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Thurman AR, Johnson I, Cornell KA, Hatheway J, Kim NN, Parish SJ, Dart C, Friend DR, Goldstein A. Safety of topical sildenafil cream, 3.6% in a randomized, placebo-controlled trial for the treatment of female sexual arousal disorder. J Sex Med 2024; 21:793-799. [PMID: 39079074 DOI: 10.1093/jsxmed/qdae089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 06/05/2024] [Accepted: 07/11/2024] [Indexed: 09/05/2024]
Abstract
BACKGROUND There are currently no Food and Drug Administration-approved treatments for female sexual arousal disorder (FSAD), which is physiologically analogous to male erectile dysfunction. AIMS The study sought to test the systemic and local genital safety of topical sildenafil cream, 3.6% (sildenafil cream) among healthy premenopausal women with FSAD and their sexual partners over a 12-week treatment period. METHODS This was a phase 2b, exploratory, randomized, placebo-controlled, double-blind study of sildenafil cream among healthy premenopausal women with FSAD. Safety was assessed by the frequency and incidence of treatment-emergent adverse events (TEAEs) among participants and their sexual partners. Participants recorded the incidence of TEAEs in a daily eDiary (electronic diary). Sexual partners were contacted within 72 hours of each sexual event in which investigational product was used. All participants used placebo cream for 1 month, during a single-blind run-in period, and then if eligible, were randomized 1:1 to sildenafil cream or placebo cream. Participants used their assigned investigational product over a 12-week double-blind dosing period. They attended monthly follow-up visits, in which their eDiary TEAE data were reviewed by the study staff and graded for severity and relationship to study product. OUTCOMES The frequency and incidence of TEAEs among participants and their sexual partners. RESULTS During the 12-week double-blind dosing period, there were 78 TEAEs reported by 29 of 99 sildenafil-assigned participants and 65 TEAEs reported by 28 of 94 placebo-assigned participants (P = .76). All TEAEs were mild or moderate in severity. The most common treatment-related TEAE among active and placebo-assigned participants was application site discomfort. There were no differences in the number of treatment-related TEAEs among sildenafil cream vs placebo cream users (P > .99). Four sildenafil cream participants and 3 placebo cream participants discontinued the study due to TEAEs involving application site discomfort (P > .99). There were 9 TEAEs reported by 7 of 91 sexual partners exposed to sildenafil cream vs 4 TEAEs reported by 4 of 84 sexual partners exposed to placebo cream (P = .54). CLINICAL IMPLICATIONS These data support further clinical development of topical sildenafil cream for the treatment of FSAD. STRENGTHS AND LIMITATIONS Safety was assessed among participants and their sexual partners after 1357 and 1160 sexual experiences in which sildenafil cream or placebo cream were used, respectively. The phase 2b study was powered for the primary objectives of efficacy, rather than safety. CONCLUSION These data demonstrate that topically applied sildenafil cream was safe and well tolerated by exposed users and their sexual partners.
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Affiliation(s)
| | | | | | | | - Noel N Kim
- Institute for Sexual Medicine, San Diego, CA 92120, United States
| | | | - Clint Dart
- Premier Research, Morrisville, NC 27560, United States
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Rafati M, Bazrafshan E, Shaki F, Ghalini-Moghaddam T, Moghimi M. The relationship between serum vitamin D, testosterone, and oxidative stress levels in women with sexual dysfunction: A case-controlled study. Taiwan J Obstet Gynecol 2024; 63:673-678. [PMID: 39266147 DOI: 10.1016/j.tjog.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2024] [Indexed: 09/14/2024] Open
Abstract
OBJECTIVE Female sexual dysfunction (FSD) is highly prevalent and can result from hypovitaminosis D. Besides the role of vitamin D in normal bone development, studies showed it could reduce oxidative stress and lipid peroxidation. This prospective study aims to evaluate the relationship between serum vitamin D, testosterone, and oxidative stress levels in women with FSD. MATERIALS AND METHODS In this cross-sectional study, a total of 40 women with FSD (age range: 18-45 years) were randomly assigned into two groups of intervention and control. In the intervention group, patients received vitamin D 300,000 IU intramuscularly (IM) and then 50,000 IU orally once a week for four weeks. We measured the serum vitamin D, testosterone, and oxidative stress levels, as well as the Female Sexual Function Index (FSFI) at baseline and monthly for three months. RESULTS Serum testosterone levels significantly increased in the intervention group at the end of the third month (P = 0.014). Also, FSFI scores significantly improved (P < 0.01) in the intervention group compared to the control group. While there was positive a correlation between serum vitamin D levels with glutathione, total antioxidant capacity (TAC), testosterone, and FSFI score, there was a negative correlation between serum vitamin D levels with malondialdehyde (MDA), protein carbonyl, and nitric oxide. CONCLUSION We witnessed that women with FSD had low serum vitamin D levels. So, modifying serum vitamin D levels must be considered as a treatment option. Moreover, vitamin D supplementation improved testosterone, serum oxidative stress, and sexual function.
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Affiliation(s)
- Mohammadreza Rafati
- Department of Clinical Pharmacy, Faculty of Pharmacy, Pharmaceutical Sciences Research Center, Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Elahe Bazrafshan
- Bu-Ali Sina Hospital, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Fatemeh Shaki
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Tahereh Ghalini-Moghaddam
- Department of Obstetrics and Gynecology, College of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Minoo Moghimi
- Department of Clinical Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran.
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Johnson I, Thurman AR, Cornell KA, Hatheway J, Dart C, Brainard CP, Friend DR, Goldstein A. Preliminary Efficacy of Topical Sildenafil Cream for the Treatment of Female Sexual Arousal Disorder: A Randomized Controlled Trial. Obstet Gynecol 2024; 144:144-152. [PMID: 38889431 PMCID: PMC11250102 DOI: 10.1097/aog.0000000000005648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/06/2024] [Accepted: 05/09/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVE To assess the efficacy of topical sildenafil cream, 3.6% among healthy premenopausal women with female sexual arousal disorder. METHODS We conducted a phase 2b, exploratory, randomized, placebo-controlled, double-blind study of sildenafil cream. Coprimary efficacy endpoints were the change from baseline to week 12 in the Arousal Sensation domain of the SFQ28 (Sexual Function Questionnaire) and question 14 of the FSDS-DAO (Female Sexual Distress Scale-Desire, Arousal, Orgasm). RESULTS Two hundred women with female sexual arousal disorder were randomized to sildenafil cream (n=101) or placebo cream (n=99). A total of 174 participants completed the study (sildenafil 90, placebo 84). Among the intention-to-treat (ITT) population, which included women with only female sexual arousal disorder and those with female sexual arousal disorder with concomitant sexual dysfunction diagnoses or genital pain, although the sildenafil cream group demonstrated greater improvement in the SFQ28 Arousal Sensation domain scores, there were no statistically significant differences between sildenafil and placebo cream users in the coprimary and secondary efficacy endpoints. An exploratory post hoc subset of the ITT population with an enrollment diagnosis of female sexual arousal disorder with or without concomitant decreased desire randomized to sildenafil cream reported significant increases in their SFQ28 Arousal Sensation domain score (least squares mean 2.03 [SE 0.62]) compared with placebo cream (least squares mean 0.08 [SE 0.71], P =.04). This subset achieved a larger mean improvement in the SFQ28 Desire and Orgasm domain scores. This subset population also had significantly reduced sexual distress and interpersonal difficulties with sildenafil cream use as measured by FSDS-DAO questions 3, 5, and 10 (all P ≤.04). CONCLUSION Topical sildenafil cream improved outcomes among women with female sexual arousal disorder, most significantly in those who did not have concomitant orgasmic dysfunction. In particular, in an exploratory analysis of a subset of women with female sexual arousal disorder with or without concomitant decreased desire, topical sildenafil cream increased sexual arousal sensation, desire, and orgasm and reduced sexual distress. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov , NCT04948151.
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Affiliation(s)
- Isabella Johnson
- Daré Bioscience, San Diego, California; Strategic Science & Technologies, LLC, Cambridge, Massachusetts; Premier Research, Morrisville, North Carolina; and Copperstate OB/GYN, Tucson, Arizona
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Poston AM, Oliver TL, Lanti A, Benning SD. Why College Women and Men Refrain from Sex Despite Desire: Development of the No Sex Despite Desire (NSDD) Measure. JOURNAL OF SEX RESEARCH 2024:1-14. [PMID: 38940432 DOI: 10.1080/00224499.2024.2368695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
Humans have sex for myriad reasons, many unrelated to desire. But under what conditions does sexual desire not lead to sex? We investigated reasons college students refrain from sex despite desire and having an attractive, willing partner and relationships between these reasons and other aspects of sexuality and personality. For item generation, 604 participants identified 109 reasons why individuals may refrain from sex despite desire. For construct validation, 712 participants reported the frequency they experienced these reasons on a novel measure. Every reason evidencing discernible gender differences was endorsed more by women. These items largely concentrated in factors of Personal Insecurities and Principled Concerns. No gender differences emerged on the Partner Issues factor. Factors differentially related to sexuality and personality variables. Principled Concerns related negatively to sociosexual behavior and attitudes and positively to sexual traditionalism across genders. Partner Issues positively correlated with sociosexual behavior and desire for women. Personal Insecurities negatively correlated with sociosexual attitudes for men. Principled Concerns related to sexual functioning issues for women. Personal Insecurities and Principled Concerns related to worse sexual functioning for men. Personal Insecurities related to Neuroticism across genders. These results suggest potential directions for therapeutic interventions and further research.
