Top 50 most cited articles about female sexual dysfunction: a bibliometric analysis

INTRODUCTION

Female sexual dysfunction (FSD) consists of low libido, sexual arousal problems, anorgasmia, and dyspareunia. Sexual function is an important aspect of life for many women and is closely correlated with overall well-being. FSD is often underrepresented in the academic space when compared with male sexual disorders, such as erectile dysfunction. As FSD spans many fields (eg, urology, gynecology, psychology), bibliometric analyses are an important resource to highlight landmark articles.

OBJECTIVES

To identify key articles about FSD by citation number and bibliometric analysis to facilitate future scholarly efforts into more FSD research.

METHODS

We searched for articles in the Web of Science Core Collection between 1900 and 2023 using terms specific to FSD. We identified relevant FSD articles and selected the top 50 most cited. A bibliometric analysis was performed to collect and analyze data about title, authorship, publication year, citation number, journal and impact factor, country and institution, study type, citation index, specialty, and conflict of interest.

RESULTS

An overall 6858 results were identified. The top 50 most cited articles were published between 1997 and 2014 in 12 countries, across 32 institutions, and in 20 journals. The United States produced the most articles. The Journal of Sexual Medicine published the most articles. The mean number of citations per article was 351.64. Observational studies were most common. More than half were sponsored. Of all the specialties, most articles were categorized as urology and nephrology. Research about FSD has been much less impactful than research about male sexual dysfunction, possibly owing to stigma and decreased clinical training.

CONCLUSION

As FSD covers many fields, bibliometric analyses are invaluable to understand the vast body of knowledge. We hope that this research emphasizes the lack of attention that FSD has had and that it provides health care professionals with a valuable tool to understand the trajectory of FSD to guide future education efforts.

Global prevalence of sexual dysfunction among women with metabolic syndrome: a systematic review and meta-analysis

Background

Sexual dysfunction is a common disorder among women, especially during menopause. Metabolic syndrome is a multifactorial disease that, according to previous studies, there is a relationship between the metabolic syndrome and sexual dysfunction among women. The aim of this systematic review and meta-analysis is to obtain the prevalence of Female Sexual Dysfunction (FSD) among women with metabolic syndrome, and to analyze available related evidence.

Methods

In this systematic review and meta-analysis, the keywords of MeSH, female sexual dysfunction, FSD, metabolic syndrome were searched in PubMed, Web of Science, Scopus, Science Direct and Google Scholar. The searches were conducted without a lower time limit and until May 2022.

Results

The prevalence of FSD among women with metabolic syndrome was found to be 39.3% (95% CI: 28.3-51.5). In the subgroup analysis and in the review of 4 studies, the prevalence of sexual dysfunction in postmenopausal women with metabolic syndrome was 49.8% (95% CI: 26.1-73.6). Analyzing the results of the meta-regression test in examining the effect of the three factors of sample size, year of the study, age, and BMI of the patients on the heterogeneity of the meta-analysis, showed that with the increase of the sample size, the prevalence of sexual dysfunction among women with metabolic syndrome decreases (p < 0.05). Moreover, the prevalence of sexual dysfunction among women with metabolic syndrome increases (p < 0.05) with the increase in the years of conducting studies and the mean of age of women with metabolic syndrome. Also, with increasing mean of BMI of female patients with metabolic syndrome, the prevalence of sexual dysfunction in these women also increases (p < 0.05).

Conclusion

Female sexual dysfunction is a global health problem that can affect women's life to a great extent. Metabolic syndrome, which is a set of factors such as obesity, high blood pressure, and diabetes, affects sexual dysfunction in women. From this study, it can be concluded that there is a close relationship between metabolic syndrome and female sexual dysfunction.

The global prevalence of sexual dysfunction in obese and overweight women: a systematic review and meta-analysis

BACKGROUND

Obesity is a pressing public health risk issue worldwide. Women, in particular, face a higher risk of obesity. Recent research has highlighted the association between obesity and female sexual dysfunction. Therefore, the objective of this study is to investigate the global prevalence of sexual dysfunction in obese and overweight women through a systematic review and meta-analysis.

