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SUMMARY OBJECTIVE: This study aimed to investigate female sexual function in patients with type 1 diabetes by comparing female sexual function index scores between women with and without type 1 diabetes. METHODS: A total of 62 women with type 1 diabetes and 69 age-matched women without diabetes but with similar backgrounds were enrolled in the patient and control groups, respectively. All participants were sexually active and had no systemic diseases other than diabetes in the patient group. RESULTS: The frequency of female sexual dysfunction was significantly higher, and the mean female sexual function index score was significantly lower in women with diabetes compared to the control group (p=0.01). There was a significant relationship between sexual dysfunction and duration of diabetes, glycosylated hemoglobin test, and body mass index (p

Objective To investigate depression and sexual function among pregnant and non-pregnant women throughout the COVID-19 pandemic. Methods A total of 188 women, 96 pregnant and 92 non-pregnant were included. The Beck Depression Inventory (BDI) and the Arizona Sexual Experience Scale (ASEX) were applied to the participants after obtaining sociodemographic data. Results The depression scores of pregnant and non-pregnant women were similar (p = 0.846). We found that the depression scores were significantly higher among the group of participants who have lower economic status (p = 0.046). Moreover, the depression score was significantly higher among women who lost their income during the pandemic (p = 0.027). The score on the ASEX was significantly higher, and sexual dysfunction was more prevalent among women who have lower levels of schooling and income (p Conclusion In times of global crisis, such as the current pandemic, low-income families have an increased risk of experiencing depression and sexual dysfunction. When we compared pregnant women with non-pregnant women, depression scores were similar, but pregnant women were at a 6.2 times higher risk of developing sexual dysfunction.

Background : Sexual dysfunction is highly prevalent worldwide. A specific form is persistent sexual dysfunction after SSRI withdrawal. We conducted a systematic literature review in order to characterize factors related to post SSRI sexual dysfunction (PSSD) and analyzed spontaneous reports of persistent sexual dysfunction reported to the Netherlands Pharmacovigilance Centre Lareb. Research design and methods A systematic literature review was conducted following the PRISMA-ScR guidelines. In addition, reports of PSSD submitted to the Netherlands Pharmacovigilance Centre Lareb between 1992 and 2021 were analyzed. Results : A total of 237 articles were retrieved through the search and 33 articles were selected for inclusion in this review, in accordance with the inclusion criteria. Information regarding the characteristics of the condition, it's clinical management, patient characteristics and impact of PSSD is presented. A total of 86 reports of persistent sexual dysfunction, were analyzed. The longest case being a patient with PSSD for 23 years. The main symptoms were: loss or decreased libido (n= 53), erectile dysfunction (n= 23) and anorgasmia (n= 5). Conclusions PSSD impact includes sexual, psychological and social consequences. Little is known about the mechanisms underlying PSSD and no effective treatment exists. It is necessary to increase recognition of PSSD among prescribers and improve its management at the clinical level.

Background: The removal of the spleen due to disease or trauma may be followed by disorders due to the asplenic state, including immunodeficiency, hematological and metabolic diseases, mainly related to dyslipidemia, which can lead to sepsis, pulmonary embolism and early death. Although patients frequently report sexual disinterest after splenectomy, this feature has not yet been studied. Objective: To verify libido and other sexual functions after the complete removal of the spleen. Method: This study was performed on 60 healthy adults, 30 men and 30 women, after more than one year of total splenectomy to treat isolated splenic trauma. The International Index of Erectile Function was applied to men and the Female Sexual Function Index to women. The analysis compared the responses obtained in the periods before and after the splenectomy. Laboratory tests with hematological and biochemical analyses, including sex hormones, were performed in all patients. The pre- and postoperative results were compared in each group using the paired t-test, with each patient being his or her own control and with significance corresponding to p < 0.05. Results: A decrease in libido and an increase in sexual dysfunction was observed after splenectomy in all men and women, p < 0.001. All postoperative laboratory tests showed normal values in both genders. Conclusion: Asplenia is associated with a marked decrease in libido and intense sexual dysfunction in both men and women, with no change in hematological and biochemical laboratory tests, including hormonal exams. Funding: This study was funding by the Research Support Foundation of the State of Minas Gerais (FAPEMIG) and the National Council for Scientific and Technological Development (CNPq). Declaration of Interest: None to declare. Ethical Approval: This research was carried out in accordance with the recommendations of the Declaration of Helsinki and was approved by the Research Ethics Committee of the Hospital Foundation of the State of Minas Gerais, logged under protocol number 4068934/2016.

Background and aims Limitations of research into sexuality and compulsive sexual behavior disorder (CSBD) include the use of simplistic methodological designs and the absence of quality and unified measurements, empirically supported theoretical models, and large, collaborative studies between laboratories. We aim to fill these gaps with the International Sex Survey (ISS, http://internationalsexsurvey.org/). Methods The ISS is a large-scale, international, multi-lab, multi-language study using cross-sectional survey methods, involving more than 40 countries. Participants responding to advertisements complete a self-report, anonymous survey on a secure online platform. Collaborators from each country collect a community sample of adults with a minimum sample size of 2,000 participants with a gender ratio of approximately 50–50% men and women, including diverse individuals with respect to sexuality and gender. The ISS includes a wide range of sociodemographic questions and scales assessing a diverse set of sexual behaviors, pornography use, psychological characteristics, and potential comorbid disorders. Analyses are conducted within a structural equation modeling framework, including variable (e.g., measurement invariance tests) and person-centered approaches (e.g., latent profile analysis). Discussion and conclusions The ISS will provide well-validated, publicly available screening tools, helping to eliminate significant measurement issues in the field of sexuality research and health care. It will provide important insights to improve the theoretical understanding of CSBD as well as help to identify empirically supported treatment targets for prevention and intervention programs. Following open-science practices and making study materials open-access, the ISS may serve as a blueprint for future large-scale research in addiction and sexuality research.

Background and aims Despite the inclusion of the Compulsive Sexual Behavior Disorder (CSBD) in the International Classification of Diseases, very little is known about the underlying affective and cognitive processes. To fill this gap, we compared CSBD subjects and Healthy-Controls (HC) across negative/positive valence, cognitive and sensorimotor systems, as proposed by the Research Domain Criteria framework. Methods 74 heterosexual CSBD and 66 matched HC males were studied with 10 questionnaires and 8 behavioral tasks. Analyses were conducted with frequent and Bayesian statistics. Results CSBD individuals showed significantly higher (than HC) punishment sensitivity, anxiety, depression, compulsivity, and impulsivity symptoms. Frequentist statistical analysis revealed significant interaction between subject group and condition in Incentive Delay Task, concerning the strength of motivation and hedonic value of erotic rewards. Bayesian analysis produced evidence for the absence of group differences in Facial Discrimination Task, Risk-Ambiguity Task, and Learning Task. Also, Bayesian methods provided evidence for group differences in the Emotional Stroop Task and the Incentive Delay Task. Sexual Discounting Task, Attentional Network Task, and Stop Signal Task produced mixed results. Conclusions Higher punishment sensitivity and impulsivity among CSBD subjects, along with significant interaction between these groups and erotic vs. non-erotic reward processing is in line with previous findings on negative/positive valence alterations in CSBD patients. This result shows that there are similarities to substance and behavioral addictions. The absence of group differences and mixed results related to cognitive and sensorimotor systems raise concerns to what extent CSBD resembles a wide spectrum of impairments observed in disorders, and demand further research.

