Female Hypoactive Sexual Desire Disorder Research Articles

Commentary on "Characteristics of systemic testosterone therapy for female hypoactive sexual desire disorder - a claims database analysis".

Commentary on "Characteristics of systemic testosterone therapy for female hypoactive sexual desire disorder - a claims database analysis".

(279) Quantitative Analyze of Psycho Diagnostic Data in the Diagnosis of Female Sexual Dysfunctions

Abstract Introduction Sexual activity is an important aspect of quality of life. It's a fact that mental disorders caused by sexual trauma in past, bullying, strict up bringing, stigmatization, low level of sexual education, playing important role in development of female sexual dysfunctions. Objective The aim of our study was to detect how effective is psycho diagnostic examination for timely diagnosis and adequately treatment of women with sexual dysfunctions. Methods In our research that was conducted from October 2022 to July 2023, at the Z.Marshania’s sexual medicine center participated 75 women with different sexual dysfunctions. The study was quantitative. We used a correlational analysis to assess the association between dependent and independent variables. Independent variables with a p-value < 0.05 were taken as statistically significant with sexual dysfunction. To evaluate psychological characteristics, we took MMPI-1, SSTAI, and Beck Depression Questionnaire. Results All our patients had different sexual difficulties. 55% among 75 had psychological problems that were identified before the sexual dysfunction was discovered. The largest correlation (53%) was found between anxiety disorders and Female Orgasmic Disorder (FOD), as well as between depression and Female Hypoactive Sexual Desire Disorder (FHSDD) which was 34%. It is also worth emphasizing the style of life caused by strict traditional family education, due to which some of the patients had an inadequate perception of sexual life (63%). Conclusions The prevalence of sexual dysfunction among women with mental disorders is quite high, therefore, along with the treatment of sexual dysfunctions, it is important to properly evaluate the psychological state that can be performed effectively by psycho-diagnostic examination. Without it, the treatment of sexual dysfunctions among women will not be managed adequately. Disclosure No.

MP35-18 CHARACTERISTICS OF SYSTEMIC TESTOSTERONE THERAPY FOR FEMALE HYPOACTIVE SEXUAL DESIRE DISORDER - A CLAIMS DATABASE ANALYSIS

You have accessJournal of UrologyCME1 May 2022MP35-18 CHARACTERISTICS OF SYSTEMIC TESTOSTERONE THERAPY FOR FEMALE HYPOACTIVE SEXUAL DESIRE DISORDER - A CLAIMS DATABASE ANALYSIS Pranjal Agrawal, Kathryn Dumas, Taylor P. Kohn, Jaden R. Kohn, and Marisa Clifton Pranjal AgrawalPranjal Agrawal More articles by this author , Kathryn DumasKathryn Dumas More articles by this author , Taylor P. KohnTaylor P. Kohn More articles by this author , Jaden R. KohnJaden R. Kohn More articles by this author , and Marisa CliftonMarisa Clifton More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002589.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Hypoactive sexual desire disorder (HSDD) is estimated to impact approximately 10% of women but is commonly undiagnosed. Systemic testosterone therapy (alone or with estrogen) improves libido in women with HSDD; however, concern for adverse effects may limit broad utilization. Our objective is to describe trends in systemic testosterone for HSDD using a large US claims database. METHODS: The TriNetX Diamond Network database was queried: a US health research network of 190 million patients, encompassing healthcare encounters and prescriptions. We identified female patients with HSDD (ICD-10 F52.0) without age limitation from 2010 to September 2021. Testosterone prescription trends (total prescriptions, number per patient, incidence over time [prescriptions/person-day] assessed in 2010–2012, 2013–2015, 2016–2018, and 2019–2021), route of administration, and coadministration with estrogen were extracted. Significance over time was assessed using Chi Square for trend. RESULTS: 37,491 women diagnosed with HSDD were identified with mean age 46.5±12.4 years. Only 3.9% of women with HSDD (n=1444) were prescribed systemic testosterone (mean age 50.6±10.0 years). Over time, a statistically significant increase in testosterone prescriptions for HSDD occurred, specifically for women age 18–40 years and 41–55 years, as seen in Figure 1 (p <0.05). Most prescriptions were for injectable testosterone (56.8%), while 29.3% were for topical testosterone and 13.9% with route unknown. 556 women received only 1 prescription for systemic testosterone, 327 received 2-3 prescriptions, 262 received 4-9 prescriptions, and 299 received 10+ prescriptions. Systemic estrogen was co-prescribed for 543 women and vaginal estrogen was co-prescribed for 259 women; 642 women received no estrogen prescription. CONCLUSIONS: Systemic testosterone therapy for HSDD remains rare but its use has increased over time; duration, route, and co-administration with estrogen remain highly variable. Long-term compliance with systemic testosterone therapy remains relatively low. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e594 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pranjal Agrawal More articles by this author Kathryn Dumas More articles by this author Taylor P. Kohn More articles by this author Jaden R. Kohn More articles by this author Marisa Clifton More articles by this author Expand All Advertisement PDF DownloadLoading ...

