Treatment Of Sexual Dysfunction Research Articles

Epimedium brevicornum Maxim. Extract exhibits pigmentation by melanin biosynthesis and melanosome biogenesis/transfer.

Epimedium brevicornum Maxim. (Epimedii Folium) is a traditional medicine widely utilized in China for sexual dysfunction and osteoporosis treatment. Recently, studies have reported that Epimedium flavonoid icariin displayed hair growth and melanogenic ability by targeting tyrosinase activity. Nevertheless, icariin hydrolysate icariside II and icaritin cause depigmentation due to their tyrosinase inhibition. These pigment functional discrepancies from Epimedium constituents arouse our great interest. Then, this study focused on the pigmentation effects of Epimedii Folium extract (EFE) on melanin synthesis and melanosome biogenesis/transfer, and further identified the bioactive constituents. First, in in vitro systemic studies, we discovered that the potent melanogenic and repigmented effects of EFE were dependent on concentration and amount of time in multi-melanocytes, normal human skin tissue, and vitiligo perilesional areas. In vivo, EFE exhibited repigmented effect on two kinds of depigmented models of N-phenylthiourea-induced zebrafish and hydroquinone-induced mice. Mechanistically, EFE strongly promoted tyrosinase activity and upregulated the protein expression of tyrosinase families which finally contribute to melanin biosynthesis by activating the MAPK/ERK1/2 signal pathway. In addition, EFE effectively increased melanosome number, accelerated melanosome maturity and cytoplasmic transport through the growth/extension of melanocyte dendrites, and induced melanosome transfer from melanocyte to keratinocyte for pigmentation. The six main flavonoid ingredients were identified among EFE. Compared to others, epimedin B (EB) was confirmed as a high-content, low-toxicity, and effective melanogenic compound in EFE. Taking all these together, this study systematically demonstrates the potential pigmentation effect of Epimedium brevicornum Maxim., and clarifies its related molecular mechanisms and melanogenesis basis. These results give additional insight into Epimedium herb pharmacology and may provide a novel therapy basis for hypopigmentation disorders.

"Adipose-derived mesenchymal stem cell therapy for the management of female sexual dysfunction: Literature reviews and study design of a clinical trial".

Hormone imbalance and female sexual dysfunction immensely affect perimenopausal female health and quality of life. Hormone therapy can improve female hormone deficiency, but long-term use increases the risk of cardiovascular diseases and cancer. Therefore, it is necessary to develop a novel effective treatment to achieve long-term improvement in female general and sexual health. This study reviewed factors affecting syndromes of female sexual dysfunction and its current therapy options. Next, the authors introduced research data on mesenchymal stromal cell/mesenchymal stem cell (MSC) therapy to treat female reproductive diseases, including Asherman’s syndrome, premature ovarian failure/primary ovarian insufficiency, and vaginal atrophy. Among adult tissue-derived MSCs, adipose tissue-derived stem cells (ASCs) have emerged as the most potent therapeutic cell therapy due to their abundant presence in the stromal vascular fraction of fat, high proliferation capacity, superior immunomodulation, and strong secretion profile of regenerative factors. Potential mechanisms and side effects of ASCs for the treatment of female sexual dysfunction will be discussed. Our phase I clinical trial has demonstrated the safety of autologous ASC therapy for women and men with sexual hormone deficiency. We designed the first randomized controlled crossover phase II trial to investigate the safety and efficacy of autologous ASCs to treat female sexual dysfunction in perimenopausal women. Here, we introduce the rationale, trial design, and methodology of this clinical study. Because aging and metabolic diseases negatively impact the bioactivity of adult-derived MSCs, this study will use ASCs cultured in physiological oxygen tension (5%) to cope with these challenges. A total of 130 perimenopausal women with sexual dysfunction will receive two intravenous infusions of autologous ASCs in a crossover design. The aims of the proposed study are to evaluate 1) the safety of cell infusion based on the frequency and severity of adverse events/serious adverse events during infusion and follow-up and 2) improvements in female sexual function assessed by the Female Sexual Function Index (FSFI), the Utian Quality of Life Scale (UQOL), and the levels of follicle-stimulating hormone (FSH) and estradiol. In addition, cellular aging biomarkers, including plasminogen activator inhibitor-1 (PAI-1), p16 and p21 expression in T cells and the inflammatory cytokine profile, will also be characterized. Overall, this study will provide essential insights into the effects and potential mechanisms of ASC therapy for perimenopausal women with sexual dysfunction. It also suggests direction and design strategies for future research.

