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Lin YX, Zhao FF, Kong WM. Effects of vaginal dilation therapy on vaginal length, vaginal stenosis, vaginal elasticity and sexual function of cervical cancer survivors. J OBSTET GYNAECOL 2024; 44:2317387. [PMID: 38466132 DOI: 10.1080/01443615.2024.2317387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/05/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Cervical cancer survivors can experience vaginal length shortening, vaginal stenosis, vaginal elasticity deterioration, sexual frequency reduction and sexual dysfunction. This prospective, uncontrolled, monocentric clinical interventional study aimed to evaluate the effect of vaginal dilation therapy on vaginal condition and sexual function of cervical cancer survivors who had not received timely vaginal dilation. METHODS A total of 139 patients completed the study. They received 6 months of vaginal dilation therapy. We evaluated their vaginal elasticity, vaginal diameter, vaginal length and sexual function before and after vaginal dilation therapy. Their vaginal conditions were evaluated by customised vaginal moulds, and the sexual function was assessed by female sexual function index. The SPSS 25 software was used to analyse all the data. RESULTS Age, vaginal diameter and sexual intercourse frequency before diagnosis were significantly associated with female sexual dysfunction of the patients after cancer treatment. Vaginal dilation therapy improved vaginal stenosis, vaginal length and sexual function in all the patients; however, the vaginal elasticity and incidence of sexual dysfunction did not improve significantly. Sexual intercourse frequency before diagnosis, vaginal elasticity, time interval from last treatment and treatment modalities were significantly associated with the change in female sexual function index score before and after vaginal dilation therapy. Patients with a time interval from the last treatment less than 24 months or those who had moderate or good vaginal elasticity, benefitted more from vaginal dilatation therapy. CONCLUSIONS Cervical cancer survivors who had not received timely vaginal dilation still benefitted from vaginal dilation therapy, irrespective of the treatment methods they received. Moreover, vaginal dilation therapy should be performed as early as possible after cervical cancer treatment.
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Affiliation(s)
- Yu-Xuan Lin
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, China
| | - Fei-Fei Zhao
- Department of Gynecology and Obstetrics, Beijing Fuxing Hospital, Capital Medical University, Beijing, China
| | - Wei-Min Kong
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, China
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Pereira GMV, Brito LGO, Ledger N, Juliato CRT, Domoney C, Cartwright R. Associated factors of vaginal laxity and female sexual function: a cross-sectional study. J Sex Med 2024:qdae042. [PMID: 38614472 DOI: 10.1093/jsxmed/qdae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/20/2024] [Accepted: 02/10/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Female sexual dysfunction (FSD), including vaginal laxity (VL), can lead to a decrease in quality of life and affect partner relationships. AIM We aimed to investigate the associated factors of VL and FSD and their relationship with other pelvic floor disorders in a female population. METHODS This cross-sectional study was conducted at Chelsea and Westminster Hospital from July to December 2022. All women referred to clinical care at the urogynecology clinic were included. Participants were assessed according to sociodemographic and clinical aspects, the Pelvic Organ Prolapse Quantification system, sexual function, VL, sexual attitudes, sexual distress, sexual quality of life, vaginal symptoms, and pelvic floor disorders. Unadjusted and adjusted associated factors of VL and FSD were analyzed. OUTCOMES The primary outcome was the identification of the associated factors of VL and FSD in a female population, and secondary outcomes included the association between VL and pelvic organ prolapse (POP) with the questionnaire scores. RESULTS Among participants (N = 300), vaginal delivery, multiparity, perineal laceration, menopause, and gel hormone were significantly more frequent in those reporting VL (all P < .05). When compared with nulliparity, primiparity and multiparity increased the odds of VL by approximately 4 and 12 times, respectively (unadjusted odds ratio [OR], 4.26 [95% CI, 2.05-8.85]; OR, 12.77 [95% CI, 6.53-24.96]). Menopause and perineal laceration increased the odds of VL by 4 and 6 times (unadjusted OR, 4.65 [95% CI, 2.73-7.93]; OR, 6.13 [95% CI, 3.58-10.49]). In multivariate analysis, menopause, primiparity, multiparity, and POP remained associated with VL. CLINICAL IMPLICATIONS Parity, as an obstetric factor, and menopause and staging of POP, as clinical factors, were associated with VL. STRENGTHS AND LIMITATIONS The investigation of associated factors for VL will contribute to the understanding of its pathophysiology. The study design makes it impossible to carry out causal inference. CONCLUSION Menopause, primiparity, multiparity, and POP were highly associated with VL complaints in multivariate analysis.
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Affiliation(s)
- Gláucia Miranda Varella Pereira
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, 13083-881, Brazil
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, SW7 2AZ, United Kingdom
- Chelsea and Westminster Hospital, London, SW10 9NH, United Kingdom
| | - Luiz Gustavo Oliveira Brito
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, 13083-881, Brazil
| | - Nina Ledger
- Chelsea and Westminster Hospital, London, SW10 9NH, United Kingdom
| | - Cássia Raquel Teatin Juliato
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, 13083-881, Brazil
| | - Claudine Domoney
- Chelsea and Westminster Hospital, London, SW10 9NH, United Kingdom
| | - Rufus Cartwright
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, SW7 2AZ, United Kingdom
- Chelsea and Westminster Hospital, London, SW10 9NH, United Kingdom
- Department of Epidemiology and Biostatistics, Imperial College London, London, SW7 2AZ, UK
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Barbagallo F, Cannarella R, Condorelli RA, Cucinella L, La Vignera S, Nappi RE, Calogero AE. Thyroid diseases and female sexual dysfunctions. Sex Med Rev 2024:qeae021. [PMID: 38600719 DOI: 10.1093/sxmrev/qeae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/28/2024] [Accepted: 03/24/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION Female sexual dysfunctions (FSDs) have received little attention in the context of thyroid diseases, despite the high prevalence of both conditions. OBJECTIVES This review aims to update and summarize the state of knowledge on the association between thyroid diseases and FSDs and to investigate the complex mechanisms through which thyroid hormone imbalance can impact female sexual health in the context of the biopsychosocial model. METHODS A comprehensive literature search was performed through the PubMed, MEDLINE, and Scopus databases, using the following keywords: "female sexual function," "sexual dysfunction," "hypoactive sexual desire disorder," "thyroid disease," "thyroiditis," "hypothyroidism," and "hyperthyroidism." RESULTS To date, well-designed studies that describe the relationship between FSDs and thyroid disorders are lacking. However, despite the limitations on available studies, current data indicate that sexual alterations are frequently associated with thyroid diseases in women. A complex interplay of direct and indirect hormonal and nonhormonal mechanisms has been hypothesized, including hormonal changes, neurotransmitter imbalance, reduced nitric oxide release, mood disorders, and other systemic consequences of both hypothyroidism and hyperthyroidism. Thyroid hormone receptors have also been identified in the genitourinary system. CONCLUSIONS In a clinical setting, physicians should investigate the sexuality of patients consulting for thyroid disease. At the same time, an evaluation of thyroid function should be performed in patients presenting with FSD, especially after menopause, when the risk of thyroid diseases and FSDs increases strongly.
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Affiliation(s)
- Federica Barbagallo
- Department of Clinical and Experimental Medicine, University of Catania, 95123, Catania, Italy
| | - Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, 95123, Catania, Italy
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Rosita A Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, 95123, Catania, Italy
| | - Laura Cucinella
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 2700, Pavia, Italy
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, 2700, Pavia, Italy
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, 95123, Catania, Italy
| | - Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 2700, Pavia, Italy
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, 2700, Pavia, Italy
| | - Aldo E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, 95123, Catania, Italy
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Bottorff EC, Gupta P, Ippolito GM, Moore MB, Rodriguez GM, Bruns TM. Short-term Dorsal Genital Nerve Stimulation Increases Subjective Arousal in Women With and Without Spinal Cord Injury: A Preliminary Investigation. Neuromodulation 2024:S1094-7159(24)00059-X. [PMID: 38573280 DOI: 10.1016/j.neurom.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 12/23/2023] [Accepted: 02/13/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVES Female sexual dysfunction (FSD) affects an estimated 40% of women. Unfortunately, FSD is understudied, leading to limited treatment options for FSD. Neuromodulation has shown some success in alleviating FSD symptoms. We developed a pilot study to investigate the short-term effect of electrical stimulation of the dorsal genital nerve and tibial nerve on sexual arousal in healthy women, women with FSD, and women with spinal cord injury (SCI) and FSD. MATERIALS AND METHODS This study comprises a randomized crossover design in three groups: women with SCI, women with non-neurogenic FSD, and women without FSD or SCI. The primary outcome measure was change in vaginal pulse amplitude (VPA) from baseline. Secondary outcome measures were changes in subjective arousal, heart rate, and mean arterial pressure from baseline. Participants attended one or two study sessions where they received either transcutaneous dorsal genital nerve stimulation (DGNS) or tibial nerve stimulation (TNS). At each session, a vaginal photoplethysmography sensor was used to measure VPA. Participants also rated their level of subjective arousal and were asked to report any pelvic sensations. RESULTS We found that subjective arousal increased significantly from before to after stimulation in DGNS study sessions across all women. TNS had no effect on subjective arousal. There were significant differences in VPA between baseline and stimulation, baseline and recovery, and stimulation and recovery periods among participants, but there were no trends across groups or stimulation type. Two participants with complete SCIs experienced genital sensations. CONCLUSIONS To our knowledge, this is the first study to measure sexual arousal in response to short-term neuromodulation in women. This study indicates that short-term DGNS but not TNS can increase subjective arousal, but the effect of stimulation on genital arousal is inconclusive. This study provides further support for DGNS as a treatment for FSD.
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Affiliation(s)
- Elizabeth C Bottorff
- Biomedical Engineering Department, University of Michigan, Ann Arbor, MI, USA; Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
| | - Priyanka Gupta
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | | | - Mackenzie B Moore
- Biomedical Engineering Department, University of Michigan, Ann Arbor, MI, USA; Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
| | - Gianna M Rodriguez
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Tim M Bruns
- Biomedical Engineering Department, University of Michigan, Ann Arbor, MI, USA; Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA.
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Barbagallo F, Cucinella L, Tiranini L, Chedraui P, Calogero AE, Nappi RE. Obesity and sexual health: focus on postmenopausal women. Climacteric 2024; 27:122-136. [PMID: 38251874 DOI: 10.1080/13697137.2024.2302429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024]
Abstract
Menopause is a cardiometabolic transition with many women experiencing weight gain and redistribution of body fat. Hormonal changes may affect also several dimensions of well-being, including sexual function, with a high rate of female sexual dysfunction (FSD), which displays a multifactorial etiology. The most important biological factors range from chronic low-grade inflammation, associated with hypertrophic adipocytes that may translate into endothelial dysfunction and compromised blood flow through the genitourinary system, to insulin resistance and other neuroendocrine mechanisms targeting the sexual response. Psychosocial factors include poor body image, mood disorders, low self-esteem and life satisfaction, as well as partner's health and quality of relationship, and social stigma. Even unhealthy lifestyle, chronic conditions and putative weight-promoting medications may play a role. The aim of the present narrative review is to update and summarize the state of the art on the link between obesity and FSD in postmenopausal women, pointing to the paucity of high-quality studies and the need for further research with validated end points to assess both biomarkers of obesity and FSD. In addition, we provide general information on the diagnosis and treatment of FSD at menopause with a focus on dietary interventions, physical activity, anti-obesity drugs and bariatric surgery.
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Affiliation(s)
- F Barbagallo
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - L Cucinella
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy
| | - L Tiranini
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - P Chedraui
- Escuela de Posgrados en Salud, Universidad Espíritu Santo, Samborondón, Ecuador
| | - A E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - R E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy
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Yavuzkir Ş, Aslan M, Yurt N, Baykara S. Association between non-penetrative sexual activities and depression in women with vaginismus: a cross-sectional study. J Int Med Res 2024; 52:3000605241244762. [PMID: 38676541 DOI: 10.1177/03000605241244762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024] Open
Abstract
OBJECTIVE This cross-sectional study aimed to explore the association between non-penetrative sexual activities (NPSA) and depression levels in women diagnosed with vaginismus. METHODS A cross-sectional retrospective study was conducted between March 2016 and June 2019, after approval by the Fırat University Faculty of Medicine ethics committee. Participants comprised married women referred to our female sexual dysfunction outpatient clinic with vaginismus. Diagnosis of vaginismus was established following comprehensive evaluations, including gynecological examination and psychiatric assessment. Sociodemographic data and Beck Depression Inventory (BDI) scores were collected. We compared depression levels between women who engaged in NPSA and those who did not. RESULTS Of the 75 women with primary vaginismus included in the study, 18 did not engage in any NPSA and 57 engaged in at least one NPSA. The average BDI score of those who engaged in NPSA was significantly lower than those who did not. A negative correlation was found between the number of NPSA engaged in and BDI scores (r = -0.494). CONCLUSIONS Women with vaginismus had high depression scores, but engaging in NPSA was associated with lower depression levels. The findings suggest that incorporating NPSA into clinical interventions may be beneficial for managing depression in women with vaginismus.
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Affiliation(s)
- Şeyda Yavuzkir
- Obstetrics and Gynecology Department, Fırat University, Elazığ, Turkey
| | - Melike Aslan
- Obstetrics and Gynecology Department, Fırat University, Elazığ, Turkey
| | - Nurdan Yurt
- Obstetrics and Gynecology Department, Fırat University, Elazığ, Turkey
| | - Sema Baykara
- Psychiatry Department, Fırat University, Elazığ, Turkey
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Gupta P, Doherty L, Temprosa M, Pop-Busui R, Gadde KM, Singh P, Owora AH, Wessells H, Sarma AV. Prevalence and predictors of female sexual dysfunction among sexually active women in the diabetes prevention program outcomes study. Neurourol Urodyn 2024; 43:977-990. [PMID: 38501372 DOI: 10.1002/nau.25436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/30/2024] [Accepted: 02/19/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE To determine the burden and identify correlates of female sexual dysfunction (FSD) among women with prediabetes (PreD) and type 2 diabetes (T2D) enrolled in the Diabetes Prevention Program (DPP) Outcomes Study (DPPOS). METHODS The DPPOS visit included the Female Sexual Function Index (FSFI) to determine sexual function. Of 1464 participants, 1320 (90%) completed the (FSFI) and 426 were sexually active. A backward selection multivariable logistic regression model estimated the odds of FSD for sociodemographic, clinical, and diabetes-related covariates. RESULTS One hundred and eighty-five (43%) had a score of ≤26.55 and met the criteria for FSD. After adjustment for DPP treatment and age, urinary incontinence (UI) (odds ratio [OR] = 1.91, 95% confidence interval [CI] = 1.15-3.17) and hysterectomy (OR = 1.89, 95% CI = 1.01-3.53) were associated with increased odds of FSD. Increased body mass index was protective for FSD (OR = 0.93 per kg/m2, 95% CI = 0.89-0.96). Michigan Neuropathy Screening Instrument-based peripheral neuropathy (mean±SD scores 1.1±1.3 vs. 0.9±1.1, p < 0.0001) and Electrocardiogram (ECG)-based autonomic dysfunction measures (mean ± SD heart rate levels 64.3 ± 6.8 vs. 65.6 ± 10.2, p = 0.008) were associated with FSD. There were no differences in diabetes rates between women who did (66.5%) and did not (66%) have (p = 0.7). CONCLUSIONS FSD is prevalent in women with PreD and T2D. Our findings suggest that FSD is associated with neuropathic complications commonly observed in PreD and T2D.
