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A letter to the editor is presented regarding female sexual arousal disorder (FSAD).

The article presents report of the International Consensus Development Conference on Female Sexual Dysfunction. Female sexual dysfunction is a multicausal and multidimensional problem combining biological, psychological and interpersonal determinants. It is age related, progressive and highly prevalent, affecting 20% to 50% of women. Based on epidemiological data from the National Health and Social Life Survey a third of women lack sexual interest and nearly a fourth do not experience orgasm. Approximately 20% of women report lubrication difficulties and 20% find sex not pleasurable. Female sexual dysfunction has a major impact on quality of life and interpersonal relationships. For many women it has been physically disconcerting, emotionally distressing and socially disruptive. In contrast to the widespread interest in research and treatment of male sexual dysfunction, less attention has been paid to the sexual problems of women. Few studies have investigated the psychological and physiological underpinnings of female sexual dysfunction and fewer treatments are available for women than for men.

We are sad to report the recent death of two members of the editorial board of this journal: Professor Abraham Wolf from the United States and Professor Marcel Waldinger from the Netherlands. However, as a perceptive and sharp clinician, Marcel studied other sexual disorders he observed in his clinical practice, such as persistent genital arousal disorder, postorgasm illness syndrome, and restless genital syndrome. Marcel was not just a passionate researcher and clinician; he was also a passionate about many other issues, such as critique of pharmaceutical companies or critique of poor methodology of studies in sexology. [Extracted from the article]

The article reflects the view of the authors on the issues to be included in the fifth issue of "Diagnostic and Statistical Manual of Mental Disorders," which focuses on sexual dysfunction, disorder, or variation along normal distribution. Issues include as to when does a sexual problem become a sexual dysfunction, whether there should be a specific duration criterion for sexual dysfunction and whether distress should be used as a diagnostic criterion of sexual disorders.

The article focuses on historical origins of the need for classification systems in female sexual dysfunction. Prior to the adoption of the International Classification of Diseases (lCD) by psychiatric associations in different countries, there was considerable confusion about how classification systems in one country corresponded to systems adopted in other countries. Differing systems clearly hampered international research and communication. The use of explicit or operationalized diagnostic criteria in a survey commissioned by the World Health Organization was proposed. Many countries use the lCD as their basis for diagnosis. Diagnostic and Statistical Manual (DSM)-I was developed in 1952. The DSM-II was developed to correspond with the 8th revision of the lCD, and both were adopted in 1968. The progression of diagnoses related to sexual dysfunctions can be followed through various versions of the DSM of the American Psychiatric Association. DSM-III listed inhibited sexual desire, inhibited sensual excitement, and inhibited females orgasm, inhibited male orgasm, premature ejaculation, functional dyspareunia, functional vaginismus, and ego-dystonic homosexuality.

This article studies two cases of sexual disorders and the use of sildenafil in such patients. To date, sildenafil has been reported to reverse antidepressant-induced sexual dysfunction. A 54-year-old man with recurrent schizoaffective disorder was maintained on 20 mg haloperidol and 1200 mg lithium carbonate daily. The patient reported experiencing erectile problems after starting haloperidol. This became a problem, as he had met someone with whom he wished to have sexual relations. He currently reported the absence of erections both upon awakening and with masturbation. Physical examination did not reveal any evidence of vascular or neurological disease. In another case a 46-year-old male social worker was referred to the author with a complaint of erectile failure. Prior evaluation by his internist had not revealed any obvious organic etiology to his problem. The patient had never married, and his primary sexual outlet was with a married neighbor who would visit his apartment when her husband was away. The patient had a lifelong history of premature ejaculation and was anxious about his ability to please women sexually.

A letter to the editor about the use of bethanechol in reversal of imipramine-induced ejaculatory dysfunction is presented.

A letter to the editor is presented regarding the use of lorazepam as a treatment for premature ejaculation.