Scalable flibanserin nanocrystal-based novel sublingual platform for female hypoactive sexual desire disorder: engineering, optimization adopting the desirability function approach and in vivo pharmacokinetic study

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.

Female Hypoactive Sexual Desire Disorder: A Practical Guide to Causes, Clinical Diagnosis, and Treatment.

Hypoactive sexual desire disorder (HSDD) in women is defined as the persistent or recurrent absence of sexual thoughts or fantasies and/or lack of desire for sexual activity that is associated with marked personal distress and/or interpersonal difficulties, and cannot be better attributed to another primary disorder, medication, or general medical condition. Notably, HSDD shares some similarity with depression, as its etiology can be explained using a biopsychosocial model that includes biological, psychological, and sociocultural factors, as well as interpersonal influences. Due to its high prevalence and negative impact on the overall health and well-being of women, primary care health professionals and women's health practitioners need to be actively aware of HSDD, particularly because patients may be reluctant or unwilling to initiate a discussion about their sexual concerns during routine visits. HSDD is well established as a valid and treatable clinical entity. Even for those inexperienced in treating sexual problems, there are simple and validated screening tools such as the Decreased Sexual Desire Screener that can help identify HSDD and a need for further evaluation and treatment. There have been few established pharmacologic treatments for HSDD. Flibanserin was the first drug approved for the treatment of HSDD by the U.S. Food and Drug Administration (FDA). Bremelanotide, a novel melanocortin receptor agonist, was recently approved by the FDA for the treatment of acquired, generalized HSDD in premenopausal women. Increased awareness and recognition of HSDD as a medical condition should provide an incentive for further clinical development of effective treatments for HSDD.

Evolutionary Perspectives on Hypoactive Sexual Desire Disorder in Women

This review attempts to explain female hypoactive sexual desire disorder (HSDD) from a functional evolutionary perspective. Can theory and data regarding the evolved functions of female sexual motivation help explain cases of low sexual desire in women? If so, might some such cases be the product of brain mechanisms operating in ways that promoted reproductive success during human evolution, rather than low desire resulting from pathology? A functional theory of women’s sexual motivation is first summarized, which posits that sexual desire is modulated by both conception probability and social variables related to the initiation and maintenance of pair bonds. Recent evidence consistent with this theory is reviewed, followed by review of evidence showing that variables predicting sexual desire in most women may also explain cases of HSDD. Women’s sexual desire varies in functionally patterned ways. Discovering the evolved design of brain mechanisms that generate those patterns is crucial for understanding HSDD.

012 Eye Dynamics in Patients with Female Hypoactive Sexual Desire Disorder (HSDD): Evidence towards the Top-Down NeuroFunctional Self-Attention-Model (SAM) of Desire

012 Eye Dynamics in Patients with Female Hypoactive Sexual Desire Disorder (HSDD): Evidence towards the Top-Down NeuroFunctional Self-Attention-Model (SAM) of Desire

063 Brain Dynamics of Female Hypoactive Sexual Desire Disorder (HSDD)

Hypoactive sexual desire disorder (HSDD) is one of the most prevalent female sexual health problems. Because of its negative impact on health and well-being, there is a crucial need to better understand its nature and dynamics. The top-down neurofunctional self-attention-model (SAM) of desire suggests that HSDD is partly modulated by a specific cognitive interference that inhibits sexual desire and arousal. Recent neuroimaging research reinforced SAM in patients with HSDD by demonstrating not only lower brain activity in brain network of sexual desire, but also higher brain activation in the self-referential brain network—suggesting that inspecting, monitoring, and evaluating a public perspective of oneself (rather than sensory experience) before or during sexual activities interfere with sexual desire. Because of the temporal limitation of functional magnetic resonance imaging (fMRI), the spatiotemporal dynamics of the HSDD brain network remains unresolved. Here, we investigated the spatio-temporal dynamics of female HSDD by combining a behavioral desire decision task with high-performance electrical neuroimaging.

