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Journal of the American Academy of... Jul 2019Prescription medications are among the most common causes of sexual dysfunction, and patients are often hesitant to seek help when experiencing these symptoms.
BACKGROUND
Prescription medications are among the most common causes of sexual dysfunction, and patients are often hesitant to seek help when experiencing these symptoms.
OBJECTIVE
In this review, we identify the available evidence of sexual adverse effects in men using systemic dermatologic medications and suggest screening protocols and actions that may improve a patient's symptoms where possible.
METHODS
A systematic review was conducted of all articles in the PubMed database published from the time of inception to May 2018 to identify studies evaluating the use of systemic dermatologic medications in men with evidence of sexual adverse effects. Subsequently, a secondary in-depth literature review was performed for each individual medication.
RESULTS
There were 5497 articles reviewed in the primary systematic review, and 59 articles covering 11 systemic dermatologic medications met inclusion criteria. We identified level 1 evidence for sexual adverse effects as a primary outcome in patients taking finasteride.
LIMITATIONS
Many included studies were limited by sample size and methodology.
CONCLUSION
The information in this review may serve as a reference of adverse effects when deciding on a therapeutic agent and a guide to help identify patients to screen for sexual dysfunction.
Topics: Adrenal Cortex Hormones; Adult; Age Factors; Cyclosporine; Dermatologic Agents; Finasteride; Humans; Itraconazole; Male; Middle Aged; Prevalence; Prognosis; Risk Assessment; Sexual Dysfunction, Physiological
PubMed: 30905792
DOI: 10.1016/j.jaad.2019.03.043 -
Clinical Interventions in Aging 2019We performed a meta-analysis to evaluate the efficacy and safety of dutasteride and finasteride in treating men with androgenetic alopecia (AGA) during a 24-week...
AIM
We performed a meta-analysis to evaluate the efficacy and safety of dutasteride and finasteride in treating men with androgenetic alopecia (AGA) during a 24-week treatment cycle.
METHODS
Randomized controlled trials of dutasteride and finasteride for treating AGA were searched using MEDLINE, EMBASE, and the Cochrane Controlled Trials Register. The data were calculated using Rev Man v5.3.0. The reference lists of retrieved studies were also investigated.
RESULTS
Three articles including 576 participants which compared dutasteride with finasteride were selected for our analysis. The mean change in total hair count (mean difference [MD], 28.57; 95% CI, 18.75-38.39; <0.00001), investigator's assessment of global photographs for the vertex (MD, 0.68; 95% CI, 0.13-1.23; =0.02) and frontal (MD, 0.63; 95% CI, 0.13-1.13; =0.01) views, panel global photographic assessment for the vertex (MD, 0.17; 95% CI, 0.09-0.24; <0.00001) and frontal (MD, 0.25; 95% CI, 0.18-0.31; <0.00001) views, and subjects' assessment (MD, 0.56; 95% CI, 0.18-0.94; =0.003) suggested that dutasteride provided a better efficacy in treating men with AGA compared with finasteride. With regard to the assessment of safety, altered libido (=0.54), erectile dysfunction (=0.07), and ejaculation disorders (=0.58), dutasteride did not show a significant difference compared with finasteride.
CONCLUSION
Dutasteride seems to provide a better efficacy compared with finasteride in treating AGA. The two drugs appear to show similar rates of adverse reactions, especially in sexual dysfunction.
Topics: 5-alpha Reductase Inhibitors; Adult; Alopecia; Dutasteride; Finasteride; Humans; Male; Middle Aged; Safety; Treatment Outcome; Young Adult
PubMed: 30863034
DOI: 10.2147/CIA.S192435 -
Sexual Medicine Reviews Jan 2020The literature showed the need for a better understanding of the male sexual response, which has historically been considered as simpler and more mechanistic compared...
INTRODUCTION
The literature showed the need for a better understanding of the male sexual response, which has historically been considered as simpler and more mechanistic compared with that in women.
AIM
To examine the literature on biopsychosocial factors associated with the level of sexual desire in men and discuss some interesting directions for future research.
METHODS
A systematic literature review was conducted.
MAIN OUTCOME MEASURES
169 articles published in Google Scholar, Web of Science, Scopus, EBSCO, and Cochrane Library about male sexual desire and related biopsychosocial factors.
RESULTS
We found a lack of multidimensional studies on male sexual desire. Most existing research has focused on hypoactive sexual desire disorder in coupled heterosexual men. Biological factors play important roles in the level of sexual desire, but they are insufficient to explain the male sexual response. Psychological, relational, and sexual factors (eg depression, anxiety, emotions, attraction, conflicts, communication, sexual functioning, distress, satisfaction) are involved in the development/maintenance of lack of sexual interest in men. Cultural influence is also relevant, with cognitive factors linked to gender roles and sexual scripts of masculinity identified as important predictors of low sexual desire.
