonal parameters evaluated in such women, possible hallmarks of NAFLD may be identified. To this purpose, 66 women who attended our Outpatient Clinic for oligomenorrhea and/or hyperandrogenism were included in the study. In order to validate the results obtained in the first cohort, a second independent sample of 233 women evaluated for female sexual dysfunction (FSD) was analyzed. In cohort 1, NAFLD-LFS positively correlated with metabolic and inflammatory parameters. Among the hormone parameters, NAFLD-LFS showed no significant relationships with androgens but a significant negative correlation with SHBG (p<0.0001) that therefore appeared as a candidate hallmark for pathologic NAFLD-LFS. The ROC analysis showed a significant accuracy (81.1%, C.I.69.1-93.0, p <0.0001) for SHBG in identifying women with a pathological NAFLD-LFS. In particular, a SHBG 33.4 nmol/l was recognized as the best threshold, with a sensitivity of 73.3% and a specificity of 70.7%. In order to validate this SHBG as a marker of metabolic impairment possible related with the presence of NAFLD, we tested this threshold in cohort 2. FSD women with SHBG <33.4 nmol/l had worse metabolic parameters than women with SHBG ≥33.4 nmol/l and a significantly higher NAFLD-LFS even after adjusting for confounders (B=4.18 [2.05; 6.31], p=0.001). In conclusion, this study provides a new evidence in the diagnostic process of NAFLD, showing that the measurement of SHBG, which is routinely assessed in the workup of women referred for possible PCOS, could identify women at higher metabolic risk, thus detecting those who may deserve further targeted diagnostic assessment.
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Affiliation(s)
- Vincenza Di Stasi
- Andrology, Women’s Endocrinology and Gender Incongruence Unit, Department of Experimental Clinical and Biomedical Sciences “Mario Serio,” University of Florence, Florence, Italy
| | - Elisa Maseroli
- Andrology, Women’s Endocrinology and Gender Incongruence Unit, Department of Experimental Clinical and Biomedical Sciences “Mario Serio,” University of Florence, Florence, Italy
| | - Giulia Rastrelli
- Andrology, Women’s Endocrinology and Gender Incongruence Unit, Department of Experimental Clinical and Biomedical Sciences “Mario Serio,” University of Florence, Florence, Italy
| | - Irene Scavello
- Andrology, Women’s Endocrinology and Gender Incongruence Unit, Department of Experimental Clinical and Biomedical Sciences “Mario Serio,” University of Florence, Florence, Italy
| | - Sarah Cipriani
- Andrology, Women’s Endocrinology and Gender Incongruence Unit, Department of Experimental Clinical and Biomedical Sciences “Mario Serio,” University of Florence, Florence, Italy
| | - Tommaso Todisco
- Andrology, Women’s Endocrinology and Gender Incongruence Unit, Department of Experimental Clinical and Biomedical Sciences “Mario Serio,” University of Florence, Florence, Italy
| | - Sara Marchiani
- Andrology, Women’s Endocrinology and Gender Incongruence Unit, Department of Experimental Clinical and Biomedical Sciences “Mario Serio,” University of Florence, Florence, Italy
| | - Flavia Sorbi
- Gynecology Unit, Department of Biomedical, Experimental and Clinical Sciences “Mario Serio,” University of Florence, Florence, Italy
| | - Massimiliano Fambrini
- Gynecology Unit, Department of Biomedical, Experimental and Clinical Sciences “Mario Serio,” University of Florence, Florence, Italy
| | - Felice Petraglia
- Gynecology Unit, Department of Biomedical, Experimental and Clinical Sciences “Mario Serio,” University of Florence, Florence, Italy
| | - Mario Maggi
- Endocrinology Unit, Department of Experimental Clinical and Biomedical Sciences “Mario Serio,” University of Florence, Florence, Italy
- I.N.B.B. (Istituto Nazionale Biostrutture e Biosistemi), Rome, Italy
| | - Linda Vignozzi
- Andrology, Women’s Endocrinology and Gender Incongruence Unit, Department of Experimental Clinical and Biomedical Sciences “Mario Serio,” University of Florence, Florence, Italy
- I.N.B.B. (Istituto Nazionale Biostrutture e Biosistemi), Rome, Italy
- *Correspondence: Linda Vignozzi,
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Affiliation(s)
- Linda Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.