Background Infertility, an important source of stress, could affect sexual life. Extensive studies suggest that the incidence of sexual dysfunction is highly prevalent in infertile women. As the duration of infertility increases, the level of stress is also likely to increase even further, and this could aggravate psychological pain and cause sexual dysfunction. However, the effect of infertility duration on sexual health is unclear. Methods We conducted a case-control study in which 715 patients participated between September 1,2020 and December 25, 2020. We included patients diagnosed with infertility (aged between 20 to 45), who were divided into four groups according to their infertility durations: ≤ 2 years (Group I, n = 262), > 2 years but ≤ 5 years (Group II, n = 282), > 5 years but ≤ 8 years (Group III, n = 97), and > 8 years (Group IV, n = 74). A questionnaire survey on female sexual functions and psychological depression was administered to participants, and their female sexual functions and depression status were measured using the Female Sexual Function Index (FSFI) and Patient Health Questionnaire (PHQ-9), respectively. Results As the number of years of infertility increased, the PHQ-9 score as well as the incidence of psychological depression increased significantly (p < 0.05), but the total score of FSFI and those of its six domains/sub-scales were not significantly different among the four groups. An analysis of the relevant factors affecting sexual functions, using the multivariable logistic regression model, revealed that when the infertility duration was greater than 8 years, there was a significant increase in the incidence of sexual dysfunction [adjusted odds ratios (AOR) = 5.158, 95% confidence interval (CI): 1.935–13.746, P = 0.001], arousal disorder (AOR = 2.955, 95% CI: 1.194–7.314, P = 0.019), coital pain (AOR = 3.811, 95% CI: 1.045–13.897, P = 0.043), and lubrication disorder (AOR = 5.077, 95% CI: 1.340–19.244, P = 0.017). Conclusions An increasing infertility duration is a risk factor for the occurrence of sexual dysfunction. Hence, as the infertility duration increases, the incidence of female sexual dysfunction and psychological distress could also increase, especially when the infertility duration is more than 8 years.

DNA methylation shifts in Hypothalamic–pituitary–adrenal (HPA) axis related genes is reported in psychiatric disorders including hypersexual disorder. This study, comprising 20 dexamethasone suppression test (DST) non-suppressors and 73 controls, examined the association between the HPA axis dysregulation, shifts in DNA methylation of HPA axis related genes and importantly, gene expression. Individuals with cortisol level ≥ 138 nmol/l, after the low dose (0.5 mg) dexamethasone suppression test (DST) were classified as non-suppressors. Genome-wide methylation pattern, measured in whole blood using the EPIC BeadChip, investigated CpG sites located within 2000 bp of the transcriptional start site of key HPA axis genes, i.e.: CRH, CRHBP, CRHR-1, CRHR-2, FKBP5 and NR3C1. Regression models including DNA methylation M-values and the binary outcome (DST non-suppression status) were performed. Gene transcripts with an abundance of differentially methylated CpG sites were identified with binomial tests. Pearson correlations and robust linear regressions were performed between CpG methylation and gene expression in two independent cohorts. Six of 76 CpG sites were significantly hypermethylated in DST non-suppressors (nominal P CRH, CRHR1, CRHR2, FKBP5 and NR3C1. NR3C1 transcript AJ877169 showed statistically significant abundance of probes differentially methylated by DST non-suppression status and correlated with DST cortisol levels. Further, methylation levels of cg07733851 and cg27122725 were positively correlated with gene expression levels of the NR3C1 gene. Methylation levels of cg08636224 (FKBP5) correlated with baseline cortisol and gene expression. Our findings revealed that DNA methylation shifts are involved in the altered mechanism of the HPA axis suggesting that new epigenetic targets should be considered behind psychiatric disorders.

We sought to determine the prevalence of female sexual dysfunction (FSD) and to examine the influence of age, menopausal state and quality of life (QoL) on the female sexual function (FSF) of healthy women and those with benign gynaecological disease. With this purpose, we conducted a cross-sectional study, based on self-report questionnaires (sociodemographic, WHOQOL-BREF and FSFI), enrolling 107 women. Some 51.6% (n = 55) were diagnosed with FSD. We found no statistical significant differences between grouped reason for consultation and FSFI total score (p = .72) and its domains (p > .05). The results showed a negative strong correlation between age and FSFI total score (S= -0.71) and a positive moderate correlation between WHOQOL-BREF and FSFI total scores (S = 0.39). We observed statistically significant differences between menopausal state and FSFI total score (p = .001). In conclusion, the prevalence of FSD in our population was 51.6%. Our study results reveal that a reduction in FSFI scores has a negative impact on QoL and vice versa, regardless of the reason for consultation. Elderly age and postmenopausal state have deleterious effects on FSF.Impact statementWhat is already known on this subject? Poor QoL can adversely affect FSF and vice versa. The study of FSF is relatively recent and there is controversy regarding the deleterious effects of elderly age and menopause on FSF. The prevalence of FSD is difficult to precisely determine, given the studies' use of different definitions for FSD and the highly heterogeneous study populations, as well as the types of tests and questionnaires employed. Sexual difficulties are problems seldom discussed between patients and their physicians. Lack of time, misconceptions, shame and frustration, considering sexuality as too intimate to discuss in the doctor's office, uncertainty regarding therapeutic options and insufficient training of health professionals are just some of the reasons mentioned for not addressing sexual dysfunction in a general consultation.What do the results of this study add? Our study is the first research in Spain on the impact of age, menopause and QoL on gynaecological patients´ FSF. Our results indicate that an impaired FSF could be related to poorer well-being and QoL; however, benign gynaecological disease does not appear to affect FSF. Elderly age and postmenopausal state can have deleterious effects on FSF.What are the implications of these findings for clinical practice and/or further research? Sexuality is an important aspect of QoL. Therefore, gynaecologists should discuss issues of sexuality with their patients in routine visits, especially in case of elderly and postmenopausal women. In addition, gynaecologists should train in the diagnosis and treatment of the female sexual dysfunction.

BACKGROUND: The only treatment in patients developing liver failure is liver transplantation. According to the Ministry of Health, the number of patients waiting for a liver transplantation is 2141, the average waiting period for liver transplantation is approximately 5 years, and 15-18% of these patients lose their life while waiting for transplantation. In these patients, limitations in daily activities and depression–anxiety are commonly found. The aim of this study was to analyze life quality, depression symptoms, and existence of sexual functional disorders of patients waiting for liver transplantation. METHODS: A total of 74 patients, who were registered in Başkent University Hospital between 2015 and 2018, were included into the study. Short Form-36, Beck Depression Inventory, and Arizona Sexual Experiences Scale were applied to 56 patients who approved study. RESULTS: Most of the patients were male (64.3%), and the mean age was 46 (18-64). Short Form-36 scores were low in all patients. The mean Beck Depression Inventory score of patients was found as 18.4 ± 11.3, and they were suffering from moderate depressive symptoms. According to Arizona Sexual Experiences Scale, total mean scores of males was found as 16.3 ± 5.5, and for females, it was 19.5 ± 5.3 with a statistically significant difference (P < .05). It was found that sexual dysfunction mostly had moderate to mild. CONCLUSION: Depression and sexual dysfunction are common in patients with chronic liver diseases, and their life qualities deteriorate significantly. It is anticipated that evaluation of these patients in terms of psychological issues and sexual dysfunction will increase their quality of life during the organ waiting period and affect their well-being post-transplant.