Anxiolytic Herbs and Naturopathic Treatment of Anxiety-Induced Female Sexual Dysfunction: A Case Report

We report on successful treatment of female sexual dysfunction in a young (23-year-old) woman (she/her) with a combination of anxiolytic and stress-relieving natural health products (NHPs) together with patient education and lifestyle counselling. Presenting symptoms included decreased sexual desire and arousal, anorgasmia, dyspareunia, and vaginismus that had improved with pelvic physiotherapy prior to the onset of naturopathic treatment. Contributing factors in this case included a personal history of abuse and sexual trauma. Alongside counseling and patient education, NHPs initially included L-theanine, Rhodiola rosea, Panax ginseng, and vitamin D. Over approximately 4 months of treatment, the patient reported significant improvements in sexual desire, both physical and psychological arousal, and was able to achieve orgasm. This case report identifies the important role of mental health and stress in female sexual dysfunction and supports the use of natural anxiolytics to support sexual function, in particular in patients with a history of trauma.

The global prevalence of sexual dysfunction in women with multiple sclerosis: a systematic review and meta-analysis.

Sexual function is often impaired following neurological disorders such as multiple sclerosis (MS). Young women with MS encourage disruptions in sexual function, sexual behaviors, and family formation as common global problems. Thus, the aim of the present systematic review and meta-analysis study was to investigate the global prevalence of female sexual dysfunction (FSD) worldwide. Various databases (PubMed, Scopus, Web of Science, Embase, and ScienceDirect) along with Google Scholar search engine were hired for systematic searching in the field of the prevalence of FSD (by July 2022). The heterogeneity of the studies was assessed using I2 index, and random effects model was used to perform the analysis (CMA software, v.2). Following assessment of 14 included studies with the sample size of 2115 women, a total prevalence of sexual dysfunction (SD) in women with MS was reported 62.5% (95% CI 53.9-70.5). Meta-regression assessment also showed that FSD accelerates following increasing the sample size and the year of the studies. The total prevalence of SD in women with MS was found considerably high (62.5%) in the world, which needs more serious attention by health policymakers. Correct implementation of health policies can potentially increase the society's awareness and successful treatment of SD in MS patients.

Bupropion - an antidepressant drug with broad therapeutic potential

Introduction: Bupropion is currently mainly used as an atypical antidepressant due to its psychotropic effects. In addition, it shows high potential in reducing withdrawal cravings in addicts, which is also used in the treatment of nicotinism. However, studies in recent years have shown that it may also be useful in other conditions.Aim of the study: Our aim was to review the known usage of bupropion in the fields of psychiatry, neurology and internal medicine, and to identify potential directions for further research. Methods and materials: We reviewed the literature available in the PubMed database, using the key words: "bupropion"; "depression"; "smoking cessation"; "obesity"; "ADHD".Results: Bupropion- an antidepressant drug belonging to the group of selective norepinephrine and dopamine reuptake inhibitors. Bupropion is approved by the FDA(Food and Drug Administration) for the treatment of depression, seasonal affective disorder and nicotinism. The literature shows that it is also effective in off-label indications - treatment of antidepressant-induced sexual dysfunction, attention deficit hyperactivity disorder (ADHD), depression in bipolar disorder, obesity, neuropathic pain and cancer-related fatigue syndrome.Conclusion: Due to the specific effects of bupropion, there are many more usage for the drug than the primary indications for which it is usually used. The usage of the drug described in the literature require additional studies on a larger group of patients.

Sexual dysfunctions and their treatment in liver diseases.

Sexual dysfunction (SD) is a prevalent but very commonly ignored aspect in the treatment of liver diseases and cirrhosis. The etiology of SD is multifactorial and therefore treatment strategies are complex, especially in females. Phosphodiesterase inhibitors are useful and effective in erectile dysfunction in males but in females, no single drug is available for SD, therefore multimodal treatment is required depending upon the cause. The foremost and fundamental requirement in both genders is to be stress-free and have adequate control of liver diseases. Improved quality of life is helpful in improving SD and vice versa is also true. Therefore, patients suffering from liver diseases should come forward and ask for treatment for SD, and physicians should actively enquire about SD while history taking and evaluating these patients. SD results in deterioration of quality of life, and both are modifiable and treatable aspects of liver diseases, which are never addressed actively, due to social taboos and fears of SD treatment in the presence of liver diseases. The diagnosis of SD does not require costly investigations, as the diagnosis can be established based on validated questionnaires available for both genders, therefore detailed targeted history taking using questionnaires is essential. Data are emerging in this area but is still at an early stage. More studies should be dedicated to SD in liver diseases.