METHODS

In this study, a systematic search was conducted across electronic databases, including PubMed, Scopus, Web of Science, Embase, ScienceDirect, and Google Scholar. The search aimed to identify studies published between December 2000 and August 2022 that reported metabolic syndrome's impact on female sexual dysfunction.

RESULTS

The review included nine studies with a sample size of 1508 obese women. The I2 heterogeneity index indicated high heterogeneity (I2: 97.5). As a result, the random effects method was used to analyze the data. Based on this meta-analysis, the prevalence of sexual dysfunction in women with obesity was reported as 49.7% (95%CI: 35.8-63.5). Furthermore, the review comprised five studies involving 1411 overweight women. The I2 heterogeneity test demonstrated high heterogeneity (I2: 96.6). Consequently, the random effects model was used to analyze the results. According to the meta-analysis, the prevalence of sexual dysfunction in overweight women was 26.9% (95% CI: 13.5-46.5).

CONCLUSION

Based on the results of this study, it has been reported that being overweight and particularly obese is an important factor affecting women's sexual dysfunction. Therefore, health policymakers must acknowledge the significance of this issue in order to raise awareness in society about its detrimental effect on the female population.

The risk of sexual dysfunction associated with alcohol consumption in women: a systematic review and meta-analysis

BACKGROUND

Alcohol abuse among women is a significant health problem. Consuming alcohol in high amounts causes decreased sexual stimulation, vaginal lubrication, dyspareunia, and difficulty reaching orgasm. Due to the different effects of alcohol consumption on sexual function, this study aimed to investigate the effect of alcohol consumption on sexual dysfunction in women.

METHODS

In this study, the researchers conducted a systematic search of several databases, including PubMed, Google Scholar, Scopus, Web of Science, Embase, and ScienceDirect, as well as the Google Scholar search engine, to identify studies reporting the impact of alcohol consumption on female sexual dysfunction. The search was conducted up until July 2022. A total of 225 articles were searched in the databases, and an additional 10 relevant articles were identified through manual search. After removing 93 articles due to duplication, 90 articles were excluded based on the study's inclusion and exclusion criteria. During the merit evaluation phase, 26 articles were excluded through the full-text study based on the study's inclusion and exclusion criteria, while 26 articles were excluded due to their low quality. Ultimately, only 7 studies were deemed suitable for the final evaluation. The analysis was conducted using a random effects model, while the heterogeneity of the studies was assessed using the I² index. Data analysis was performed using the Comprehensive Meta-Analysis Version 2 software.

RESULTS

Based on the review of 7 studies involving a total sample size of 50,225 women and using the random effects method, the calculated odds ratio was 1.74 (95% CI: 1.006-3.04). This indicates that alcohol consumption increases the likelihood of sexual dysfunction in women by 74%. The Begg and Mazumdar rank correlation test, was used to analyze the distribution bias, but the results were not significant at the 0.1 significance level (p = 0.763).

CONCLUSION

The findings of this study demonstrate a significant correlation between alcohol consumption and an increased risk of sexual dysfunction in women. These results highlight the need for policymakers to prioritize this issue and raise awareness regarding the harmful effects of alcohol consumption on female sexual function and its impact on population health and reproduction.

Symptoms and associated impact in pre- and postmenopausal women with sexual arousal disorder: a concept elicitation study

BACKGROUND

Approximately 26% of adult women in the United States suffer from female sexual arousal disorder (FSAD), yet little has been done to compare the experience of FSAD in pre- and postmenopausal women, which is critical to enhance the current understanding of FSAD and inform the development and assessment of treatment options for these patient populations.

AIM

To explore the experience of condition-associated symptoms and the relative importance of FSAD symptoms, including their severity, bother, and impact, on participants' health-related quality of life (HRQoL) in pre- and postmenopausal women with FSAD.

