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Epilepsy & Behavior : E&B Nov 2015Therapeutic treatment for persons with epilepsy (PWE) should address seizure control and the broad spectrum of associated comorbidities. Since both epilepsy and...
Therapeutic treatment for persons with epilepsy (PWE) should address seizure control and the broad spectrum of associated comorbidities. Since both epilepsy and antiepileptic drugs (AEDs) can induce decreased libido, sexual health assessment is an important aspect of quality care in PWE as well as other patients receiving AEDs. This paper presents findings from a pilot quality initiative conducted in the ambulatory care epilepsy, pain management, and psychiatric services (N=15 clinicians) which addressed two themes: 1) whether libido is routinely questioned with/without the electronic medical record (EMR) and 2) clinicians' knowledge that both epilepsy and AEDs can induce decreased libido. All clinicians used the EMR, 40% used the GU-ROS section, but only 1 clinician (6.67%) questioned patients regarding libido. Of the clinicians, 26.7% demonstrated knowledge that both AEDs and epilepsy can cause decreased libido. Our results suggest that a treatment gap for epilepsy-induced and AED-induced decreased libido may be related to systems issues (duration of clinical visit, billing codes, EMR template) and physician barriers including decreased knowledge. Further research in this field and replication of this pilot quality initiative are indicated.
Topics: Ambulatory Care Facilities; Anticonvulsants; Comorbidity; Electronic Health Records; Epilepsy; Humans; Libido; Pilot Projects; Quality Improvement
PubMed: 26469800
DOI: 10.1016/j.yebeh.2015.09.015 -
The Urologic Clinics of North America May 2016Testosterone and sexual function are related. Current evidence suggests that testosterone replacement therapy (TRT) may improve sexual dysfunction. Sexual dysfunction in... (Review)
Review
Testosterone and sexual function are related. Current evidence suggests that testosterone replacement therapy (TRT) may improve sexual dysfunction. Sexual dysfunction in men who are hypogonadal, mixed, or eugonadal have all been examined through numerous studies. The most recent large analysis showed an overall improvement in sexual function outcomes in men treated with TRT. This improvement is difficult to measure and seems to differ based on the baseline hormonal status of the patient at the beginning of treatment.
Topics: Erectile Dysfunction; Humans; Libido; Male; Sexual Dysfunction, Physiological; Testosterone
PubMed: 27132579
DOI: 10.1016/j.ucl.2016.01.008 -
Climacteric : the Journal of the... Apr 2017Faced with the growing interest about the action of dehydroepiandrosterone (DHEA) and its benefits, as well as the negative impacts that sexual dysfunctions have on... (Review)
Review
OBJECTIVE
Faced with the growing interest about the action of dehydroepiandrosterone (DHEA) and its benefits, as well as the negative impacts that sexual dysfunctions have on people's quality of life, this systematic review was undertaken with the objective of evaluating the effect of DHEA use on aspects of sexual function.
METHOD
An electronic search was conducted in the databases of PubMed, ISI Web of Science and Virtual Health Library (VHL) combining the terms 'DHEA treatment' and 'DHEA use' with terms such as 'sexual dysfunction', 'sexual frequency' and 'libido'. No limits on time and language were imposed. Clinical studies were considered eligible where individuals for any reason made use of DHEA and if they had any aspect of sexual function assessed. Preclinical studies and systematic reviews were considered ineligible.
RESULTS
The search identified 183 references and 38 were considered eligible. DHEA improved aspects such as sexual interest, lubrication, pain, arousal, orgasm and sexual frequency. Its effect was better in populations with sexual dysfunction, especially in perimenopausal and postmenopausal women.
CONCLUSION
Considering the studies currently published, DHEA is effective in improving several aspects of sexual function, but this effect did not reach all the populations studied.
Topics: Dehydroepiandrosterone; Female; Humans; Libido; Middle Aged; Postmenopause; Quality of Life; Sexual Behavior; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological
PubMed: 28118059
DOI: 10.1080/13697137.2017.1279141 -
Menopause (New York, N.Y.) Jul 2022All women will experience menopause transition, and a majority will experience symptoms that negatively affect their quality of life. Current validated menopause symptom...