Transdermal Testosterone in Female Hypoactive Sexual Desire Disorder: A Rapid Qualitative Systematic Review Using Grading of Recommendations Assessment, Development and Evaluation.

Female hypoactive sexual desire disorder (HSDD) is a multifactorial sexual dysfunction disorder characterized by a decrease in sexual desire and personal distress. HSDD occurs in naturally occurring postmenopausal women or secondary to oophorectomy. Multiple studies have assessed the use of transdermal testosterone (TDT) as a management option for patients with HSDD. Our aim is to assess published studies using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework for the quality of evidence regarding testosterone use as a short- and long-term therapy for HSDD. We implemented this qualitative systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. We set a GRADE score of 4 (high evidence) as a cutoff point for the quality measure of published studies assessing the use of TDT in HSDD. The outcomes of interest were the efficacy of TDT on the total number of satisfying sexual activity, number of orgasms, sexual desire and distress level in patients with HSDD. These outcomes were evaluated through Sexual Activity Log (SAL), Profile of Female Sexual Function (PFSF), and Personal Distress Scale (PDS) evaluation tools. Five randomized controlled trials were identified to meet the inclusion criteria. The selected studies were of high evidence based on the GRADE score as two of the studies scored 4 points, the other two studies scored 5 points and one study scored 6 points. All of the high quality selected studies had similar outcomes suggesting high effectiveness for the use of 300 µg/d TDT with or without estrogen for the management of HSDD with minimal side effects. One study showed a trend for higher risk of breast cancer in long-term use (0.37%). The use of 300 µg/d of TDT in surgical and natural menopause is an effective plan to manage HSDD in the short- and long-term. Although side effects are minimal, further prospective research is needed to assess the more severe side effects such as breast cancer in the long-term use of TDT.

Flibanserin: A controversial drug for female hypoactive sexual desire disorder

Sexual functioning is an integral part of human life. Female sexual dysfunction (FSD) adversely affects quality of life and general well-being. The Food and Drug Administration recently approved flibanserin, for treatment of female hypoactive sexual desire disorder (HSDD), regarded as the most common FSD, amid great controversy. A novel multifunctional serotonin agonist and antagonist, flibanserin, has been shown to be efficacious in treating HSDD but with a rather tenacious side effect profile. We review this interesting drug in its entirety. Data for the article were collected by reviewing articles on PubMed, the drug (Addyi) website, and related websites on the internet.

Women With Hypoactive Sexual Desire Disorder Versus Sexual Interest/Arousal Disorder: An Empirical Test of Raising the Bar

In 2013, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published with a major revision to the sexual dysfunction categories, and the diagnosis of female hypoactive sexual desire disorder (HSDD) was replaced with female sexual interest/arousal disorder (SIAD). Since being introduced, concern has been expressed that SIAD inappropriately “raises the bar” for diagnosis. To address these concerns, we sought to evaluate the number of women with a diagnosis of HSDD who also met criteria for SIAD. In a sample of 151 women, we found that 73.5% of women with a diagnosis of HSDD met criteria for SIAD. The two groups were compared on the Sexual Interest/Desire Inventory, and women who met criteria for both HSDD and SIAD consistently scored lower on sexual desire frequency and satisfaction, satisfaction with sex, receptivity, positive sexual thoughts, reactions to erotica, arousal frequency, ease, continuation, and orgasm ease/achievement, and higher on distress. In addition, women meeting criteria for HSDD only tended to have mild symptoms across the six SIAD criteria compared to those meeting criteria for both HSDD and SIAD. These findings suggest that the SIAD criteria does not unduly raise the bar for diagnosis.

New developments in the treatment of hypoactive sexual desire disorder - a focus on Flibanserin.

