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International Journal of Impotence... May 2024Delayed orgasm (DO) is defined as increased latency of orgasm despite adequate sexual stimulation and desire. Anorgasmia (AO) is characterized as the absence of orgasm.... (Review)
Review
Delayed orgasm (DO) is defined as increased latency of orgasm despite adequate sexual stimulation and desire. Anorgasmia (AO) is characterized as the absence of orgasm. Etiologies of DO/AO include medication-induced, psychogenic, endocrine, and genitopelvic dysesthesia. Given the multifactorial complex nature of this disorder, a thorough history and physical examination represent the most critical components of patient evaluation in the clinical setting. Treating DO/AO can be challenging due to the lack of standardized FDA-approved pharmacotherapies. There is no standardized treatment plan for DO/AO, though common treatments plans are often multidisciplinary and may include adjustment of offending medications and sex therapy. In this review, we summarize the etiology, diagnosis, and treatment of DO/AO.
PubMed: 37061617
DOI: 10.1038/s41443-023-00692-7 -
Women's Health (London, England) 2024Breast cancer accounts for one in three new cancer cases in women each year. Despite having a higher survival rate than other cancers, it is associated with various side... (Review)
Review
Breast cancer accounts for one in three new cancer cases in women each year. Despite having a higher survival rate than other cancers, it is associated with various side effects, including anorgasmia, vaginismus, hair loss, and decreased libido. This review aims to explore trends in the incidence of sexual dysfunction in breast cancer survivors, the etiology of sexual dysfunction, and the role of factors such as family history, age, duration of marriage, and depression in predisposing patients. We summarize the limitations of the treatment modalities already used to cater to sexual dysfunction in breast cancer survivors and patients. The authors conducted searches on databases such as PubMed and Google Scholar using relevant search terms: sexual dysfunction, breast cancer, breast cancer survivors, chemotherapy, dyspareunia, vaginismus, and anorgasmia from 1997-2023. The inclusion criteria encompassed all types of articles with abstracts or titles indicating research on sexual dysfunction in breast cancer survivors in Asia. A total of 64 articles were included out of which 10 were systematic reviews and meta-analyses. The literature search yielded results showing high incidence rates of breast cancer in Asia (45.4%), with 31.6%-91.2% of breast cancer survivors likely to experience sexual dysfunction. Regional differences were noted, as female sexual dysfunction occurred in 74.1% of Asian breast cancer women. Further randomized controlled trials should be conducted to assess the effectiveness of treatment modalities. Personalized approaches should be tailored to address beliefs, such as the potential impact of sexual activity on disease recovery. Utilizing a family history of breast cancer as a preemptive tool can help reduce the risk of developing female sexual dysfunction in survivors, and factors such as age and depression should be considered when formulating solutions.
Topics: Female; Humans; Breast Neoplasms; Cancer Survivors; Vaginismus; Sexual Dysfunction, Physiological; Sexual Behavior; Survivors
PubMed: 38481086
DOI: 10.1177/17455057241237687 -
Cureus Jul 2023Introduction Sexual dysfunction is rarely studied in Indonesian patients with breast cancer. We aimed to assess the prevalence of sexual dysfunction symptoms following...