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Gollapudi M, Thomas A, Yogarajah A, Ospina D, Daher JC, Rahman A, Santistevan L, Patel RV, Abraham J, Oommen SG, Siddiqui HF. Understanding the Interplay Between Premenstrual Dysphoric Disorder (PMDD) and Female Sexual Dysfunction (FSD). Cureus 2024; 16:e62788. [PMID: 39036127 PMCID: PMC11260262 DOI: 10.7759/cureus.62788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2024] [Indexed: 07/23/2024] Open
Abstract
Premenstrual dysphoric disorder (PMDD) is a severe variant of premenstrual syndrome (PMS), categorized as a mood disorder due to marked symptoms of depression and anxiety, compounded with severe physical symptoms. Female sexual dysfunction (FSD) can manifest as low libido, difficulty achieving sexual pleasure, and dyspareunia, causing functional and psychological distress. PMDD and FSD are globally prevalent conditions with postulated biological, psychological, and social associations between them. Nevertheless, sexual dysfunction in PMDD is an important aspect of women's health that has been understudied and has notable methodological limitations. In this narrative review, we summarize the existing literature on sexual function in women with PMDD and PMS, specify the distinctions between PMDD and other general symptoms of PMS, highlight the significance of understanding sexual dysfunction in the female population, and outline some available therapeutic options. Studies show that women frequently experience debilitating sexual distress during the premenstrual phase; however, there is an essential need to formulate standardized tools for definite diagnosis. Selective serotonin re-uptake inhibitors (SSRIs) and combined oral contraceptive pills (COCPs) are approved medications for PMDD, while flibanserin and bremelanotide are effective in treating FSD. However, the potential effects of these treatment modalities on the two comorbid conditions render them inconclusive. Awareness of PMDD and FSD among clinicians and society can allow the implementation of targeted interventions to alleviate the suffering of women and enhance their quality of life.
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Affiliation(s)
- Mahati Gollapudi
- Department of Medicine, Saba University School of Medicine, Caribbean, NLD
| | - Angelica Thomas
- Department of Internal Medicine, Anhui Medical University, Hefei, CHN
| | - Angelina Yogarajah
- Department of Family Medicine, Medical University of the Americas, Devens, USA
| | - David Ospina
- Department of Internal Medicine, Universidad de los Andes, Bogotá, COL
| | - Jean C Daher
- Department of Medicine, Lakeland Regional Health, Lakeland, USA
- Department of Medicine, Universidad de Ciencias Médicas Andrés Vesalio Guzman, San José, CRI
| | - Aaliya Rahman
- Department of Internal Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Lucia Santistevan
- Department of Medicine, University of San Martín de Porres, Lima, PER
| | - Ruby V Patel
- Department of Surgery, Hemchandracharya North Gujarat University, Ahmedabad, IND
| | - Jeby Abraham
- Department of General Medicine, Yenepoya Medical College, Mangalore, IND
| | - Sheethal G Oommen
- Department of Psychiatry, University of Medicine and Pharmacy "Gr. T. Popa", Iași, ROU
| | - Humza F Siddiqui
- Department of Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
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Caruso S, Caruso G, Iraci Sareri M, Di Guardo F, Incognito GG, Palumbo M. Correlation of sexual desire with sexual hormone binding globulin and free androgen index in women using combined contraceptives. EUR J CONTRACEP REPR 2024; 29:103-108. [PMID: 38588444 DOI: 10.1080/13625187.2024.2332302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/13/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE To correlate the sexual desire levels with sexual hormone binding globulin and free androgen index in women taking different types of hormonal contraceptives (HCs) containing ethinylestradiol (EE), oestradiol valerate (E2V), 17β-oestradiol (E2), or estetrol (E4), combined or in phasic formulation with different progestogens having antiandrogenic properties. METHODS Three hundred and sixty-seven women (age range 18-46) participated in the study. SHBG and total testosterone (TT) were measured, and the Free Androgen Index (FAI) was calculated. The Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS) questionnaires were used to assess sexual function and distress, respectively. RESULTS The highest SHBG values and the lowest FAIs were obtained of women on HCs containing EE than those of women on HCs containing E2V/17β E2 or E4 (p < 0.001). Desire scores and FSFI total scores were lower in women on HCs with EE than in those using HCs containing E2V, 17β E2, or E4 (p ≤ 0.001). The women who were on HCs containing EE reported FSDS levels higher than those containing all the other types of oestrogen. Finally, sexual desire and FSFI total scores had a negative correlation with the SHBG values and a positive correlation with FAI percentage (p ≤ 0.0001). CONCLUSIONS A minority of women using HCs with EE might experience a decreased sexual desire. This was not observed in women on HCs containing E2V, 17 E2, or E4. To avoid HC discontinuation, due to sexual desire reduction, HCs having minor antiandrogenic effects could be taken into consideration.
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Affiliation(s)
- Salvatore Caruso
- Research Center for the PreDiCT Study -Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy
| | - Giuseppe Caruso
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic, School of Medicine, University of Catania, Catania, Italy
| | - Marco Iraci Sareri
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic, School of Medicine, University of Catania, Catania, Italy
| | - Federica Di Guardo
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic, School of Medicine, University of Catania, Catania, Italy
| | - Giosuè Giordano Incognito
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic, School of Medicine, University of Catania, Catania, Italy
| | - Marco Palumbo
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic, School of Medicine, University of Catania, Catania, Italy
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Parish SJ, Pope R. Female Sexual Health: Screening and Evaluation. Obstet Gynecol Clin North Am 2024; 51:223-239. [PMID: 38777480 DOI: 10.1016/j.ogc.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Female sexual dysfunction is highly prevalent, affecting 30% to 50% of cisgender women globally. Low sexual desire, sexual arousal disorder, and orgasm disorder affect 10% to 20%, 6% to 20%, and 4% to 14% of women, respectively. Dyspareunia or pain with intercourse affects 8% to 22% of women. Universal screening is recommended; and a thorough medical history and physical examination are the foundations of evaluation and assessment. Laboratory tests and imaging are sometimes warranted, but referral to a sexual medicine expert is suggested if the practitioner is unfamiliar or uncomfortable with treatment.
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Affiliation(s)
- Sharon J Parish
- Departments of Medicine and Psychiatry, Weill Cornell Medical College, New York, NY, USA.
| | - Rachel Pope
- Division of Female Sexual Health, University Hospitals Cleveland Medical Center, Urology Institute, 11100 Euclid Avenue, Lakeside 4th Floor, Cleveland, OH 44106, USA
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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; 21:548-555. [PMID: 38614472 DOI: 10.1093/jsxmed/qdae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 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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Tetik S, Yalçinkaya Alkar Ö. Turkish women's perception of low sexual desire, its causes and consequences: an online qualitative survey. Sex Health 2024; 21:SH23185. [PMID: 38709901 DOI: 10.1071/sh23185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/08/2024] [Indexed: 05/08/2024]
Abstract
Background The nature of sexual desire is complex, and little phenomenological consensus exists about its meaning. Low sexual desire (LSD) is a commonly reported sexual difficulty among women, but it is less frequently associated with sexual distress. The aim of this qualitative study is to explore women's understanding of sexual desire, and their perceptions of factors that may contribute to LSD, its effects and their methods of seeking help. Methods The research employed a questionnaire with 12 open-ended questions, developed by the researchers based on sexual script theory. Data were collected from 165 heterosexual Turkish women who reported LSD, recruited through social media platforms between August and October 2021. The data were analysed using a contextual form of thematic analysis to identify and explore patterns. Results The ages of the participants ranged from 20 to 63years. The majority of participants held a Bachelor's degree (81.2%) and in a relationship (78.8%). Three main themes emerged from the study: (1) gendered messages concerning sex, (2) multi-level sexual desire, and (3) minimisation. The research revealed that women's sexual desire is often ignored and repressed, and has negative consequences if not expressed in socially acceptable contexts. The causes of LSD in women go beyond personal factors, and include relational and social influences. Women experiencing LSD report distressing effects on their relationships and general wellbeing, yet they tend not to seek help. Conclusions Our findings contribute to a deeper understanding of the factors impacting women's sexual desire and the barriers to seeking help.
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Affiliation(s)
- Sinan Tetik
- Psychiatry Outpatient Clinic, Ankara Etlik City Hospital, Varlik Mh., Halil Sezai Erkut Cd., Yenimahalle, Ankara, 06170, Turkey
| | - Özden Yalçinkaya Alkar
- Department of Clinical Psychology, Ankara Yildirim Beyazit University, Esenboga Campus Cubuk, Ankara, 06810, Turkey
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Spielmans GI, Ellefson EM. Small Effects, Questionable Outcomes: Bremelanotide for Hypoactive Sexual Desire Disorder. JOURNAL OF SEX RESEARCH 2024; 61:540-561. [PMID: 36809187 DOI: 10.1080/00224499.2023.2175192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Efficacy outcomes are only informative to the extent that they are validated. We examined the measurement properties of efficacy measures from the phase III ("RECONNECT") bremelanotide trials for hypoactive sexual desire disorder (HSDD) in women. Continuous efficacy outcomes, including a) the Female Sexual Function Index (FSFI) and its Desire domain (FSFI-D) and b) the Female Sexual Distress Scale-Desire/Arousal/Orgasm (FSDS-DAO) and its item assessing distress due to low desire (FSDS-DAO #13) have questionable, at best, validity evidence for women with HSDD. We found no validity evidence for previously published categorical treatment response outcomes from the RECONNECT trials. All efficacy results should be reported, but results on 8 of the 11 clinicaltrials.gov-specified efficacy outcomes were heretofore unpublished (including FSDS-DAO total score, FSFI total score, FSFI arousal domain, and items from the Female Sexual Encounter Profile-Revised). We analyzed these outcomes, upon which effect sizes ranged from nil to small. Several other continuous and categorical outcomes generated modest apparent benefits, though nearly all of these outcomes were likely derived post-hoc. Across RECONNECT trial data from two prior publications and the current study, bremelanotide's benefits are statistically modest and limited to outcomes for which scant evidence of validity among women with HSDD exists.