METHODS

In-depth, qualitative, semistructured concept elicitation interviews were conducted with premenopausal (n = 23) and postmenopausal (n = 13) women who were clinically diagnosed with FSAD by a trained sexual medicine clinician. All interviews were audio recorded and transcribed verbatim by a professional transcription company. Thematic analysis was performed with the assistance of NVivo qualitative analysis software.

OUTCOMES

Outcomes included qualitative interview data about FSAD symptoms and HRQoL, as well as a comparison between pre- and postmenopausal populations.

RESULTS

The most frequently reported symptom in both cohorts was "inability or difficulty with orgasm" (premenopausal, n = 21; postmenopausal, n = 13). The symptom that premenopausal women most desired to have treated was lubrication, and for postmenopausal women, it was a lack of lubrication or wetness and loss of feeling/sensation. In total, 21 of 23 premenopausal women and all 13 postmenopausal women reported a lack of feeling or sensation in the genitals. The most frequently reported HRQoL impact in both groups was decreased confidence.

CLINICAL IMPLICATIONS

Results from this study suggest that the manifestation and experience of FSAD are similar in pre- and postmenopausal women and that the unmet need for an FSAD treatment in the postmenopausal population is just as great as that of the premenopausal population.

STRENGTHS AND LIMITATIONS

This study involved in-depth qualitative interviews with a relatively small group of women (N = 36) recruited from only 5 study sites across the United States.

CONCLUSION

The analysis of qualitative data from the concept elicitation interviews revealed a substantial physical and emotional burden of FSAD, underscoring the need for Food and Drug Administration-approved treatment options for pre- and postmenopausal women with FSAD.

The global prevalence of sexual dysfunction in women with multiple sclerosis: a systematic review and meta-analysis

BACKGROUND

Sexual function is often impaired following neurological disorders such as multiple sclerosis (MS). Young women with MS encourage disruptions in sexual function, sexual behaviors, and family formation as common global problems. Thus, the aim of the present systematic review and meta-analysis study was to investigate the global prevalence of female sexual dysfunction (FSD) worldwide.

METHODS

Various databases (PubMed, Scopus, Web of Science, Embase, and ScienceDirect) along with Google Scholar search engine were hired for systematic searching in the field of the prevalence of FSD (by July 2022). The heterogeneity of the studies was assessed using I² index, and random effects model was used to perform the analysis (CMA software, v.2).

RESULTS

Following assessment of 14 included studies with the sample size of 2115 women, a total prevalence of sexual dysfunction (SD) in women with MS was reported 62.5% (95% CI 53.9-70.5). Meta-regression assessment also showed that FSD accelerates following increasing the sample size and the year of the studies.

CONCLUSION

The total prevalence of SD in women with MS was found considerably high (62.5%) in the world, which needs more serious attention by health policymakers. Correct implementation of health policies can potentially increase the society's awareness and successful treatment of SD in MS patients.

Ethnic Minority Representation in Female Sexual Dysfunction Questionnaire Validation: A Scoping Review

BACKGROUND

Female sexual dysfunction (FSD) is a significant cause of distress for an estimated 12-24% of women, and over the past 5 decades several questionnaires have been developed for clinical practice.

AIM

The purpose of this scoping review is to evaluate the ethnic representation of sample populations used in the studies to validate FSD questionnaires.

METHODS

A scoping review was performed using electronic databases, including PubMed and Scopus, to identify FSD questionnaires validated between 1976 and 2021. Weighted averages from the combined ethnicity data were compared to population data from 2019 US census data and 2018 healthcare workforce reports to evaluate epidemiologic diversity. Ethnicity data from each questionnaire were also investigated longitudinally to evaluate trends in representation over the past 50 years.

OUTCOMES

Our outcome of interest was comparison of the weighted averages for ethnicity categories from validation populations to the US female general population, US female health care workforce, and US census data.