| | - Yacov Reisman
- Flare-Health, W.H. Keesomlaan 12, Amstelveen, Netherlands
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10
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Scavello I, Maseroli E, Di Stasi V, Cipriani S, Verde N, Magini A, Maggi M, Vignozzi L. Nomegestrol acetate/17beta-estradiol does not negatively alter the vascular resistance of clitoral arteries: a prospective, exploratory study. Int J Impot Res 2019; 32:239-247. [PMID: 31263248 DOI: 10.1038/s41443-019-0162-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/18/2019] [Accepted: 05/14/2019] [Indexed: 01/08/2023]
Abstract
The effect of nomegestrol acetate/estradiol (NOMAC/E2) on clitoral and uterine vascularization has never been evaluated. We aimed to investigate, in women consulting for contraceptive needs, the possible changes in clitoral and uterine arteries hemodynamic parameters after 6 months treatment with NOMAC/E2 as compared with other hormonal contraceptives (HCs). In this observational, prospective pilot study, ten women were enrolled. Color Doppler ultrasound was performed on the clitoral and uterine arteries at baseline and after 6 months treatment with NOMAC/E2 (n = 5) or other HCs (n = 5). NOMAC/E2 did not exert any significant effect on clitoral vascular resistance expressed by the pulsatility index (PI); conversely, treatment with other HCs significantly increased this parameter (p = 0.04). The change in clitoral PI between the two groups retained a statistically significant difference even after adjusting for age. In the NOMAC/E2 group, at follow-up, uterine artery PI and acceleration were significantly reduced (p = 0.04), whereas no significant differences were observed in the HCs group; however, the change in uterine artery parameters did not differ significantly between the two groups. NOMAC/E2, differently from other COCs, does not negatively alter the vascular resistance of clitoral arteries and appears as a good contraceptive choice to protect both cardiovascular and sexual health.
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Affiliation(s)
- Irene Scavello
- Department of Experimental, Clinical, and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.,Andrology, Women's Endocrinology and Gender Inconguence Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Elisa Maseroli
- Department of Experimental, Clinical, and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.,Andrology, Women's Endocrinology and Gender Inconguence Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Vincenza Di Stasi
- Department of Experimental, Clinical, and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.,Andrology, Women's Endocrinology and Gender Inconguence Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Sarah Cipriani
- Department of Experimental, Clinical, and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.,Andrology, Women's Endocrinology and Gender Inconguence Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Nunzia Verde
- Medicine and Surgery, Section of Endocrinology, Federico II, University of Naples, Naples, Italy
| | - Angela Magini
- Department of Experimental, Clinical, and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.,Andrology, Women's Endocrinology and Gender Inconguence Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Mario Maggi
- Department of Experimental, Clinical, and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.,Endocrinology Unit, Medical-Geriatric Department, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.,Istituto Nazionale Biostrutture e Biosistemi, Rome, Italy
| | - Linda Vignozzi
- Department of Experimental, Clinical, and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy. .,Andrology, Women's Endocrinology and Gender Inconguence Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy. .,Istituto Nazionale Biostrutture e Biosistemi, Rome, Italy.
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Casado-Espada NM, de Alarcón R, de la Iglesia-Larrad JI, Bote-Bonaechea B, Montejo ÁL. Hormonal Contraceptives, Female Sexual Dysfunction, and Managing Strategies: A Review. J Clin Med 2019; 8:E908. [PMID: 31242625 PMCID: PMC6617135 DOI: 10.3390/jcm8060908] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 06/06/2019] [Accepted: 06/24/2019] [Indexed: 12/18/2022] Open
Abstract
In recent decades, hormonal contraceptives (HC) has made a difference in the control of female fertility, taking an unequivocal role in improving contraceptive efficacy. Some side effects of hormonal treatments have been carefully studied. However, the influence of these drugs on female sexual functioning is not so clear, although variations in the plasma levels of sexual hormones could be associated with sexual dysfunction. Permanent hormonal modifications, during menopause or caused by some endocrine pathologies, could be directly related to sexual dysfunction in some cases but not in all of them. HC use seems to be responsible for a decrease of circulating androgen, estradiol, and progesterone levels, as well as for the inhibition of oxytocin functioning. Hormonal contraceptive use could alter women's pair-bonding behavior, reduce neural response to the expectation of erotic stimuli, and increase sexual jealousy. There are contradictory results from different studies regarding the association between sexual dysfunction and hormonal contraceptives, so it could be firmly said that additional research is needed. When contraceptive-related female sexual dysfunction is suspected, the recommended therapy is the discontinuation of contraceptives with consideration of an alternative method, such as levonorgestrel-releasing intrauterine systems, copper intrauterine contraceptives, etonogestrel implants, the permanent sterilization of either partner (when future fertility is not desired), or a contraceptive ring.