Introduction Sexual dysfunction is rarely studied in Indonesian patients with breast cancer. We aimed to assess the prevalence of sexual dysfunction symptoms following chemotherapy, as well as the pattern and the associated factors. Methods This cross-sectional study included 135 female breast cancer patients receiving primary chemotherapy. The present study measured the prevalence of sexual dysfunction symptoms using an e-questionnaire containing Common Toxicity Criteria for Adverse Events (CTCAE) version 4 at different time points. Other data included sociodemography, clinicopathology, treatment, and other concurrent symptom characteristics. Bivariate and multivariate logistic regression tests were used to analyze any association among variables. Results In the whole panel, 86 (63.7%) of 135 cases experienced sexual dysfunction. The most common symptom was vaginal dryness (45.9%), followed by decreased libido (45.2%), dyspareunia (13.3%), delayed orgasm (11.1%), and anorgasmia (8.9%). When observed at five different time points, the frequency of symptoms increased during chemotherapy and persisted until six months after completing treatment. Chemotherapy duration of >120 days was associated with a higher probability of vaginal dryness (p=0.012) and decreased libido (p=0.033). Spouse age ≥55 years old and body mass index (BMI) ≥23 kg/m were associated with a reduced probability of decreased libido (p=0.033 and 0.025, respectively). The presence of comorbidity was associated with a reduced probability of delayed orgasm (p=0.034). Conclusions A significant proportion of patients with breast cancer had sexual dysfunction following chemotherapy. Vaginal dryness, decreased libido, and dyspareunia were the commonest symptoms observed. Duration of chemotherapy, spouse age, BMI, and comorbidity were associated with the risk of sexual dysfunction occurrence.
PubMed: 37449290
DOI: 10.7759/cureus.41744 -
Journal of Clinical Medicine Jan 2024Treatment-emergent sexual dysfunction (TESD) is one of the most frequent and persistent adverse effects of antidepressant medication. Sexual dysfunction (SD) secondary...
UNLABELLED
Treatment-emergent sexual dysfunction (TESD) is one of the most frequent and persistent adverse effects of antidepressant medication. Sexual dysfunction (SD) secondary to SSRIs occurs in >60% of sexually active patients and >80% of healthy volunteers, with this causing treatment discontinuation in >35% of patients. However, this factor is rarely addressed in routine examinations, and only 15-30% of these events are spontaneously reported. A strategy of switching to a different non-serotonergic antidepressant could involve a risk of relapse or clinical worsening due to a lack of serotonergic activity. Vortioxetine appears to have less impact on sexual function due to its multimodal mechanism of action. No studies have been published on the effectiveness of switching to vortioxetine in patients with poorly tolerated long-term antidepressant-related SD in naturalistic settings.
STUDY OBJECTIVES
To determine the effectiveness of switching to vortioxetine due to SD in a routine clinical practice setting.
METHODOLOGY
observational pragmatic and naturalistic study to determine the effectiveness of the switch to vortioxetine (mean dosage 13.11 ± 4.03) in 74 patients aged 43.1 ± 12.65 (54% males) at risk of discontinuing treatment due to sexual dysfunction. The PRSexDQ*- SALSEX scale ( Psychotropic-Related Sexual Dysfunction Questionnaire) was applied at two moments: baseline visit and after 3 months of follow-up.
RESULTS
global Sexual Dysfunction (SD) measured with the SALSEX scale decreased significantly between the baseline visit (10.32; SD 2.73) and the follow-up visit (3.78; SD 3.68), < 0.001. There was a significant improvement ( < 0.001) at the endpoint including decreased libido, delay of orgasm, anorgasmia and arousal difficulties in both sexes. After switching to vortioxetine, 83.81% of patients experienced an improvement in sexual function (43.2% felt greatly improved). Most patients (83.3%) who switched to vortioxetine continued treatment after the follow-up visit. A total of 58.1% of patients showed an improvement in depressive symptoms from the baseline visit.
CONCLUSION
switching to vortioxetine is an effective and reliable strategy to treat patients with poorly tolerated previous antidepressant-related sexual dysfunction in real-life clinical settings.
PubMed: 38256680
DOI: 10.3390/jcm13020546 -
BMC Women's Health Jul 2023To estimate the pooled prevalence of sexual dysfunction (SD) in women with multiple sclerosis (MS). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To estimate the pooled prevalence of sexual dysfunction (SD) in women with multiple sclerosis (MS).
