Progress in female sexual dysfunction

INTRODUCTION: Female sexual dysfunction (FSD) is a significant age-related, progressive and highly prevalent problem that affects a substantial number of women that causes personal distress and has negative effects on quality of life and interpersonal relationships. DEFINITIONS: The female sexual response cycle consists of three phases: desire, arousal, and orgasm, and is initiated by non-adrenergic/non-cholinergic, e.g. vasoactive intestinal polypeptide and nitric oxide, neurotransmitters that maintain vascular and non-vascular smooth muscle relaxation resulting in increased pelvic blood flow, vaginal lubrication, and clitoral and labial engorgement. Furthermore, hormonal status may influence female sexual function. For the diagnosis of FSD, a detailed history should be taken initially, followed by a physical examination and laboratory studies. CONCLUSION: Due to the fact that there has been little research and attention on FSD, our knowledge in this field is quite limited and there is still no approved therapy. Future advances in evaluation and treatment of female sexual problems are forthcoming.     

Regulatory perspective on clinical trials and end points for female sexual dysfunction, in particular, hypoactive sexual desire disorder: formulating recommendations in an environment of evolving clinical science

This article examines the history, current status, and potential future challenges in the development of drugs for female sexual dysfunction (FSD) from the perspective of the United States Food and Drug Administration. In particular, the article focuses on testosterone therapy for hypoactive sexual desire disorder (a component of FSD), and the role of the Division of Reproductive and Urologic Products in facilitating the development of safe and effective therapies for this indication.     

The epidemiology and definition of female sexual disorders

Female sexual dysfunction (FSD) is a multifactorial condition that has anatomical, physiological, medical, psychological, and social components. Similar to erectile dysfunction in men, FSD is highly prevalent and often undertreated. Due to the development of successful treatment for male erectile dysfunction, FSD is receiving increased attention. Only a few studies dealing with epidemiology of female sexual dysfunction are available in the literature. However, research efforts in the field are increasing. This overview presents currently used classification systems, recently updated definitions, as well as prevalence data on the different entities of female sexual disorders.     

女性性功能障碍诊断和治疗的新领域

女性性功能障碍 (FSD)是一种与年龄相关的进展性的疾病 ,可能影响多达半数的成年妇女 ,长期以来 ,FSD未得到应有的重视。本文系统地阐述了FSD的解剖、生理及病理主观原因基础 ,以及诊断、治疗的新进展 ,以期提高对FSD的认识。     

Commentary on androgen deficiency in women and the FDA advisory board's recent decision to request more safety data

Editor's note: The FDA's decision regarding Intrinsa has potential widespread implications for the medical treatment of female sexual dysfunction (FSD). Dr Andre Guay is a world-renowned authority on the topic of female sexuality and FSD. Accompanying Dr Spark's perspective in issue 2, this perspective will shed important light on the topic and offer insight into the past, present and future of FSD.     

高血压对女性性功能的影响

女性性功能障碍(FSD)是一种与年龄相关的进展性疾病,可能影响多达半数的成年妇女,长期以来,FSD未得到重视.高血压是一种常见病、多发病.高血压及抗高血压药物与FSD有密切关系,其中高血压引起的动脉粥样硬化和内皮功能障碍、抗高血压药物对女性性功能的影响尤为显著,现就高血压对女性性功能的影响机制及研究进展作一综述.     

妇科良性疾病与女性性功能障碍相关性分析

目的探讨妇科良性疾病与女性性功能障碍(FSD)相关性,为防治FSD的发生及防治提供理论依据。方法采用横断面调查方法,选取中等收入城市及农村居民区20岁及其以上女性进行问卷调查,收集其人口学特征及目前所患妇科疾病(经诊断确诊过的疾病)等信息。采用中文版女性性功能量表(FSFI)进行FSD评估,总分小于26.55说明存在FSD。应用多因素非条件Logistic回归模型分析妇科良性疾病与FSD相关性。结果发放问卷1 130份,收回1 068份(回收率94.5%),去除不符合要求问卷80份,共纳入有效问卷988份。988例被访者中妇科良性疾病患者占39.8%(393/988),为患病组,其余为健康组。393例患者中,性功能障碍者占71.2%(280/393),高于健康组性功能障碍患病率(P0.05)。与健康组相比,患病组在总分及性欲、性唤起、性高潮方面的评分分值均较健康组低(P0.05)。多因素非条件Logistic回归分析显示,妇科良性疾病、年龄(≥40岁)及绝经是FSD的独立危险因素,较高的教育水平是其保护性因素。结论 FSD是一个重要的公共卫生问题,甘肃省在妇科良性疾病者中FSD现患率较高,应加强性健康教育,降低FSD发生率。     

