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Hormones and Behavior Feb 2016Both estradiol and testosterone have been implicated as the steroid critical for modulating women's sexual desire. By contrast, in all other female mammals only... (Review)
Review
Both estradiol and testosterone have been implicated as the steroid critical for modulating women's sexual desire. By contrast, in all other female mammals only estradiol has been shown to be critical for female sexual motivation and behavior. Pharmaceutical companies have invested heavily in the development of androgen therapies for female sexual desire disorders, but today there are still no FDA approved androgen therapies for women. Nonetheless, testosterone is currently, and frequently, prescribed off-label for the treatment of low sexual desire in women, and the idea of testosterone as a possible cure-all for female sexual dysfunction remains popular. This paper places the ongoing debate concerning the hormonal modulation of women's sexual desire within a historical context, and reviews controlled trials of estrogen and/or androgen therapies for low sexual desire in postmenopausal women. These studies demonstrate that estrogen-only therapies that produce periovulatory levels of circulating estradiol increase sexual desire in postmenopausal women. Testosterone at supraphysiological, but not at physiological, levels enhances the effectiveness of low-dose estrogen therapies at increasing women's sexual desire; however, the mechanism by which supraphysiological testosterone increases women's sexual desire in combination with an estrogen remains unknown. Because effective therapies require supraphysiological amounts of testosterone, it remains unclear whether endogenous testosterone contributes to the modulation of women's sexual desire. The likelihood that an androgen-only clinical treatment will meaningfully increase women's sexual desire is minimal, and the focus of pharmaceutical companies on the development of androgen therapies for the treatment of female sexual desire disorders is likely misplaced.
Topics: Estradiol; Female; Hormone Replacement Therapy; Humans; Libido; Postmenopause; Testosterone
PubMed: 26589379
DOI: 10.1016/j.yhbeh.2015.11.003 -
The Journal of Sexual Medicine Aug 2021Women treated for rectal cancer are at risk of sexual dysfunction and impaired ovarian androgen production.
BACKGROUND
Women treated for rectal cancer are at risk of sexual dysfunction and impaired ovarian androgen production.
AIM
To investigate a possible association between serum levels of endogenous androgens and sexual function in women with rectal cancer.
METHODS
Women diagnosed with stage I-III rectal cancer were consecutively included and prospectively followed with the Female Sexual Function Index (FSFI) questionnaire from baseline to 2 years postoperatively and blood samples for hormone analyses, baseline to 1 year. Androgens were measured with liquid chromatography-mass spectrometry and electrochemiluminescence. The associations between the 4 measured androgens (testosterone, free testosterone, androstenedione, and dehydroepiandrosterone sulphate) and sexual function were assessed with generalized least squares random effects regression analysis in sexually active women.
OUTCOMES
The primary outcome measure was the mean change observed in the FSFI total score when the serum androgen levels changed with one unit. Secondary outcomes were the corresponding mean changes in the FSFI domain scores: sexual desire, arousal, lubrication, orgasm, satisfaction, and pain/discomfort.
RESULTS
In the 99 participants, the median FSFI total score decreased from 21.9 (range 2.0 - 36.0) to 16.4 (3.5 - 34.5) and 11.5 (2.0 to 34.8) at 1 and 2-years follow-up. After adjustment for age, partner, psychological well-being, preoperative (chemo)radiotherapy, and surgery, total testosterone and androstenedione were significantly associated with FSFI total score (β-coefficients 3.45 (95% CI 0.92 - 5.97) and 1.39 (0.46 - 2.33) respectively). Testosterone was significantly associated with the FSFI-domains lubrication and orgasm, free testosterone with lubrication, androstenedione with all domains except desire and satisfaction, and dehydroepiandrosterone sulphate with none of the domains.
STRENGTHS AND LIMITATIONS
This is the first study investigating whether androgen levels are of importance for the impaired sexual function seen in women following rectal cancer treatment. The prospective design allows for repeated measures and the use of the FSFI for comparisons across studies. No laboratory data were collected at the 2-year follow-up, and the missing data could have further clarified the studied associations.
CONCLUSION AND CLINICAL IMPLICATION
Testosterone and androstenedione were associated with sexual function in female rectal cancer patients. The results are of interest for future intervention studies and contribute to the understanding of sexual problems, which is an essential component of the rehabilitation process in pelvic cancer survivors. Svanström Röjvall A, Buchli C, Flöter Rådestad A, et al. Impact of Androgens on Sexual Function in Women With Rectal Cancer - A Prospective Cohort Study. J Sex Med 2021;18:1374-1382.
