1
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Janssen E, Bancroft J. The Dual Control Model of Sexual Response: A Scoping Review, 2009-2022. JOURNAL OF SEX RESEARCH 2023; 60:948-968. [PMID: 37267113 DOI: 10.1080/00224499.2023.2219247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The Dual Control Model proposes that sexual arousal and related processes are dependent on the balance between sexual excitation and sexual inhibition, and that individuals vary in their propensity for these processes. This scoping review provides an overview and discussion of the questionnaires used to measure the propensities for sexual excitation and inhibition, their translation and validation in other languages, and their application in empirical research on topics ranging from sexual desire and arousal, sexual (dys)function, sexual risk taking, asexuality, hypersexuality, and sexual aggression. A total of 152 papers, published between 2009 and 2022 and identified using online databases, were included in this review. The findings, consistent with those reviewed by Bancroft et al. (2009), suggest that sexual excitation is particularly relevant to sexual desire and responsivity and predictive of asexuality and hypersexuality. Sexual inhibition plays a role in sexual dysfunction. sexual risk taking, and sexual aggression, although often in interaction with sexual excitation. Suggestions for the further development of the model and for future studies are discussed.
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Affiliation(s)
- Erick Janssen
- Institute for Family and Sexuality Studies, Department of Neurosciences, KU Leuven, Belgium
- The Kinsey Institute, Indiana University, Bloomington, IN, USA
| | - John Bancroft
- Horspath, Oxfordshire, UK
- The Kinsey Institute, Indiana University, Bloomington, IN, USA
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2
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Cellai I, Filippi S, Comeglio P, Cipriani S, Maseroli E, Di Stasi V, Todisco T, Marchiani S, Tamburrino L, Villanelli F, Vezzani S, Corno C, Fambrini M, Guarnieri G, Sarchielli E, Morelli A, Rastrelli G, Maggi M, Vignozzi L. Testosterone positively regulates vagina NO-induced relaxation: an experimental study in rats. J Endocrinol Invest 2022; 45:1161-1172. [PMID: 35072927 PMCID: PMC9098587 DOI: 10.1007/s40618-022-01743-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/01/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE Female sexual response involves a complex interplay between neurophysiological mechanisms and the nitric oxide (NO)-mediated relaxation of clitoris and vagina. The aim of this study was to evaluate sex steroids regulation of the relaxant pathway in vagina, using a validated animal model. METHODS Subgroups of OVX Sprague-Dawley rats were treated with 17β-estradiol, testosterone, or testosterone and letrozole, and compared with a group of intact animals. Masson's trichrome staining was performed for morphological evaluation of the distal vaginal wall, in vitro contractility studies investigated the effect of OVX and in vivo treatments on vaginal smooth muscle activity. RNA from vaginal tissue was analyzed by semi-quantitative RT-PCR. RESULTS Immunohistochemical analysis showed that OVX induced epithelial and smooth muscle structural atrophy, testosterone and testo + letrozole increased the muscle bundles content and organization without affecting the epithelium while 17β-estradiol mediated the opposite effects. In vitro contractility studies were performed on noradrenaline pre-contracted vaginal strips from each experimental group. Acetylcholine (0.001-10 µM) stimulation induced a concentration-dependent relaxation, significantly reduced by NO-synthase inhibitor L-NAME and by guanylate cyclase inhibitor ODQ. OVX resulted in a decreased responsiveness to acetylcholine, restored by testosterone, with or without letrozole, but not by 17β-estradiol. OVX sensitivity to the NO-donor SNP was higher than in the control. Vardenafil, a PDE5 inhibitor, enhanced SNP effect in OVX + testosterone as well as in control, as supported by RNA expression analysis. CONCLUSIONS Our study demonstrates that testosterone improves the NO-mediated smooth muscle vaginal cells relaxation confirming its role in maintaining the integrity of muscular relaxant machinery.
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Affiliation(s)
- I Cellai
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Excellence Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50134, Florence, Italy
| | - S Filippi
- Interdepartmental Laboratory of Functional and Cellular Pharmacology of Reproduction, Department of Neurosciences, Drug Research and Child Health (NEUROFARBA), University of Florence, Viale Pieraccini 6, 50134, Florence, Italy
| | - P Comeglio
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Excellence Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50134, Florence, Italy
| | - S Cipriani
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Excellence Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50134, Florence, Italy
| | - E Maseroli
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Excellence Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50134, Florence, Italy
| | - V Di Stasi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Excellence Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50134, Florence, Italy
| | - T Todisco
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Excellence Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50134, Florence, Italy
| | - S Marchiani
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Excellence Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50134, Florence, Italy
| | - L Tamburrino
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - F Villanelli
- Endocrinology Unit, Department of Excellence Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50134, Florence, Italy
| | - S Vezzani
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Excellence Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50134, Florence, Italy
| | - C Corno
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Excellence Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50134, Florence, Italy
| | - M Fambrini
- Division of Obstetrics and Gynecology, Department of Excellence Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Viale Morgagni 50, 50134, Florence, Italy
| | - G Guarnieri
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - E Sarchielli
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - A Morelli
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - G Rastrelli
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Excellence Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50134, Florence, Italy
| | - M Maggi
- Endocrinology Unit, Department of Excellence Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50134, Florence, Italy
- I.N.B.B. (Istituto Nazionale Biostrutture e Biosistemi), Viale delle Medaglie d'Oro 305, 00136, Rome, Italy
| | - L Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Excellence Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50134, Florence, Italy.
- I.N.B.B. (Istituto Nazionale Biostrutture e Biosistemi), Viale delle Medaglie d'Oro 305, 00136, Rome, Italy.
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3
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Cucinella L, Martini E, Tiranini L, Battista F, Molinaro P, Casiraghi A, Cominotti S, Piccinino M, Rossini R, Nappi RE. Menopause and female sexual dysfunctions (FSDs). Minerva Obstet Gynecol 2022; 74:234-248. [PMID: 35107240 DOI: 10.23736/s2724-606x.22.05001-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Biological and psycho-relational factors contribute equally to the development of sexual symptoms and associated distress, a key element to diagnose female sexual dysfunctions (FSDs) in menopausal women. Consultation at midlife represents an optimal time to discuss sexual life, and healthcare providers (HCPs) have to be proactive in rising the conversation, as patients may not report their sexual concerns spontaneously. An accurate sexual history is essential to characterize the primary symptom, determine the impact on patient's quality of life and identify risk and precipitating factors. Among FSDs, hypoactive sexual desire disorder (HSDD) is very frequent at midlife together with genitourinary syndrome of menopause (GSM), a chronic condition negatively affecting the full sexual response. A multidimensional approach targeted to the patient's characteristics, goals and expectations is mandatory and should start from educative counselling and correction of modifiable risk factors. When specific treatments are required, they should include non-pharmacological and pharmacological options, often prescribed in combination to address concomitantly the biological and psychosocial components of FSDs.
