Female Sexual Dysfunction Symptoms Research Articles

Pre-pregnancy preparation of women with hypoandrogenism and female sexual dysfunction

The onset of pregnancy in the natural cycle is a task that requires the coordinated work of both central and peripheral levels of regulation of hypothalamic‑pituitary hormones. An analysis of the reproductive health of women with a menstrual cycle disorder against the background of hypoandrogenism indicates an unsatisfactory course of the early stages of the pregnancy process with the subsequent formation of infertility against the background of a reduced ovarian reserve. Hypolubrication is considered a clinical marker of hypoandrogenism in women of reproductive age.
 Objective — Optimization of pre‑pregnancy training in women with hypoandrogenism, menstrual cycle disorders and early pregnancy losses in the anamnesis.
 Materials and methods. A comprehensive clinical, laboratory and instrumental examination involved 90 women with menstrual cycle disorders and hypoandrogenism, from them 45 women received the proposed therapy (group Ia), and 45 patients traditional therapy (group IIa). The control group consisted of 30 healthy women at the stage of pre‑gravid examination. The age of women was 18 to 35 years. Hormonal reproductive background was determined on the 5 ‑ 7th day of the menstrual cycle in all examined women, as well as levels of thyroid‑stimulating hormone (TSH), thyroid peroxidase antibody, vitamin D, homocysteine. The proposed algorithm of pre‑gravid measures included: 1) optimization of thyroid gland function (after consultation with an endocrinologist); 2) restoration of pituitary‑ovarian relationships in case of functional central hypogonadism; 3) therapy aimed at optimizing the prolactin level (target value 12.5ng/ml); 4) reduction of homocysteine level (target level 5.6 mmol/l); 5) normalization of vitamin D level (norm is 75—125 nM/l, insufficiency defined as 50—75 nM/l, and deficiency <50 nM/l). The target control parameters included restoration of lubrication, ovulatory menstrual cycle, onset and progression of pregnancy. IBM SPSS Statistics version 25.0 software was used for statistical processing of the obtained data. The control periods of therapy were 3, 6 and 9 months.
 Results. In women with proposed treatment algorithm, therapy resulted in the recovery of vitamin D levels, starting from the 6th month of therapy, and complete normalization was recorded at the 9th month of treatment. This indicates the need for long‑term supplementation of vitamin D in women with hypoandrogenism. A decrease in the homocysteine levels was also noted on the 6th month of treatment, and its normalization after 9 months of treatment. Elevated homocysteine levels and vitamin D insufficiency/deficiency were observed throughout the follow‑up period in the conventional therapy group. In women with the proposed therapy, the levels of follicle‑stimulating hormone (FSH), TSH, luteinizing hormone (LH) and prolactin tend to normalize already from the 3rd month of therapy, while the highest positive increase was noted in the LH indicator on the 3rd‑6th month of treatment. Ovarian steroidogenesis approached the indicators of the control group after 6—9 months of therapy. Proandrogenic steroidogenesis began to increase on the 3rd month of therapy, reaching maximum on the 9th month. Unsatisfactory indicators of changes in free testosterone and dehydroepiandrosterone sulfate (DHEA‑C) were noted in women from the group of the traditional pre‑pregnancy preparation even after 9 months.
 The specified features of steroid support of the hormonal background of women’s reproductive health demonstrated the following: signs of female sexual dysfunction in the group with the proposed therapy completely disappeared after the 9th month of treatment, and in the group of traditional therapy they continued to bother 91.1% of women. At the end of the observation period, the regular menstrual cycle was gained in 40.0% of women with the proposed therapy and in 6.7% with the traditional one. Progressive pregnancies in the group with the proposed algorithm were achieved in 37.5% of women (successfully overcame the luteoplacental barrier), and in 8.8% in the group of the traditional approach (ended by early termination of pregnancy).
 Conclusions. The period of formation of the luteal phase insufficiency is the specific feature of the restoration of menstrual cycle fullness in women with hypoandrogenism, which requires additional therapy to ensure the conditions for a full‑fledged secretory endometrium transformation. The pregnancy process takes place in unfavorable conditions, which can lead to early pregnancy losses. The period of pre‑pregnancy measures in this group of patients should last at least 6—9 months. Traditional pre‑pregnancy preparation does not contribute to the restoration of the central mechanisms of menstrual cycle regulation in women with hypoandrogenism, nor does it contribute to the restoration of full‑fledged ovarian steroidogenesis, it is accompanied by anovulation and insufficiency of the luteal phase, early pregnancy losses. Symptoms of female sexual dysfunction do not disappear under the influence of traditional treatment.