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Affiliation(s)
- Glen I Spielmans
- Department of Psychology, Metropolitan State University, Saint Paul, Minnesota, USA
| | - Elaine M Ellefson
- Department of Psychology, Metropolitan State University, Saint Paul, Minnesota, USA
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Baszak-Radomańska E, Wańczyk-Baszak J, Paszkowski T. Women's sexual health improvement: sexual quality of life and pelvic floor muscle assessment in asymptomatic women. Front Med (Lausanne) 2024; 11:1289418. [PMID: 38449880 PMCID: PMC10916695 DOI: 10.3389/fmed.2024.1289418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/06/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction Problems related to the quality of sexual life in gynecological practice are usually neglected. This study aimed to highlight the significance of this area of concern and evaluate the usefulness of tools, such as patient-reported outcomes (PROs) and pelvic floor examination, to improve women's sexual wellbeing and to identify predictors of poor quality of sexual life during the well-woman annual visit. Methods A cross-sectional study was designed to examine 300 healthy women to determine whether the sexual quality of life (SQOL) questionnaire (on electronic devices) and pelvic floor muscle assessment (the vulva, anus, muscles, and periurethral (VAMP) protocol) of asymptomatic women during the annual bimanual examination (BME) help differentiate patients who would benefit from discussing sexual problems with a gynecologist. Dyspareunia was an exclusion criterion. Results The majority of subjects experienced high sexual wellbeing (82.0% with SQOL score of ≥84), with a mean of 85.7 points. SQOL scores were lower for psychiatric disorders or symptoms (37.0% of subjects), although they did not correlate with age, BMI, parity, contraception use, history of vulvovaginal symptoms, neurosurgical/orthopedic problems, and rectal, bowel, or bladder symptoms. Patients with dyspareunia (16.0% of participants, although they denied it during the face-to-face consultation) had a 3.6 times higher prevalence of low or moderate quality of sexual life. The VAMP protocol score was low in asymptomatic women, 33.0% met positive criteria (VAMP+, NRS ≥3) for pelvic floor dysfunction (overactivity), although at borderline levels. VAMP+ was positively correlated with chronic pain and genitourinary symptoms, but neither with dyspareunia nor incontinence, and was unrelated to the SQOL score (p = 0.151). Conclusion Women's sexual health is a global health priority. Finding a way to start a discussion with an asymptomatic patient is crucial to increasing patients' interest in disclosing a sexual health problem to be resolved. PROs or simple questions about sexual wellbeing direct the discussion mainly toward the at-risk group for sexual deterioration: those with mental health problems and women with dyspareunia. Dyspareunia is considered a predictor of decreased quality of sexual life, a major sexual disorder that should not be overlooked. Gynecological consultation should resolve concerns, identify the problem, and refer for professional sexual care if still needed.
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Affiliation(s)
| | - Jadwiga Wańczyk-Baszak
- Terpa Clinic, OB/GYN Department, Lublin, Poland
- Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Tomasz Paszkowski
- Department of Gynecology, Medical University of Lublin, Lublin, Poland
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Jehan M, Azam S, Taimuri MA, Sumbal A, Azhar A, Amir A, Oduoye MO, Zainab A, Ikram A, Ali T. Care for breast cancer survivors in Asian countries: A review of sexual dysfunction. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241237687. [PMID: 38481086 PMCID: PMC10938604 DOI: 10.1177/17455057241237687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/21/2024] [Accepted: 02/20/2024] [Indexed: 03/17/2024]
Abstract
Breast cancer accounts for one in three new cancer cases in women each year. Despite having a higher survival rate than other cancers, it is associated with various side effects, including anorgasmia, vaginismus, hair loss, and decreased libido. This review aims to explore trends in the incidence of sexual dysfunction in breast cancer survivors, the etiology of sexual dysfunction, and the role of factors such as family history, age, duration of marriage, and depression in predisposing patients. We summarize the limitations of the treatment modalities already used to cater to sexual dysfunction in breast cancer survivors and patients. The authors conducted searches on databases such as PubMed and Google Scholar using relevant search terms: sexual dysfunction, breast cancer, breast cancer survivors, chemotherapy, dyspareunia, vaginismus, and anorgasmia from 1997-2023. The inclusion criteria encompassed all types of articles with abstracts or titles indicating research on sexual dysfunction in breast cancer survivors in Asia. A total of 64 articles were included out of which 10 were systematic reviews and meta-analyses. The literature search yielded results showing high incidence rates of breast cancer in Asia (45.4%), with 31.6%-91.2% of breast cancer survivors likely to experience sexual dysfunction. Regional differences were noted, as female sexual dysfunction occurred in 74.1% of Asian breast cancer women. Further randomized controlled trials should be conducted to assess the effectiveness of treatment modalities. Personalized approaches should be tailored to address beliefs, such as the potential impact of sexual activity on disease recovery. Utilizing a family history of breast cancer as a preemptive tool can help reduce the risk of developing female sexual dysfunction in survivors, and factors such as age and depression should be considered when formulating solutions.
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Affiliation(s)
- Minal Jehan
- Karachi Medical and Dental College, Karachi, Pakistan
| | - Sumran Azam
- Karachi Medical and Dental College, Karachi, Pakistan
| | | | - Anusha Sumbal
- Dow University of Health Sciences, Karachi, Pakistan
| | - Ayesha Azhar
- Dow University of Health Sciences, Karachi, Pakistan
| | - Alina Amir
- Dow University of Health Sciences, Karachi, Pakistan
| | | | - Asra Zainab
- Dow University of Health Sciences, Karachi, Pakistan
| | - Areeba Ikram
- Dow University of Health Sciences, Karachi, Pakistan
| | - Tehreem Ali
- Dow University of Health Sciences, Karachi, Pakistan
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Cucinella L, Tiranini L, Nappi RE. Sexual health and contraception in the menopause journey. Best Pract Res Clin Endocrinol Metab 2024; 38:101822. [PMID: 37748960 DOI: 10.1016/j.beem.2023.101822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Women may experience changes in sexuality across menopause, because at this step in life hormone deficiency interacts with several determinants in a bio-psycho-social perspective. Healthcare providers should inform women about menopause impact on sexuality and be proactive during consultation in disclosing sexual concerns that would require a targeted assessment. Sexual symptoms become more frequent as women age, but they do not always translate into sexual dysfunction diagnosis, for which distress is required. It is important to recognize conditions that may increase the risk of dysfunctional response to menopause challenges in order to promote sexual longevity through counselling and specific management. In this review, we report key elements for a comprehensive assessment of sexual health around menopause, with a focus on genitourinary syndrome of menopause (GSM) and hypoactive sexual desire disorder (HSDD), representing well identified clinical conditions affecting sexuality at midlife and beyond. We also address the issue of contraception across the menopausal transition, highlighting risks and benefits, and possible implications on sexual function.
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Affiliation(s)
- Laura Cucinella
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy
| | - Lara Tiranini
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Rossella 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 S. Matteo Foundation, Pavia, Italy.
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14
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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] [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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Smetanina D, Awar SA, Khair H, Alkaabi M, Das KM, Ljubisavljevic M, Statsenko Y, Zaręba KT. Risk of sexual dysfunctions in breastfeeding females: protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e074630. [PMID: 37527888 PMCID: PMC10394553 DOI: 10.1136/bmjopen-2023-074630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/19/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Epidemiological studies do not provide accurate statistics on the percentage of breastfeeding women experiencing sexual dysfunctions and restraining from sexual activity. The data vary between 40% and 83% in the first group and 20-50% in the second one. Despite excessive studies on contributors to intimacy changes, breast feeding received little attention from researchers. The relationship between lactation and postpartum sexual dysfunctions remains unclear. This systematic review and meta-analysis will synthesise available data and establish the link between breast feeding and sexuality problems. METHODS AND ANALYSIS A comprehensive literature search will be performed in biomedical databases PubMed/Medline, Scopus, Web of Science, EMBASE and CINAHL. We will extract peer-reviewed original studies written in English, Arabic or Polish from 2000 to June 2023. We will also search for reports from international health organisations and local health authorities. The preliminary search was performed on 04 April 2023. The studies must provide data on dysfunction prevalence/incidence and the strength of the relationship between breast feeding and sexuality in generally healthy women. The Covidence software will be used to perform literature screening, data extraction and quality assessment of individual studies. We will use a random-effects model meta-analysis to calculate pooled weighted frequency measures and effect size. Between-study heterogeneity will be assessed with the I2 test. ETHICS AND DISSEMINATION This meta-analysis does not require ethical approval because it synthesises data from previously published original studies. The final work will be published in a peer-reviewed journal and presented at scientific conferences. PROSPERO REGISTRATION NUMBER CRD42023411053.
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Affiliation(s)
- Darya Smetanina
- Department of Radiology, United Arab Emirates University College of Medicine and Health Sciences, Al Ain, Abu Dhabi Emirate, UAE
- Medical Imaging Platform, ASPIRE Precision Medicine Research Institute Abu Dhabi, Al Ain, Abu Dhabi Emirate, UAE
| | - Shamsa Al Awar
- Department of Obstetrics & Gynecology, United Arab Emirates University College of Medicine and Health Sciences, Al Ain, UAE
| | - Howaida Khair
- Department of Obstetrics & Gynecology, United Arab Emirates University College of Medicine and Health Sciences, Al Ain, UAE
| | - Meera Alkaabi
- Department of Obstetrics & Gynecology, United Arab Emirates University College of Medicine and Health Sciences, Al Ain, UAE
| | - Karuna M Das
- Department of Radiology, United Arab Emirates University College of Medicine and Health Sciences, Al Ain, Abu Dhabi Emirate, UAE
| | - Milos Ljubisavljevic
- Department of Physiology, United Arab Emirates University College of Medicine and Health Sciences, Al Ain, Abu Dhabi Emirate, UAE
- Neuroscience Platform, ASPIRE Precision Medicine Institute in Abu Dhabi, Al Ain, Abu Dhabi Emirate, UAE
| | - Yauhen Statsenko
- Department of Radiology, United Arab Emirates University College of Medicine and Health Sciences, Al Ain, Abu Dhabi Emirate, UAE
- Medical Imaging Platform, ASPIRE Precision Medicine Research Institute Abu Dhabi, Al Ain, Abu Dhabi Emirate, UAE
| | - Kornelia Teresa Zaręba
- Department of Obstetrics & Gynecology, United Arab Emirates University College of Medicine and Health Sciences, Al Ain, UAE
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Asencio FDA, Fins RJP, Mitie CK, Ussia A, Wattiez A, Ribeiro HS, Ribeiro PA, Koninckx PR. Segmental Rectum Resection for Deep Endometriosis and Excision Similarly Improve Sexual Function and Pain. Clin Pract 2023; 13:780-790. [PMID: 37489420 PMCID: PMC10366930 DOI: 10.3390/clinpract13040071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/08/2023] [Accepted: 06/30/2023] [Indexed: 07/26/2023] Open
Abstract
Segmental rectum resections for indications other than endometriosis were reported to result in up to 40% sexual dysfunctions. We, therefore, evaluated sexual function after low bowel resection (n = 33) for deep endometriosis in comparison with conservative excision (n = 23). Sexual function was evaluated with the FSFI-19 (Female Sexuality Functioning Index) and EHP 30 (Endometriosis Health Profile). The pain was evaluated with visual analogue scales. Linear excision and bowel resections improved FSFI, EHP 30, and postoperative pain comparably. By univariate analysis, a decreased sexual function was strongly associated with pain both before (p < 0.0001) and after surgery (p = 0.0012), age (p = 0.05), and duration of surgery (p = 0.023). By multivariate analysis (proc logistic), the FSFI after surgery was predicted only by FSFI before or EHP after surgery. No differences were found between low bowel segmental resection and a more conservative excision. In conclusion, improving pain after surgery can explain the improvement in sexual function. A deleterious effect of a bowel resection on sexual function was not observed for endometriosis. Sexual function in women with endometriosis can be evaluated using a simplified questionnaire such as FSFI-6.