Male Sexual Dysfunction

Male sexual dysfunction is a series of conditions, most notably including erectile dysfunction (ED), Peyronie’s disease (PD), and premature ejaculation (PE), defined by impaired sexual functioning. The prevalence of male sexual dysfunction increases with age and is relatively high with greater than 50% of men aged 40 to 70 describing some degree of erectile dysfunction. Risk factors for male sexual dysfunction include age, diabetes mellitus (DM), cancer, stroke, hypertension, penile trauma, depression, anxiety, and disturbance in central serotonin neurotransmission and 5-HT postsynaptic receptor functioning. Sexual questionnaires including the International Index of Erectile Dysfunction, Sexual Health Inventory for Men, and the Premature Ejaculation Diagnostic Tool are useful in screening for these disorders. Focused history and physical can establish diagnoses. For a condition to be diagnosed as male sexual dysfunction, the patient or their partner must view their sexual functioning as impaired. Treatment of male sexual dysfunction is etiology dependent. For ED, first-line therapy is a phosphodiesterase-5 inhibitor or mental health care for psychogenic ED. More complicated cases may be treated with injections, surgery, or shockwave therapy. PD is either treated with medications for pain management, collagenase clostridium histolyticum injection, corpoplasty, plication, or shockwave therapy. PE may be treated behaviorally or with SSRIs as first line medication.

Sexual dysfunction in women with systemic autoimmune rheumatic disorders: a systematic review and meta-analysis.

In women with systemic autoimmune rheumatic diseases (SARDs), female sexual dysfunction (SD) remains underestimated. We aimed to explore the prevalence and correlates of SD in females with SARDs. We performed a systematic review and meta-analysis of studies assessing the prevalence of SD and the pooled Female Sexual Function Index (FSFI) scores in this setting (PROSPERO: CRD42021287346). We searched PubMed, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) databases and grey literature until February 2022. We evaluated the quality of the selected records using the Hoy Risk of Bias tool. A random-effects meta-analysis of proportions with the double arcsine transformation was conducted. Subgroup and sensitivity analyses, as well as meta-regression of important correlates, were conducted. We included 68 studies with 5457 females diagnosed with a SARD (mean age: 43.7 [12.9] years). The overall SD prevalence was 63% (95% CI: 56, 69%, I2 = 94%) and the overall FSFI total score was 19.7 points (95% CI: 18.4, 21, I2 = 97%). Including only sexually active females, the SD prevalence was estimated as 60% (95% CI: 53, 67%, I2 = 88%), whereas the FSFI total score was 22 points (95% CI: 20.8, 23.1, I2 = 93%). Across the different SARDs, women with Sjögren's syndrome and systemic sclerosis reported the highest levels of SD (74%, 95% CI: 58, 87%, I2 = 84% and 69%, 95% CI: 54, 83%, I2 = 94%, respectively). Sexual function in females with SARDs seems to be severely impaired, irrespective of the type of SARD. Screening and treatment of SD in females with SARDs should become an integral part of healthcare clinical practice.

Managing female sexual dysfunction.

Provide an overview of sexual dysfunction in female urologic cancer patients, approaches for assessing sexual problems, and interventions to treat sexual dysfunction in this patient population. A review of the literature in urologic oncology was conducted. Research on other female pelvic cancers with similar treatments was also reviewed. Sexual health is an important element of women's quality of life that is often not discussed and problems remain unaddressed. Urologic cancer treatments commonly result in sexual dysfunction (e.g., dyspareunia, vaginal dryness, problems with orgasm) in female patients, although more research is necessary to understand the impact of non-surgical treatments (e.g., radiation, chemotherapy, immunotherapy). As such, provider teams should complete necessary screening for sexual dysfunction during and after treatment. The 5 A's model (i.e., Ask, Advise, Assess, Assist, Arrange Follow-Up) provides a helpful guide for communicating about and addressing sexual health concerns with patients during the screening process. If it is determined that referral for further assessment and treatment of sexual dysfunction is needed, a number of non-pharmacologic (e.g., pelvic floor physical therapy; psychosexual counseling) and pharmacologic treatment approaches are available. Sexual dysfunction is common in female urologic cancer survivors. Routine assessment and appropriate referral are essential for high quality patient care.

