Domains Of Sexual Function Research Articles

The Effects of Exercise on Sexual Function in Women.

Acute exercise is associated with transient changes in metabolic rate, muscle activation, and blood flow, whereas chronic exercise facilitates long-lasting adaptations that ultimately improve physical performance. Exercise in general is known to improve both physical and psychological health, but the differential effects of brief bouts of exercise vs long-term exercise regimens on sexual function are less clear. The purpose of this review was to assess the direct and indirect effects of both acute and chronic exercise on multiple domains of sexual function in women. A literature review of published studies on exercise and sexual function was conducted. Terms including "acute exercise," "chronic exercise," "sexual function," "sexual arousal," "sexual desire," "lubrication," "sexual pain," and "sexual satisfaction" were used. This review identifies key relationships between form of exercise (ie, chronic or acute) and domain of sexual function. Improvements in physiological sexual arousal following acute exercise appear to be driven by increases in sympathetic nervous system activity and endocrine factors. Chronic exercise likely enhances sexual satisfaction indirectly by preserving autonomic flexibility, which benefits cardiovascular health and mood. Positive body image due to chronic exercise also increases sexual well-being. Though few studies have examined the efficacy of month-long exercise programs for the treatment of sexual dysfunction, exercise interventions have alleviated sexual concerns in 2 specific clinical populations: women with anti-depressant-induced sexual dysfunction and women who have undergone hysterectomies. This review highlights the positive effects of acute and chronic exercise on sexual function in women. Directions for future research are discussed, and clinicians are encouraged to tailor specific exercise prescriptions to meet their patients' individual needs. Stanton AM, Handy AB, Meston CM. The Effects of Exercise on Sexual Function in Women. Sex Med Rev 2018;6:548-557.

Effect of Single-Session, Cryogen-Cooled Monopolar Radiofrequency Therapy on Sexual Function in Women with Vaginal Laxity: The VIVEVE I Trial.

Objective: This subanalysis of the VIVEVE I trial aimed to evaluate the impact of cryogen-cooled monopolar radiofrequency (CMRF) therapy, for the treatment of vaginal laxity, on the domains of sexual function included in the Female Sexual Function Index (FSFI).Materials and Methods: The VIVEVE I clinical trial was prospective, randomized, single-blind, and Sham-controlled. Nine clinical study centers in Canada, Italy, Spain, and Japan were included. This subanalysis included premenopausal women with self-reported vaginal laxity who had ≥1 term vaginal delivery and a baseline FSFI total score ≤26.5, indicating sexual dysfunction. Enrolled subjects were randomized (2:1) to receive CMRF therapy [Active (90 J/cm2) vs. Sham (≤1 J/cm2)] delivered to the vaginal tissue. Independent analyses were conducted for each FSFI domain to evaluate both the mean change, as well as the clinically important change for Active- versus Sham-treated subjects at 6 months post-intervention.Results: Subjects randomized to Active treatment (n = 73) had greater improvement than Sham subjects (n = 35) on all FSFI domains of sexual function at 6 months postintervention. The analysis of covariance change from baseline analyses showed statistically significant improvements, in favor of Active treatment, for sexual arousal (p = 0.004), lubrication (p = 0.04), and orgasm (p = 0.007). In addition, Active treatment was associated with clinically important and statistically significant improvements in sexual desire [Odds ratio (OR) = 3.01 (1.11–8.17)], arousal [OR = 2.73 (1.06–7.04)], and orgasm [OR = 2.58 (1.08–6.18)].Conclusions: This subanalysis showed CMRF therapy is associated with statistically significant and clinically important improvements in sexual function in women with vaginal laxity. These findings provide the first randomized, placebo-controlled energy-based device evidence for functional improvements associated with a nonsurgical modality for a highly prevalent and undertreated condition.

