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The article delves into testimonial smothering and testimonial quieting in erotically oppressive lifeworlds, particularly focusing on women's sexual arousal. It critiques the DSM-IV's approach to women's sexual arousal and highlights the harms of mainstream media, pornography, and scientific naturalism. The paper argues that these lifeworlds limit women's agency in expressing their sexual desires. It also responds to objections to DSM-5's conceptualization of women's sexual arousal, emphasizing the importance of recognizing women's subjective experiences. The document explores various aspects of sexual arousal, desire, and dysfunction in women, challenging traditional models and societal norms. [Extracted from the article]

Background: Hypoactive Sexual Desire Disorder (HSDD) is a frequent sex-related problem in women; however, a specific tool to characterize HSDD subtypes based on sexual inhibitory and excitatory factors is still lacking. Aim: (1) To find a cutoff value in Sexual Inhibition Scale (SIS)/Sexual Excitation Scale (SES) scores predicting a diagnosis of HSDD in women consulting for sexual symptoms, (2) to explore the sexual inhibitory and excitatory profiles in women referred to a clinic for female sexual dysfunction by stratifying the sample according to the newfound cutoffs, and (3) to identify biopsychosocial factors significantly associated with the 2 profiles. Methods: An overall 133 women consulting for sexual symptoms were retrospectively evaluated for clinical, biochemical, and psychosexologic data collected at the first visit. A subgroup of 55 women treated with transdermal testosterone was retrospectively analyzed at baseline and the 6-month visit. Outcomes: Patients underwent physical and laboratory examinations and completed the SIS/SES, Female Sexual Function Index, Female Sexual Distress Scale–Revised, Emotional Eating Scale, and Middlesex Hospital Questionnaire. Results: Specific cutoffs for SIS1 (≥32.5; indicating threat of performance failure) and SES (≤46.5) predicted HSDD diagnosis with an accuracy of 66.4% (P = .002) and 68.7% (P < .0001), respectively. Patients with impaired SIS1 scores showed higher distress and psychopathologic symptoms, while those with impaired SES scores demonstrated lower desire and arousal and a negative association with some metabolic and hormonal parameters. SES score also showed a significant predictive value on testosterone treatment efficacy for HSDD. Clinical Translation: A better characterization of HSDD would enable individualized treatment based on the main underlying etiologies. Strengths and Limitations: Limitations of the study include the small sample size and cross-sectional retrospective design, with the choice of treatment for HSDD limited to transdermal testosterone. Strengths comprise the thorough and multifactorial evaluation of every aspect potentially affecting inhibitory and excitatory components of sexual desire. Conclusion: Validated cutoffs of SIS/SES scores could allow deep characterization of women diagnosed with HSDD, thus ensuring better tailoring of therapy and prediction of the probability of response to specific treatments. [ABSTRACT FROM AUTHOR]

Objective: There are inconsistent reports regarding the relationship between cannabis use and male sexual function with almost no data about synthetic cannabinoids (SC) and their effect on male sexual functions. This study investigated psychological concerns related to male sexual functions among cannabis and SC users. The research assessed different sexual functions and aspects of sexual psychopathology in cannabis and SCs dependent men compared to controls. Method: Thirty male patients with cannabis dependence, thirty male patients with SCs dependence, and thirty matched controls from the outpatient clinic at Kasr Al Ainy hospital, Egypt, were assessed using the Structured Clinical Interview for DSM-IV TR Axis I Disorders (SCID-I), International Index of Erectile Function (IIEF), and Sexuality scale. Results: The means of IIEF questionnaire in the cannabis and SC group were significant lower (worse) than the means of the control group (P <.001) except the orgasmic function in cannabis group (P =.052). In the SCs group, sexual depression was higher and preoccupation lower than in the cannabis group (P <.020; P <.003, respectively) and control groups (P <.001; P <.001, respectively). The duration and dose of cannabis and SCs correlated significantly with sexual esteem, sexual preoccupation and all domains of IIEF. Conclusion: Cannabis and SC dependence were associated with lower erectile function, sexual desire, intercourse satisfaction and overall satisfaction, and lower orgasmic functions in the SC group than controls. Both groups showed higher sexual depression, lower sexual esteem and sexual preoccupation than controls. SC has a higher negative impact on male sexual functions and psychopathology than does cannabis. [ABSTRACT FROM AUTHOR]

The objective of this study is to examine the relationship between relational factors and sexual desire and sexual distress. In order to achieve these goals, a sample of 788 married Turkish women was recruited through social media platforms between June and July 2022. The study employed three instruments to assess the relevant variables: the Sexual Satisfaction Scale for Women to measure sexual distress, the Female Sexual Function Index to assess sexual desire, and the Couple Burnout Measure Short Form to evaluate couple burnout. Structural equation modeling was utilized to analyze the data and test the proposed models. The initial model indicated a negative correlation between marriage length, parenthood, couple burnout, and sexual desire. The employment status of the participants was not found to be a significant factor. The second model revealed that marriage length, parenthood, and sexual desire were negatively correlated with sexual distress, whereas couple burnout was positively associated. In conclusion, our study highlights the intricate interplay between various factors and their impact on sexual desire and distress among married women. Specifically, marriage length, parenthood, and couple burnout were identified as significant determinants of sexual desire and distress. These findings underscore the importance of addressing relationship dynamics, parental responsibilities, and couple well-being in order to promote sexual well-being within committed relationships. [ABSTRACT FROM AUTHOR]

Background: Male sexual dysfunction (MSD) is a common occurrence in diabetic patients, which is not routinely assessed in clinical settings. Aim: The aim of the study was to assess the prevalence of MSD and hypogonadism in young type 2 diabetes mellitus (T2DM) patients aged between 20 and 40 years and its association with duration, glycaemic control and complications of diabetes. Settings and Design: This is a cross-sectional study involving 70 men with T2DM of 20-40 years of age visiting the endocrinology department in a tertiary care centre. This study was conducted from November 2021 to March 2023. Materials and Methods: Seventy subjects satisfying inclusion criteria were included in the study and assessed using the International Index of Erectile Function-15 questionnaire, intravaginal ejaculation latency time, androgen deficiency in ageing male questionnaire, hormonal parameters (Luteinising Hormone, Follicle stimulating hormone, Testosterone and sex hormone-binding globulin) and penile Doppler. Statistical Analysis Used: The statistical analysis was done using SPSS version 21. A P < 0.05 is considered statistically significant. Data were checked for normality using Kolmogorov-Smirnov and Shapiro-Wilk tests. For determining statistical significance between continuous variables with non-normal data, the Mann-Whitney U test and Kruskal-Wallis tests were used. Pie charts, bar diagrams and scatter plots were used for descriptive statistics. Frequency, percentage, means, median, range and standard deviation were used for all quantitative data. The Chi-square test was used to find a significant association between categorical variables. Results: Sixty per cent of men had at least one form of MSD. Hypoactive sexual desire disorder (HSDD) - 44.28% was the most common MSD, followed by erectile dysfunction (ED) - 42.85% and ejaculatory disorders - 18.57%. Penile Doppler was done in 15 patients, of whom 9 patients had normal Doppler, venous incompetence was present in 3, followed by mixed (arterial and venous) in 2 and arterial insufficiency in 1 subject. Hypogonadism was present in 27.14% of men and secondary hypogonadism was the most common cause (84.21%). There was a significant association between neuropathy and ED and between hypogonadism and HSDD. There was also a significant association between fasting plasma glucose, post-prandial plasma glucose and MSD. Conclusion: MSD is common in young T2DM men, which should be given due importance in clinical practice to improve their quality of life. Glycaemic control is of utmost importance in these men. [ABSTRACT FROM AUTHOR]

Introduction Female sexual interest and arousal disorder (FSIAD) is the most prevalent female sexual dysfunction in the postmenopause.Objective The aim of this review is to provide a summary of the currently available evidence on the use of testosterone in the treatment of FSIAD in postmenopausal women.Methods A narrative review on the topic was performed. Only randomized controlled trials (RCTs) and systematic reviews and meta-analysis were considered. 123 articles were screened, 105 of them assessed for eligibility, and finally 9 were included in qualitative synthesis following the PRISMA declaration.Results Current evidence recommends, with moderate therapeutic benefit, the use of systemic transdermal testosterone within the premenopausal physiological range in postmenopausal women with Hypoactive Sexual Desire Disorder (HSDD), the previous entity for low desire dysfunction, not primarily related to modifiable factors or comorbidities such as relationship or mental health problems. The available evidence is based on studies with heterogeneity on their design (different testosterone doses, routes of administration, testosterone use in combination and alone, sexual instruments of measurement). There is no data indicating severe short-term adverse effects, although long-term safety data is lacking.Conclusions Despite having testosterone as a valuable tool, therapeutic strategies are lacking in the pharmacological field of HSDD/FSIAD. Neuroimaging studies could provide valuable information regarding the sexual desire substrate and suggest the potential application of already approved drugs for women with a good safety profile. The use of validated instruments for HSDD in postmenopausal women, considering the level of distress, is necessary to be able to draw robust conclusions on the evaluated treatments.