(PM-14) THE USE OF VIBRATIONS IN FEMALE SEXUAL DYSFUNCTIONS: NARRATIVE REVIEW OF THE LITERATURE

Abstract Introduction There are several aspects that involve the sexual function of an individual, such as biological, psychological and interpersonal factors. Based on this, symptoms of female sexual dysfunction are classified according to the response phase of the affected sexual cycle. In physiotherapy there are some resources that are used for the treatment of sexual dysfunctions, including vibration, which is used with the aim of improving muscle condition and vascularization, but the real effects of applying this technique in the treatment are not known. of sexual dysfunctions. Thus, the objective of this study was to identify evidence on the benefits of vibration in female sexual dysfunctions. Methodology The PubMed and VHL databases were searched according to a search strategy defined by PICOS: ((((sexuality) OR (sexual dysfunction)) OR (pelvic floor disorders)) OR (women's health)) AND (vibration), which included systematic reviews, meta-analyses and clinical trials from 2012 to 2022 that approached vibration as a resource investigated or used in female sexual dysfunctions. Other study designs were excluded, as well as those that did not use vibration as a resource or that were aimed solely at the male audience. Results A total of 89 articles were found, of which 83 were excluded for not meeting the inclusion criteria; six articles were selected to compose this review. Among the selected articles, three brought vibration as a purely evaluative resource, and three articles also looked for evidence on the use of vibration as a treatment for female sexual dysfunctions. Conclusion No studies were found in which vibration has been used as a therapeutic resource in female sexual dysfunctions, which opens precedents for future studies in this regard. Financing No conflict.

HERBS TO TREAT FEMALE SEXUAL DYSFUNCTION (MATI PUTIK) IN MALAY MEDICAL MANUSCRIPTS

Introduction: Lack of libido is one of the most common symptoms of female sexual dysfunction among women in the global community. In Malaysia, low levels of libido have been demonstrated in women experiencing mati putik or female sexual dysfunction (FSD). Due to the lack of awareness about FSD, people commonly misunderstand that the signs and symptoms are due to the aging process. The most common signs of mati putik or FSD are fatigue and no desire or interest in engaging in sexual activity. To date, there has been no comprehensive review of the practice of Malay ancestors regarding FSD. Thus, the aim of this study was to document the formulations and practices recorded in Malay medical manuscripts for enhancing female sexual libido. Methods: The secondary texts of Malay medical manuscripts were reviewed to discover the ingredients used as aphrodisiac agents in the Malay Archipelago. The Malay term shahwat was the keyword used to describe sexual libido in the Malay community. A comparative analysis was then conducted to evaluate the materia medica found in the academic literature. Results: Four formulations were found that comprised four different aphrodisiac ingredients, including cabbage, fenugreek, kati, and honey. From all the ingredients, only fenugreek has found clinical evidence in the academic literature. Conclusion: Therefore, it is suggested that the materia medica found in the study be further explored to demonstrate its relationship with libido. This study is important as a part of preserving Malay medical knowledge and heritage, as well as providing insight into information on aphrodisiac plants for enhancing women’s libido that can be applied in conventional medicine.

Female sexual dysfunction in undergraduate medical education: a survey of U.S. medical students.

Physicians often report low levels of confidence in diagnosing and treating female sexual dysfunction (FSD), which may stem from inadequate education and exposure to the topic. The study sought to determine the extent to which FSD is covered in undergraduate medical education and evaluate student comfort with the topic and familiarity with treatments. We created a novel, 50-question survey to be administered online to any current U.S. medical student. Obstetrician-gynecologist clerkship directors at 146 U.S. medical schools were contacted and asked to invite any current student at their school to participate. A link to the electronic REDCap (Research Electronic Data Capture) survey was distributed to eligible students via the clerkship directors. The survey collected data regarding (1) coverage of FSD and male sexual dysfunction (MSD) in preclinical and clinical curricula, (2) student self-ratings of comfort in hypothetical scenarios in which a patient exhibits symptoms of FSD or MSD, and (3) student familiarity with treatments for FSD and MSD. Outcomes included the proportion of students reporting that their school covered FSD/MSD in its preclinical/clinical curriculum, the mean comfort ratings for each of the FSD and MSD scenarios, and the proportion of students indicating knowledge of various FSD and MSD treatments. A smaller proportion of students (N = 236) reported receiving instruction in FSD (58.5%) compared with MSD (78.4%) in their preclinical curriculum (P < .001). Students' average self-ratings of comfort in the sexual dysfunction scenarios were significantly lower for patients with symptoms of FSD compared with MSD (P < .001). Students had higher average self-ratings of confidence in FSD scenarios if their intended specialty was obstetrician-gynecologist (P = .003), if their school included FSD in its clinical curriculum (P = .01), and if they had ever participated in the care of a patient with FSD (P = .006). There are important gaps in the coverage of FSD in undergraduate medical education that may be mitigated through improvements to curriculum and increased exposure to patients with FSD. This is the first study, to our knowledge, to directly survey medical students regarding their educational experience and comfort with FSD. Our study was limited by a small sample size, the use of a novel and nonvalidated questionnaire, and the potential for bias given our sampling method. Medical schools must work toward improving instruction in FSD for their students to address these disparities and improve students' comfort with the topic.

Female sexual dysfunction and lower urinary tract symptoms associated with vulvovaginal atrophy symptoms: Results of the GENJA study.