RESULTS

48 validation studies were reviewed and showed that the average ethnic representation of the study populations relative to the US general population and US female health care workforce, respectively, was: Caucasian (83.7% vs 62.7% and 68.5%), Black (7.8% vs 13.3% and 8.3%), Hispanic (3.6% vs 16.0% and 9.6%), Native American (0.1% vs 0.8% and 0.3%), Asian (0.6% vs 6.4% and 6.2%), and Other (3.1% vs 0.7% and 1.4%).

CLINICAL IMPLICATIONS

FSD questionnaires are relied upon in research and clinical settings, so lack of diversity in validation populations could lead to under recognition and undertreatment in ethnic minority women.

STRENGTHS & LIMITATIONS

Our results are dependent on the quality of data available from previously published validation studies. We attempted to account for biases in lack of data and size of validation populations by using weighted averages for making comparisons. We chose the US general population and female healthcare workforce for comparison and analyzed validation populations across multiple decades and geographic locations. Many of the validation studies were performed at least 10 years ago and may not reflect the current state of FSD and potential of questionnaire responses of ethnic minority women. This manuscript raises critical awareness regarding the lack of validated instruments for FSD in ethnically diverse women.

CONCLUSION

Study populations used to validate FSD questionnaires demonstrate a trend of ethnic minority underrepresentation relative to the US female general and healthcare workforce populations. Battle CR, Rubin RS, Kingsberg SA, et al. Ethnic Minority Representation in Female Sexual Dysfunction Questionnaire Validation: A Scoping Review. J Sex Med 2022;19:1824-1838.

The effects of smoking on female sexual dysfunction: a systematic review and meta-analysis

The increased number of female smokers is considered a global health challenge in recent years. One of the detrimental effects of smoking is sexual hormone fluctuation causing female sexual dysfunction (FSD). This systematic review and meta-analysis aimed to investigate the effects of smoking leading to FSD. Electronic databases (PubMed, Scopus, Web of Science, Embase, Science Direct, and Google Scholar) were hired for systematic searching. Until June 2022, whole qualified studies reporting the consequences of smoking on FSD were gathered for data analysis based on the random effects model (CMA software, v.2). Study heterogeneity and publication bias were also assessed using I² index and Egger test, respectively. Ten eligible studies with a sample size of 15,334 female smokers (18-79 years) were selected. Following data analysis, the odds ratio representing the effects of smoking on FSD was found 1.48 (95%CI: 1.2-1.83), indicating that female smokers were 48% more susceptible to FSD than non-smokers. Also, the publication bias was reported as non-significant (p = 0.178). Since smoking is an increasingly common phenomenon in females and women smokers are 48% more susceptible to the FSD, preparation of necessary health measures by the health policymakers to reduce the number of female smokers and subsequent health services seems necessary.

DHEA on Sexual Function in Sheehan Syndrome: A Randomized Double-Blind Placebo-Controlled Crossover Trial

CONTEXT

The majority of women with Sheehan syndrome (SS) suffer from sexual dysfunction. Severe androgen deficiency is a major contributory factor. Dehydroepiandrosterone (DHEA) supplementation has been reported to have variable efficacious in improving female sexual dysfunction (FSD) in several trials but studies using DHEA in SS are not available.

OBJECTIVE

We aimed to study the use of DHEA supplementation in patients with SS.

METHODS

In this crossover trial, 28 participants with SS (age 39.7 ± 8.6 years) were divided into 2 groups (using block randomization) who received DHEA supplements (25 mg twice daily) or matched placebo sequentially for 3 months each. Female Sexual Functioning Index (FSFI) score and serum DHEA sulfate (DHEAS) were measured at baseline and after completion of each phase. Glycemic parameters, lipid profile, and liver enzymes were also measured to assess metabolic side effects.