METHODS
We systematically searched PubMed, Scopus, EMBASE, Web of Science, and google scholar and also gray literature up to October 2021. The search strategy includes: ("Multiple Sclerosis" OR "MS" OR "Disseminated Sclerosis" OR (Disseminated AND Sclerosis) OR (Sclerosis AND Multiple)) AND ("Sexual Dysfunction" OR (Sexual AND Dysfunction) OR (Sexual AND Dysfunctions) OR (Sexual AND Disorders) OR (Sexual AND Disorder) OR "Sexual Dysfunctions" OR "Sexual Disorders" OR "Sexual Disorder" OR "Psychosexual Dysfunctions" OR (Dysfunction AND Psychosexual) OR (Dysfunctions AND Psychosexual) OR "Psychosexual Dysfunction" OR "Psychosexual Disorders" OR (Disorder AND Psychosexual) OR (Disorders AND Psychosexual) OR "Psychosexual Disorder" OR "Hypoactive Sexual Desire Disorder" OR "Sexual Aversion Disorder" OR (Aversion Disorders AND Sexual) OR (Disorders AND Sexual Aversion) OR "Sexual Aversion Disorders" OR "Orgasmic Disorder" OR (Disorders AND Orgasmic) OR "Orgasmic Disorders" OR "Sexual Arousal Disorder" OR (Arousal Disorders AND Sexual) OR (Disorders AND Sexual Arousal) OR "Sexual Arousal Disorders" OR "Frigidity").
RESULTS
We found 2150 articles by literature search, after deleting duplicates 1760 remained. Fifty-six articles remained for meta-analysis. The pooled prevalence of SD in MS patients estimated as 61% (95%CI:56-67%) (I:95.7%, P < 0.001). The pooled prevalence of Anorgasmia in MS patients estimated as 29% (95%CI:20-39%) (I:85.3%, P < 0.001). The pooled odds of developing SD in MS women estimated as 3.05(95%CI: 1.74-5.35) (I:78.3%, P < 0.001). The pooled prevalence of decreased vaginal lubrication in MS patients estimated as 32%(95%CI:27-37%) (I = 94.2%, P < 0.001). The pooled prevalence of reduced libido was 48%(95%CI:36-61%) (I:92.6%, P < 0.001). The pooled prevalence of arousal problems was 40%(95%CI: 26-54%) (I:97.4%, P < 0.001). The pooled prevalence of intercourse satisfaction was 27% (95%CI: 8-46%) (I:99%, P < 0.001).
CONCLUSION
The result of this systematic review and meta-analysis show that the pooled prevalence of SD in women with MS is 61% and the odds of developing SD in comparison with controls is 3.05.
Topics: Female; Humans; Prevalence; Sclerosis; Sexual Dysfunction, Physiological; Multiple Sclerosis; Sexual Dysfunctions, Psychological
PubMed: 37403051
DOI: 10.1186/s12905-023-02501-1 -
Sexual Medicine Dec 2023Anorgasmia is a poorly understood phenomenon defined as either a lifelong or acquired consistent inability to achieve ejaculation. Despite the prevalence of anorgasmia,...
INTRODUCTION
Anorgasmia is a poorly understood phenomenon defined as either a lifelong or acquired consistent inability to achieve ejaculation. Despite the prevalence of anorgasmia, there is currently no established treatment for the condition.
AIMS
To report a unique case of a patient with lifelong anorgasmia who was able to achieve his first orgasm with off-label use of flibanserin.
METHODS
The present case study relies on the patient's self-report and a review of the relevant literature. The patient provided written informed consent.
RESULTS
A 28-year-old male presented to our office with complaints of lifelong anorgasmia, without any signs of erectile dysfunction. He reported good libido and energy levels and denied any urinary symptoms or history of depression. The patient failed medical management with numerous off-label medications, including bupropion and bremelanotide. Despite having received 4 or 5 sex therapy sessions over 3 months, the patient reported that this treatment approach was not effective. Off-label use of flibanserin was then initiated, and after 28 to 32 doses over 4 weeks, he achieved his first orgasm. Notably, the patient experienced nocturia and insomnia. The follow-up International Index of Erectile Function score marginally improved by 2 points without any improvement in the overall satisfaction subdomain.
