Sexual Arousal Disorder Research Articles

Female sexual dysfunction is an artificial concept driven by commercial interests: FOR: FSD is a multimillion dollar business.

Female sexual dysfunction (FSD) can be classified as low sexual desire (diminished libido), sexual arousal disorder (difficulty to become aroused or maintain arousal during sexual activity), orgasmic disorder (persistent or recurrent difficulty in achieving orgasm after sufficient sexual arousal and continuing stimulation), and sexual pain disorder (pain associated with sexual stimulation or vaginal contact). Prevalence data suggest that 10–42% of women experience orgasmic disorder, and that 15% of women report some pain during intercourse. If a woman has an orgasm through clitoral stimulation, but not during intercourse, it does not meet the criteria for a clinical diagnosis of female orgasmic disorder. If the orgasmic difficulties are the result of inadequate sexual stimulation, these cases should not be diagnosed as a disorder of female orgasm (American Psychiatric Association, American Psychiatric Publishing 2013). Questionnaires are used to establish the diagnosis and to assess the response to treatment of FSD. The female sexual function index (FSFI) questionnaire is the most widely used measure of FSD, and has been cited in more than 1500 articles; however, the validity of the FSFI has not been addressed in the literature (Forbes et al. J Sex Res 2014;51:485–91). Physiologically the FSFI does not provide an assessment of female sexual function as it contains mainly psychological terms (Rosen et al. J Sex Marital Ther 2000;26:191–208). The FSFI seems to assess the degree of lubrication and ease of penetration, whereas very little attention is paid to clitoral sensation. In fact, a decline in desire, and a decreased ability to achieve orgasm, is associated specifically with penile–vaginal intercourse. As a matter of fact, FSD as a concept is popular because it is based on something that doesn't exist, i.e. the vaginal orgasm. Female orgasm is caused by the female erectile organs and, physiologically, female sexual satisfaction is based on orgasm and resolution (Puppo Clin Anat 2013;26:134–52). Moynihan stated: ‘I described the making of female sexual dysfunction as the freshest, clearest example of the corporate sponsored creation of a disease…The 19 item female sexual function index, published in 2000, was supported by Bayer and Zonagen at a time they hoped to treat so-called arousal disorder. The sexual function questionnaire was funded by Pfizer, and half of the authors on the 2002 paper describing its development were Pfizer employees, including the lead author’ (Moynihan BMJ 2010;341:c5050). FSD has become the centre of a multimillion-dollar business, and seems to be essentially focused on sexual function resulting from penile–vaginal intercourse. The FSFI questionnaire must not be used to assess FSD. Is FSD an illness constructed by sexologists under the influence of drug companies? Questionnaires for the diagnosis and treatment of male and female sexual dysfunctions must mainly assess the presence or absence of orgasm (a function of the human body, which must be assessed in the subject) with masturbation, and the questions posed should not use the words ‘intercourse’ or ‘satisfaction’. None declared. Completed disclosure of interests form available to view online as supporting information.

Pelvic nerve injury negatively impacts female genital blood flow and induces vaginal fibrosis-implications for human nerve-sparing radical hysterectomy.

This study sought to develop a novel animal model to study the impact of nerve-sparing radical hysterectomy (NSRH) on female genital blood flow. In vivo animal study. Thirty Sprague-Dawley female rats. Female rats underwent either unilateral pelvic nerve (PN) crush (PNC; n=9), or crush of both the PNs and all efferent nerves in the pelvic plexus ('clock-nerve crush', CNC; n=9). Under anaesthesia, we electrically stimulated the crushed PN at 3 and 10days after crush while monitoring blood pressure and recording clitoral and vaginal blood flows by laser Doppler. Uninjured PNs were stimulated as an internal control. Twelve additional rats were assigned either to bilateral PNC or sham surgery, and genital tissues were processed 10days after injury for invitro analysis. Genital blood flow, nNOS, eNOS, collagen I-III. Stimulation of the crushed PN in both groups subjected to PNC and CNC induced significantly lower peak genital blood flow at 3 and 10days (P<0.05) compared to stimulation of the non-crushed control PN. The immunofluorescence and Western blot analyses revealed that all injured rats exhibited more vaginal collagen III and collagen I than rats did that ad undergone sham surgeries (P<0.05). PCN reduced nNOS expression in both clitoral and vaginal tissue. Based on our study it may be hypothesised that NSRH might cause reductions of genital blood flow and vaginal fibrosis due to neurapraxia of the pelvic nerve and reductions of nNOS nerve fibres in clitoral and distal vaginal tissue. Pelvic nerve neurapraxia during nerve-sparing radical hysterectomy could lead to sexual arousal dysfunction.