149 Extent of Female Partner Sexual Function Improvement in Female Partners of Men With Peyronie's Disease Who Received Collagenase Clostridium Histolyticum

To examine the impact of erectile dysfunction severity in men with Peyronie's disease (PD) on improvement of female partner satisfaction after collagenase clostridium histolyticum (CCH) treatment. Men with PD (penile curvature ≥30° and ≤90°) who previously received placebo during the IMPRESS I or II trials and their female partners, who were willing to participate, were included in a separate subsequent open-label, phase 3 study. Men received up to 4 treatment cycles; cycles were separated by 6 weeks. Each treatment cycle consisted of 2 injections of CCH 0.58 mg separated by 24 to 72 hours. The second injection was followed by 6 weeks of daily penile plaque modeling. Men completed the International Index of Erectile Function (IIEF) at baseline and week 36. The IIEF is a 15-item questionnaire that assesses 5 domains (erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction) of male sexual function. Female sexual function was assessed at baseline and week 36 using the Female Sexual Function Index (FSFI), a 19-item questionnaire that measures desire or arousal, lubrication, orgasm, satisfaction, and pain. The relationship between baseline IIEF male erectile dysfunction and improvement of female sexual function after CCH therapy in males was examined using regression analysis (Pearson correlation coefficient [r]).

Testosterone therapy for sexual dysfunction in men with Type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials.

To evaluate the effectiveness of testosterone therapy on a range of sexual function domains in men with Type 2 diabetes. Electronic databases were searched for studies investigating the effect of testosterone therapy on sexual function in men with Type 2 diabetes. All randomized controlled trials were considered for inclusion if they compared the efficacy of testosterone therapy with that of placebo and reported sexual function outcomes. Statistical analysis was performed using a random-effects model, and heterogeneity was expressed using the I2 statistic. A total of 611 articles were screened. Six randomized control trials, in a total of 587 men with Type 2 diabetes, were eligible for inclusion. The pooled data suggested that testosterone therapy improves sexual desire (random-effects pooled effect size 0.314; 95% CI 0.082-0.546) and erectile function (random-effects pooled effect size 0.203; 95% CI 0.007-0.399) when compared with control groups. Testosterone therapy had no significant effect on constitutional symptoms or other sexual domains compared with control groups. No studies have investigated the incidence of prostate cancer, fertility and cardiovascular disease after testosterone therapy in men with Type 2 diabetes. Testosterone therapy may moderately improve sexual desire and erectile function in men with Type 2 diabetes; however, available data are limited, and the long-term risks of testosterone therapy are not known in this specific patient group. We conclude that testosterone therapy is a potential treatment for men with Type 2 diabetes non-responsive to phosphodiesterase-5 inhibitors. Testosterone therapy could be considered for men with Type 2 diabetes when potential risks and benefits of therapy are carefully considered and other therapeutic options are unsuitable.

The \u2018heat\u2019 goes away: sexual disorders of married women with female genital mutilation/cutting in Kenya

BackgroundFemale genital mutilation/cutting (FGM/C) has been implicated in sexual complications among women, although there is paucity of research evidence on sexual experiences among married women who have undergone this cultural practice. The aim of this study was to investigate the sexual experiences among married women in Mauche Ward, Nakuru County.MethodsQuantitative and qualitative data collection methods were used. Quantitative data were obtained from 318 married women selected through multistage sampling. The women were categorized into: cut before marriage, cut after marriage and the uncut. A questionnaire was used to collect demographic information while psychometric data were obtained using a female sexual functioning index (FSFI) tool. The resulting quantitative data were analyzed using SPSS® Version 22. Qualitative data were obtained from five FGDs and two case narratives. The data were organized into themes, analyzed and interpreted. Ethical approval for the study was granted by Kenyatta National Hospital-University of Nairobi Ethics and Research Committee.ResultsThe mean age of the respondents was 30.59 ± 7.36 years. The majority (74.2%) had primary education and 76.1% were farmers. Age (p = 0.008), number of children (p = 0.035) and education (p = 0.038) were found to be associated with sexual functioning. The cut women reported lower sexual functioning compared to the uncut. ANOVA results show the reported overall sexual functioning to be significantly (p = 0.019) different across the three groups. Women cut after marriage (mean = 22.81 ± 4.87) scored significantly lower (p = 0.056) than the uncut (mean = 25.35 ± 3.56). However, in comparison to the cut before marriage there was no significant difference (mean = 23.99 ± 6.63). Among the sexual functioning domains, lubrication (p = 0.008), orgasm (p = 0.019) and satisfaction (p = 0.042) were significantly different across the three groups. However, desire, arousal and pain were not statistically different.ConclusionGenerally, cut women had negative sexual experiences and specifically adverse changes in desire, arousal and satisfaction were experienced among cut after marriage. FGM/C mitigating strategies need to routinely provide sexual complications management to safeguard women’s sexual right to pleasure subsequently improving their general well-being.