To investigate the main symptoms of female sexual dysfunction (FSD) and lower urinary tract symptoms associated with vulvovaginal atrophy (VVA) symptoms as the core symptoms of genitourinary syndrome of menopause. We extracted the data of 4134 Japanese women aged 40-79 years who participated in the GENitourinary syndrome of menopause in JApanese women (GENJA) study. All participants responded to web-based questionnaires assessing their health situation, including the Vulvovaginal Symptoms Questionnaire, the Female Sexual Function Index (FSFI), and the Core Lower Urinary Tract Symptom Score. Multivariable regression and multivariable logistic regression analyses were applied to analyze the association between VVA symptoms and FSD, and between VVA symptoms and lower urinary tract symptoms. Multivariable regression analysis revealed that VVA symptoms were associated with lower scores for arousal, lubrication, orgasm, satisfaction, and pain domains in the FSFI in sexually active women (p < 0.01). Regression coefficients were higher for lubrication and pain domains than for the other domains. Multivariable logistic regression analysis revealed that women reporting VVA symptoms were more likely to have increased daytime urinary frequency, nocturia, urgency, slow stream, straining to void, feeling of incomplete emptying, bladder pain, and feeling a bulge/lump from or in the vagina (p < 0.05). Adjusted odds ratios were particularly high for straining to void, feeling of incomplete emptying, and bladder pain. Vulvovaginal atrophy symptoms were significantly associated with decreased lubrication and dyspareunia in FSD, and urinary symptoms of straining to void, feeling of incomplete emptying, and bladder pain.

Montelukast, a LRRC8A inhibitor, decreases the contractile response to Endothelin-1 in the vaginal smooth muscle of aged mice

Introduction: Vaginal smooth muscle (VaSM) is an important contributor to female sexual function, desire, and arousal. Increased vaginal blood flow via vasodilation of the vaginal blood vessels is key to the of lubrication and creating an enjoyable sexual experience. Female sexual dysfunction (FSD) is common in hypertensive and diabetic women, as well as many who suffer from hormonal imbalances, including menopause. Despite the substantial population that suffers from FSD, research into the mechanisms and non-hormonal treatments are limited. Leucine rich repeat containing channel 8A (LRRC8A) is a volume regulated anion channel (VRAC) that regulates Nox1 and can modulate the extracellular production of superoxide (O2∙-). In aged tissues, there are increased in extracellular ROS production as well as vascular and smooth muscle dysfunction. The objective of these experiments is to elucidate the mechanisms behind female sexual dysfunction that present with vascular and smooth muscle dysfunction and determine if the LRRC8A inhibitor, Montelukast, can alleviate some of the symptoms of FSD and improve quality of life. In this study, we hypothesize that the inhibition of LRRC8A in will decrease the contraction to Endothelin-1 in the vaginal smooth muscle of the aged mice. Methods: Aged (16 mo and 20 mo old) female lean mice underwent distal vaginal dissection. Vaginal tissue was cleaned and mounted on a strip myograph in Krebs solution and the contraction elicited by Endothelin-1 was performed in the absence and repeated in the presence of the LRRC8A inhibitor, Montelukast (1uM) after a 30-minute incubation. Data was analyzed using Prism. The maximal contraction in the absence of the inhibitor was taken as 100%, and the contraction in the presence of the inhibitor was calculated as a percentage of the maximal contraction attained in the absence of the inhibitor. Results: Contraction induced by Endothelin-1 (10-12 M to 3✕10 -8 M) alone compared to in the presence of Montelukast (1 uM) showed that Montelukast decreased both the potency and the maximum force of contraction in the aged VaSM. After incubation with 1 mM Montelukast, the EC50 and Emax were significantly different (0.0430 and &lt;0.0001, respectively). Conclusion: This is the first study investigating the vaginal smooth muscle from the perspective of ROS production and the influence of LRRC8A in aged animals. The change in the contractile response in the treated animals may be due to the modulation of the production of O2∙-. Patients that suffer from FSD are a large and overlooked community in need of new therapeutic approaches. Treatment with LRRC8A offers a potential novel approach to treat FSD and should be further researched to observe its overall impact in FSD. 1R01DK132948-01, SMSNA Student Grant This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