Heart Rate Variability: A Risk Factor for Female Sexual Dysfunction.

Heart rate variability (HRV) is a measure of autonomic nervous system activity, which reflects an individual's ability to adapt to physiological and environmental changes. Low resting HRV has been linked to several mental health conditions, including depression, anxiety, and alcohol dependence (Kemp et al. in Biological Psychiatry 67(11):1067-1074, 2010. doi:10.1016/j.biopsych.2009.12.012; Kemp et al. in PloS One, 7(2):e30777, 2012; Quintana et al. in Drug and Alcohol Dependence, 132(1-2):395-398, 2013. doi:10.1016/j.drugalcdep.2013.02.025). HRV has also been used as a method for indexing the relative balance of sympathetic nervous system (SNS) activity to parasympathetic nervous system activity. This balance--in particular, moderately dominant SNS activity--has been shown to play a significant role in women's genital sexual arousal in the laboratory; however, the role of SNS activity in clinically relevant sexual arousal function is unknown. The present study assessed the feasibility of using HRV as an index of women's self-reported sexual arousal function outside the laboratory. Sexual arousal function, overall sexual function, and resting HRV were assessed in 72 women, aged 18-39. Women with below average HRV were significantly more likely to report sexual arousal dysfunction (p < .001) and overall sexual dysfunction (p < .001) than both women with average HRV and women with above average HRV. In conclusion, low HRV may be a risk factor for female sexual arousal dysfunction and overall sexual dysfunction.

A Systematic Review Of The Use Of Bupropion For Hypoactive Sexual Desire Disorder In Premenopausal Women.

Objective: To assess the efficacy of bupropion therapy for hypoactive sexual desire disorder (HSDD) in women. Methods: A systematic review was performed utilizing the standard databases. Data were abstracted for study quality, characteristics, and outcomes. Due to the small number of studies and lack of consistently reported outcomes, a meta-analysis was not performed. Results: Two studies (289 women) met inclusion criteria. While one study had low risk of bias, the other had areas of high risk of bias. Both trials reported improvement in sexual function domains with treatment ranging from 12 weeks to 112 days. Conclusions: Despite two trials demonstrating benefit with bupropion treatment for premenopausal women with HSDD, the evidence is limited and not of adequate quality to recommend the therapy. More trials are needed in this area. Corresponding author: David M. Haas, MD, MS Dept. of OB/GYN, 550 N University Blvd, UH 2440, Indianapolis, IN 46202 (317)880-3959 (office), dahaas@iupui.edu DOI : 10.14302/issn.2381-862X.jwrh-14-546 Freely Available Online www.openaccesspub.org | JWRH CC-license DOI : 10.14302/issn.2381-862X.jwrh-14-546 Vol-1 Issue 1 Pg. no.15 INTRODUCTION Female sexual dysfunction is a prevalent problem worldwide with reported rates of 10-30% . Hypoactive sexual desire disorder (HSDD) is a common form of sexual dysfunction affecting females more often than males at rates of 30% and 15%, respectively 2, . HSDD is defined in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as “the persistent or recurrent deficiency or absence of sexual fantasies/thought, and/or desire for sexual activity that causes personal distress or interpersonal difficulties”. It is not uncommon for women with HSDD to also have concomitant sexual arousal and/or orgasmic disorders . Additionally, HSDD and low sexual desire in general are believed to be underestimated by health care providers and are associated with decreased relationship satisfaction and distress for many women and their partners 1, . Furthermore, impaired sexual desire has been shown to be associated with depressed mood. While studies have shown improvement in sexual function with relief of depressive symptoms, additional investigation into the psychological and physiological effects of antidepressants has provided evidence of antidepressant-induced sexual dysfunction as an adverse effect of many of these medications . Despite ongoing research into female sexual dysfunction and HSDD, the exact etiology of these disorders is yet to be determined. There have been many trials conducted to determine the efficacy of various therapies in the treatment of HSDD. Decreased androgen levels have been shown to be associated with a decline in libido. Testosterone therapy (oral, transdermal patch, or topical) has been investigated through randomized controlled trials (RCTs) indicating statistically significant improvement in sexual desire . Testosterone transdermal patches have been approved for HSDD treatment in Europe. However, the U.S. Food and Drug Administration did not approve testosterone therapy for the treatment of HSDD due to the unknown long term adverse events (Moynihan 2004). In addition to testosterone therapies, investigations of genital vasodilators, dopaminergic therapies, estrogen therapies, and melanocortin receptor-acting bremelanotide have been conducted 1, . However, despite these investigations, there continues to be no FDA approved treatment for HSDD in the United States. Bupropion is a centrally-acting medication that is currently approved for use in the treatment of major depressive disorder, seasonal affective disorder, and smoking cessation (Bupriopion package insert 2014). The exact mechanism of action of bupropion has yet to be determined, however, it is believed to act centrally on both dopaminergic and norepinephrine systems with no serotonergic action . In addition to its role in mood improvement, bupropion has been shown to be effective in the reversal of SSRI-induced sexual dysfunction when supplemented to current therapy as well as a (Continued on page 16) Freely Available Online www.openaccesspub.org | JWRH CC-license DOI : 10.14302/issn.2381-862X.jwrh-14-546 Vol-1 Issue 1 Pg. no.16 substitution therapy . In addition to treatment of iatrogenic sexual dysfunction, study results indicate prosexual effects through the use of bupropion 12, . The objective of this study was to systematically review the data regarding bupropion treatment for HSDD treatment and to perform a meta-analysis to synthesize the trial results to determine if bupropion is effective