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Affiliation(s)
- Priyanka Gupta
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Lindsay Doherty
- Department of Biostatistics and Bioinformatics, Biostatistics Center, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Marinella Temprosa
- Department of Biostatistics and Bioinformatics, Biostatistics Center, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Kishore M Gadde
- Department of Surgery, University of California Irvine, Orange, California, USA
| | - Prachi Singh
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana, USA
| | - Arthur H Owora
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, Indiana, USA
| | - Hunter Wessells
- Department of Urology and Diabetes, Research Center, University of Washington School of Medicine, Seattle, Washington, USA
| | - Aruna V Sarma
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
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Angulo J. Commentary on "Characteristics of systemic testosterone therapy for female hypoactive sexual desire disorder - a claims database analysis". J Sex Med 2024; 21:294-295. [PMID: 38441523 DOI: 10.1093/jsxmed/qdae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 04/04/2024]
Affiliation(s)
- Javier Angulo
- Servicio de Histología-Investigación, Unidad de Investigación Traslacional en Cardiología, Instituto Ramón y Cajal de Investigación Sanitaria-Universidad Francisco de Vitoria (IRYCIS-UFV), Hospital Universitario Ramón y Cajal, 28034-Madrid, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable, 28029-Madrid, Spain
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Saadedine M, Faubion SS, Grach SL, Nordhues HC, Kapoor E. Association between obesity and female sexual dysfunction: a review. Sex Med Rev 2024; 12:154-163. [PMID: 38112599 DOI: 10.1093/sxmrev/qead047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/20/2023] [Accepted: 10/26/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Obesity is a global health crisis that has been growing over the past few decades. The economic burden associated with obesity is substantial as it is associated with multiple disabling chronic diseases, such as cardiovascular disease, certain cancers, osteoarthritis, chronic pain, and mental illness. Obesity is known to be a risk factor for sexual dysfunction in men, but this association is less well understood in women. AIMS To provide a narrative review of the available literature on the relationship between overweight/obesity and female sexual dysfunction, elaborate on the possible mechanisms explaining this association, and discuss the effects of weight loss on sexual function in those with obesity. METHODS A search of the medical literature was carried out in PubMed and Medline, focusing on original research and systematic reviews of original research on obesity and sexual function in women. RESULTS The relationship between obesity and female sexual function is not consistent across studies. While women with obesity are more likely to have worse sexual function and avoid sexual activity, many studies have failed to identify these associations. Lifestyle changes resulting in weight loss lead to better sexual function, and bariatric surgery has been shown to improve sexual function in the first couple of years following the procedure; yet, the long-term effects of weight loss and bariatric surgery are still uncertain. CONCLUSIONS The evidence on the relationship between obesity and female sexual function is mixed. Nevertheless, weight loss has been shown to improve sexual function in women with obesity. The impact of weight loss medications and the long-term effect of bariatric surgery on female sexual function require further study.
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Affiliation(s)
- Mariam Saadedine
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL 32224, United States
- Center for Women's Health, Mayo Clinic, Rochester, MN 55905, United States
| | - Stephanie S Faubion
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL 32224, United States
- Center for Women's Health, Mayo Clinic, Rochester, MN 55905, United States
| | - Stephanie L Grach
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Hannah C Nordhues
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Ekta Kapoor
- Center for Women's Health, Mayo Clinic, Rochester, MN 55905, United States
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, United States
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN 55905, United States
- Women's Health Research Center, Rochester, MN 55905, United States
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Krapf JM, Goldstein AT. Combined estrogen-progestin oral contraceptives and female sexuality: an updated review. Sex Med Rev 2024:qeae011. [PMID: 38515302 DOI: 10.1093/sxmrev/qeae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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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Krapf JM, Kopits I, Holloway J, Lorenzini S, Mautz T, Goldstein AT. Efficacy of in-office lysis of clitoral adhesions with excision of keratin pearls on clitoral pain and sexual function: a pre-post interventional study. J Sex Med 2024:qdae034. [PMID: 38515327 DOI: 10.1093/jsxmed/qdae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 01/08/2024] [Accepted: 02/04/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Keratin pearls are foci of central keratinization within concentric layers of squamous cells that can form under the clitoral prepuce and cause pain (clitorodynia); in-office removal of keratin pearls may reduce clitoral pain and improve sexual function. AIM This study aims to investigate clitoral pain and sexual function in women with partial clitoral phimosis and keratin pearls before and after in-office lysis of clitoral adhesions with keratin pearl excision (LCA-KPE). METHODS A pre-post interventional study evaluated patients who underwent LCA-KPE between January 2017 and February 2023 in 2 metropolitan gynecology clinics specializing in vulvar pain. Patients presenting with keratin pearls and partial clitoral phimosis identified through retrospective chart review were asked to complete postprocedure questionnaires and provide subjective responses on clitoral discomfort, sexual function, sexual distress, and their experience with in-office LCA-KPE. Bivariate analyses with paired t tests were conducted to determine the effect of LCA-KPE. Qualitative data were analyzed with thematic coding. OUTCOMES An 11-point pain visual analog scale was utilized to determine pre- and postprocedure clitoral discomfort and difficulty with orgasm. Female sexual dysfunction was measured with the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised. RESULTS A total of 32 of 74 patients who met inclusion criteria completed postprocedure surveys (43% response rate). Mean clitoral pain for respondents was 6.91 at baseline and 2.50 after LCA-KPE (P < .001). Mean difficulty with orgasm was significantly decreased from 5.45 at baseline to 3.13 after LCA-KPE (P < .001). Participants had a mean FSFI total score of 17.68 after treatment compared with a mean total baseline FSFI of 12.12 (P = .017). The mean FSFI score for pain was 2.43 at follow-up compared with 1.37 at baseline (P = .049). There was no significant difference in the mean Female Sexual Distress Scale-Revised score before vs after the procedure (P = .27). Qualitative themes described the procedure as painful but worthwhile, with 77% of participants reporting the overall experience as positive. Recurrence rate overall was 28%, with a median of 2 repeat procedures. CLINICAL IMPLICATIONS Recognizing keratin pearls as a structural cause of clitoral pain and offering in-office treatment is an important tool in addressing clitorodynia and improving sexual function. STRENGTHS AND LIMITATIONS This is the largest study to date documenting the occurrence, identifying associated pain conditions, and evaluating procedural outcomes for clitoral keratin pearls. This study was limited by a relatively small sample size. CONCLUSION In-office LCA-KPE significantly reduced clitoral discomfort and difficulty with orgasm.
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Affiliation(s)
- Jill M Krapf
- Department of Gynecology, The Centers for Vulvovaginal Disorders, Washington DC 20037, United States
- Department of Obstetrics and Gynecology, George Washington University, Washington DC 20037, United States
| | - Isabella Kopits
- Department of Gynecology, The Centers for Vulvovaginal Disorders, Washington DC 20037, United States
| | - Jessica Holloway
- Department of Gynecology, The Centers for Vulvovaginal Disorders, Washington DC 20037, United States
| | - Sylvia Lorenzini
- Department of Gynecology, The Centers for Vulvovaginal Disorders, Washington DC 20037, United States
| | - Theodora Mautz
- Department of Gynecology, The Centers for Vulvovaginal Disorders, Washington DC 20037, United States
| | - Andrew T Goldstein
- Department of Gynecology, The Centers for Vulvovaginal Disorders, Washington DC 20037, United States
- Department of Obstetrics and Gynecology, George Washington University, Washington DC 20037, United States
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12
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Gong S, Yim S, Kabarriti A. Top 50 most cited articles about female sexual dysfunction: a bibliometric analysis. Sex Med Rev 2024:qeae013. [PMID: 38490968 DOI: 10.1093/sxmrev/qeae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/18/2024] [Accepted: 01/26/2024] [Indexed: 03/18/2024]
Abstract
INTRODUCTION Female sexual dysfunction (FSD) consists of low libido, sexual arousal problems, anorgasmia, and dyspareunia. Sexual function is an important aspect of life for many women and is closely correlated with overall well-being. FSD is often underrepresented in the academic space when compared with male sexual disorders, such as erectile dysfunction. As FSD spans many fields (eg, urology, gynecology, psychology), bibliometric analyses are an important resource to highlight landmark articles. OBJECTIVES To identify key articles about FSD by citation number and bibliometric analysis to facilitate future scholarly efforts into more FSD research. METHODS We searched for articles in the Web of Science Core Collection between 1900 and 2023 using terms specific to FSD. We identified relevant FSD articles and selected the top 50 most cited. A bibliometric analysis was performed to collect and analyze data about title, authorship, publication year, citation number, journal and impact factor, country and institution, study type, citation index, specialty, and conflict of interest. RESULTS An overall 6858 results were identified. The top 50 most cited articles were published between 1997 and 2014 in 12 countries, across 32 institutions, and in 20 journals. The United States produced the most articles. The Journal of Sexual Medicine published the most articles. The mean number of citations per article was 351.64. Observational studies were most common. More than half were sponsored. Of all the specialties, most articles were categorized as urology and nephrology. Research about FSD has been much less impactful than research about male sexual dysfunction, possibly owing to stigma and decreased clinical training. CONCLUSION As FSD covers many fields, bibliometric analyses are invaluable to understand the vast body of knowledge. We hope that this research emphasizes the lack of attention that FSD has had and that it provides health care professionals with a valuable tool to understand the trajectory of FSD to guide future education efforts.
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Affiliation(s)
- Susan Gong
- Department of Urology, State University of New York Downstate Health Science University, Brooklyn, NY 11203, United States
| | - Samuel Yim
- Department of Urology, State University of New York Downstate Health Science University, Brooklyn, NY 11203, United States
| | - Abdo Kabarriti
- Department of Urology, State University of New York Downstate Health Science University, Brooklyn, NY 11203, United States
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Lin YX, Kong WM. Effects of vaginal dilation therapy on vaginal condition and sexual function of endometrial cancer patients treated with radiotherapy after surgery. J Obstet Gynaecol Res 2024; 50:485-493. [PMID: 38097390 DOI: 10.1111/jog.15857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/29/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE This study aimed to evaluate the effect of vaginal dilation therapy on vaginal length, vaginal stenosis, vaginal elasticity, and sexual function of endometrial cancer patients treated with radiotherapy after surgery. METHODS A total of 117 women were enrolled in this study. They received 6 months of vaginal dilation therapy. We evaluated their vaginal length, vaginal diameter, vaginal elasticity, and sexual function before radiotherapy, after radiotherapy, and after 6 months of vaginal dilation therapy. Their vaginal condition was assessed by customized vaginal dilating molds. Their sexual function was assessed by female sexual function index. The SPSS 25 software was used to analyze all the data. RESULTS According to multivariate analysis, vaginal diameter (β = 0.300, 95% CI [0.217-1.446], p = 0.010) and sexual intercourse frequency before diagnosis (β = 0.424, 95% CI [0.164-0.733], p = 0.006) were significantly correlated with female sexual function after radiotherapy. Vaginal dilation therapy helped increase vaginal length, improve vaginal stenosis and sexual function (p < 0.05), though most of the figures at the end of the intervention did not fully return to those before radiotherapy. Noticeably, vaginal dilation therapy was ineffective in improving vaginal elasticity and the incidence rate of female sexual dysfunction (p > 0.05). Moreover, patients with medium or good vaginal elasticity benefited more from vaginal dilation therapy than patients with poor vaginal elasticity (p < 0.05). CONCLUSION Vaginal dilation therapy should be carried out timely and preventatively in endometrial cancer patients treated with radiotherapy after surgery to improve their vaginal condition and sexual function.
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Affiliation(s)
- Yu-Xuan Lin
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Wei-Min Kong
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
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Nappi RE, Martella S, Tiranini L, Cucinella L, Palacios S. Efficacy and safety of a device that combines multipolar radiofrequency with pulsed electromagnetic field for the treatment of vulvovaginal atrophy: a randomized, sham-controlled trial. J Sex Med 2024; 21:203-210. [PMID: 38286753 DOI: 10.1093/jsxmed/qdad166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/26/2023] [Accepted: 11/09/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Vulvovaginal atrophy (VVA) negatively affects the sexual well-being and quality of life of postmenopausal women, yet it is underreported and undertreated. AIM The study sought to investigate the efficacy and safety of a nonablative, noncoagulative multipolar radiofrequency (RF) and pulsed electromagnetic field-based device (PEMF) in treatment of symptoms related to VVA. METHODS Seventy-six women ≥19 years of age with symptoms associated with VVA were enrolled into this prospective, randomized, sham-controlled, multicenter clinical study. Subjects were randomized to receive 3 RF + PEMF treatments (active group) or sham treatments (sham group) delivered to vaginal tissue at monthly intervals. The Vaginal Health Index (VHI), along with the Female Sexual Function Index (FSFI), subject sexual satisfaction and vaginal laxity (VL) score, treatment-associated pain, and adverse events were assessed at 4 follow-up (FU) visits between 1 and 12 months after treatment. OUTCOMES Changes from baseline VHI, pH, FSFI, VL, and sexual satisfaction scores between the active and sham groups were compared before and after treatment. RESULTS Mean VHI scores in the active group were significantly better compared with the sham group after treatment at all but the last FU visit (P < .001). A greater decrease in pH (active over sham) was seen at 1 and 4 months after treatment (P < .05). FSFI improvement was shown in the active group; however, it was not significantly better than sham improvement at all FU visits. Subject sexual satisfaction in the active group showed better improvement over sham at all FU visits (P < .05), while VL evaluations saw greater improvement in the active group at 4, 6, and 12 months posttreatment (P < .05). Treatment satisfaction was greater in the active group and pain was minimal in both groups. No serious adverse effects were reported. CLINICAL IMPLICATIONS As a noninvasive alternative to traditional surgical and topical procedures, 3 sessions of noninvasive combination RF/PEMF safely demonstrated improvement in symptoms related to VVA. STRENGTHS AND LIMITATIONS This study was strengthened by the randomized, sham-controlled design; large sample size; and extended FU period. The study assessments were decreased at later FU visits due to the global COVID pandemic, and this was a key limitation to the study. CONCLUSION Nonablative, noncoagulative multipolar RF/PEMF therapy was safe, improved symptoms associated with VVA, and improved female sexual function while yielding high subject satisfaction.