CONCLUSION
This case highlights the challenges of managing anorgasmia and anejaculation in a young male patient. A stepwise approach involving pharmacotherapy and sex therapy was not successful. However, the off-label use of flibanserin ultimately resulted in the patient achieving his first orgasm, albeit with some side effects. Further studies are needed to evaluate the efficacy and safety of flibanserin in men for this indication.
PubMed: 38222292
DOI: 10.1093/sexmed/qfad066 -
BMC Psychiatry May 2024This study aims to conduct an exhaustive evaluation of Vilazodone's safety in clinical application and to unearth the potential adverse event (AE) risks associated with...
OBJECTIVE
This study aims to conduct an exhaustive evaluation of Vilazodone's safety in clinical application and to unearth the potential adverse event (AE) risks associated with its utilization based on FDA Adverse Event Reporting System (FAERS) database.
METHODS
This research employed data spanning from the first quarter of 2011 to the third quarter of 2023 from the FAERS database. Various signal detection methodologies, including the Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), and Empirical Bayesian Geometric Mean (EBGM), were utilized to ascertain the correlation between Vilazodone and specific AEs.
RESULTS
The study compiled a total of 17,439,268 reports of drug AEs, out of which 5,375 were related to Vilazodone. Through signal mining, 125 Preferred Terms (PTs) encompassing 27 System Organ Classes (SOCs) were identified. The findings indicated a higher prevalence among females and patients within the 45 to 65 age bracket. The principal categories of AEs included Psychiatric disorders, Nervous system disorders, and Gastrointestinal disorders, with prevalent incidents of Diarrhoea, Nausea, and Insomnia. Moreover, the study identified robust signals of novel potential AEs, notably in areas such as sleep disturbances (Sleep paralysis, Hypnagogic hallucination, Rapid eye movements sleep abnormal, Sleep terror, Terminal insomnia, Tachyphrenia), sexual dysfunctions (Female orgasmic disorder, Orgasm abnormal, Disturbance in sexual arousal, Spontaneous penile erection, Anorgasmia, Sexual dysfunction, Ejaculation delayed), and other symptoms and injuries (Electric shock sensation, Violence-related symptom, Gun shot wound).
CONCLUSION
Although Vilazodone presents a positive prospect in the management of MDD, the discovery of AEs linked to its use, particularly the newly identified potential risks such as sleep and sexual dysfunctions, necessitates heightened vigilance among clinicians.
Topics: Humans; Vilazodone Hydrochloride; Male; Female; Adverse Drug Reaction Reporting Systems; Middle Aged; United States; Adult; Aged; Databases, Factual; United States Food and Drug Administration; Young Adult; Adolescent; Bayes Theorem
PubMed: 38755677
DOI: 10.1186/s12888-024-05813-0 -
Cureus Dec 2023Epilepsy is a chronic neurological disorder characterized by recurrent seizures, necessitating lifelong medication management. One common side effect of these...
Epilepsy is a chronic neurological disorder characterized by recurrent seizures, necessitating lifelong medication management. One common side effect of these medications is sexual dysfunction. In this case report, a 37-year-old male epilepsy patient who was an office clerk by occupation presented at the outpatient department (OPD) of occupational therapy with the chief complaints of anxiety, depression, and sexual dysfunction primarily reporting of anorgasmia, which required longer foreplay to reach an effective erection leading to delayed ejaculation. The patient reported a nine-year history of complicated, partial, and generalized seizures for which he consulted the physician who prescribed him AED (antiepileptic drug) carbamazepine twice a day; however, the symptoms persisted, and the medication was changed to pregabalin. In addition to this, the patient was advised for occupational therapy intervention by the physician. In the occupational therapy department, the patient was assessed for various parameters that involved sexual functioning using the Changes in Sexual Functioning Questionnaire-Male (CSFQ-M), for anxiety using the Generalised Anxiety Disorder-7 (GAD-7) questionnaire, for depression using the Patient Health Questionnaire-9 (PHQ-9), and quality of life (QOL) using the Quality of Life in Epilepsy Inventory - 31 (QOLIE-31) questionnaire. As part of the intervention, occupational therapy was provided to the patient for four months, which mainly focused on three major areas: health promotion, remediation, and modification. Each of these methods was used at all levels of the intervention, as outlined by the EX-Permission, Limited Information, Specific Suggestions, and Intensive Therapy model (P-LI-SS-IT), which reflected positive results, as there was enhanced sexual functioning, reduced symptoms of depression, and anxiety, and improved quality of life. In conclusion, occupational therapists along with doctors and other practitioners should focus on addressing intimacy and sexuality within their practice for epilepsy patients demonstrating symptoms of sexual dysfunction, which will consequently impact an individual's QOL. Additionally, screening and monitoring of sexual dysfunction should be included during the routine assessment of patients with epilepsy.