Physical therapy in sexually dysfunctional women: a systematic review

The World Health Organization (WHO) considers Female Sexual Dysfunctions (FSDs) to be a public health issue. There are a multitude of disorders such as female sexual arousal disorder, hypoactive sexual desire disorder, orgasmic disorder, dyspareunia, and vaginismus. FSDs are detected in 67.9% of the women in the world and are present in 50% of Asians, in 30-50% of Americans, and in 30% of Brazilians. Objective: To systematically review the literature on the different physiotherapy techniques used in the treatment of FSDs. Methods: A systematic search was conducted in the databases EMBASE, PEDro, and MedLine in data as recent as June 2013, by combining words and descriptors of physical therapy treatments and female sexual dysfunctions. Excluded from review were articles concerning male sexual dysfunction, pilot studies, multicentric papers of projects, and those which were either not available in their entirety or were duplicated in another database. After the selection of studies was complete, the randomized clinical trials were scored on the PEDro Evaluation Scale. Results: Eleven articles were included, six of which went on to be qualitatively evaluated on the PEDro scale. The present study followed the methodological structure of PRISMA (Statement for Reporting Systematic Reviews and Meta-Analyses of Studies). All studies found used questionnaires to assess the effects of physical therapy on FSDs. A total of five different types of interventions were verified: kinesiotherapy (Kegel exercises and pelvic floor muscle training - PFMT), Cognitive behavioral therapy (CBT), biofeedback, electrotherapy (transcutaneous electrical stimulation - TENS, and therapeutic ultrasound - US), and manual therapy. The limitations found in this systematic review were related to the unavailability of the articles in full and the low methodological quality of the studies. Conclusion: All studies showed improvements in sexual function after physical therapy intervention. There is no consensus on any intervention with better results; however, kinesiotherapy using PFMT proved to be advantageous because of its easy application, low cost, easy learning curve, and lasting results achieved in a short period. However, there are methodological shortcomings that still need to be dealt with to determine the most suitable physical therapy treatment for FSDs, as well as defining the best dosage, the protocol to be followed, and the duration of therapy, as well as the best cost-benefit

Prevalence and risk factors of sexual dysfunction in postpartum Australian women.