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Affiliation(s)
- Nerea M Casado-Espada
- Psychiatry Service, Institute of Biomedical Research of Salamanca (IBSAL), University Clinical Hospital of Salamanca, Paseo San Vicente, SN 37007 Salamanca, Spain.
| | - Rubén de Alarcón
- Psychiatry Service, Institute of Biomedical Research of Salamanca (IBSAL), University Clinical Hospital of Salamanca, Paseo San Vicente, SN 37007 Salamanca, Spain.
| | - Javier I de la Iglesia-Larrad
- Psychiatry Service, Institute of Biomedical Research of Salamanca (IBSAL), University Clinical Hospital of Salamanca, Paseo San Vicente, SN 37007 Salamanca, Spain.
| | - Berta Bote-Bonaechea
- Psychiatry Service, Institute of Biomedical Research of Salamanca (IBSAL), University Clinical Hospital of Salamanca, Paseo San Vicente, SN 37007 Salamanca, Spain.
| | - Ángel L Montejo
- Psychiatry Service, Institute of Biomedical Research of Salamanca (IBSAL), University Clinical Hospital of Salamanca, Paseo San Vicente, SN 37007 Salamanca, Spain.
- Nursing School E.U.E.F., University of Salamanca, Av. Donantes de Sangre SN 37007 Salamanca, Spain.
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Coppola A, Gallotti P, Choussos D, Pujia A, Montalcini T, Gazzaruso C. Association between clitoral tissue perfusion and female sexual dysfunction in healthy women of reproductive age: a pilot study. Int J Impot Res 2019; 32:221-225. [DOI: 10.1038/s41443-019-0155-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/15/2019] [Accepted: 04/23/2019] [Indexed: 12/21/2022]
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Coppola A, Montalcini T, Gallotti P, Luzi L, Pujia A, Giustina A, Gazzaruso C. Transmucosal oxygen tension of the clitoris: a new parameter for future investigations of the sexual, metabolic, and cardiovascular health of women. Endocrine 2019; 63:177-181. [PMID: 30302662 DOI: 10.1007/s12020-018-1782-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/01/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Several studies suggested that abnormalities in tissue perfusion of external genitalia and vagina can lead to female sexual dysfunctions (FSDs) and can be associated to metabolic and cardiovascular risk factors. However, there are some technical difficulties in assessing these abnormalities. The measurement of oxygen partial pressure is a noninvasive method to measure oxygen partial pressure (pO2) at the skin surface to assess tissue perfusion. The aim of this study was to evaluate whether transmucosal oxygen tension (TmPO2) can be measured at the mucosal surface of clitoris and whether the measurements are reliable. METHODS TmPO2 was measured in six young healthy women by using a device to measure transcutaneous pO2 on the skin and by choosing a small sensor, usually used for newborns. The identical procedure for the detection of pO2 at the skin surface was used. RESULTS The mean value of TmPO2 was 42.3 mmHg (range: 24.1-53.4 mmHg). All the trend curves of the TmPO2 showed the same behavior: after a stabilization time, there was a stable pO2 (plateau phase) that corresponds to the TmPO2 of the clitoris. These curves had a similar trend to those recorded at the skin surface. CONCLUSIONS TmPO2 can be easily measured at the mucosal surface of clitoris. Large epidemiological studies in healthy and unhealthy women and in women with FSD are needed to establish both the normal range of TmPO2 and the meaning that different values of TmPO2 can have on sexual and general health of the women.