Female sexual dysfunction (FSD) may be a mirror of a poor cardiometabolic state. In a small pilot study enrolling 71 women with FSD, we previously demonstrated that clitoral Pulsatility Index (PI) evaluated by using color Doppler ultrasound (CDU), reflecting vascular resistance, was associated with cardiometabolic risk factors. Data on uterine CDU in this context are lacking. First, to confirm previously reported data on the direct association between clitoral PI and cardiometabolic risk factors on a larger study population of women consulting for sexual symptoms; second, to investigate eventual similar correlations between cardiometabolic risk factors and CDU parameters of the uterine artery. We also ascertained whether uterine artery PI, similarly to what had previously been observed for clitoral artery PI, was directly related to body image uneasiness and psychopathological symptoms, assessed by validated questionnaires. N = 230 women consulting our clinic for sexual symptoms were examined with clitoral CDU and blood sampling and were asked to fill out the Female Sexual Function Index, the Middlesex Hospital Questionnaire (MHQ) and the Body Uneasiness Test (BUT). In a subgroup of women (n = 164), we also performed transvaginal CDU with measurement of uterine artery parameters. At multivariate analysis, we found a direct association between clitoral PI and body mass index (BMI) (p = 0.004), waist circumference (WC) (p = 0.004), triglycerides (p = 0.006), insulin (p = 0.029) and HOMA-IR (p = 0.009). Furthermore, a correlation between obesity and Metabolic Syndrome (MetS) and a higher clitoral PI was observed (p = 0.003 and p = 0.012, respectively). Clitoral PI was also correlated with MHQ-S (p = 0.010), a scale exploring somatized anxiety symptoms, and BUT-B Positive Symptom Distress Index (p = 0.010), a measure of body image concerns. Similarly, when investigating the uterine artery, we were able to demonstrate an association between its PI and BMI (p p = 0.001), insulin (p = 0.006), glycated haemoglobin (p = p = 0.009). Women diagnosed with obesity and MetS showed significantly higher uterine PI values vs. those without obesity or MetS (p = 0.001 and p = 0.004, respectively). Finally, uterine PI was associated with BUT-A Global Severity Index (p

Objective: To determine the prevalence of sexual dysfunction and to identify the factors associated with sexual dysfunction in young adult childhood cancer survivors. Methods: All survivors of childhood cancer (aged 19-40 years) in Sweden were invited to this population-based study, and 2546 men and women (59%) participated. Sexual function was examined with the PROMIS Sexual Function and Satisfaction Measure. Logistic regression was used to assess the differences between survivors and a general population sample (n = 819) and to identify the factors associated with sexual dysfunction in survivors. Results: Sexual dysfunction in at least one domain was reported by 57% of female and 35% of male survivors. Among females, dysfunction was most common for Sexual interest (36%), Orgasm -ability (32%) and Vulvar discomfort -labial (19%). Among males, dysfunction was most common for the domains satisfaction with sex life (20%), Sexual interest (14%) and Erectile function ( 9%). Compared with the general population, male survivors more frequently reported sexual dysfunction in >2 domains (OR = 1.67, 95% CI: 1.03-2.71), with an increased likelihood of dysfunction regarding Orgasm -ability (OR = 1.82; 95% CI: 1.01-3.28) and Erectile function (OR = 2.30; 95% CI: 1.18-4.49). Female survivors reported more dysfunction regarding Orgasm pleasure (9% versus 5%, OR Z 1.86; 95% CI: 1.11-3.13). A more intensive cancer treatment, emotional distress and body image disturbance were associated with sexual dysfunction in survivors. Conclusions: The findings underscore the need for routine assessment of sexual health in follow-up care of childhood cancer survivors and highlight that those treated with more intensive cancer treatment and who experience concurrent psychological concerns may benefit from targeted screening and interventions. 2021 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

To evaluate menopausal symptoms and sexual problems in Hispanic and non-Hispanic women in two Southwest areas.An anonymous survey including the Green Climacteric Scale (GCS), Female Sexual Function Index (FSFI), and demographics was distributed to English and Spanish-speaking women age 40 to 60 in Scottsdale, Arizona, and West Texas. FSFI for sexually active women and GCS scores for the Hispanic and non-Hispanic women in Texas were analyzed with multivariable analysis and compared between Texas and Arizona for Non-Hispanic participants.Predominantly non-Hispanic women (70%), average age 51.5 (SD = 7.25) completed questionnaires (199 West Texas, 163 Scottsdale). A majority of sexually active women (88%) were found to be at risk of sexual dysfunction. Within the Texas cohort, GCS score was estimated to be 3.49 points lower (less symptoms) in Hispanic versus non-Hispanic participants [95% CI -6.58 to -0.40, P = 0.03], and FSFI score was estimated to be 2.31 points lower (more symptoms) in Hispanic versus non-Hispanic participants [95% CI -4.49 to -0.14, P = 0.04]. Among non-Hispanic women, GCS scores were lower (less symptoms) in Texas versus Arizona by 10.25 points [95% CI -14.83 to -5.66, P 0.01], while FSFI scores were higher overall (less symptoms) in Texas by 3.65 points [95% CI 0.53-6.77), P = 0.02]. All FSFI and GCS scores were adjusted for multiple variables.In a group of menopausal women from the Southwest, most reported symptoms were consistent with FSD, and the degree of sexual problems appeared to be greater in the Hispanic participants from Texas.Video Summary:http://links.lww.com/MENO/A781.

Resumen Objetivo: Realizar una reflexión sobre la relación etiológica recíproca entre la disfunción sexual femenina y la drogodependencia, y sus implicaciones prácticas e investigativas. Materiales y métodos: Se presenta una descripción de los efectos y las consecuencias a corto y a largo plazo del uso de drogas en mujeres y se analiza si el uso de drogas es la causa de la disfunción sexual o si, por el contrario, la disfunción sexual conduce al uso de drogas. Asimismo, se discute la necesidad de ahondar en la investigación que relaciona estas dos variables y sus implicaciones clínicas. Conclusión: El consumo de drogas afecta la función sexual femenina, por lo que es pertinente un diagnóstico inicial y la rehabilitación sexual tras el uso crónico de sustancias psicoactivas; asimismo, se hace indispensable implementar medidas profilácticas para disminuir el uso de drogas en la actividad sexual y sus consecuencias asociadas, y ampliar la investigación de esta área del conocimiento médico y psicológico. Abstract Objective: To reflect on the reciprocal etiologic relationship between female sexual dysfunction and drug abuse, and its implications for practice and research. Materials and Methods: A description of the effects and short-term and long-term consequences of drug use in women is presented together with an analysis of whether drug use is the cause of sexual dysfunction or on the contrary, if sexual dysfunction leads to drug abuse. The need to conduct further research into the relationship between these two variables and their clinical implications is also discussed. Conclusion: Drug use affects female sexual function, hence the importance of initial diagnosis and sexual rehabilitation following chronic use of psychoactive substances; Implementing prophylactic measures in order to reduce drug use during sexual activity and its associated consequences; and expanding research in this area of medical and psychological knowledge.

We evaluated the efficacy of Tribulus terrestris in two different dosage regimes for the treatment of sexual dysfunction in pre and postmenopausal women and its effect on the vascular resistance of the clitoral artery using Power Doppler. A total of 104 women were randomly assigned to receive 94mg, three times/day (TT3) or 280mg once/day for 90 days (TT1). Evaluation was performed using FSFI and QS-F questionnaires, serum levels of prolactin, TSH, total testosterone and SHBG, and clitoral artery assessment with Power Doppler ultrasound. FSFI results demonstrated an improvement in all domains in both groups (P < 0.05) except for the "Satisfaction" in the TT3 premenopausal group. QS-F results showed a significant improvement in the mean total score in women of both reproductive phases, for both groups. Postmenopausal patients improved in all sexual domains, except for "orgasm" in the TT1 group. PI of the clitoral artery showed no difference in both reproductive phases, in both groups. We conclude that TTerrestris can be a safe alternative for the treatment of sexual dysfunction in pre and postmenopausal women as it is effective in reducing the symptoms with no side effects. Moreover, its use, increased total, free and bioavailable testosterone.

Flibanserin (FLB) was approved by FDA for the treatment of pre-menopausal female hypoactive sexual desire disorder (HSDD). FLB suffers from low oral bioavailability (33%) which might be due to hepatic first-pass metabolism in addition to its poor aqueous solubility. The sublingual route could be a promising alternative for FLB due to the avoidance of enterohepatic circulation. However, the drug needs to dissolve in the small volume of saliva in order to be absorbed through the sublingual mucosa. Therefore, FLB nanocrystals were prepared by sono-precipitation technique according to 23 full factorial design. FLB-nanocrystals were formulated using two surfactants (PVP K30 and PL F127) in two different amounts (200 and 400 mg) and the volume of ethanol was either 3 or 5 mL. Nanocrystal formulation was optimized according to the desirability function to have a minimum particle size, zeta potential, polydispersity index, and maximum saturated solubility. The optimized formula had a particle size of 443.12 ± 14.91 nm and a saturated solubility of 23.27 ± 4.62 mg/L which is five times the saturated solubility of FLB. Nanocrystal dispersion of the optimized formula was solidified by freeze-drying and used to prepare rapidly disintegrating sublingual tablets containing Pharmaburst® as superdisintegrant. Sublingual tablet formulation with the shortest disintegration time (36 s) was selected for the in vivo study. FLB nanocrystal-based sublingual tablets exhibited a two-fold increase in bioavailability with a faster onset of action compared to the commercially available oral formulation. These findings prove the potential application of FLB nanocrystal-based sublingual tablets in the treatment of HSDD.