Background: The nature of sexual desire is complex, and little phenomenological consensus exists about its meaning. Low sexual desire (LSD) is a commonly reported sexual difficulty among women, but it is less frequently associated with sexual distress. The aim of this qualitative study is to explore women's understanding of sexual desire, and their perceptions of factors that may contribute to LSD, its effects and their methods of seeking help. Methods: The research employed a questionnaire with 12 open-ended questions, developed by the researchers based on sexual script theory. Data were collected from 165 heterosexual Turkish women who reported LSD, recruited through social media platforms between August and October 2021. The data were analysed using a contextual form of thematic analysis to identify and explore patterns. Results: The ages of the participants ranged from 20 to 63 years. The majority of participants held a Bachelor's degree (81.2%) and in a relationship (78.8%). Three main themes emerged from the study: (1) gendered messages concerning sex, (2) multi-level sexual desire, and (3) minimisation. The research revealed that women's sexual desire is often ignored and repressed, and has negative consequences if not expressed in socially acceptable contexts. The causes of LSD in women go beyond personal factors, and include relational and social influences. Women experiencing LSD report distressing effects on their relationships and general wellbeing, yet they tend not to seek help. Conclusions: Our findings contribute to a deeper understanding of the factors impacting women's sexual desire and the barriers to seeking help. Our research indicates that women's sexual desire is frequently ignored and suppressed, which can have negative consequences when not expressed within socially acceptable contexts. The causes and solutions for decreased desire in women extend beyond individual factors, and encompass relational and social influences. Sexual desire plays a crucial role in motivating sexual behaviour, and as such, it should be incorporated into health education, health promotion and public health policies. [ABSTRACT FROM AUTHOR]

Distressing low sexual desire, termed Hypoactive Sexual Desire Disorder (HSDD), affects approximately 10% of women and 8% of men. In women, the 'top-down' theory of HSDD describes hyperactivity in higher-level cognitive brain regions, suppressing lower-level emotional/sexual brain areas. However, it is unknown how this neurofunctional disturbance compares to HSDD in men. To investigate this, we employed task-based functional MRI in 32 women and 32 men with HSDD to measure sexual-brain processing during sexual versus non-sexual videos, as well as psychometric questionnaires to assess sexual desire/arousal. We demonstrate that women had greater activation in higher-level and lower-level brain regions, compared to men. Indeed, women who had greater hypothalamic activation in response to sexual videos, reported higher psychometric scores in the evaluative (r = 0.55, P = 0.001), motivational (r = 0.56, P = 0.003), and physiological (r = 0.57, P = 0.0006) domains of sexual desire and arousal after watching the sexual videos in the scanner. By contrast, no similar correlations were observed in men. Taken together, this is the first direct comparison of the neural correlates of distressing low sexual desire between women and men. The data supports the 'top-down' theory of HSDD in women, whereas in men HSDD appears to be associated with different neurofunctional processes. [ABSTRACT FROM AUTHOR]

Up to 8% of cisgender women meet diagnostic criteria for Female Sexual Interest/Arousal Disorder (SIAD), a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, yet treatment research for SIAD remains scarce, particularly for transgender women and non-binary individuals. The treatment relevance of the Approach-Avoidance Motivation Model for SIAD was tested in a sample of cis- and transgender women, and non-binary individuals, who either met criteria for SIAD (n = 45) or reported no sexual concerns (n = 76). Participants completed an online writing exercise previously found to increase the salience of approach or avoidance sexual motivation, or a control writing task. At baseline, and 72 hours following the writing task, they completed measures of sexual motivation, sexual desire, and partnered sexual behaviors. Participants with SIAD in the approach condition significantly increased in approach sexual motivation immediately following the manipulation but these improvements were not maintained 72 hours later. Compared to baseline, participants who wrote about an approach-motivated sexual encounter experienced a decrease in sexual desire and partnered sexual behaviors, while participants who wrote about an avoidance-motivated sexual encounter had decreased motivation but increased partnered sexual behaviors 72 hours following the manipulation. Overall, findings did not show support for the relevance of the approach-avoidance motivation manipulation for SIAD. Future studies might explore novel ways of targeting sexual motivation to address sexual difficulties. [ABSTRACT FROM AUTHOR]

Efficacy outcomes are only informative to the extent that they are validated. We examined the measurement properties of efficacy measures from the phase III ("RECONNECT") bremelanotide trials for hypoactive sexual desire disorder (HSDD) in women. Continuous efficacy outcomes, including a) the Female Sexual Function Index (FSFI) and its Desire domain (FSFI-D) and b) the Female Sexual Distress Scale-Desire/Arousal/Orgasm (FSDS-DAO) and its item assessing distress due to low desire (FSDS-DAO #13) have questionable, at best, validity evidence for women with HSDD. We found no validity evidence for previously published categorical treatment response outcomes from the RECONNECT trials. All efficacy results should be reported, but results on 8 of the 11 clinicaltrials.gov-specified efficacy outcomes were heretofore unpublished (including FSDS-DAO total score, FSFI total score, FSFI arousal domain, and items from the Female Sexual Encounter Profile-Revised). We analyzed these outcomes, upon which effect sizes ranged from nil to small. Several other continuous and categorical outcomes generated modest apparent benefits, though nearly all of these outcomes were likely derived post-hoc. Across RECONNECT trial data from two prior publications and the current study, bremelanotide's benefits are statistically modest and limited to outcomes for which scant evidence of validity among women with HSDD exists. [ABSTRACT FROM AUTHOR]

Background: Testosterone therapy (TTh) is recommended for postmenopausal women with hypoactive sexual desire disorder (HSDD); however, there remain insufficient data to support use of TTh in premenopausal women with sexual dysfunction. Aim: In this study, we used a large national database to evaluate prescribing trends of TTh for women with HSDD. Methods: We conducted a cohort analysis of information from electronic health records acquired from the data network TriNetX Diamond. The study cohort consisted of women 18-70 years of age with a diagnosis of HSDD. We analyzed trends of testosterone prescriptions, routes of testosterone administration, and coadministration of testosterone with estrogen. Outcomes: Despite an increase in rates of testosterone prescriptions for HSDD, there remains a high degree of variability in the duration of treatment, route of administration, and coadministration of estrogen with significant underprescription of testosterone. Results: Our query of the TriNetX database led to the identification of 33 418 women diagnosed with HSDD at a mean age of 44.2 ± 10.8 years, among whom 850 (2.54%) women received a testosterone prescription. The testosterone prescriptions were highly variable with regard to duration and route of administration and coadministration with estrogen. For all patients until 2015, the prevalence of testosterone prescriptions for HSDD showed a positive quadratic relation was observed. Since 2015 a linear increase in prevalence was observed, with the highest rate of increase for patients aged 41-55 years. Clinical Implications: The findings of this study reveal a significant need for further research investigating the optimal use of TTh to enhance the sexual health of women with HSDD, and further studies on the long-term effects of testosterone use must be undertaken to ensure that patients have access to safe and effective treatment. Strengths and Limitations: Limitations to this study include patient de-identification and lack of availability of testosterone dosage data. However, this study also has many strengths, including being the first, to our knowledge, to characterize the prescribing trends of testosterone for women with HSDD. Conclusion: Testosterone therapy should be considered as a potential therapy for premenopausal female patients with HSDD. Further studies on the long-term effects of testosterone use must be undertaken to address disparities in the management of HSDD and to ensure patients can access treatment. [ABSTRACT FROM AUTHOR]