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Affiliation(s)
| | | | - Carolina Kami Mitie
- Medicine College, University of Santa Casa de São Paulo, São Paulo 01224-001, Brazil
| | - Anastasia Ussia
- Gemelli Hospital, Universtità Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Arnauld Wattiez
- Department of Obstetrics and Gynaecology, University of Strasbourg, 67081 Strasbourg, France
- Latifa Hospital, Dubai P.O. Box 9115, United Arab Emirates
| | | | - Paulo Ayrosa Ribeiro
- Department of Gynaecology Endoscopy, Santa Casa de São Paulo Hospital, São Paulo 01221-010, Brazil
| | - Philippe Robert Koninckx
- Latifa Hospital, Dubai P.O. Box 9115, United Arab Emirates
- Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Catholic University Leuven, 3000 Leuven, Belgium
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17
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Åsberg RE, Giskeødegård GF, Raj SX, Karlsen J, Engstrøm M, Salvesen Ø, Nilsen M, Lundgren S, Reidunsdatter RJ. Sexual functioning, sexual enjoyment, and body image in Norwegian breast cancer survivors: a 12-year longitudinal follow-up study and comparison with the general female population. Acta Oncol 2023; 62:719-727. [PMID: 37534752 DOI: 10.1080/0284186x.2023.2238548] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 06/27/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Given the scarcity of evidence concerning the long-term sexual health of breast cancer (BC) survivors (BC-Pop), we aimed to assess how BC treatments affect short- and long-term sexual functioning, sexual enjoyment, and body image, and compare with aged-matched women in the Norwegian general population (F-GenPop). MATERIAL AND METHODS The 349 patients in BC-Pop treated at Trondheim University Hospital in 2007-2014, were assessed in clinical controls at the hospital; before starting radiotherapy (T1, baseline), immediately after ending radiotherapy (T2), and after 3, 6, and 12 months (T3-T5), and at a long-term follow-up 7-12 years after baseline (T6). Meanwhile, F-GenPop included 2254 age-matched women in the Norwegian general population. The impact of BC treatment on sexual functioning was examined using a Linear Mixed Model. Sexual functioning, sexual enjoyment, and body image were assessed with the EORTC's QLQ-BR23 scales and compared between the populations in the four age groups (30-49, 50-59, 60-69, and 70+ years) using means with 95% confidence intervals and Student t-test. Linear regression, adjusted for age and comorbidity was applied to estimate individual scores. RESULT BC survivors treated with mastectomy had overall lower sexual functioning than patients who had received breast-conserving surgery (p = 0.017). Although BC survivors treated with chemotherapy had lower sexual functioning than those treated without chemotherapy at T1-T5 (p = 0.044), both groups showed the same level of functioning at T6. BC-Pop exhibited significantly poorer sexual functioning (p < 0.001), lower sexual enjoyment (p < 0.05), and better body image (p < 0.001) than F-GenPop in all age groups. CONCLUSION The impact of specific BC treatments on sexual functioning was modest; only mastectomy had a persistent negative influence. Nevertheless, all age groups in BC-Pop displayed significantly poorer sexual functioning than F-GenPop at both 12 months and up to 12 years after treatment.
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Affiliation(s)
- Ragnhild Emilie Åsberg
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Guro F Giskeødegård
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
- Department of Breast and Endocrine Surgery, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Sunil X Raj
- Department of Oncology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Jarle Karlsen
- Department of Oncology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Monica Engstrøm
- Department of Breast and Endocrine Surgery, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Øyvind Salvesen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Marianne Nilsen
- Department of Social Work, Faculty of Social and Educational Sciences, NTNU, Trondheim, Norway
| | - Steinar Lundgren
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
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Werner M, Borgmann M, Laan E. Sexual Pleasure Matters - and How to Define and Assess It Too. A Conceptual Framework of Sexual Pleasure and the Sexual Response. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2023; 35:313-340. [PMID: 38595929 PMCID: PMC10903685 DOI: 10.1080/19317611.2023.2212663] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 04/11/2024]
Abstract
Objective Sexual pleasure is central to current understandings of sexual function, health, and wellbeing. In this article, we suggest that we lack a sufficiently specific, yet encompassing, definition of sexual pleasure and that we therefore lack comprehensive assessments of sexual pleasure. We introduce a definition of sexual pleasure and position it centrally in an adapted framework of the sexual response. In the framework, we include a taxonomy of rewards which can be retrieved from sex and thereby aim to capture the multifaceted nature of sexual pleasure. Methods/Results Through narrative review, we arrive at the definition, framework, and taxonomy by integrating theories of sexual motivation and response with the literature on sexual pleasure and basic rewards. We position this literature within theories of affect and personality which allows us to differentiate between the experience of and the tendency to experience sexual pleasure (i.e., state versus trait sexual pleasure). We discuss how this conceptualization of sexual pleasure could be reflected in self-report assessments to quantitatively assess sexual pleasure. Conclusions The framework may aid to understand the role of the diverse facets of sexual pleasure in sexual function, health, and wellbeing and contribute to giving sexual pleasure the center position it deserves in sex research and therapy.
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Affiliation(s)
- Marlene Werner
- Department of Sexology and Psychosomatic Obstetrics and Gynaecology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Michèle Borgmann
- Department of Health Psychology and Behavioral Medicine, Institute of Psychology, University of Bern, Bern, Switzerland
| | - Ellen Laan
- Department of Sexology and Psychosomatic Obstetrics and Gynaecology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Tetik S, Yalçınkaya Alkar Ö. Incidence and Predictors of Low Sexual Desire and Hypoactive Sexual Desire Disorder in Women: A Systematic Review and Meta-Analysis. JOURNAL OF SEX & MARITAL THERAPY 2023; 49:842-865. [PMID: 37158079 DOI: 10.1080/0092623x.2023.2208564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Determining the true incidence and identifying the risk factors of low sexual desire (LSD) and hypoactive sexual desire disorder (HSDD) are essential to prevent sexual dysfunctions and provide adequate treatment resources. This systematic review and meta-analysis were performed on research articles reporting women with LSD and HSDD in PsycArticles, Scopus, MEDLINE, Web of Science databases, and reference lists till October 2021. All cross-sectional studies published in English that assessed both sexual desire and sexual distress were included. Of 891 full-text articles identified, 24 were eligible, all of which had a low risk of overall bias. We did separate random-effects meta-analyses for LSD and HSDD outcomes. The incidence of LSD and HSDD were 29% and 12%, respectively. Studies that used the convenience sampling method reported a higher incidence of HSDD than studies that used the probability sampling method. No differences were found between the assessment method and across cultures in LSD and HSDD. A majority of studies reviewed addressed demographic (e.g. age, education), physiological (e. g. menopausal status, body mass index), psychological (e.g. depression, daily internal stress), relational (e.g. relationship length, relationship satisfaction), and sexual predictors (e.g. sexual activity, sexual pleasure) between LSD and HSDD. This systematic review may inform researchers, guideline developers, and policy-makers about LSD associated with distress and help health professionals to identify women most at risk.
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Affiliation(s)
- Sinan Tetik
- Psychiatric Outpatient Clinic, Ankara Etlik City Hospital, Ankara, Turkey
| | - Özden Yalçınkaya Alkar
- Clinical Psychology Department, Faculty of Humanities and Social Sciences, Ankara Yildirim Beyazit University, Ankara, Turkey
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20
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Caruso G, Falzone L, Palermo G, Ricci D, Mazza G, Libra M, Caruso S, Gattuso G. Analysis of hsa-miR-19a-3p and hsa-miR-19b-3p modulation and phosphodiesterase type 5 expression in the vaginal epithelium of premenopausal women with genital arousal disorder. J Sex Med 2023:7143629. [PMID: 37185899 DOI: 10.1093/jsxmed/qdad057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/28/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Few studies have investigated the role of the phosphodiesterase type 5A (PDE5A) isoenzyme in female genital tissue disorders, exclusively taken from cadavers, as well as the epigenetic mechanisms responsible for the regulation of PDE5A levels. AIM The aim was to study the in vivo association between microRNA (miRNA) expression and the expression levels of PDE5A in women with female genital arousal disorder (FGAD) compared with healthy women. METHODS Premenopausal women affected by FGAD (cases) and sexually healthy women (control group) underwent microbiopsy of the periclitoral anterior vaginal wall for the collection of tissue samples. Computational analyses were preliminarily performed in order to identify miRNAs involved in the modulation of PDE5A by using miRNA-messenger RNA interaction prediction tools. Differences in the expression levels of miRNAs and PDE5A were finally investigated in cases and control subjects by using the droplet digital polymerase chain reaction amplification system and stratifying women considering their age, number of pregnancies, and body mass index. OUTCOMES Expression levels of miRNAs were able to target PDE5A and the tissue expression in women with FGAD compared with healthy women. RESULTS The experimental analyses were performed on 22 (43.1%) cases and 29 (56.9%) control subjects. Two miRNAs with the highest interaction levels with PDE5A, hsa-miR-19a-3p (miR-19a) and hsa-miR-19b-3p (miR-19b), were identified and selected for validation analyses. A reduction of the expression levels of both miRNAs was observed in women with FGAD compared with the control subjects (P < .05). Moreover, PDE5A expression levels were higher in women with FGAD and lower in women without sexual dysfunctions (P < .05). Finally, a correlation between body mass index and the expression levels of miR-19a was found (P < .01). CLINICAL IMPLICATIONS Women with FGAD had higher levels of PDE5 compared with control subjects; therefore, the administration of PDE5 inhibitors (PDE5 inhibitors) could be useful in women with FGAD. STRENGTHS AND LIMITATIONS The strength of the current study was to analyze genital tissue obtained in vivo from premenopausal women. A limitation was to not investigate other factors, including endothelial nitric oxide synthetases, nitric oxide, and cyclic guanosine monophosphate. CONCLUSION The results of the present study indicate that the modulation of selected miRNAs could influence PDE5A expression in genital tissues in healthy women or in those with FGAD. Such findings further suggest that treatment with PDE5 inhibitors, as a modulator of PDE5A expression, could be indicated for women with FGAD.