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Affiliation(s)
- Rossella E Nappi
- University of Pavia, Pavia 27100, Italy
- IRCCS Policlinico San Matteo, Pavia 27100, Italy
| | - Silvia Martella
- Unit of Preventative Gynecology, IRCCS European Institute of Oncology, Milan 20141, Italy
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15
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Fukumoto Y. Impact of Female Sexual Dysfunction on Cardiovascular Diseases. Eur J Prev Cardiol 2024:zwae051. [PMID: 38365264 DOI: 10.1093/eurjpc/zwae051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 02/06/2024] [Indexed: 02/18/2024]
Affiliation(s)
- Yoshihiro Fukumoto
- From the Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
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Abdus-Salam RA, Idowu OC, Akinlusi FM, Bello Y, Morhason-Bello IO. Effect of COVID-19 on sexual function and activities among reproductive-age women in Ibadan, South-West Nigeria. Sex Med 2024; 12:qfae004. [PMID: 38390285 PMCID: PMC10881290 DOI: 10.1093/sexmed/qfae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/29/2023] [Accepted: 01/16/2024] [Indexed: 02/24/2024] Open
Abstract
Background Since the outbreak of COVID-19 disease, the environment, families, individuals, and their ways of living have been affected. Social distancing was one of the strategies for the prevention of SARS-CoV-2 infection. It led to limited social interactions for fear of contracting the infection, which ultimately affected relationships, among which is sexual health. Aim To determine the risk of female sexual dysfunction and the effect of the COVID-19 pandemic on sexual function and activities among women of reproductive age in Ibadan, South-West Nigeria. Methods This cross-sectional study of 218 reproductive-age women evaluated the sexual function before, during, and after the COVID-19 disease pandemic and lockdown. Pretested semistructured self-administered questionnaires with the Female Sexual Function Index (FSFI) were used for data collection. Information collected included sociodemographic and gynecologic characteristics and COVID-19 experiences, as well as sexual history and function before, during, and after the COVID-19 pandemic lockdown. The level of significance was set at P < .05. Outcomes Respondents were aged 20 to 50 years (95%) with a mean ± SD age of 34.82 ± 8.52 years; the majority were married (75.58%); one-fifth (21.9%) tested positive for COVID-19 infection; and participants who tested positive for COVID-19 infections were mostly health care workers. Results An absence of sexual activity was reported in 9.18% of participants during lockdown, 7.73% before lockdown, and 4.18% after lockdown. The risk of female sexual dysfunction was prevalent among participants, especially those who tested positive for COVID-19 infection. The prevalence was worse during the pandemic lockdown (53.57%) than before (48.39%) or after (51.61%), and a similar pattern was seen among those who tested negative. There was no statistically significant difference in risk of developing sexual dysfunction during the COVID-19 pandemic between those who tested positive and negative to COVID-19. The arousal and desire domains contributed the highest proportion of low FSFI scores. Clinical Implications Nationwide lockdowns, which may be a method of control for pandemics, may result in psychosocial complications such as female sexual dysfunction. Strength and Limitations Most respondents had tertiary education and were able to respond to self-administered questionnaires, yet the risk of recall bias remains a concern whereas the pandemic met the world unprepared and baseline FSFI prior the pandemic was not available for participants. There are no local validation studies for the FSFI in Nigeria, which could have aided interpretation of results. Conclusion A low FSFI score is prevalent in Ibadan, South-West Nigeria, with a higher incidence reported during the COVID-19 pandemic lockdown.
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Affiliation(s)
- Rukiyat Adeola Abdus-Salam
- Department of Obstetrics and Gynaecology, University College Hospital, Ibadan 200212, Nigeria
- Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan 200005, Nigeria
| | - Oluwasegun Caleb Idowu
- Department of Obstetrics and Gynaecology, University College Hospital, Ibadan 200212, Nigeria
| | - Fatimat Motunrayo Akinlusi
- Department of Obstetrics and Gynecology, Lagos State University College of Medicine/Lagos State University Teaching Hospital, Ikeja 100254, Nigeria
| | - Yusuf Bello
- Department of Statistics, Faculty of Science, University of Ibadan, Ibadan 200005, Nigeria
- Institute of Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan 200212, Nigeria
| | - Imran Oludare Morhason-Bello
- Department of Obstetrics and Gynaecology, University College Hospital, Ibadan 200212, Nigeria
- Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan 200005, Nigeria
- Institute of Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan 200212, Nigeria
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17
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Zulfikaroglu EE. The Comparison of Patient Characteristics, Therapy Outcome, and Sexual Functions in Vaginismus Patients Prior to and During the COVID-19 Pandemic. Cureus 2024; 16:e52612. [PMID: 38374859 PMCID: PMC10875713 DOI: 10.7759/cureus.52612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2024] [Indexed: 02/21/2024] Open
Abstract
Background The objective of this study conducted at one center is to compare the demographic features and female sexual functions of patients treated for vaginismus before the COVID-19 pandemic to those treated for vaginismus during the pandemic. Aim Additionally, the study intends to evaluate the results of vaginismus therapy and assess the post-treatment sexual functioning of women. Methods A retrospective analysis was conducted on the medical records of patients diagnosed with vaginismus who sought treatment between March 2018 and March 2022. The enrolled patients were categorized into two groups: the pre-COVID-19 group and the COVID-19 group. The following data have been collected: age, education level, occupation, and marriage duration. After three months of treatment, the patients were called for a follow-up examination and evaluation of their sexual functions. Outcomes Compared to the pre-COVID-19 group, an increase of 52.51% was observed in the number of patients admitted for treatment in the COVID-19 group. Results The severity of vaginismus in the patients was similar in both groups. There were no statistically significant changes observed in any of the areas of the Female Sexual Function Index (FSFI) scale. Clinical implications According to our findings, there was no significant difference in female sexual functioning between women who had vaginismus treatment during the pandemic and those who underwent pre-pandemic treatment. Strengths and limitations The research sample comprised women who sought medical care at our women's health clinic. Conclusions We believe that vaginismus patients who had previously avoided seeking treatment are now seeking it during the pandemic.
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Alharbi A, Alomar TH, Alharbi TS, Alamri RS, Alharbi AK, Almadani BS. Saudi Female Sexual Dysfunction After Bariatric Surgery: A Cross-Sectional Survey. Cureus 2024; 16:e53196. [PMID: 38425602 PMCID: PMC10902206 DOI: 10.7759/cureus.53196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Background Obesity disrupts the equilibrium of sexual hormones, resulting in decreased sexual desire, arousal, and orgasm. The aim of this study was to investigate the effects of substantial weight loss after bariatric surgery on sexual function, psychological health, and the overall quality of sexual life in a group of Saudi females. Method The study used a cross-sectional design and was conducted at King Fahad Hospital in Medina, Saudi Arabia. The study included adult female patients who had previously undergone bariatric surgery. We used the Sexual Quality of Life for Female (SQoL-F) and the Female Sexual Function Index (FSFI) questionnaires to collect data. The study was extended from January 1, 2021, to December 30, 2022. Results A total of 100 participants were included in this study, all the samples underwent vertical sleeve gastrectomy, their mean age was 36.7±9.3, 94% (n=94) of the respondents had high school education or above, 50.0% (n=50) were unemployed, and around 13% (n=13) of the samples had a psychiatric history. Surgery complications were reported in 10% (n=10), which were reported as esophagitis (n=4), gastric ulcer (n=2), gastric stricture (n=1), infection (n=2), and leakage (n=1). The median of the FSFI and SQoL-F was 47.0 and 24.5, respectively. Approximately 66% of the respondents agreed that their sexual lives improved after surgery, 22% did not feel any difference before and after surgery, and 9% witnessed deterioration. In total, 61.0% had female sexual dysfunction (FSD) (25% had no dysfunction afterward, 45% had mild dysfunction, 27% suffered mild to moderate dysfunction, and only 2% had severe dysfunction). Regarding SQoL-F, the mean score was 5.59 for sexual repression, 6.1 for self-worthlessness, 18.56 for sexual and relationship satisfaction, and 16.4 for psychological feelings. Conclusions Bariatric surgery was associated with the improvement of female sexual function.
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Affiliation(s)
- Abdulhamid Alharbi
- General Surgery Obesity Center, King Fahad General Hospital, Medina, SAU
| | - Taif H Alomar
- Medicine, College of Medicine, Taibah University, Medina, SAU
| | - Taif S Alharbi
- Medicine and Surgery, College of Medicine, Taibah University, Medina, SAU
| | - Ranad S Alamri
- Medicine, College of Medicine, Taibah University, Medina, SAU
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Ward SA, Cornely RM, Mendiola M, Royce CS, Winkelman WD, Hacker MR, Anand M. Education in Female Sexual Function and Dysfunction among American Urogynecologic Society Members: An Unmet Need. South Med J 2024; 117:7-10. [PMID: 38151244 PMCID: PMC10756638 DOI: 10.14423/smj.0000000000001637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
OBJECTIVES Sexual function is an important component of women's health that has not been traditionally emphasized during medical training, suggesting that further education is needed to provide comprehensive patient care. The purpose of this study was to describe education and interest in female sexual function among urogynecology providers. METHODS Conducted in 2020, this was a cross-sectional survey of American Urogynecologic Society members assessing educational and clinical experience with female sexual function. RESULTS Of 642 members who opened the survey, 123 (19%) completed it. Most of the respondents were fellowship trained (70%), and 74% reported ≥10% of their patients had sexual function questions or concerns unrelated to prolapse or incontinence. Most (71%) of the members strongly agreed/agreed that they were comfortable evaluating and managing these patients. This was more common in providers who saw more patients (≥25%) with sexual function concerns (83%) compared with those who saw <25% (65%; P = 0.04). Most of the respondents reported receiving ≤1 lecture on normal sexual function (82%) or sexual dysfunction (85%) during medical training. Most (67%) would expand their practice if they received additional education. The most requested topics were disorders of desire (72%), orgasm (71%), and arousal (67%). The most common reasons for not expanding practice even with additional education were female sexual function not being of significant interest (30%) and time and interruption of practice flow (28%). CONCLUSIONS Most of the respondents felt comfortable caring for patients with sexual function concerns, but reported that they would expand their practice with additional education. The majority reported having received ≤1 female sexual function/dysfunction lecture during their medical training. This highlights a critical need and desire for more female sexual function education among the urogynecologic provider population.
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Affiliation(s)
- Sarah A. Ward
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
- Department of Obstetrics and Gynecology, Mount Auburn Hospital, Cambridge, Massachusetts
| | | | - Monica Mendiola
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
| | - Celeste S. Royce
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
| | - William D. Winkelman
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
- Department of Obstetrics and Gynecology, Mount Auburn Hospital, Cambridge, Massachusetts
| | - Michele R. Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
| | - Mallika Anand
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
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Bottorff EC, Gupta P, Ippolito GM, Moore MB, Rodriguez GM, Bruns TM. Acute dorsal genital nerve stimulation increases subjective arousal in women with and without spinal cord injury: a preliminary investigation. medRxiv 2023:2023.04.24.23288935. [PMID: 37163021 PMCID: PMC10168483 DOI: 10.1101/2023.04.24.23288935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Introduction Female sexual dysfunction (FSD) impacts an estimated 40% of women. Unfortunately, female sexual function is understudied, leading to limited treatment options for FSD. Neuromodulation has demonstrated some success in improving FSD symptoms. We developed a pilot study to investigate the short-term effect of electrical stimulation of the dorsal genital nerve and tibial nerve on sexual arousal in healthy women, women with FSD, and women with spinal cord injury (SCI) and FSD. Methods This study consists of a randomized crossover design in three groups: women with SCI, women with non-neurogenic FSD, and women without FSD or SCI. The primary outcome measure was change in vaginal pulse amplitude (VPA) from baseline. Secondary outcome measures were changes in subjective arousal, heart rate, and mean arterial pressure from baseline. Participants attended one or two study sessions where they received either transcutaneous dorsal genital nerve stimulation (DGNS) or tibial nerve stimulation (TNS). At each session, a vaginal photoplethysmography sensor was used to measure VPA. Participants also rated their level of subjective arousal and were asked to report any pelvic sensations. Results We found that subjective arousal increased significantly from before to after stimulation in DGNS study sessions across all women. TNS had no effect on subjective arousal. There were significant differences in VPA between baseline and stimulation, baseline and recovery, and stimulation and recovery periods among participants, but there were no trends across groups or stimulation type. Two participants with complete SCIs experienced genital sensations. Discussion This is the first study to measure sexual arousal in response to acute neuromodulation in women. This study demonstrates that acute DGNS, but not TNS, can increase subjective arousal, but the effect of stimulation on genital arousal is inconclusive. This study provides further support for DGNS as a treatment for female sexual dysfunction.
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Affiliation(s)
- Elizabeth C. Bottorff
- University of Michigan, Biomedical Engineering Department, Ann Arbor, MI, USA
- University of Michigan, Biointerfaces Institute, Ann Arbor, MI, USA
| | - Priyanka Gupta
- University of Michigan, Department of Urology, Ann Arbor, MI, USA
| | | | - Mackenzie B. Moore
- University of Michigan, Biomedical Engineering Department, Ann Arbor, MI, USA
| | - Gianna M. Rodriguez
- University of Michigan, Department of Physical Medicine and Rehabilitation, Ann Arbor, MI, USA
| | - Tim M. Bruns
- University of Michigan, Biomedical Engineering Department, Ann Arbor, MI, USA
- University of Michigan, Biointerfaces Institute, Ann Arbor, MI, USA
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Wexler A, Dubinskaya A, Suyama J, Komisaruk BR, Anger J, Eilber K. Does MDMA have treatment potential in sexual dysfunction? A systematic review of outcomes across the female and male sexual response cycles. Sex Med Rev 2023; 12:26-34. [PMID: 37888490 DOI: 10.1093/sxmrev/qead046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023]
Abstract
INTRODUCTION Sexual health, an integral component of overall well-being, is frequently compromised by common yet underdiagnosed sexual dysfunctions. Traditional interventions encompass pharmaceutical and psychological treatments. Unconventional therapies, like MDMA, offer hope for sexual dysfunction. This review delves into MDMA's effects on sexual responsiveness and its potential role in treating sexual dysfunction. OBJECTIVES The purpose of this review is to elucidate effects of MDMA on different domains of the female and male sexual response cycles. METHODS We conducted a systematic review on the effects of MDMA on each domain of the female and male sexual response cycles. PubMed, MEDLINE, and EMBASE were queried, and results were screened using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Search terms utilized were "MDMA" or "ecstasy" in combination with "desire," "arousal," "lubrication," "orgasm," "pleasure," "libido," "erection," and "ejaculation." Inclusion criteria for this review were MDMA use by study subjects and sexual outcomes in at least 1 domain of the female and/or male sexual response cycles were described and measured. Randomized controlled trials, cohort studies (both prospective and retrospective), surveys, and literature reviews published between January 2000 and June 2022 were included. Case reports and studies that did not address conditions of interest were excluded from analysis. Duplicated search results were screened out. The remaining studies were then read in full text to ensure they met inclusion and exclusion criteria for analysis. RESULTS We identified 181 studies, of which 6 met criteria for assessment of the female sexual response cycle and 8 met criteria for assessment of the male sexual response cycle. Four of 6 studies reported increased sexual desire with MDMA use among women. Arousal and lubrication were improved with MDMA use in 3 of 4 studies, but they were not affected in 1 randomized control study. In men, 7 studies evaluated the effects of MDMA on desire and/or arousal, 5 studies measured impact on erection, 3 on orgasm, and 2 on ejaculation. Sixty percent of interview-based studies reported increased sexual desire in men, while 40% reported mixed or no effect. Two studies reported impairment of erection, 2 reported mixed effects, and 1 reported fear of erection impairment. In both men and women, all studies evaluating orgasm reported delay in achieving orgasm but increased intensity and pleasure if achieved. Primary outcome measures were variable and largely qualitative. CONCLUSION Our findings suggest that MDMA generally increases sexual desire and intensifies orgasm when achieved. While producing conflicting evidence on sexual arousal in both sexes, MDMA may impair erectile and ejaculatory function in men.