The British Menopause Society (BMS) has released a statement addressing the growing hype around testosterone use during menopause. The BMS expressed concern about the misinformation being spread by laypeople and the media, leading to an increase in testosterone prescriptions. They emphasized that testosterone is not an essential hormone for women and should only be prescribed for persistent low libido. The BMS also warned against the use of compounded hormones and highlighted the need for further research on the long-term effects and safety of testosterone in women. In another study, researchers found that postmenopausal women with a shorter reproductive lifespan and certain reproductive factors had higher levels of adiposity, particularly visceral adipose tissue. They suggested that adiposity may mediate the relationship between reproductive health history and morbidity and mortality in postmenopausal women. Additionally, a review proposed a new term, "musculoskeletal syndrome of menopause," to describe the collective symptoms of joint and muscle pain, loss of muscle mass, and bone density associated with menopause. The authors argued that this unified nomenclature would provide a better understanding of the physiological changes and encourage more active treatment for women experiencing these symptoms. [Extracted from the article]

Background. Hypogonadism is frequent among HIV-infected males and might have significant clinical impact leading to sexual impairment and metabolic derangement. There is limited information about the magnitude of hypogonadism and its associated factors among people living with HIV in Tanzania. We aimed to determine the prevalence of hypogonadism and associated risk factors among newly diagnosed ART naïve HIV-infected men in Mwanza, Tanzania. Methods. Newly diagnosed ART naïve HIV-infected men were enrolled at Voluntary Counseling and Testing Centres of four selected hospitals in the Mwanza region and subjected to thorough clinical and general physical examination including anthropometric measurements. A prestructured questionnaire was used to collect sociodemographic characteristics and clinical data. Serum total testosterone, follicle-stimulating hormone, luteinizing hormone, and estradiol were estimated. Serum total testosterone <300 ng/dl or testosterone >300 ng/dl with high LH and FSH (compensatory hypogonadism) was taken as markers of hypogonadism. Data were analyzed using STATA version 15. Results. Of the 388 enrolled participants, hypogonadism was found in 47.9%, with secondary hypogonadism (83.9%, 156/186) being the most frequent form. Logistic regression analysis showed a significant association between hypogonadism and CD4+ count (OR 2.0; 95% CI 1.1–3.6; p = 0.022), decreased libido (OR 1.6; 95% CI 1.1–2.4; p = 0.024), age of above 46 years (OR 2.3; 95% CI 1.1–4.6; p = 0.023), herbal medicine use (OR 2.4; 95% CI 1.5–3.9; p < 0.001), WHO clinical stage 3 (OR 2.7; 95% CI 1.4–5.2; p = 0.003), and weight loss (OR 1.8; 95% CI 1.1–3.0; p = 0.016). Conclusion. Hypogonadism was found in nearly half (47.9%) of ART naïve HIV-infected men. The majority (83.9%) had secondary hypogonadism. There was a significant association of hypogonadism with older age, herbal medicine use, weight loss, advanced clinical stage, CD4+ count, and decreased libido. [ABSTRACT FROM AUTHOR]

Background: Hypoactive sexual desire disorder (HSDD) in premenopausal women involves biological, psychological, and social aspects. In the European Society for Sexual Medicine meeting in Rotterdam in February 2023, several leading experts in the field discussed the multifaceted nature of this disorder and the state of the art regarding treatment at a round table. This review reflects the information discussed at this event and further discusses current controversies. Summary: HSDD is the most prevalent female-estimated sexual disorder reported by 28% of the 40% premenopausal women with sexual dysfunction. Flibanserin and bremelanotide are the only approved medications to treat HSDD in the USA, and none are approved in Europe. Lybrido, Lybridos, and Lorexys are under development. There are several psychological factors with impact in sexual desire, including depression and sexual abuse. Feminine sexual scripts, the pleasure gap, and structural inequalities also affect sexual desire. Evidence strongly supports the value of combining medical and psychological approaches in the treatment of HSDD, but there is ongoing controversy regarding the pharmacological treatment of young women with HSDD. However, some women seem open and would like to have access to drug treatment. Key Messages: The treatment of HSDD in young women requires a mixed treatment approach that addresses the disorder's complexity. Despite clinicians seeming to be divided between using pharmacological and/or psychosocial approaches, some women might respond better to one type of intervention over the others. This calls for the development of tools that assess the best approach for each person, including their will and informed choice. [ABSTRACT FROM AUTHOR]

Hypoactive sexual desire disorder (HSDD) in men, characterized by chronically low sexual desire, is associated with poor sexual well-being, such as lower sexual satisfaction and higher sexual distress. Additionally, despite their low desire, men with HSDD often report wanting sexual intimacy and validation within their sexual lives/relationships. Studies that apply self-determination theory to sexual relationships demonstrate that adopting more autonomous (e.g., engaging in sex for its inherent pleasure) and less controlled (e.g., engaging in sex for some external reward or consequence) motives for engaging in sex is associated with greater sexual well-being for both members of the couple. Given that autonomous motivation in relationships is associated with intimacy and sexual satisfaction, and lower sexual distress, having sex for autonomous reasons may allow men with HSDD and their partners to feel more sexually intimate despite their lower sexual desire, whereas having sex for controlled reasons may hinder sexual intimacy and satisfaction and augment sexual distress. In this dyadic cross-sectional study, we examined the associations between types of sexual motivation and sexual intimacy, sexual satisfaction, and sexual distress for men with HSDD and their partners (n = 64 couples). Men with HSDD who reported having sex for more autonomous reasons reported more sexual satisfaction and both partners reported more sexual intimacy. Men with HSDD who had sex for more controlled reasons had partners who felt less sexual intimacy and satisfaction, and both partners were more sexually distressed. Promoting autonomous sexual motivation and decreasing controlled motivation may help couples navigating HSDD to feel closer in their relationship, more sexually satisfied, and less sexually distressed. [ABSTRACT FROM AUTHOR]

Background: Female sexual interest/arousal disorder (FSIAD) is the most common female sexual disorder with adverse effects on women's health and interpersonal relationships. Aim: This survey evaluated the effects of sexual counseling based on the "good enough sex" (GES) model on the sexual health variables of women with FSIAD. Methods: A randomized clinical trial with a 1:1 allocation ratio was conducted among 80 women with FSIAD in Iran in 2021. Eligible participants were randomly assigned to group A (women) and group B (couples). Women attended 4 weekly online group sexual counseling sessions based on the GES model, each lasting 120 minutes. In group B, husbands participated in sessions 2 and 3. Outcomes: Women's sexual health parameters—including sexual desire, sexual satisfaction, sexual function, sexual distress, sexual communication, frequency of sexual intercourse, and dysfunctional beliefs—were evaluated before and 3 months after counseling. The significance threshold considered P < .007 due to Bonferroni correction. Results: After the intervention, all sexual parameters except sexual dysfunctional beliefs showed significant improvement (P < .001) in both groups. During the follow-up period, the average scores for all sexual variables were slightly higher in group B vs group A. The between-group difference was significant only for frequency of sexual intercourse (P < .01). Clinical Implications: This study reaffirms the impact of the GES model as biopsychosocial therapy in managing female sexual problems. Considering men's reluctance to accompany their wives to sex clinics, counseling for women alone can play a significant role in solving sexual problems, especially in the case of FSIAD. Online sexual consultation offers cost and time savings, provides a secure space for discussing sensitive topics, and facilitates group program coordination. It ensures universal access to counseling, thereby addressing gender incompatibility issues. It is a powerful, interactive, and acceptable alternative to in-person visits, providing convenience and confidentiality for clients seeking sexual health support. Strengths and Limitations: The following were among the survey strengths: conducting a randomized controlled trial on women with FSIAD by applying an appropriate model and scales, involving spouses, and evaluating online group sexual counseling. However, the results of this study may not be generalizable to women without partners. Conclusion: The GES model, emphasizing intimacy and sexual dialogue, reduces unrealistic sexual expectations and improves women's sexual desire and overall health. Our results showed that instead of insisting on the physical presence of husbands in counseling sessions, clinicians should emphasize their emotional support and companionship during the treatment process. [ABSTRACT FROM AUTHOR]

Hyperandrogenism and hypoandrogenism are complex disorders involving multiple-organ systems. While androgen excess is a well-characterized condition, androgen deficiency still needs diagnostic criteria, as there are no specific cutoffs. We highlight the most recent findings on the role of androgens in female pathophysiology, investigating clinically relevant conditions of androgen insufficiency or excess throughout a woman's life, and their possible therapeutic management. Combined oral contraceptives (COCs) should be considered as first-line therapy for the management of menstrual irregularity and/or clinical hyperandrogenism in adolescents with a clear diagnosis of polycystic ovary syndrome (PCOS). There are limited evidence-based data regarding specific types or doses of COCs for management of PCOS in women; however, the lowest effective estrogen dose should be considered for treatment. Despite evidence regarding safety, efficacy, and clinical use, testosterone therapy has not been approved for women by most regulatory agencies for treatment of hypoactive sexual desire disorder (HSDD). The long-term safety for treatments with testosterone is still to be evaluated, and this review highlights the need for more research in this area. [ABSTRACT FROM AUTHOR]