RESULTS

There was significant improvement in FSFI score from baseline to end of the study in the DHEA group compared with the placebo group (P = 0.006). Mean FSFI score and most of the individual domains of female sexual dysfunction (FSD) improved with DHEA significantly in both groups (P = 0.001 for each group with DHEA). In those who received DHEA first followed by placebo, FSFI declined significantly after placebo (P = 0.041) but remained at an acceptable level of sexual functioning. Serum DHEAS increased significantly with DHEA treatment. No significant changes in glycemic index, lipid profile, and liver enzymes were noted with DHEA treatment.

CONCLUSION

A short duration of DHEA supplementation in women with SS with FSD is efficacious and safe.

The inverse square law: A basic principle in brachytherapy

The purpose of this article is to remind the importance of the inverse square law in radiotherapy and especially in brachytherapy. Indeed, beyond the impact in radiation therapy with high energy beam, there is the use of radionuclides and low energy photons with short FSD where it is still more important. Comparisons between Iridium Brachytherapy and low energy X-rays brachytherapy show equivalent dose distributions in the first few centimeters. If the inverse square law is not the only element influencing the dose distributions calculations, it must not be forgotten. And it is playing a major role in brachytherapy with short FSD (<6cm).

Sexual dysfunction in Thai gynecologic malignancies survivors: A single-institutional cross-sectional observational survey

OBJECTIVE

To examine the prevalence of female sexual dysfunction (FSD) in gynecologic cancer survivors.

METHODS

A cross-sectional observation survey recruited women aged 18-65 years old who were diagnosed with gynecologic cancers and underwent surgery, radiation, chemotherapy, or combined modalities. Data were collected from September 2019 to March 2020 by the Thai version of the female sexual function index questionnaire to define FSD. The survey contained six domains: desire, arousal, lubrication, orgasm, satisfaction, and pain.

RESULTS

Of the 98 women included in the study, the mean age was 48.7 ± 10.6 years old. Two-third (67.3%) of the participants was premenopausal, had been diagnosed with ovarian cancer, and had early-stage gynecologic cancers. Fifty-eight of 98 (59.2%) participants were sexually active in the past 4 weeks before the survey. Among those, 89.6% had FSD. The median scores in the FSD group were significantly lower than those in the non-FSD group in all six domains, namely, desire, arousal, lubrication, orgasm, satisfaction, and pain (p < 0.05). There was no statistically significant difference observed between participants with and without FSD in terms of age group, cancer-related data, or sexual behavior data, except participants who had good/excellent relationships with their partners, which impacted FSD (p = 0.01).

CONCLUSIONS

This study discovered the high prevalence (89.6%) of hidden issue of "female sexual dysfunction" in Thai gynecologic cancer survivors. The good/excellent relationships with their partners affected the FSD who were sexually active in the past 4 weeks before the survey.

Serotonin Selective Reuptake Inhibitors (SSRIs) and Female Sexual Dysfunction (FSD): Hypothesis on its Association and Options of Treatment

Sexual dysfunctions are commonly seen in women on selective serotonin reuptake inhibitors (SSRIs). The complexities of female sexual functioning are reflected through modulation of inter- playing factors like the neuropsychophysiological factors, inter-personal and relationship issue, psychiatric co-morbidities and physical disorder. The incidence of SSRIs-induced FSD is difficult to estimate because of the potential confounding effects of SSRIs, presence of polypharmacy, marital effect, socio-cultural factors and due to the design and assessment problems in majority of the studies. The exact mechanism of FSD-induced SSRIs is unknown. It has been postulated that although SSRIs may modulate other neurotransmitter system such as nitric oxide (NO), noradrenergic and dopamine in inducing FSD. In the present review, we highlight current evidence regarding potential mechanism of SSRIs in causing FSD, which include low sexual desire (low libido), arousal difficulties (lack of lubrication), and anorgasmia. The specific association of FSD to SSRI use, has not been ellucidated. The relationship is dose-dependent, and may vary among the groups with respect to mechanism of serotonin and dopamine reuptake, induction of release of prolactin from the pituitary gland, anticholinergic side-effects, inhibition of NO synthesis and emotional-memory circuit encryption for sexual experiences. Various interventional strategies exist regarding the treatment of SSRI-induced FSD and this includes tolerance, titration dosage, substitution to another antidepressant drug and psychotherapy. There is a need of better understanding of SSRIs-induced FSD for better treatment outcome.