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Affiliation(s)
- A Coppola
- Diabetes and Endocrine and Metabolic Diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.) Clinical Institute "Beato Matteo" (Hospital Group San Donato), 27029, Vigevano, Italy
| | - T Montalcini
- Nutrition Unit, Department of Clinical and Experimental Medicine, University Magna Grecia, Catanzaro, Italy
| | - P Gallotti
- Diabetes and Endocrine and Metabolic Diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.) Clinical Institute "Beato Matteo" (Hospital Group San Donato), 27029, Vigevano, Italy
| | - L Luzi
- Department of Biomedical Sciences for Health, University of Milan, 20100, Milan, Italy
- Metabolism Research Center, IRCCS Policlinico San Donato, 20097, San Donato Milanese, Italy
| | - A Pujia
- Nutrition Unit, Department of Clinical and Experimental Medicine, University Magna Grecia, Catanzaro, Italy
| | - A Giustina
- Chair of Endocrinology, San Raffaele Vita-Salute University, Milan, Italy
| | - C Gazzaruso
- Diabetes and Endocrine and Metabolic Diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.) Clinical Institute "Beato Matteo" (Hospital Group San Donato), 27029, Vigevano, Italy.
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Morotti E, Casadio P, Guasina F, Battaglia B, Mattioli M, Battaglia C. Weight gain, body image and sexual function in young patients treated with contraceptive vaginal ring. A prospective pilot study. Gynecol Endocrinol 2017; 33:660-664. [PMID: 28412867 DOI: 10.1080/09513590.2017.1306850] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Oral contraceptives could induce mood changes. As far as our knowledge, there are no studies in literature that have examined the role of vaginal contraception in self-perceived body image. AIM To evaluate the effects of intravaginal contraception on weight gain and perceived body image in relation with the Beck's Depression Inventory questionnaire (BDI) and the McCoy Female Sexuality Questionnaire (MFSQ). METHODS Twenty-one adult (18-35 years old) eumenorrheic (menstrual cycle of 25-35 days), lean (body mass index - BMI - of 19-25 kg/m2) women who were referred for hormonal contraception were administered the Stunkard Figure Rating Scale (FRS), BDI and MFSQ. Subjects were studied in basal condition and after 6 months of therapy with vaginal contraception (NuvaRing®; Organon-Schering-Plough Italia, Milan, Italy). MAIN OUTCOME MEASURES BMI, FRS, MFSQ and BDI. RESULTS After 6 months of therapy with NuvaRing®, both body weight (60.0 ± 8.3; p = 0.050) and BMI (22.1 ± 3.1; p = 0.028) slightly, but statistically, increased. FRS and BDI showed no differences after the vaginal contraception. Hormonal contraception was associated with a significant decrease in the two-factor Italian MFSQ score. CONCLUSIONS Vaginal ring seems a good alternative to other hormonal contraceptive not significantly altering the female sexuality and not influencing the FRS and BDI.
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MESH Headings
- Adolescent
- Adult
- Body Dysmorphic Disorders/chemically induced
- Body Dysmorphic Disorders/ethnology
- Body Dysmorphic Disorders/etiology
- Body Dysmorphic Disorders/psychology
- Body Mass Index
- Contraceptive Devices, Female/adverse effects
- Desogestrel/adverse effects
- Desogestrel/analogs & derivatives
- Drug Combinations
- Ethinyl Estradiol/adverse effects
- Female
- Health Knowledge, Attitudes, Practice/ethnology
- Humans
- Italy
- Overweight/chemically induced
- Overweight/ethnology
- Overweight/etiology
- Overweight/psychology
- Pilot Projects
- Prospective Studies
- Psychiatric Status Rating Scales
- Sexual Dysfunction, Physiological/chemically induced
- Sexual Dysfunction, Physiological/ethnology
- Sexual Dysfunction, Physiological/etiology
- Sexual Dysfunction, Physiological/psychology
- Sexual Dysfunctions, Psychological/chemically induced
- Sexual Dysfunctions, Psychological/ethnology
- Sexual Dysfunctions, Psychological/etiology
- Sexual Dysfunctions, Psychological/psychology
- Weight Gain/drug effects
- Weight Gain/ethnology
- Young Adult
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Affiliation(s)
- Elena Morotti
- a Department of Gynaecology and Pathophysiology of Human Reproduction , Alma Mater Studiorum-University of Bologna , Italy
| | - Paolo Casadio
- a Department of Gynaecology and Pathophysiology of Human Reproduction , Alma Mater Studiorum-University of Bologna , Italy
| | - Francesca Guasina
- a Department of Gynaecology and Pathophysiology of Human Reproduction , Alma Mater Studiorum-University of Bologna , Italy
| | - Bruno Battaglia