Abstract Introduction In 2016 the International Society for the Study of Women's Sexual Health (ISSWSH) published an expert consensus report on new nomenclature that addressed the need for comprehensive, evidence-based criteria for new diagnoses in desire, arousal, and orgasm, with the definition on arousal focusing exclusively on female genital arousal disorder (FGAD). Aim A new expert panel solely focused on mechanisms of arousal disorders convened to revise the nomenclature to include female cognitive arousal disorder (FCAD) and FGAD. Methods The ISSWSH co-chairs identified experts on arousal disorders in women. The 10 participants included clinicians, researchers, and educators, representing a diverse, multidisciplinary group. Pre-meeting preparation included evidence-based literature review as the basis of presentations panelists made at the meeting on the current knowledge in cognitive arousal. Consensus was reached using a modified Delphi method. Writing assignments were made as a basis of manuscript development. Main Outcome Measures The new definition of FCAD is characterized by distressing difficulty or inability to attain or maintain adequate mental excitement associated with sexual activity, as manifested by problems with feeling engaged and mentally turned on or sexually aroused for a minimum of 6 months. Results Female sexual arousal disorder encompasses both FGAD (revised definition) and FCAD (new definition). Recommendations regarding diagnosis include a clinical interview to assess for FCAD using targeted questions. Patient-reported outcomes that contain questions to assess FCAD are described, including limitations for differentiating between cognitive arousal, genital arousal, and sexual desire. Laboratory measures of cognitive and genital arousal are discussed, including the relationships between genital and cognitive arousal patterns. Biopsychosocial risk factors for FCAD and FGAD, as well as exclusionary conditions, are presented. Clinical Implications The revision of the ISSWSH nomenclature regarding the criteria for the 2 arousal categories, FCAD and FGAD, and the recommended diagnostic strategies offers a framework for management of women with arousal disorders. Strengths & Limitations This nomenclature allows for basic science and clinical research in subtypes of arousal in order to develop better diagnostic and treatment options for use by clinicians, scientists, and regulatory agencies. There are limited validated measures of cognitive arousal, including the Female Sexual Function Index, the most commonly used measure, which does not effectively distinguish between cognitive excitement, genital sensations, and event-related desire. Conclusion Future directions include the refinement of FCAD and FGAD and development and validation of patient-reported outcomes that distinguish between the cognitive processes and genital responses to enhance clinical care and research in this area. Parish SJ, Meston CM, Althof SE, et al. Toward a More Evidence-Based Nosology and Nomenclature for Female Sexual Dysfunctions—Part III. J Sex Med 2019;16:452–462. [ABSTRACT FROM AUTHOR]

Introduction The International Society for Sexual Medicine ( ISSM) Ad Hoc Committee for the Definition of Premature Ejaculation developed the first evidence-based definition for lifelong premature ejaculation ( PE) in 2007 and concluded that there were insufficient published objective data at that time to develop a definition for acquired PE. Aim The aim of this article is to review and critique the current literature and develop a contemporary, evidence-based definition for acquired PE and/or a unified definition for both lifelong and acquired PE. Methods In April 2013, the ISSM convened a second Ad Hoc Committee for the Definition of Premature Ejaculation in Bangalore, India. The same evidence-based systematic approach to literature search, retrieval, and evaluation used by the original committee was adopted. Results The committee unanimously agreed that men with lifelong and acquired PE appear to share the dimensions of short ejaculatory latency, reduced or absent perceived ejaculatory control, and the presence of negative personal consequences. Men with acquired PE are older, have higher incidences of erectile dysfunction, comorbid disease, and cardiovascular risk factors, and have a longer intravaginal ejaculation latency time ( IELT) as compared with men with lifelong PE. A self-estimated or stopwatch IELT of 3 minutes was identified as a valid IELT cut-off for diagnosing acquired PE. On this basis, the committee agreed on a unified definition of both acquired and lifelong PE as a male sexual dysfunction characterized by (i) ejaculation that always or nearly always occurs prior to or within about 1 minute of vaginal penetration from the first sexual experience (lifelong PE) or a clinically significant and bothersome reduction in latency time, often to about 3 minutes or less (acquired PE); (ii) the inability to delay ejaculation on all or nearly all vaginal penetrations; and (iii) negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intimacy. Conclusion The ISSM unified definition of lifelong and acquired PE represents the first evidence-based definition for these conditions. This definition will enable researchers to design methodologically rigorous studies to improve our understanding of acquired PE. Serefoglu EC, McMahon CG, Waldinger MD, Althof SE, Shindel A, Adaikan G, Becher EF, Dean J, Giuliano F, Hellstrom WJG, Giraldi A, Glina S, Incrocci L, Jannini E, McCabe M, Parish S, Rowland D, Segraves RT, Sharlip I, and Torres LO. An evidence-based unified definition of lifelong and acquired premature ejaculation: Report of the second International Society for Sexual Medicine Ad Hoc Committee for the Definition of Premature Ejaculation. J Sex Med 2014;11:1423-1441. [ABSTRACT FROM AUTHOR]