Lysis of Clitoral Adhesions Should be in the Scope of a Urologist's Care

ABSTRACT Introduction Clitoral phimosis occurs when the prepuce adheres to the glans clitoris. Similarly, penile phimosis occurs when the prepuce adheres to the glans penis. Symptoms of clitoral phimosis can include pain, difficulty with arousal, and muted or absent orgasm. While previous studies on the prevalence of clitoral phimosis in a group of 589 college students in a health clinic was 33%, and in a population of 614 patients with sexual dysfunction, it was 23%. While the treatment of penile phimosis is widely practiced by urologists, training on the diagnosis and treatment of clitoral phimosis is lacking. Lysis of clitoral phimosis is a minimally invasive, office-based procedure to stretch the preputial tissue. Lysis of clitoral phimosis can be performed with a topical anesthetic or nerve block of the dorsal nerve of the clitoris. A fine Jacobsen mosquito forceps can then be used to separate the plane between the prepuce and the glans clitoris. Following the procedure, patients are instructed to pull back the prepuce at least once daily to prevent re-adherence. Objective To determine the efficacy and patient satisfaction of the office-based lysis of clitoral phimosis procedure and to demonstrate that diagnosing and treating clitoral phimosis should be in the scope of a urologist's practice. Methods Survey responses from 41 females who underwent the lysis procedure for clitoral phimosis from one sexual medicine practice. The survey was sent to 61 patients and 41 responded (67% response rate). Results Among participants who reported pain as a symptom of phimosis (n=25), 76% saw an improvement in pain, with 44%, 28%, and 4% reporting significantly, moderately, or slightly improved pain. Among those who reported difficulty with arousal before the procedure (n=40), 62.5% saw improvement, with 25%, 25%, and 12.5% considering it to be significantly, moderately, or slightly easier to become aroused. Among those who reported difficulty achieving orgasm before the procedure (n=39), 64% saw improvement, with 25.6%, 17.9%, and 20.5% reporting that they found it significantly, moderately, or slightly easier to achieve orgasm. Of the women that could not orgasm before the procedure (n=16), 6 were able to afterward. All women who reported the ability to orgasm from external clitoral stimulation maintained this ability after the procedure (n=24). 92.7% (n=41) would recommend the procedure to a friend who had phimosis. Conclusions These findings show that most patients reported improvement in their pain and sexual function, and no patient reported loss of functioning or worsening of symptoms. The lysis procedure should be recognized as a treatment for pain and sexual dysfunction associated with clitoral phimosis. Since urologists are trained in procedural management of male preputial disorders, urologists are uniquely positioned to also routinely manage clitoral phimosis. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Sprout (Raleigh, NC), Absorption Pharmaceuticals

Clitoral Phimosis Should Have its own Diagnostic and Procedural Codes

ABSTRACT Introduction Clitoral phimosis occurs when the prepuce adheres to the glans clitoris. Similarly, penile phimosis occurs when the prepuce adheres to the glans penis. Symptoms of clitoral phimosis can include pain, difficulty with arousal, and muted or absent orgasm. While previous studies on the prevalence of clitoral phimosis in a group of 589 college students in a health clinic was 33%, and in a population of 614 patients with sexual dysfunction, it was 23%. There are no diagnosis codes (ICD codes) or procedure codes (CPT codes) for clitoral phimosis or the lysis procedure for clitoral phimosis. Proper codes ensure that patients receive adequate treatment and are charged appropriately for medical services. Objective To determine the efficacy and patient satisfaction of the office-based lysis of clitoral phimosis procedure and to demonstrate that clitoral phimosis should have its own diagnosis and procedure codes. Methods To evaluate the efficacy and patient satisfaction of the lysis procedure, survey responses from 41 females who underwent the lysis procedure for clitoral phimosis from one sexual medicine practice were analyzed. The survey was sent to 61 patients and 41 responded (67% response rate). Results Among participants who reported pain as a symptom of phimosis (n=25), 76% saw an improvement in pain, with 44%, 28%, and 4% reporting significantly, moderately, or slightly reduced pain. Among those who reported difficulty with arousal before the procedure (n=40), 62.5% saw improvement, with 25%, 25%, and 12.5% considering it to be significantly, moderately, or slightly easier to become aroused. Among those who reported difficulty achieving orgasm before the procedure (n=39), 64% saw improvement, with 25.6%, 17.9%, and 20.5% reporting that they found it significantly, moderately, or slightly easier to achieve orgasm. All women who reported the ability to orgasm from external clitoral stimulation maintained this ability after the procedure (n=24). Of the women that could not orgasm before the procedure (n=16), 6 were able to afterward. 92.7% would recommend the procedure to a friend who had phimosis. Conclusions These findings show that most patients reported improvement in their pain and sexual function, and no patient reported a loss of functioning or worsening of symptoms. The lysis procedure should be recognized as a treatment for pain and sexual dysfunction associated with clitoral phimosis. The routine management of clitoral phimosis in clinical practice should be reflected in diagnosis and procedure codes, which currently do not exist. The lack of proper codes creates a barrier to diagnosis and treatment of clitoral phimosis. If doctors use the ICD code for phimosis, it is rejected by insurance - the codes for “phimosis” and “balanitis” are only designated for male patients. Proper codes support the importance and medical necessity for performing the lysis procedure, and would help communicate a patient's health to other healthcare providers, specialists, insurance payers, and data registries. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Sprout, Absorption Pharmaceuticals