Hypertension and obesity comorbidities increases coronary risk, affects domains of sexual function and sexual quality of life.

About 25% of the world's adult population suffers from arterial hypertension with about 1.5 billion estimated to develop hypertension by 2025. Hypertensive patients have been reported to have a higher risk of developing diabetes and sexual dysfunction. Hypertension have been linked with lubricative and orgasmic difficulties in females, as wel as ED and vascular disease in men. Obesity has also been linked to ED in diabetic males as well as several aspects of female sexuality. Hypertension and obesity are closely related, each occurring in greater frequency with the other, it is only logical to think that comorbidities of obesity and hypertension could increase the risk of cardiovascular disease and SD. This research looks at the relationship between hypertension and obesity comorbidities and its association with sexual function in type II diabetics. Diabetic patients who were at least 18 years old and were engaged in a stable heterosexual relationships for at least 1 year were recruited for this study. Participants were categorized into the -HYP/-OB, +HYP/-OB and the +HYP/+OB groups. Sexual function was assessed using the GRISS-M and GRIS-F for the diabetic males and females respectively. Early morning fasting blood samples was used in lipid profile as well as FBG assay. The Coronary risk was estimated as Total/HDL Cholesterol. Triglyceride levels and coronary risk were highest in the +HYP/+OBES group, followed by the +HYP/-OBES group, with the -HYP/-OBES group recording the lowest levels. PE and infrequency recorded the highest score among the +HYP/+OBES group with the +HYP/-OBES group recording the lowest scores. SQoL was highest amongst the -HYP/-OBES group, with the +HYP/+OBES group recording the lowest scores. Anorgasmia and avoidance increased along the shades of HYP/OBES groups. Comorbidities of hypertension and obesity increases the risk of coronary disease, affects some domains of sexual function and decreases the SQoL of diabetics.

A prospective randomised placebo-controlled study of the impact of dutasteride/tamsulosin combination therapy on sexual function domains in sexually active men with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH).

To prospectively assess the impact of the fixed-dose combination (FDC) of the 5α-reductase inhibitor (5ARI), dutasteride 0.5 mg and the α1 -adrenoceptor antagonist, tamsulosin 0.4 mg (DUT-TAM FDC) therapy on sexual function domain scores in sexually active men with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH), using the Men's Sexual Health Questionnaire (MSHQ). This European and Australian double-blind, placebo-controlled, parallel-group study was conducted at 51 centres. age ≥50 years, International Prostate Symptom Score ≥12, prostate volume ≥30 cc, prostate-specific antigen 1.5-10 ng/mL. Patients were randomised 1:1 to DUT-TAM FDC therapy or placebo for 12 months. The change from baseline to Month 12 on the total MSHQ (primary endpoint) and MSHQ erection, ejaculation and satisfaction domains (secondary outcome) was assessed, using a mixed model repeated measures analysis. Safety was evaluated. The intention-to-treat population included 489 patients (243 DUT-TAM FDC therapy; 246 placebo). A significant decrease (worsening) was observed with DUT-TAM FDC therapy versus placebo on the total MSHQ score (-8.7 vs -0.7; standard error [se]: 0.81, 0.78; P < 0.001), and the ejaculation (-7.5 vs -0.6; se: 0.56, 0.55; P < 0.001) and satisfaction (-0.6 vs +0.3; se: 0.3, 0.29, P = 0.047) domains, but not the erection domain (-1.0 vs -0.5; se: 0.19, 0.19, P = 0.091). This is the first domain-specific quantitative evaluation of DUT-TAM FDC therapy on sexual function in men with LUTS secondary to BPH. The observed changes in the MSHQ with DUT-TAM FDC therapy were mainly driven by changes in the ejaculation domain. These findings will help give context to erectile and ejaculatory dysfunction AEs reported spontaneously in earlier 5ARI studies.