Circular RNA Expression Profiles in Vaginal Epithelial Tissue of Women With Lubrication Disorders

INTRODUCTION

Recently, circular RNA (circRNA) has been proved to occupy a vital pathological position in many diseases by acting as microRNAs sponges. However, the role of circRNA in female sexual dysfunction (FSD), especially in lubrication disorders (LDs), remains unclear.

AIM

The aim of this study was to detect circRNA expression in LDs, analyzed target genes, and pathways regulated by the differently expressed circRNAs.

METHODS

In this study, next-generation sequencing was first conducted to produce circRNA expression profiles of FSD groups and normal control groups. Furthermore, differences in expression of 6 randomly selected circRNAs were confirmed through real-time quantitative polymerase chain reaction. Kyoto Encyclopedia of Genes and Genomes biological pathway analysis and Gene Ontology showed that immune processes and infection could be involved in the development of FSDs.

MAIN OUTCOME MEASURE

CircRNA expression in vaginal epithelial tissue obtained from women with LDs have been detected. Gene Ontology, Kyoto Encyclopedia of Genes and Genomes biological pathway analysis, and circRNA-microRNA interaction predictions were investigated.

RESULTS

Totally, 7,746 circRNAs of vaginal epithelial tissue from women of 2 groups were sequenced. Preliminary judgment revealed that there were 73 circRNAs that have significant differential expression, including 53 downregulated circRNAs and 20 upregulated circRNAs. Research results also displayed that the majority of circRNAs has multiple binding sites of microRNAs, including miR-137, which has been reported to be linked to FSD.

CLINICAL IMPLICATIONS

We predicted 10 circRNAs paired with hsa-miR-137-5p, but the mechanism of circRNA involvement in disease development remains to be further explored.

STRENGTHS & LIMITATIONS

For the first time, the research disclosed the potential pathogenesis of LDs. However, we only analyzed the expression profile of circRNA in FSD, no specific mechanism was further confirmed or proposed. We still have a preliminary understanding, and more research is needed to explore the target of FSD treatment.

CONCLUSION

The results suggest that circRNAs have different expression in the FSD groups and play a vital part in the occurrence and development of FSD. Zhang J, Xia H, Zhang A, et al. Circular RNA Expression Profiles in Vaginal Epithelial Tissue of Women With Lubrication Disorders. J Sex Med 2019;16:1696-1707.

Sexual function and sex hormones in breast cancer patients

PURPOSE

Breast cancer patients (BCP) are at risk of female sexual dysfunction (FSD). Our aim was to clarify the effects of treatment strategies, and steroid hormones levels on FSD.

METHODS

We enrolled 136 BCP (46.9 ± 0.8 years), and 122 completed questionnaires. BCP were divided into four groups: 22 women with advanced breast cancer on neoadjuvant therapy (NAT), 48 on adjuvant therapy (AT), 30 taking hormonal therapy (HT) and 22 with metastatic cancer on first line chemotherapy (FLT). Fifty-eight healthy women (43 ± 2.8 years) were enrolled as controls. FSD was evaluated by FSFI, and sexual distress was assessed with FSDS-R. We have collected demographic data, laboratory values, and LH, FSH, total testosterone (T), and estradiol (E2) levels.

RESULTS

BCP showed a prevalence of FSD of 69%, total FSFI score was 17. FSDS-R was 8.3. FSD had a prevalence of 72 % in NAT, 65% in AT, 77% in metastatic BCP under FLT, 67% in HT, compared with a prevalence of 20% in controls. BCP showed lower E2 than normal values, as well as T. LH and FSH were significantly elevated than normal values. Total FSFI score was positively correlated with T in 122 BCP, no significant correlation was found between E2 and FSFI. Significant differences were found between NAT and HT in lubrication, pain domains and total FSDS-R score, AT and HT in pain domain, AT and NAT in lubrication domain.