Topics: Androgens; Female; Humans; Libido; Orgasm; Prospective Studies; Rectal Neoplasms; Surveys and Questionnaires
PubMed: 34284953
DOI: 10.1016/j.jsxm.2021.05.018 -
Cancer Control : Journal of the Moffitt... Jul 2006Compromised sexual function is often a side effect for patients following radical surgical procedures for bladder or prostate cancer. (Review)
Review
BACKGROUND
Compromised sexual function is often a side effect for patients following radical surgical procedures for bladder or prostate cancer.
METHODS
The authors review the classification and physiology of sexual function and dysfunction. Moreover, they explain the possible pathophysiology directly resulting from surgery, and they discuss several approaches available to address these problems.
RESULTS
Options for male sexual dysfunction, primarily erectile dysfunction resulting from radical prostatectomy or surgery for bladder cancer, range from patient education to penile prosthesis implantation. Female sexual dysfunction caused by surgical intervention for bladder cancer includes problems with libido, arousal, orgasm, and dyspareunia. Treatment options for women can include sex therapy, hormonal therapy, and preventive strategies. However, no consensus has been established on the most effective agents and time points to treat male or female sexual dysfunction following radical cystectomies or prostatectomies. The chronic intermittent treatment of erectile dysfunction following radical prostatectomy has been commonly referred to as penile rehabilitation.
CONCLUSIONS
Additional research is needed to obtain further data concerning sexual dysfunction in both men and women following radical pelvic surgeries. Modification of surgical techniques, the use of various treatment modalities for sexual dysfunction, and the development of new agents will help to successfully minimize or prevent damage and restore normal sexual function after local surgical therapy for prostate or bladder cancer in the future.
Topics: Erectile Dysfunction; Female; Humans; Libido; Male; Prostatectomy; Prostatic Neoplasms; Urinary Bladder Neoplasms
PubMed: 16885913
DOI: 10.1177/107327480601300304 -
Clinical Diabetes : a Publication of... 2023Male reproductive disorders are a less discussed complication of diabetes. These disorders can include balanitis, erectile dysfunction, decreased libido, erectile...
Male reproductive disorders are a less discussed complication of diabetes. These disorders can include balanitis, erectile dysfunction, decreased libido, erectile impotence, and infertility. This article reviews the epidemiology, pathophysiology, classic presentation, and treatment of balanitis, erectile dysfunction, and sperm dysfunction.
PubMed: 37092160
DOI: 10.2337/cd21-0121 -
Frontiers in Bioscience (Scholar... Jan 2012The area of natural product research is rapidly progressing from traditional medicine to modern medicine having proper scientific basis of its usage. However,... (Review)
Review
The area of natural product research is rapidly progressing from traditional medicine to modern medicine having proper scientific basis of its usage. However, identifying the active constituent or the basis of its mechanism holds the key to synthesis of these drugs in the laboratory. Traditional Indian literature such as Ayurveda has listed several plant and animal based resources for treatment of almost every ailment. Erectile dysfunction and male sexual debilities are among the most explored areas in traditional medicine. A number of natural products, mostly plant based, have been claimed to cure erectile dysfunction and related male sexual debilities. These products often are aphrodisiac and have multi-fold effects on male reproductive system. This review aims at compiling the animal and plant based resources which bear promise of treating loss of libido and erectile dysfunction. A special emphasis is paid to find out scientific basis of their usage. The identification of potential resources could help undertake further studies to establish their possible mechanism of action; opening the doors to proper clinical trials for human use.
Topics: Animals; Aphrodisiacs; Biological Products; Erectile Dysfunction; Female; Humans; Libido; Male; Medicine, Traditional; Plant Extracts; Sexual Behavior; Sexual Dysfunction, Physiological
PubMed: 22202051
DOI: 10.2741/s259 -
Safety of Flibanserin in Women Treated With Antidepressants: A Randomized, Placebo-Controlled Study.The Journal of Sexual Medicine Jan 2018Depression is often associated with sexual dysfunction, and pharmacologic treatment for hypoactive sexual desire disorder can be considered in women receiving treatment... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Depression is often associated with sexual dysfunction, and pharmacologic treatment for hypoactive sexual desire disorder can be considered in women receiving treatment for depression.
AIM
To evaluate the safety of flibanserin in women treated for depression with selective serotonin reuptake inhibitors or serotonin and norepinephrine reuptake inhibitors.