OBJECTIVE
All women will experience menopause transition, and a majority will experience symptoms that negatively affect their quality of life. Current validated menopause symptom scales are time consuming, phrased in clinical language, and difficult to adopt for digital use. This study seeks to validate a short novel survey which can be reliably completed without coaching and accurately represents the experience of the menopause transition.
METHODS
We developed a patient-centric questionnaire (Menopause Transition Scale, MTS) to examine for symptoms of menopause. Survey responders represented a total of 144 women with at least one symptom of menopause. Survey responders included women affected by cancer aged 30 to 65 (n = 72) and women not affected by cancer aged 45 to 60 (n = 72). Cronbach Alpha was used to examine for internal consistency and dimensionality was assessed using exploratory factor analysis. The cross-validation was analyzed against established patient scales using Spearman correlations or Chi-Square analysis, as appropriate.
RESULTS
The MTS questions showed internal consistency with a Cronbach Alpha of 0.63. The individual questions loaded into three unique domains. The MTS overall correlated with validated scales for menopause symptoms, the Menopause-Specific Quality of Life Questionnaire (r = -0.86, P < 0.0001) and Greene Climacteric Scale (r = -0.65, P < 0.0001). Libido correlated with scales (P = 0.0150) and subscales (r = -0.70, P < 0.0001) relating low sexual desire. Energy (r = -0.62, P < 0.0001), Mood (r = -0.48, P < 0.0001), and Hot Flashes/Night Sweats (r = -0.77, P < 0.0001) correlated with scales and subscales related to mood, depression, and vasomotor symptoms. The majority of our responders expressed mild vaginal bleeding. The highest frequency of severe symptoms were low libido and poor energy.
CONCLUSIONS
The MTS is a short thorough patient-centric survey that is readily amenable to digital adoption to measure symptoms of menopause as women transition in the out-patient setting. Further study is needed for the longitudinal assessment of symptoms through the transition process and the response of women to therapeutic options.Video Summary: http://links.lww.com/MENO/A938.
Topics: Climacteric; Female; Hot Flashes; Humans; Libido; Menopause; Quality of Life; Surveys and Questionnaires
PubMed: 35796559
DOI: 10.1097/GME.0000000000001975 -
Current Opinion in Psychiatry Nov 2015Psychotropic-related sexual dysfunction is a quite frequent issue in clinical practice, mainly in chronic treatments affecting both quality of life and compliance. (Review)
Review
PURPOSE OF REVIEW
Psychotropic-related sexual dysfunction is a quite frequent issue in clinical practice, mainly in chronic treatments affecting both quality of life and compliance.
RECENT FINDINGS
In the last decade fortunately antidepressants and antipsychotic compounds have been deeply screened in order to identify sexual adverse events that were commonly underdiagnosed and previously underestimated by clinicians and perhaps by pharmaceutical companies as well. Some differences in the mechanism of action are the nucleus of this poorly tolerated adverse event. All antidepressants with serotonergic activity can cause mild to severe sexual dysfunction such as decreased libido and delayed orgasm frequently (>60%) or anorgasmia and arousal difficulties sometimes (30%). In contrast, noradrenergic, dopaminergic, or melatonergic antidepressants do not cause sexual dysfunction but perhaps the clinical profile of patients receiving these compounds could be different. Antipsychotics that highly increase prolactin levels and strongly block dopamine receptors could be related to sexual dysfunction as well. Unfortunately, these dysfunctions are present during the long term after the antipsychotic onset to provide continued symptom control and enable recovery. Young patients suffering psychosis and concomitant sexual dysfunction (erectile and/or orgasmic difficulties) tend to show poor compliance in chronic treatments affecting the outcomes.
SUMMARY
The implications of psychotropic-related sexual dysfunction in clinical practice are relevant mainly in patients under long-term treatment with previous satisfactory sexual life. Implications for future research about sexual dysfunction in all new treatments should be strongly taken into account.