- a Department of Gynaecology and Pathophysiology of Human Reproduction , Alma Mater Studiorum-University of Bologna , Italy
| | - Mara Mattioli
- a Department of Gynaecology and Pathophysiology of Human Reproduction , Alma Mater Studiorum-University of Bologna , Italy
| | - Cesare Battaglia
- a Department of Gynaecology and Pathophysiology of Human Reproduction , Alma Mater Studiorum-University of Bologna , Italy
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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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Coelingh Bennink HJT, Zimmerman Y, Laan E, Termeer HMM, Appels N, Albert A, Fauser BCJM, Thijssen JHH, van Lunsen RHW. Maintaining physiological testosterone levels by adding dehydroepiandrosterone to combined oral contraceptives: I. Endocrine effects. Contraception 2016; 96:322-329. [PMID: 27393080 DOI: 10.1016/j.contraception.2016.06.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/22/2016] [Accepted: 06/28/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine whether adding dehydroepiandrosterone to combined oral contraceptives (COCs) maintains physiological levels of free testosterone. STUDY DESIGN A randomized, double-blind, placebo-controlled, two-way crossover study conducted in 81 healthy women (age range: 20-35 years; Body mass index (BMI) range: 18-35 kg/m2) using oral contraceptives. Androgens, sex hormone-binding globulin (SHBG), estradiol (E2) and estrone (E1) were measured, and free testosterone and the free testosterone index were calculated. Subjects discontinued oral contraceptive use for at least one menstrual cycle before being randomized to receive five cycles of ethinyl estradiol (EE) combined with either levonorgestrel (EE/LNG group) or drospirenone (EE/DRSP group) together with either dehydroepiandrosterone (DHEA) (50 mg/day orally) or placebo. Subsequently, all subjects crossed over to the other treatment arm for an additional five cycles. RESULTS Both COCs decreased the levels of all androgens measured. Significant decreases (p<.05) were found with EE/LNG and EE/DRSP for total testosterone (54.5% and 11.3%, respectively) and for free testosterone (66.8% and 75.6%, respectively). Adding DHEA to the COCs significantly increased all androgens compared to placebo. Moreover, including DHEA restored free testosterone levels to baseline values in both COC groups and total testosterone levels to baseline in the EE/LNG group and above baseline in the EE/DRSP group. SHBG concentrations were significantly higher with EE/DRSP compared to EE/LNG (p<.0001). The addition of DHEA did not affect the levels of SHBG. CONCLUSIONS Taking COCs reduces total and free testosterone levels and increases SHBG concentrations. By coadministration with DHEA, physiological levels of total and free testosterone are restored while using EE/LNG. With EE/DRSP, only the free testosterone level is normalized by DHEA coadministration. IMPLICATIONS A daily oral dose of 50-mg DHEA maintains physiological free and total testosterone levels in women who are using an EE/LNG-containing COC.
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Affiliation(s)
| | | | - Ellen Laan
- Department of Sexology and Psychosomatic Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Hanneke M M Termeer
- Department of Sexology and Psychosomatic Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, The Netherlands
| | | | - Adelin Albert
- Department of Biostatistics, University Hospital of Liege, Belgium
| | - Bart C J M Fauser
- Department of Reproductive Medicine & Gynecology, University Medical Center Utrecht, The Netherlands
| | - Jos H H Thijssen
- Department of Endocrinology, University Medical Center Utrecht, The Netherlands
| | - Rik H W van Lunsen
- Department of Sexology and Psychosomatic Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, The Netherlands
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Vitale SG, Caruso S, Rapisarda AMC, Valenti G, Rossetti D, Cianci S, Cianci A. Biocompatible porcine dermis graft to treat severe cystocele: impact on quality of life and sexuality. Arch Gynecol Obstet 2015; 293:125-131. [DOI: 10.1007/s00404-015-3820-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 07/13/2015] [Indexed: 01/23/2023]
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Zimmerman Y, Foidart JM, Pintiaux A, Minon JM, Fauser B, Cobey K, Coelingh Bennink H. Restoring testosterone levels by adding dehydroepiandrosterone to a drospirenone containing combined oral contraceptive: II. Clinical effects. Contraception 2015; 91:134-42. [DOI: 10.1016/j.contraception.2014.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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