Remission of female sexual dysfunction in morbidly obese female patients with the Scopinaro procedure

BackgroundThe prevalence of obesity has increased in Spain in recent years. Obese women are at increased risk for sexual dysfunction, and important remission of this condition has been previously reported with bariatric surgery.ObjectivesThe major aim of this study was to assess the effects of the Scopinaro biliopancreatic diversion on female sexual dysfunction (FSD) using a validated Female Sexual Function Index (FSFI).MethodsEighty sexually active women with morbid obesity and with FSD underwent surgery. All patients completed the FSFI before surgery, as well as 6 and 12 months after surgery. The FSFI evaluates the sexual function using 6 items: desire, arousal, lubrication, orgasm, satisfaction, and pain. We used a<26.5 cut-point to assess the presence of FSD. This cut-point is used as a standard for the investigation.ResultsBefore surgery, all patients had FSD (mean 19.9±1.6). Six months after surgery, the FSD improved (mean 25.4±4.1; P<.001), and 12 months after surgery FSD resolved in most of the patients (mean 30.4±3.5; P<.001). All of the parameters evaluated by the FSFI (P<.001) improved significantly in all patients.ConclusionFSD improved significantly 6 months after biliopancreatic diversion among obese women with preoperative sexual dysfunction and continued improving up to 12 months later.     

Sexual function in women with coronary artery disease: a preliminary study

We investigated sexual function in female patients with coronary artery disease (CAD). A total of 20 consecutive female patients (38.2+/-3.8 years) with CAD diagnosed by coronary angiography and 15 healthy subjects (37.9+/-5.4 years) were enrolled in this study. The Female Sexual Function Index (FSFI) was used to assess sexual function in all the participants. Women with psychiatric disorders, gynecologic and systemic diseases that may affect sexual function were excluded from the study. The other exclusion criteria were usage of antidepressants and drugs affecting sexual function. Patients with CAD and healthy women were comparable in age, body mass index and education level. Female sexual dysfunction (FSD) was diagnosed in 12 of 20 women with CAD (60%), whereas five of 15 healthy women (33.3%) were found to have FSD (P<0.05). Patients with CAD had a significantly lower number of sexual intercourse episodes per month than healthy women volunteers (2.24 versus 5.2, respectively; P<0.05). The FSFI total score was clearly significantly decreased in the CAD group compared with that in healthy controls (17.8+/-2.9 and 26.0+/-4.8, P=0.001). When the subscores of each domain of FSFI were evaluated, all the subscores of FSFI, except the satisfaction domain, in patients with CAD were significantly lower than those of healthy subjects (P<0.05). This preliminary study demonstrates that female patients with CAD have distinct sexual dysfunction compared with healthy controls. Women with CAD should be evaluated also in terms of sexual function to provide better quality of life.     

Prevalence and degree of sexual dysfunction in a sample of women seeking bariatric surgery

BackgroundSexual functioning has been shown to be impaired in women who are obese, particularly those seeking bariatric surgery. However, most previous studies evaluating sexual function in these populations have not used validated measures. We used the validated Female Sexual Function Index (FSFI) to assess the prevalence of female sexual dysfunction (FSD) in a sample of >100 women evaluated for bariatric surgery.MethodsThe FSFI was administered to reportedly sexually active women during their preoperative evaluation. The scores for the individual FSFI domains (desire, arousal, lubrication, orgasm, satisfaction, and pain) ranging from 0 (or 1.2) to 6 were summed to produce a FSFI total score (range 2–36). A FSFI total cutoff score of ≤26.55 was used to identify participants with FSD. The participants' FSFI total and domain scores were compared with previously published norms available for women diagnosed with female sexual arousal disorder and healthy controls.ResultsOf the 102 women, 61 (59.8%) had FSFI total scores of ≤26.55, indicative of FSD. Older age and menopause were associated with FSD. Compared with published norms, bariatric surgery candidates had FSFI domain scores that were lower than those of the control group (all P values < 0.0001) but greater than those of the female sexual arousal disorder group (all P values < 0.0001), except for desire, for which the scores were similar.ConclusionWomen seeking bariatric surgery are clearly a population with substantial sexual function impairment, with 60% of participants reporting FSD. These findings highlight the need to initiate routine assessment of sexual functioning in this population and examine whether the weight loss after bariatric surgery contributes to a reversal of FSD.     