Sexual Dysfunction in Urethral Reconstruction: A Review of the Literature.

Urethral stricture disease accounts for 5,000 hospitalizations and 1.5 million office visits per year. Urethral reconstruction has become more commonplace with the recognition of the poor long-term success of the endoscopic management of stricture disease. Sexual dysfunction related to the surgical management of urethral strictures is an under-recognized sequela. To characterize and elucidate the various factors that contribute to sexual dysfunction after urethroplasty and hypospadias reconstruction to improve surgical decision making and patient counseling. A Medline PubMed search was used to identify articles of interest related to sexual dysfunction and urethral stricture disease. The following were included in the search for articles of interest: "urethroplasty and sexual dysfunction," "urethral stricture and erectile dysfunction," "urethroplasty and ejaculatory dysfunction," and "sexual function and hypospadias." Rates and types of sexual dysfunction after urethral reconstructive surgery. Urethral reconstructive surgery has the potential to affect many domains of sexual function and thus negatively affect quality of life for patients with urethral stricture disease and hypospadias. These domains include erectile function, ejaculatory function, penile shortening, penile curvature, and altered penile sensation. The etiology, location, length and type of urethral stricture, and importantly the reconstructive technique have different repercussions on sexual function. Sexual dysfunction after urethral reconstruction is underappreciated and has a significant consequence on quality of life. Thus, it is important to recognize these sequelae and counsel patients accordingly. Benson CR, Hoang L, Clavell-Hernández J, Wang R. Sexual Dysfunction in Urethral Reconstruction: A Review of the Literature. Sex Med Rev 2018;6:492-503.

The effect of bromocriptine treatment on sexual functioning and depressive symptoms in women with mild hyperprolactinemia.

Elevated prolactin levels are associated with sexual dysfunction in women. No previous study has investigated the effect of dopamine agonists on sexual functioning in women. The study enrolled 30 young women with mild hyperprolactinemia (serum prolactin levels in the range between 25 and 50ng/mL), 15 of whom were later treated with bromocriptine (5-10mg daily), as well as 14 age- and weight-matched healthy women. All women completed a questionnaire evaluating female sexual function (Female Sexual Function Index - FSFI) and a questionnaire evaluating the presence and severity of depressive symptoms (Beck Depression Inventory Second Edition - BDI-II). Women with mild hyperprolactinemia had a lower total FSFI score, lower scores in all domains of sexual functioning (desire, arousal, lubrication, and dyspareunia), as well as a lower total BDI-II score than control women. Bromocriptine increased the FSFI score and tended to reduce BDI-II score. Moreover, the drug normalized desire, arousal, lubrication and dyspareunia, as well as improved orgasm and sexual satisfaction and this action correlated with changes in prolactin levels and an improvement in insulin sensitivity. No changes in sexual functioning and depressive symptoms were observed in untreated women with mild hyperprolactinemia and healthy controls. Bromocriptine treatment improves female sexual functioning and slightly affects depressive symptoms in women with elevated prolactin levels and this effect is related to its prolactin-lowering and metabolic effects.

Effect of Pelvic Floor Muscle Training on Female Sexual Function During Pregnancy and Postpartum: A Randomized Controlled Trial