The objective of the authors is to highlight the historical complexities for the diagnosis and treatment of hypoactive sexual desire disorder (HSDD) with a focus on Flibanserin. A systematic review of the medical literature published in PubMed using the search terms HSDD and Flibanserin was conducted. Each author reviewed the results of the systematic review for articles to include in this study. HSDD is defined as a persistent or recurrent deficiency or absence of sexual fantasies and desire for sexual activity causing marked distress or interpersonal difficulty that is not better accounted for by another diagnosis. Until 2015, only homeopathic products and off-label use of prescription medications were medical treatment options for women with HSDD. Flibanserin, approved by the US Food and Drug Administration (FDA) in 2015, is the first to target female HSDD in premenopausal women. Flibanserin is a centrally acting nonhormonal oral medication taken once daily that affects serotonin, dopamine and norepinephrine levels, the key neurotransmitters in the biology of desire. Understanding prescribing guidelines and awareness of black box warnings is paramount for prescribers. Adherence to proper oversight will ensure Flibanserin can fulfil an unmet need for an FDA approved prescription medication for the treatment of HSDD in premenopausal women.

Flibanserin for hypoactive sexual desire disorder: place in therapy.

The pathophysiology, diagnosis and treatment of female sexual interest in pre- and post-menopausal women present a complex arena for patients and physicians to navigate. Flibanserin was the first pharmacologic treatment, approved by the United States Food and Drug Administration in August 2015, for hypoactive sexual desire disorder (HSDD) in premenopausal women. Side effects, contraindications and lack of approval in postmenopausal women are all limitations, as are issues surrounding patient and physician knowledge and access. Testosterone, buspirone, sildenafil, bupropion, bremelanotide, as well as herbal medications (Herbal vX or Tribulus terrestris) have demonstrated some clinical benefit in women with sexual dysfunction disorders however, trials have significant design, dosing or generalizability limitations. Nonpharmaceutical cognitive behavioral therapy, mindfulness meditation, pelvic floor therapy, and clitoral stimulators are also interventions women may pursue. This manuscript will explore the clinical data regarding these therapeutic modalities so as to bring attention to this issue of female HSDD, to offer an overview of current research, and to incite providers to initiate discussion among themselves and their patients.

What Sexual Behaviors Relate to Decreased Sexual Desire in Women? A Review and Proposal for End Points in Treatment Trials for Hypoactive Sexual Desire Disorder.

IntroductionCounts of satisfying sexual events (SSEs) per month have been criticized as an end point in treatment trials of women with hypoactive sexual desire disorder (HSDD) but grounding improvement in sexual desire by assessing changes in sexual behavior remains of some importance.MethodsWe conducted a literature review to find validated measurements that are specific sexual behavioral correlates of low sexual desire. We compared expert-proposed criteria for dysfunctional desire, expert-developed sets of scale items, and self-rated scales developed before issuance of, or in accordance with, the Food and Drug Administration’s guidance on developing patient-reported outcomes. Behavioral measurements of HSDD were isolated from these sets of criteria or scales.Main Outcome MeasuresWe outline a plan to evaluate such behavioral measurements of HSDD with reference to SSEs.ResultsEleven rating scales, four expert-originated and seven self-rated scales mainly derived from patient input were identified as well validated and relevant to HSDD. Three recent sets of diagnostic criteria for conditions such as HSDD were compared with the scales. Twenty-four different symptoms were found in the scales. Content found relevant to HSDD during development of the rating scales varied highly among measurements, including the self-rated scales developed in conformity with current recommendations for patient-reported outcome measurements. The only item on all sets was desire for sexual activity. Four other items were in approximately at least half the sets: sexual thoughts or fantasies, frequency of sexual activity, receptivity, and initiations. Sexual thoughts or fantasies were in every expert-derived set but in only three of the seven patient-derived sets. Receptivity was in five of the seven expert-derived sets vs two of the seven patient-derived sets. Frequency of sexual activity was in one of the seven expert-derived sets but in five of the patient-derived sets. Initiation was in approximately half the two sets. All other items were on one to three sets each. We identified three sexual behaviors of validated specificity for female HSDD: frequency of sexual activity, receptivity, and initiations. Six or seven items are relevant and informative. The item on frequency of sexual activity in the Changes in Sexual Functioning–Female scale is the only item that covers frequency of dyadic and solitary sexual activity. An item in the Female Sexual Desire Questionnaire (FSDQ) covers the intuitively relevant topic of frequency of sexual activity motivated by the woman’s desire. Three FSDQ items on initiations and two items on receptivity reflect expert opinion on the sexual behaviors of most relevance to HSDD, but the FSDQ has not been validated in women with HSDD.ConclusionsSSEs have been discredited as the primary measurement in clinical trials of women with HSDD, but it would be meaningful to include at least one sexual behavioral symptom specific to HSDD as an end point. Expert-recommended sexual behaviors specifically related to HSDD are irregularly represented in self-rating scales whether developed as in the Food and Drug Administration guidance on patient-reported outcomes or not. Six or seven items on sexual behavior in self-rated scales can be recommended for relevance to women with HSDD in clinical trials. Items on female sexual behavior should be tested in comparison with SSEs in women with HSDD for relevance and for treatment sensitivity, and responder and functional and dysfunctional cutoffs should be determined before incorporation into large-scale clinical trials.Pyke R and Clayton A. What Sexual Behaviors Relate to Decreased Sexual Desire in Women? A Review and Proposal for End Points in Treatment Trials for Hypoactive Sexual Desire Disorder. Sex Med 2017;5:e73–e83.