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Affiliation(s)
- Ava Wexler
- The Hebrew University- Hadassah Medical School, Jerusalem, 9112001, Israel
| | - Alexandra Dubinskaya
- Los Angeles Institute for Pelvic and Sexual Medicine, Beverly Hills, CA, 90210, United States
| | - Julie Suyama
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, CA, 90213, United States
| | - Barry R Komisaruk
- Psychology Department, Rutgers University, Newark, NJ, 07102, United States
| | - Jennifer Anger
- Division of Gender Affirming Surgery, Urologic Reconstruction, and Female Pelvic Medicine, Department of Urology, University of California San Diego, La Jolla, CA, 92093, United States
| | - Karyn Eilber
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Beverly Hills, 90048, CA, United States
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22
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Maseroli E, Vignozzi L, Reisman Y. Clitoris color Doppler ultrasound: a 2023 update. J Sex Med 2023; 20:1367-1368. [PMID: 38037428 DOI: 10.1093/jsxmed/qdad140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/11/2023] [Accepted: 10/01/2023] [Indexed: 12/02/2023]
Affiliation(s)
- Elisa Maseroli
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Florence 6772829, Italy
| | - Linda Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Florence 6772829, Italy
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence 6772829, Italy
| | - Yacov Reisman
- Sexual Medicine, Flare-Health, Amsterdam, Netherlands Oudezijds Achterburgwal 141-D, 1012DG Amsterdam, Netherlands
- Center for Sexual Health, Reuth Rehabilitation Hospital, Tel-Aviv, 6772829, Israel
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23
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Dankova I, Pyrgidis N, Tishukov M, Georgiadou E, Nigdelis MP, Solomayer EF, Marcon J, Stief CG, Hatzichristou D. Efficacy and Safety of Platelet-Rich Plasma Injections for the Treatment of Female Sexual Dysfunction and Stress Urinary Incontinence: A Systematic Review. Biomedicines 2023; 11:2919. [PMID: 38001920 PMCID: PMC10669888 DOI: 10.3390/biomedicines11112919] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/17/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023] Open
Abstract
Introduction: There is no clear evidence in the literature that platelet-rich plasma (PRP) injections improve female sexual dysfunction (FSD) and female stress urinary incontinence (SUI). Objectives: A systematic review was performed to study the efficacy and safety of PRP injections in women with the above pathologies, as well as to explore the optimal dosing, frequency and area of injections, and duration of treatment. Methods: A systematic search on PubMed, Embase and the Cochrane Library database was performed, as well as sources of grey literature from the date of database or source creation to January 2023. After title/abstract and full-text screening, clinical studies on humans evaluating the efficacy of PRP in gynecological disorders using standardized tools were included. Risk of bias was undertaken with RoB-2 for randomized-controlled trials (RCT) and the Newcastle-Ottawa Scale (NOS) for observational studies. Results: Four prospective and one retrospective study explored FSD, while six prospective and one RCT evaluated female SUI. A total of 327 women with a mean age of 51 ± 12 years were included. For FSD, PRP significantly improved the Female Sexual Function Index (FSFI), the Vaginal Health Index (VHI) and the Female Sexual Distress score (FSDS). For SUI, PRP led to a significant improvement in the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and the Urogenital Distress Inventory (UDI-6). The identified RCT reported a significantly higher mean score of ICIQ-SF (p < 0.05) and UDI-6 (p < 0.01) in the midurethral sling group compared to the PRP injections group. Regarding the risk of bias, the RCT was characterized by high risk, whereas the observational studies were of moderate risk. The protocol for PRP injections for FSD is the injection of 2 mL of PRP into the distal anterior vaginal wall once a month for 3 months. For female SUI, 5-6 mL of PRP should be injected into the periurethral area once a month for 3 months. Conclusions: Despite the promising initial results of PRP injections, the level of current evidence is low due to methodological issues in the available studies. It becomes clear that there is an emerging need for high-quality research examining PRP injections for the treatment of FSD and female SUI.
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Affiliation(s)
- Irina Dankova
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece (M.T.)
| | - Nikolaos Pyrgidis
- Department of Urology, University Hospital, LMU Munich, 81377 Munich, Germany; (J.M.); (C.G.S.)
| | - Maksim Tishukov
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece (M.T.)
| | - Efstratia Georgiadou
- Department of Gynecology & Obstetrics, Buelach Hospital, 8180 Bülach, Switzerland;
| | - Meletios P. Nigdelis
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, 66421 Homburg, Germany; (M.P.N.); (E.-F.S.)
| | - Erich-Franz Solomayer
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, 66421 Homburg, Germany; (M.P.N.); (E.-F.S.)
| | - Julian Marcon
- Department of Urology, University Hospital, LMU Munich, 81377 Munich, Germany; (J.M.); (C.G.S.)
| | - Christian G. Stief
- Department of Urology, University Hospital, LMU Munich, 81377 Munich, Germany; (J.M.); (C.G.S.)
| | - Dimitrios Hatzichristou
- First Department of Urology, G. Gennimatas Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
- Institute for the Study of Urological Diseases, 54622 Thessaloniki, Greece
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24
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Granero-Molina J, Jiménez-Lasserrotte MDM, Dobarrio-Sanz I, Correa-Casado M, Ramos-Rodríguez C, Romero-Alcalá P. Sexuality in Women with Fibromyalgia Syndrome: A Metasynthesis of Qualitative Studies. Healthcare (Basel) 2023; 11:2762. [PMID: 37893837 PMCID: PMC10606292 DOI: 10.3390/healthcare11202762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/13/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
Fibromyalgia syndrome (FMS) is a nonarticular rheumatic syndrome which presents as chronic musculoskeletal pain, stiffness and body aches. FMS affects approximately 2.5% of the population, mostly women. FMS causes physical and psychological problems and reduces quality of life. The objective of this study is to identify qualitative evidence about experiences of women diagnosed with FMS about their sexuality. METHODS Metasynthesis of qualitative studies. The search included articles published between 2000 and June 2023 on the PubMed, WOS, CINAHL, SCOPUS, and SCIELO databases. RESULTS 450 articles were found through the initial search, of which, only nine fulfilled the criteria and were included in the thematic synthesis. From this analysis, three main themes emerged: (1) "I want to, but I can't": FMS causes a shift in feminine sexuality. (2) Resetting sex life and intimacy. (3) Taking charge of a "new sexuality." CONCLUSIONS Women with FMS suffer from limitations of their sexuality that affect their partner. Pain, stiffness and a loss of desire make sexual encounters difficult. Becoming aware of this and striving not to lose their sexuality is key to coping with this problem. Women and their sexual partners can change roles and encourage communication, games, foreplay or touching. The use of lubricants, physical exercise and complementary therapies, along with social, professional and partner support, are key to coping with FMS.
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Affiliation(s)
- José Granero-Molina
- Nursing, Physiotheraphy and Medicine Department, University of Almería, 04120 Almería, Spain; (J.G.-M.); (I.D.-S.); (M.C.-C.)
- Faculty of Health Sciences, Universidad Autónoma de Chile, Santiago 7500000, Chile
| | | | - Iria Dobarrio-Sanz
- Nursing, Physiotheraphy and Medicine Department, University of Almería, 04120 Almería, Spain; (J.G.-M.); (I.D.-S.); (M.C.-C.)
| | - Matías Correa-Casado
- Nursing, Physiotheraphy and Medicine Department, University of Almería, 04120 Almería, Spain; (J.G.-M.); (I.D.-S.); (M.C.-C.)
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25
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Szymanska E, Kisielewski R. Female sexual functioning during pregnancy. Ginekol Pol 2023:VM/OJS/J/93464. [PMID: 37842988 DOI: 10.5603/gpl.93464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/12/2023] [Indexed: 10/17/2023] Open
Abstract
Sexuality is a fundamental, biological function of every human body, regardless of age, gender or race. However, the need for intimacy, closeness and sexual activity changes over time; it is influenced by the age, experience, physical and health condition. Sex is also one of the most important domains of the quality of life (QoL). However, this topic is still uneasy and rarely discussed, even though female sexual dysfunction (FSD) is a common problem, which affects 20% to 50% of women. Moreover, women experience processes that do not affect men, such as menstruation, pregnancy and menopause. In this review we focused on pregnancy, since sexual life of pregnant women alters during pregnancy due to the physiological, anatomical and hormonal changes in her body. Nonetheless, woman can keep having sex during a physiological pregnancy, but this issue is rarely addressed by physicians-gynecologists. Therefore, the aim of this manuscript was to discuss female sexuality during pregnancy.
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Affiliation(s)
| | - Rafal Kisielewski
- Department of Gynecologic Oncology, The Centre of Oncology, Bialystok, Poland
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26
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Berry WCE, Capbarat EV, Walker TV, Rosenberg SF, Keegan EA, Carter-Brooks CM, Cigna ST. Associations between gynecologic clinician type and routine female sexual dysfunction screening. J Sex Med 2023; 20:1235-1240. [PMID: 37553089 DOI: 10.1093/jsxmed/qdad106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Female sexual dysfunction (FSD) is a common problem in the United States; however, only 14% to 40% of women are screened by their health care clinicians. There are few data on how differences in clinician type affects screening rates. AIM This study aimed to assess differences in FSD screening rates among gynecology clinician types, identify factors associated with screening, and compare screening rates of FSD against conditions with established screening recommendations. METHODS Data were collected by retrospective chart review of annual visits at an urban tertiary care center. Screening rates for FSD, depression, cervical cancer, and breast cancer were calculated and compared. Multivariable logistic regression modeling was utilized to assess the correlation between various patient characteristics and FSD screening rates. OUTCOMES Study outcome measures included percentages of women who were screened for FSD, depression, cervical cancer, and breast cancer. RESULTS FSD screening rate was significantly higher among resident-level clinicians vs nonresident clinicians (59% vs 31%; P < .001). When the nonresident clinicians were subanalyzed, certified nursing midwives were the second most likely to screen for FSD (odds ratio [OR], 0.41), followed by nurse practitioners (OR, 0.29) and attending physicians (OR, 0.22). According to multivariable logistic regression techniques, 5 factors were associated with an increased likelihood of a patient being screened for FSD at an annual examination: patient seen by a resident physician rather than an attending physician, patient history of FSD, patient age ≥40 years, patient report of being sexually active at the time of visit, and patient history of cervical procedures. CLINICAL IMPLICATIONS There is an opportunity to improve FSD screening rates by clinicians. Future research may assess what factors, such as increased sexual function education or greater incentives to document FSD screening, may result in higher screening rates. From this, targeted and effective interventions might be crafted to improve future screening rates. STRENGTHS AND LIMITATIONS This study is one of the first to compare FSD screening rates among clinician types in the same specialty. Study limitations include the inherent limitations of a retrospective design, including selection biases. CONCLUSION Residents were more likely to screen for FSD at annual well-woman visits than attending clinicians, nurse practitioners, and certified nurse midwives. Understanding the reasons for varied FSD screening rates among clinician types may aid in the development of strategies to improve screening for this important aspect of women's health.
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Affiliation(s)
- William C E Berry
- The Department of Obstetrics and Gynecology, The George Washington University, Washington, DC, 20037, United States
- The Department of Obstetrics and Gynecology, W.C.E.B., School of Medicine, Indiana University, Indianapolis, IN 46202, United States
| | - Emily V Capbarat
- The Department of Obstetrics and Gynecology, The George Washington University, Washington, DC, 20037, United States
| | - Taniya V Walker
- The Department of Obstetrics and Gynecology, The George Washington University, Washington, DC, 20037, United States
| | - Sedona F Rosenberg
- The Department of Obstetrics and Gynecology, The George Washington University, Washington, DC, 20037, United States
| | - Emma A Keegan
- The Department of Obstetrics and Gynecology, The George Washington University, Washington, DC, 20037, United States
| | - Charelle M Carter-Brooks
- The Department of Obstetrics and Gynecology, The George Washington University, Washington, DC, 20037, United States
| | - Sarah T Cigna
- The Department of Obstetrics and Gynecology, The George Washington University, Washington, DC, 20037, United States
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27
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Saltzman RG, G Campbell K, J Ripps S, Golan R, Cabreja-Castillo MA, Garzon AM, Rahman F, Caceres LV, Tovar JA, Khan A, Hare JM, Ramasamy R. The impact of cell-based therapy on female sexual dysfunction: a systematic review and meta-analysis. Sex Med Rev 2023; 11:333-341. [PMID: 37279578 DOI: 10.1093/sxmrev/qead023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/04/2023] [Accepted: 05/07/2023] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Female sexual dysfunction (FSD) is a complex issue affecting women of all ages; it involves several overlapping body systems and profoundly affects quality of life. The use of cell-based therapy, such as mesenchymal stem cells, has recently been investigated as a potential treatment for FSD. OBJECTIVES This systematic review and meta-analysis aim to assess FSD outcomes following cell-based therapy. METHODS We evaluated peer-reviewed articles from multiple online databases through November 2022 to identify studies that used cell-based therapy and reported sexual function outcomes in women. We performed a meta-analysis using data pooled from 3 clinical trials at our institution: CRATUS (NCT02065245), ACESO (NCT02886884), and CERES (NCT03059355). All 3 trials collected data from the Sexual Quality of Life-Female (SQOL-F) questionnaire as an exploratory outcome. RESULTS Existing literature on this topic is scarce. Five clinical studies and 1 animal study were included in the systematic review, and only 2 clinical studies were considered good quality: 1 reported significant SQOL-F improvement in women 6 months after cell therapy, and 1 reported posttherapy sexual satisfaction in all women. When individual patient data were pooled in a meta-analysis from 29 women across 3 trials at our institution, the SQOL-F was not significantly improved. CONCLUSION Despite growing interest in cell-based therapy for women's sexual health, this important issue is understudied in the literature. The optimal route, source, and dose of cell therapy to produce clinically meaningful change have yet to be determined, and further research is needed in larger randomized placebo-controlled clinical trials.