Background: Current evidence on the effect of pelvic floor muscle (PFM) training for promoting sexual function is limited. Recent reviews indicate need for high quality trials in this area. Objectives: To examine the effect of PFM training on sexual function (primary outcome), sexual quality of life, and PFM strength (secondary outcomes) in pregnant and postpartum women. Methods: This was an assessor-blind two parallel arm superiority trial. A total of 84 nulliparous women with a singleton pregnancy at 17 - 20 weeks, aged 18 - 35 years, were recruited using purposive sampling among clients of five public health centers or two governmental maternity clinics in Sari-Iran. The recruitment was done from May to November 2014 and follow up ended on July 2015. Participants were equally allocated into either PFM training or routine care groups using block randomization. Women allocated to the PFM group received 4 sessions of supervised training, with practical, oral, and written instructions on how to continue performing regular PFM exercises at home. Female sexual function index, sexual quality of life questionnaire-female, and Oxford scoring were used to assess the outcomes at 28 - 30 weeks gestation and 80 - 90 days following birth. Results: There was one loss to follow-up from each group. A total of 6 women had not exercised regularly. Compared with the control group, the mean total sexual function score was significantly greater in the PFM training group during both pregnancy (29.3 vs 21.1; adjusted difference 9.4, 95%CI 7.7 to 11.0, P < 0.001) and postpartum (28.7 vs 16.0; adjusted difference 13.0, 95%CI 12.1 to 13.9, P < 0.001). Also, almost all domains of sexual function, sexual quality of life, and PFM strength during both periods improved significantly in women who received the PFM training compared with the controls. Conclusions: Based on the results, PFM training during pregnancy and postpartum could improve sexual function in nulliparous women. Therefore, it should be recommended to all of the women.

Healthcare utilization in men with poorer sexual and urinary function recovery following robot-assisted radical prostatectomy.

Robotic radical prostatectomy focuses on oncologic cure, urinary continence and sexual function recovery. However, little is known about the effect of declines in urinary continence and sexual function on healthcare utilization. We aim to identify these factors. From March 2011 to September 2013, all men undergoing robotic prostatectomy within our healthcare system were enrolled. Men completed the expanded prostate cancer index composite-26 survey at the time of diagnosis and 90days post-operatively. Patients were stratified according to change in scores in the sexual function and urinary incontinence domains. Patient, treatment and post-op utilization patterns were examined for association with the extent of decline in sexual function and urinary continence. Multivariate linear regression was used to identify factors independently associated with decline in continence and sexual function. A total of 411 men who completed the baseline survey and at 90days postoperatively were included. On multivariate linear regression, younger age (p<0.01), higher preoperative sexual function (<0.01), single marital status (p=0.04) and more post-surgery email contacts (p=0.04) were associated with higher declines in sexual function. For continence, no family history of prostate cancer (p=0.01), higher baseline continence (p<0.01) and more post-surgery physical therapy visits (p<0.01) were associated with higher declines. Patients with the poorest quality of life outcomes at 90days post-operatively were more likely to seek care via email and physical therapy encounters related to sexual function and urinary incontinence, respectively. This suggests that maximizing post-treatment quality of life can potentially reduce healthcare utilization.

Sexual function in adolescents and young adults diagnosed with cancer: A systematic review.

The purpose of this systematic review was to identify, with supporting evidence, the impact of cancer and its treatment on the sexual function of adolescents and young adults. PubMed, CINAHL, and PsycINFO articles were searched for relevant studies published in English. Fifteen studies, 13 quantitative and two qualitative, were included in this review. Results indicated that cancer during the adolescent and young adult period has a significant negative impact on certain domains of sexual function in both men and women. Among adolescent and young adult males, there is evidence that cancer has detrimental effects on erection, ejaculation, and orgasm. Among adolescent and young adult females, cancer is associated with decreased desire, but there appear to be mixed findings with respect to arousal, orgasm, and satisfaction. Directions for future research are discussed. A better understanding of the effects of cancer and its treatment during adolescence and young adulthood on sexual function could increase attention paid to sexual health in oncology settings and lead to improved psychosexual services for this population.

Occupational Exposure to Bisphenol A (BPA): A Reality That Still Needs to Be Unveiled.