MP27-13 PERIPHERAL NEUROMODULATION OF VAGINAL BLOOD FLOW: A POTENTIAL TREATMENT FOR FEMALE SEXUAL DYSFUNCTION

You have accessJournal of UrologyCME1 Apr 2023MP27-13 PERIPHERAL NEUROMODULATION OF VAGINAL BLOOD FLOW: A POTENTIAL TREATMENT FOR FEMALE SEXUAL DYSFUNCTION Priyanka Gupta, Elizabeth Bottorff, Patricia Maymi-Castrodad, Mackenzie Moore, Giulia Lane, Gianna Rodriguez, and Tim Bruns Priyanka GuptaPriyanka Gupta More articles by this author , Elizabeth BottorffElizabeth Bottorff More articles by this author , Patricia Maymi-CastrodadPatricia Maymi-Castrodad More articles by this author , Mackenzie MooreMackenzie Moore More articles by this author , Giulia LaneGiulia Lane More articles by this author , Gianna RodriguezGianna Rodriguez More articles by this author , and Tim BrunsTim Bruns More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003255.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Female sexual dysfunction (FSD) is a potentially life altering condition that impacts an estimated 40% of women. Unfortunately, the few treatment options available have limited success due to their high incidence of adverse events and inability to improve subjective arousal. One potential treatment option, peripheral neuromodulation, has been successful in improving female sexual function index scores. However, the underlying mechanisms of how neuromodulation improves FSD are still largely unknown. We hypothesize that improvements in FSD symptoms are due to improvements in genital hemodynamics. METHODS: We developed a clinical study to investigate changes in vaginal blood flow (VBF) in response to dorsal genital nerve (DGN) and tibial nerve stimulation in three cohorts of women: healthy controls, women with FSD, and women with spinal cord injury (SCI). Incorporating women with SCI allows us to investigate which neural pathways contribute to genital sexual arousal. Each participant attends two study visits: one for each nerve target, randomly ordered. At each visit, a vaginal photoplethysmography (VPP) sensor is used to measure blood flow during a 5-minute baseline, 20 minutes of nerve stimulation, and a 5-minute washout period. The VPP signals are filtered in the neurogenic energy frequency spectrum (0.76 – 0.20 Hz) for analysis. RESULTS: Seven out of eight participants reported genital sensations due to nerve stimulation, three of whom have SCI. One participant with a complete SCI had increases in their VPP neurogenic energy during dorsal genital nerve stimulation (Figure 1). An animal study is being planned to investigate the VBF response observed in complete SCI. CONCLUSIONS: This work provides further support for neuromodulation as a treatment for neurogenic and non-neurogenic FSD. Source of Funding: Craig H. Neilsen Foundation and International Society for the Study of Women’s Sexual Health © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e367 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Priyanka Gupta More articles by this author Elizabeth Bottorff More articles by this author Patricia Maymi-Castrodad More articles by this author Mackenzie Moore More articles by this author Giulia Lane More articles by this author Gianna Rodriguez More articles by this author Tim Bruns More articles by this author Expand All Advertisement PDF downloadLoading ...

Improvement of diagnostic methods of reproductive health disorders in women of early reproductive age with sexual dysfunction and hypoandrogenism

Female sexual dysfunction (FSD) is a global health problem. This is a multifaceted problem that requires the coordinated interaction of many neurotransmitters and hormones, both central and peripheral. In young women with reproductive health problems, the first clinical signs of future imbalances manifest in adolescence. Disruption of adaptation mechanisms at this age leads to the activation of polymorphic genes, resulting in the multifunctional disorders of women’s health in the future. In particular, the role of vitamin D deficiency as a trigger in the formation of many immune‑hormonal imbalances is noted, including formation of methionine metabolism disorders and the accumulation of excess homocysteine in cells. Therefore, improving methods of diagnosing reproductive health disorders in women of early reproductive age with sexual dysfunction and hypoandrogenism can be considered as a method of preventing the formation of conditions in them for future fertility disorders, decreased ovarian reserve, and infertility.&#x0D; Objective — to improve methods to diagnose the reproductive health disorders in women of early reproductive age with sexual dysfunction and hypoandrogenism.&#x0D; Materials and methods. The research included 20 women of early reproductive age with symptoms of FSD and hypoandrogenism (group I) and 20 healthy women (group II). The hormonal reproductive background was determined on the 5—7th day of the menstrual cycle in all examined women, including levels of thyroid‑stimulating hormone (TSH), antibodies to thyroid peroxidase (TPO‑Ab), vitamin D, homocysteine. IBM SPSS Statistics version 25.0 software was used for statistical processing of the obtained data.&#x0D; Results. Vitamin D deficiency significantly raised the probability of decreased levels of luteinizing hormone (LH) (R2=0.705; p&lt;0.001), estradiol (R2=0.320; p=0.022), free testosterone (R2=0.419; p=0.007), dihydroepiandrosterone sulfate (DHEA‑S) (R2=0.697; p&lt;0.001) and increased levels of prolactin (R2=0.691; p&lt;0.001), 17‑OP (R2=0.748; p&lt;0.001). Hyperhomocysteinemia did not significantly affected the changes in the levels of these hormones (p&gt;0.05), but significantly increases the probability of decreased FSH levels (R2=0.376; p=0.012). Moreover, it was established that high TSH levels increased the probability of elevation homocysteine rates (R2=0.561; p=0.001) and decreased levels of reproductive hormones: FSH (R2=0.357; p=0.014), LH (R2=0.626; p&lt;0.001), estradiol (R2=0.451; p=0.004), free testosterone (R2=0.587; p=0.001) and DHEA‑S (R2=0.661; p&lt;0.001). The increased TPO‑Ab levels can serve as a significant predictor of the increased prolactin levels (R2=0.675; p&lt;0.001).&#x0D; Conclusions. Optimization of the medical care to women with FSD should include early diagnosis of vitamin D status and evaluation of homocysteine levels. Determination of women’s hormonal background should include assessments of the levels of TSH and antibodies to thyroperoxidase. An endocrinologist’s consultation is required in case of the reveal of thyroid gland disorders. The assessments of polymorphism of folate‑methionine cycle genes and thrombophilia should be performed in case of high levels of homocysteine.

Relationship between sexual and bladder dysfunction in women consuming ketamine.