CONCLUSIONS

BCP are at high risk of developing FSD both for treatment choice and hormonal status, but they have not sexually related personal distress.

Bremelanotide for female sexual dysfunctions in premenopausal women: a randomized, placebo-controlled dose-finding trial

Aim: Evaluate efficacy/safety of bremelanotide (BMT), a melanocortin-receptor-4 agonist, to treat female sexual dysfunctions in premenopausal women. Methods: Patients randomized to receive placebo or BMT 0.75, 1.25 or 1.75 mg self-administered subcutaneously, as desired, over 12 weeks. Primary end point was change in satisfying sexual events/month. Secondary end points included total score changes on female sexual function index and female sexual distress scale-desire/arousal/orgasm. Results: Efficacy data, n = 327. For 1.25/1.75-mg pooled versus placebo, mean changes from baseline to study end were +0.7 versus +0.2 satisfying sexual events/month (p = 0.0180), +3.6 versus +1.9 female sexual function index total score (p = 0.0017), −11.1 versus −6.8 female sexual distress scale-desire/arousal/orgasm total score (p = 0.0014). Adverse events: nausea, flushing, headache. Conclusion: In premenopausal women with female sexual dysfunctions, self-administered, as desired, subcutaneous BMT was safe, effective, and well tolerated (NCT01382719).

Postcoital Dysphoria: Prevalence and Psychological Correlates

Introduction

While problems related to desire, arousal, and orgasm have been subject to extensive epidemiologic research, women's postcoital reactions and feelings, and postcoital dysphoria (PCD) remains under‐researched.

Aim

The study examined the association between women's attachment anxiety and avoidance, differentiation of self, and the experience of PCD symptoms.

Methods

Two hundred and thirty female university students completed an online survey.

Main Outcome Measures

The Female Sexual Function Index, the Experiences in Close Relationships Scale, the Differentiation of Self Inventory‐Revised, and study specific questions.

Results

Forty‐six percent of respondents reported experiencing PCD symptoms at least once in their lifetime with 5.1% experiencing PCD symptoms a few times within the past 4 weeks. A small but significant inverse correlation was found between lifetime prevalence of PCD and sexual functioning (r = −0.16). While the regression model accounted for 22% of variance in lifetime prevalence of PCD, attachment and differentiation of self variables did not account for significant variance.

Conclusions

The findings confirm that PCD is under‐recognized and under‐researched. There appears to be no relationship between PCD and intimacy in close relationships. Further research is necessary to understand the subjective experience of PCD and to inform the development of a reliable measure. Schweitzer RD, O'Brien J, and Burri A. Postcoital dysphoria: Prevalence and psychological correlates. Sex Med 2015;3:229–237.

Mitogen-activated protein kinase kinase 5 (MKK5)-mediated signalling cascade regulates expression of iron superoxide dismutase gene in Arabidopsis under salinity stress

Superoxide dismutases (SODs) are involved in plant adaptive responses to biotic and abiotic stresses but the upstream signalling process that modulates their expression is not clear. Expression of two iron SODs, FSD2 and FSD3, was significantly increased in Arabidopsis in response to NaCl treatment but blocked in transgenic MKK5-RNAi plant, mkk5. Using an assay system for transient expression in protoplasts, it was found that mitogen-activated protein kinase kinase 5 (MKK5) was also activated in response to salt stress. Overexpression of MKK5 in wild-type plants enhanced their tolerance to salt treatments, while mkk5 mutant exhibited hypersensitivity to salt stress in germination on salt-containing media. Moreover, another kinase, MPK6, was also involved in the MKK5-mediated iron superoxide dismutase (FSD) signalling pathway in salt stress. The kinase activity of MPK6 was totally turned off in mkk5, whereas the activity of MPK3 was only partially blocked. MKK5 interacted with the MEKK1 protein that was also involved in the salt-induced FSD signalling pathway. These data suggest that salt-induced FSD2 and FSD3 expressions are influenced by MEKK1 via MKK5-MPK6-coupled signalling. This MAP kinase cascade (MEKK1, MKK5, and MPK6) mediates the salt-induced expression of iron superoxide dismutases.