To assess possible risk factors for female sexual dysfunction (FSD), aiming especially at smoking in China.Female Sexual Function Index (FSFI) for assessing FSD; 621 women (24-75 years) divided into 'group FSD' (FSFI≤ 26.55) and 'group No FSD' (FSFI26.55). Univariate and multivariate analysis to detect potential risk factors for FSD.Active smoking was the strongest risk factor after multiple adjustments (OR= 6.226, 95%CI = 1.561 ∼ 24.822), but passive smoking also was significantly associated with a risk of FSD (OR = 1.887, 95%CI = 1.092 ∼ 3.260) (The risk of FSD was closely related to depletion of ovarian function. Active smokers had the highest risk, but passive smoking also had a significant relationship to FSD. Although female smokers are rare in China, 'husband smoking' is frequent. Thus, our results should have significant healthcare consequences.

Devices designed to enhance and diversify sexual pleasure are useful in clinical practice; however, many taboos still seem to exist and the scientific literature on the prevalence, application and effectiveness of sexual devices for therapeutic use is sparse. In this Review, Dewitte and Reisman discuss the clinical use of sex toys and sexual devices, as well as sexually explicit media, across a variety of indications to expand individual and partnered sexuality and to treat sexual difficulties. Given that sexual pleasure is a core component of sexual health, devices that are designed to enhance and diversify sexual pleasure are particularly useful in clinical practice. Despite their growing popularity and widespread use in various biopsychosocial circumstances, many taboos still seem to exist, as indicated by the paucity of scientific literature on the prevalence, application and effectiveness of sexual devices for therapeutic use. However, sex toys and sexual devices are commonly used and have a variety of indications to expand individual and partnered sexuality and to treat sexual difficulties. Different devices are associated with specific advantages and potential risks, opportunities, barriers and ethical challenges when used in a clinical context. Increased knowledge about the aim and functional possibilities of sexual devices might help health-care professionals overcome potential embarrassment, preconceptions and other barriers, learn which patients might benefit from which products, consider their use in treatment programmes, educate about correct use and safety issues, and facilitate open communication about sexual pleasure with their patients.

Objective To better understand the physical and psychosocial components of female sexual dysfunction (FSD) among women undergoing radical cystectomy (RC) for bladder cancer (BCa). Methods We conducted semistructured individual interviews and a focus group with pre- and post-RC female patients and their partners regarding the impact of RC on sexual health and psychosocial wellbeing. Themes were inductively identified by 2 independent coders and subsequently organized into themes and subthemes using qualitative description and constant comparison. Results In the preoperative cohort, 6 women and 1 partner participated (50% contact rate, 75% participation rate). In the postoperative cohort, 16 women and 2 partners participated (61% contact rate, 64% participation rate). Major themes that emerged in interviews with both cohorts included concerns about changes to body image, the psychological impact of BCa diagnosis and treatment, concerns about the impact of RC on sexual function, and inadequacies in provider-led sexual health counseling. Participants varied in the importance they placed on sexual function, with factors such as age, relationship status, and oncologic concerns impacting prioritization, although both younger and older patients expressed a desire to retain the option of sexual function. Conclusion Female patients with BCa undergoing RC experience changes in body image, psychological distress, physical disruptions in sexual function, and inadequacies in sexual health counseling and education. Future efforts should be directed towards improving sexual health counseling and psychosocial support resources for women with BCa.

Background The Global Consensus Position Statement on the Use of Testosterone Therapy for Women (Global Position Statement) recommended testosterone therapy for postmenopausal women with hypoactive sexual desire disorder (HSDD). Aim To provide a clinical practice guideline for the use of testosterone including identification of patients, laboratory testing, dosing, post-treatment monitoring, and follow-up care in women with HSDD. Methods The International Society for the Study of Women's Sexual Health appointed a multidisciplinary panel of experts who performed a literature review of original research, meta-analyses, review papers, and consensus guidelines regarding testosterone use in women. Consensus was reached using a modified Delphi method. Outcomes A clinically useful guideline following a biopsychosocial assessment and treatment approach for the safe and efficacious use of testosterone in women with HSDD was developed including measurement, indications, formulations, prescribing, dosing, monitoring, and follow-up. Results Although the Global Position Statement endorses testosterone therapy for only postmenopausal women, limited data also support the use in late reproductive age premenopausal women, consistent with the International Society for the Study of Women's Sexual Health Process of Care for the Management of HSDD. Systemic transdermal testosterone is recommended for women with HSDD not primarily related to modifiable factors or comorbidities such as relationship or mental health problems. Current available research supports a moderate therapeutic benefit. Safety data show no serious adverse events with physiologic testosterone use, but long-term safety has not been established. Before initiation of therapy, clinicians should provide an informed consent. Shared decision-making involves a comprehensive discussion of off-label use, as well as benefits and risks. A total testosterone level should not be used to diagnose HSDD, but as a baseline for monitoring. Government-approved transdermal male formulations can be used cautiously with dosing appropriate for women. Patients should be assessed for signs of androgen excess and total testosterone levels monitored to maintain concentrations in the physiologic premenopausal range. Compounded products cannot be recommended because of the lack of efficacy and safety data. Clinical Implications This clinical practice guideline provides standards for safely prescribing testosterone to women with HSDD, including identification of appropriate patients, dosing, and monitoring. Strengths & Limitations This evidence-based guideline builds on a recently published comprehensive meta-analysis and the Global Position Statement endorsed by numerous societies. The limitation is that testosterone therapy is not approved for women by most regulatory agencies, thereby making prescribing and proper dosing challenging. Conclusion Despite substantial evidence regarding safety, efficacy, and clinical use, access to testosterone therapy for the treatment of HSDD in women remains a significant unmet need. Parish SJ, Simon JA, Davis SR, et al. International Society for the Study of Women's Sexual Health Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women. J Sex Med 2021;18:849–867.

To evaluate associations between sleep and female sexual function.A cross-sectional analysis from the Data Registry on Experiences of Aging, Menopause and Sexuality (DREAMS) was performed using questionnaires in women presenting for menopause or sexual health consult at Mayo Clinic from December, 2016 to September, 2019. Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), and the Pittsburgh Sleep Quality Index (PSQI) assessed sexual function and sleep parameters, respectively. Associations between sleep quality (PSQI score ≥ 5 poor sleep quality), sleep durations (5 h, 5-6 h, 6-7 h,7 h) and female sexual dysfunction (FSFI ≤ 26.55 and FSDS-R ≥ 11) were evaluated utilizing a multivariable logistic model adjusting for multiple factors. A secondary analysis evaluated sleep quality by sexual activity and also included sexually inactive women.A total of 3,433 women were included (mean age 53). Sexually active women (N = 2,487; 72.4%) were included in the primary analysis; 75% had poor sleep quality, and 54% met criteria for female sexual dysfunction. On multivariable analysis, women with poor sleep quality were 1.48 times more likely to report female sexual dysfunction (95% CI 1.21-1.80, P 0.001). Of women who reported sleeping 5 hours nightly, 63.3% had female sexual dysfunction, and their Female Sexual Function Index total and domain scores were significantly lower than women sleeping 7 hours nightly (P = 0.004); however, this was not statistically significant in multivariable analysis. Sexually active women were more likely to report good sleep quality compared with sexually inactive women (25.3% vs 20.5%, P = 0.003).Poor sleep quality, but not sleep duration, was associated with greater odds of female sexual dysfunction. Good sleep quality was linked to sexual activity. In addition to its myriad effects on health, poor sleep quality is associated with female sexual dysfunction.Video Summary:http://links.lww.com/MENO/A714.