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Affiliation(s)
- Giuseppe Caruso
- Research Group for Sexology, Gynecological Clinic, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania 95123, Italy
| | - Luca Falzone
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania 95123, Italy
| | - Gaia Palermo
- Research Group for Sexology, Gynecological Clinic, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania 95123, Italy
| | - Daria Ricci
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania 95123, Italy
| | - Gabriele Mazza
- Research Group for Sexology, Gynecological Clinic, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania 95123, Italy
| | - Massimo Libra
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania 95123, Italy
| | - Salvatore Caruso
- Research Group for Sexology, Gynecological Clinic, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania 95123, Italy
| | - Giuseppe Gattuso
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania 95123, Italy
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Dilixiati D, Kadier K, Laihaiti D, Lu JD, Rezhake R, Azhati B, Rexiati M. The relationship between sleep disorders, quality, and duration and sexual dysfunction: a systematic review and meta-analysis. J Sex Med 2023:7143630. [PMID: 37186140 DOI: 10.1093/jsxmed/qdad054] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/24/2023] [Accepted: 03/24/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND The associations between sexual dysfunction (SD) and sleep disorders, sleep quality, and sleep duration remain unclear. AIM To assess the relationship between sleep and SD through a literature review and meta-analysis. METHODS The PubMed, Scopus, Embase, Ovid MEDLINE, and Cochrane Library databases were systematically searched from inception to November 10, 2022. OUTCOMES Pooled relative risks and 95% CIs were used to examine the association of sleep disorders with SD in longitudinal studies. Pooled odds ratios (ORs) and 95% CIs were used to examine the associations between SD and sleep disorders, sleep quality, and sleep duration in cross-sectional studies. RESULTS Forty-three articles, including 11 longitudinal studies and 32 cross-sectional studies, were included in the quantitative analysis. The pooled relative risk of SD in patients with sleep disorders was 1.97 in longitudinal studies (95% CI, 1.46-2.67, P < .001; heterogeneity: I2 = 95.0%, P < .001), while the pooled OR of SD in patients with sleep disorders was 2.05 in cross-sectional studies (95% CI, 1.76-2.39, P < .001; heterogeneity: I2 = 91.4%, P < .001). When compared with controls, subjects with poor sleep quality had a 1.49-fold increased risk of SD (OR, 1.49; 95% CI, 1.31-1.71, P < .001; heterogeneity: I2 = 73.4%, P < .001). In addition, short sleep duration was associated with the risk of SD (OR, 1.14; 95% CI, 1.06-1.22, P < .001; heterogeneity: I2 = 0.0%, P = .849). CLINICAL IMPLICATIONS The risk of SD is significantly increased in patients with sleep disorders and poor sleep quality, indicating that clinicians should monitor sleep among patients with SD. STRENGTHS AND LIMITATIONS This study is the most comprehensive meta-analysis of the association between sleep and SD to date. However, different sleep disorders may have varying associations with sleep duration and sleep quality; thus, we could not identify the independent effects across the studies. CONCLUSION Our systematic review and meta-analysis results suggest that sleep disorders, especially obstructive sleep apnea, increase the risk of SD in men and women. Poor sleep quality is significantly associated with SD. Short sleep duration is associated with an increased risk of SD.
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Affiliation(s)
- Diliyaer Dilixiati
- Department of Urology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
- Xinjiang Clinical Medical Research Center of Urogenital Diseases, Urumqi 830054, China
| | - Kaisaierjiang Kadier
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Duolikun Laihaiti
- Department of Joint Surgery, Changji Branch of First Affiliated Hospital of Xinjiang Medical University, Changji 831199, China
| | - Jian-De Lu
- Department of Urology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
- Xinjiang Clinical Medical Research Center of Urogenital Diseases, Urumqi 830054, China
| | - Remila Rezhake
- Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi 830017, China
| | - Baihetiya Azhati
- Department of Urology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
- Xinjiang Clinical Medical Research Center of Urogenital Diseases, Urumqi 830054, China
| | - Mulati Rexiati
- Department of Urology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
- Xinjiang Clinical Medical Research Center of Urogenital Diseases, Urumqi 830054, China
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22
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Li L, Zhang Y, Feng S, Cao Y, Li H, Li X, Ji Y, Sun H, Mao X, Zhou B, Ni A, Zhang J, Zhao Z, Li X, Wei X, Wu A, Yuan Y. Reliability and validity of the brief psychosomatic symptom scale (BPSS) in patients from general hospitals. Gen Hosp Psychiatry 2023; 83:1-7. [PMID: 37028094 DOI: 10.1016/j.genhosppsych.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVES To verify the Brief Psychosomatic Symptom Scale (BPSS) among patients with psychosomatic-related disorders in general hospitals and determine the threshold of BPSS. METHODS The BPSS is a shortened 10-item version of the psychosomatic symptoms scale (PSSS). Data from 483 patients and 388 healthy controls were included for psychometric analyses. Internal consistency, construct validity, and factorial validity were verified. The threshold of BPSS in distinguishing psychosomatic patients from healthy controls were determined using receiver operating characteristic (ROC) curve analysis. The ROC curve of the BPSS was compared with that of the PSSS and patient health questionnaire-15 (PHQ-15) by using Venkatraman's method with 2000 times Monte-Carlo simulations. RESULTS The reliability of the BPSS was good with Cronbach's α of 0.831. BPSS was significantly correlated with PSSS (r = 0.886, P < 0.001), PHQ-15 (r = 0.752, P < 0.001), PHQ-9 (r = 0.757, P < 0.001) and GAD-7 (r = 0.715, P < 0.001), which indicated good construct validity. ROC analyses demonstrated that the AUC of the BPSS was comparable with that of PSSS. The gender-specific threshold of BPSS was determined as ≥8 in males and ≥ 9 in females. CONCLUSIONS The BPSS is a brief and validated instrument for screening common psychosomatic symptoms.
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Affiliation(s)
- Lei Li
- The Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China; Department of Depression and Sleep Disorders, The Fourth People's Hospital of Lianyungang, Lianyungang, China
| | - Yubo Zhang
- The Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Simiao Feng
- The Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yin Cao
- Department of Clinical Psychology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Hengfen Li
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Xiangping Li
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yunxin Ji
- Department of Psychosomatic, Ningbo First Hospital, Ningbo, China
| | - Hua Sun
- Department of Clinical Psychology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xueqin Mao
- Department of Psychology, Qilu Hospital of Shandong University, Jinan, China
| | - Bo Zhou
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Aihua Ni
- Department of Clinical Psychology, HeBei General Hospital, Shijiazhuang, China
| | - Jing Zhang
- Department of Cardiovascular Medicine, the First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Zhong Zhao
- Department of Neurology, Suzhou Municipal Hospital, Suzhou, China
| | - Xiuli Li
- Department of Clinical Psychology, YiDu central hospital of Weifang, Weifang, China
| | - Xianwen Wei
- Department of Neurology, Puer People's Hospital, Puer, China
| | - Aiqin Wu
- Department of Clinical Psychology, The First Affiliated Hospital of Soochow University, SuZhou, China
| | - Yonggui Yuan
- The Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China; Jiangsu Provincial Key Laboratory of Critical Care Medicine, Southeast university, Nanjing, China.
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23
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Kim CW, Goldstein I, Komisaruk BR, Goldstein SW, Kim NN, Hartzell-Cushanick R, Uloko M, Yee A. Lumbar endoscopic spine surgery for persistent genital arousal disorder/genitopelvic dysesthesia resulting from lumbosacral annular tear-induced sacral radiculopathy. J Sex Med 2023; 20:210-223. [PMID: 36763933 DOI: 10.1093/jsxmed/qdac017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 10/18/2022] [Accepted: 10/24/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Persistent genital arousal disorder/genitopelvic dysesthesia (PGAD/GPD) is characterized by distressing, abnormal genitopelvic sensations, especially unwanted arousal. In a subgroup of patients with PGAD/GPD, cauda equina Tarlov cyst-induced sacral radiculopathy has been reported to trigger the disorder. In our evaluation of lumbosacral magnetic resonance images in patients with PGAD/GPD and suspected sacral radiculopathy, some had no Tarlov cysts but showed lumbosacral disc annular tear pathology. AIM The aims were 2-fold: (1) to utilize a novel multidisciplinary step-care management algorithm designed to identify a subgroup of patients with PGAD/GPD and lumbosacral annular tear-induced sacral radiculopathy who could benefit from lumbar endoscopic spine surgery (LESS) and (2) to evaluate long-term safety and efficacy of LESS. METHODS Clinical data were collected on patients with PGAD/GPD who underwent LESS between 2016 and 2020 with at least 1-year follow-up. LESS was indicated because all had lumbosacral annular tear-induced sacral radiculopathy confirmed by our multidisciplinary management algorithm that included the following: step A, a detailed psychosocial and medical history; step B, noninvasive assessments for sacral radiculopathy; step C, targeted diagnostic transforaminal epidural spinal injections resulting in a temporary, clinically significant reduction of PGAD/GPD symptoms; and step D, surgical intervention with LESS and postoperative follow-up. OUTCOMES Treatment outcome was based on the validated Patient Global Impression of Improvement, measured at postoperative intervals. RESULTS Our cohort included 15 cisgendered women and 5 cisgendered men (mean ± SD age, 40.3 ± 16.8 years) with PGAD/GPD who fulfilled the criteria of lumbosacral annular tear-induced sacral radiculopathy based on our multidisciplinary management algorithm. Patients were followed for an average of 20 months (range, 12-37) post-LESS. Lumbosacral annular tear pathology was identified at multiple levels, the most common being L4-L5 and L5-S1. Twenty-two LESS procedures were performed in 20 patients. Overall, 80% (16/20) reported improvement on the Patient Global Impression of Improvement; 65% (13/20) reported improvement as much better or very much better. All patients were discharged the same day. There were no surgical complications. CLINICAL IMPLICATIONS Among the many recognized triggers for PGAD/GPD, this subgroup exhibited lumbosacral annular tear-induced sacral radiculopathy and experienced long-term alleviation of symptoms by LESS. STRENGTHS AND LIMITATIONS Strengths include long-term post-surgical follow-up and demonstration that LESS effectively treats patients with PGAD/GPD who have lumbosacral annular tear-induced sacral radiculopathy, as established by a multidisciplinary step-care management algorithm. Limitations include the small study cohort and the unavailability of a clinical measure specific for PGAD/GPD. CONCLUSION LESS is safe and effective in treating patients with PGAD/GPD who are diagnosed with lumbosacral annular tear-induced sacral radiculopathy.