Female sexual dysfunction is highly prevalent and reportedly has adverse impacts on quality of life. Although it is prevalent after childbirth, women rarely seek advice or treatment from health care professionals. The aim of this study was to assess the sexual functioning of Australian women during the first year after childbirth. Postpartum women who had given birth during the previous 12 months were invited to participate in this cross-sectional study. A multidimensional online questionnaire was designed for this study. This questionnaire included a background section, the Female Sexual Function Index, the Patient Health Questionnaire (PHQ-8), and the Relationship Assessment Scale. Responses from 325 women were analyzed. Almost two-thirds of women (64.3%) reported that they had experienced sexual dysfunction during the first year after childbirth, and almost three-quarters reported they experienced sexual dissatisfaction (70.5 %). The most prevalent types of sexual dysfunction reported by the affected women were sexual desire disorder (81.2%), orgasmic problems (53.5%), and sexual arousal disorder (52.3%). The following were significant risk factors for sexual dysfunction: fortnightly or less frequent sexual activity, not being the initiator of sexual activity with a partner, late resumption of postnatal sexual activity (at 9 or more weeks), the first 5 months after childbirth, primiparity, depression, and relationship dissatisfaction. Sexual satisfaction is important for maintaining quality of life for postpartum women. Health care providers and postpartum women need to be encouraged to include sexual problems in their discussions.

Testocap – a herbal solution for erectile dysfuncyion and premature ejaculation

Sexual activity is a vital principle of human living that connects the desire, energy and pleasure of the body to a knowledge of human intimacy, for the sake of erotic love, intimate friendship, human mating and procreation. Sexuality is the capacity to have erotic experiences and responses. According to Masters and Johnson, the human sexual response cycle consists of four phases: excitement, plateau, orgasm, and resolution. The World Health Organization's International Classifications of Diseases defines sexual problems as ways in which an individual is unable to participate in a sexual relationship as he or she would wish. There are four major categories of sexual problems: desire disorders, arousal disorders, orgasmic disorders, and sexual pain disorders. Sexual arousal disorder in men, erectile dysfunction. Erectile dysfunction (ED) or impotence is sexual dysfunction characterized by the inability to develop or maintain an erection of the penis during sexual activity.Orgasmic disorders In men, premature ejaculation Premature ejaculation (PE) occurs when a man experiences orgasm and expels semen soon after sexual activity and with minimal penile stimulation. Sexuality has been explained in the Ayurveda classics in detail along with the various disorders related to desire, arousal, orgasmic and sexual pain disorders. The various formulations have been explained in classics to relieve these disorders and help the man to enjoy their sexual life.Considering these issues the need of hour this conceptual study has been carried out to help, support and provide enhanced sexual life with readily available pure botanicals which are time tested evidenced based and 100% safe and effective.

Reconceptualising women’s sexual desire and arousal in DSM-5

The publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013 was the culmination of more than a decade of work by the APA DSM-5 task force and Work Groups. From 2007 to 2013, I served as a member of the Sexual Dysfunctions subworkgroup, part of the Sexual and Gender Identity Disorders workgroup. In the area of sexual disorders, some of the most significant changes were made in diagnostic categories for female sexual dysfunction. The DSM-IV categories of desire and arousal disorders (Hypoactive Sexual Desire Disorder and Female Sexual Arousal Disorder) were replaced by a new, much broader diagnosis which included behavioural, subjective and physical aspects of sexual experience (Female Sexual Interest/Arousal Disorder). Other major changes included the addition of more specific and stringent severity and duration criteria and a list of contextual factors, for example, partner factors or cultural/religious factors that should be assessed by clinicians before making a diagnosis. This article reviews the rationale behind these major changes and outlines the process and some of the key challenges faced by the DSM-5 Sexual Dysfunctions subworkgroup in developing their recommendations.

Epidemiology of Sexual Dysfunction in Iran: A Systematic Review and Meta-analysis.

Background:The aim of this study was to determine the cumulative prevalence rate of every sexual dysfunctions (SDs) in Iranian population.Methods:We searched international database such as: PubMed/Medline, Scopus, PsychNET, and Scholar Google and Iranian database such as Iran Psych, IranDoc, IranMedex, and SID. Search duration was between 1990 and 2013.Results:From 449 articles were retrieved, then 11 articles on male with total sample size of 2142 and 8 articles on female with total sample size of 4391 were selected after critical appraisal. For quality assessment check list to evaluate a prevalence article was contained study population, sampling method, sample size, criteria for SD diagnosis, specific rates, study location, and authors list. In male, erectile dysfunction was 56.1%. In female, pooled estimation prevalence of hypoactive sexual desire disorder in complained group was 65.8% (95% confidence interval [CI]: 51.1-80.6%) compared to general population 35% (95% CI: 17.6-52.1%). Sexual arousal disorder in clinical patient was 59.6% (95% CI: 39-80%) against 33.8% (95% CI: 18.3-49.3%) in general population. Orgasmic disorder in complained was 35.5% (95% CI: 16-55%) and in general population was 35.3% (95% CI: 26.8-43.8%). Sexual pain disorder pooled estimation prevalence were 35.2% (95% CI: 14.5-56%) versus 20.1% (95% CI: 6.4-33.8%) in complained and general population consecutively.Conclusions:The rate of SD in Iran was approximately the same of worldwide except orgasmic disorder which was two times more than the worldwide average.