Introduction In 2000, the FDA began issuing advice about treatments for hypoactive sexual desire disorder (HSDD) in women. How its recommendations have evolved has not been reviewed. Its consistent preference for self-rating by patients over evaluation by an examining clinician has not been addressed. Objectives Recount the changes in FDA’s proposals about patient-reported outcomes and diagnostics. Compare the value of patient-reported measures and clinical interviews. Methods Historical review is based on draft guidances, publications, meetings, and prescribing information. Results The FDA has avoided clinician input into diagnosis and evaluation of the severity of HSDD in women. It abandoned its initial (2000) insistence on counts of satisfying sexual events to define efficacy in favor of symptom-related scales to evaluate desire and distress with daily self-ratings. By 2015, the FDA accepted the self-rated Female Sexual Function Index-Desire Domain (FSFI-D) to measure desire and the most relevant item of the Female Sexual Distress Scale-Revised (FSDS-R) to measure distress; retrospection for both is one month. The FDA rejected the one clinician-rated broad measure of HSDD, the Sexual Interest and Desire Inventory (SIDI-F), although well-validated and treatment-sensitive. Since 2005, the FDA has accepted the Decreased Sexual Desire Screener (DSDS) to diagnose HSDD by non-expert clinicians using self-ratings and exploring them in more depth in a clinical interview. Conclusion FDA’s decisions on how to measure HSDD in women may have stabilized on accepting 2 co-primary measures: the FSFI-D and the FSDS-R item on bother about low desire, and on accepting the DSDS for diagnosis. FDA’s rejection of clinician ratings of severity through interviews in clinical trials seems unsound because interviews can give broader assessments than (brief) self-ratings, although the agency’s logic was to avoid diagnostic controversies and help avoid overcommercialization. Semistructured clinical interviews for diagnosis (DSDS) and severity-rating (SIDI-F) are well validated and are recommended for clinical practice. Pyke RE. FDA Decisions on Measures of Hypoactive Sexual Desire Disorder in Women: A History, With Grounds to Consider Clinical Judgment. Sex Med Rev 2021;9:186–193.

Objective To develop a better understanding of the strengths and deficiencies of female sexual health education and the attitudes toward female sexual health amongst urology, obstetrics and gynecology, psychiatry, and family medicine trainees. Female sexual dysfunction (FSD) is characterized as distress related to sexual pain, interest/arousal, or orgasm. Despite the high prevalence of FSD there are few clinical resources available for patients and providers in Canada. Methods An anonymous online survey explored trainee knowledge of, and experiences with, female sexual dysfunction. Questions regarding male sexual dysfunction (MSD) were included as a comparison. Results One hundred and fourteen residents participated in the survey and 107 were included in the final analysis. Respondents receive significantly more teaching and exposure to MSD compared to FSD in medical school and residency (when obstetrics and gynecology excluded). Ninety-six percent of respondents agreed that FSD is an important educational topic in residency, while only 12% felt their residency program provides adequate teaching and exposure to FSD. Conclusions Although physician trainees recognize the importance of education related to FSD, the majority report little time being allocated to it in their training programs.

Background Persistent genital arousal disorder (PGAD), a condition of unwanted, unremitting sensations of genital arousal, is associated with a significant, negative psychosocial impact that may include emotional lability, catastrophization, and suicidal ideation. Despite being first reported in 2001, PGAD remains poorly understood. Aim To characterize this complex condition more accurately, review the epidemiology and pathophysiology, and provide new nomenclature and guidance for evidence-based management. Methods A panel of experts reviewed pertinent literature, discussed research and clinical experience, and used a modified Delphi method to reach consensus concerning nomenclature, etiology, and associated factors. Levels of evidence and grades of recommendation were assigned for diagnosis and treatment. Outcomes The nomenclature of PGAD was broadened to include genito-pelvic dysesthesia (GPD), and a new biopsychosocial diagnostic and treatment algorithm for PGAD/GPD was developed. Results The panel recognized that the term PGAD does not fully characterize the constellation of GPD symptoms experienced by patients. Therefore, the more inclusive term PGAD/GPD was adopted, which maintains the primacy of the distressing arousal symptoms and acknowledges associated bothersome GPD. While there are diverse biopsychosocial contributors, there is a common underlying neurologic basis attributable to spontaneous intense activity of the genito-pelvic region represented in the somatosensory cortex and its projections. A process of care diagnostic and treatment strategy was developed to guide the clinician, whenever possible, by localizing the symptoms as originating in any of five regions: (i) end organ, (ii) pelvis/perineum, (iii) cauda equina, (iv) spinal cord, and (v) brain. Psychological treatment strategies were considered critical and should be performed in conjunction with medical strategies. Pharmaceutical interventions may be used based on their site and mechanism of action to reduce patients’ symptoms and the associated bother and distress. Clinical Implications The process of care for PGAD/GPD uses a personalized, biopsychosocial approach for diagnosis and treatment. Strengths and Limitations Strengths and Limitations: Strengths include characterization of the condition by consensus, analysis, and recommendation of a new nomenclature and a rational basis for diagnosis and treatment. Future investigations into etiology and treatment outcomes are recommended. The main limitations are the dearth of knowledge concerning this condition and that the current literature consists primarily of case reports and expert opinion. Conclusion We provide, for the first time, an expert consensus review of the epidemiology and pathophysiology and the development of a new nomenclature and rational algorithm for management of this extremely distressing sexual health condition that may be more prevalent than previously recognized. Goldstein I, Komisaruk BR, Pukall CF, et al. International Society for the Study of Women’s Sexual Health (ISSWSH) Review of Epidemiology and Pathophysiology, and a Consensus Nomenclature and Process of Care for the Management of Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD). J Sex Med 2021;18:665–697.

OBJECTIVE: To evaluate the relation between sexual function and depressive symptoms in puerperal women during the pandemic period. STUDY DESIGN: Prospective cohort with 125 women evaluated in the immediate postpartum period (before the pandemic - T1) in Hospital de Clinicas de Porto Alegre, 3 months (pandemic onset - T2) and 6 months (pandemic peak - T3) after birth by email and WhatsApp. The Female Sexual Function Index (FSFI) and the Edinburgh Postnatal Depression Scale (EPDS) were applied. RESULTS: Fifty puerperal women participated in the three periods of the study. The median age was 25 years. There was an inverse correlation between the ​​ FSFI and EPDS values at T2 (p < 0.001) and T3 (p < 0.001), demonstrating that the worsening sexual response was secondary to the higher prevalence of depressive symptoms in the puerperium in the COVID-19 pandemic. There was an increase in EPDS scores in the three periods: at T1, the EPDS scores ​​were 5.0 (2.0-9.0), increasing to 7.0 (4.0-14.0) at T2 and 6.5 (3.0-13.0) at T3 (p = 0.004). There was no difference between the FSFI index at the three evaluated times. CONCLUSIONS: Puerperal women are a susceptible subgroup for sexual dysfunction and depressive symptoms, which are correlated to each other and worsen in periods of stress, therefore, it is mandatory to investigate depressive symptoms in puerperal women with sexual complaints, especially during the COVID-19 pandemic.

Transdermal testosterone therapy, dosed within premenopausal physiologic testosterone ranges, used alone or with menopausal hormone therapy for postmenopausal hypoactive sexual desire disorder, has shown short-term efficacy, with few androgenic side effects. After natural or surgical menopause, meaningful improvements include an additional satisfying sexual episode per month; improvement in desire, arousal, orgasm, pleasure, and responsiveness; and a reduction in distress. Long-term data on cardiovascular, cancer, and cognitive safety are lacking. No approved testosterone preparation is available for women. Compounded testosterone creams or reduced dosing of male-approved therapies represent off-label use. Injections or pellets cause supraphysiological testosterone levels and are not recommended.