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Affiliation(s)
- Russell G Saltzman
- Interdisciplinary Stem Cell Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, United States
| | - Katherine G Campbell
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, United States
| | - Sarah J Ripps
- College of Medicine, Florida State University, Tallahassee, FL 32304, United States
| | - Roei Golan
- College of Medicine, Florida State University, Tallahassee, FL 32304, United States
| | - Maria A Cabreja-Castillo
- Interdisciplinary Stem Cell Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, United States
| | - Ana Maria Garzon
- Interdisciplinary Stem Cell Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, United States
| | - Farah Rahman
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, United States
| | - Lina V Caceres
- Interdisciplinary Stem Cell Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, United States
| | - Jairo A Tovar
- Interdisciplinary Stem Cell Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, United States
| | - Aisha Khan
- Interdisciplinary Stem Cell Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, United States
| | - Joshua M Hare
- Interdisciplinary Stem Cell Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, United States
- Division of Cardiovascular Medicine, Miller School of Medicine, University of Miami, Miami, FL 33136, 33136. United States
| | - Ranjith Ramasamy
- Interdisciplinary Stem Cell Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, United States
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, United States
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28
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Wang N, Li H. Therapeutic effect of the temperature-controlled radio frequency technology in female sexual dysfunction. Ginekol Pol 2023:VM/OJS/J/94788. [PMID: 37642251 DOI: 10.5603/gpl.94788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/12/2023] [Accepted: 07/19/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES To explore the therapeutic effect of the temperature-controlled radiofrequency technology in female sexual dysfunction (FSD). MATERIAL AND METHODS From July 2020 to June 2021, patients with FSD who visited the Gynecology Clinic of Peking University Shenzhen Hospital were treated with the temperature-controlled radiofrequency technology once every two weeks, for a total of five times. The therapeutic effect was objectively evaluated with pelvic floor dysfunction (PFD) indicators (FSFI score, pelvic floor muscles surface electromyography, sexual function test). The pre- and post-treatment (2 weeks)/follow-up (3 months) results were compared to evaluate the feasibility of this technology for treating FSD, as well as using PFD-related indicators in objective evaluation of FSD patients. RESULTS Fifty patients completed treatment; 31 patients completed follow-up. The mean FSFI score for post-treatment/follow-up was significantly higher than pre-treatment (p < 0.05). There were no significant changes in the mean pelvic floor resting surface myoelectric potential and its variability and mean myoelectric potential of sexual function test between pre- and post-treatment/follow-up. The mean surface myoelectric potential of the patients' type I and II muscle fibers of the pelvic floor for post-treatment/follow-up was significantly higher than pre-treatment (p < 0.05). The mean peak myoelectric potential for post-treatment was significantly higher than pre-treatment (p < 0.05). CONCLUSIONS Temperature-controlled radiofrequency technology has a certain therapeutic effect on FSD. Pelvic floor surface electromyography and sexual function test can be used as an objective indicator for PFD in FSD patients. Subsequent studies may involve a larger size sample and evaluate the effect over a consecutive time-point, to develop a better therapeutic approach.
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Affiliation(s)
- Nan Wang
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Huan Li
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China.
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29
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Saadedine M, Faubion SS, Kling JM, Kuhle C, Shufelt CL, Mara K, Enders F, Kapoor E. History of infertility and sexual dysfunction in midlife women: Is there a link? J Sex Med 2023; 20:1188-1194. [PMID: 37537692 PMCID: PMC10472170 DOI: 10.1093/jsxmed/qdad097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/16/2023] [Accepted: 06/26/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Infertility has been linked with an increased risk of sexual dysfunction in reproductive-aged women, with longer periods of infertility associated with a greater risk. AIM The study's aim was to examine whether a history of infertility treatment in women is linked to sexual dysfunction during midlife. METHODS The cross-sectional study was conducted among sexually active women, between the ages of 45 and 65 years, who sought consultation at the women's health clinics at a US tertiary care center. History of infertility treatment was assessed with a single question that asked participants if they were treated for infertility in the past. The association between a history of infertility treatment and sexual dysfunction-which was diagnosed by a combination of Female Sexual Function Index score ≤26.55 and Female Sexual Distress Scale-Revised score ≥11-was assessed in a multivariable logistic regression model that adjusted for multiple confounders. OUTCOMES The primary outcome was sexual dysfunction in midlife women. RESULTS The analysis included 5912 women, with a mean age of 54.1 years. Nearly 16% of women reported receiving treatment for infertility. More than half the women (55%) had sexual dysfunction: 56.3% of those with previous fertility treatments and 54.4% of those without any fertility treatment (P = .3). Receiving treatment for infertility in the younger years did not significantly increase the odds of sexual dysfunction in midlife in univariate (odds ratio, 1.08; 95% CI, 0.94-1.24; P = .3) and multivariable analyses (odds ratio, 1.11; 95% CI, 0.96-1.29; P = .17). CLINICAL IMPLICATIONS While infertility is known to be predictive of sexual dysfunction in women during their reproductive years, there was no association between a history of infertility treatment and sexual dysfunction in midlife women in the current study. STRENGTHS AND LIMITATIONS The study used validated questionnaires accounting for sexual complaints and distress and adjusted for multiple confounding factors. Limitations include the selection bias introduced by the study of women presenting for evaluation of sexual dysfunction, which may have been a result of factors stronger than the influence of infertility. Other limitations include the study's cross-sectional nature with suboptimal racial and ethnic representation. CONCLUSION Although infertility is commonly associated with female sexual dysfunction in women of reproductive age, the association was not present in midlife women in the current study.
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Affiliation(s)
- Mariam Saadedine
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, 32224, United States
- Center for Women’s Health, Mayo Clinic, Rochester, MN, 55905, United States
| | - Stephanie S Faubion
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, 32224, United States
- Center for Women’s Health, Mayo Clinic, Rochester, MN, 55905, United States
| | - Juliana M Kling
- Center for Women’s Health, Mayo Clinic, Rochester, MN, 55905, United States
- Division of Women’s Health Internal Medicine, Mayo Clinic, Scottsdale, AZ, 85259, United States
| | - Carol Kuhle
- Center for Women’s Health, Mayo Clinic, Rochester, MN, 55905, United States
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, 55905, United States
| | - Chrisandra L Shufelt
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, 32224, United States
- Center for Women’s Health, Mayo Clinic, Rochester, MN, 55905, United States
| | - Kristin Mara
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, 55905, United States
| | - Felicity Enders
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, 55905, United States
| | - Ekta Kapoor
- Center for Women’s Health, Mayo Clinic, Rochester, MN, 55905, United States
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, 55905, United States
- Women’s Health Research Center, Mayo Clinic, Rochester, MN, 55905, United States
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, 55905, United States
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30
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Codispoti N, Negris O, Myers MC, Petersen A, Nico E, Romanello JP, Rubin RS. Female sexual medicine: an assessment of medical school curricula in a major United States city. Sex Med 2023; 11:qfad051. [PMID: 37720816 PMCID: PMC10501464 DOI: 10.1093/sexmed/qfad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/04/2023] [Accepted: 08/09/2023] [Indexed: 09/19/2023] Open
Abstract
Background Although approximately 41% of women experience sexual dysfunction, limited education on female sexual medicine (FSM) in medical school results in underpreparedness among physicians when addressing these bothersome conditions. Aim This study aims to evaluate the extent to which FSM is represented in medical education by examining current preclinical and clinical curricula. Methods Preclinical curriculum materials on female sexual anatomy, physiology, and pathology, as well as obstetrics and gynecology clinical materials (syllabi, lecture materials, and supplemental resources), were collected from medical schools in the Chicago area. We utilized previous literature to identify specific components of medical school content to evaluate. Outcomes Upon reviewing each institution's curricula, we evaluated materials for topic saturation and assessed goals of each syllabus in terms of required content. Results Curriculum materials were collected from 7 medical schools. In the preclinical assessment, 1 institution identified all anatomic components of the clitoris in our review, 4 discussed the physiology of the female orgasm, 3 highlighted the prevalence and epidemiology of female sexual dysfunction (FSD), 3 addressed treatments for FSD, and 1 instructed a genitourinary physical exam specific to assessing FSD. When assessing obstetrics and gynecology clinical materials, 5 institutions included topics related to FSM. Of these, only 1 institution had corresponding required synchronous clerkship time dedicated to these topics as a 1-hour lecture, in addition to an optional online training to third-year clinical students in comprehensive sexual history-taking practices, including screening for FSD. One other institution offered supplemental case-based gynecology modules including vulvovaginal diseases and chronic pelvic pain, though sexual pleasure, arousal, and libido were not included. Clinical Implications The results of this study highlight the need for the inclusion of standardized curricula related to FSM in medical education to equip future physicians to treat patients with sexual dysfunction. Strengths and Limitations The strengths of this study include that it is the first of its kind to complete a comprehensive review of FSM curricula at a cohort of undergraduate medical institutions. Its limitations include a small sample size of 7 medical schools limited to 1 geographical area. Conclusion Our focused needs assessment of medical schools in the Chicago area reveals inconsistencies in outlined institution-specific course goals related to FSM and thus highlights the need for restructuring the curricula to prepare future physicians to recognize and treat patients with sexual dysfunction.
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Affiliation(s)
- Nicolette Codispoti
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, United States
| | - Olivia Negris
- Rush Medical College, Rush University, Chicago, IL 60612, United States
| | - Monica C Myers
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, United States
| | - Anna Petersen
- Rush Medical College, Rush University, Chicago, IL 60612, United States
| | - Elsa Nico
- University of Illinois College of Medicine at Chicago, Chicago, IL 60612, United States
| | | | - Rachel S Rubin
- Medstar Georgetown University Hospital, Department of Urology, Washington, DC 20007, United States
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Goddard B, Brucker B. Female sexual dysfunction in undergraduate medical education: a survey of U.S. medical students. Sex Med 2023; 11:qfad049. [PMID: 37692127 PMCID: PMC10484727 DOI: 10.1093/sexmed/qfad049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 07/29/2023] [Accepted: 08/03/2023] [Indexed: 09/12/2023] Open
Abstract
Background Physicians often report low levels of confidence in diagnosing and treating female sexual dysfunction (FSD), which may stem from inadequate education and exposure to the topic. Aim The study sought to determine the extent to which FSD is covered in undergraduate medical education and evaluate student comfort with the topic and familiarity with treatments. Methods We created a novel, 50-question survey to be administered online to any current U.S. medical student. Obstetrician-gynecologist clerkship directors at 146 U.S. medical schools were contacted and asked to invite any current student at their school to participate. A link to the electronic REDCap (Research Electronic Data Capture) survey was distributed to eligible students via the clerkship directors. The survey collected data regarding (1) coverage of FSD and male sexual dysfunction (MSD) in preclinical and clinical curricula, (2) student self-ratings of comfort in hypothetical scenarios in which a patient exhibits symptoms of FSD or MSD, and (3) student familiarity with treatments for FSD and MSD. Outcomes Outcomes included the proportion of students reporting that their school covered FSD/MSD in its preclinical/clinical curriculum, the mean comfort ratings for each of the FSD and MSD scenarios, and the proportion of students indicating knowledge of various FSD and MSD treatments. Results A smaller proportion of students (N = 236) reported receiving instruction in FSD (58.5%) compared with MSD (78.4%) in their preclinical curriculum (P < .001). Students' average self-ratings of comfort in the sexual dysfunction scenarios were significantly lower for patients with symptoms of FSD compared with MSD (P < .001). Students had higher average self-ratings of confidence in FSD scenarios if their intended specialty was obstetrician-gynecologist (P = .003), if their school included FSD in its clinical curriculum (P = .01), and if they had ever participated in the care of a patient with FSD (P = .006). Clinical Implications There are important gaps in the coverage of FSD in undergraduate medical education that may be mitigated through improvements to curriculum and increased exposure to patients with FSD. Strengths and Limitations This is the first study, to our knowledge, to directly survey medical students regarding their educational experience and comfort with FSD. Our study was limited by a small sample size, the use of a novel and nonvalidated questionnaire, and the potential for bias given our sampling method. Conclusion Medical schools must work toward improving instruction in FSD for their students to address these disparities and improve students' comfort with the topic.
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Affiliation(s)
- Brian Goddard
- Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA 19140, United States
| | - Benjamin Brucker
- Department of Urology, NYU Grossman School of Medicine, 550 First Avenue, New York, NY 10016, United States
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Gan L, Miao YM, Dong XJ, Zhang QR, Ren Q, Zhang N. Investigation on sexual function in young breast cancer patients during endocrine therapy: a latent class analysis. Front Med (Lausanne) 2023; 10:1218369. [PMID: 37484843 PMCID: PMC10358731 DOI: 10.3389/fmed.2023.1218369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 06/21/2023] [Indexed: 07/25/2023] Open
Abstract
Backgrounds The aim of this study was to investigate the sexual function status of young breast cancer patients during endocrine therapy, identify potential categories of sexual function status, and analyze the factors affecting the potential categories of sexual function status during endocrine therapy. Methods A cross-sectional survey was conducted on 189 young breast cancer patients who underwent postoperative adjuvant endocrine therapy in Shanghai Ruijin Hospital. The latent class analysis was used to identify potential categories of patient sexual function characteristics with respect to the FSFI sex health measures. Logistic regression analysis was used to analyze the influencing factors for the high risk latent class groups. A nomogram prognostic model were then established to identify high risk patients for female sexual dysfunction (FSD), and C-index was used to determine the prognostic accuracy. Results Patients were divided into a "high dysfunction-low satisfaction" group and a "low dysfunction-high satisfaction" group depending on the latent class analysis, accounting for 69.3% and 30.7%, respectively. Patients who received aromatase inhibitors (AI) combined with ovarian function suppression (OFS) treatment (p = 0.027), had poor body-image after surgery (p = 0.007), beared heavy medical economy burden(p < 0.001), and had a delayed recovery of sexual function after surgery (p = 0.001) were more likely to be classified into the "high dysfunction-low satisfaction" group, and then conducted into the nomogram. The C-index value of the nomogram for predicting FSD was 0.782. Conclusion The study revealed the heterogeneity of sexual function status among young breast cancer patients during endocrine therapy, which may help identify high-risk patients and provide early intervention.
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Affiliation(s)
- Lu Gan
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yi-Ming Miao
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Jing Dong
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qi-Rong Zhang
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Ren
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Nan Zhang
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Daescu AMC, Navolan DB, Dehelean L, Frandes M, Gaitoane AI, Daescu A, Daniluc RI, Stoian D. The Paradox of Sexual Dysfunction Observed during Pregnancy. Healthcare (Basel) 2023; 11:1914. [PMID: 37444748 DOI: 10.3390/healthcare11131914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/24/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
The aim of this study is to analyze the evolution of sexual function throughout pregnancy and highlight the predicting factors of sexual dysfunction in pregnant women. Our study included 144 participants, aged 16 to 45. Patients were evaluated three times during pregnancy by filling out the Female Sexual Function Index (FSFI) and the Body Exposure in Sexual Activities Questionnaire (BESAQ). At the time of the last evaluation, we asked patients to also fill out Beck's Depression Inventory (BDI-II) and a questionnaire regarding their psychological status and relationship satisfaction. We observed that the FSFI lubrication, satisfaction, and pain domains and the FSFI total score significantly decreased from the 1st to the 3rd evaluation. We observed that an increase in BDI score and the presence of abortion in the patient's history increase the risk of developing female sexual dysfunction (FSD). Higher BMIs were found to be a protective factor against FSD, as was being unmarried. The relationship satisfaction score was found to be an independent predictor of FSD. These findings support previous studies that indicate that pregnancy and postpartum sexuality are multifaceted phenomena and that psycho-social factors have a greater impact on sexuality than biological factors.