CONCLUSION
Male sexual desire is characterized by an interplay among biological, psychological, sexual, relational, and cultural elements. This interplay merits further study to better understand how sexual desire works and how treatments for low sexual interest could be improved. Nimbi FM,Tripodi F, Rossi R, et al. Male Sexual Desire: An Overview of Biological, Psychological, Sexual, Relational, and Cultural Factors Influencing Desire. Sex Med Rev 2020;8:59-91.
Topics: Cultural Characteristics; Humans; Interpersonal Relations; Libido; Male; Sexual Behavior
PubMed: 30803921
DOI: 10.1016/j.sxmr.2018.12.002 -
Obstetrics and Gynecology Feb 2019Counseling about potential side effects and health benefits of contraceptive methods could facilitate continued method use and method satisfaction, yet no evidence-based...
OBJECTIVE
Counseling about potential side effects and health benefits of contraceptive methods could facilitate continued method use and method satisfaction, yet no evidence-based compilation of side effects and benefits exists to aid such counseling. Among contraceptive methods in the United States, depot medroxyprogesterone acetate (DMPA) injectables have the highest discontinuation rates, and most discontinuation is attributable to side effects. This review examines the side effects and health benefits of DMPA to inform counseling.
DATA SOURCES
We searched PubMed, POPLINE, EMBASE, Web of Science, Campbell Collaboration Library of Systematic Reviews, the Cochrane Database of Systematic Reviews, the Cochrane Center Register of Controlled Trials, and ClinicalTrials.gov.
METHODS OF STUDY SELECTION
We included English-language studies published from 1985 to 2016 that enrolled healthy, nonbreastfeeding females aged 13-49 years at risk of unintended pregnancy, compared intramuscular or subcutaneous progestin-only injectables to a contemporaneous comparison group, and addressed at least one key question: 1) What side effects are associated with progestin-only injectable contraceptive use? 2) What health benefits are associated with progestin-only injectable contraceptive use? Study quality was assessed using criteria from the U.S. Preventive Services Task Force.
TABULATION, INTEGRATION, AND RESULTS
Twenty-four studies met inclusion criteria. None were randomized controlled trials. There were 13 prospective cohort, five retrospective cohort, four case-control, and two cross-sectional studies. Studies of moderate or high risk of bias suggest an association between DMPA use and weight gain, increased body fat mass, irregular bleeding, and amenorrhea. Inconsistent evidence exists for an association between DMPA use and mood or libido changes. Limited evidence exists for an association between DMPA use and decreased risk of cancers and tubal infertility.
CONCLUSION
Higher-quality research is needed to clarify DMPA's side effects and benefits. In absence of such evidence, patient-centered counseling should incorporate the available evidence while acknowledging its limitations and recognizing the value of women's lived experiences.
Topics: Contraceptive Agents, Female; Delayed-Action Preparations; Female; Humans; Long-Acting Reversible Contraception; Medroxyprogesterone Acetate
PubMed: 30633132
DOI: 10.1097/AOG.0000000000003089 -
Clinical Endocrinology Mar 2019The clinical sequelae of oestrogen deficiency during menopause are undoubted. However, the pathophysiological role of testosterone during the menopause is less clear....
The clinical sequelae of oestrogen deficiency during menopause are undoubted. However, the pathophysiological role of testosterone during the menopause is less clear. Several randomized, placebo-controlled clinical trials suggest that testosterone therapy improves sexual function in postmenopausal women. Some studies suggest that testosterone therapy has additional effects, which include increased bone mineral density and decreased serum high-density lipoprotein (HDL) cholesterol. Furthermore, the long-term safety profile of testosterone therapy in postmenopausal women is not clear. This article will provide a concise and critical summary of the literature, to guide clinicians treating postmenopausal women.
Topics: Androgens; Female; Hormone Replacement Therapy; Humans; Postmenopause; Randomized Controlled Trials as Topic; Sexual Dysfunction, Physiological; Testosterone
PubMed: 30488972
DOI: 10.1111/cen.13906 -
BMC Medical Research Methodology Oct 2018Sexual desire is one of the domains of sexual function with multiple dimensions, which commonly affects men and women around the world. Classically, its assessment has...
BACKGROUND
Sexual desire is one of the domains of sexual function with multiple dimensions, which commonly affects men and women around the world. Classically, its assessment has been applied through self-report tools; however, an issue is related to the evidence level of these questionnaires and their validity. Therefore, a systematic review addressing the available questionnaires is really relevant, since it will be able to show their psychometric properties and evidence levels.