Female sexual dysfunction in a population-based study in Iran: prevalence and associated risk factors

To explore the prevalence and risk factors of female sexual dysfunction (FSD) in Iran. A total of 2626 women aged 20-60 years old were interviewed by 41 female general practitioners and answered a self-administered questionnaire on several aspects of FSD including desire, arousal, pain and orgasmic disorders (OD). Criteria of sexual dysfunction followed classification by DSM-IV. The sexual function was evaluated by the Female Sexual Function Index (FSFI). The subjects were randomly identified from 28 counties of Iran. Data on medical history, toxic habits and current use of medication were also obtained. Of the women interviewed, 31.5% (759) reported FSD. The prevalence increased with age, from 26% in women aged 20-39 years to 39% in those >50 years (tested for trend P<0.001). Thirty-seven percent reported OD, 35% desire disorders (DD) and 30% arousal disorders (AD), all of which increased significantly with age. Pain disorders were reported by 26.7%, occurring most frequently in women aged 20-29 years. The educational level (P=0.01) and marriage age (<18 years) (P=0.04) were inversely correlated with the risk of DD, OD and AD. No significant differences were detected in smoking history (P=0.18), the presence of previous pelvic surgery (P=0.08) and contraception methods used (P=0.42). A history of psychological problems (P=0.04), married status (P=0.03), low physical activity (P=0.012), chronic disease (P<0.01), multiparity (P<0.05) menopause status (P相似文献   

Sexual dysfunction in women partners of men with erectile dysfunction

We evaluated 113 female partners of men with erectile dysfunction (ED) attending a sexual dysfunction clinic in order to define sexual dysfunction among these women. In all, 51 (45%) women denied having any sexual dysfunction. The other 62 (55%) responded to questions classifying their complaint(s) according to the international classification of female sexual dysfunction (FSD) in the following topics (40/62, 65%, reported having more than one problem): decreased sexual desire (n=35, 56%), sexual aversion (none), arousal (n=23, 37%) and orgasmic disorders (n=39, 63%), dyspareunia (n=19, 31%), vaginismus (n=3, 5%), and noncoital sexual pain (none). Many female partners of men with ED report having some form of sexual disorder, mostly orgasmic problems and decreased sexual desire. Therefore, for optimal outcome of ED treatment, evaluation and treatment of male and FSD should be addressed as one unit within the context of the couple, and be incorporated into one clinic of sexual medicine.     

Weibliche sexuelle Dysfunktion

Female sexual dysfunction (FSD) is a very common disorder in Germany with a prevalence of approximately 38%. FSD includes persistent or recurrent disorders of sexual desire, disorders of subjective or genital arousal and pain during intercourse. An overview of the epidemiology, the current definitions of the single domains of FSD, the pathophysiology and recommendations on the treatment of FSD is given.     

Female sexual dysfunction

Female sexual dysfunction (FSD) is a very common disorder in Germany with a prevalence of approximately 38%. FSD includes persistent or recurrent disorders of sexual desire, disorders of subjective or genital arousal and pain during intercourse. An overview of the epidemiology, the current definitions of the single domains of FSD, the pathophysiology and recommendations on the treatment of FSD is given.     

Female sexual arousal disorder: new insights

Epidemiologic investigations of women with female sexual dysfunction (FSD) from well-designed, random-sample, community-based populations are limited. Based on available information, FSD is common and estimated to occur in 22-43% of women. There are limited data on age-related and para-aging risk factors, which are critical to understand when planning treatment and prevention efforts. Based on correlates of FSD, associated risk factors include age, education, history of sexual abuse or sexually transmitted disease, overall state general happiness and physical health. This brief overview attempts to review what is known about the female sexual anatomy, describes factors that may affect female sexual responsiveness, and identifies several areas where additional research is needed to promote understanding of this complex physiological and psychosocial phenomenon. International Journal of Impotence Research (2000) 12, Suppl 4, S152-S157.     