Although ketamine has become the second most popular recreational drug in Taiwan, there have been very few reported studies that investigated female sexual dysfunction (FSD) in ketamine abusers (KAs). We sought to compare the difference between street and hospital KAs and explored the risk factors for FSD and lower urinary tract symptoms (LUTS) in KAs. In this cross-sectional study, female KAs aged 18 years or older were invited to complete anonymous questionnaires during an educational course provided by the departments of substance control and prevention of the local government or under the instruction of medical providers at a urology clinic. Data were reported as median (IQR) and OR and analyzed with commercial statistical software. Key outcome measurements were illicit drug use history, FSD symptoms, and LUTS severity. We included 139 women (104 street and 35 hospital KAs) with a median age of 27.08years. FSD was reported in 76% of all the participants (street vs hospital KAs, 68% vs 97%, P < 0.001). LUTS (Interstitial Cystitis Symptom Index [ICSI] + Interstitial Cystitis Problem Index [ICPI] ≥12) was found to be a significant risk factor for FSD in KAs. More hospital KAs (71%) reported experiencing LUTS (ICSI + ICPI ≥12) than street KAs (8%, P < 0.001). Longer duration of ketamine use (≥36months) and mild to severe psychological symptoms (5-item Brief Symptom Rating Scale [BSRS-5] ≥6) were significant risk factors for LUTS. Sexual problems among KAs should not be overlooked since more severe sexual dysfunction was observed in patients reporting LUTS. To our knowledge, the present study is the largest study using validated and reliable questionnaires to examine FSD in KAs and also the first study to include street KAs. The main limitation of this study is using self-report questionnaires as they are subjective and susceptible to human errors and recall biases. Women who abused ketamine and reported experiencing LUTS were found to be more likely to have FSD.

HIFEM procedure for Treatment of Urinary Incontinence Accompanied with Female Sexual Dysfunction: 1-year Follow-up Data

ABSTRACT Introduction The pelvic floor muscles (PFMs) have an essential role in the structural support for the pelvic organs. Weakening of the PFMs, primarily due to childbirth, may lead to urinary incontinence (UI), impairment of sexual function, and possible development of female sexual dysfunction (FSD). Objective This multi-center study aims to investigate the long-term effectiveness of HIFEM-induced PFMs strengthening to reduce UI and improve female sexual function. Methods Thirty-one females (47.9±8.6 years) diagnosed with UI and FSD symptoms (FSFI baseline score &amp;lt;26.55) underwent a total of six HIFEM procedures. Treatments were scheduled twice a week over three weeks with five follow-up visits at 1, 3, 6, 9, and 12 months after the final treatment. The stimulation intensity was gradually set according to the patient's feedback. Standardized questionnaires evaluating UI and sexual function (ICIQ-UI SF, FSFI, and PISQ-12) and Therapy Comfort Questionnaire were administered. Due to patients’ drop-out at the last two follow-up visits (9 and 12 months), data evaluation was divided into two subgroups – patients monitored from baseline to 6 months (Group A, N=31) and from baseline to 1 year (Group B, N=17). Results At baseline, the ICIQ-UI SF score showed 12.1±4.8 points (A) and 12.5±4.7 points (B) on average, referring to moderate to severe UI symptoms. The severity of UI significantly (P&amp;lt;0.001) decreased post-treatment, and subjects achieved the most noticeable improvement of 69.7% (A, -8.5 points) and 71.7% (B, -8.9 points) at 6-month follow-up. In both groups, patients reported lesser leakage occurrence during certain activities, especially when coughing, sneezing, or physically active. At six months, 25% of patients had no UI symptoms, as shown by the zero score from ICIQ-UI SF (A). The results of Group B indicated the maintenance of achieved outcomes up to 12 months.Two patients with no sexual activity were excluded from FSFI and PISQ-12 evaluation in both groups. FSFI baseline score indicated considerable impairment of sexual function with an average score of 18.4±5.8 points (A) and 20.4±3.5 points (B). The improvement from 7.4 to 9.4 points was noticeable immediately after the final treatment and maintained during the whole follow-up, with an insignificant decline at one month (B) and six months(A). At 12 months after the last treatment, 71.4% of patients were above the threshold for FSD as described by the FSFI. The most notable changes were seen in the following subdomains: Orgasm, Lubrication, Arousal, and Satisfaction response. Lastly, the PISQ-12 score was also continuously increasing from baseline values (28.1±5.8 and 28.9±4.3 points for Group A and B), peaking at three months (+10.2 points in Group A) while maintaining up to 12 months (+10.2 points in Group B). Patients reported higher orgasm frequency, lubrication, and increased sexual desire. Furthermore, 93.3% of subjects agreed that the therapy was comfortable, and no adverse events were documented. Conclusions Our results suggest that the HIFEM procedure considerably reduces the severity of UI. In addition, the treatment enhances female sexual function; and may result in more frequent orgasms and increased sexual desire. Outcomes showed to be maintained during the observed period. Disclosure Yes, this is sponsored by industry/sponsor: BTL Industries Clarification Industry initiated, executed and funded study

Female Sexual Dysfunction Following Pelvic Radiation for Anal Cancer: A Systematic Review