METHOD
A systematic review was carried out in the PubMed, EMBASE, PsycINFO, Science Direct, and Web of Science databases. The search strategy was developed according to the following research question and combination of descriptors and keywords, including original studies with no limit of publication date and in Portuguese, English, and Spanish. Two reviewers carried out the selection of articles by abstracts and full texts as well as the analysis of the studies independently. The methodological quality of the instruments was evaluated by the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist.
RESULTS
The search resulted in 1203 articles, of which 15 were included in the review. It identified 10 instruments originally developed in the English language. Unsatisfactory results on methodological quality were evidenced in cultural adaptation studies with no description of the steps of the processes and inadequacy of techniques and parameters of adequacy for models. The Principal Component Analysis with Varimax rotation predominated in the studies.
CONCLUSIONS
The limitation of the techniques applied in the validation process of the reviewed instruments was evident. A limitation was observed in the number of adaptations conducted and contexts to which the instruments were applied, making it impossible to reach a better understanding of the functioning of instruments. In future studies, the use of robust techniques can ensure the quality of the psychometric properties and the accuracy and stability of instruments. A detailed description of procedures and results in validation studies may facilitate the selection and use of instruments in the academic and/or clinical settings.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42018085706.
Topics: Data Accuracy; Databases, Bibliographic; Female; Humans; Male; Psychometrics; PubMed; Self Report; Sexual Behavior; Surveys and Questionnaires
PubMed: 30340533
DOI: 10.1186/s12874-018-0570-2 -
Maturitas Oct 2018There is uncertainty whether treatment with dehydroepiandrosterone (DHEA) decreases menopausal symptoms for women in the peri- or postmenopausal phase. A previous... (Review)
Review
OBJECTIVE
There is uncertainty whether treatment with dehydroepiandrosterone (DHEA) decreases menopausal symptoms for women in the peri- or postmenopausal phase. A previous systematic review considering this subject suggested that DHEA may slightly improve sexual function compared with placebo (CS. Scheffers, S. Armstrong, AEP. Cantineau, C. Farquhar, V. Jordan Dehydroepiandrosterone for women in the peri- or postmenopausal phase. Cochrane Database of Systematic Reviews 2015, Issue 1. Art. No.: CD011066. DOI: https://doi.org/10.1002/14651858.CD011066.pub2). The purpose of this article is to review recent research investigating whether the use of DHEA, and in particular intravaginal DHEA (Prasterone), improves sexual function.
METHODS
We conducted an online search using Medline OVID for recent articles related to DHEA and menopause. We found 48 relevant publications, out of which 14 papers were original research, all related to the development and licensing of intravaginal DHEA. We critically analysed these 14 articles in relation to sexual function.
RESULTS
All the randomised controlled trials assessed the efficacy of vaginal DHEA in women with vulvovaginal atrophy and showed that sexual dysfunction improved with treatment regardless of the level of dyspareunia at baseline. Treatment with DHEA was found to be superior to placebo and at least as efficacious as vaginal oestrogens in improving symptoms.
CONCLUSION
Intravaginal DHEA appears to be a safe and effective treatment for menopausal vulvovaginal atrophy and dyspareunia in most women. Further studies are required before it can be recommended for women with a history of thrombosis, cardiovascular disease or hormone-sensitive neoplasms.
Topics: Administration, Intravaginal; Dehydroepiandrosterone; Female; Humans; Perimenopause; Postmenopause; Randomized Controlled Trials as Topic; Sexual Dysfunction, Physiological; Treatment Outcome
PubMed: 30244783
DOI: 10.1016/j.maturitas.2018.07.016 -
Acta Dermato-venereologica Jan 2019Treatment of male androgenetic alopecia with 5α-reductase inhibitors is efficacious. However, the risk of adverse sexual effects remains controversial. This systematic... (Meta-Analysis)
Meta-Analysis
Treatment of male androgenetic alopecia with 5α-reductase inhibitors is efficacious. However, the risk of adverse sexual effects remains controversial. This systematic review and meta-analysis investigated the risk of adverse sexual effects due to treatment of androgenetic alopecia in male patients with finasteride, 1 mg/day, or dutasteride, 0.5 mg/day. Fifteen randomized double-blinded placebo-controlled trials (4,495 subjects) were meta-analysed. Use of 5α-reductase inhibitors carried a 1.57-fold risk of sexual dysfunction (95% confidence interval (95% CI) 1.19-2.08). The relative risk was 1.66 (95% CI 1.20-2.30) for finasteride and 1.37 (95% CI 0.81-2.32) for dutasteride. Both drugs were associated with an increased risk, although the increase was not statistically significant for dutasteride. As studies into dutasteride were limited, further trials are required. It is important that physicians are aware of, and assess, the possibility of sexual dysfunction in patients treated with 5α-reductase inhibitors.