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Affiliation(s)
- Ana-Maria Cristina Daescu
- Doctoral School Department, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Internal Medicine II, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Neurosciences Department, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Dan-Bogdan Navolan
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Liana Dehelean
- Neurosciences Department, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Mirela Frandes
- Functional Sciences Department, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | | | - Andrei Daescu
- Department of Mathematics, Politehnica University of Timisoara, 300006 Timisoara, Romania
| | - Razvan-Ionut Daniluc
- Doctoral School Department, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Internal Medicine II, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Dana Stoian
- Department of Internal Medicine II, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
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Elsaie ML, Hanafy NS, Hussein SM, Abou Zeid OO, Zaky MS, Eldahshan RM, Nada HA, Sayedahmed O, El Zawahry YB. Prevalence of Female Sexual Dysfunction Among Psoriatic Females: A Cross Sectional Case Controlled Study. Dermatol Pract Concept 2023; 13:e2023209. [PMID: 37557143 PMCID: PMC10412072 DOI: 10.5826/dpc.1303a209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Sexual relationships are an integral part of females psychological and physiological wellbeing. OBJECTIVES The study aimed to identify prevalence and impact of Female Sexual Dysfunction (FSD) in women affected with psoriasis. METHODS This cross-sectional study was carried out on 150 married females who were interviewed to answer Female Sexual Function Index (FSFI) questionnaire and were divided into two groups: the first group included 100 female patients complaining of psoriasis (50 suffering from moderate psoriasis and 50 with severe psoriasis). The disease severity was graded according to the Psoriasis Area and Severity Index (PASI) while the second group included 50 age matched women who served as controls. RESULTS Female sexual dysfunction (FSD) in psoriasis female groups was higher than that in the control group (47%, 24%, P < 0.05). The mean total scores of FSFI ranged from 12.30 to 34.20 and were significantly lower in the severe PASI affected group (22.34 ± 5.35) when compared to moderate PASI group (26.24 ± 2.67) or control group (28.79 ± 2.22). In addition, total scores were significantly lower among moderate PASI affected females when compared to control group. CONCLUSIONS Sexual dysfunction should be routinely investigated in female patients with psoriasis in the case of moderate-severe disease due to its negative impact on quality of life. Further research over the effect of certain interventional programs on FSD should be considered for patients suffering from psoriasis.
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Affiliation(s)
- Mohamed L. Elsaie
- Department of Dermatology, Medical Research and Clinical Studies Institute, National Research Centre, Egypt
| | - Noha S. Hanafy
- Department of Dermatology, Medical Research and Clinical Studies Institute, National Research Centre, Egypt
| | - Sherief M. Hussein
- Department of Dermatology, Medical Research and Clinical Studies Institute, National Research Centre, Egypt
| | - Ola O. Abou Zeid
- Department of Dermatology, Medical Research and Clinical Studies Institute, National Research Centre, Egypt
| | - Mohamed S. Zaky
- Department of Dermatology, Venereology and Andrology, Damietta Faculty of Medicine, Al-Azhar University, Egypt
| | - Ramadan M. Eldahshan
- Department of Dermatology, Venereology and Andrology, Damietta Faculty of Medicine, Al-Azhar University, Egypt
| | - Hesham A. Nada
- Department of Dermatology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Osama Sayedahmed
- Department of Dermatology, Venereology and Andrology, Damietta Faculty of Medicine, Al-Azhar University, Egypt
| | - Yasmin B. El Zawahry
- Department of Dermatology, Medical Research and Clinical Studies Institute, National Research Centre, Egypt
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Silva C, Rebelo M, Chendo I. Managing antipsychotic-related sexual dysfunction in patients with schizophrenia. Expert Rev Neurother 2023; 23:1147-1155. [PMID: 37941377 DOI: 10.1080/14737175.2023.2281399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 11/06/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Schizophrenia is a psychotic disorder and one of the most severe and impactful mental illnesses. Sexual dysfunction is highly prevalent in patients with schizophrenia but remains underdiagnosed and undertreated. Sexual dysfunction is frequently attributed to antipsychotics which may reduce medication adherence, but negative symptoms can also reduce sexual drive. AREAS COVERED This review provides an overview of the current knowledge about sexual dysfunction in patients with schizophrenia. The authors first review the literature concerning the mechanisms of sexual dysfunction and explore the impact of antipsychotics on sexual function. Finally, they present the available non-pharmacological and pharmacological treatment strategies for sexual dysfunction in patients with schizophrenia. EXPERT OPINION Sexual dysfunction in patients with schizophrenia is still underrated by clinicians despite having a negative impact on the quality of life and therapeutic adherence. Antipsychotic treatment is still perceived as a major cause of sexual impairment. Psychiatrists must be aware of this condition and actively question the patients. A comprehensive approach, addressing pharmacological and non-pharmacological aspects, is fundamental for managing sexual dysfunction in schizophrenia. Pharmacological strategies include (1) Serum-level adjustment of the antipsychotic dose, if possible (2) switching to a well-tolerable antipsychotic (aripiprazole, brexpiprazole) and (3) adding a coadjuvant drug (phosphodiesterase-5 inhibitors).
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Affiliation(s)
- Carlos Silva
- Psychiatry Department, Department of Neurosciences, Hospital de Santa Maria, Lisbon, Portugal
- Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Marta Rebelo
- Psychiatry Department, Department of Neurosciences, Hospital de Santa Maria, Lisbon, Portugal
| | - Inês Chendo
- Psychiatry Department, Department of Neurosciences, Hospital de Santa Maria, Lisbon, Portugal
- Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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Lynn M, Iftekhar N, Adams W, Mumby P. Multidisciplinary approach to the treatment of sexual dysfunction in couples using a biopsychosocial model. J Sex Med 2023; 20:991-997. [PMID: 37170949 DOI: 10.1093/jsxmed/qdad059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 03/28/2023] [Accepted: 04/18/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Given the complexity of the psychological and biological pathologies associated with sexual dysfunction, which affects at least a third of adult women and men worldwide, a multidisciplinary approach has been advocated. AIM To assess sexual functioning, relationship satisfaction, and mood stability pre- and post- treatment at the Loyola University Sexual Wellness Program. METHODS Couples attending the 6-week multidisciplinary Sexual Wellness Program provided consent and completed pre- and post- intervention assessments. Linear mixed effects models were used to estimate the mean change from baseline to first follow-up. A covariance matrix was used to account for dependency. OUTCOMES All patients completed self-reported surveys: Dyadic Adjustment Scale, PROMIS Sexual Function and Satisfaction Measures Brief Profile (Patient-Reported Outcomes Measurement Information), and International Index of Erectile Function. RESULTS There were 85 respondents: 42 men and 43 women. The mean age was 49.82 years (range, 25-77). The largest improvement was on the total Dyadic Adjustment Scale score, which increased by approximately 5.18 points (95% CI, 2.55-7.81). PROMIS scores for global satisfaction with sex life, erectile function, and interest in sexual activity significantly increased from baseline, while the vaginal discomfort score significantly declined. Overall the score for global satisfaction with sex life increased from baseline by approximately 5.57 points (95% CI, 3.03-8.10). On average, men reported a 4.33-point increase (95% CI, 0.04-8.62) in their International Index of Erectile Function score from baseline. CLINICAL IMPLICATIONS A multidisciplinary treatment approach focused on the couple positively affects a couple's relationship, including global satisfaction with sex life, relationship satisfaction, interest in sexual activity, and erectile function. STRENGTHS AND LIMITATIONS This study is one of the few to document the effects of a multidisciplinary treatment approach for both members of a heterosexual couple-male and female. Limitations include the narrow demographics and lack of a control group in our population. Furthermore, this was completed at 1 academic center. CONCLUSION These findings emphasize that multidisciplinary sexual therapy programs aimed at the couple can help address multiple aspects of sexual well-being.
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Affiliation(s)
- Mary Lynn
- Department of Obstetrics and Gynecology, Loyola University Medical System, Maywood, IL 60153, United States
| | - Noama Iftekhar
- Department of Surgery, University of Nevada, Las Vegas, Nevada, NV 89154, United States
| | - William Adams
- Loyola University Medical Center, Department of Medicine, Maywood, IL 60153, United States
| | - Patricia Mumby
- Loyola University Medical Center, Department of Psychiatry and Behavioral Neurosciences, Maywood, IL 60153, United States
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Cipriani S, Maseroli E, Ravelli SA, Vignozzi L. The vagina as source and target of androgens: implications for treatment of GSM/VVA, including DHEA. Climacteric 2023:1-7. [PMID: 37288964 DOI: 10.1080/13697137.2023.2213827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The vagina is traditionally thought of as a passive organ in the female reproductive system, serving primarily as a passageway for menstrual blood, sexual intercourse and childbirth. However, recent research has shed light on the vagina's role as an endocrine organ that plays a crucial role in female hormonal balance and overall health. Particularly, growing evidence shows that the human vagina can be considered both as source and target of androgens, in view of the novel concept of 'intracrinology'. Besides the well-known role of estrogens, androgens are also crucial for the development and maintenance of healthy genitourinary tissues in women. As androgen levels decline with age, and estrogen levels fall during the menopausal transition, the tissues in the vagina, together with those in the urinary tract, become thinner, drier and less elastic, leading to a variety of uncomfortable and sometimes painful symptoms, clustered in the genitourinary syndrome of menopause (GSM). Given the lack of testosterone-based or androstenedione-based products approved by regulatory agencies to treat GSM, the possibility of using intravaginal prasterone, which works by providing a local source of dehydroepiandrosterone (DHEA) to the vaginal tissues, appears to be a targeted treatment. Further studies are needed to better assess its safety and efficacy.
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Affiliation(s)
- S Cipriani
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - E Maseroli
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Florence, Italy
| | - S A Ravelli
- Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - L Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
- Istituto Nazionale Biostrutture e Biosistemi (INBB), Rome, Italy
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Krieger JF, Kristensen E, Marquardsen M, Ofer S, Mortensen EL, Giraldi A. Mindfulness in sex therapy and intimate relationships: a feasibility and randomized controlled pilot study in a cross-diagnostic group. Sex Med 2023; 11:qfad033. [PMID: 37465532 PMCID: PMC10350486 DOI: 10.1093/sexmed/qfad033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/16/2023] [Accepted: 05/21/2023] [Indexed: 07/20/2023] Open
Abstract
Background Mindfulness facets can be trained with structured mindfulness interventions, but little is known regarding application on a broader level within sex therapy (e.g. men, partners and different sexual dysfunctions). Aim To evaluate the feasibility and preliminary efficacy of an 8-week intervention-specifically, mindfulness for sex and intimacy in relationships (MSIR)-as a supplement to treatment as usual (TAU) as compared with only TAU in a clinical sample of men and women referred for sexual difficulties with or without a partner. Methods In this randomized controlled feasibility pilot study, 34 participants were randomized to MSIR + TAU (n = 15) or TAU (n = 19). Six healthy partners were also included in the study. MSIR was administered as 2 individual evaluations and six 2-hour group sessions of mixed gender and different types of sexual dysfunction. Outcomes The primary outcome measures were as follows: (1) feasibility, defined as the implementation of recruitment, acceptance, and attendance of intervention in daily clinical practice and the MSIR completion rate; (2) sexual functioning, as measured on a visual analog scale ("bothered by problem") and by validated questionnaires (Changes in Sexual Function Questionnaire for Females and Males, Female Sexual Function Index, Female Sexual Distress Scale, International Index of Erectile Function). Results MSIR was feasible and well received by patients, with high rates of acceptance and intervention completion. As compared with pretreatment, the MSIR + TAU group and TAU control group were significantly less bothered by their sexual problems at the end of treatment, but the change was significantly larger in the MSIR + TAU group (P = .04). Participants in the MSIR + TAU group did not receive fewer TAU sessions than the TAU group (MSIR + TAU mean, 6 sessions; TAU mean, 8 sessions). Clinical Implications MSIR could be effectively used in a clinical setting as an add-on to TAU in the treatment of female and male sexual dysfunction and healthy partners. Strengths and Limitations The major strength of the study is that it is a randomized controlled study. This study is novel in the sense that it included men and women with different types of sexual dysfunction in the same mindfulness group. Limitations include the pilot nature of the study (e.g. a small sample size), and statistical conclusions should be made with caution. More accurate results may be found in a larger sample. Conclusion Results from this study support already existing evidence that mindfulness-based interventions are feasible and effective for targeting sexual dysfunctions in men and women.
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Affiliation(s)
- Julie Fregerslev Krieger
- Corresponding author: Sexological Clinic, Mental Health Centre Copenhagen, Ole Maaløes Vej 14, 2200 Copenhagen N.
| | - Ellids Kristensen
- Sexological Clinic, Mental Health Centre Copenhagen, Mental Health Services - Capital Region of Denmark 2200, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen 2200, Denmark
| | - Mikkel Marquardsen
- Sexological Clinic, Mental Health Centre Copenhagen, Mental Health Services - Capital Region of Denmark 2200, Denmark
| | - Shlomy Ofer
- Sexological Clinic, Mental Health Centre Copenhagen, Mental Health Services - Capital Region of Denmark 2200, Denmark
| | | | - Annamaria Giraldi
- Sexological Clinic, Mental Health Centre Copenhagen, Mental Health Services - Capital Region of Denmark 2200, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen 2200, Denmark
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Daescu AMC, Dehelean L, Navolan DB, Gaitoane AI, Daescu A, Stoian D. Effects of Hormonal Profile, Weight, and Body Image on Sexual Function in Women with Polycystic Ovary Syndrome. Healthcare (Basel) 2023; 11:healthcare11101488. [PMID: 37239774 DOI: 10.3390/healthcare11101488] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/01/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is a hyperandrogenic endocrinological disorder associated with chronic oligo-anovulation and polycystic ovarian morphology. Compared to women without PCOS, women with PCOS have a risk of sexual dysfunction that is more than 30% higher. Although alterations in sex hormones and psychosocial wellbeing have been proposed, the precise mechanisms of FSD in PCOS remain unclear. The aim of our study was to analyze how the hormonal, clinical and psychometric parameters of PCOS patients are involved in the development of sexual dysfunction. The study group consisted of 54 women, aged between 21 and 32 years, diagnosed with PCOS. We collected the following parameters: age, body mass index (BMI), the Ferriman-Gallwey score (FG), maximum duration of oligomenorrhea, abdominal circumference (AC), free testosterone value (FT), luteinizing hormone/follicle stimulating hormone (LH/FSH) ratio value, serum cortisol value and ovarian ultrasound appearance. At the time of the examination, patients were asked to fill in the Female Sexual Function Index (FSFI) and the Body Exposure during Sexual Activities Questionnaire (BESAQ). Statistically significant differences were observed between normal weight and overweight women regarding BESAQ (p-value = 0.02) and FSFI total (p-value <0.001). Elevated BMI, AC or BESAQ scores correlated with a lower FSFI score. The most involved domains of the scale were orgasm, arousal, and desire. Elevated BESAQ scores increase the risk of female sexual dysfunction (FSD) by 4.24 times. FT, BESAQ score, BMI, and LH/FSH ratio were found to independently predict FSD. The cutoff point for the BESAQ score in detecting FSD was found to be 1.97. Weight, body image and anxiety related to sexual activities seem to be significant components in the development of sexual dysfunction in PCOS patients, beyond the effect due to hyperandrogenism. FT value has a U-shape effect in sexual dysfunction, because both in the case of deficit and in the case of excess, sexual function is impaired. BESAQ is a strong predictor for sexual dysfunction in women with PCOS, along with FT value, LH/FSH ratio and BMI.