IntroductionHypoactive Sexual Desire Disorder (HSDD) / Female Sexual Interest/Arousal Disorder (FSIAD) impacts health-related quality of life (HRQoL) of women and their partners, yet existing measures fail to adequately capture relevant concepts (ie, what is essential to measure including symptoms/impacts) important to women with HSDD/FSIAD.ObjectivesTo identify HRQoL tools used to assess women with HSDD/FSIAD, and to evaluate their psychometric properties (ie, reliability, validity, and responsiveness).MethodsWe conducted searches in PubMed, Embase and PsychINFO from June 5, 1989 to September 30, 2020 for studies in women with HSDD/FSIAD and psychometric analyses (English only). Principles of the Preferred Reporting Items for Systematic reviews and Meta-Analyses, the COnsensus-based Standards for the selection of health Measurement INstruments Risk of Bias Checklist and other psychometric criteria were applied. Based on this search, 56 papers were evaluated including 15 randomized-controlled trials, 11 observational/single arm/open label studies, and 30 psychometric studies.ResultsOf the 18 measures identified, the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised (FSDS-R) were included in most studies (> 50%). General HRQoL instruments were not used in any of the clinical trials; the SF-12, SF-36 and EQ-5D-5L were reported in two observational studies. No instruments achieved positive quality ratings across all psychometric criteria. The FSFI, FSDS-R, Sexual Event Diary (SED) and the Sexual Desire Relationship Distress Scale (SDRDS), were the only measures to receive a positive rating for content validity.ConclusionReliable and valid HRQoL measures that include sexual desire and distress are needed to provide a more systematic and comprehensive assessment of HRQoL and treatment benefits in women with HSDD/FSIAD. While inferences about HRQoL are limited due to the lack of uniformity in concepts assessed and limited psychometric evaluation of these measures in women with HSDD/FSIAD, opportunities exist for the development of reliable and validated tools that comprehensively measure the most relevant and important concepts in women with HSDD/FSIAD. Lim-Watson MZ, Hays RD, Kingsberg S, et al. A systematic literature review of health-related quality of life measures for women with Hypoactive Sexual Desire Disorder and Female Sexual Interest/Arousal Disorder. Sex Med Rev 2022;10:23-41.

This analytic essay challenges the psychiatric practice of treating absent/ low sexual interest/desire/arousal as a mental disorder. It does so by calling attention to the fact that asexuality is treated differently than other non-heterosexual orientations. The current DSM contains no psychiatric diagnosis which has, as its primary symptom, same-sex sexual desire. Yet, the same DSM offers diagnoses such as male hypoactive sexual desire disorder and female sexual interest/arousal disorder which have, as their primary symptom, absent/low sexual interest/desire/arousal. One of the unfortunate consequences of treating absent/low sexual desire as a mental disorder is that it perpetuates the false belief that those who experience their sexuality differently than the heterosexual ‘sexusociety’ norm are less healthy and more dysfunctional. It is also troubling because of the implied gender bias: women are more likely to experience absent/ low sexual interest/desire/arousal than men and more likely to be diagnosed with a sexual interest/desire/arousal disorder. Women’s sexual desires, or the absence thereof, are, thus, more likely to be seen as abnormal. Since that judgment has long been used to pressure women to engage in sex they do not want, the unavoidable inference is that the psychiatric tradition of diagnosing absent/low sexual desire as pathological has placed, and continues to place, women at greater risk of sexual exploitation and abuse. The remedy: stop treating absent/low sexual desire as pathological. Recognize that people are sexually different and are entitled to desire sex a lot, a little, or not at all—whatever feels right for them. [ABSTRACT FROM AUTHOR]

Background and Objectives: Testicular involvement in leprosy is neglected as it is insidious and silent, although it can have an impact on quality of life. Our study aimed at evaluating and estimating the frequency of the hormonal, radiological and clinical parameters in these patients. Materials and Methods: A cross-sectional study was conducted including 31 male leprosy patients attending our OPD. After detailed clinical assessment, patients were subjected to ultrasonological with Doppler examination of the scrotum and hormonal evaluation by ELISA technique for serum follicle-stimulating hormone (FSH), luteinising hormone (LH) and total testosterone. Results: Thirty-one patients were included with ages ranging from 19 to 54 with a mean of 34 years. Decreased libido (19.3%) was significantly observed in the abnormal FSH (P < 0.01) and testosterone (P < 0.01) groups. The majority of the clinical findings such as erectile dysfunction, infertility and altered pubic hair pattern were seen in the lepromatous spectrum. Six (19.6%) patients had increased LH and FSH. Twenty-three (74%) had testicular atrophy (<12 ml) as assessed by USG. There was a significant association between the bilateral decreased testicular volumes (TVs) and FSH (P = 0.016 on the left and P < 0.01 on the right). Four of 31 patients had altered testicular echo texture of which two belong to the BL spectrum. The increase in the resistive index (RI) corresponded significantly to the decreased TV (P < 0.01) albeit on the left side only. Conclusion: A sizeable proportion (74%) of the study sample had testicular atrophy. The significant association between increased RI and testicular atrophy, especially in patients with infertility, emphasises the ancillary role of Doppler indices in methodical diagnosis. Risk factors noted in the study include increased bacillary index, delayed initiation of treatment and recurrent ENL. Early detection, early initiation of MDT and specific therapies such as testosterone replacement can help improve the quality of life. [ABSTRACT FROM AUTHOR]

Determining the true incidence and identifying the risk factors of low sexual desire (LSD) and hypoactive sexual desire disorder (HSDD) are essential to prevent sexual dysfunctions and provide adequate treatment resources. This systematic review and meta-analysis were performed on research articles reporting women with LSD and HSDD in PsycArticles, Scopus, MEDLINE, Web of Science databases, and reference lists till October 2021. All cross-sectional studies published in English that assessed both sexual desire and sexual distress were included. Of 891 full-text articles identified, 24 were eligible, all of which had a low risk of overall bias. We did separate random-effects meta-analyses for LSD and HSDD outcomes. The incidence of LSD and HSDD were 29% and 12%, respectively. Studies that used the convenience sampling method reported a higher incidence of HSDD than studies that used the probability sampling method. No differences were found between the assessment method and across cultures in LSD and HSDD. A majority of studies reviewed addressed demographic (e.g. age, education), physiological (e. g. menopausal status, body mass index), psychological (e.g. depression, daily internal stress), relational (e.g. relationship length, relationship satisfaction), and sexual predictors (e.g. sexual activity, sexual pleasure) between LSD and HSDD. This systematic review may inform researchers, guideline developers, and policy-makers about LSD associated with distress and help health professionals to identify women most at risk. [ABSTRACT FROM AUTHOR]

IntroductionHypoactive Sexual Desire Disorder (HSDD) / Female Sexual Interest/Arousal Disorder (FSIAD) impacts health-related quality of life (HRQoL) of women and their partners, yet existing measures fail to adequately capture relevant concepts (ie, what is essential to measure including symptoms/impacts) important to women with HSDD/FSIAD.ObjectivesTo identify HRQoL tools used to assess women with HSDD/FSIAD, and to evaluate their psychometric properties (ie, reliability, validity, and responsiveness).MethodsWe conducted searches in PubMed, Embase and PsychINFO from June 5, 1989 to September 30, 2020 for studies in women with HSDD/FSIAD and psychometric analyses (English only). Principles of the Preferred Reporting Items for Systematic reviews and Meta-Analyses, the COnsensus-based Standards for the selection of health Measurement INstruments Risk of Bias Checklist and other psychometric criteria were applied. Based on this search, 56 papers were evaluated including 15 randomized-controlled trials, 11 observational/single arm/open label studies, and 30 psychometric studies.ResultsOf the 18 measures identified, the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised (FSDS-R) were included in most studies (> 50%). General HRQoL instruments were not used in any of the clinical trials; the SF-12, SF-36 and EQ-5D-5L were reported in two observational studies. No instruments achieved positive quality ratings across all psychometric criteria. The FSFI, FSDS-R, Sexual Event Diary (SED) and the Sexual Desire Relationship Distress Scale (SDRDS), were the only measures to receive a positive rating for content validity.ConclusionReliable and valid HRQoL measures that include sexual desire and distress are needed to provide a more systematic and comprehensive assessment of HRQoL and treatment benefits in women with HSDD/FSIAD. While inferences about HRQoL are limited due to the lack of uniformity in concepts assessed and limited psychometric evaluation of these measures in women with HSDD/FSIAD, opportunities exist for the development of reliable and validated tools that comprehensively measure the most relevant and important concepts in women with HSDD/FSIAD. Lim-Watson MZ, Hays RD, Kingsberg S, et al. A systematic literature review of health-related quality of life measures for women with Hypoactive Sexual Desire Disorder and Female Sexual Interest/Arousal Disorder. Sex Med Rev 2021;XX:XXX-XXX.