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Affiliation(s)
- 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
| | - 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
| | - Federica Battista
- 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
| | - Pietro Molinaro
- 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
| | - Arianna Casiraghi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Urogynecology Unit, Division of Gynecology and Obstetrics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Selene Cominotti
- Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Manuela Piccinino
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy
| | - Roberta Rossini
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy
| | - 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
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4
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Cocchetti C, Ristori J, Mazzoli F, Vignozzi L, Maggi M, Fisher AD. Management of hypoactive sexual desire disorder in transgender women: a guide for clinicians. Int J Impot Res 2021; 33:703-709. [PMID: 33558671 DOI: 10.1038/s41443-021-00409-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 12/29/2020] [Accepted: 01/12/2021] [Indexed: 11/09/2022]
Abstract
Hypoactive sexual desire disorder (HSDD) represents a common condition among transgender women. However, to date no specific guidelines for the management of HSDD in transgender persons are available. The aim of the present narrative Review is to evaluate evidence-based treatment for HSDD and to suggest treatment options for HSDD in transgender women. Clinically relevant publications on the management of HSDD (from 1985 to 2020) were searched in PubMed and Medline databases, using the following terms: "sexual desire", "sexual health", "HSDD", "transgender", "gender-affirming treatment", "sexual therapy", "testosterone treatment", "Central nervous system-active medications", and variants. Since sexual desire could be affected by several factors, a comprehensive assessment of HSDD- exploring biological, psychological, and social domains- is recommended, in order to identify possible predisposing, precipitating and maintaining factors. Among treatment options, transgender women may benefit of different sex therapy strategies and/or central nervous system-active medications-such as flibanserin, bremelanotide, bupropion and buspirone-and transdermal testosterone, bearing in mind that this option could be poorly accepted by patients due to the risk of virilizing effects. The lack of data regarding the efficacy of HSDD treatment options in transgender women emphasize the need for literature to focus more on this topic in the future.
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Affiliation(s)
- Carlotta Cocchetti
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Viale Pieraccini 6, 50139, Florence, Italy
| | - Jiska Ristori
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Viale Pieraccini 6, 50139, Florence, Italy
| | - Francesca Mazzoli
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Viale Pieraccini 6, 50139, Florence, Italy
| | - Linda Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Viale Pieraccini 6, 50139, Florence, Italy
| | - Mario Maggi
- Department of Experimental, Clinical and Biomedical Sciences, Careggi University Hospital, Viale Pieraccini 6, 50139, Florence, Italy
| | - Alessandra Daphne Fisher
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Viale Pieraccini 6, 50139, Florence, Italy.
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5
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Rao TSS, Andrade C. Personalized Pharmacotherapy for Women With Sexual Interest/Arousal Disorder. JOURNAL OF PSYCHOSEXUAL HEALTH 2020. [DOI: 10.1177/2631831820973142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- T. S. Sathyanarayana Rao
- Department of Psychiatry, JSS Medical College Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Chittaranjan Andrade
- Department of Clinical Psychopharmacology and Neurotoxicology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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6
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Gombert M, Ballester P, Segura A, Peiró AM. Introducing sexual dysfunction in mental care. Expert Opin Drug Saf 2020; 20:69-79. [PMID: 33191796 DOI: 10.1080/14740338.2020.1849135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Introduction: People with any psychiatric disorder tend to have difficulties in responding sexually. However,sexual dysfunction (SD) is usually under-recognized, even the tightly hormonal and neuronal common connexions through the brain-sex axis. Multiple sources of resistance to SD assessment and intervention persist. Areas covered: The present review aims to underline the feasibility to introduce SD evaluation in patients with any psychiatric disorders, evaluating the potential mutual benefits of their management. Expert opinion: Women and men living with mental disorders frequently display sexual difficulties; however, some of them consider sexuality as a relevant parameter of their quality of life. In fact, SD as a side effect is a frequent reason for stopping the intake of medication. What is more, a holistic approach integrating sexual function could foster a better understanding of mental pathologies due to a common origin of pathogenesis. This could improve care quality, in keeping with the global tendency toward the development of personalized medicine. Consistently, the integration of SD assessment is highly recommended in mental health, all the more so when a psychotropic drug is prescribed. An expected consequence would be a reconstruction of the healthcare professional's consideration for the sexuality of people experiencing mental disorders.
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Affiliation(s)
- Marie Gombert
- Department of Paediatrics, Obstetrics and Gynecology, University of Valencia , Valencia, Spain
| | - Pura Ballester
- Department of Pharmacology, Paediatrics and Organic Chemistry , Alicante, Spain.,Neuropharmacology on Pain (NED) Group, Alicante Institute for Health and Biomedical Research (ISABIAL) , Alicante, Spain
| | - Ana Segura
- Andrology Unit, Department of Health of Alicante - General Hospital, Alicante, Spain.,Clinical Pharmacology Unit, Department of Health of Alicante - General Hospital, Alicante, Spain
| | - Ana M Peiró
- Department of Pharmacology, Paediatrics and Organic Chemistry , Alicante, Spain.,Clinical Pharmacology Unit, Department of Health of Alicante - General Hospital, Alicante, Spain
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7
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Kingsberg SA, Simon JA. Female Hypoactive Sexual Desire Disorder: A Practical Guide to Causes, Clinical Diagnosis, and Treatment. J Womens Health (Larchmt) 2020; 29:1101-1112. [PMID: 32460605 DOI: 10.1089/jwh.2019.7865] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Hypoactive sexual desire disorder (HSDD) in women is defined as the persistent or recurrent absence of sexual thoughts or fantasies and/or lack of desire for sexual activity that is associated with marked personal distress and/or interpersonal difficulties, and cannot be better attributed to another primary disorder, medication, or general medical condition. Notably, HSDD shares some similarity with depression, as its etiology can be explained using a biopsychosocial model that includes biological, psychological, and sociocultural factors, as well as interpersonal influences. Due to its high prevalence and negative impact on the overall health and well-being of women, primary care health professionals and women's health practitioners need to be actively aware of HSDD, particularly because patients may be reluctant or unwilling to initiate a discussion about their sexual concerns during routine visits. HSDD is well established as a valid and treatable clinical entity. Even for those inexperienced in treating sexual problems, there are simple and validated screening tools such as the Decreased Sexual Desire Screener that can help identify HSDD and a need for further evaluation and treatment. There have been few established pharmacologic treatments for HSDD. Flibanserin was the first drug approved for the treatment of HSDD by the U.S. Food and Drug Administration (FDA). Bremelanotide, a novel melanocortin receptor agonist, was recently approved by the FDA for the treatment of acquired, generalized HSDD in premenopausal women. Increased awareness and recognition of HSDD as a medical condition should provide an incentive for further clinical development of effective treatments for HSDD.