Patient Satisfaction and Efficacy of Non-Surgical Lysis of Clitoral Adhesions

ABSTRACT Introduction In clitoral adhesions (CA), a closed compartment of space under the clitoral hood can lead to accumulation of squamous cells and smegma, irritation, erythema, and infection. This causes the prepuce to adhere to the glans clitoris and prevents the corona, a ridge of tissue between the glans clitoris and the clitoral body, from being visualized. CA can cause discomfort, hypersensitivity or hyposensitivity, difficulty reaching orgasm, and chronic vulvar pain including clitorodynia. One treatment for CA is a non-surgical lysis procedure that is minimally invasive and stretches the preputial tissue open, yet there is a paucity of data on its effectiveness in treatment of symptoms and restoration of function. Objective To evaluate patient-reported outcomes of the non-surgical lysis procedure in order to determine if this procedure is an appropriate treatment for symptomatic CA that can be performed in the office-based setting. Methods 61 women who have been treated for CA using the non-surgical lysis procedure at one sexual medicine practice from 2017-2021 were identified using a chart review and an online survey was sent to patients to evaluate the efficacy of the procedure in improving pain and sexual functioning, as well as patient satisfaction with the procedure. Results There were 41 survey responses (67% response rate). All women that reported the ability to achieve orgasm from external clitoral stimulation maintained this ability after the procedure (n=24), and of the women that could not do so before the procedure (n=16), 6 were able to afterwards. 76% of respondents reported improvement in pain with 44%, 28%, and 4% reporting significant, moderate, and slight improvement. 63% reported improvement in sexual arousal with 25%, 25%, and 13% reporting significant, moderate, and slight improvement. 64% reported improvement in their ability to achieve orgasm with 26%, 18%, and 21% reporting significant, moderate, and slight improvement. 71% reported improvement in their satisfaction with sex with 27%, 17%, and 27% reporting significant, moderate, and slight improvement. 80% of respondents reported they could have comfortable physical/sexual stimulation within one month of the procedure, and 31% of respondents reported that it took one week or less. 93% of participants would recommend the procedure to a friend who also had CA. 65% and 18% of respondents reported being extremely and mostly satisfied with their decision to have the procedure. Conclusions These findings indicate that most patients reported improvement in their pain and sexual functioning, and no participants reported worsening in their pain, sexual arousal, or ability to achieve orgasm. 6 of 16 patients that could not achieve orgasm from external clitoral stimulation prior to the procedure were able to afterwards. Thus, the non-surgical lysis procedure could be considered as a treatment for pain and sexual dysfunction associated with CA. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Sprout (Raliegh, NC), Absorption Pharmaceuticals

What's Preventing Healthcare Providers from Screening for Female Sexual Dysfunction?

ABSTRACT Introduction Female sexual dysfunction (FSD) significantly decreases qualify of life and the prevalence of FSD increases with age.(1) It is known that many healthcare providers do not screen for sexual dysfunction due to discomfort, not having enough time, or not having enough knowledge on the subject.(2) However the overall incidence of FSD will continue to increase as our postmenopausal population continues to grow. It is estimated that by the year of 2025 there will be 1.1 billion postmenopausal women worldwide.(3) Women in this age group often rely on their family medicine or internal medicine physician as the gatekeeper for their healthcare needs.(4) Therefore, healthcare providers both within the field of obstetrics and gynecology and general practitioners need to be prepared to screen, diagnose, and treat FSD. Objective The purpose of this study is to add to the current gaps in literature regarding screening for sexual dysfunction. Our goal is to identify what barriers exist to screening for sexual dysfunction across different fields. Identifying barriers by field will allow for targeted interventions to increase the screening, diagnosis, and treatment of female sexual dysfunction. Methods This study was based on a questionnaire that was distributed to healthcare providers practicing at an academic institution via email. The email was distributed as a one-time survey via residency programs across the country. Descriptive statistics were performed to assess study characteristics. Results 220 physicians and advanced practice providers completed the survey. 182 within the field of OBGYN completed the survey and 38 within the field of family or internal medicine completed the survey. Our results found that while 59% of providers responded they are screening for sexual dysfunction, only 5% of providers surveyed overall reported that they always screen for FSD. Of those not screening for FSD, the primary reason for OBGYNs is not feeling that they have enough time (22%) compared to other specialties reporting lack of knowledge about FSD (67%). Of those who stated they screened for FSD, 45% stated they were not familiar with any screening tool or questionnaires. Conclusions OBGYNs, Internal Medicine, and Family Medicine providers have room to improve screening for FSD. Our study shows that the primary barrier reported by OBGYNs related to time constraints, whereas other primary care providers reported not having enough knowledge. Future studies should focus on interventions for these two respective barriers. Disclosure No