Sexual functioning in women after surgical treatment for endometrial cancer: a prospective controlled study.

Endometrial cancer (EC) can affect sexual functioning based on anatomical, physiological, psychological, and relational mechanisms. The aim of this study was to prospectively investigate sexual adjustment of women with EC during a follow-up period of 2 years after surgical treatment and to compare the results with women who underwent a hysterectomy for a benign gynecological condition and healthy control women. In this prospective controlled study, participants completed the Short Sexual Functioning Scale, Specific Sexual Problems Questionnaire, Beck Depression Inventory Scale, World Health Organization-5 Well-being Scale, and Dyadic Adjustment Scale to assess various aspects of sexual and psychosocial functioning before undergoing a hysterectomy and 6 months, 1 year, and 2 years after surgery. Eighty-four women with EC, 84 women with a benign gynecological condition, and 84 healthy controls completed the survey. In EC survivors, no differences were found in sexual functioning during prospective analyses. In comparison with women with a benign gynecological condition, significantly more EC patients reported entry dyspareunia 1 year after surgical treatment. Moreover, compared with healthy women, pre- and postoperatively, significantly more EC patients reported sexual dysfunctions, including sexual desire dysfunction, arousal dysfunction, entry dyspareunia, and a reduced intensity of orgasm. Furthermore, compared with healthy controls, EC patients reported significantly lower overall well-being 1 year after surgical treatment. Nevertheless, consensus in the partner relationship was significantly higher in EC patients compared with healthy controls. Moreover, before treatment, quality of partner relationship was negatively associated with sexual arousal dysfunction and orgasm dysfunction. In EC patients, no differences were found in sexual functioning when prospectively comparing the situation before surgery with the situation after surgery. However, when compared with healthy controls, EC patients are at high risk for sexual dysfunctions, both before and after surgical treatment.

Chapter 10 - Sexual and bladder comorbidity in women

Sexual dysfunction in women is defined as disorders of sexual desire, arousal, orgasm, and/or sexual pain, which result in significant personal distress and may have a negative effect on a woman's health and an impact on her quality of life. A comprehensive understanding of the anatomic, neurobiologic, and psychologic mechanisms behind women's sexual function and dysfunction is of paramount importance. This chapter reviews the most frequent comorbid conditions related to urinary tract symptoms (thus including symptoms related to overactive bladder syndrome and urinary incontinence) and sexual dysfunction in women. Likewise, it considers the different disorders from the point of view of daily clinical practice.

Physical therapy in sexually dysfunctional women: a systematic review

The World Health Organization (WHO) considers Female Sexual Dysfunctions (FSDs) to be a public health issue. There are a multitude of disorders such as female sexual arousal disorder, hypoactive sexual desire disorder, orgasmic disorder, dyspareunia, and vaginismus. FSDs are detected in 67.9% of the women in the world and are present in 50% of Asians, in 30-50% of Americans, and in 30% of Brazilians. Objective: To systematically review the literature on the different physiotherapy techniques used in the treatment of FSDs. Methods: A systematic search was conducted in the databases EMBASE, PEDro, and MedLine in data as recent as June 2013, by combining words and descriptors of physical therapy treatments and female sexual dysfunctions. Excluded from review were articles concerning male sexual dysfunction, pilot studies, multicentric papers of projects, and those which were either not available in their entirety or were duplicated in another database. After the selection of studies was complete, the randomized clinical trials were scored on the PEDro Evaluation Scale. Results: Eleven articles were included, six of which went on to be qualitatively evaluated on the PEDro scale. The present study followed the methodological structure of PRISMA (Statement for Reporting Systematic Reviews and Meta-Analyses of Studies). All studies found used questionnaires to assess the effects of physical therapy on FSDs. A total of five different types of interventions were verified: kinesiotherapy (Kegel exercises and pelvic floor muscle training - PFMT), Cognitive behavioral therapy (CBT), biofeedback, electrotherapy (transcutaneous electrical stimulation - TENS, and therapeutic ultrasound - US), and manual therapy. The limitations found in this systematic review were related to the unavailability of the articles in full and the low methodological quality of the studies. Conclusion: All studies showed improvements in sexual function after physical therapy intervention. There is no consensus on any intervention with better results; however, kinesiotherapy using PFMT proved to be advantageous because of its easy application, low cost, easy learning curve, and lasting results achieved in a short period. However, there are methodological shortcomings that still need to be dealt with to determine the most suitable physical therapy treatment for FSDs, as well as defining the best dosage, the protocol to be followed, and the duration of therapy, as well as the best cost-benefit