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Affiliation(s)
- Ana-Maria Cristina Daescu
- Doctoral School Department, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Internal Medicine II, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Neurosciences Department, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Liana Dehelean
- Neurosciences Department, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Dan-Bogdan Navolan
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | | | - Andrei Daescu
- Department of Mathematics, Politehnica University of Timisoara, 300006 Timisoara, Romania
| | - Dana Stoian
- Department of Internal Medicine II, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
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Katsimardou A, Patoulias D, Zografou I, Tegou Z, Imprialos K, Stavropoulos K, Toumpourleka M, Karagiannis A, Petidis K, Doumas M. The Associations between Kidney Function and Sexual Dysfunction among Males and Females with Type 2 Diabetes Mellitus. Medicina (Kaunas) 2023; 59:medicina59050969. [PMID: 37241201 DOI: 10.3390/medicina59050969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/04/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Diabetic kidney disease (DKD), expressed either as albuminuria, low estimated glomerular filtration rate (eGFR) or both, and sexual dysfunction (SD), are common complications among type 2 diabetes mellitus (T2DM) patients. This study aims to assess whether an association exists between DKD and SD, erectile dysfunction (ED) or female sexual dysfunction (FSD) in a T2DM population. Materials and Methods: A cross-sectional study was designed and conducted among T2DM patients. The presence of SD was assessed using the International Index of Erectile Function and the Female Sexual Function Index questionnaires for males and females, respectively, and patients were evaluated for DKD. Results: Overall, 80 patients, 50 males and 30 females, agreed to participate. Sexual dysfunction was present in 80% of the study population. Among the participants, 45% had DKD, 38.5% had albuminuria and/or proteinuria and 24.1% had an eGFR below 60 mL/min/1.73 m2. The eGFR was associated with SD, ED and FSD. Moreover, SD and ED were proven as significant determinants for lower eGFR values in multiple linear regression analyses. DKD was associated with lower lubrication scores and eGFR was associated with lower desire, arousal, lubrication and total scores; however, the multivariate linear regression analyses showed no significant associations between them. Older age resulted in significantly lower arousal, lubrication, orgasm and total FSFI scores. Conclusions: SD is commonly encountered in older T2DM patients and DKD affects almost half of them. The eGFR has been significantly associated with SD, ED and FSD, while SD and ED were proven to be significant determinants for the eGFR levels.
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Affiliation(s)
- Alexandra Katsimardou
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital "Hippokration", 54642 Thessaloniki, Greece
| | - Dimitrios Patoulias
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital "Hippokration", 54642 Thessaloniki, Greece
| | - Ioanna Zografou
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital "Hippokration", 54642 Thessaloniki, Greece
| | - Zoi Tegou
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital "Hippokration", 54642 Thessaloniki, Greece
| | - Konstantinos Imprialos
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital "Hippokration", 54642 Thessaloniki, Greece
| | - Konstantinos Stavropoulos
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital "Hippokration", 54642 Thessaloniki, Greece
| | - Maria Toumpourleka
- 3rd Department of Cardiology, Aristotle University of Thessaloniki, General Hospital "Hippokration", 54642 Thessaloniki, Greece
| | - Asterios Karagiannis
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital "Hippokration", 54642 Thessaloniki, Greece
| | - Konstantinos Petidis
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital "Hippokration", 54642 Thessaloniki, Greece
| | - Michael Doumas
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital "Hippokration", 54642 Thessaloniki, Greece
- Veterans Affairs Medical Center, George Washington University, Washington, DC 20422, USA
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Saadedine M, Faubion S, Kingsberg S, Enders F, Kuhle C, Kling JM, Mara K, Kapoor E. Adverse childhood experiences and sexual dysfunction in midlife women: Is there a link? J Sex Med 2023; 20:792-799. [PMID: 37105936 DOI: 10.1093/jsxmed/qdad053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND One in 3 children has had at least 1 adverse childhood experience (ACE), and ACEs have been associated with multiple medical and psychiatric morbidities in women later in life, including greater menopause symptom burden. AIM To evaluate the association between ACEs and female sexual dysfunction (FSD) in midlife women. METHODS A cross-sectional analysis from DREAMS-the Data Registry on Experiences of Aging, Menopause, and Sexuality-was conducted with questionnaires completed by women aged 40 to 65 years who presented to a women's health clinic at Mayo Clinic in Rochester, Minnesota, from May 2015 to December 2016. History of ACEs was obtained with the validated ACE questionnaire. FSD was assessed by the Female Sexual Function Index and the Female Sexual Distress Scale-Revised. OUTCOMES The association between ACEs and FSD (defined as Female Sexual Function Index score ≤26.55 and Female Sexual Distress Scale-Revised score ≥11) was evaluated via a multivariable logistic regression model, adjusting for age, menopause status, hormone therapy use, anxiety, depression, relationship satisfaction, hot flash severity, and history of abuse in the past year. RESULTS Women (N = 1572) had a mean age of 53.2 years. Overall 59% reported having at least 1 ACE. When compared with no ACEs, a history of ≥4 ACEs significantly increased the odds of not being sexually active (odds ratio, 1.83; 95% CI, 1.30-2.57; P < .001). Among sexually active women, the proportion of women with FSD increased sequentially as the number of ACEs increased. In the univariate analysis, a history of ≥4 ACEs significantly increased the odds of FSD as compared with no ACEs (odds ratio, 2.12; 95% CI, 1.50-2.99; P < .001). The association remained statistically significant in the multivariable analysis after adjusting for confounders (odds ratio, 1.75; 95% CI, 1.15-2.68; P = .009). CLINICAL IMPLICATIONS The findings highlight an opportunity for clinicians to screen for ACEs in women with sexual dysfunction and offer appropriate treatment and counseling as indicated. STRENGTHS AND LIMITATIONS Strengths of the study include the large cohort, the use of validated tools for assessment of ACEs and FSD, and the adjustment for multiple potential confounding factors. Limitations include the cross-sectional study design, recall bias in reporting ACEs and recent abuse, and the low representation of racially and ethnically diverse women in the cohort. CONCLUSION The study demonstrates an increased risk of sexual inactivity and sexual dysfunction in midlife women who experienced childhood adversity. The sexual dysfunction in women with ACEs seems to be independent of other factors that potentially affect female sexual function in midlife.
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Affiliation(s)
- Mariam Saadedine
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL 32224, United States
- Mayo Clinic Women's Health, Rochester, MN 55902, United States
| | - Stephanie Faubion
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL 32224, United States
- Mayo Clinic Women's Health, Rochester, MN 55902, United States
| | - Sheryl Kingsberg
- Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, United States
| | - Felicity Enders
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55902, United States
| | - Carol Kuhle
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55902, United States
| | - Juliana M Kling
- Mayo Clinic Women's Health, Rochester, MN 55902, United States
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ 85260, United States
| | - Kristin Mara
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55902, United States
| | - Ekta Kapoor
- Mayo Clinic Women's Health, Rochester, MN 55902, United States
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN 55902, United States
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN 55902, United States
- Women's Health Research Center, Mayo Clinic, Rochester, MN 55902, United States
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El Ayadi AM, Nalubwama H, Miller S, Mitchell A, Korn AP, Chen CCG, Byamugisha J, Painter C, Obore S, Barageine JK. Women's sexual activity and experiences following female genital fistula surgery. J Sex Med 2023; 20:633-644. [PMID: 36892111 PMCID: PMC10149378 DOI: 10.1093/jsxmed/qdad010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 12/23/2022] [Accepted: 01/09/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Surgical repair has a transformative impact on the lives of women affected by female genital fistula; however, various physical, social, and economic challenges may persist postrepair and prevent complete reengagement in relationships and communities. Nuanced investigation of these experiences is needed to inform programming that aligns with women's reintegration needs. AIM We investigated the sexual activity resumption, experiences, and concerns of women in Uganda during the year following genital fistula repair surgery. METHODS Women were recruited from Mulago Hospital between December 2014 and June 2015. We collected data at baseline and 4 times postsurgery about sociodemographic characteristics and physical/psychosocial status; we also assessed sexual interest and satisfaction twice. We performed in-depth interviews with a subset of participants. We analyzed quantitative findings via univariate analyses, and qualitative findings were coded and analyzed thematically. OUTCOMES We assessed sexual readiness, fears, and challenges following surgical repair of female genital fistula using quantitative and qualitative measures of sexual activity, pain with sex, sexual interest/disinterest, and sexual satisfaction/dissatisfaction. RESULTS Among the 60 participants, 18% were sexually active at baseline, which decreased to 7% postsurgery and increased to 55% at 1 year after repair. Dyspareunia was reported by 27% at baseline and 10% at 1 year; few described leakage during sex or vaginal dryness. Qualitative findings showed wide variance of sexual experiences. Some reported sexual readiness quickly after surgery, and some were not ready after 1 year. For all, fears included fistula recurrence and unwanted pregnancy. CONCLUSION These findings suggest that postrepair sexual experiences vary widely and intersect meaningfully with marital and social roles following fistula and repair. In addition to physical repair, ongoing psychosocial support is needed for comprehensive reintegration and the restoration of desired sexuality. HIGHLIGHTS
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Affiliation(s)
- Alison M El Ayadi
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94158, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA 94158, United States
| | - Hadija Nalubwama
- Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Suellen Miller
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94158, United States
| | - Ashley Mitchell
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA 94158, United States
| | - Abner P Korn
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94158, United States
| | - Chi Chiung Grace Chen
- Department of Gynecology and Obstetrics, School of Medicine, Johns Hopkins University, Baltimore, MD 21218, United States
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Caitlyn Painter
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94158, United States
- Urogynecology Division, Department of Obstetrics and Gynecology, Kaiser Permanente, Oakland, CA 94611, United States
| | - Susan Obore
- Urogynecology Division, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Justus K Barageine
- Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University, Kampala, Uganda
- Urogynecology Division, Mulago National Referral and Teaching Hospital, Kampala, Uganda
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Dubinskaya A, Heard JR, Choi E, Cohen T, Anger J, Eilber K, Scott V. Female sexual health digital resources: women and health care providers need more options. Sex Med Rev 2023:7143623. [PMID: 37102305 DOI: 10.1093/sxmrev/qead016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/23/2023] [Accepted: 03/25/2023] [Indexed: 04/28/2023]
Abstract
INTRODUCTION Female sexual health and female sexual dysfunction (FSD) are usually poorly diagnosed and treated because of the numerous barriers providers and patients face. Internet platforms, such as mobile applications (apps) are potential tools that help overcome these barriers and improve patient access to education and management options for FSD. OBJECTIVES The aim of this review was to identify existing applications on female sexual health and evaluate their educational content and services. METHODS We searched the internet and Apple App Store using multiple keywords. A panel of physicians specialized in the treatment of FSD reviewed the apps for content quality, the scientific basis of provided information, interactivity, usability, and whether they would recommend it as a reference tool for patients. RESULTS Of the 204 apps identified, 17 met the inclusion criteria and were reviewed further. The selected apps were organized into groups based on common themes such as educational (n = 6), emotions and communication (n = 2), relaxation and meditation (n = 4), general sexual health (n = 2), and social and fun (n = 3). All apps from the educational category provided scientific information in collaboration with health experts. When assessed for usability, 1 app received good and 5 received excellent scores based on the System Usability Scale. Most apps (n = 5) provided information on pathology and treatments of orgasmic dysfunction, but only 1 app, created by a physician, provided comprehensive information on all the types of FSD. CONCLUSION Digital technology could be an effective way to overcome barriers to accessing information and ultimately care for female sexual health. Our review demonstrated that there is still a need for more accessible educational resources addressing female sexual health and FSD for patients and providers.
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Affiliation(s)
- Alexandra Dubinskaya
- Division of Urology, Department of Surgery, Cedar-Sinai Medical Center, Los Angeles, CA, United States
| | - John R Heard
- Division of Urology, Department of Surgery, Cedar-Sinai Medical Center, Los Angeles, CA, United States
| | - Eunice Choi
- Division of Urology, Department of Surgery, Cedar-Sinai Medical Center, Los Angeles, CA, United States
| | - Tara Cohen
- Department of Surgery, Cedar-Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Jennifer Anger
- Department of Urology, University of California San Diego, La Jolla, CA 92037, United States
| | - Karyn Eilber
- Division of Urology, Department of Surgery, Cedar-Sinai Medical Center, Los Angeles, CA, United States
| | - Victoria Scott
- Division of Urology, Department of Surgery, Cedar-Sinai Medical Center, Los Angeles, CA, United States
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Arzu Özkarafakılı M, Kutsal C. Female sexual dysfunction in chronic obstructive pulmonary disease. Colomb Med (Cali) 2023; 54:e2025633. [PMID: 37818280 PMCID: PMC10561549 DOI: 10.25100/cm.v54i2.5633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/04/2023] [Accepted: 06/18/2023] [Indexed: 10/12/2023] Open
Abstract
Background Sexual life of women with chronic obstructive pulmonary disease (COPD) can be affected by breathing difficulties, a decrease in functional status, depressive mood and fatigue. Objetive To evaluate the sexual dysfunction in female COPD patients and the possible explanatory mechanisms or correlations between these conditions. Methods The study included 70 female patients with COPD aged between 36-65 and 70 age-matched controls. All the subjects completed questionnaires for the Female Sexual Functional Index (FSFI), BECK depression inventory and, spirometry. Results Statistically significant sexual dysfunction was noted in COPD patients compared to the non-COPD group (p<0.001). BECK depression inventory scores of the COPD patients were also significantly lower (p<0.001). no correlation between FSFI and BECK depression scores in 'patients' characteristics (r=-0.055, p=0.651). No significant difference was found in age, forced expiratory volume (FEV)1%, and exacerbation history of the previous year according to severity of depression (p>0.005). In linear regression analysis determining depression, no statistically significant factor was found among age, number of comorbidities, and FEV1/ forced vital capacity (FVC) % predicted (p>0.05). In multivariable analysis, only fatigue during intercourse was found to be a statistically significant factor in predicting sexual dysfunction among factors like age, presence of comorbidities, duration of the disease, smoking status, FEV1%, m MRCpoints, 6-minutes walk test, BECK depression scores (p=0.008). Conclusion Sexual dysfunction is reported in many COPD females and seems to be related not to spirometric measures or exercise capacity but to fatigue. Depression is also a common comorbidity, of which both disorders are often neglected.