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Affiliation(s)
- Sheryl A Kingsberg
- Division of Behavioral Medicine, University Hospitals Cleveland Medical Center, MacDonald Women's Hospital, Cleveland, Ohio, USA.,Departments of Reproductive Biology and Psychiatry, Case Western Reserve University School of Medicine, MacDonald Women's Hospital, Cleveland, Ohio, USA
| | - James A Simon
- IntimMedicine™ Specialists, George Washington University School of Medicine, Washington, District of Columbia, USA
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8
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Skoczyński S, Nowosielski K, Minarowski Ł, Brożek G, Oraczewska A, Glinka K, Ficek K, Kotulska B, Tobiczyk E, Skomro R, Mróz R, Barczyk A. Sexual disorders and dyspnoea among women with obstructive sleep apnea. Adv Med Sci 2020; 65:189-196. [PMID: 32000113 DOI: 10.1016/j.advms.2019.12.003] [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: 12/21/2018] [Revised: 09/10/2019] [Accepted: 12/04/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE We aimed to assess sexual function, sexual distress and the prevalence of female sexual dysfunction (FSD) among women with obstructive sleep apnea syndrome (OSA), and to assess if the presence of OSA and dyspnea influences the prevalence of FSD, body image during sexual activity and sexual function. METHODS We assessed 23 women with new OSA diagnosis and 23 healthy age and body mass index (BMI) matched controls. Sexual functions were evaluated by Changes in Sexual Functioning Questionnaire (CSFQ), sexual dysfunction was diagnosed based on DSM-5 criteria during the semi-structured sexual interview, whereas body image was evaluated by Body Exposure during Sexual Activities Questionnaire (BESAQ). New York Heart Association score (NYHA) and Visual Analogue Scale (VAS) were used to assess dyspnea. RESULTS OSA women had worse general sexual function and lower frequency of desire assessed by CSFQ (37.0 vs. 42 and 5 vs. 6), were at higher risk for FSD (CSFQ; 80% vs. 48%) and had a higher NYHA score (II vs. I). The prevalence of FSD did not differ in both groups, nor did sexual dysfunctions or body image (BESAQ). The multiple regression analysis revealed that OSA was associated with lower desire/frequency, higher NYHA scores with decreased desire/interest and worse body image during sexual activity, whereas higher VAS scores with worse desire/frequency. CONCLUSIONS OSA probably does not influence the prevalence of sexual dysfunction in females. However, OSA, as well as the higher level of dyspnea assessed by NYHA, may decrease sexual body image and sexual performance in females.
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9
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Abstract
Sexual arousal in women comprises two components: genital arousal and subjective arousal. Genital arousal is characterized by genital vasocongestion and other physiological changes that occur in response to sexual stimuli, whereas subjective arousal refers to mental engagement during sexual activity. For some women, genital arousal enhances subjective arousal; for others, the two types of arousal are desynchronous. However, the relationship between genital and subjective arousal might not be relevant to the diagnosis and treatment of sexual arousal dysfunction. Studies have shown that not all women who report sexual arousal problems have decreased genital arousal, and only some women with decreased genital arousal have low subjective arousal. To develop efficacious treatments for female sexual arousal dysfunction, researchers need to differentiate the women for whom genital sensations have a critical role in their subjective arousal from those who are not mentally aroused by genital cues. The mechanisms by which women become aroused and the inputs into arousal have considerable implications for treatment outcomes.
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10
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Costa RM, Oliveira G, Pestana J, Costa D, Oliveira RF. Do Psychosocial Factors Moderate the Relation between Testosterone and Female Sexual Desire? The Role of Interoception, Alexithymia, Defense Mechanisms, and Relationship Status. ADAPTIVE HUMAN BEHAVIOR AND PHYSIOLOGY 2018. [DOI: 10.1007/s40750-018-0102-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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11
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Tuiten A, Michiels F, Böcker KB, Höhle D, van Honk J, de Lange RP, van Rooij K, Kessels R, Bloemers J, Gerritsen J, Janssen P, de Leede L, Meyer JJ, Everaerd W, Frijlink HW, Koppeschaar HP, Olivier B, Pfaus JG. Genotype scores predict drug efficacy in subtypes of female sexual interest/arousal disorder: A double-blind, randomized, placebo-controlled cross-over trial. ACTA ACUST UNITED AC 2018; 14:1745506518788970. [PMID: 30016917 PMCID: PMC6052493 DOI: 10.1177/1745506518788970] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Attempts to develop a drug treatment for female sexual interest/arousal disorder
have so far been guided by the principle of ‘one size fits all’, and have failed
to acknowledge the complexity of female sexuality. Guided by personalized
medicine, we designed two on-demand drugs targeting two distinct hypothesized
causal mechanisms for this sexual disorder. The objective of this study was to
design and test a novel procedure, based on genotyping, that predicts which of
the two on-demand drugs will yield a positive treatment response. In a
double-blind, randomized, placebo-controlled cross-over experiment, 139 women
with female sexual interest/arousal disorder received three different on-demand
drug-combination treatments during three 2-week periods: testosterone
0.5 mg + sildenafil 50 mg, testosterone 0.5 mg + buspirone 10 mg, and matching
placebo. The primary endpoint was change in satisfactory sexual events.