Abstract Background The target population for women’s sexual health services in China was unclear. To identify high-risk individuals with psychological barriers to sexual health-seeking behaviors and those at high risk of hypoactive sexual desire disorder (HSDD), we investigated correlates of Chinese women’s unwillingness to communicate sexual health, the shame of sexual health-related disorders, sexual distress, and HSDD. Methods An online survey was conducted from April to July 2020. Results We received 3443 valid responses online (effective rate 82.6%). Participants were mainly Chinese urban women of childbearing age (median 26 years old, Q1-Q3 23–30). Women who knew little about sexual health knowledge (aOR 0.42, 95%CI 0.28–0.63) and were ashamed (aOR 0.32–0.57) of sexual health-related disorders were less willing to communicate sexual health. Age (aOR 4.29, 95%CI 2.26–8.17), low income (aOR 1.52–2.11), family burden (aOR 1.34–1.43), and living with friends (aOR 1.39, 95%CI 1.02–1.91) were independent correlates of women’s shame about sexual health-related disorders while living with a spouse (aOR 0.66, 95%CI 0.51–0.86) or children (aOR 0.77, 95%CI 0.62–0.96) were correlated with less shame. Age (aOR 0.98, 95%CI 0.96–0.99) and a postgraduate degree (aOR 0.45, 95%CI 0.28–0.71) were linked with less sexual distress of low sexual desire while having children (aOR 1.38–2.10), intense work pressure (aOR 1.32, 95%CI 1.10–1.60) and heavy family burden (aOR 1.43, 95%CI 1.07–1.92) increased women’s odds of having distress. Women with a postgraduate degree (aOR 0.42, 95%CI 0.19–0.90), more knowledge about sexual health (aOR 0.53–0.67), and decreased sexual desire caused by pregnancy, recent childbirth, or menopausal symptoms (aOR 0.60, 95%CI 0.41–0.85) were less likely to have HSDD, while they were more likely to have HSDD when their decreased sexual desire was due to other sexual issues (aOR 2.56, 95%CI 1.84–3.57) and partners’ sexual problems (aOR 1.72, 95%CI 1.23–2.39). Conclusion Sexual health education and related services need to focus on psychological barriers of women with older age, insufficient knowledge of sexual health, intense work pressure, and poor economic conditions. The medical staff need to pay attention to the sexual health of women with intense work or life pressure and a history of gynecological disease. Low sexual desire is not equal to the sexual desire problem, which should be noticed in the future.

The article discusses the increasing number of transgender and gender-diverse individuals seeking hormone therapy for gender affirmation in Australia. The study aimed to estimate the number of trans people receiving PBS-subsidized testosterone for gender affirmation during a specific period. The data showed that a substantial proportion of Australians receiving subsidized testosterone were likely trans individuals, especially those under 40 years old. The authors suggest the need for a specific PBS authority indication for "gender affirmation" to improve access to medical gender affirmation treatment. [Extracted from the article]

The article discusses the controversy surrounding the use of testosterone therapy (TT) and its potential impact on cardiovascular health. While some studies have reported increased cardiovascular risk with TT, these studies were later found to be flawed. Short-term trials have shown improvements in cardiometabolic parameters with TT, but the overall evidence on its safety and efficacy is conflicting. Long-term, high-quality studies are needed. The article also explores the risk of polycythemia and venous thromboembolism with TT, as well as its use in transgender men and women. Further research is needed to determine the safety and efficacy of TT in different populations. [Extracted from the article]

A large body of preclinical and clinical data shows that the central melanocortin system is a promising therapeutic target for treating various metabolic disorders such as obesity and cachexia, as well as anorexia nervosa. Setmelanotide, which functions by engaging the central melanocortin circuitry, was approved by the FDA in 2020 for use in certain forms of syndromic obesity. Furthermore, the FDA approvals in 2019 of two peptide drugs targeting melanocortin receptors for the treatment of generalized hypoactive sexual desire disorder (bremelanotide) and erythropoietic protoporphyria-associated phototoxicity (afamelanotide) demonstrate the safety of this class of peptides. These approvals have also renewed excitement in the development of therapeutics targeting the melanocortin system. Here, we review the anatomy and function of the melanocortin system, discuss progress and challenges in developing melanocortin receptor-based therapeutics, and outline potential metabolic and behavioural disorders that could be addressed using pharmacological agents targeting these receptors. This article discusses the neuroanatomy and function of the central melanocortin circuitry, focusing on metabolic disorders. Progress and limitations of therapeutics targeting this system and potential strategies to improve melanocortin-based therapeutics are outlined. Key points: Several monogenic and polygenic obesity syndromes involve defective leptin–melanocortin signalling. The non-specific melanocortin peptide agonist setmelanotide, which acts via the MC4R to inhibit food intake and produce weight loss, has been approved by the FDA for the treatment of proopiomelanocortin deficiency, leptin receptor deficiency and Bardet–Biedl syndrome. Two non-specific melanocortin agonist peptides, bremelanotide and afamelanotide, have been approved for the treatment of hypoactive sexual desire disorder and erythropoietic protoporphyria-associated phototoxicity, respectively, demonstrating the safety of this new drug class. Melanocortin therapeutics might also have applications in eating disorders, such as cachexia and anorexia nervosa, and disorders of neuroendocrine function. [ABSTRACT FROM AUTHOR]

Background: Flibanserin (FLB) was first synthesized as an antidepressant drug; however, due to its enhancing effects on sexual activity, it was approved for treatment of hypoactive sexual desire disorder in women in 2015. Objective: The aim of this study was to develop a new and fully validated HPLC method for analysis of FLB in pharmaceutical formulations besides its degradation products, and identification of possible formationmechanisms by using HPLC-DAD-ESI-IT-TOF-MSn. Method: The HPLC separation was achieved in a Supelco Ascentis® Express series phenyl hexyl column (100 4.6mm, ID 2.7 mm). The mobile phase was acetonitrile-ammonium acetate solution (50:50, v/v, 10mM, pH 5.4) mixture, which was pumped at the rate of 0.5 mL/min. Chromatography, detection, and structural identification was performed by using a LCMS-IT-TOF instrument (Shimadzu, Japan). Results: 1-(2-(4-(3-hydroxy-5-(trifluoromethyl)phenyl)piperazine-1-yl)ethyl)-1,3-dihydro-2H-benzo[d]imidazol-2-one is proposed as a novel degradation product, with a mass of 407.1695 and a formula of C20H21F3N4O2 with a margin of error about 0.001 ppm. The developed method is applicable with 98% accuracy within the 2.5-50.0 mg/mL range. The LOD and LOQ were about 500 ng/mL and 1.50 mg/mL, respectively. The transferability and variation between laboratories were tested by inter-laboratory comparison and evaluated with one-way analysis of variance. Conclusions: A novel FLB degradation product, which was produced under oxidative forced degradation conditions was observed and identified for the first time; in addition, the formation kinetics of the degradation product besides decomposition of FLB was studied. Furthermore, an inter-laboratory comparison was carried out, and application of the proposed method on a pseudo Addyi® (Sprout Pharmaceuticals, Inc.) sample was tested using both instrument configurations. Highlights: A novel stability-indicating assay method was developed and fully validated according to the International Council on Harmonization (Q2) R1 for the analysis of FLB in the pharmaceutical preparations. A new degradation product was identified in the oxidative forced degradation condition and characterized using HPLC-DAD-ESI-IT-TOF-MS³. Moreover, the possible mechanism and the formation kinetic of the degradation product were revealed. In addition, the developed method was transferred to another LC-PDA instrument for inter-laboratory comparison. Finally, the current method was applied to a pseudo formulation of Addy in both instruments, and ANOVA was applied for evaluation. [ABSTRACT FROM AUTHOR]