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Affiliation(s)
- Choll W Kim
- Excel Spine Center, San Diego, CA 92120, United States.,Alvarado Hospital, San Diego, CA 92120, United States
| | - Irwin Goldstein
- Alvarado Hospital, San Diego, CA 92120, United States.,San Diego Sexual Medicine, San Diego, CA 92120, United States
| | | | - Sue W Goldstein
- San Diego Sexual Medicine, San Diego, CA 92120, United States
| | - Noel N Kim
- Institute for Sexual Medicine, San Diego, CA 92121, United States
| | | | - Maria Uloko
- Alvarado Hospital, San Diego, CA 92120, United States.,San Diego Sexual Medicine, San Diego, CA 92120, United States.,University of California San Diego, San Diego, CA 92093, United States
| | - Alyssa Yee
- Alvarado Hospital, San Diego, CA 92120, United States.,San Diego Sexual Medicine, San Diego, CA 92120, United States
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24
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Kadah S, Soh SE, Morin M, Schneider M, Heron E, Frawley H. Is there a difference in pelvic floor muscle tone between women with and without pelvic pain? A systematic review and meta-analysis. J Sex Med 2023; 20:65-96. [PMID: 36897234 DOI: 10.1093/jsxmed/qdac002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 09/06/2022] [Accepted: 09/15/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Alterations in pelvic floor muscle (PFM) function have been observed in women with persistent noncancer pelvic pain (PNCPP) as compared with women without PNCPP; however, the literature presents conflicting findings regarding differences in PFM tone between women with and without PNCPP. AIM To systematically review the literature comparing PFM tone in women with and without PNCPP. METHODS MEDLINE, Embase, Emcare, CINAHL, PsycINFO, and Scopus were searched from inception to June 2021 for relevant studies. Studies were included that reported PFM tone data in women aged ≥18 years with and without PNCPP. The risk of bias was assessed with the National Heart, Lung, and Blood Institute Quality Assessment Tool. Standardized mean differences (SMDs) for PFM tone measures were calculated via random effects models. OUTCOMES Resting PFM tone parameters, including myoelectrical activity, resistance, morphometry, stiffness, flexibility, relaxation, and intravaginal pressure, measured by any clinical examination method or tool. RESULTS Twenty-one studies met the inclusion criteria. Seven PFM tone parameters were measured. Meta-analyses were conducted for myoelectrical activity, resistance, and anterior-posterior diameter of the levator hiatus. Myoelectrical activity and resistance were higher in women with PNCPP than in women without (SMD = 1.32 [95% CI, 0.36-2.29] and SMD = 2.05 [95% CI, 1.03-3.06], respectively). Women with PNCPP also had a smaller anterior-posterior diameter of the levator hiatus as compared with women without (SMD = -0.34 [95% CI, -0.51 to -0.16]). Meta-analyses were not performed for the remaining PFM tone parameters due to an insufficient number of studies; however, results of these studies suggested greater PFM stiffness and reduced PFM flexibility in women with PNCPP than in women without. CLINICAL IMPLICATIONS Available evidence suggests that women with PNCPP have increased PFM tone, which could be targeted by treatments. STRENGTHS AND LIMITATIONS A comprehensive search strategy was used with no restriction on language or date to review studies evaluating PFM tone parameters between women with and without PNCPP. However, meta-analyses were not undertaken for all parameters because few included studies measured the same PFM tone properties. There was variability in the methods used to assess PFM tone, all of which have some limitations. CONCLUSION Women with PNCPP have higher PFM tone than women without PNCPP; therefore, future research is required to understand the strength of the relationship between pelvic pain and PFM tone and to investigate the effect of treatment modalities to reduce PFM tone on pelvic pain in this population.
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Affiliation(s)
- Shaza Kadah
- Department of Physiotherapy, Monash University, Melbourne, Victoria 3199, Australia.,Department of Physical Therapy, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Sze-Ee Soh
- Department of Physiotherapy, Monash University, Melbourne, Victoria 3199, Australia
| | - Melanie Morin
- School of Rehabilitation Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Québec J1K 2R1, Canada
| | - Michal Schneider
- Department of Medical Imaging and Radiation Sciences, Monash University, Melbourne, Victoria 3800, Australia
| | - Emma Heron
- School of Allied Health, Curtin University, Bentley, Western Australia 6102, Australia
| | - Helena Frawley
- School of Health Sciences, The University of Melbourne, Melbourne, Victoria 3010, Australia.,Allied Health Research, Royal Women's Hospital, Melbourne, Victoria 3052, Australia.,Allied Health Research, Mercy Hospital for Women, Melbourne, Victoria 3084, Australia
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25
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Nappi RE, Tiranini L, Cucinella L, Martini E, Bosoni D, Righi A, Cassani C, Gardella B. Pharmacotherapy for female sexual dysfunctions (FSDs): what is on the market and where is this field heading? Expert Opin Pharmacother 2023; 24:135-143. [PMID: 35430926 DOI: 10.1080/14656566.2022.2066997] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Female sexual dysfunctions (FSDs) are common in women of any age and have a huge impact on quality of life and relationships. They have a multifaceted etiology limiting the development of pharmacotherapies with a high rate of effectiveness. Safety issues are also a concern. AREAS COVERED The authors report the most recent advances in pharmacotherapy for premenopausal and postmenopausal women with a main focus on hypoactive sexual desire disorders (HSDD) and associated sexual symptoms. Good levels of evidence have emerged for psychoactive agents, such as flibanserin and bremelanotide, as well as hormonal compounds (transdermal testosterone). The authors also report briefly on intravaginal DHEA (prasterone), local estrogen therapy (LET), and ospemifene to manage effectively vulvovaginal atrophy/genitourinary syndrome of menopause (VVA/GSM). In addition, they discuss promising therapeutic options highlighting the main reasons that hamper the availability of new labeled products. Finally, they include the importance of the multimodal approach to address FSDs. EXPERT OPINION Approved pharmacotherapies for FSD are limited. Validated multidimensional instruments and adequate objective measures of physical and mental responses to sexual external and internal incentives are mandatory to identify women suitable to chronic or on-demand treatments and to assess their pattern of response in research and practice.
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Affiliation(s)
- Rossella E Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Lara Tiranini
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Laura Cucinella
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Ellis Martini
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - David Bosoni
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Alessandra Righi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Chiara Cassani
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Unit of Obstetrics and Gynecology, IRCCS S. Matteo Foundation, Pavia, Italy
| | - Barbara Gardella
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Unit of Obstetrics and Gynecology, IRCCS S. Matteo Foundation, Pavia, Italy
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26
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Baniotopoulos P, Pyrgidis N, Minopoulou I, Tishukov M, Sokolakis I, Hatzichristodoulou G, Dimitroulas T. Treatment of Sexual Dysfunction in Women with Systemic Autoimmune Rheumatic Disorders: A Systematic Review. Sex Med Rev 2022; 10:520-528. [PMID: 37051964 DOI: 10.1016/j.sxmr.2022.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/16/2022] [Accepted: 08/02/2022] [Indexed: 02/04/2023]
Abstract
Abstract
Introduction
Female sexual dysfunction (SD) is an under-recognized and undertreated problem in patients with systemic autoimmune rheumatic disorders (SARDs).
Objectives
To summarize and evaluate the existing treatment modalities for SD in females with SARDs.
Methods
A systematic review was conducted following the PRISMA guidelines. Electronic databases were searched up to April 2022 for studies that assessed the use of pharmacological and non-pharmacological treatment modalities for the management of SD in females with SARDs. Randomized and observational studies were included. (PROSPERO: CRD42022296381).
Results
Seven studies with 426 females with SD were included. Seven different treatment modalities belonging to 5 different classes (androgen therapy, phosphodiesterase-5 inhibitors, exercise, education and local creams) were evaluated in patients with systemic lupus erythematosus, rheumatoid arthritis and systemic sclerosis. The majority of the studies were of low methodological quality. Standardized patient education and 8-week aerobic walking programs were successful in improving female SD. Local creams improved dyspareunia in females with systemic sclerosis. Testosterone did not significantly improve SD in patients with systemic lupus erythematosus. Accordingly, tadalafil did not result in a significant improvement of SD in females with systemic sclerosis, based on the Female Sexual Function Index.
Conclusion
There is a lack of sufficient evidence to recommend a certain management strategy for SD in females with SARDs. Nonpharmacological therapy and lubricant creams may be beneficial in females with SARDs. No benefit was demonstrated after androgen therapy or tadalafil. Still, no definite conclusions can be drawn due to the important limitations of the available literature. Overall, our results may be considered preliminary and further research in the field is mandatory.