Subjects’ genetic profile was assessed using a microarray chip that measures
300,000 single-nucleotide polymorphisms. A preselection of single-nucleotide
polymorphisms associated with genes that are shown to be involved in sexual
behaviour were combined into a Phenotype Prediction Score. The Phenotype
Prediction Score demarcation formula was developed and subsequently validated on
separate data sets. Prediction of drug-responders with the Phenotype Prediction
Score demarcation formula gave large effect sizes (d = 0.66 through 1.06) in the
true drug-responders, and medium effect sizes (d = 0.51 and d = 0.47) in all
patients (including identified double, and non-responders). Accuracy,
sensitivity, specificity, positive predictive value, and negative predictive
value of the Phenotype Prediction Score demarcation formula were all between
0.78 and 0.79, and thus sufficient. The resulting Phenotype Prediction Score was
validated and shown to effectively and reliably predict which women would
benefit from which on-demand drug, and could therefore also be useful in
clinical practice, as a companion diagnostic establishing the way to a true
personalized medicine approach.
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Affiliation(s)
| | - Frits Michiels
- 2 Chemistry and Life Sciences, V.O. Patients & Trademarks, Amsterdam, The Netherlands
| | | | - Daniël Höhle
- 3 Alan Turing Institute Almere, Almere, The Netherlands
| | - Jack van Honk
- 4 Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands.,5 Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa.,6 Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Kim van Rooij
- 1 Emotional Brain BV, Almere, The Netherlands.,7 Utrecht Institute for Pharmaceutical Sciences and Rudolf Magnus Institute of Neuroscience, Utrecht University, Utrecht, The Netherlands
| | - Rob Kessels
- 1 Emotional Brain BV, Almere, The Netherlands
| | - Jos Bloemers
- 1 Emotional Brain BV, Almere, The Netherlands.,7 Utrecht Institute for Pharmaceutical Sciences and Rudolf Magnus Institute of Neuroscience, Utrecht University, Utrecht, The Netherlands
| | - Jeroen Gerritsen
- 1 Emotional Brain BV, Almere, The Netherlands.,7 Utrecht Institute for Pharmaceutical Sciences and Rudolf Magnus Institute of Neuroscience, Utrecht University, Utrecht, The Netherlands
| | - Paddy Janssen
- 8 Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,9 Department of Central Hospital Pharmacy, Viecuri Hospital, Venlo, The Netherlands
| | - Leo de Leede
- 10 Exelion Bio-Pharmaceutical Consultancy B.V., Waddinxveen, The Netherlands
| | - John-Jules Meyer
- 3 Alan Turing Institute Almere, Almere, The Netherlands.,11 Department of Information and Computing Sciences, Utrecht University, Utrecht, The Netherlands
| | - Walter Everaerd
- 12 Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Henderik W Frijlink
- 13 Research Group of Pharmaceutical Technology and Biopharmacy, University of Groningen, Groningen, The Netherland
| | | | - Berend Olivier
- 7 Utrecht Institute for Pharmaceutical Sciences and Rudolf Magnus Institute of Neuroscience, Utrecht University, Utrecht, The Netherlands.,14 Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.,15 Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, The Netherlands
| | - James G Pfaus
- 16 Department of Psychology, Centre for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada
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12
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An international Urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for the assessment of sexual health of women with pelvic floor dysfunction. Int Urogynecol J 2018; 29:647-666. [DOI: 10.1007/s00192-018-3603-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 12/18/2017] [Indexed: 01/13/2023]
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13
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Abstract
INTRODUCTION Hypoactive sexual desire disorder (HSDD) often has a negative impact on the health and quality of life of women; however, many women do not mention-let alone discuss-this issue with their physicians. Providers of gynecologic services have the opportunity to address this subject with their patients. AIM To review the diagnosis and evidence-based treatment of low sexual desire in women with a focus on strategies that can be used efficiently and effectively in the clinic. METHODS The Medline database was searched for clinically relevant publications on the diagnosis and management of HSDD. RESULTS HSDD screening can be accomplished during an office visit with a few brief questions to determine whether further evaluation is warranted. Because women's sexual desire encompasses biological, psychological, social, and contextual components, a biopsychosocial approach to evaluating and treating patients with HSDD is recommended. Although individualized treatment plan development for patients requires independent medical judgment, a simple algorithm can assist in the screening, diagnosis, and management of HSDD. Once a diagnosis of HSDD has been made, interventions can begin with office-based counseling and progress to psychotherapy and/or pharmacotherapy. Flibanserin, a postsynaptic 5-hydroxytryptamine 1A agonist and 2A antagonist that decreases serotonin levels and increases dopamine and norepinephrine levels, is indicated for acquired, generalized HSDD in premenopausal women and is the only agent approved in the United States for the treatment of HSDD in women. Other strategies to treat HSDD include using medications indicated for other conditions (eg, transdermal testosterone, bupropion). Bremelanotide, a melanocortin receptor agonist, is in late-stage clinical development. CONCLUSIONS Providers of gynecologic care are uniquely positioned to screen, counsel, and refer patients with HSDD. Options for pharmacotherapy of HSDD are currently limited to flibanserin, approved by the US Food and Drug Administration, and off-label use of other agents. Clayton AH, Kingsberg SA, Goldstein I. Evaluation and Management of Hypoactive Sexual Desire Disorder. Sex Med 2018;6:59-74.
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Rogers RG, Pauls RN, Thakar R, Morin M, Kuhn A, Petri E, Fatton B, Whitmore K, Kinsberg S, Lee J. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the assessment of sexual health of women with pelvic floor dysfunction. Neurourol Urodyn 2018; 37:1220-1240. [PMID: 29441607 DOI: 10.1002/nau.23508] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 12/18/2017] [Indexed: 12/18/2022]
Abstract
AIMS The terminology in current use for sexual function and dysfunction in women with pelvic floor disorders lacks uniformity, which leads to uncertainty, confusion, and unintended ambiguity. The terminology for the sexual health of women with pelvic floor dysfunction needs to be collated in a clinically-based consensus report. METHODS This report combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA), and the International Continence Society (ICS), assisted at intervals by many external referees. Internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). Importantly, this report is not meant to replace, but rather complement current terminology used in other fields for female sexual health and to clarify terms specific to women with pelvic floor dysfunction. RESULTS A clinically based terminology report for sexual health in women with pelvic floor dysfunction encompassing over 100 separate definitions, has been developed. Key aims have been to make the terminology interpretable by practitioners, trainees, and researchers in female pelvic floor dysfunction. Interval review (5-10 years) is anticipated to keep the document updated and as widely acceptable as possible. CONCLUSION A consensus-based terminology report for female sexual health in women with pelvic floor dysfunction has been produced aimed at being a significant aid to clinical practice and a stimulus for research.