The role of testosterone in women and its potential as a therapeutic agent continue to attract controversy. The clinical trials of testosterone therapy for women primarily have focused on treatment of female sexual dysfunction, with the largest placebo-controlled studies being of transdermal testosterone in postmenopausal women. Based on the cumulative data from these studies, loss of sexual desire with associated personal distress currently is the only agreed-on indication for judicious testosterone supplementation for postmenopausal women. This article reviews the physiology of testosterone in women, summarizes the findings from observational studies and clinical trials, and considers indications for testosterone use.

Background Empirical data on sexual boredom are scarce and unsystematized, contrasting with the literature on general boredom. Aim The aim of this review of literature is to verify how sexual boredom is defined in previous research and which relationships were found with sexual functioning, relationship dynamics, or gender. Methods A systematic search was conducted in EBSCO, Scopus, Web of Science, and PubMed databases for papers published until August 2020. Search terms used were “sexual boredom” or “sexual tedium” or “sexual indifference” or “sexual monotony” or a combination of “boredom” and “sexual activity” or “intercourse”. This systematic review followed PRISMA guidelines. Outcomes Articles were grouped in general boredom and sexuality research and in sexual boredom research. RESULTS This review consists of 43 articles, of which 31 are quantitative studies, 8 are qualitative studies, and 4 are mixed-method studies. Studies concerning general boredom and sexuality include research on diverse aspects of sexual behavior, namely solitary sexual behavior, extra-dyadic sex, compulsive sexual behavior, and risky sexual behavior. Sexual boredom research included papers regarding personality, sexual response, and varied aspects of sexual behavior. Clinical Implications Findings suggest sexual boredom is related with sexual response, sexual satisfaction, and hypersexuality, which renders clinical relevance. Sexual boredom impacts well-being, and further research should focus on exploring potential mechanisms underpinning this sexual problem. Strengths and limitations To the authors’ knowledge, this is the only existing systematic review of sexual boredom and allowed identifying key features of sexual boredom and related aspects. However, because most studies are correlational, and several do not use comprehensive measures of sexual boredom, no causal relationships were identified. CONCLUSION This review indicates the construct of sexual boredom includes individual, relationship, and societal aspects. However, no definition of sexual boredom includes these, and current knowledge does not allow formulating a model or a theory of sexual boredom.

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.

Item does not contain fulltext Hypothyroidism and hyperthyroidism are observationally associated with sex hormone concentrations and sexual dysfunction, but causality is unclear. We investigated whether TSH, fT4, hypo- and hyperthyroidism are causally associated with sex hormones and sexual function. We used publicly available summary statistics from genome-wide association studies on TSH and fT4 and hypo- and hyperthyroidism from the ThyroidOmics Consortium (N ≤ 54,288). Outcomes from UK Biobank (women ≤ 194,174/men ≤ 167,020) and ReproGen (women ≤ 252,514) were sex hormones (sex hormone binding globulin [SHBG], testosterone, estradiol, free androgen index [FAI]) and sexual function (ovulatory function in women: duration of menstrual period, age at menarche and menopause, reproductive lifespan, and erectile dysfunction in men). We performed two-sample Mendelian randomization (MR) analyses on summary level, and unweighted genetic risk score (GRS) analysis on individual level data. One SD increase in TSH was associated with a 1.332 nmol/L lower (95% CI: - 0.717,- 1.946; p = 2 × 10(-5)) SHBG and a 0.103 nmol/l lower (- 0.051,V0.154; p = 9 × 10(-5)) testosterone in two-sample MR, supported by the GRS approach. Genetic predisposition to hypothyroidism was associated with decreased and genetic predisposition to hyperthyroidism with increased SHBG and testosterone in both approaches. The GRS for fT4 was associated with increased testosterone and estradiol in women only. The GRS for TSH and hypothyroidism were associated with increased and the GRS for hyperthyroidism with decreased FAI in men only. While genetically predicted thyroid function was associated with sex hormones, we found no association with sexual function.

The aims of the study were to investigate female sexual dysfunction (FSD) at different reproductive stages and the effect on FSD of hormone replacement therapy (HRT).Participants (There was an increase in FSD in groups EP and LP, but not in groups R, ET and LT; most FSFI scores were lower in groups EP and LP than in groups R, ET and LT (We report a clear association between deteriorating sexual function and increasing STRAW + 10 classification, suggesting the consequence of decreasing ovarian function. HRT containing 'natural hormones' was shown to have a beneficial effect on FSD. The results are reported here for the first time in Chinese women.

Hypoactive sexual desire disorder (HSDD) is a common female sexual dysfunction and is estimated to affect approximately 10% of women in the United States. It has been suggested that HSDD is associated with an imbalance of hormone and neurotransmitter levels in the brain, resulting in decreased excitation, increased inhibition, or a combination of both. Evidence suggests neurotransmitters, including dopamine (DA), norepinephrine, and serotonin, as well as hormones such as estradiol and testosterone, contribute to female sexual desire and response. Current treatments for HSDD include psychotherapy, and two US Food and Drug Administration-approved medications for premenopausal women: flibanserin, a serotonin mixed agonist and antagonist, and bremelanotide, a melanocortin receptor (MCR) agonist. Melanocortins are endogenous neuropeptides associated with the excitatory pathway of the female sexual response system. MCRs are found throughout the body, including the brain. Bremelanotide is an MCR agonist that nonselectively activates several of the receptor subtypes, of which subtype 4 (MC4R) is the most relevant at therapeutic doses. MC4R is predominantly expressed in the medial preoptic area (mPOA) of the hypothalamus in the brain, and is important for female sexual function. Animal studies suggest that bremelanotide may affect female sexual desire by activating presynaptic MC4Rs on neurons in the mPOA of the hypothalamus, leading to increased release of DA, an excitatory neurotransmitter that increases sexual desire. This review presents what is known about the mechanism of action of bremelanotide in the context of treating HSDD.

Introduction: In the present study, we prospectively investigated the impact of endoscopic transnasal trans-sphenoidal surgery (ETTS) on sexual function in male and female patients with pituitary adenoma. Methods: The study included a total of 40 consecutive patients (male, n = 28 and female, n = 12) aged 22–65 years, who underwent ETTS for pituitary adenoma in our center between March 2019 and August 2019. Twenty-seven (67.5%) and 13 (32.5%) patients had functioning and nonfunctioning pituitary adenomas, respectively. Routine preoperative hormone levels were obtained in every patient. The tests were repeated at the postoperative third month. Preoperatively and at the postoperative third month, the 5-item version of the International Index of Erectile Function and the Female Sexual Function Index (FSFI) was used in male and female patients, respectively. Results: Before surgery, 24 (85.7%) men had erectile dysfunction (ED), and 10 (83%) women had female sexual dysfunction. After surgery, all the patients’ abnormal hormone parameters improved. All the male patients’ ED degrees were positively affected by surgery. In women, the FSFI was significantly better than in the preoperative period. Discussion/Conclusion: Our results showed that both males and females with pituitary adenomas benefitted from minimally invasive pituitary surgery in terms of a high-remission rate and improvement in sexual dysfunction.

Background Pregnancy is a unique period with the increased likelihood of psychological changes and emotional disturbances such as depression, anxiety, and stress. In this study, we investigated the factors influencing depression, anxiety, and stress in pregnancy and identify their associations with Sexual Distress (SD) and Genital Self-Image (GSI). Methods This was a descriptive, correlational, cross-sectional study performed using the two-stage cluster sampling method between September 2019 and January 2020. Overall, 295 pregnant women completed a demographics and obstetric information checklist, Depression Anxiety and Stress Scale-21 (DASS-21), Female Genital Self-Image Scale (FGSI), and Female Sexual Distress Scale-Revised (FSDS-R). Results Analysis of Variance (ANOVA) showed significant differences in the mean scores of SD between the groups with varying degrees of depression, anxiety, and stress (P P = 0.01) and anxiety (P Conclusion Various factors contribute to the development of antenatal depression, anxiety, and stress. A positive correlation was found between SD and the severity of depression, anxiety, and stress, while a negative correlation was noted between GSI and the severity of depression and anxiety. Therefore, raising awareness regarding SD and GSI through screening and counseling sessions can have beneficial effects for mothers and their fetuses.