Bisphenol A (BPA), 2,2-bis(4-hydroxyphenyl) propane, is one of the most utilized industrial chemicals worldwide, with the ability to interfere with/or mimic estrogenic hormones with associated biological responses. Environmental human exposure to this endocrine disruptor, mostly through oral intake, is considered a generalized phenomenon, particularly in developed countries. However, in the context of occupational exposure, non-dietary exposure sources (e.g., air and contact) cannot be underestimated. Here, we performed a review of the literature on BPA occupational exposure and associated health effects. Relevantly, the authors only identified 19 studies from 2009 to 2017 that demonstrate that occupationally exposed individuals have significantly higher detected BPA levels than environmentally exposed populations and that the detection rate of serum BPA increases in relation to the time of exposure. However, only 12 studies performed in China have correlated potential health effects with detected BPA levels, and shown that BPA-exposed male workers are at greater risk of male sexual dysfunction across all domains of sexual function; also, endocrine disruption, alterations to epigenetic marks (DNA methylation) and epidemiological evidence have shown significant effects on the offspring of parents exposed to BPA during pregnancy. This overview raises awareness of the dramatic and consistent increase in the production and exposure of BPA and creates urgency to assess the actual exposure of workers to this xenoestrogen and to evaluate potential associated adverse health effects.

Effect of female genital mutilation/cutting; types I and II on sexual function: case-controlled study

BackgroundThe existing literature is contradictory regarding effects of female genital mutilation/cutting (FGM/C) on sexual functions. The aim of this study was to explore the impact of type I and II FGM/C on sexual function of Egyptian women.MethodsWe recruited 197 cut women and 197 control women from those visiting Assiut University hospitals for different reasons. We asked each woman to fill the Arabic female sexual function index (FSFI) (a self reported 19-item questionnaire assessing the main domains of female sexual function). Genital Examination was done to confirm the type of FGM.ResultsFemale sexual dysfunction (FSD) was found in 83.8% of FGM/C cases in contrast to 64.5% of the control. The total FSFI score in the FGM/C group (19.82 ± 7.1) was significantly lower than in the control group (23.34 ± 8.1). Concerning the types of FGM/C, type 73.6% of cases had type I and 26.4% had type II. Type I FGM/C was performed mainly by physicians (62.1%) while type II was performed mainly by midwives (44.4%).FSD was found in 83.4% of FGM/C I cases and in 84.6% of FGM/C II cases. There was no statistically significant difference between the two types of FGM/C as regards total and individual domain scores except for the pain domain. There were significantly lower total and individual domain scores in both FGM/C types except for the desire domain compared to control.ConclusionIn this study, FGM/C was associated with reduced scores of FSFI on all domains scores, and among both types I and II, both were associated with sexual dysfunction.

Effects of Oral vs Transdermal Estrogen Therapy on Sexual Function in Early Postmenopause

Sexual dysfunction, an important determinant of women's health and quality of life, is commonly associated with declining estrogen levels around the menopausal transition. To determine the effects of oral or transdermal estrogen therapy vs placebo on sexual function in postmenopausal women. Ancillary study of the Kronos Early Estrogen Prevention Study (KEEPS), a 4-year prospective, randomized, double-blinded, placebo-controlled trial of menopausal hormone therapy in healthy, recently menopausal women. Of 727 KEEPS enrollees, 670 agreed to participate in this multicenter ancillary study. Women were 42 to 58 years old, within 36 months from last menstrual period. Data were collected from July 2005 through June 2008 and analyzed from July 2010 through June 2017. Women were randomized to either 0.45 mg/d oral conjugated equine estrogens (o-CEE), 50 µg/d transdermal 17β-estradiol (t-E2), or placebo. Participants also received 200 mg oral micronized progesterone (if randomized to o-CEE or t-E2) or placebo (if randomized to placebo estrogens) for 12 days each month. Aspects of sexual function and experience (desire, arousal, lubrication, orgasm, satisfaction, and pain) were assessed using the Female Sexual Function Inventory (FSFI; range, 0-36 points; higher scores indicate better sexual function). Low sexual function (LSF) was defined as an FSFI overall score of less than 26.55. Distress related to low FSFI score (required for the diagnosis of sexual dysfunction) was not evaluated. The 670 participants had a mean (SD) age of 52.7 (2.6) years. The t-E2 treatment was associated with a significant yet moderate improvement in the FSFI overall score across all time points compared with placebo (average efficacy, 2.6; 95% CI, 1.11-4.10; adjusted P = .002). With o-CEE treatment, there was no significant difference in FSFI overall score compared with placebo (mean efficacy, 1.4; 95% CI, -0.1 to 2.8; adjusted P = .13). There was no difference in FSFI overall score between the t-E2 and o-CEE groups on average across 48 months (adjusted P = .22). In the individual domains of sexual function, t-E2 treatment was associated with a significant increase in mean lubrication (0.61; 95% CI, 0.25-0.97; P = .001) and decreased pain (0.67; 95% CI, 0.25-1.09; P = .002) compared with placebo. Overall, the proportion of women with LSF was significantly lower after t-E2 treatment compared with placebo (67%; 95% CI, 55%-77% vs 76%; 95% CI, 67%-83%; P = .04). For o-CEE there was no significant reduction in the odds of LSF. Treatment with t-E2 modestly improved sexual function in early postmenopausal women, but whether it relieved symptoms of distress is not known. clinicaltrials.gov Identifier: NCT00154180.