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Affiliation(s)
| | | | - Ranee Thakar
- Croydon University Hospital Croydon, London, United Kingdom
| | | | - Annette Kuhn
- University Teaching Hospital Berne (Inselspital), Bern, Switzerland
| | | | - Brigitte Fatton
- University Hospital Nîmes, Nimes, Languedoc-Roussillon, France
| | | | | | - Joseph Lee
- University of New South Wales, St Vincents Hospital, Sydney, New South Wales, Australia
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Both S. Recent Developments in Psychopharmaceutical Approaches to Treating Female Sexual Interest and Arousal Disorder. CURRENT SEXUAL HEALTH REPORTS 2017; 9:192-199. [PMID: 29225554 PMCID: PMC5711968 DOI: 10.1007/s11930-017-0124-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose of Review This review summarizes the recent literature and empirical studies on psychopharmacological approaches to treating female sexual interest/arousal disorder (FSIAD). Recent Findings Several new drugs for FSIAD that are intended to increase sexual responsiveness by influencing central excitatory and inhibitory neuromodulatory processes are under development. Studies on flibanserin resulted in the first approved medication for the treatment of low sexual desire in premenopausal women. New drugs under development are testosterone combined with sildenafil or buspiron, bremelanotide, BP101, and nasal testosterone (TBS-2). Summary Although pharmacological enhancement of sexual responsiveness may be potentially helpful in the treatment of FSIAD, the observed effects of flibanserin and other new drugs under development seem limited in terms of clinical significance. Given the multifactorial character of FSIAD, it may be important to integrate psychopharmacological treatment with sex therapy for optimal treatment efficacy.
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Affiliation(s)
- Stephanie Both
- Department of Psychosomatic Gynecology and Sexology, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, The Netherlands
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Brotto LA. Evidence-based treatments for low sexual desire in women. Front Neuroendocrinol 2017; 45:11-17. [PMID: 28237271 DOI: 10.1016/j.yfrne.2017.02.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 02/14/2017] [Accepted: 02/16/2017] [Indexed: 02/06/2023]
Abstract
Low sexual desire is the most common sexual complaint in women, with multinational studies finding that at least a third of women experience low sexual desire. No single etiology for the development of Female Sexual Interest/Arousal Disorder, the diagnosis laid out by the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, has been established. There has been considerable interest in pharmacological approaches to improving low desire, and agents targeting a range of neurotransmitters have been examined. To date, only flibanserin, a centrally acting medication targeting the serotonin, dopamine, and norepinephrine systems, has been approved by the Food and Drug Administration (FDA). Despite statistically significant effects on sexual desire, sexual distress, and sexually satisfying events, side-effects are significant, and flibanserin is completely contraindicated with alcohol. As such, there has been renewed interest in advancing the science of psychological approaches to low desire, including cognitive behavioral and mindfulness therapies.
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Affiliation(s)
- Lori A Brotto
- University of British Columbia, Department of Obstetrics and Gynaecology, Canada.
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Gelman F, Atrio J. Flibanserin for hypoactive sexual desire disorder: place in therapy. Ther Adv Chronic Dis 2017; 8:16-25. [PMID: 28203348 DOI: 10.1177/2040622316679933] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The pathophysiology, diagnosis and treatment of female sexual interest in pre- and post-menopausal women present a complex arena for patients and physicians to navigate. Flibanserin was the first pharmacologic treatment, approved by the United States Food and Drug Administration in August 2015, for hypoactive sexual desire disorder (HSDD) in premenopausal women. Side effects, contraindications and lack of approval in postmenopausal women are all limitations, as are issues surrounding patient and physician knowledge and access. Testosterone, buspirone, sildenafil, bupropion, bremelanotide, as well as herbal medications (Herbal vX or Tribulus terrestris) have demonstrated some clinical benefit in women with sexual dysfunction disorders however, trials have significant design, dosing or generalizability limitations. Nonpharmaceutical cognitive behavioral therapy, mindfulness meditation, pelvic floor therapy, and clitoral stimulators are also interventions women may pursue. This manuscript will explore the clinical data regarding these therapeutic modalities so as to bring attention to this issue of female HSDD, to offer an overview of current research, and to incite providers to initiate discussion among themselves and their patients.
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Affiliation(s)
- Faina Gelman
- Department of Obstetrics and Gynecology, Montefiore Hospital and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jessica Atrio
- Department of Obstetrics and Gynecology, Montefiore Hospital and Albert Einstein College of Medicine, 1695 Eastchester Road, Bronx, NY 10467-2490, USA
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Abstract
Abstract. The past three decades have seen an unprecedented increase in empirical research on women’s sexual response. In this review, we critically examine current controversies and assumptions associated with the nature of women’s sexual arousal and desire. We focus specifically on four assumptions: (1) the assumption that women should be aroused by stimuli that align with their stated preferences, (2) the assumption that women’s physiological and self-reported arousal should perfectly align, (3) the assumption that sexual desire precedes sexual arousal, and (4) the assumption that a single pharmaceutical compound will adequately restore women’s sexual response to her level of satisfaction. Engaging a gendered psychological framework for conceptualizing women’s sexuality, we emphasize the need for models of women’s sexual response to be sensitive to the sexed biological processes and gendered psychosocial factors that contribute to a woman’s unique sexual experience.