Women taking the "blue pill" (sildenafil citrate): such a big deal?

For years, phosphodiesterase type 5 inhibitors have been used for the treatment of erectile dysfunctions. Due to the similarities between male and female sexual response, several studies have assessed the effects of sildenafil citrate (Viagra®) in women affected by female sexual arousal disorder. The results are still conflicting and the drug is not devoid of adverse effects. Furthermore, female sexual arousal disorder is a heterogeneous condition whose underlying causes are difficult to diagnose and appropriate treatment requires a thorough sexual, psychological, and medical history along with specialist consultations. The clinician should pursue a global approach to the patient with sexual difficulties, while non-hormonal treatment such as phosphodiesterase type 5 inhibitors (ie, sildenafil citrate) should be kept as the last option.

Long-term sexual functioning in women after surgical treatment of cervical cancer stages IA to IB: a prospective controlled study.

Women with cervical cancer (CC) may be faced with changes in sexual functioning resulting from the cancer itself and/or its surgical treatment. The aims of this study were to prospectively investigate sexual adjustment of CC patients during a follow-up period of 2 years after radical hysterectomy without adjuvant treatment and to compare the results with women who underwent a hysterectomy for a benign gynecological condition and with healthy control women. In this prospective controlled study, participants completed the Short Sexual Functioning Scale, Specific Sexual Problems Questionnaire, Beck Depression Inventory Scale, World Health Organization-5 Well-Being Scale, and Dyadic Adjustment Scale to assess various aspects of sexual and psychosocial functioning at certain time intervals, namely, before surgery and 6 months, 1 year, and 2 years after surgical treatment. Thirty-one women with CC, 93 women with a benign gynecological condition, and 93 healthy controls completed the survey. In CC survivors, no differences were found in sexual functioning during prospective analyses and in comparison with women with a benign gynecological condition. However, compared with healthy women, preoperatively and postoperatively, significantly more CC patients reported sexual dysfunctions, including sexual arousal dysfunction, entry dyspareunia, deep dyspareunia, abdominal pain during intercourse, and reduced intensity of the orgasm. Furthermore, compared with healthy controls, CC patients reported worse psychological functioning before surgery and at 6 months after surgery. Finally, before surgery, quality of partner relationship was rated significantly better by CC patients compared with healthy controls; however, quality of the partner relationship declined during the first year of follow-up compared with the situation before surgery. In CC patients, no differences were found in sexual functioning when prospectively comparing the situation before and after surgery. However, when compared with healthy controls, CC patients are at high risk for sexual dysfunctions, both before and after surgical treatment.

The Prevalence of Sexual Dysfunction among the Patients with End Stage Renal Disease in Jamaica.

Sexual performance and gratification impact quality of life. Although recognized in the literature as a problem, sexual dysfunction among patients with end stage renal disease (ESRD) has never been studied in Jamaica. The prevalence of sexual dysfunction was determined among 268 adult Jamaican patients (166 males, 102 females) with ESRD who had been on haemodialysis for at least three months. Erectile dysfunction (ED) was assessed using the International Index of Erectile Function (IIEF). Female sexual dysfunction (FSD) was determined using the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) and International Classification of Diseases (ICD)-10 classifications of sexual disorders. Prevalence, severity of sexual dysfunctions and relationships with the primary aetiology of ESRD and anaemia were assessed. Erectile dysfunction, desire and orgasmic disorderS were found in 91.4%, 88.3%, and 81.6% of male subjects, respectively. The majority of male patients were dissatisfied with their performance at intercourse after progressing to ESRD. Hypoactive sexual disorder, sexual arousal and orgasmic disorders, and aversion sexual disorder were prevalent, found in 96%, 88.1% and 87.1% of female patients. All diabetic patients with ESRD reported hypoactive sexual disorder and orgasmic dysfunction; arousal disorder was found in 94.7%. Aversion sexual disorder was found more among patients with underlying chronic glomerulonephritis. All patients with severe anaemia were found to have hypoactive sexual disorder and among these, 87.5% and 97.8% had severe arousal and orgasmic disorders, respectively. Sexual dysfunction among patients with ESRD in Jamaica was prevalent in males and females. Associations exist between sexual dysfunction and diabetes mellitus, chronic glomerulonephritis and anaemia.