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Affiliation(s)
| | - Nikolaos Pyrgidis
- Department of Urology , Nuremberg , Germany
- ‘Martha-Maria’ Hospital Nuremberg , Nuremberg , Germany
| | - Ioanna Minopoulou
- Fourth Department of Internal Medicine , Thessaloníki , Greece
- Medical School , Thessaloníki , Greece
- Hippokration General Hospital , Thessaloníki , Greece
- Aristotle University of Thessaloniki , Thessaloníki , Greece
| | - Maksim Tishukov
- Medical School , Thessaloniki , Greece
- Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Ioannis Sokolakis
- Department of Urology , Nuremberg , Germany
- ‘Martha-Maria’ Hospital Nuremberg , Nuremberg , Germany
| | | | - Theodoros Dimitroulas
- Fourth Department of Internal Medicine , Thessaloníki , Greece
- Medical School , Thessaloníki , Greece
- Hippokration General Hospital , Thessaloníki , Greece
- Aristotle University of Thessaloniki , Thessaloníki , Greece
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27
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Szell N, Flashenburg J. Midurethral Slings and Female Sexual Dysfunction. J Sex Med 2022; 19:1317-1320. [DOI: 10.1016/j.jsxm.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/19/2022] [Accepted: 06/24/2022] [Indexed: 10/16/2022]
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28
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Mosca L, Riemma G, Braga A, Frigerio M, Ruffolo AF, Dominoni M, Munno GM, Uccella S, Serati M, Raffone A, Salvatore S, Torella M. Female Sexual Dysfunctions and Urogynecological Complaints: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:981. [PMID: 35893096 PMCID: PMC9331312 DOI: 10.3390/medicina58080981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/05/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022]
Abstract
Female sexual dysfunctions represent a real widespread problem, usually faced from a psychological point of view; however, millions of women worldwide are impacted by pelvic floor dysfunction, personal shame and social taboos, however, continue to inhibit free conversation on the subject. Women's quality of life is considerably improved by screening, diagnosing, and controlling urogenital and sexual issues. This review aims to provide a critical perspective of urogenital conditions and common disturbances in female sexual function associated with these issues. It also includes a discussion of postpartum pelvic dysfunction.
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Affiliation(s)
- Lavinia Mosca
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy; (L.M.); (G.R.); (G.M.M.)
| | - Gaetano Riemma
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy; (L.M.); (G.R.); (G.M.M.)
| | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, 6850 Mendrisio, Switzerland;
| | - Matteo Frigerio
- Department of Obstetrics and Gynecology, ASST Monza, Ospedale San Gerardo, 20900 Monza, Italy;
| | - Alessandro Ferdinando Ruffolo
- Obstetrics and Gynecology Unit, Vita-Salute University and IRCCS San Raffaele Hospital, 20132 Milan, Italy; (A.F.R.); (S.S.)
| | - Mattia Dominoni
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Gaetano Maria Munno
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy; (L.M.); (G.R.); (G.M.M.)
| | - Stefano Uccella
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, 37100 Verona, Italy;
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy;
| | - Antonio Raffone
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy;
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80100 Naples, Italy
| | - Stefano Salvatore
- Obstetrics and Gynecology Unit, Vita-Salute University and IRCCS San Raffaele Hospital, 20132 Milan, Italy; (A.F.R.); (S.S.)
| | - Marco Torella
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy; (L.M.); (G.R.); (G.M.M.)
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29
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Nappi RE, Tiranini L, Martini E, Bosoni D, Righi A, Cucinella L. Medical Treatment of Female Sexual Dysfunction. Urol Clin North Am 2022; 49:299-307. [DOI: 10.1016/j.ucl.2022.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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30
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Berenguer-Soler M, Navarro-Sánchez A, Compañ-Rosique A, Luri-Prieto P, Navarro-Ortiz R, Gómez-Pérez L, Pérez-Tomás C, Font-Juliá E, Gil-Guillén VF, Cortés-Castell E, Navarro-Cremades F, Montejo AL, Arroyo-Sebastián MDÁ, Pérez-Jover V. Genito Pelvic Pain/Penetration Disorder (GPPPD) in Spanish Women-Clinical Approach in Primary Health Care: Review and Meta-Analysis. J Clin Med 2022; 11:2340. [PMID: 35566467 PMCID: PMC9105657 DOI: 10.3390/jcm11092340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/09/2022] [Accepted: 04/12/2022] [Indexed: 12/10/2022] Open
Abstract
Sexuality is a component of great relevance in humans. Sexual disorders are a major public health problem representing a high prevalence in the general population. DSM-5 genito-pelvic pain/penetration disorder (GPPPD) includes dyspareunia and vaginismus (DSM-IV-TR). To assess the importance of research on these disorders in Spain, we evaluated the Spanish scientific publications of primary and community care. The objective was to quantify the magnitude of the publications of GPPPD in Spanish women in primary and community care. For this, we used the method of conducting a systematic review and meta-analysis of studies evaluating GPPPD. As main results, of the 551 items found, we selected 11 studies that met the inclusion criteria. In primary care in Spain, one in nine women has these disorders; the percentage of women with GPPPD in this study (raw data) was 11.23% (95% CI: 0-29%) (vaginismus 5%; penetration pain 8.33%; dyspareunia 16.45%). These percentages can differ of those from other countries, and they are at the top of the data of the European countries (9-11.9%). There is much variability in the studies found in the world with respect to the prevalence of these health problems.
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Affiliation(s)
- María Berenguer-Soler
- Faculty of Psychology, Miguel Hernández University, 03202 Elche, Spain; (M.B.-S.); (A.N.-S.); (V.P.-J.)
| | - Antonio Navarro-Sánchez
- Faculty of Psychology, Miguel Hernández University, 03202 Elche, Spain; (M.B.-S.); (A.N.-S.); (V.P.-J.)
| | - Antonio Compañ-Rosique
- University Hospital of San Juan, 03550 San Juan de Alicante, Spain; (A.C.-R.); (P.L.-P.); (C.P.-T.); (E.F.-J.)
- School of Medicine, Miguel Hernández University, 03550 San Juan de Alicante, Spain; (L.G.-P.); (V.F.G.-G.); (E.C.-C.); (F.N.-C.)
| | - Paloma Luri-Prieto
- University Hospital of San Juan, 03550 San Juan de Alicante, Spain; (A.C.-R.); (P.L.-P.); (C.P.-T.); (E.F.-J.)
| | | | - Luis Gómez-Pérez
- School of Medicine, Miguel Hernández University, 03550 San Juan de Alicante, Spain; (L.G.-P.); (V.F.G.-G.); (E.C.-C.); (F.N.-C.)
- General University Hospital of Elche, 03203 Elche, Spain
| | - Carla Pérez-Tomás
- University Hospital of San Juan, 03550 San Juan de Alicante, Spain; (A.C.-R.); (P.L.-P.); (C.P.-T.); (E.F.-J.)
| | - Elsa Font-Juliá
- University Hospital of San Juan, 03550 San Juan de Alicante, Spain; (A.C.-R.); (P.L.-P.); (C.P.-T.); (E.F.-J.)
| | - Vicente F. Gil-Guillén
- School of Medicine, Miguel Hernández University, 03550 San Juan de Alicante, Spain; (L.G.-P.); (V.F.G.-G.); (E.C.-C.); (F.N.-C.)
| | - Ernesto Cortés-Castell
- School of Medicine, Miguel Hernández University, 03550 San Juan de Alicante, Spain; (L.G.-P.); (V.F.G.-G.); (E.C.-C.); (F.N.-C.)
| | - Felipe Navarro-Cremades
- School of Medicine, Miguel Hernández University, 03550 San Juan de Alicante, Spain; (L.G.-P.); (V.F.G.-G.); (E.C.-C.); (F.N.-C.)
| | - Angel L. Montejo
- Psychiatry Service, Clinical Hospital of the University of Salamanca, 37007 Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Paseo San Vicente SN, 37007 Salamanca, Spain
- Nursing School, University of Salamanca, Av. Donantes de Sangre SN, 37007 Salamanca, Spain
| | | | - Virtudes Pérez-Jover
- Faculty of Psychology, Miguel Hernández University, 03202 Elche, Spain; (M.B.-S.); (A.N.-S.); (V.P.-J.)
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Sansone A, Reisman Y, Jannini EA. Relationship between hyperuricemia with deposition and sexual dysfunction in males and females. J Endocrinol Invest 2022; 45:691-703. [PMID: 34997558 PMCID: PMC8741558 DOI: 10.1007/s40618-021-01719-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 12/01/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE The association between gout, the most common crystal arthropathy, and sexual dysfunctions has often been investigated by studies in the last decades. Despite the presence of shared risk factors and comorbidities and the possible effects on sexual health of long-term gout complications, awareness of this association is severely lacking and the pathogenetic mechanisms have only partially been identified. In the present review, we aimed to investigate the current evidence regarding the potential mechanisms linking sexual dysfunctions and gout. METHODS A comprehensive literature search within PubMed was performed to provide a summary of currently available evidence regarding the association between gout and sexual dysfunctions. RESULTS Gout and sexual dysfunctions share several risk factors, including diabesity, chronic kidney disease, hypertension, metabolic syndrome, and peripheral vascular disease. Gout flares triggered by intense inflammatory responses feature severe pain and disability, resulting in worse sexual function, and some, but not all, treatments can also impair sexual health. Long-term gout complications can result in persistent pain and disability due to joint deformity, fractures, or nerve compression, with negative bearing on sexual function. The presence of low-grade inflammation impairs both sex steroids synthesis and endothelial function, further advancing sexual dysfunctions. The psychological burden of gout is another issue negatively affecting sexual health. CONCLUSIONS According to currently available evidence, several biological and psychological mechanisms link sexual dysfunctions and gout. Addressing risk factors and providing adequate treatment could potentially have beneficial effects on both conditions. Appropriate clinical evaluation and multidisciplinary approach are recommended to improve patient care.
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Affiliation(s)
- A Sansone
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy
| | - Y Reisman
- Flare-Health, Amstelveen, The Netherlands
| | - E A Jannini
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy.