Testosterone and sexual function.

Testosterone therapy has been advocated in the treatment of symptoms that may represent normal aging. We briefly review randomized clinical trials on the effects of testosterone therapy on sexual function. About half of clinical trials showed no benefit of testosterone therapy on any aspect of sexual function. In those studies showing a benefit on some aspect of sexual function, most sexual function domains were not improved. Testosterone therapy has been disappointing in the treatment of erectile dysfunction. Potential risks of therapy include an increase in thromboembolic and other cardiovascular diseases. The limited and inconsistent benefits of testosterone therapy for sexual function argue against use of this therapy in aging men, including those with 'low testosterone'.

Rheumatoid arthritis is associated with negatively variable impacts on domains of female sexual function: evidence from a systematic review and meta-analysis

To systematically review the literature to identify the impact of rheumatoid arthritis (RA) on specific female sexual function domains. A meta-analysis was performed and the related literature were searched in MEDLINE, EMBASE, Cochrane Library, CNKI, CBM and Web of Science databases, and in reference lists of articles and systematic reviews. Score of the Female Sexual Function Index (FSFI) was used as the outcome measurement, and mean differences (MD) with 95% confidence intervals (CI) were calculated. Five studies were included, including 346 women with RA and 237 healthy female controls. Each domain of the FSFI score: lubrication (MD, −2.48; 95% CI, −3.69, −1.28), orgasm-1.71 (−2.09, −1.33), sexual desire-1.27 (−1.59, −0.95), satisfaction-1.67 (−2.18, −1.16), arousal-1.83 (−2.85, −0.82), pain-1.57 (−2.43, −0.70) and the total score −8.84 (−11.88, −5.79) were lower in RA women than healthy controls. Furthermore, lubrication dimension was most severely affected especially. This meta-analysis showed that female RA patients scored lower in each dimension of FSFI, mostly in the lubrication domain. It demonstrated that targeted interventions should be done to improve their sexual function. Future well-designed researches with larger sample sizes are necessary to evaluate the potential risk factors which determine female sexual dysfunction.

The prevalence and correlates of low sexual functioning in women on hemodialysis: A multinational, cross-sectional study.

Sexual dysfunction may affect 80% of women in hemodialysis. However the specific patterns and clinical correlates of sexual functioning remain poorly described. The aim of this study was to assess prevalence and correlates of the individual domains of sexual functioning in women treated with hemodialysis. We recruited, into this multinational cross-sectional study, women treated with long-term hemodialysis (Collaborative Working Group on Depression and Sexual dysfunction in Hemodialysis study). Self-reported domains of sexual functioning were assessed by the Female Sexual Function Index, which is routinely administered within the network of dialysis patients followed by the working group. Lower scores represented lower sexual functioning. Socio-demographic and clinical correlates of each domain of sexual functioning were identified by stepwise multivariable linear regression. Sensitivity analyses were restricted to women who reported being sexually active. We found that of 1309 enrolled women, 659 (50.3%) provided complete responses to FSFI survey questions and 232 (35%) reported being sexually active. Overall, most respondents reported either no sexual activity or low sexual functioning in all measured domains (orgasm 75.1%; arousal 64.0%; lubrication 63.3%; pain 60.7%; satisfaction 60.1%; sexual desire 58.0%). Respondents who were waitlisted for a kidney transplant reported scores with higher sexual functioning, while older respondents reported scores with lower functioning. The presence of depression was associated with worse lubrication and pain scores [mean difference for depressed versus non-depressed women (95% CI) -0.42 (-0.73 to -0.11), -0.53 (-0.89 to -0.16), respectively] while women who had experienced a previous cardiovascular event reported higher pain scores [-0.77 (-1.40- to -0.13)]. In conclusion, women in hemodialysis reported scores consistent with marked low sexual functioning across a range of domains; the low functioning appeared to be associated with comorbidity.