Numerous surveys have documented that sexuality and/or sexual activity is important to women at all stages of adulthood, including postmenopause. Genitourinary syndrome of menopause (GSM) and hypoactive sexual desire disorder (HSDD) are common disorders in postmenopausal women and may co-occur. Both are often undiagnosed due to a lack of knowledge of the disorder, health-care professional discomfort in discussing sexual problems or a lack of routine screening. It is incumbent upon health-care professionals to identify and differentiate these conditions in women through a biopsychosocial assessment, and may require a focused physical examination. Numerous treatments, both non-pharmacologic and pharmacologic, are available to address GSM and HSDD. [ABSTRACT FROM AUTHOR]

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%) (I2:95.7%, P < 0.001). The pooled prevalence of Anorgasmia in MS patients estimated as 29% (95%CI:20–39%) (I2:85.3%, P < 0.001). The pooled odds of developing SD in MS women estimated as 3.05(95%CI: 1.74–5.35) (I2:78.3%, P < 0.001). The pooled prevalence of decreased vaginal lubrication in MS patients estimated as 32%(95%CI:27–37%) (I2 = 94.2%, P < 0.001). The pooled prevalence of reduced libido was 48%(95%CI:36–61%) (I2:92.6%, P < 0.001). The pooled prevalence of arousal problems was 40%(95%CI: 26–54%) (I2:97.4%, P < 0.001). The pooled prevalence of intercourse satisfaction was 27% (95%CI: 8–46%) (I2:99%, 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. [ABSTRACT FROM AUTHOR]

Background: Hypoactive sexual desire disorder (HSDD) is characterized by persistently low desire and associated distress. Low desire is one of the most common sexual complaints among men and is associated with poor well-being. Interpersonal factors are key to understanding low desire, yet there are few dyadic studies of HSDD in men. Previous work on genito-pelvic pain and low desire in women has established that greater facilitative (eg, affectionate) partner responses are associated with greater sexual satisfaction and function and that more negative (eg, critical) or solicitous (eg, sympathetic, avoidant) partner responses are associated with lower sexual satisfaction and function. Examining how partner responses are associated with adjustment to HSDD may shed light on the interpersonal dynamics of this understudied sexual dysfunction. Aim: In a cross-sectional study, we examined whether partner responses to low desire in men were associated with sexual desire, sexual satisfaction, and sexual distress for both members of the couple. Methods: Men with HSDD and their partners (N  =  67 couples) completed measures of facilitative, negative, and avoidant partner responses to men's low sexual desire—as perceived by the man with HSDD and self-reported by their partner—and sexual desire, sexual satisfaction, and sexual distress. Data were analyzed using multilevel modeling guided by the actor–partner interdependence model. Outcomes: Outcomes included the partner-focused subscale of the Sexual Desire Inventory–2, Global Measure of Sexual Satisfaction, and Sexual Distress Scale–Revised. Results: When men with HSDD perceived more facilitative partner responses to their low desire, they and their partners reported greater sexual satisfaction. When men with HSDD perceived and their partners self-reported more negative partner responses, they each reported lower sexual satisfaction. In addition, when men with HSDD perceived more avoidant partner responses, their partners reported greater sexual distress. Partner responses were not associated with sexual desire for either member of the couple. Clinical Implications: Findings support the importance of the interpersonal context for HSDD in men and suggest potential future targets of treatment when working with affected couples. Strengths and Limitations: This study is one of the only dyadic studies of HSDD in men, as assessed via clinical interview or self-report symptoms reviewed by the clinical team. Despite our best efforts to recruit this sample over 6 years, the small size limited power to detect all predicted effects. Conclusion: More facilitative and fewer negative or avoidant partner responses to low desire are associated with greater sexual well-being in couples coping with HSDD. [ABSTRACT FROM AUTHOR]

Alcohol use disorder affects various body systems and gives rise to sexual problems. Our aim in this qualitative study was to increase the visibility of the sexual problems and related life experiences of men receiving treatment at an Alcohol and Substance Dependency Treatment and Education Center (Turkish acronym, AMATEM) for alcohol use disorder. Methods: The study was conducted over the period February-April 2022 on the basis of a descriptive and phenomenological design; data were collected in semi-structured individual interviews held with the participants. Results: In-depth interviews were conducted with fifteen male patients of a mean age of 36.58 ± 6.25 who were being treated for a diagnosis of alcohol use disorder. We determined four ongoing themes in the study: perceptions of sexuality, difficulties in sexual relations, barriers to receiving medical support for sexual problems, and help-seeking behaviors. Conclusion: Our findings showed that the participants believed that sexuality was a need and that when they indulged in alcohol, they experienced a loss of libido, had problems in becoming aroused, had long-lasting problems with ejaculation, impotence, and difficulty with orgasm. [ABSTRACT FROM AUTHOR]

This article presents data on the use of some psychotherapy methods in the correction of hypoactive sexual desire. Brief office counseling using the PLISSIT model includes four levels of exposure: 1) permission, in which sexologists allow clients to feel comfortable during discussing a topic, to change lifestyle, and to receive medical care; 2) limited information; 3) specific suggestions; and 4) intensive therapy. However, it is not always necessary to use all of these levels of exposure. In addition, an extended version of this model (EXPLISSIT) is presented. Also experiences are presented with the use of classical cognitive and cognitive-behavioral therapy (CBT) and psychotherapy methods that belong to the third wave of cognitive (cognitive-behavioral) therapy: mindfulnessbased cognitive therapy; acceptance and responsibility therapy; schema therapy; and metacognitive therapy. Mindfulness-based CBT can help patients increase awareness of the present moment, minimize cognitive distractions during sexual activity, and increase awareness of pleasurable sensations. In acceptance and responsibility therapy, no attempts are made to reduce, alter, avoid, suppress, or control subjective experiences. Patients learn to reduce the influence of unwanted thoughts and feelings through the effective use of mindfulness, to stop feuding with their experiences, to open up to them, to give them space, and to allow them to come and to go without struggle. Six principles of this therapy are emphasized: 1) separation (non-alienation); 2) acceptance; 3) contact with the present; 4) the position of observer; 5) values; 6) proactivity. Schema therapy aims to break maladaptive schemas ("life traps") that form as a result of unmet basic emotional needs during childhood or adolescence. These patterns subsequently prevent basic emotional needs from being met in adulthood. In metacognitive therapy, as opposed to classical cognitive therapy, the attitude is that it is not about the content of the thoughts, because both sick and healthy people can have negative thoughts, but healthy people get along quite well with them. It is all about the attitude towards these thoughts. The therapy in this approach is to change the way patients respond to negative thoughts. Sex therapy for diminished sexual desire is also presented, in particular the approach used at the Masters and Johnson Institute (USA). [ABSTRACT FROM AUTHOR]

The article provides some general information about hypnosuggestive therapy, the author's highlighted models of therapeutic interventions in the hypnotic state: hypnosuggestive programming and modeling, hypnocatharsis, movement on the time scale (age regression, regressive hypnosis, age progression). The author's own data and his recommendations on the use of hypnosuggestive therapy for the correction of hypoactive sexual desire, as well as the experience of other specialists in this field, are presented. It is reported that the approaches of the hypnosuggestive therapy models listed above can be used to correct such a craving. Various recommendations on the use of autogenic training for the correction of weakened sexual desire are also given, including the use of the accelerated version of autogenic training proposed by the author for the treatment of sexual disorders. A characterization of focal psychodynamic therapy and the possibility of using it to correct hypoactive sexual desire is also given. This method of therapy is also referred to as brief (short-term) psychodynamic therapy. Within this therapy, which belongs to the psychoanalytic direction, the focus is understood as a specific problem on which the efforts and attention of both the patient and the therapist are concentrated during the sessions. This therapy is not aimed at restructuring the patient's personality as a whole, but at solving one problem or a limited their numbers that the patient suffers from in a short period of time. The possibility of using "extended" psychodynamic therapy, covering a large time period, for the correction of weakened sexual desire is also discussed. [ABSTRACT FROM AUTHOR]