The article presents a response to commentaries published in "The Journal of Sexual Medicine," by the Diagnostic and Statistical Manual of Mental Disorders (DSM) sexual dysfunctions subworkgroup on male and female sexual disorders. The commentaries on male orgasmic disorder are effective as basis for the modification of the provisional criteria. The proposed diagnostic criteria for female sexual disorders include the biopsychosocial aspect.

Introduction. Hypoactive sexual desire disorder (HSDD) is the most common sexual complaint in women. Currently there are no validated instruments for specifically assessing HSDD severity, or change in HSDD severity in response to treatment, in premenopausal women. The Sexual Interest and Desire Inventory—Female (SIDI-F) is a clinician-administered instrument that was developed to measure severity and change in response to treatment of HSDD. Seventeen items were included in a preliminary version of the SIDI-F, including 10 items related to desire, and seven items related to possible comorbid factors (e.g., other kinds of sexual dysfunction, general relationship satisfaction, mood, and fatigue). Aim. The aim of the study was to use the outcome of item response analyses of blinded data from two randomized, placebo-controlled trials, to assist in the revision of the scale. Methods. A nonparametric item response (IRT) model was used to assess the relation between item functioning and HSDD severity on this preliminary version of the SIDI-F. Results. Results show that the majority of SIDI-F items demonstrated good sensitivity to differences in overall HSDD severity. That is, there was an orderly relation between differences in option selection for an item and differences in overall HSDD severity. The IRT analyses further indicated that revisions were warranted for a number of these items. Five items were not sensitive to differences in HSDD severity and were removed from the scale. Conclusion. The SIDI-F is a brief, clinician-administered rating scale designed to assess severity of HSDD symptoms in women. IRT analyses show that majority of the items of the SIDI-F function well in discriminating individual differences in HSDD severity. A revised 13-item version of the SIDI-F is currently undergoing further validation. Sills T, Wunderlich G, Pyke R, Segraves RT, Leiblum S, Clayton A, Cotton D, and Evans K. The Sexual Interest and Desire Inventory—Female (SIDI-F): item response analyses of data from women diagnosed with hypoactive sexual desire disorder. J Sex Med 2005;2:801–818. [ABSTRACT FROM AUTHOR]

Introduction. Clinical trials on sexual dysfunctions in women are limited in spite of the fact that sexual dysfunctions are likely more common in women than in men. Currently there are no medications approved for treatment in women, and limited data on drug efficacy or psychological efficacy in well-controlled studies. Aim. To provide recommendations/guidelines concerning state-of-the-art knowledge for the research design and outcome assessment standards for clinical trials in women's sexual dysfunctions. Methods. An International Consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respective sexual medicine topic represent the opinion of experts from five continents developed in a process over a 2-year period. Concerning the Standards for Clinical Trials in Women's Sexual Dysfunctions Committee, there were seven experts from two countries. Main Outcome Measure. Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation and debate. Results. A comprehensive update was created which included references and recommended guidelines for rationale and design of clinical trials, study populations, outcome assessments, protocol design and implementation, data analysis and reporting, as well as ethical and clinical issues related to sexual dysfunction research. Conclusions. There is a need for more research in developing standards to be used when performing clinical trials and outcomes assessment research in sexual dysfunctions of women. [ABSTRACT FROM AUTHOR]