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Affiliation(s)
| | - Lori A. Brotto
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
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Costa RM, Oliveira TF, Pestana J, Costa D. Self-transcendence is related to higher female sexual desire. PERSONALITY AND INDIVIDUAL DIFFERENCES 2016. [DOI: 10.1016/j.paid.2016.02.078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Altered states of consciousness are related to higher sexual responsiveness. Conscious Cogn 2016; 42:135-141. [DOI: 10.1016/j.concog.2016.03.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 03/02/2016] [Accepted: 03/14/2016] [Indexed: 01/24/2023]
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Bloemers J, van Rooij K, de Leede L, Frijlink HW, Koppeschaar HPF, Olivier B, Tuiten A. Single dose sublingual testosterone and oral sildenafil vs. a dual route/dual release fixed dose combination tablet: a pharmacokinetic comparison. Br J Clin Pharmacol 2016; 81:1091-102. [PMID: 26804967 DOI: 10.1111/bcp.12887] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 01/14/2016] [Accepted: 01/21/2016] [Indexed: 01/04/2023] Open
Abstract
AIM The aim was to compare the pharmacokinetic profiles of two formulations of a combination drug product containing 0.5 mg testosterone and 50 mg sildenafil for female sexual interest/arousal disorder. The prototype (formulation 1) consists of a testosterone solution for sublingual administration and a sildenafil tablet that is administered 2.5 h later. The dual route/dual release fixed dose combination tablet (formulation 2) employs a sublingual and an oral route for systemic uptake. This tablet has an inner core of sildenafil with a polymeric time delay coating and an outer polymeric coating containing testosterone. It was designed to increase dosing practicality and decrease potential temporal non-adherence through circumventing the relatively complex temporal dosing scheme. METHODS Twelve healthy premenopausal subjects received both formulations randomly on separate days. Blood was sampled frequently to determine the pharmacokinetics of free testosterone, total testosterone, dihydrotestosterone, sildenafil and N-desmethyl-sildenafil. RESULTS Formulation 2 had a higher maximum concentration (Cmax ) for testosterone, 8.06 ng ml(-1) (95% confidence interval [CI] 6.84, 9.28) and higher area under the plasma concentration-time curve (AUC), 7.69 ng ml(-1) h (95% CI 6.22, 9.16) than formulation 1, 5.66 ng ml(-1) (95% CI 4.63, 6.69) and 5.12 ng ml(-1) h (95% CI 4.51, 5.73), respectively. Formulation 2 had a lower Cmax for sildenafil, 173 ng ml(-1) (95% CI 126, 220) and a lower AUC, 476 ng ml(-1) h (95% CI 401, 551) than formulation 1, 268 ng ml(-1) (95% CI 188, 348) and 577 ng ml(-1) h (95% CI 462, 692), respectively. Formulation 2 released sildenafil after 2.75 h (95% CI 2.40, 3.10). CONCLUSIONS The dual route/dual release fixed dose combination tablet fulfilled its design criteria and is considered suitable for further clinical testing. WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT Female sexual interest/arousal disorder (FSIAD) is a significant problem impacting psychological well-being, but the pharmacotherapeutic options for this problem are lacking. The combined, on-demand, sublingual administration of low dose sublingual testosterone and oral administration of sildenafil is a novel pharmacotherapeutic option under development for FSIAD. In proof-of-concept trials, these compounds were successfully administered via different dosage forms (sublingual and oral) at different time points (separated by 2.5 h) because of their markedly different pharmacokinetic-pharmacodynamic profiles. For future larger scale studies and the clinical practice, this raises obvious adherence issues. WHAT THIS STUDY ADDS A newly developed dual route/dual release fixed dose combination tablet containing testosterone and sildenafil mimics the pharmacokinetic profile of these components when they are administered as different dosage forms, 2.5 h apart. This combination tablet is a suitable final pharmaceutical drug product that will be used in future studies.
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Affiliation(s)
- Jos Bloemers
- Emotional Brain B.V., Almere.,Utrecht Institute for Pharmaceutical Sciences and Rudolf Magnus Institute of Neuroscience, Utrecht University, Utrecht
| | - Kim van Rooij
- Emotional Brain B.V., Almere.,Utrecht Institute for Pharmaceutical Sciences and Rudolf Magnus Institute of Neuroscience, Utrecht University, Utrecht
| | - Leo de Leede
- Exelion Bio-Pharmaceutical Consultancy B.V., Waddinxveen
| | - Henderik W Frijlink
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, Groningen, The Netherlands
| | | | - Berend Olivier
- Utrecht Institute for Pharmaceutical Sciences and Rudolf Magnus Institute of Neuroscience, Utrecht University, Utrecht.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Adriaan Tuiten
- Emotional Brain B.V., Almere.,Department of Psychopharmacology, Utrecht University, Utrecht, The Netherlands
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Gao L, Yang L, Qian S, Li T, Han P, Yuan J. Systematic review and meta-analysis of phosphodiesterase type 5 inhibitors for the treatment of female sexual dysfunction. Int J Gynaecol Obstet 2015; 133:139-45. [DOI: 10.1016/j.ijgo.2015.08.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 08/14/2015] [Accepted: 12/01/2015] [Indexed: 12/29/2022]
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Abstract
INTRODUCTION Multiple methods and devices are available for the assessment of female sexual response, each with strengths and limitations that can impact interpretation of research results. As such, it is important to have an understanding of available methodologies and instruments. AIM To review recent literature on the measurement of female sexual response, and to describe the methods and devices, and their strengths and limitations. METHODS A literature review was performed regarding methodology and instruments used to quantify female sexual response. MAIN OUTCOME MEASURES The description of currently available instruments and methods to quantify sexual response in women. RESULTS Methodologies used to examine female sexual arousal employ a variety of stimuli and instruments to elicit and record sexual response. The variation in research designs across studies highlights the importance of understanding (i) how sexual response is elicited in studies; (ii) what kinds of experimental designs are available for assessing sexual psychophysiology; and (iii) the various types of instrumentation used to collect data. CONCLUSIONS The physiological and self-reported measurement of female sexual response is crucial to our understanding of the mechanisms and factors involved with healthy sexual functioning. As such, it is important to understand the strengths and limitations associated with different stimuli, research designs, and instruments. Kukkonen TM. Devices and methods to measure female sexual arousal.
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Affiliation(s)
- Tuuli M Kukkonen
- Department of Family Relations and Applied NutritionUniversity of GuelphGuelphONCanada.