Background: Breast cancer targets women’s sexual organs and deals with patients’ femininity. The low age of incidence and the late stage of diagnosis of the disease in Iran give rise to sexual dysfunction among patients. Identifying the severity of the disorder, and its determiners can specify the probable groups to be influenced. Materials and Methods: In a descriptive cross-sectional study, 144 women with breast cancer who underwent surgical and complementary therapies were included in the study. Data collection was done through questionnaires: FSFI, SSSW and the demographic and clinical information questionnaire. Results: The mean age of patients was 42.31 ± 5.18 years. 76 patients (52.8%) underwent partial mastectomy and complementary treatments, and 68 cases (47.2%) underwent total mastectomy and complementary treatments. All patients had sexual dysfunction in all dimensions. The average score of sexual satisfaction was 84.3±10 10. The lowest sexual satisfaction score (79.6 ± 9.6) belonged to patients with total mastectomy (P = 0.013). Regression analysis showed predictability of patients’ sexual satisfaction by type of treatment and sexual function (P = 0.002 and P = 0.003, respectively). Conclusion: Sexual dysfunction and the low level of sexual satisfaction in patients with significant predictive effect of treatment type and sexual function denote that the patients with breast cancer need to be assisted to have proper sexual function and satisfaction leading to higher quality of life.

Objectives: The menopausal transition is a biological adaptation to the variety of life changes (body, comorbidities, relationship), but that biology is not an “end all” in the context of sexual function and overall sexual health. The aim of this study is to evaluate determinants altering the risk of female sexual dysfunction (FSD) and other sexual problems and to establish whether menopausal hormonal therapy (MHT) decreases that risk and modifies sexual behaviors. Methods: A cross-sectional observational study was conducted in 210 women between the ages of 45 and 55. Two groups were identified: MHT users (n = 107) and controls—MHT non-users (n = 103). Diagnostic and Statistical Manual of Mental Disorders -five criteria were used to assess sexual dysfunction. Sexual problems were evaluated by the Changes in Sexual Function Questionnaire (CSFQ), body image by Body Exposure during Sexual Activity Questionnaire, and quality of relationship by the Well-Match Relationship Questionnaire. Logistic regression was used to determine the risk factors for FSD and sexual problems. Results: Women using MHT had higher body esteem during sexual activities, better sexual function (CSFQ) in all domains except desire/interest, better quality of relationship, and lower prevalence of FSD and sexual complaints (CSFQ) except arousal/excitement problems. However, self-rated effects of MHT on sexual behaviors showed that MHT did not play a major role. Women with secondary and higher education (OR = 0.09, CI: 0.02-0.4; P < 0.01 and OR = 0.2, CI: 0.05-1.0; P < 0.05, respectively) and with a higher number of lifetime sexual partners (OR = 0.6, CI: 0.4-0.9; P < 0.01) were less likely to have FSD. In contrast, individuals with more anxious behaviors during sexual activity (OR = 3.2, CI: 1.3-7.3; P < 0.01) and with more severe menopausal symptoms (OR = 1.1, CI: 1.0-1.2; P < 0.001) were more likely to have FSD. Using MHT was not associated with that risk nor with sexual function. Conclusion: In women during menopausal transition, sexual behaviors were different in MHT users compared with non-users. However, in this cross-sectional observational study conducted in 210 women between the ages of 45 to 55 years, using MHT was not associated with modification of sexual function, decreasing the risk of sexual dysfunction, nor sexual problems.

Sexual function is a vital aspect of quality of life among adolescent and young adult (AYA) (ages 15-39 years) cancer survivors. Sexual function encompasses physical, psychosocial, and developmental factors that contribute to sexual health, all of which may be negatively impacted by cancer and treatment. However, limited information is available to inform the care of AYA cancer survivors in this regard. This scoping review, conducted by the Children's Oncology Group AYA Oncology Discipline Committee, summarizes available literature regarding sexual function among AYA cancer survivors, including relevant psychosexual aspects of romantic relationships and body image. Results suggest that, overall, AYA cancer survivors experience a substantial burden of sexual dysfunction. Both physical and psychosocial sequelae influence survivors' sexual health. Interventions to support sexual health and psychosexual adjustment after cancer treatment are needed. Collaborations between the Children's Oncology Group and adult-focused cooperative groups within the National Cancer Institute's National Clinical Trials Network are warranted to advance prospective assessment of sexual dysfunction and test interventions to improve sexual health among AYA cancer survivors.

The aim of the present study was to develop and validate the scenarios of cognitive bias modification of interpretation (CBM-I) in women with sexual interest arousal disorder (SIAD) and comparing its effectiveness with mindfulness therapy in Iran. This study was performed by mixed method in two phases. In the first phase of the study, CBM treatment scenarios were developed. In the second phase, 45 women with SIAD were selected and randomly divided into three groups (two experimental groups and one control group). In the qualitative phase of the research on the evaluation of the designed scenarios, 80 scenarios remained among the 100 scenarios by meeting the content validity criteria, fidelity, acceptance, and satisfaction with the treatment. Both experimental treatments exceeded the no treatment control but that mindfulness was more effective than CBM-I as measured by the Female Sexual Function Index Questionnaire (

Introduction Rectal cancer treatment can lead to sexual dysfunction. Methods We designed a retrospective survey-based study to quantify rates of sexual dysfunction in rectal cancer survivors. Patients that underwent surgery for rectal cancer between 2005 and 2016 at our institution were identified, and the following were distributed: Quality of Life measure for oncology (QoL-30), Female Sexual Function Index (FSFI), and International Index of Erectile Function (IIEF). Results Survey response rate was 21%, 17 females and 30 males (n = 47). 50% of males recalled a physician asking about sexual function during or after treatments, compared to 18% of females (p = 0.034). More than 50% of those surveyed wished one of their physicians had discussed the possibility of sexual dysfunction. In men, the QoL-30 significantly correlated with IIEF orgasmic function (r = 0.50, p = 0.004) and IIEF overall satisfaction (r = 0.60, p Conclusions Our findings demonstrate that rectal cancer patients experience posttreatment sexual dysfunction, desire discussion with their physicians on this topic, and that there are gender differences in how providers approach counseling regarding posttreatment sexual dysfunction.

Objectives: Being overweight and obesity, one of the biggest health problems in developing countries, is known to affect reproductive health problems. More and more Polish women are struggling with infertility and sexual dysfunctions. Such complications are often diagnosed to be linked directly with patients’ excess weight. The main objectives of the study were to assess the influence of increased BMI (≥ 25.0) on sexual activity and the prevalence of sexual dysfunctions in overweight and obese women in Upper Silesia. Additionally, the occurrence of health problems existing along with obesity was analyzed. Material and methods: The study was carried out at the Department of Pregnancy Pathology, Department of Woman’s Health, School of Health Sciences in Katowice of Medical University of Silesia in Poland. From 526 examined patients, 38% had normal BMI (18.5–24.9), 27% were overweight (BMI 25–29.9) and 35% were obese (BMI score ≥ 30). The patients answered a completely self-administered questionnaire, which was divided into two parts. The first part consisted of general questions about the patient and her past medical history. The second part was the Polish version FSFI questionnaire. The results obtained from FSFI were analyzed using the STATISTICA program. Results: Statistically significant (p < 0.001) reduction in the level of satisfaction was found in the group of obese women when compared to patients with BMI < 30. Also among obese patients the occurrence of sexual dysfunction (FSFI ≤ 26) was significantly increased (p < 0.05). A significantly higher number of patients from an average socio-economic situation suffered from sexual dysfunctions, when compared with patients from good a socio-economic group. Conclusions: Obesity and being overweight lead to more frequent sexual dysfunctions, especially through prevalence of decreased level of sexual satisfaction. Sexual activity problems may be exacerbated by increased body weight in combination with its comorbidities such as insulin resistance, PCOS, obstetric difficulties and irregular menstruation. What is more, a worse socio-economic situation of women predisposes them to the occurrence of sexual dysfunctions.