ABSTRACT Introduction Female cancer patients subjected to pelvic radiation often present post-treatment with genitourinary symptoms. Anal cancer is more common in women, and the mainstays of treatment are radiation and chemotherapy. There is minimal focus in the current literature on the sexual pathophysiology that specifically affects female anal cancer patients as a result of radiation therapy. Assessing the data from existing female anal cancer studies may elucidate the impact of pelvic radiation on female sexual dysfunction (FSD). Objective To evaluate the current literature on FSD in anal cancer patients who received pelvic radiation without surgical intervention. Methods A search strategy with concept groups inclusive of female pelvic cancers, FSD, and radiation or radiotherapy was iteratively developed by two librarians, and peer reviewed by a third. We conducted a search of the databases MEDLINE via Pubmed, Embase, Scopus, CINAHL Complete, PsycINFO, and Cochrane CENTRAL. After deduplication, 5,142 citations were assessed by two independent screeners during the initial title and abstract screening. 4,488 were deemed to not fit the inclusion/exclusion criteria. Exclusion criteria included: animal studies, feasability studies, secondary research studies, populations that were entirely male or did not separate results by sex, who underwent surgical intervention, or consisted entirely of HIV/AIDS patients. Of the 654 items selected for full-text review we filtered for the word “anal” which resulted in 76 articles to screen at the full-text level. Results Our search identified 76 papers of which 10 met inclusion criteria, 23 are not yet categorized. Of the included studies, 6 were cross sectional, 3 were prospective longitudinal, and 1 consisted of qualitative interviews. Studies were published from 1996-2021, with the majority (n=8) being published after 2013. While total population of anal cancer patients in each study was small, with 9 out of 10 study populations ≤100 subjects, females comprised the majority of patients without exception. The EORTC QLQ CR38/CR29 was employed in 3 studies while the remaining 7 relied on independent questionnaires or interviews, often utilizing CTCAE grading scale. These 7 studies focused on similar symptoms of FSD after radiotherapy. The most common were dyspareunia, impacting 0.037%-35% of patients (3 studies), vaginal/vulvar pain impacting 10-53% of patients (2 studies), vaginal dryness impacting 7-45% of patients (3 studies), and vaginitis impacting 17-33.3% of patients (3 studies). A major limitation to several studies was the proportion of women who were not sexually active after radiation therapy. Conclusions Assessing the association between pelvic radiation and FSD in anal cancer patients is challenging due to the lack of detailed, validated sexual function questionnaire data, such as the FSFI. With few studies available on this topic and variability of FSD symptoms between the existing studies, additional research is required to more accurately predict adverse outcomes of anal cancer treatment related to FSD. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: GenesisCare

Female Sexual Dysfunction as Measured by Low Sexual Frequency is Associated With Lower Socioeconomic Status: An Analysis of the National Health and Nutrition Examination Survey (NHANES), 2007-2016

Female sexual dysfunction (FSD) is a complex disorder of biopsychosocial etiology, and FSD symptoms affect more than 40% of adult women worldwide. In this cross-sectional study, we sought to investigate the association between FSD and socioeconomic status (SES) in a nationally representative female adult population. Economic and sexual data for women aged 20-59 from the 2007-2016 National Health and Nutrition Examination Survey, a United States nationwide representative database, was analyzed. Poverty income ratio (PIR), a ratio of family income to poverty threshold, was used as a measure of SES, and low sexual frequency was used as a measure of FSD. The association between FSD and SES was analyzed using survey-weighted logistic regression after adjusting for relevant social and gynecologic covariates, such as marital status and history of pregnancy, as well as significant medical comorbidities. We found that FSD, as measured by low sexual frequency, was associated with lower SES. Among the 7,348 women of mean age 38.4 (IQR 29-47) included in the final analysis, 26.3% of participants reported sexual frequency of 0-11 times/year and 73.7% participants reported sexual frequency >11 times/year. Participants of PIR <2 were 92% more likely to report sexual frequency ≤11 times/year than those of PIR ≥2 after adjusting for demographics, social history, gynecologic history and significant medical conditions (OR=1.92; 95% CI=1.21-3.05; P < .006). The evaluation and treatment of FSD may benefit from a comprehensive approach that takes SES into account. This study is limited by its cross-sectional design, but it is strengthened by a large, nationally representative sample with extensive, standardized data ascertainment. Lower SES and lower sexual frequency are directly correlated among female adults in the United States; future studies should focus on social determinants of health as risk factors for FSD. Kim JI, Zhu D, Davila J, et al. Female Sexual Dysfunction as Measured by Low Sexual Frequency is Associated With Lower Socioeconomic Status: An Analysis of the National Health and Nutrition Examination Survey (NHANES), 2007-2016. J Sex Med 2022;19:90-97.