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The Female Sexual Response: Current Models, Neurobiological Underpinnings and Agents Currently Approved or Under Investigation for the Treatment of Hypoactive Sexual Desire Disorder. CNS Drugs 2015; 29:915-33. [PMID: 26519340 DOI: 10.1007/s40263-015-0288-1] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
How a woman responds to sexual cues is highly dependent on a number of distinct, yet related, factors. Researchers have attempted to explain the female sexual response for decades, but no single model reigns supreme. Proper female sexual function relies on the interplay of somatic, psychosocial and neurobiological factors; misregulation of any of these components could result in sexual dysfunction. The most common sexual dysfunction disorder is hypoactive sexual desire disorder (HSDD). HSDD is a disorder affecting women across the world; a recent in-person diagnostic interview study conducted in the USA found that an estimated 7.4% of US women suffer from HSDD. Despite the disorder's prevalence, it is often overlooked as a formal diagnosis. In a survey of primary care physicians and obstetrics/gynaecology specialists, the number one reason for not assigning an HSDD diagnosis was the lack of a safe and effective therapy approved by the US Food and Drug Administration (FDA). This changed with the recent FDA approval of flibanserin (Addyi™) for the treatment of premenopausal women with acquired, generalized HSDD; there are still, however, no treatments approved outside the USA. HSDD is characterized by a marked decrease in sexual desire, an absence of motivation (also known as avolition) to engage in sexual activity, and the condition's hallmark symptom, marked patient distress. Research suggests that HSDD may arise from an imbalance of the excitatory and inhibitory neurobiological pathways that regulate the mammalian sexual response; top-down inhibition from the prefrontal cortex may be hyperactive, and/or bottom-up excitation to the limbic system may be hypoactive. Key neuromodulators for the excitatory pathways include norepinephrine, oxytocin, dopamine and melanocortins. Serotonin, opioids and endocannabinoids serve as key neuromodulators for the inhibitory pathways. Evolving treatment strategies have relied heavily on these crucial research findings, as many of the agents currently being investigated as treatment options for HSDD target and influence key players within these excitatory and inhibitory pathways, including various hormone therapies and centrally acting drugs, such as buspirone, bupropion and bremelanotide.
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Costa RM, Oliveira RF. Maladaptive defense mechanisms are associated with decoupling of testosterone from sexual desire in women of reproductive age. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/15294145.2015.1089184] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Abstract
Sexual problems are highly prevalent among patients with psychiatric disorders. They may be caused by the psychopathology of the psychiatric disorder but also by its pharmacotherapy. Both positive symptoms (e.g., psychosis, hallucinations) as well as negative symptoms (e.g., anhedonia) of schizophrenia may negatively interfere with interpersonal and sexual relationships. Atypical antipsychotics have fewer sexual side-effects than the classic antipsychotics. Mood disorders may affect libido, sexual arousal, orgasm, and erectile function. With the exception of bupropion, agomelatine, mirtazapine, vortioxetine, amineptine, and moclobemide, all antidepressants cause sexual side-effects. Selective serotonin reuptake inhibitors (SSRIs) may particularly delay ejaculation and female orgasm, but also can cause decreased libido and erectile difficulties. SSRI-induced sexual side-effects are dose-dependent and reversible. Very rarely, their sexual side-effects persist after SSRI discontinuation. This is often preceded by genital anesthesia. Some personality characteristics are a risk factor for sexual dysfunction. Also patients with eating disorders may suffer from sexual difficulties. So far, research into psychotropic-induced sexual side-effects suffers from substantial methodologic limitations. Patients tend not to talk with their clinician about their sexual life. Psychiatrists and other doctors need to take the initiative to talk about the patient's sexual life in order to become informed about potential medication-induced sexual difficulties.
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Affiliation(s)
- Marcel D Waldinger
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of BetaSciences, Utrecht University, Utrecht, The Netherlands.
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Kurpisz J, Mak M, Lew-Starowicz M, Nowosielski K, Samochowiec J. The Dual Control Model of sexual response by J. Bancroft and E. Janssen. Theoretical basis, research and practical issues. POSTĘPY PSYCHIATRII I NEUROLOGII 2015. [DOI: 10.1016/j.pin.2015.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pharmacokinetics of a prototype formulation of sublingual testosterone and a buspirone tablet, versus an advanced combination tablet of testosterone and buspirone in healthy premenopausal women. Drugs R D 2015; 14:125-32. [PMID: 24849043 PMCID: PMC4070462 DOI: 10.1007/s40268-014-0047-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The study aimed to compare the kinetics of two novel combination drug products for Female Sexual Interest/Arousal Disorder (FSIAD). Thirteen women received testosterone via the sublingual route followed 2.5 hours later by a buspirone tablet, versus a single combination tablet swallowed at once. The first clinical prototype consisted of a sublingual solution containing testosterone (0.5 mg) complexed with cyclodextrin and a tablet containing 10 mg buspirone, in a gelatin capsule to ensure blinding during the clinical studies. The innovative fixed-combination tablet consists of an inner-core component of 10 mg buspirone coated with a polymeric time-delay coating and an outer polymeric coating containing testosterone with hydroxypropyl-beta cyclodextrin. We observed an immediate testosterone pulse absorption from both formulations. We also demonstrated that there was adequate absorption of buspirone (>80 % relative to the conventional tablet) and a time delay in release of buspirone of 3.3 hours, close to the 3.0 hours of the reference formulation that showed clinical efficacy in early proof-of-principle studies. The newly developed combination tablet fulfils its design criteria and is a convenient tablet for further clinical studies in FSIAD.