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Nappi RE, Cucinella L. Sexuality, pelvic floor/vaginal health and contraception at menopause. Best Pract Res Clin Obstet Gynaecol 2021; 81:85-97. [PMID: 34876374 DOI: 10.1016/j.bpobgyn.2021.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/07/2021] [Accepted: 11/07/2021] [Indexed: 01/14/2023]
Abstract
A multitude of biopsychosocial factors influences sexual health at midlife, a common concern in daily practice along with vaginal and pelvic health. Health-care providers (HCPs) need to be proactive in dealing with possible symptoms because in most cases early management prevents distress and improves quality of life. Female sexual dysfunctions (FSDs) may have a complex etiology but sexual history is not difficult implementing basic knowledge of risk factors and some skills helping women to cope with hormonal and age-related changes. This work summarizes key points to approach sexual symptoms in midlife women, providing principles to diagnose and manage hypoactive sexual desire disorder (HSDD) and genitourinary syndrome of menopause (GSM)/vulvovaginal atrophy (VVA), as well as manage contraceptive needs.
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Affiliation(s)
- Rossella E Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100, Pavia, Italy.
| | - Laura Cucinella
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100, Pavia, Italy.
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Parish SJ, Clayton AH, Kingsberg SA. Response to Balon's Commentary: Is Basson's Model of Sexual Response Relevant? JOURNAL OF SEX & MARITAL THERAPY 2021; 48:17-19. [PMID: 34772322 DOI: 10.1080/0092623x.2021.1995092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Sharon J Parish
- Departments of Psychiatry and Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Anita H Clayton
- Department of Psychiatry & Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Sheryl A Kingsberg
- Division of Behavioral Medicine, Department of OB/GYN, MacDonald Women's Hospital, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Departments of Reproductive Biology and Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Siegal A, Chubak BM. Pharmaceutical and Energy-Based Management of Sexual Problems in Women. Urol Clin North Am 2021; 48:473-486. [PMID: 34602169 DOI: 10.1016/j.ucl.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article summarizes and critiques the evidence for use of available pharmacotherapies (vasoactive, psychoactive, and hormonal medications) and energy-based therapies (laser, radiofrequency, shockwave, and neurostimulation) for treatment of female sexual dysfunction. The enthusiasm with which energy-based treatments for sexual dysfunction have been adopted is disproportionate to the amount of data currently available to support their clinical use. Pharmacotherapy for female sexual dysfunction has considerably more research evidence to justify its use. Patients must be empowered to make an informed, autonomous determination as to whether the risk/reward ratio favors the use of pharmacotherapy, energy-based therapy, or some other treatment intervention.
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Affiliation(s)
- Alexandra Siegal
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, 6th Floor, New York, NY 10029, USA
| | - Barbara M Chubak
- Department of Urology, Icahn School of Medicine at Mount Sinai, 10 Union Square #3A, New York, NY 10003, USA.
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Abstract
Sexual dysfunction is extremely common in cancer survivors. Cancer survivors are living longer, and survivorship issues like sexual functioning are now a part of routine cancer care. Oncology providers need to be as comfortable assessing and addressing these issues as they would any other aspect relating to cancer care. Providers should know how to perform an evaluation for sexual dysfunction, understand basic treatment options, and have appropriate referrals available to ensure that the patient's needs are met. This review provides an overview of sexual dysfunction pertaining to women who are survivors of cancer and articulates areas needing further research.
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Affiliation(s)
- Mindy Goldman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 2356 Sutter Street, San Francisco, CA 94143, USA.
| | - Mary Kathryn Abel
- University of California, San Francisco School of Medicine, 2356 Sutter Street, San Francisco, CA 94143, USA
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Lim-Watson MZ, Hays RD, Kingsberg S, Kallich JD, Murimi-Worstell IB. A Systematic Literature Review of Health-related Quality of Life Measures for Women with Hypoactive Sexual Desire Disorder and Female Sexual Interest/Arousal Disorder. Sex Med Rev 2021; 10:23-41. [PMID: 34481749 DOI: 10.1016/j.sxmr.2021.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/19/2021] [Accepted: 07/23/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Hypoactive Sexual Desire Disorder (HSDD) / Female Sexual Interest/Arousal Disorder (FSIAD) impacts health-related quality of life (HRQoL) of women and their partners, yet existing measures fail to adequately capture relevant concepts (ie, what is essential to measure including symptoms/impacts) important to women with HSDD/FSIAD. OBJECTIVES To identify HRQoL tools used to assess women with HSDD/FSIAD, and to evaluate their psychometric properties (ie, reliability, validity, and responsiveness). METHODS We conducted searches in PubMed, Embase and PsychINFO from June 5, 1989 to September 30, 2020 for studies in women with HSDD/FSIAD and psychometric analyses (English only). Principles of the Preferred Reporting Items for Systematic reviews and Meta-Analyses, the COnsensus-based Standards for the selection of health Measurement INstruments Risk of Bias Checklist and other psychometric criteria were applied. Based on this search, 56 papers were evaluated including 15 randomized-controlled trials, 11 observational/single arm/open label studies, and 30 psychometric studies. RESULTS Of the 18 measures identified, the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised (FSDS-R) were included in most studies (> 50%). General HRQoL instruments were not used in any of the clinical trials; the SF-12, SF-36 and EQ-5D-5L were reported in two observational studies. No instruments achieved positive quality ratings across all psychometric criteria. The FSFI, FSDS-R, Sexual Event Diary (SED) and the Sexual Desire Relationship Distress Scale (SDRDS), were the only measures to receive a positive rating for content validity. CONCLUSION Reliable and valid HRQoL measures that include sexual desire and distress are needed to provide a more systematic and comprehensive assessment of HRQoL and treatment benefits in women with HSDD/FSIAD. While inferences about HRQoL are limited due to the lack of uniformity in concepts assessed and limited psychometric evaluation of these measures in women with HSDD/FSIAD, opportunities exist for the development of reliable and validated tools that comprehensively measure the most relevant and important concepts in women with HSDD/FSIAD. Lim-Watson MZ, Hays RD, Kingsberg S, et al. A systematic literature review of health-related quality of life measures for women with Hypoactive Sexual Desire Disorder and Female Sexual Interest/Arousal Disorder. Sex Med Rev 2021;XX:XXX-XXX.
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Affiliation(s)
- Michelle Z Lim-Watson
- Department of Pharmacoeonomics and Policy, Massachusetts College of Pharmacy and Health Sciences University, Boston, MA, USA.
| | - Ron D Hays
- Department of Health Policy and Management, School of Public Health, University of California, Los Angeles, CA, USA; Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, Los Angeles, CA, USA; RAND Corporation, Santa Monica, CA, USA
| | - Sheryl Kingsberg
- OB/GYN Behavioral Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Joel D Kallich
- Department of Pharmacoeonomics and Policy, Massachusetts College of Pharmacy and Health Sciences University, Boston, MA, USA
| | - Irene B Murimi-Worstell
- Department of Pharmacoeonomics and Policy, Massachusetts College of Pharmacy and Health Sciences University, Boston, MA, USA
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Frawley H, Shelly B, Morin M, Bernard S, Bø K, Digesu GA, Dickinson T, Goonewardene S, McClurg D, Rahnama'i MS, Schizas A, Slieker-Ten Hove M, Takahashi S, Voelkl Guevara J. An International Continence Society (ICS) report on the terminology for pelvic floor muscle assessment. Neurourol Urodyn 2021; 40:1217-1260. [PMID: 33844342 DOI: 10.1002/nau.24658] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The terminology for female and male pelvic floor muscle (PFM) assessment has expanded considerably since the first PFM function and dysfunction standardization of terminology document in 2005. New terms have entered assessment reports, and new investigations to measure PFM function and dysfunction have been developed. An update of this terminology was required to comprehensively document the terms and their definitions, and to describe the assessment method and interpretation of the finding, to standardize assessment procedures and aid diagnostic decision making. METHODS This report combines the input of members of the Standardisation Committee of the International Continence Society (ICS) Working Group 16, with contributions from recognized experts in the field and external referees. A logical, sequential, clinically directed assessment framework was created against which the assessment process was mapped. Within categories and subclassifications, each term was assigned a numeric coding. A transparent process of 12 rounds of full working group and external review was undertaken to exhaustively examine each definition, plus additional extensive internal development, with decision making by collective opinion (consensus). RESULTS A Terminology Report for the symptoms, signs, investigations, and diagnoses associated with PFM function and dysfunction, encompassing 185 separate definitions/descriptors, has been developed. It is clinically based with the most common assessment processes defined. Clarity and user-friendliness have been key aims to make it interpretable by clinicians and researchers of different disciplines. CONCLUSION A consensus-based Terminology Report for assessment of PFM function and dysfunction has been produced to aid clinical practice and be a stimulus for research.
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Affiliation(s)
- Helena Frawley
- School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Beth Shelly
- Beth Shelly Physical Therapy, Moline, Illinois, USA.,Department of Physical Therapy, Saint Ambrose University Davenport, Iowa, USA
| | - Melanie Morin
- School of Rehabilitation Faculty of Medecine and Health Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - Stéphanie Bernard
- Department of Rehabilitation, Faculté de Médecine, Université Laval, Québec, Quebec, Canada
| | - Kari Bø
- Department of Sports Medicine, Norwegian School of Sports Sciences, Akershus University Hospital, Oslo, Norway.,Department of Obstetrics and Gynecology, Lørenskog, Norway
| | - Giuseppe Alessandro Digesu
- Academic Department of Obstetrics and Gynaecology, St. Mary's Hospital, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Tamara Dickinson
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, USA
| | | | - Doreen McClurg
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Mohammad S Rahnama'i
- Uniklinik RWTH, University Hospital of Aachen, Aachen, Germany.,Society of Urological Research and Education (SURE), Heerlen, The Netherlands
| | - Alexis Schizas
- Department of Colorectal Surgery, Guy's and St. Thomas NHS Foundation Trust, London, UK
| | - Marijke Slieker-Ten Hove
- Department Gynaecology, University of Erasmus, Rotterdam, The Netherlands.,Pelvic Floor Physiotherapy, ProFundum Instituut, Dordrecht, The Netherlands
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