Transcripts of Unfulfillment: A Study of Sexual Dysfunction and Dissatisfaction among Malay-Muslim Women in Malaysia

The prevalence of female sexual dysfunction (FSD), or in everyday notion, sexual dissatisfaction, among Malay women remains high, denoting that there are several influences shaping their experience of sex within marriage. This qualitative study identified the perceived effects of social factors in the development of sexual dysfunction among Malay women. Engaging a phenomenological framework, 26 in-depth face-to-face interviews were conducted among married women from Peninsular Malaysia, based on their self-reporting of FSD symptoms. All sessions were audio-recorded and the data were transcribed verbatim and managed in the ATLAS.ti software before being analysed. The three themes that emerged—‘sex is taboo and culturally unacceptable’, ‘self-ignorance about sex’, and ‘lack of husband’s role in mutual sexual enjoyment’—suggest some influence of Islamic teachings and cultural conduct, as in Adat, on sexuality in society. However, a lack of knowledge and nonadherence to positive values and teachings around sexual satisfaction between men and women, as espoused through the Islamic religion, have affected woman’s sexual functions and coupling relationship even more significantly. The results of this qualitative study show that a formal, culturally sensitive, and comprehensive sex education programme incorporating both medical and Islamic knowledge may work to effectively reduce FSD.

Transcutaneous Electrical Nerve Stimulation to Improve Female Sexual Dysfunction Symptoms: A Pilot Study

To perform a pilot study using transcutaneous electrical nerve stimulation (TENS) on the dorsal genital nerve and the posterior tibial nerve for improving symptoms of female sexual dysfunction (FSD) in women without bladder problems. We hypothesize that this therapy will be effective at improving genital arousal deficits. Nine women with general FSD completed the study. Subjects received 12 sessions of transcutaneous dorsal genital nerve stimulation (DGNS; n = 6) or posterior tibial nerve stimulation (PTNS; n = 3). Stimulation was delivered for 30 min at 20 Hz. Sexual functioning was evaluated with the female sexual functioning index (FSFI), and surveys were also given on general health, urological functioning, and the Patients' Global Impression of Change (PGIC) after treatment. Surveys were given before treatment (baseline), after 6 and 12 weeks of treatment, and 6 weeks after the completion of stimulation sessions. The average total FSFI score across all subjects significantly increased from 15.3 ± 4.8 at baseline to 20.3 ± 7.8 after six sessions, 21.7 ± 7.5 after 12 sessions, and 21.3 ± 7.1 at study completion (p < 0.05 for all time points). Increases were observed in both DGNS and PTNS subjects. Significant FSFI increases were seen in the subdomains of lubrication, arousal, and orgasm, each of which is related to genital arousal. Bladder and general health surveys did not change across the study. PGIC had a significant increase. This study provides evidence that transcutaneous stimulation of peripheral nerves has the potential to be a valuable therapeutic tool for women with FSD.

Oral Contraception and Female Sexual Dysfunction in Reproductive Women

Abstract Introduction Oral contraception (OC) remains one of the most commonly used forms of family planning. It allows couples to continue sexual activity without the worry of unintended pregnancy. However, one possible side effect of OC use is female sexual dysfunction (FSD), of which many patients and even physicians are unaware. This would be counter to the original intent of an OC and thus could affect a couple's relationship. Aim To examine the prevailing evidence on the effect of OCs on FSD in women of reproductive age. Methods A search of PubMed and the Cochrane Central Register of Controlled Trials for all relevant studies was conducted in February 2016. Relevant studies pertaining to OCs and FSD in women of reproductive age were examined. Main Outcome Measures A comprehensive review of the current literature on FSD as measured by the Female Sexual Function Index. Results Most studies indicated that women who use OC pills have decreased sexual desire and libido. OCs also can cause dyspareunia owing to increased risk of vestibulitis and vaginal dryness. This risk is increased if OCs are used in adolescents and the duration of OC use is at least 2 years. Newer OCs containing drospirenone 3 mg plus ethinylestradiol (EE) 30 μg (drospirenone 3 mg + EE 30 μg; Yasmin; Bayer Healthcare Pharmaceuticals, Inc, Berkeley, CA, USA), non-antiandrogenic progestin gestodene 75 μg plus EE 20 μg (gestodene 75 μg + EE 20 μg; Meliane; Bayer Healthcare Pharmaceuticals, Inc), and estradiol valerate plus dienogest (Qlaira; Bayer AG, Leverkusen, Germany) or EE plus levonorgestrel (Jolessa; Teva Specialty Pharmaceuticals, Petah Tikva, Israel; and Seasonale; Duramed Pharmaceuticals, Augusta, GA, USA) do not seem to cause OC-related FSD symptoms. Conclusion This review suggests that OCs can cause FSD in reproductive women. Domains that include female sexual interest and arousal and genito-pelvic pain are affected. Newer OCs such as drospirenone 3 mg plus EE 30 μg (Yasmin) and gestodene 75 μg plus EE 20 μg (Meliane) could be better alternatives because FSD symptoms are less likely to occur.

The Relationship between Sexual Function

The Relationship between Sexual Function

Phosphodiesterase inhibitors in clinical urology

To date, benign diseases of the male and female lower urinary and genital tract, such as erectile dysfunction, bladder overactivity, lower urinary tract symptomatology secondary to benign prostatic hyperplasia and symptoms of female sexual dysfunction (including arousal and orgasmic disorders), can be therapeutically approached by influencing the function of the smooth musculature of the respective tissues. The use of isoenzyme-selective phosphodiesterase (PDE) inhibitors is considered a great opportunity to treat various diseases of the human urogenital tract. PDE inhibitors, in particular the PDE5 (cyclic GMP PDE) inhibitors avanafil, lodenafil, sildenafil, tadalafil, udenafil and vardenafil, are regarded as efficacious, having a fast onset of drug action and an improved effect-to-adverse event ratio, combining a high response rate with the advantage of an on-demand intake. The purpose of this review is to summarize recent as well as potential future indications, namely, erectile dysfunction, Peyronie’s disease, overactive bladder, urinary stone disease, lower urinary tract symptomatology secondary to benign prostatic hyperplasia and premature ejaculation, for the use of PDE inhibitors in clinical urology.