Effects of Sex Education and Kegel Exercises on the Sexual Function of Postmenopausal Women: A Randomized Clinical Trial

BackgroundThe sex lives of women are strongly affected by menopause. Non-pharmacologic approaches to improving the sexual function of postmenopausal women might prove effective. AimTo compare two methods of intervention (formal sex education and Kegel exercises) with routine postmenopausal care services in a randomized clinical trial. MethodsA randomized clinical trial was conducted of 145 postmenopausal women residing in Chalus and Noshahr, Iran. Their sexual function statuses were assessed using the Female Sexual Function Index (FSFI) questionnaire. After obtaining written informed consents, they were randomly assigned to one of three groups: (i) formal sex education, (ii) Kegel exercises, or (iii) routine postmenopausal care. After 12 weeks, all participants completed the FSFI again. Analysis of covariance was used to compare the participants' sexual function before and after the interventions, and multiple linear regression analysis was used to determine the predictive factors for variation in FSFI scores in the postintervention stage. OutcomesSexual function was assessed using the FSFI. ResultsThere were no statistically significant differences in demographic and socioeconomic characteristics and FSFI total scores among the three study groups at the outset of the study. After 12 weeks, the scores of arousal in the formal sex education and Kegel groups were significantly higher compared with the control group (3.38 and 3.15 vs 2.77, respectively). The scores of orgasm and satisfaction in the Kegel group were significantly higher compared with the control group (4.43 and 4.88 vs 3.95 and 4.39, respectively). Clinical ImplicationsFormal sex education and Kegel exercises were used as two non-pharmacologic approaches to improve the sexual function of women after menopause. Strengths and LimitationsThe main strength of this study was its design: a well-organized randomized trial using precise eligibility criteria with a small sample loss. The second strength was the methods of intervention used, namely non-pharmacologic approaches that are simple, easily accessible, and fairly inexpensive. The main limitation of the study was our inability to objectively assess the participants' commitment to exercise and the sexual function of their partners. ConclusionSex education programs and Kegel exercises could cause improvements in some domains of sexual function—specifically arousal, orgasm, and satisfaction—in postmenopausal women.Nazarpour S, Simbar M, Tehrani FR, Majd HA. Effects of Sex Education and Kegel Exercises on the Sexual Function of Postmenopausal Women: A Randomized Clinical Trial. J Sex Med 2017;14:959–967.

Study of sexual dysfunction in newly diagnosed depressed males at tertiary care centre

Background: Aim of the study was to assess the sexual dysfunction in newly diagnosed depressed males at tertiary care centre. Material and Method: Total of 43 cases of newly diagnosed depression as per ICD-10, were analysed. Detailed history and physical examination was carried out. Hamilton depression rating scale (HDRS) was applied to assess the severity of depression. The International index of erectile function (IIEF) was applied to assess sexual dysfunction. Result: Out of 43 cases, 79% patients had sexual dysfunction. Maximum i.e.79% had intercourse satisfaction dysfunction and overall satisfaction dysfunction followed by 76.74% had erectile dysfunction, 55.81% had sexual desire dysfunction and 53.48% had orgasmic dysfunction. Conclusion: Our study showed high prevalence of sexual dysfunction in depressed males. All the domains of sexual functioning were affected. We did not found any association between severity of depression and sexual dysfunction. Keywords: Depression, Sexual dysfunction, Desire dysfunction, Erectile dysfunction, Orgasmic dysfunction, Intercourse satisfaction