A Multidisciplinary Approach to the Treatment of Sexual Dysfunction in Couples

ABSTRACT Introduction Sexual dysfunction (SD) affects at least a third of adult women worldwide which makes it a public health concern. Given the complexity of both psychological and biological pathology associated with these conditions, a multidisciplinary approach has been advocated. However, there is a limited amount of literature examining a multidisciplinary treatment approach to a couple's sexual and psychological functioning. This program, emphasizes treatment of the couple. This program includes a multidisciplinary team consisting of psychologists, gynecologists, urologists, dieticians, physical therapists, yoga instructors, and nurses. Our group collaborates in the care of each couple; working together to participate in the diagnosis and treatment of their sexual dysfunction. The treatment approach is a biopsychosocial model. Our couples attended weekly lectures on the follow topics: communication, female sexual functioning, male sexual functioning, stress management, chemistry of love, pelvic floor physical therapy, healthy diet, sexual aids, and gaining momentum. They also received counseling from a dyad therapist team. additionally, the couple was responsible for completing weekly homework consisting of sensate focus exercises and other gestures to help them engage with one another. In therapy sessions, communication and visualization exercises were also utilized. Objective This study prospectively followed couples pre- and post-attendance of a six-week sexual wellness treatment program (SWP) at a single academic medical center. The following outcomes were used: (1) sexual functioning (2) relationship satisfaction (3) mood stability. Methods The study was approved by the IRB. Couples attending the six-week multidisciplinary SWP, were consented and then completed surveys both pre-treatment and at the end of treatment. Surveys administered included the Dyadic Adjustment Scale (DAS), Sexual Functioning Profile (PROMIS), and International Index of Erectile Dysfunction (IIEF) for men only. Linear mixed-effects models were used to estimate the mean change from baseline to first follow-up. A covariance matrix was used to account for dependency. The program included weekly didactic sessions following an initial evaluation. Didactics included cognitive behavioral sex therapy with an attending (psychologist, psychiatrist or gynecologist) paired with a trainee (psychiatry, psychology or gynecology resident or a medical student), and home assignments. Results There were 85 respondents – 42 men, 43 women. Mean age was 49.82 years (Range 25-77). Most frequently reported SD were hypoactive sexual desire (32.2%), erectile dysfunction (21.4%), dyspareunia (14.3%), and female orgasmic disorder (10.7%). controlling for patients’ sex and baseline PHQ severity, all DAS measurements increased from baseline. The largest improvement was on the total DAS score which increased by approximately 5.18 (95% CI: 2.55 – 7.81) points. Similarly, the PROMIS global satisfaction with sex life score, erectile function score, and interest in sexual activity score significantly increased from baseline while the vaginal discomfort score significantly declined from baseline. Overall, the global satisfaction with sex life score increased from baseline by approximately 5.57 (95% CI: 3.03 – 8.10) points. Among male participants, the IIEF erectile, sexual, and satisfaction scores increased from baseline. On average, men reported a 4.33 (95% CI: 0.04 – 8.62) point increase in their IIEF erectile score from baseline. Conclusions The results indicate that a multidisciplinary treatment approach focused on the couple positively impacts multiple aspects of a couple's relationship, including global satisfaction with sex life, relationship satisfaction, interest in sexual activity, and erectile function. These findings emphasize that multidisciplinary sexual therapy programs aimed at the couple can help address multiple aspects of sexual well-being. Disclosure No

Maintenance Laser Treatment for Vaginal Looseness and Sexual Dysfunction: A Double-blinded Randomized Controlled Trial