Topics: Antidepressive Agents; Antipsychotic Agents; Erectile Dysfunction; Female; Humans; Libido; Male; Medication Adherence; Orgasm; Psychotic Disorders; Psychotropic Drugs; Quality of Life; Receptors, Dopamine; Receptors, Serotonin; Sexual Behavior; Sexual Dysfunctions, Psychological
PubMed: 26382168
DOI: 10.1097/YCO.0000000000000198 -
Current Urology Reports Jun 2018Male pattern hair loss, mediated by dihydrotestosterone, is a common hair loss disorder, affecting over 50% of men over the age of 50. The 5-α reductase inhibitors,... (Review)
Review
PURPOSE OF REVIEW
Male pattern hair loss, mediated by dihydrotestosterone, is a common hair loss disorder, affecting over 50% of men over the age of 50. The 5-α reductase inhibitors, finasteride and dutasteride, are Food and Drug Administration-approved drugs for the treatment of this disorder. Several recent studies have reported adverse sexual and spermatogenic events among young men using 5-α reductase inhibitors, such as erectile dysfunction, decreased ejaculate volume, decreased libido, and infertility. In this review, we summarize and analyze the literature regarding the efficacy and safety of these medications, with an overall focus on men's health.
RECENT FINDINGS
Finasteride for the treatment of male pattern hair loss was considered safe according to many previous clinical trials. However, these trials have been recently criticized for inadequate safety reporting. Comprehensive review of the current literature reveals that there is a disproportionately high number of men with 5-α reductase inhibitor-associated sexual dysfunction and infertility. Although uncommon, the use of 5-α reductase inhibitors is associated with serious and persistent sexual and reproductive side effects, such as erectile dysfunction, decreased ejaculate volume, decreased libido, and infertility.
Topics: 5-alpha Reductase Inhibitors; Alopecia; Dutasteride; Erectile Dysfunction; Finasteride; Humans; Infertility, Male; Libido; Male; Sexual Dysfunction, Physiological
PubMed: 29909472
DOI: 10.1007/s11934-018-0814-z -
Sexual Medicine Reviews Oct 2016The relation between infertility and sexual dysfunction can be reciprocal. Causes of sexual dysfunction that affect fertility include erectile dysfunction, Peyronie's... (Review)
Review
INTRODUCTION
The relation between infertility and sexual dysfunction can be reciprocal. Causes of sexual dysfunction that affect fertility include erectile dysfunction, Peyronie's disease (abnormal penile curvature), low libido, ejaculatory disorders in men, and genito-pelvic pain/penetration disorder (GPPPD) and low sexual desire in women.
AIM
To review the association between infertility and sexual dysfunction and discuss current management strategies to address sexual disorders in couples with infertility.
METHODS
Peer-reviewed publications from PubMed published from 1980 through February 2016 were identified that related to sexual dysfunction and infertility in men and women.
MAIN OUTCOME MEASURES
Pathophysiology and management approach of erectile dysfunction, Peyronie's disease, low libido, ejaculatory disorders in men, and GPPPD and low sexual desire in women and how each etiology contributes to sexual dysfunction and infertility in the couple.
RESULTS
Treating the infertile couple with sexual dysfunction involves addressing underlying conditions such as psychogenic erectile dysfunction, low testosterone, Peyronie's disease in men, and GPPPD and low sexual desire in women. Psychogenic erectile dysfunction can be successfully treated with phosphodiesterase inhibitors. Low testosterone is often identified in men with infertility, but testosterone therapy is contraindicated in men attempting conception. Men with Peyronie's disease have a new treatment option to address their penile curvature-collagenase Clostridium histolyticum injection directly into the penile plaque. GPPPD is a broad disorder that includes vulvodynia and vaginismus and can be treated with topical lubricants and moisturizers. We must address psychosocial factors in women with low sexual desire. Flibanserin and transdermal testosterone (off-label) are novel therapies for women with low sexual desire.
CONCLUSION
Sexual dysfunction in a couple with infertility is a complex issue. Management of infertility and sexual dysfunction should involve appropriate medical therapy and addressing the psychosocial concerns of the couple.