Topics: 5-alpha Reductase Inhibitors; Administration, Oral; Alopecia; Dutasteride; Ejaculation; Erectile Dysfunction; Finasteride; Humans; Libido; Male; Randomized Controlled Trials as Topic; Risk Assessment; Risk Factors; Sexual Behavior; Sexual Dysfunction, Physiological
PubMed: 30206635
DOI: 10.2340/00015555-3035 -
Climacteric : the Journal of the... Oct 2018This systematic review and meta-analysis aimed to critically evaluate the effectiveness of phytoestrogens on sexual disorders and severity of dyspareunia. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This systematic review and meta-analysis aimed to critically evaluate the effectiveness of phytoestrogens on sexual disorders and severity of dyspareunia.
MATERIALS AND METHODS
Relevant studies were identified through a systematic search of major databases such as PubMed, Cochrane Library, ISI Web of Science, and Scopus up to 29 September 2017, without any time limit. Two independent reviewers screened all abstracts and full-text articles. The final version of Jadad scale was used for evaluating the quality of trials.
RESULTS
Soy did not have an effect on sexual function (standardized mean difference [SMD] = 1.099 [95% CI: -3.033 to 0.835, p = 0.265]; heterogeneity I=80%; p = 0.006; random-effect model; three trials) but improved dyspareunia (p > 0.05). Red clover showed no significant effect on sexual function (SMD = -0.087 [95% CI: -0.936 to 0.763, p = 0.842]; heterogeneity I=0%, p = 0.397; fixed-effect model; two trials) and sexual satisfaction (p > 0.05). Phytoestrogens isolated from Lepidium meyenii, Foeniculum vulgare, and maritime pine bark as well as Trigonella foenum-graecum L. significantly improved sexual function. In contrast, phytoestrogens isolated from Korean red ginseng and flaxseed did not lead to significant effect on sexual function. The positive effects of Trigonella foenum-graecum L. were observed on libido.
CONCLUSION
Phytoestrogens have various effects on sexual function. Published reports show that maritime pine bark, T. foenum-graecum L., and F. vulgare could be considered as agents to overcome sexual dysfunctions while soy, red clover, genistein, and flaxseed had no promising effects on these conditions.
Topics: Dyspareunia; Female; Hot Flashes; Humans; Isoflavones; Menopause; Middle Aged; Phytoestrogens; Phytotherapy; Plant Preparations; Plants, Medicinal; Randomized Controlled Trials as Topic; Sexual Dysfunction, Physiological
PubMed: 30156931
DOI: 10.1080/13697137.2018.1472566 -
Sexual Medicine Reviews Jan 2019There is limited evidence that current sexuality measures accurately reflect the experience of sexuality among older people.
BACKGROUND
There is limited evidence that current sexuality measures accurately reflect the experience of sexuality among older people.
AIM
This review investigates whether sexuality scales that examine aspects of sexuality for heterosexual men and women in mid-life and beyond accurately reflect the experiences of these individuals as discussed within qualitative studies.
METHODS
Online databases and reference lists were searched for articles from 1997 that investigated experiences of sexuality, aging, and validated sexuality scales. Articles describing scales were included if they reported on a statistically validated measurement scale that was used to measure 1 or more aspects of sexuality for heterosexual adults aged 45 years and above. Qualitative articles were included if they discussed the sexuality experiences of this population.
OUTCOMES
19 Qualitative articles and 11 sexuality scales were located.
RESULTS
Aspects of sexuality identified in the qualitative studies were sexual thoughts and fantasies, sexual desire, sexual beliefs, sexual attitudes, sexual values, sexual behaviors and practices, sexual roles, and thoughts and/or feelings about intimacy and relationships. Aspects assessed in the sexuality scales were sexual desire, sexual beliefs, sexual attitudes, sexual behaviors and practices, sexual roles, and thoughts and/or feelings about intimacy and relationships. Gaps between how sexuality at mid-life and later life is experienced and how it is measured in existing scales were found. Existing validated measurement tools fail to provide a nuanced picture of the sexual experiences of adults in mid-life and beyond, which may impact the success of clinical interventions. This article demonstrated the need for more comprehensive sexuality measurement scales. However, it focused exclusively on the experiences of heterosexual adults aged 45 years and above.
CONCLUSION
To validly evaluate the sexual expression of older people, new measurement scales are needed that assess multiple aspects of sexuality within a single scale. Macleod A, McCabe MP. How Well Do Measurement Scales Reflect the Actual Experience of Sexuality in Mid-Life and Beyond? Sex Med Rev 2019;7:29-45.
Topics: Aged; Aging; Attitude; Data Interpretation, Statistical; Female; Health Surveys; Humans; Libido; Male; Middle Aged; Psychometrics; Reproducibility of Results; Sexual Behavior; Sexual Dysfunction, Physiological; Sexual Partners
PubMed: 30057138
DOI: 10.1016/j.sxmr.2018.04.004