Background: The target population for women's sexual health services in China was unclear. To identify high-risk individuals with psychological barriers to sexual health-seeking behaviors and those at high risk of hypoactive sexual desire disorder (HSDD), we investigated correlates of Chinese women's unwillingness to communicate sexual health, the shame of sexual health-related disorders, sexual distress, and HSDD. Methods: An online survey was conducted from April to July 2020. Results: We received 3443 valid responses online (effective rate 82.6%). Participants were mainly Chinese urban women of childbearing age (median 26 years old, Q1-Q3 23–30). Women who knew little about sexual health knowledge (aOR 0.42, 95%CI 0.28–0.63) and were ashamed (aOR 0.32–0.57) of sexual health-related disorders were less willing to communicate sexual health. Age (aOR 4.29, 95%CI 2.26–8.17), low income (aOR 1.52–2.11), family burden (aOR 1.34–1.43), and living with friends (aOR 1.39, 95%CI 1.02–1.91) were independent correlates of women's shame about sexual health-related disorders while living with a spouse (aOR 0.66, 95%CI 0.51–0.86) or children (aOR 0.77, 95%CI 0.62–0.96) were correlated with less shame. Age (aOR 0.98, 95%CI 0.96–0.99) and a postgraduate degree (aOR 0.45, 95%CI 0.28–0.71) were linked with less sexual distress of low sexual desire while having children (aOR 1.38–2.10), intense work pressure (aOR 1.32, 95%CI 1.10–1.60) and heavy family burden (aOR 1.43, 95%CI 1.07–1.92) increased women's odds of having distress. Women with a postgraduate degree (aOR 0.42, 95%CI 0.19–0.90), more knowledge about sexual health (aOR 0.53–0.67), and decreased sexual desire caused by pregnancy, recent childbirth, or menopausal symptoms (aOR 0.60, 95%CI 0.41–0.85) were less likely to have HSDD, while they were more likely to have HSDD when their decreased sexual desire was due to other sexual issues (aOR 2.56, 95%CI 1.84–3.57) and partners' sexual problems (aOR 1.72, 95%CI 1.23–2.39). Conclusion: Sexual health education and related services need to focus on psychological barriers of women with older age, insufficient knowledge of sexual health, intense work pressure, and poor economic conditions. The medical staff need to pay attention to the sexual health of women with intense work or life pressure and a history of gynecological disease. Low sexual desire is not equal to the sexual desire problem, which should be noticed in the future. [ABSTRACT FROM AUTHOR]

We discuss the CV safety and efficacy data for subcutaneous testosterone therapy (STT) in postmenopausal women. We also highlight new directions and applications of correct dosages performed in a specialized center. To recommend STT, we propose innovative criteria (IDEALSTT) according to total testosterone (T) level, carotid artery intima-media thickness, and calculated SCORE for a 10-year risk of fatal cardiovascular disease (CVD). Despite all the controversies, hormone replacement therapy (HRT) with T has gained prominence in treating pre and postmenopausal women in the last decades. HRT with silastic and bioabsorbable testosterone hormone implants has gained prominence recently due to its practicality and effectiveness in treating menopausal symptoms and hypoactive sexual desire disorder. A recent publication on the complications of STT, looking at a large cohort of patients over seven years, demonstrated its long-term safety. However, the cardiovascular (CV) risk and safety of STT in women are still controversial. [ABSTRACT FROM AUTHOR]

The article reports that hypoactive sexual desire occurs quite often in both sexes, but in women, such a complaint came to the first position. The article is devoted to the presentation and discussion of various medications and dietary supplements used to enhance sexual desire in women and men. Adaptogens is reported to enhance libido. Flibanserin was the first drug approved in the United States by the Food and Drug Administration (FDA) for the treatment of acquired generalized hypoactive sexual desire disorder (HSDD) in premenopausal women. Testosterone is used in men and women with a weakened libido, and Tibolone enhances sexual desire in women. Also reported on the use of bremelanotide, the second drug approved by the FDA for the treatment of acquired generalized HSDD in premenopausal women, which is also used to increase sexual desire in men. It is informed that it also increases libido in men. In addition, bupropion and its combination with trazadone have been reported to enhance libido in women. Buspirone is reportedly used to treat sexual side effects, including diminished libido, caused by antidepressants from the selective serotonin reuptake inhibitor group. It has been noted that the enhancing sex drive in men and women may cause Tribulus Terrestris L. use and drugs created on its basis (Tribestan and its analogues). To enhance the sexual desire, two combined drugs are tested: testosterone + sildenafil and testosterone + buspirone. Also named a number of biologically active supplements used to strengthen the weakened libido and eliminate other sexual dysfunctions. [ABSTRACT FROM AUTHOR]

A female patient Ch., 30 years old, married. She has two daughters (age - 7 years and 2 years). Husband is 29 years old. Living conditions are normal. Her relationship with her husband is good, they love each other. She says that she has no spontaneous sexual desire and arousal. They only appears during cunnilingus. At the same time, her erotic libido is completely intact. Have sex with her husband five to six times a week and only at his suggestion. Initially, the spouse was the initiator of the visit to the doctor, as she had "grown cold" to him. She was not bothered by the current state of affairs, but since her husband was not happy about it, she sought medical help on her own. Before the first birth she was very passionate, there was no sexual dysfunction of any kind. Interest in sex disappeared at 5-6 months of the first pregnancy. One and a half months after the first birth, she started to live a sexual life. Since then, in addition to the absence of spontaneous desire for sexual intercourse, insufficient lubrication of the vagina was also revealed. She has no bad habits, is gynecologically healthy, and has no chronic diseases. We attributed the occurrence of sexual problems to the first pregnancy. However there were no changes in her sexual sphere after the childbirth. Due to the absence of obvious somatic reasons of sexual disorders, as well as to the efficiency of hypno-suggestive therapy (we made the final diagnostic conclusion considering the results of treatment) we concluded that her sexual disorders were the result of existing inertial shifts in the body which had conserved the sexual dysfunctions originally caused by factors related to pregnancy. A program (stereotype) of sexual response was formed, the existence of which persisted for a long time, although the influence of factors associated with the first pregnancy was absent. Five sessions of hypnosuggestive therapy (programming, modeling) were conducted. The results obtained indicated complete elimination of sexual problems. If before the treatment the patient's sexual libido did not arise even during foreplay, that as a result of it, it began to appear even before caressing and kissing, and she became a frequent initiator of sexual contacts. This happened immediately after the first hypnosis session. Before the beginning of the treatment, lubrication had not appeared in the patient during the preliminary period, but appeared only during cunnilingus. At the 3rd session of hypnosis the patients felt the sensation of moistness in the vagina, and when she came home she found that there was a lot of lubrication in the vagina. After this session there was enough lubricant when fondling and kissing to perform intercourse, but less than before the development of the disorder. After the 4th session of hypnotherapy during caressing and kissing an abundant amount of lubricant began to be secreted. Moreover, lubrication in the presence of sexual desire began to occur even before caressing and kissing. [ABSTRACT FROM AUTHOR]

The article reports on the weakening of sex drive, which is caused by psychogenic factors. Hypnosuggestive correction can be highly effective in the treatment of hypoactive sexual drive. A clinical case is presented in the article. A 32-year-old married woman, mother of two children, consulted a doctor with complaints of 'absence" of libido for 8 years, which is combined with a small component of sexual aversion (when a man hugs her, she is "to be electrocuted"), but mainly it is about the "absence" of sexual desire. During the taking anamnesis, it became clear that currently the sexual desire is quite pronounced (but it is weaker than was before the occurrence of sexual problems with the husband) and occurs once every 2 weeks. If they don't have sex for two weeks, then the desire arises on its own. She is quite satisfied with her own sexual need. At the same time, the patient complained of sleep disorders. The woman reported that in the first years of married life the need for sexual contact arose almost every day. From 2002 to 2007 she had more than 8 abortions. Then, every time she was intimate with her husband, she worried that she would have to have an abortion as a result. From 2007 to today, condoms are used during sexual intercourse. The diagnosis of this case was based on two existing classification approaches: taking into account (DSM-V and ICD-11) and without taking into account (ICD-10) the criterion of the presence of clinically expressed distress caused by an existing sexual problem. The patient had hypnosuggestive correction: 1) strengthening of the patient's sexual desire with the help of 10 sessions of hypnosuggestion; 2) explaining to the patient's husband that even healthy sexual partners may have different needs for sexual activity. As a result of the treatment, the woman has sexual desire 2-3 times a week, sexual aversion was eliminated and sleep was completely normalized. A follow-up survey was conducted 7.5 years after the end of the correction. The patient reported that everything is fine with her husband sexually. [ABSTRACT FROM AUTHOR]