Autophagy-enhancing drug carbamazepine diminishes hepatocellular death in fibrinogen storage disease

Fibrinogen storage disease (FSD) is a rare autosomal-dominant hereditary disorder characterized by hypofibrinogenemia and accumulation of fibrinogen aggregates within the hepatocellular endoplasmatic reticulum (ER). Some FSD patients present with elevated amino-transferases and fibrosis/cirrhosis similar to alpha-1-antitrypsin deficiency (ATD), also an ER storage disease. Pharmacological stimulation of autophagy has been shown to mediate clearance of protein aggregates and halt progression of liver fibrosis in in vivo models of ATD. Our aim was to evaluate the presence of autophagy and a possible response to autophagy-enhancing therapy in patients with FSD. Hepatic fibrosis was assessed by transient elastography in 2 newly identified FSD families with fibrinogen Aguadilla and Brescia mutations, encompassing 8 affected members. Available liver biopsies were assessed for autophagy. Two patients, who had had elevated alanine amino-transaminase levels (2-5 above upper limit of normal), were treated with the autophagy enhancer carbamazepine (CBZ). Transient elastography did not show evidence of significant fibrosis in any affected family members. Quantitative electron microscopy of one patient showed a 5.15-fold increase of late stage autophagocytic vacuoles compared to control livers. CBZ at low anticonvulsive treatment levels led to rapid normalization of alanine-aminotransferase and decrease of caspase-cleaved and uncleaved cytokeratin-18 fragments (M30 and M65). These effects reversed after discontinuation of treatment. Response to CBZ may be mediated by pharmacologically enhanced autophagy resulting in reduction of aggregate-related toxicity in FSD. These results suggest clinical applicability of pharmacological stimulation of autophagy in FSD, but potentially also in other related disorders.

Long-term functional outcomes following nonradiated vesicovaginal repair

PURPOSE

We investigated the long-term impact on bladder and sexual symptoms in women with prior vesicovaginal fistula repair, particularly those previously treated before referral.

MATERIALS AND METHODS

After receiving institutional review board approval we reviewed the charts of women who underwent nonradiated vesicovaginal fistula repair for demographics, surgical approach (vaginal or abdominal) and functional outcomes with a minimum 6-month followup. Patients lost to followup were reached by a structured phone interview and/or mailed validated lower urinary tract questionnaires, including the UDI-6 (Urogenital Distress Inventory-6), IIQ-7 (Incontinence Impact Questionnaire-7) and FSFI (Female Sexual Function Index). Three surgical groups were compared, including naïve-no prior repair, recurrent-1 prior repair and other-more than 2 repairs with the hypothesis of worse outcomes with more repairs.

RESULTS

From 1996 to 2011 vesicovaginal fistula repair was performed in 66 patients, including in 42 as primary treatment (vaginal vs abdominal approach in 31 vs 11), in 14 as secondary treatment, and in 10 who underwent more than 2 repairs. Mean patient age was 45 years (range 24 to 87), mean body mass index was 29 kg/m(2) (range 19 to 43) and mean followup was 55 months (range 6 to 198). The overall repair success rate was 97%. There was no difference in functional outcomes in questionnaire responders among the 3 groups for lower urinary tract symptoms (62% on UDI-6/IIQ-7). However, for FSFI (33% of patients) there was female sexual dysfunction in patients who underwent transabdominal repair and in women with 2 repairs.

CONCLUSIONS

Long-term followup of patients with vesicovaginal fistula repair indicated no differences in lower urinary tract outcomes at a mean 7-year followup between primary and recurrent repairs. There was a difference in sexual function, although it was not statistically significant. Sexual activity among responders was low.