Vaginal looseness and decreased sensation during intercourse is prevalent in up to 30%-55% of premenopausal women. The efficacy and safety of CO2 laser have been demonstrated for these indications; however, the effect is temporary, up to 6-12 months. No studies regarding the efficacy and safety of adjuvant laser treatments have been conducted to date. To evaluate the efficacy and safety of a single maintenance CO2 laser treatment in women with vaginal looseness and a concurrent decline in sexual sensation during intercourse. This prospective double-blinded randomized controlled trial included premenopausal women who experienced significant temporary improvement in symptoms following previous treatment with CO2 laser due to the abovementioned indications. Participants were randomized to either a single CO2 laser treatment or a single sham treatment. Treatment efficacy evaluated with the female sexual function index (FSFI) and the vaginal health index (VHI). Overall, 119 women were included in the study. Mean VHI and FSFI scores were significantly higher in the study group compared to the control group at three months post-treatment (17.34±1.39 vs 12.86±2.23, P=.023 and 30.93±1.79 vs 25.78±1.87, P=.044, respectively). In the study group, both VHI and FSFI returned to baseline at six months post-treatment. The median rate of sexual intercourse per month was increased in the study group at three months post-treatment (8 vs 4, P=.011), and returned to baseline at six months post-treatment. Maintenance laser treatment provides a temporary non-surgical alternative for women with vaginal looseness and associated sexual dysfunction, though treatment effect seems to be limited to less than 6 months, requiring additional maintenance sessions. The strengths of the current study include a randomized-sham controlled design. Furthermore, VHI was used as an objective evaluation tool, in addition to the FSFI, and assessment of the rate of sexual intercourse. The homogeneity and the relatively small sample size of the cohort is a limitation, and calls for caution in interpretation of the results, and the use of CO2 laser treatment in different age groups and populations. A single maintenance laser treatment in women who previously underwent successful treatment with laser is an effective, well-tolerated, and safe procedure for treating symptoms of vaginal looseness and sexual dysfunction, though effects are temporary. Lauterbach R, Aharoni S, Farago N, et al. Maintenance Laser Treatment for Vaginal Looseness and Sexual Dysfunction: A Double-blinded Randomized Controlled Trial. J Sex Med 2022;19:1404-1411.

Employer Health Plan Exclusions are a Barrier to Access of Penile Implants for Erectile Dysfunction

Introduction: Many commercial insurers and Medicare have published coverage policies detailing the medical necessity and accessibility of erectile dysfunction (ED) treatment, including implantable penile prosthesis (IPP). Approximately 61% of adults aged 18–64 years in the United States (US) receive health benefits via employer-sponsored health plans (ESHP) and 23% of employers reported medical benefit exclusion for sexual dysfunction treatment. Objective: To obtain nationwide US estimates of the proportions of patients denied IPP treatment due to ESHP exclusions (overall and by state, healthcare insurer, and labor sector industry). Methods: De-identified data from an industry IPP insurance benefit verification database from October 1, 2018 to December 31, 2021 were analyzed to evaluate ESHP-related barriers to IPP access. Results: Among 2,638 patients with commercial insurance and employer data, 34.0% were denied IPP treatment due to ESHP benefit exclusions. ESHPs in Washington (60.7%), Louisiana (55.4%), Arizona (46.6%), Nebraska (45.5%), Ohio (43.3%), and Georgia (43.1%) had the highest exclusion rates, whereas Iowa (19.0%), Alabama (18.9%), Maryland (17.3%), Rhode Island (13.0%), and New York (7.1%) had the lowest exclusion rates. Patients with Aetna insurance had the greatest proportion of exclusions (62.4%), followed by Cigna (61.0%), employer-owned health plans (47.2%), other commercial plans (41.8%), Anthem (37.3%), Blue Cross Blue Shield (BCBS) state plans (24.1%), United Healthcare (15.4%), and Humana (0.0%). The exclusion rate was highest for employees of the leisure and hospitality industry (51.9%), followed by religious organizations (50.0%), health care (40.5%), construction, mining, or agriculture (39.1%), education (38.9%), retail and wholesale trade (36.9%), manufacturing (36.7%), utilities (36.2%), professional and business services (35.4%), transportation (32.6%), finance and insurance (29.1%), labor union organizations (26.9%), and finally public, state, and government administration (25.1%). Conclusions: Despite insurance carrier medical policies, 34.0% of men with an ESHP are denied access to IPP ED treatment due to their ESHP benefit exclusions. ESHP exclusion rates varied geographically, by insurer, and by labor sector industry.

Clinical Study on the Use of Acupuncture for the Treatment of Female Sexual Dysfunction: A Pilot Study.

IntroductionFemale sexual dysfunction (FSD) seriously affects the quality of life of women. However, most women do not have access to effective treatment.AimThis study aimed to determine the feasibility and effectiveness of the use of acupuncture in FSD treatment based on existing clear acupuncture protocol and experience-supported face-to-face therapy.MethodsA retrospective analysis was performed on 24 patients with FSD who received acupuncture from October 2018 to February 2022. The Chinese version of the female sexual function index , subjective sensation, sexual desire, sexual arousal, vaginal lubrication, orgasm, sexual satisfaction, and dyspareunia scores were compared before and after the treatment in all 24 patients.Main Outcome MeasureA specific female sexual function index questionnaire was used to assess changes in female sexual function before and after the acupuncture treatment.ResultsIn this study, the overall treatment improvement rate of FSD was 100%. The Chinese version of the female sexual function index total score, sexual desire score, sexual arousal score, vaginal lubrication score, orgasm score, sexual satisfaction score, and dyspareunia score during intercourse were significantly different before and after the treatment (P < .05). Consequently, participants reported high levels of satisfaction with acupuncture. This study indicates that acupuncture could be a new and effective technique for treating FSD. The main advantages of this study are its design and efficacy in treating FSD. To the best of our knowledge, this is the first study to evaluate the efficacy of acupuncture in the treatment of FSD using the female sexual function index scale from 6 dimensions. The second advantage is that the method used (ie, the nonpharmacological method) is simple, readily available, highly safe with few side effects, and relatively inexpensive with high patient satisfaction. However, limitations include small sample size and lack of further detailed grouping, pre and post control study of patients, blank control group, and pre and post control study of sex hormones.ConclusionAcupuncture can effectively treat FSD from all dimensions with high safety, good satisfaction, and definite curative effect, and thus, it is worthy of promotion and application.Zhang JT, Ma L, Gong X, et al. Clinical Study on the Use of Acupuncture for the Treatment of Female Sexual Dysfunction: A Pilot Study. Sex Med 2022;10:100541.