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Affiliation(s)
- Müfide Arzu Özkarafakılı
- University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Department of Chest Diseases, Istanbul, Turkey
| | - Cemil Kutsal
- University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Department of Urology, Istanbul Turkey
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Savoie MB, Paciorek A, Van Loon K, Anwar M, Atreya CE, Johnson PC, Kenfield SA, Laffan A, Levin AO, Smith JF, Stanfield D, Venook A, Zhang L, Van Blarigan EL, Rowen T. Sexual function remains persistently low in women after treatment for colorectal cancer and anal squamous cell carcinoma. J Sex Med 2023; 20:439-446. [PMID: 36805959 PMCID: PMC10078939 DOI: 10.1093/jsxmed/qdac047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 12/04/2022] [Accepted: 12/14/2022] [Indexed: 02/20/2023]
Abstract
BACKGROUND Women diagnosed with colorectal cancer (CRC) or anal squamous cell carcinoma (ASCC) are at high risk of sexual dysfunction after treatment, yet little is known about recovery and risk factors for chronic dysfunction. AIM We aimed to describe sexual function and sexual activity among women who underwent definitive treatment for CRC or ASCC, examine relationships between time since treatment completion and sexual function, and explore factors associated with desire and changes in sexual desire over time. METHODS As part of a prospective cohort study of patients with gastrointestinal cancer at the University of California San Francisco, female-identifying participants who finished definitive treatment for CRC or ASCC completed the Female Sexual Function Index (FSFI) at 6- to 12-month intervals. We used multivariable linear mixed models to explore factors associated with the FSFI desire subscale. OUTCOMES Outcomes were rates of sexual activity, proportion at risk for sexual dysfunction (FSFI score <26.55), total FSFI score, and FSFI desire subscale. RESULTS Among the 97 cancer survivors who completed at least 1 FSFI, the median age was 59 years, the median time since treatment end was 14 months, and 87% were menopausal. Fifty-five women (57%) had a history of colon cancer; 21 (22%), rectal cancer; and 21 (22%), ASCC. An additional 13 (13%) had a current ostomy. Approximately half the women were sexually active (n = 48, 49%). Among these 48 sexually active women, 34 (71%) had FSFI scores indicating risk for sexual dysfunction. Among the 10 sexually active women who completed a FSFI ≥2 years since end of treatment, the median total score was 22.6 (IQR, 15.6-27.3). None of the evaluated characteristics were associated with desire (age, tumor site, treatment, menopause status, or ostomy status). CLINICAL IMPLICATIONS Consistent with prior studies, we found low desire scores after treatment for CRC or ASCC, with little recovery over time, suggesting that patients should not expect an eventual rebound of sexual function. STRENGTHS AND LIMITATIONS Strengths of our study include longitudinal data and use of the validated FSFI. Women with ASCC composed 22% of our cohort, allowing for insight into this rare disease group. Limitations of this study include the small sample size, particularly for longitudinal analyses, and the enrollment of patients at variable times since treatment end. CONCLUSION We observed a high prevalence of sexual health concerns, including low desire, after the treatment of CRC and ASCC that persisted for years after treatment was completed.
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Affiliation(s)
- Marissa B Savoie
- School of Medicine, University of California San Francisco, San Francisco, CA 94143, United States
| | - Alan Paciorek
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA 94143, United States
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94143, United States
| | - Katherine Van Loon
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA 94143, United States
- Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA 94143, United States
| | - Mekhail Anwar
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA 94143, United States
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA 94143, United States
- Department of Electrical Engineering and Computer Sciences, University of California Berkeley, Berkeley, CA 94720, United States
| | - Chloe E Atreya
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA 94143, United States
- Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA 94143, United States
| | - P Connor Johnson
- Harvard Medical School, Boston, MA 02115, United States
- Massachusetts General Hospital Cancer Center, Boston, MA 02114, United States
| | - Stacey A Kenfield
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94143, United States
- Department of Urology, University of California San Francisco, San Francisco, CA 94143, United States
| | - Angela Laffan
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA 94143, United States
| | - Anna O Levin
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA 94143, United States
- Department of Psycho-Oncology, University of California San Francisco, San Francisco, CA 94143, United States
| | - James F Smith
- Department of Urology, University of California San Francisco, San Francisco, CA 94143, United States
| | - Dalila Stanfield
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA 94143, United States
| | - Alan Venook
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA 94143, United States
- Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA 94143, United States
| | - Li Zhang
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA 94143, United States
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94143, United States
- Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA 94143, United States
| | - Erin L Van Blarigan
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94143, United States
- Department of Urology, University of California San Francisco, San Francisco, CA 94143, United States
| | - Tami Rowen
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA 94143, United States
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA 94143, United States
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Romanello JP, Myers MC, Nico E, Rubin RS. Clitoral adhesions: a review of the literature. Sex Med Rev 2023:7087163. [PMID: 36973166 DOI: 10.1093/sxmrev/qead004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 01/08/2023] [Accepted: 01/08/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Clitoral adhesions occur when the prepuce adheres to the glans. These adhesions have been found in up to 22% of women seeking evaluation for sexual dysfunction. The etiology of clitoral adhesions remains largely unclear. Studies published to date on the presentation and management of clitoral adhesions are relatively recent and raise questions for future research. OBJECTIVES We sought to provide a background of existing knowledge on the prevalence, presentation, etiology, associated conditions, and management of clitoral adhesions and to identify areas for future research. METHODS A review of literature was performed for studies that investigate clitoral adhesions. RESULTS Conditions associated with chronic clitoral scarring appear to have a role in the development of clitoral adhesions. Symptoms include clitoral pain (clitorodynia), discomfort, hypersensitivity, hyposensitivity, difficulty with arousal, and muted or absent orgasm. Complications include inflammation, infection, and the development of keratin pearls and smegmatic pseudocysts. There are surgical and nonsurgical interventions to manage clitoral adhesions. Additionally, topical agents can be included in conservative and/or postprocedural management. Although many studies on clitoral adhesions are limited to patients with lichen sclerosus (LS), clitoral adhesions are not confined to this population. CONCLUSION Areas for future research include etiologies of clitoral adhesion; such knowledge is imperative to improve prevention and management. Also, in previous studies, patients were instructed to apply various topical agents and manually retract the prepuce for conservative management or postlysis care. However, the efficacy of these interventions has not been investigated. Surgical and nonsurgical lysis procedures have been described for the management of pain and difficulties with arousal and orgasm that are causes of the sexual dysfunction associated with clitoral adhesion. Although previous studies have assessed efficacy and patient satisfaction, many of these studies were limited to small sample sizes and focused solely on patients with LS. Future studies are needed to inform a standard of care for the management of clitoral adhesions.
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Affiliation(s)
| | - Monica C Myers
- Chicago Medical School, North Chicago, IL 60064, United States
| | - Elsa Nico
- University of Illinois College of Medicine at Chicago, Chicago, IL 60612, United States
| | - Rachel S Rubin
- Department of Urology, MedStar Georgetown University, Washington DC 20015, United States
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Qaderi K, Yazdkhasti M, Zangeneh S, Behbahani BM, Kalhor M, Shamsabadi A, Jesmani Y, Norouzi S, Kajbafvala M, Khodavirdilou R, Rahmani N, Namadian M, Ezabadi SG, Alkatout I, Mehraeen E, Rasoal D. Changes in sexual activities, function, and satisfaction during the COVID-19 pandemic era: a systematic review and meta-analysis. Sex Med 2023; 11:qfad005. [PMID: 36970584 PMCID: PMC10037164 DOI: 10.1093/sexmed/qfad005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/19/2023] [Accepted: 01/28/2023] [Indexed: 03/26/2023] Open
Abstract
Introduction Little is known about the impact of the coronavirus on sexual behavior, function, and satisfaction. Aim The aim of the present study was to systematically review people’s sexual function and behaviors and their changes in sexual activities during the COVID-19 pandemic. Methods Comprehensive searches in PubMed, Web of Science, and Scopus were conducted with keywords in accordance with MeSH terms: COVID-19, SARS-CoV-2, coronavirus, sexual health, sexual function, sexual dysfunctions, sexuality, sexual orientation, sexual activities, and premarital sex. Two reviewers independently assessed full-text articles according to predefined criteria: original design, English studies, and investigating either the general population or sexual minorities. Results Risk of bias in the studies was assessed by the Newcastle-Ottawa Scale, and data were pooled via random effects meta-analyses. We utilized the standardized mean difference to evaluate the effects of the COVID-19 pandemic on sexual activity, functioning, and satisfaction. We included 19 studies in the analysis and 11 studies in the meta-analysis, with a sample size of 12 350. To investigate sexual activity changes, a sample size of 8838 was entered into the subgroup analysis, which showed a significant decrease in both genders (5821 women, P < .033; 3017 men, P < .008). A subgroup meta-analysis showed that the sexual function of men and women during the COVID-19 pandemic significantly declined (3974 women, P < .001; 1427 men, P < .001). Sexual desire and arousal decreased in both genders, though mainly in women. In investigating sexual satisfaction changes during the COVID-19 pandemic, a meta-analysis with a sample size of 2711 showed a significant decrease (P < .001). The most indicative changes in sexual behaviors during the pandemic were the increase in masturbating and usage of sex toys. Greater COVID-19 knowledge was associated with lower masturbation, oral sex, and vaginal sex. The more protective behaviors were associated with less hugging, kissing, cuddling, genital touching, watching porn with a partner, and vaginal sex. Conclusion The COVID-19 pandemic led to increased challenges and changes for individuals’ sexual behaviors. Efforts for preventive strategies should therefore be concentrated between pandemics, while ensuring that there is information available to the population during a pandemic for help in times of psychological distress or crisis.
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Affiliation(s)
- Kowsar Qaderi
- Midwifery Department, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mansoureh Yazdkhasti
- Reproductive Health Department, Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Sanaz Zangeneh
- Midwifery and Reproductive Health Department, Student Research Committee, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bahar Morshed Behbahani
- Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehri Kalhor
- Kowsar Hospital, Qazvin University of Medical Sciences, Tehran, Iran
| | - Ahmadreza Shamsabadi
- Department of Health Information Technology, Esfarayen Faculty of Medical Science, Esfarayen, Iran
| | - Younes Jesmani
- Medicine School, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Solmaz Norouzi
- Department of Statistics and Epidemiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mehrnaz Kajbafvala
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Rasa Khodavirdilou
- Department of Reproductive Biology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nahid Rahmani
- Pediatric Neurorehabilitation Research Center, Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Masoumeh Namadian
- Social Determinants of Health Research Center, Zanjan University of Medical Sciences, Zanhan, Iran
| | | | - Ibrahim Alkatout
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Leitender Oberarzt Leiter der Kiel School of Gynaecological Endoscopy, Kiel, Germany
| | - Esmaeel Mehraeen
- Department of Health Information Technology, Khalkhal Faculty of Medical Science, Khalkhal, Iran
| | - Dara Rasoal
- Corresponding author: Högskolegatan, Academy of Education, Health and Society, Dalarna University, Falun 6631145632, Sweden.
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Susser LC, Parish S, Dumas E, Nappi RE. Premenstrual dysphoric disorder and sexual function: a narrative review. Sex Med Rev 2023:7080908. [PMID: 36941212 DOI: 10.1093/sxmrev/qead007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 03/23/2023]
Abstract
INTRODUCTION Premenstrual dysphoric disorder (PMDD) and female sexual dysfunction (FSD) are 2 prevalent illnesses in women that cause distress and affect quality of life. There are plausible biological, social, and psychological links between these 2 conditions. Nevertheless, few studies have examined sexual function in women with PMDD. OBJECTIVES In this narrative review we summarize the existing literature on sexual function in women with PMDD and with the broader diagnostic classification of premenstrual syndrome and discus the differences between PMDD and more general premenstrual symptomatology, as well as why studying sexual function specifically in PMDD is necessary. We explored reasons why these 2 illnesses may be comorbid and the importance of studying sexual function in this population of women. METHODS PubMed literature searches were conducted using relevant keywords. RESULTS Currently, there are few studies examining PMDD and FSD, and the studies available have significant methodologic limitations. CONCLUSIONS Investigation of sexual function in women with PMDD is needed. Awareness of the comorbidities for PMDD and FSD can allow implementation of targeted interventions for women suffering from these disorders.
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Affiliation(s)
- Leah C Susser
- Weill Cornell Medical College, New York, NY, United States
| | - Sharon Parish
- Weill Cornell Medical College, New York, NY, United States
| | - Emily Dumas
- New York-Presbyterian Hospital/Weill Cornell, New York, NY, United States
| | - Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Reproductive Medicine Unit, University of Pavia, IRCCS Policlinico San Matteo, Pavia, Italy
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Minopoulou I, Pyrgidis N, Tishukov M, Sokolakis I, Baniotopoulos P, Kefas A, Doumas M, Hatzichristodoulou G, Dimitroulas T. Sexual dysfunction in women with systemic autoimmune rheumatic disorders: a systematic review and meta-analysis. Rheumatology (Oxford) 2023; 62:1021-1030. [PMID: 35951753 DOI: 10.1093/rheumatology/keac457] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/28/2022] [Accepted: 08/03/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES In women with systemic autoimmune rheumatic diseases (SARDs), female sexual dysfunction (SD) remains underestimated. We aimed to explore the prevalence and correlates of SD in females with SARDs. METHODS We performed a systematic review and meta-analysis of studies assessing the prevalence of SD and the pooled Female Sexual Function Index (FSFI) scores in this setting (PROSPERO: CRD42021287346). We searched PubMed, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) databases and grey literature until February 2022. We evaluated the quality of the selected records using the Hoy Risk of Bias tool. A random-effects meta-analysis of proportions with the double arcsine transformation was conducted. Subgroup and sensitivity analyses, as well as meta-regression of important correlates, were conducted. RESULTS We included 68 studies with 5457 females diagnosed with a SARD (mean age: 43.7 [12.9] years). The overall SD prevalence was 63% (95% CI: 56, 69%, I2 = 94%) and the overall FSFI total score was 19.7 points (95% CI: 18.4, 21, I2 = 97%). Including only sexually active females, the SD prevalence was estimated as 60% (95% CI: 53, 67%, I2 = 88%), whereas the FSFI total score was 22 points (95% CI: 20.8, 23.1, I2 = 93%). Across the different SARDs, women with Sjögren's syndrome and systemic sclerosis reported the highest levels of SD (74%, 95% CI: 58, 87%, I2 = 84% and 69%, 95% CI: 54, 83%, I2 = 94%, respectively). CONCLUSION Sexual function in females with SARDs seems to be severely impaired, irrespective of the type of SARD. Screening and treatment of SD in females with SARDs should become an integral part of healthcare clinical practice.
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Affiliation(s)
- Ioanna Minopoulou
- Fourth Department of Internal Medicine, Medical School, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Pyrgidis
- Department of Urology, 'Martha-Maria' Hospital Nuremberg, Nuremberg, Germany
| | - Maksim Tishukov
- Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Sokolakis
- Department of Urology, 'Martha-Maria' Hospital Nuremberg, Nuremberg, Germany
| | | | - Aristeidis Kefas
- Second Propedeutic Department of Internal Medicine, Medical School, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michael Doumas
- Second Propedeutic Department of Internal Medicine, Medical School, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Theodoros Dimitroulas
- Fourth Department of Internal Medicine, Medical School, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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50
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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