Female sexual dysfunction in patients with substance-related disorders

OBJECTIVE:To estimate the prevalence of female sexual dysfunction symptoms and the associated risk factors in a sample of patients with substance-related disorders admitted to a specialized in-patient care unit.METHODS:This study used a cross-section design, with eight months of data collection, conducted with substance-dependent women using structured questionnaires to collect socio-demographic data and identify their drug of choice. The Drug Abuse Screening Test, Short Alcohol Dependence Data questionnaire, Fagerström Test for Nicotine Dependence, and Arizona Sexual Experience Scale were also administered.RESULTS:The sample consisted of 105 women who had a mean age of 34.8 years (SD = 12.1, range = 18-65) and were predominantly heterosexual (74.3%), single (47.6%), Caucasian (50.5%), catholic (36.2%), and educated only to the level of primary education (40%), with a monthly family income of up to one minimum salary (37.5%). In 42.9% of the patients, crack was the drug of choice; 47.6% of the sample qualified for the Drug Abuse Screening Test (substantial problems related to drugs), 43.8% exhibited Short Alcohol Dependence Data (moderate or severe dependency), 47.6% exhibited Fagerström Test for Nicotine Dependence (high or very high nicotine dependence). The prevalence of sexual dysfunction symptoms was 34.2% (95% CI = [25.3, 44.1]), and a high level of nicotine dependence and low income increased the chances of having sexual dysfunction by 2.72-fold and 2.54 fold, respectively. An association was also observed between female sexual dysfunction symptoms and schooling and levels of drug dependence.CONCLUSIONS:Female sexual dysfunction symptoms were common among this sample and primarily associated with high levels of nicotine use.

Troubles du désir sexuel féminin

To evaluate the clinical presentation of women's sexual desire disorders (SDD) and therapeutic options, suggested in the literature. Review of articles published on this subject in the Medline database, selected according to their scientific relevance, of consensus conferences and published guidelines. Female sexual desire is eminently multifactorial. The clinician should take into account the distress of the woman presenting with a SDD by relating this to the sexual history and the general context (pathological, biological…) together with the relationship with the partner. Other sexual disorders should be considered particularly arousal disorders which are frequently associated with SDD in women. SDD is one of the most difficult symptoms of female sexual dysfunction to treat since it is difficult to delimit the normal and the pathological. Without desire, the lack of sexual activity cannot be perceived as suffering. However, the consequences of this situation mean that she will consult the specialist fearing either that she could lose her partner, or that she is different in a normative society. A woman who is fulfilled will not have a problem with desire. The therapeutic objective can be to re-establish reactive desire in the affective context of the couple. The complexity and the multifactorial nature of TDS in women means that no unique solution is satisfactory; the initial assessment and a precise aim for therapeutic management are essential.

Medicinal Plants as Alternative Treatments for Female Sexual Dysfunction: Utopian Vision or Possible Treatment in Climacteric Women?

Female sexual dysfunction (FSD) is a complex and multifactorial condition. An increased incidence of FSD is especially associated with the decline of estrogen. Thus, menopause is a critical phase for FSD complaints. In this context, medicinal plants may be a therapeutic option. To identify and describe the popular and clinical uses of medicinal plants for FSD treatment in climacteric women. We highlighted the majority of the plants commonly involved with the female reproductive system including: Angelica sinensis, Cimicifuga racemosa, Ferula hermonis, Ginkgo biloba, Humulus lupulus, Lepidium meyenii, Tribulus terrestris, Trifolium pratense, and Vitex agnus-castus. This study is a narrative review of studies of plants that are possible alternative treatments for FSD. The species described have clinical and popular uses in different cultures as well as medical indications for female reproductive disturbances, mainly in climacteric women. We have also analyzed the evidence level of clinical studies. The main outcome assessed is the efficacy of plants in improving the symptoms of FSD. There is little evidence from the literature to recommend the use of medicinal plants when treating FSD. The majority of studies with a strong level of evidence are associated with the treatment of the vasomotor symptoms of menopause. Ferula hermonis, Angelica sinensis, and Gingko biloba may be suggested for arousal disorder studies. Cimicifuga racemosa, Trifolium pratense, and Vitex agnus-castus may be recommended for several FSD. Humulus lupulus and Tribulus terrestris may help with desire disorder studies. Lepidium meyenii should be studied further. Studies of these plants indicate that they may be useful as a possible alternative and/or complementary approach for studies aimed at the treatment of FSD. At this time, however, this review cannot recommend a plant that has a strong enough level of evidence for treatment of FSD. Thus, there is a need for clinical (double-blinded and randomized) studies to evaluate the efficacy and safety of several plants that can exert a positive effect on the management of FSD.