PubMed: 38283457
DOI: 10.7759/cureus.51153 -
Sexual Medicine Dec 2023Low-dose-rate brachytherapy (LDR-B) is an established treatment for localized prostate cancer. However, while erectile function is relatively well documented, other...
BACKGROUND
Low-dose-rate brachytherapy (LDR-B) is an established treatment for localized prostate cancer. However, while erectile function is relatively well documented, other changes in sexual function are sparsely investigated.
AIM
The study sought to investigate orgasmic dysfunction, urinary incontinence during sexual activity (UIS), changes in penile morphology, and sensory disturbances in the penis following LDR-B.
METHODS
A cross-sectional questionnaire-based study in patients who underwent LDR-B at our center from 2010 to 2020. The questionnaire included the International Index of Erectile Function-Erectile Function Domain (IIEF-EF) and questions on orgasm, UIS, changes in penile morphology, and penile sensory disturbances.
OUTCOMES
Outcomes were prevalence rates of altered perception of orgasm, orgasm associated pain, anejaculation, UIS, alterations in penile morphology, penile sensory disturbances, and predictors of these side effects.
RESULTS
Overall, 178 patients responded to the questionnaire. The median age was 70 years (range, 51-83 years), and the median time since LDR-B was 93 months (range, 21-141 months).Overall, 142 (80%) were sexually active and 126 (70.8%) had erectile dysfunction (ED). Of the sexually active patients, 8 (5.6%) reported anejaculation and 7 (4.9%) reported anorgasmia. Another 67 (46.9%) had decreased orgasmic intensity, while 69 (49.3%) reported an increased time to orgasm. Twenty-six (18.3%) patients had experienced orgasm-associated pain with a median visual analog pain score of 2. Considering overlap, 44 (31.0%) patients had an unchanged orgasmic function. Six (3.3%) patients had experienced UIS at least a few times. Penile length loss was reported by 45 (25.2%) patients. Seventeen (9.6%) patients reported an altered curvature of their penis and 9 (5%) had experience painful erection. Thirty-three (18.5%) patients had experienced decreased penile sensitivity. On multivariate analyses, ED was the only independent risk factor for altered perception of orgasm (odds ratio [OR], 6.6; < .0001), orgasmic pain (OR, 5.5; = .008), and penile shortening (OR, 4.2; < .0056). No independent risk factors were identified for UIS or sensory penile disturbances.
CLINICAL IMPLICATIONS
Patients undergoing LDR-B should be adequately informed about possible side effects, and clinicians should inquire about these during follow-up visits.
STRENGTH AND LIMITATIONS
We are the first to comprehensively explore the previously neglected side effects of LDR-B for prostate cancer. Limitations are the cross-sectional design assessing the cohort at different time points following their treatment and the response rate.
CONCLUSIONS
Orgasmic dysfunction, changes in penile morphology, and sensory disturbances in the penis are common side effects of LDR-B for prostate cancer. UIS is only experienced by a small minority.
PubMed: 38074492
DOI: 10.1093/sexmed/qfad064