Platelet-rich plasma: An effective modality to improve sexuality in FGM/C

Now, accepted treatments for Female Sexual Dysfunction (FSD) are limited to surgical, psychological, behavioral, hormonal and psychopharmacologic interventions. Because of the complex and multifactorial nature of FSD, current therapeutic options may leave a subset of women suffering with sexual dysfunction without clinical improvement and may be with side effects of the procedures. This is a study to evaluate the effect of platelet rich plasma (PRP) in treating FSD FGM/C. PRP was administered to the anterior vaginal wall (1 session), clitoris of 45 females with FGM/C and non-FGM/C with sexual dysfunction and orgasmic disorder [Female Sexual Function Index (FSFI) total score ≤ 26 orgasmic subdomain score ≤ 3.75]. The correlation between PRP sessions and FSFI domain scores was done with Pearson's correlation and linear regression analysis. Following the application of the PRP, the total FSFI score was converted significantly in both FGM/C and non-FGM/C ( P < 0.05). A significant change was observed in all sub-domains of FSFI score after PRP ( P < 0.05). The total FSFI score increased in all 45 females [16 non-FGM/C and 29 FGM/C] ( P < 0.05). That correlations between all sub-domains of FSFI score before and after PRP injection were significantly positive ( P < 0.05). Also, there were statistically significant positive correlations between total FSFI scores before and after PRP injection, and sociodemographic and obstetric characteristics of the study population in both FGM/C and non-FGM/C. As a minimally invasive method, PRP administration to the distal anterior vaginal wall may improve female sexuality with high satisfaction in FGM/C.

A descriptive study of adverse childhood experiences (ACEs) among female patients with sexual dysfunctions in Armenia

BackgroundAdverse childhood experiences (ACEs) are associated with increased risk for a wide range of negative health outcomes, in-cluding sexual dysfunctions. There is a growing interest to advance the science of ACEs to improve the lives of children and families worldwide.Participants and procedureThe purpose of the present study was to explore the extent to which ACEs occur in patients with sexual dysfunctions in Armenia. To this end, the ACE questionnaire was used to assess the presence of adverse experiences from 85 female patients with sexual dysfunctions and 155 sex- and age-adjusted controls.ResultsMore than two-thirds of the patients (74.1%) had been exposed to one or more ACEs and 27.2% had been exposed to four or more ACEs. In the control group, these numbers were 56.1% and 18.1% respectively. Patients had significantly higher ACE scores (M = 2.06, SD = 1.95) than the control group (M = 1.65, SD = 2.50). Parental divorce and witnessing mother being abused (treated violently) were the most prevalent adversities in the patients.ConclusionsThe presence of multiple adverse childhood experiences in the patient group suggests that psychogenic factors are likely involved in sexual dysfunctions. ACEs Aware initiatives in Armenia aimed at screening for childhood adversities can improve the treatment of sexual dysfunctions and ultimately improve health and wellbeing.

Sexual dysfunction among adolescent and young adult cancer patients: diagnostic and therapeutic approach.

We present a review for healthcare professionals, formulated by a multidisciplinary team, for screening and interventions, describing common sexual impairments encountered by adolescent and young adult cancer patients (AYACP), and suggest a comprehensive evidence-based assessment approach and interventions for treatment of sexual dysfunction (SD). We discuss the various aspects of SD in AYACP, including causes, challenges and etiologies, and then go on to recommend increased awareness and guidance in healthcare workers, in order to optimize diagnosis and treatment of SD. Although the extent of SD among AYACP is widely recognized, oncological clinicians rarely address SD in their routine practice, lacking a clear approach of interdisciplinary diagnostic and therapeutic interventions. Here, we suggest guiding clinical management to optimize treatment quality.