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Nappi RE, Cucinella L. Advances in pharmacotherapy for treating female sexual dysfunction. Expert Opin Pharmacother 2015; 16:875-87. [DOI: 10.1517/14656566.2015.1020791] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Georgiadis JR. Functional neuroanatomy of human cortex cerebri in relation to wanting sex and having it. Clin Anat 2015; 28:314-23. [DOI: 10.1002/ca.22528] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 01/27/2015] [Indexed: 12/29/2022]
Affiliation(s)
- Janniko R. Georgiadis
- Department of Neuroscience/Section Anatomy; University Medical Center Groningen (UMCG), University of Groningen; The Netherlands
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van Rooij K, Poels S, Worst P, Bloemers J, Koppeschaar H, Goldstein A, Olivier B, Tuiten A. Efficacy of testosterone combined with a PDE5 inhibitor and testosterone combined with a serotonin (1A) receptor agonist in women with SSRI-induced sexual dysfunction. A preliminary study. Eur J Pharmacol 2014; 753:246-51. [PMID: 25460030 DOI: 10.1016/j.ejphar.2014.10.061] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 10/16/2014] [Indexed: 11/15/2022]
Abstract
Selective serotonin reuptake inhibitors (SSRIs) are known to cause sexual dysfunction, such as decreased sexual motivation, desire, arousal, and orgasm difficulties. These SSRI-induced sexual complaints have a high prevalence rate, while there is no approved pharmacological treatment for SSRI-induced sexual dysfunction. It is hypothesized that a polymorphisms in the androgen receptor gene, encoded by the nucleotides cysteine, adenine, and guanine (CAG), influence the effect of testosterone on sexual functioning. In an explorative, randomized, double-blind, placebo-controlled, crossover study we investigated the possible effects of sublingual testosterone combined with a serotonin (5-HT)1A receptor agonist, and of sublingual testosterone combined with a phosphodiesterase type 5 inhibitor (PDE5-i) on sexual functioning in women with SSRI-induced sexual dysfunction. Furthermore, we did an exploratory analysis to assess if the CAG polymorphism influences this effect. 21 pre- and postmenopausal women with SSRI-induced sexual dysfunction participated and underwent the following interventions: a combination of testosterone (0.5 mg) sublingually and the PDE5-i sildenafil (50 mg) and a combination of testosterone (0.5 mg) sublingually and the 5-HT1A receptor agonist buspirone (10 mg). The results show that women who use a low dose of SSRI and have relatively long CAG repeats report a marked improvement in sexual function in response to both treatments compared to placebo. This explorative study and preliminary results indicate that in women with SSRI-induced sexual dysfunction, a combination of testosterone sublingually and a PDE5-i or testosterone sublingually and a 5-HT1A receptor agonist might be promising treatments for certain subgroups of women with this condition.
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Affiliation(s)
- Kim van Rooij
- Emotional Brain B.V., Almere, The Netherlands; Utrecht Institute for Pharmaceutical Sciences and Rudlof Magnus Institute of Neuroscience, Utrecht University, Utrecht, The Netherlands.
| | - Saskia Poels
- Emotional Brain B.V., Almere, The Netherlands; Utrecht Institute for Pharmaceutical Sciences and Rudlof Magnus Institute of Neuroscience, Utrecht University, Utrecht, The Netherlands
| | - Petra Worst
- Emotional Brain B.V., Almere, The Netherlands
| | - Jos Bloemers
- Emotional Brain B.V., Almere, The Netherlands; Utrecht Institute for Pharmaceutical Sciences and Rudlof Magnus Institute of Neuroscience, Utrecht University, Utrecht, The Netherlands
| | | | | | - Berend Olivier
- Utrecht Institute for Pharmaceutical Sciences and Rudlof Magnus Institute of Neuroscience, Utrecht University, Utrecht, The Netherlands; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Adriaan Tuiten
- Emotional Brain B.V., Almere, The Netherlands; Department of Psychopharmacology, Utrecht University, Utrecht, The Netherlands
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Belkin ZR, Krapf JM, Goldstein AT. Drugs in early clinical development for the treatment of female sexual dysfunction. Expert Opin Investig Drugs 2014; 24:159-67. [DOI: 10.1517/13543784.2015.978283] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Zoe R Belkin
- 1The George Washington University School of Medicine and Health Sciences, Department of Obstetrics and Gynecology, Washington, DC USA
| | - Jill M Krapf
- 1The George Washington University School of Medicine and Health Sciences, Department of Obstetrics and Gynecology, Washington, DC USA
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Leusink P, Boeke AJP, Laan E. Toward Personalized Sexual Medicine: Where is the Evidence? J Sex Med 2014; 11:2357-8. [DOI: 10.1111/jsm.12619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Dawson SJ, Chivers ML. Gender Differences and Similarities in Sexual Desire. CURRENT SEXUAL HEALTH REPORTS 2014. [DOI: 10.1007/s11930-014-0027-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Poels S, Bloemers J, van Rooij K, Koppeschaar H, Olivier B, Tuiten A. Two novel combined drug treatments for women with hypoactive sexual desire disorder. Pharmacol Biochem Behav 2014; 121:71-9. [DOI: 10.1016/j.pbb.2014.02.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 02/03/2014] [Accepted: 02/05/2014] [Indexed: 01/23/2023]
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Kumsar Ş, Kumsar NA, Sağlam HS, Köse O, Budak S, Adsan Ö. Testosterone levels and sexual function disorders in depressive female patients: effects of antidepressant treatment. J Sex Med 2013; 11:529-35. [PMID: 24286389 DOI: 10.1111/jsm.12394] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Women suffer from depression more frequently than men, which indicates that sex hormones might be involved in the etiology of this disease. AIMS The purpose of this study was to assess the relationship between testosterone and depression pathophysiology in depressive women along with sexual function. We also investigated whether antidepressant treatment causes any change in levels of this hormone or in sexual function. METHODS Premenopausal female patients aged 25-46 years (n = 52) with diagnosed major depression were included in this study as the patient group, and 25- to 46-year-old premenopausal women without depression (n = 30) were included as the control group. MAIN OUTCOME MEASURES Serum testosterone and sex hormone-binding globulin (SHBG) levels were measured twice, before and after the antidepressant treatment. Bioavailable testosterone (cBT) levels were calculated using the assay results for total testosterone (TT), SHBG, and albumin according to the formulas of Vermeulen et al. Depression severity was measured using the 17-item Hamilton Depression Rating Scale, and sexual function was evaluated with the Arizona Sexual Experience Scale. RESULTS The mean TT and cBT levels significantly increased in the patient group after the antidepressant treatment (P < 0.001). Pre-treatment TT and cBT levels were significantly lower in the patient group than in the control group (P < 0.001). Similar results were obtained for post-treatment serum TT and cBT levels in the patient and control groups (P > 0.05). There were no significant differences among the groups in terms of SHBG level. CONCLUSION The low testosterone levels in depressed women compared with women in the control group and the elevated levels post-pharmacotherapy suggest that testosterone may be involved in depression.
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Affiliation(s)
- Şükrü Kumsar
- Department of Urology, Sakarya University Training and Research Hospital, Sakarya, Turkey
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