Neuropsychological Bases for the Introduction of Changes to the Classification of Sexual Disorders

This paper aims to compare and contrast proposed American Psychiatric Association website DSM 5 definitions of sexual dysfunctions with that of ICD-10 — F52 and explains the rationale for making changes. All the DSM classifications until present time based definitions of sexual dysfunctions on expert opinions that were not supported by sufficient clinical or epidemiological data. Additionally, included vague terms such as satisfactory, soon after, rapid, short, minimal, recurrent and persistent which were not precise and difficult to interpret. Showed male and female sexual dysfunctions on the same continuum based on unified sexual response cycles.The fifth version of the APA’s classification was released in May 2013. The DSM-5 merged female desire and arousal diagnosis into one entity defined as female sexual interest and arousal disorders, vaginisimus and dyspareunia as genito-pelvic pain/penetration disorder, deleted sexual aversion, the diagnostic classification separated for men and women. DSM attempted to operationalize the diagnostic criteria and avoided vague terms. It is also expected to introduce changes in the classification of disorders in ICD-10. (JNNN 2014;3(3):136–141)

Bremelanotide for Female Sexual Dysfunctions

INTRODUCTION: Bremelanotide is a novel heptapeptide melanocortin receptor-4 agonist. This study examined its at-home, as-needed subcutaneous self-administration by premenopausal women with female sexual dysfunctions. Key outcomes were subjected to prespecified responder analyses. METHODS: After 4 weeks of at-home placebo self-dosing (baseline period), premenopausal women with hypoactive sexual desire disorder, female sexual arousal disorder, or both were randomized to 12-week, at-home use of placebo or bremelanotide at 0.75, 1.25, or 1.75 mg. End points included changes from baseline to end of study in the monthly number of satisfying sexual events and in Female Sexual Function Index total score and Female Sexual Distress Scale—Desire/Arousal/Orgasm total score. Analyses of percent of responders were anchored to expert estimates of minimal clinically important differences: +1 for satisfying sexual events, +2.1 for Female Sexual Function Index, and –7 for Female Sexual Distress Scale—Desire/Arousal/Orgasm. RESULTS: Overall, 327 randomized participants used at-home study drug and provided data (for satisfying sexual events, 324). For placebo and bremelanotide at 0.75 mg, 1.25 mg, 1.75 mg, and 1.25 and 1.75 mg pooled, responder rates were 37%, 38%, 48%, 55%, and 51% for satisfying sexual events; 46%, 45%, 61%, 69%, and 65% on the Female Sexual Function Index; and 45%, 49%, 60%, 69%, and 64% on the Female Sexual Distress Scale–Desire/Arousal/Orgasm. For all three end points, the difference from placebo was statistically significant (P <.05, Cochran-Mantel-Haenszel test) at 1.75 mg and at 1.25 and 1.75 mg pooled. CONCLUSIONS: Premenopausal women using self-administered subcutaneous bremelanotide for female sexual dysfunctions showed dose-dependent separations from placebo in the percentages of patients reaching expert-determined minimally clinically important differences for three clinically relevant variables with statistical significance compared with placebo for all three responder rates at 1.75 mg and 1.25 mg and 1.75 mg pooled.