010 New Drug for Treatment of Female Hypoactive Sexual Desire Disorder - Results of Phase I Clinical Study

BP101 is a novel small peptide molecule aiming to restore sexual desire and related functions in women suffering from Hypoactive Sexual Desire Disorder (HSDD) and related sexual dysfunctions. In the Phase I clinical study BP101 safety/tolerability was assessed first in human, as well as pilot assessment of clinical effect on different aspects of female sexual function in healthy women was performed. 15 adult premenopausal healthy women were treated in 3 sequential dose cohorts (5 subjects per cohort) with daily BP101 intranasal administrations during 2 weeks with subsequent 4-weeks follow-up. 3 doses of BP101 were evaluated: 0.84, 1.68 and 2.52 mg. Adverse events frequency and profile was evaluated using clinical examination, clinical safety laboratory tests (including sex hormones panel) and electrocardiogram assessment. Clinical effect endpoints included changes from baseline to end of study in Female Sexual Function Index (FSFI) total score and domain scores, Arizona Sexual Experience Scale (ASEX) and Female Sexual Function questionnaire (Russian).

Flibanserin and Female Sexual Desire

Female hypoactive sexual desire disorder (HSDD) is one type of sexual problem that can affect women. It is characterized by low or absent sexual desire that cannot be attributed to another cause and results in difficulty in interpersonal relationships. HSDD is not well understood, and women may not report symptoms of difficulties to their health care providers. In August 2015, the U.S. Food and Drug Administration approved flibanserin, a nonhormonal oral medication for the treatment of HSDD in premenopausal women. Flibanserin is the only currently available pharmacologic treatment for HSDD. This article will provide an overview of flibanserin, including potential adverse reactions, special considerations for use, and implications for nursing practice.

An epidemiological study of sexual disorders in south Indian rural population.

Background:Sexuality is an important aspect of the personality of an individual and influences psychological, physical and social well-being of both men and women. It is a paradox, that in the country where ‘kamasutra’ (by Vatsyayana) took birth, there is a lack of research publications and sexuality related literature; hence the current study was conducted, to estimate the prevalence and association of sexual disorders with various socio-demographic variables, in the selected rural population.Materials and Methods:Subjects who were sexually active and fulfilled the study criteria were administered Arizona Sexual Experience Scale as screening tool for the presence of sexual problems. Those who were found to be having sexual problems were interviewed further using appropriate questionnaires.Results:21.15% of the male subjects were diagnosed to have one (or more) sexual disorder. Prevalence of erectile dysfunction was found to be 15.77%, male hypoactive sexual desire disorder (HSDD) 2.56%; premature ejaculation was found to be prevalent in 8.76% of the male subjects. Around 14% of the female subjects were diagnosed to have female sexual disorders. Prevalence of female arousal dysfunction was found to be 6.65%, female HSDD 8.87%, female anorgasmia 5.67%, female dyspareunia 2.34% and female sexual aversion disorder was found to be prevalent in 0.37% of the female subjects.Conclusion:This study concluded that one in five males and one in seven females were suffering from one (or more) sexual disorder. Improving the training of undergraduate medical and nursing students in sexuality related issues, increasing trained individuals in sexual medicine by starting new courses, providing sex education to the general population using media and merging sexual health care with primary care, are likely to play a significant role in addressing the increasing sexual health morbidity.