METHODS
In this double-blinded, randomized, placebo-controlled trial, women with remitted or mild depression treated with selective serotonin reuptake inhibitors or serotonin and norepinephrine reuptake inhibitors who were not postmenopausal and were experiencing symptoms of hypoactive sexual desire disorder (ie, decreased sexual desire and related distress) received flibanserin 50 mg at bedtime (qhs) for 2 weeks and up-titrated to 100 mg qhs, flibanserin 100 mg qhs for the entire treatment period, or placebo for up to 12 weeks.
OUTCOMES
Safety assessment included adverse events and symptoms of depression and anxiety.
RESULTS
73 patients were randomly assigned to flibanserin (both dose groups combined) and 38 to placebo. The sponsor terminated the study early at discontinuation of the development of flibanserin. Treatment duration was at least 8 weeks for 84.9% and 94.7% of patients in the flibanserin and placebo groups, respectively. The most common adverse events (incidence ≥ 2% in the flibanserin group and higher than that in the placebo group) included dry mouth (5.5% for flibanserin vs 2.6% for placebo), insomnia (5.5% vs 2.6%), back pain (4.1% vs 2.6%), and dizziness (4.1% vs 0.0%). There were no serious adverse events and no instances of suicidal ideation or behavior. The proportions of patients with symptom worsening in the flibanserin and placebo groups, respectively, were 6.9% and 21.6% for depression and 1.4% and 2.7% for anxiety. Remission of depression at study end point, as measured by the Quick Inventory of Depressive Symptomatology-Self Report, was experienced by 19.4% of flibanserin-treated patients and 10.8% of patients receiving placebo; remission of anxiety based on the Beck Anxiety Inventory was noted in 16.4% and 2.7% of patients, respectively.
CLINICAL IMPLICATIONS
The results of this study support the safety of flibanserin in premenopausal women being treated with a serotonergic antidepressant. No increased risks were observed when adding flibanserin to a stable selective serotonin reuptake inhibitor or serotonin and norepinephrine reuptake inhibitor treatment regimen.
STRENGTHS AND LIMITATIONS
This was a well-designed, randomized, placebo-controlled trial. The primary limitation was the early study discontinuation by the sponsor, which decreased the sample size and duration of treatment.
CONCLUSION
In this small trial, flibanserin 100 mg qhs was generally safe and well tolerated in premenopausal women with mild or remitted depression taking a serotonergic antidepressant. Clayton AH, Croft HA, Yuan J, et al. Safety of Flibanserin in Women Treated With Antidepressants: A Randomized, Placebo-Controlled Study. J Sex Med 2018;15:43-51.
Topics: Adult; Antidepressive Agents; Benzimidazoles; Depression; Dizziness; Double-Blind Method; Female; Humans; Libido; Middle Aged; Premenopause; Selective Serotonin Reuptake Inhibitors; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological
PubMed: 29289374
DOI: 10.1016/j.jsxm.2017.11.005 -
Archivio Italiano Di Urologia,... Sep 2015Andrology is a constantly evolving discipline, embracing social problems like pedophilia and its pharmacological treatment. With regard to chemical castration, the... (Review)
Review
Andrology is a constantly evolving discipline, embracing social problems like pedophilia and its pharmacological treatment. With regard to chemical castration, the andrologist may perform an important role as part of a team of specialists. At present, no knowledge is available regarding hormonal, chromosomal or genetic alterations involved in pedophilia. International legislation primarily aims to defend childhood, but does not provide for compulsory treatment. We reviewed international literature that, at present, only comprises a few reports on research concerning androgen deprivation. Most of these refer to the use of leuprolide acetate, rather than medroxyprogesterone and cyproterone acetate, which present a larger number of side effects. Current opinions on chemical castration for pedophilia are discordant. Some surveys confirm that therapy reduces sexual thoughts and fantasies, especially in recidivism. On the other hand, some authors report that chemical castration does not modify the pedophile's personality. In our opinion, once existing legislation has changed, andrologists could play a significant role in the selection of patients to receive androgen deprivation therapy, due in part to their knowledge about its action and side effects.
Topics: Androgen Antagonists; Andrology; Castration; Cyproterone Acetate; Evidence-Based Medicine; Humans; Leuprolide; Libido; Male; Medroxyprogesterone; Patient Selection; Pedophilia; Sexual Behavior; Treatment Outcome
PubMed: 26428645
DOI: 10.4081/aiua.2015.3.222 -
Medical Archives (Sarajevo, Bosnia and... Dec 2015Regarding the contradictions about positive and negative effects of hysterectomy on women's sexual functioning, this study was conducted to review the studies on the... (Review)
Review
BACKGROUND
Regarding the contradictions about positive and negative effects of hysterectomy on women's sexual functioning, this study was conducted to review the studies on the effect of hysterectomy on postoperative women's sexual function.