The assessment of sexual dysfunction in Egyptian women with lower urinary tract symptoms

IntroductionFemale sexual dysfunction (FSD) has been reported in 46% of women with lower urinary tract symptoms (LUTS). FSD is a common health problem that remains under-investigated, especially in Eastern communities, where discussion of the issue is considered a taboo. In this study we determined the prevalence of various subtypes of FSD in relation to LUTS in women in Ismailia, Egypt. Patients and methodsThis was a case-control study to assess FSD in women with LUTS in comparison to normal women. In all, 101 women patients attending the Urology clinic at our institution were divided into two groups, a study group of 52 with LUTS and a control group of 49 with no LUTS. Validated Arabic versions of the FSD index and the Bristol questionnaire were used to assess the participants, and the data analysed statistically. ResultsFSD was diagnosed in 75 of the 101 patients (74%); 87 (86%) reported hypoactive sexual desire, 61 (60%) reported sexual arousal disorder, 56 (55%) had lubrication disorders, 65 (64%) complained of orgasmic deficiency, 36 (36%) had satisfaction disorder, and 59 (58%) had sexual pain disorder (e.g., dyspareunia or non-coital genital pain). Arousal, satisfaction, orgasmic and lubrication disorders were more common in the women with LUTS. There was no statistically significant difference in desire disorders between the groups. ConclusionsFSD and its subtypes are more prevalent in women with LUTS in this sample of Egyptian women.

A Comparison of DSM-IV-TR and DSM-5 Definitions for Sexual Dysfunctions: Critiques and Challenges

The diagnostic criteria of sexual dysfunctions (SDs) are paramount for the development of sexual medicine as reliable diagnoses are essential to guide treatment plans. Prior Diagnostic and Statistical Manual of Mental Disorders (DSM) classifications based definitions of SD mostly on expert opinions and included imprecise terms. The validity of diagnoses of SD has only recently been challenged, and efforts are made to make more operational definitions. This paper aims to compare and contrast the recently released Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) diagnostic criteria of SD with that of Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition Text Revision (DSM-IV-TR) and explains the rationale for making changes in the new DSM-5. It also aims to address some issues to be considered further for the future. Online proposed American Psychiatric Association website DSM-5, the new released DSM-5, and DSM-IV-TR diagnostic criteria for SD were thoroughly inspected, and an extensive literature search was performed for comparative reasons. Changes in diagnostic criteria of DSM-5 were detected, and DSM-IV-TR and DSM-5 diagnostic criteria for SD were compared and contrasted. Diagnostic criteria were more operationalized, and explicit duration and frequency criteria were set up in DSM-5 for purposes of good clinical research. Classifications based on simple linear sexual response were abandoned, and diagnostic classifications were separately made for males and females. Desire and arousal disorders in women were merged. Drifting apart from linear sexual response cycle may be an advancement in establishing specific diagnostic criteria for different genders. However, it is still a question of debate whether there is enough evidence to lump sexual interest and arousal disorders in females. Making more precise definitions is important to differentiate disorders from other transient conditions. However, there is still room to improve our definitions and find a way to include gay and lesbian individuals. Further discussions and debates are expected to be continued in the future.

An integrative medicine approach to the treatment of HSDD: introducing the HURT Model™

Female sexual interest and arousal disorder (FSIAD), formally known as hypoactive sexual desire disorder (HSDD), is the most common complaint reported by women experiencing sexual dysfunction. In spite of this, FSIAD/HSDD is still considered treatment refractory and sexual health is only addressed by 35% of medical providers in about 75% of the time.Intrusive automatic negative thoughts (ANTs) are the number one barrier to healthy female sexual desire (FSD), and relationship satisfaction is the number one barrier to decreased FSD. Women with persistent ANTs struggle to forgive, lack emotional intimacy in romantic relationships, and report relationship dissatisfaction, depression, and anxiety. ANTs can hijack adaptive information processing through rumination on past hurts, which can result in FSIAD/HSDD. Given the complexity of FSD, an individualized, integrative, interpersonal neurobiological model is called for in the treatment of FSIAD/HSDD.Dyadic cohesion is an important predictor of FSD. The HURT (Healing Un-Resolved Trauma) study investigates the importance of emotional intimacy in partnered sex and how emotional hurt contributes to ANTs and FSAID/HSDD. Further, the HURT study investigates the role that releasing hurt, confronting the self (MIRROR exercise), and subsequent forgiveness may play in reversing FSIAD/HSDD and offers an accessible integrative treatment model for patients, medical providers, and therapists. The HURT model bridges the gap between medicine and psychotherapy, providing treatment for women who are suffering with decreased FSD and FSIAD/HSDD.