Animal models of female sexual dysfunction: Basic considerations on drugs, arousal, motivation and behavior

Female sexual dysfunctions are a heterogeneous group of symptoms with unknown but probably varying etiology. Social factors may contribute both to the prevalence and to the origin of these dysfunctions. The present review focuses on female hypoactive sexual desire disorder, sexual arousal disorder and orgasmic disorder. These disorders are generally the most common, according to epidemiological studies, and they can all be considered as disorders of motivation. An incentive motivational model of sexual behavior, applicable to humans as well as to non-human animals, is described and the dysfunctions placed into the context of this model. It is shown that endocrine alterations as well as observable alterations in neurotransmitter activity are unlikely causes of the disorders. A potential role of learning is stressed. Nevertheless, the role of some transmitters in female rodent sexual behavior is analyzed, and compared to data from women, whenever such data are available. The conclusion is that there is no direct coincidence between effects on rodent copulatory behavior and sexual behavior in women. Based on these and other considerations, it is suggested that sexual approach behaviors rather than copulatory reflexes in rodents might be of some relevance for human sexual behavior, and perhaps even for predicting the effects of interventions, perhaps even the effects of drugs. Female copulatory behaviors, including the proceptive behaviors, are less appropriate. The common sexual dysfunctions in women are not problems with the performance of copulatory acts, but with the desire for such acts, by feeling aroused by such acts and experiencing the pleasure expected to be caused by such acts. Finally, it is questioned whether female sexual dysfunctions are appropriate targets for pharmacological treatment.

Efficacy of Psychological Interventions for Sexual Dysfunction: A Systematic Review and Meta-Analysis

Sexual dysfunction is highly prevalent in the general population and associated with psychological distress and impaired sexual satisfaction. Psychological interventions are promising treatment options, as sexual dysfunction is frequently caused by and deteriorates because of psychological factors. However, research into the efficacy of psychological interventions is rather scarce and an up-to-date review of outcome studies is currently lacking. Therefore, we conducted a systematic review and meta-analysis of all available studies from 1980 to 2009 to examine the efficacy of psychological interventions for patients with sexual dysfunction. A total of 20 randomized controlled studies comparing a psychological intervention with a wait-list were included in the meta-analysis. The overall post-treatment effect size for symptom severity was d = 0.58 (95% CI: 0.40 to 0.77) and for sexual satisfaction d = 0.47 (95% CI: 0.27 to 0.70). Psychological interventions were shown to especially improve symptom severity for women with Hypoactive Sexual Desire Disorder and orgasmic disorder. Our systematic review of 14 studies comparing at least two active interventions head-to-head revealed that very few comparative studies are available with large variability in effect sizes across studies (d between -0.69 and 2.29 for symptom severity and -0.56 and 14.02 for sexual satisfaction). In conclusion, psychological interventions are effective treatment options for sexual dysfunction. However, evidence varies considerably across single disorders. Good evidence exists to date for female hypoactive sexual desire disorder and female orgasmic disorder. Further research is needed on psychological interventions for other sexual dysfunctions, their long-term and comparative effects.

Individual and Dyadic Barriers to a Pharmacotherapeutic Treatment of Hypoactive Sexual Desire Disorders: Results and Implications From a Small-Scale Study With Bupropion

This article describes the results of an independent small-scale trial with the centrally acting agent bupropion for female hypoactive sexual desire disorder. The main goals were to gain insight into the intrapsychic and interpersonal barriers to improvement associated with the pharmacological treatment of this common disorder. Eligible subjects entered a 2-week run-in period and a 4-week placebo phase, followed by a 20-week treatment phase. In addition to semi-structured clinical interviews and a set of standardized questionnaires, we used 2 self-developed questionnaires, addressing the period between visits and the week preceding each visit. Participants were 16 women who entered the placebo phase and 10 who completed the medication period. Analyses of pre–post scores and of the questionnaire addressing the time between visits yielded no significant changes. The questionnaire focusing on the week preceding each visit indicated improvements in sexual desire, arousability, and orgasmic ease after Week 8. In the clinical interviews, half of the women reported subjective improvements of sexual desire and arousability that could not be transferred to the sexual relationship as a result of individual and dyadic barriers. Overall, a centrally acting agent such as bupropion may be a viable option for female sexual dysfunction, but it seems mandatory to embed it in a psychotherapeutic approach.