Increasing numbers of women are surviving for longer with epithelial ovarian cancer. Consequently, there is increased focus on long-term quality of life in national guidance. Psychosexual morbidity including vaginal dryness, pain during intercourse (dyspareunia), reduced libido, and negative perceived body image exacerbate stress and anxiety and impact intimate relationships. Although a priority for women with epithelial ovarian cancer, clinicians seldom discuss sexual problems. Therefore, psychosexual morbidity and the associated distress remain unaddressed. We synthesize evidence from primary qualitative and quantitative research studies exploring psychosexual morbidity in women with epithelial ovarian cancer to identify potential risk factors and common symptoms, to facilitate the identification and management of sexual problems in clinic. Literature (2008–19) from 10 databases identified 29 suitable publications (4116 patients). The papers were assessed to answer the question: “What are the key potential risk factors and presentations of psychosexual morbidity in women with epithelial ovarian cancer?” Current literature lacks consensus in defining clinically significant psychosexual morbidity in women with epithelial ovarian cancer. Discrepancies in measurement tools, questionnaires, and primary outcome measures confound result interpretation, limiting wider application. Key potential risk factors identified included: younger age (

In rare cases, cervical ectropion causes symptoms such as abundant leucorrhoea, postcoital bleeding, recurrent cervicitis, pelvic pain, and dyspareunia. Cryotherapy is a commonly used treatment for symptomatic cervical ectropion. We assessed the impact of cryotherapy on sexual function and quality of life among patients with symptomatic cervical ectropion. In this prospective observational study, 73 patients were assessed before and six months after cryotherapy treatment using the Female Sexual Function Index (FSFI) and Short Form-12 Health Survey questionnaires. The double-freeze cryotherapy procedure was performed using a cryotherapy unit, and liquid nitrogen was used as a refrigerant. The mean physical and mental quality of life scores were significantly improved after treatment. With the exception of the pain domain, the overall and domain FSFI scores exhibited no significant differences before and after cryotherapy. The sexual pain domain scores were significantly increased after treatment. There was a statistically significant improvement in vaginal discharge, pelvic pain, and postcoital bleeding symptoms after the cryotherapy. We concluded that cryotherapy is an effective and feasible treatment for symptomatic cervical ectropion. Although cryotherapy results in improved quality of life scores, it has no significant impact on female sexual function.Impact statement

Background Persistent genital arousal disorder (PGAD) is a highly distressing, understudied condition characterized by persistent genital arousal (eg, genital sensations, sensitivity) in the absence of sexual desire. Currently, there is limited information about the prevalence of PGAD based on its proposed diagnostic criteria (“PGAD criteria”). Aim This study sought to assess the prevalence of PGAD criteria in 2 North American samples: a large, non-clinical sample of Canadian undergraduate students (Study 1), and a nationally representative sample from the U.S. (Study 2). Methods The incoming class of undergraduate students (N = 1,634) enrolled in the Introduction to Psychology course at a Canadian university and a nationally representative sample of U.S. participants (N = 1,026) responded to questions about each PGAD criterion, and distress associated with these experiences. Outcomes 5 self-report questions were developed based on each of the Leiblum and Nathan 2001 PGAD criteria, and a measure of associated distress was included. The U.S. sample (Study 2) also responded to questions about medical comorbidities and their knowledge of the term “PGAD.” Results 1.1% (n = 4; Study 1) to 4.3% (n = 22; Study 2) of men and 0.6% (n = 7; Study 1) to 2.7% (n = 14; Study 2) of women reported experiencing all 5 PGAD criteria at a moderate to high frequency. Even greater proportions of participants reported experiencing all 5 criteria at any frequency (6.8–18.8%). Although ratings of associated distress varied, participants who were distressed by these symptoms most frequently endorsed the first PGAD criterion: physiological genital arousal in the absence of sexual excitement or desire. These results are similar to previously reported rates of PGAD. Clinical Implications A non-trivial number of individuals may experience PGAD, and it should be screened for by healthcare practitioners. Strengths & Limitations This study is the first to use 2 large, non-clinical samples to assess the prevalence of PGAD symptoms. However, barriers to reporting symptoms, such as shame or embarrassment, may have resulted in underestimates of prevalence in the present sample. Conclusion The prevalence of the 5 PGAD criteria in 2 large non-clinical samples ranged from similar to higher than rates reported in previous research. However, distress ratings associated with each of the 5 criteria varied, with most respondents describing them primarily as neutral or non-distressing.

Background Low sexual desire and arousal are the most common sexual concerns in women, but most women lack access to effective treatment such as cognitive behavioral therapy. Web-based psychological interventions, which are economical, private, easily accessible, and potentially effective, may increase the reach of evidence-based treatment. Aim To determine the feasibility of translating cognitive behavioral therapy for the most common female sexual dysfunction, Female Sexual Interest/Arousal Disorder, into an online format. The present study examined the feasibility of an introductory psychoeducational module of eSense, an online program currently being developed that is based on existing empirically supported in-person treatments, which delivers content to the user in a visually appealing and interactive manner. Methods Sixteen cisgender women (M age = 31.9) with female sexual arousal/interest disorder worked through a pilot module of eSense inperson at a sexual health laboratory. Outcomes Qualitative semistructured interviews and online questionnaires were used to assess participants’ experiences of usability of the platform, clarity/relevance of the content, satisfaction with the experience, and any changes in clinical outcomes of sexual function and distress. Results Participants reported a high level of satisfaction with the website’s functionality and presentation. They reported greater knowledge, felt validated and more hopeful, and were eager to continue the remaining modules. Participants also reported notable prepost improvements in sexual desire, arousal, and satisfaction. Clinical Implications Initial user-experience assessment may represent a method of simultaneously improving online interventions and providing therapeutic education to participants. Strengths & Limitations This is one of the first studies, to our knowledge, to test a graphics-rich, interactive online intervention for sexual difficulties that does not require direct contact with expert providers or support groups. Limitations include the high level of education, motivation, and technical fluency of the sample and the potentially confounding effect of the researcher’s presence during interviews. Because this was a feasibility study, the sample size was small, and no control group was included, limiting conclusions about efficacy and generalizability. Conclusion The format of eSense appears to be feasible and usable, lending support to the growing evidence that it is possible to take in-person therapeutic interventions online.

Introduction. Huntington’s Disease (HD) is a neurodegenerative disorder of which the main symptoms are motor, cognitive and behavioural problems sometimes including sexual dysfunction. Aim. To review the current knowledge on sexual dysfunction in HD. Methods. Databases of Pubmed and Scopus were searched. Only original studies performed after 1994 were included (from 1994 a genetic test = proven diagnosis). Results. 162 publications were found, but only nine met our established criteria. The majority of patients with HD suffer from sexual disorders. The most common are: hypoactive sexual disorder (53–83% of patients), hyperactive sexual disorder (6–30%), erectile (48–74%) and ejaculatory dysfunctions (30–65%), lubrication problems (53–83%), and orgasmic dysfunction (35–78%). Discussion. Results may be biased for several reasons e.g.: social taboos regarding sex lives, medications that affect sexual function, impaired self–awareness of patients, small study samples, a lack of standardised questionnaires, and a focus only on the presence of sexual problems without describing them. Conclusions. Sexual disorders in HD are common. This is a problem that is probably underestimated, both by patients/caregivers and physicians, who should focus more on these symptoms in order to improve patient quality of life.