Topics: Erectile Dysfunction; Female; Humans; Infertility; Infertility, Male; Libido; Male; Penile Induration; Sexual Dysfunction, Physiological; Sexual Partners; Testosterone; Treatment Outcome
PubMed: 27872029
DOI: 10.1016/j.sxmr.2016.05.002 -
International Journal of Impotence... May 2021Androgen deprivation therapy (ADT) has a deleterious effect on sexual functions and general well-being in men. Despite this evidence, however, patient and couple... (Review)
Review
Androgen deprivation therapy (ADT) has a deleterious effect on sexual functions and general well-being in men. Despite this evidence, however, patient and couple knowledge about ADT side effects as well as their management is poor. Similar considerations can be made for physician endorsement of management strategies. In this paper, we summarize and critically discuss available evidence regarding the possible associations between ADT and sexual dysfunction as well as the best therapeutical options. Preclinical data show that ADT is associated with penile contractility impairment as well as lower response to phosphodiesterase type 5 inhibitors (PDE5i). Available data indicate that ADT resulted in a five to sixfold increased risk of reduced libido and in a threefold increased risk of ED confirming the main role of testosterone in regulating sexual desire. Despite this evidence, sexuality remains an important aspect of health and well-being for men and their partner. The best therapeutical options depend on patient and couple desires and needs. When nonpenetrative erections are still possible, nonpenetrative activities should be encouraged to maintain sexual intimacy. A combined and personal educational program including the collaboration of different professional figures (including general physicians, oncologists, andrologists, sexologists, and psychologists) trained in sexual medicine is advisable in order to provide the best support to subjects undergoing ADT.
Topics: Androgen Antagonists; Androgens; Humans; Libido; Male; Prostatic Neoplasms; Sexual Dysfunction, Physiological
PubMed: 33746211
DOI: 10.1038/s41443-021-00418-7 -
Archives of Sexual Behavior Nov 2021Some genetic males undergo voluntary castration, with and without hormonal supplementation. Here, we investigate the sexual function of 163 such individuals (average...
Some genetic males undergo voluntary castration, with and without hormonal supplementation. Here, we investigate the sexual function of 163 such individuals (average age = 52 ± 16-years-old). Specifically, we explored how hormonal, social, and psychological factors play a role in their sexual function. In this study, 47% identified their gender as "eunuch", and 36% identified their gender as "man." Furthermore, 64% were in a relationship (80% with a woman), and 28% had a strong attraction for both sexes (Kinsey 2-4). We found that castrated individuals with androgen supplementation have higher sexual function than those without any hormone supplementation. Individuals with anxiety symptoms reported better sexual parameters (better orgasm satisfaction, easier to achieve an erection and an orgasm) than those without anxiety symptoms. Among those low in anxiety, individuals without hormone supplementation had a weaker sex drive and more difficulty in getting sexually aroused than those on supplemental estrogen or androgen. Hierarchical multiple regressions indicated that control variables (i.e., age, depressive symptoms, time since castration, type of hormone supplementation) accounted for 13-30% of the variances in sexual parameters. Including sexual guilt in the models predicted 4-8% additional variances in all sexual parameters except for ease in getting and maintaining an erection. Adding in participants' sexual trauma scores accounted for an additional 3.7% in the strength of their reported sex drive. In conclusion, various factors-hormone therapy, anxiety, sexual guilt, and childhood trauma-may influence the sexual outcomes for castrated individuals.
Topics: Adult; Aged; Female; Gender Identity; Humans; Libido; Male; Middle Aged; Orchiectomy; Orgasm; Sexual Behavior
PubMed: 34704159
DOI: 10.1007/s10508-021-02094-6 -
Journal of Sex Research Sep 2023The Dual Control Model proposes that sexual arousal and related processes are dependent on the balance between sexual excitation and sexual inhibition, and that... (Review)
Review
The Dual Control Model proposes that sexual arousal and related processes are dependent on the balance between sexual excitation and sexual inhibition, and that individuals vary in their propensity for these processes. This scoping review provides an overview and discussion of the questionnaires used to measure the propensities for sexual excitation and inhibition, their translation and validation in other languages, and their application in empirical research on topics ranging from sexual desire and arousal, sexual (dys)function, sexual risk taking, asexuality, hypersexuality, and sexual aggression. A total of 152 papers, published between 2009 and 2022 and identified using online databases, were included in this review. The findings, consistent with those reviewed by Bancroft et al. (2009), suggest that sexual excitation is particularly relevant to sexual desire and responsivity and predictive of asexuality and hypersexuality. Sexual inhibition plays a role in sexual dysfunction. sexual risk taking, and sexual aggression, although often in interaction with sexual excitation. Suggestions for the further development of the model and for future studies are discussed.
Topics: Humans; Sexual Behavior; Libido; Sexual Dysfunctions, Psychological; Paraphilic Disorders; Surveys and Questionnaires
PubMed: 37267113
DOI: 10.1080/00224499.2023.2219247