METHOD
This study was a narrative review and performed in 5 steps: a) Determining the research questions, b) Search methods for identification of relevant studies, c) Choosing the studies, d) Classifying, sorting out, and summarizing the data, and e) reporting the results.
FINDINGS
The review of the studies yielded 5 main categories of results as follows: The effect of hysterectomy on Sexual desire, the effect of hysterectomy on sexual arousal, the effect of hysterectomy on orgasm, the effect of hysterectomy on dyspareunia, and the effect of hysterectomy on sexual satisfaction.
CONCLUSION
According to the studies reviewed in this study, most of the sexual disorders improve after hysterectomy for uterine benign diseases, and most of the patients who were sexually active before the surgery experienced the same or better sexual functioning after the surgery. An important solution for making these women ready to face with postoperative sexual complications is to train them on the basis of needs assessment in order that the patients undergoing hysterectomy be ready and capable of coping with the complications, and their sexual functioning improves after the surgery.
Topics: Dyspareunia; Female; Humans; Hysterectomy; Libido; Orgasm; Sexual Behavior
PubMed: 26843731
DOI: 10.5455/medarh.2015.69.387-392 -
Menopause (New York, N.Y.) Oct 2011The aim of this study was to examine the relationship between reproductive history and menopausal symptoms among urban women.
OBJECTIVE
The aim of this study was to examine the relationship between reproductive history and menopausal symptoms among urban women.
METHODS
This was a cohort study of women aged 35 to 47 years recruited in Philadelphia, PA. Two hundred ninety-one premenopausal women meeting the study eligibility criteria and contributing reproductive health history and infertility information completed the assessments of occurrence and severity of several menopausal symptoms over a 14-year period. Reproductive history included the number of pregnancies, live births, preterm deliveries, and miscarriages. Trying to get pregnant for more than 1 year was used as an assessment of infertility. The occurrence of severe hot flashes, vaginal dryness, and decreased libido was evaluated.
RESULTS
Women scoring positive on the infertility index were significantly more likely to report severe decreased libido (odds ratio [OR], 1.86; 95% CI, 1.05-3.31) and were more than twice as likely to report severe vaginal dryness (OR, 2.79; 95% CI, 1.19-6.94) in multivariable models. None of the other reproductive health indices were related to the report of severe hot flashes, vaginal dryness, or decreased libido. The race-specific models continued to find a significant increased risk of severe vaginal dryness (OR, 2.79; 95% CI, 1.22-6.36) and decreased libido (OR, 1.87; 95% CI, 1.04-3.34) among white women scoring positive on the infertility index; however, the relationship did not remain significant among African American women.
CONCLUSIONS
Severe vaginal dryness and decreased libido are common and important considerations of the menopausal transition, and the experience of infertility problems may influence the report of severe vaginal dryness and decreased libido particularly among white women.
Topics: Adult; Black or African American; Cohort Studies; Female; Gravidity; Hot Flashes; Humans; Libido; Menopause; Middle Aged; Philadelphia; Prevalence; Severity of Illness Index; Vagina; White People
PubMed: 21552165
DOI: 10.1097/gme.0b013e318214d69d -
Ugeskrift For Laeger Feb 2017Flibanserin was approved by the Food and Drug Administration in the USA in August 2015 as the first drug for the treatment of American women with the dysfunction... (Review)
Review
Flibanserin was approved by the Food and Drug Administration in the USA in August 2015 as the first drug for the treatment of American women with the dysfunction hypoactive sexual desire disorder (HSDD) and is a 5-HT1A agonist and 5-HT2A antagonist. The neurophysiological effects of flibanserin on these receptors are consistent with the clinical effects, i.e. significantly increasing sexual desire and frequency of satisfying sexual experiences. As such, shifting the balance between inhibitory and excitatory neurotransmitters of importance to sexual desire, flibanserin pharmacologically broaches a possible new approach to the treatment of HSDD.
Topics: Benzimidazoles; Female; Humans; Libido; Serotonin 5-HT2 Receptor Antagonists; Serotonin Receptor Agonists; Sexual Dysfunctions, Psychological
PubMed: 28397671
DOI: No ID Found