Female sexual dysfunction, voiding symptoms and depression: common findings in partners of men with erectile dysfunction

The aim of this study was to investigate the prevalence of female sexual dysfunction (FSD), urinary symptoms, and depressive symptoms in female partners of men presenting with erectile dysfunction (ED). A multi-component questionnaire was administered to female partners of men with erectile dysfunction presenting to a urology center. It contained a standardized sexual function component (the Brief Index of Sexual Function for Women), a depression scale (Centers for Epidemiologic Studies-Depression, CES-D), a demographics questionnaire and a general medical questionnaire. A total of 73 consecutive female partners of male patients presenting with ED, were surveyed using the questionnaire at their counterpart’s visit. Fifty-two women responded, of whom 50 filled out the questionnaire adequately for proper evaluation. This indicated a response rate of 68% (50/73). The mean age was 44.8 years (range 20.0–83.0). Thirty-eight of the 50 women (76%) reported being sexually active. A variety of sexual behaviors were reported including 40% (20/50) of women engaging in vaginal intercourse. Sexual dysfunction symptoms included: anxiety/inhibition (26%), hypoactive desire (20%), arousal/lubrication difficulty (30%), orgasmic difficulty (24%), dyspareunia (18%), incontinence during intercourse (8%), and sexual dissatisfaction (34%). Eight women (16%) reported difficulty communicating sexual issues with their partners. Forty-one women (82%) rated sexual activity as an important part of their lives. Urinary symptoms of frequency and urgency were reported by 18/50 (36%). Depressive symptoms were present in 22/50 (44%). FSD disorders, urinary symptoms and depressive symptoms are common in partners of men with erectile dysfunction.     

女性性功能障碍的药物治疗进展

近年来,女性性功能障碍的药物治疗研究取得较大发展,雌激素替代治疗能有效改善性交疼痛、性交困难,雄激素制剂有助于改善女性性欲低下,此外,5型磷酸二酯酶抑制剂、多巴胺受体兴奋剂、前列腺素E1、肾上腺素能受体阻滞剂、部分中药等多种药物及剂型治疗女性性功能障碍的研究结果令人鼓舞。现就女性性功能障碍的药物治疗方面的研究进展作一综述。     

Physiology of female sexual function and dysfunction

Female sexual dysfunction is age-related, progressive, and highly prevalent, affecting 30-50% of American women. While there are emotional and relational elements to female sexual function and response, female sexual dysfunction can occur secondary to medical problems and have an organic basis. This paper addresses anatomy and physiology of normal female sexual function as well as the pathophysiology of female sexual dysfunction. Although the female sexual response is inherently difficult to evaluate in the clinical setting, a variety of instruments have been developed for assessing subjective measures of sexual arousal and function. Objective measurements used in conjunction with the subjective assessment help diagnose potential physiologic/organic abnormalities. Therapeutic options for the treatment of female sexual dysfunction, including hormonal, and pharmacological, are also addressed.     

Physiology and pathophysiology of female sexual function and dysfunction

Female sexual dysfunction is age-related, progressive, and highly prevalent, affecting 30%-50% of American women. While there are emotional and relational elements to female sexual function and response, female sexual dysfunction can occur secondary to medical problems and have an organic basis. This paper addresses the anatomy and physiology of normal female sexual function as well as the pathophysiology of female sexual dysfunction. Although the female sexual response is inherently difficult to evaluate in the clinical setting, a variety of instruments have been developed to assess subjective measures of sexual arousal and function. Objective measurements, used in conjunction with the subjective assessment, help diagnose potential physiologic/organic abnormalities. Therapeutic options for the treatment of female sexual dysfunction, including hormonal, and pharmacological, are also addressed.     

Female sexual dysfunction in urological patients: findings from a major metropolitan area in the USA

Study Type – Symptom prevalence (prospective cohort)
Level of Evidence 1b

OBJECTIVE

To determine the prevalence of and risk factors for female sexual dysfunction (FSD) in a practice focused mainly on female urology.

PATIENTS AND METHODS

A modified version of the Female Sexual Function Index (FSFI) was used to assess the prevalence of FSD in 587 patients who completed the questionnaire. Logistic regression was used to identify risk factors.

RESULTS

The prevalence of FSD was 63%; age, menopausal status and usage of selective serotonin reuptake inhibitors were statistically significant risk factors for FSD.

CONCLUSIONS

FSD is highly prevalent in this population of patients and screening female urological patients for FSD should be considered.