Introduction: Sexual satisfaction, as a basic human need, has a determining effect on human health, and its absence can cause physical and mental pressures that will threaten individuals' health. Low sexual desire is a common disorder affecting married women and can greatly influence their well-being and disrupt their everyday life. This study aimed to analyze the lived experiences of married women suffering from hypoactive sexual desire disorder in long-term relationships considering cultural drivers. Materials and Methods: This qualitative study (2019-2020) in Mashhad-Iran, was conducted based on the descriptive phenomenology approach. The research data were collected through 20 in-depth and semi-structured interviews and then they were analyzed using Colaizzi's method of data analysis. The participants were also selected through purposive sampling. A mean score of 22.6±2.9 was obtained for full-scale score of Female Sexual Function Index (FSFI) and 107.11±3.2 for Marital Conflict Questionnaire-Revised (MCQ-R). Results: The four core themes extracted from the data were (1) incessant everyday life in long-term relationships, (2) de-sexualized roles, (3) traces of old wounds, and (4) misinterpretation of religious teachings. Conclusion: Personal conflicts and neglected foreplay priorities were the primary causes of married women's low sexual desire in long-term relationships. Couples workshops aimed at preserving and revitalizing relationships and individual treatment of affected women are some potential solutions for alleviating the suffering of this group of women.

The article discusses the management of menopause in general practice. It emphasizes the importance of primary care clinicians having a robust evidence base and easy access to clinical guidelines to ensure patient safety. The article cautions against assuming benefits with hormonal treatments for all women and highlights the need for a holistic approach to menopause management. It also discusses the importance of providing accurate information to women about menopause and treatment options. The article concludes by mentioning the availability of an online education package for clinicians to ensure they have up-to-date information and can provide individualized care. [Extracted from the article]

Introduction: Female sexual dysfunction affects approximately 40% of women in the United States, yet few therapeutic options exist for these patients. The melanocortin system is a new treatment target for hypoactive sexual desire disorder (HSDD), but the neuronal pathways involved are unclear. Methods: In this study, the sexual behavior of female MC4R knockout mice lacking melanocortin 4 receptors (MC4Rs) was examined. The mice were then bred to express MC4Rs exclusively on Sim1 neurons (tbMC4RSim1 mice) or on oxytocin neurons (tbMC4ROxt mice) to examine the effect on sexual responsiveness. Results: MC4R knockout mice were found to approach males less and have reduced receptivity to copulation, as indicated by a low lordosis quotient. These changes were independent of body weight. Lordosis behavior was normalized in tbMC4RSim1 mice and improved in tbMC4ROxt mice. In contrast, approach behavior was unchanged in tbMC4RSim1 mice but greatly increased in tbMC4ROxt animals. The changes were independent of melanocortin-driven metabolic effects. Discussion: These results implicate MC4R signaling in Oxt neurons in appetitive behaviors and MC4R signaling in Sim1 neurons in female sexual receptivity, while suggesting melanocortin-driven sexual function does not rely on metabolic neural circuits. [ABSTRACT FROM AUTHOR]

Hypoactive Sexual Desire Disorder (HSDD) is characterized by a persistent and distressing lack of sexual desire. Affected men report lower sexual well-being and romantic partners may also experience consequences. According to the Interpersonal Emotion Regulation Model of sexual dysfunction, how couples manage their emotions in relation to sexual problems may promote or hinder sexual communication. In the first dyadic study to date of men with HSDD and their partners (n = 64 couples), we investigated associations between two emotion regulation strategies – reappraisal and suppression – and couples' communication about their sexual relationship. Participants completed measures assessing use of reappraisal and suppression about their sexual relationship, sexual communication, and sexual assertiveness. Men with HSDD who reported greater suppression also reported lower sexual assertiveness and both partners reported poorer sexual communication. Partners of men with HSDD who used greater suppression were less sexually assertive. In contrast, while reappraisal was only marginally associated with perceived quality of sexual communication, men with HSDD who employed more reappraisal were also more sexually assertive. While suppression may hinder sexual communication, reappraisal may allow men with HSDD to better assert their sexual needs. Findings may inform interventions to help couples navigate impactful emotional experiences associated with HSDD. [ABSTRACT FROM AUTHOR]

Transvaginal sonographic features of diffuse adenomyosis in 18-30-year-old nulligravid women without endometriosis: association with symptoms - adenomyosis in young women. Keywords: endometriosis; deep dyspareunia; sexual functioning; female sexual health EN endometriosis deep dyspareunia sexual functioning female sexual health 240 246 7 06/15/23 20230301 NES 230301 Introduction The quality of sexual life plays an important role in the overall quality of life,[1] representing a primary care priority.[2] Sexual health is defined, according to the World Health Organization, as a state of physical, emotional, mental, and social well-being in relation to sexuality.[3] Sexual function is a complex phenomenon driven by social, psychological, and biological/hormonal factors[4] and may be impaired by medical conditions, especially when gynecologic disorders are involved.[5] In the last years, an increasing number of evidences has shown that patients with endometriosis frequently report an impairment in sexual functioning and satisfaction.[5],[6] Endometriosis is a benign hormone-dependent disorder associated with the presence of endometrial tissue displaced outside the uterine cavity. Google Scholar Crossref Search ADS PubMed WorldCat 39 Perelló MF, Martínez-Zamora MÁ, Torres X, Munrós J, Balasch Cortina J, Carmona F. Endometriotic pain is associated with adenomyosis but not with the compartments affected by deep infiltrating endometriosis. Google Scholar Crossref Search ADS PubMed WorldCat 27 Reis FM, Santulli P, Marcellin L, Borghese B, Lafay-Pillet M-C, Chapron C. Superficial peritoneal endometriosis: clinical characteristics of 203 confirmed cases and 1292 endometriosis-free controls. [Extracted from the article]

Objective: To assess the association of common sleep disorders with female sexual dysfunction.Materials and Methods: We conducted a cross-sectional analysis using the TriNetX Diamond Network. Adult women diagnosed with insomnia, obstructive sleep apnea, or circadian rhythm sleep disorder were assessed to determine the association with female sexual dysfunction, hypoactive sexual desire disorder, female orgasmic disorder, and female sexual arousal disorder. A propensity-score matched control cohort for age, race, ethnicity, tobacco use, outpatient service utilization, obesity, hyperlipidemia, diabetes mellitus, hypertensive disease, ischemic heart disease, and surgical procedures on the female genital system was generated, excluding those with any sleep disorders, sleep deprivation, or morbid obesity with alveolar hypoventilation. All cohorts excluded those with any antidepressant or antipsychotic prescriptions.Results: Our query yielded 1,317,491 women diagnosed with sleep apnea, 1,538,567 with insomnia, and 58,902 with circadian rhythm sleep disorder. Women with sleep apnea and insomnia had higher odds of hypoactive sexual desire disorder, female sexual arousal disorder, and female orgasmic disorder compared to matched controls. Women with sleep apnea, insomnia, or circadian rhythm sleep disorder all had a significantly higher odds of female sexual dysfunction compared to matched controls.Conclusions: In this large cross-sectional analysis, sleep disorders were strongly associated with female sexual dysfunction. It is thus crucial for providers to screen for poor sleep when conducting a thorough evaluation for sexual dysfunction in women to diagnose highly prevalent sleep disorders and improve overall health. [ABSTRACT FROM AUTHOR]

BACKGROUND Sexuality has a key impact on quality of life and on reproductive health. Infertility often results in sexual dysfunction. Despite this close association, addressing sexuality is not a standard component of infertility counselling, especially since in most countries sexual medicine is not a core element of specialist training. Even today, many doctors and patients consider discussing sexuality to be more challenging than other aspects of reproductive medicine. The present review addresses the complex consequences of infertility on sexuality. OBJECTIVE AND RATIONALE Our goals were: (i) to identify the prevalence of sexual problems resulting from infertility, (ii) to evaluate characteristics of sexual difficulties and disorders resulting from infertility and (iii) to analyse factors involved in the complex association between sexual problems and infertility. SEARCH METHODS A systematic search for publications containing keywords related to sexual disorders and infertility was performed via PubMed, Web of Science and Psyndex. A total of 170 manuscripts published between January 1966 and April 2021 were identified after verification of inclusion and exclusion criteria. The reference lists in these manuscripts were searched for further relevant literature. Studies were reviewed for quality-related methodological details. OUTCOMES Couples diagnosed with infertility have an increased risk of sexual disorders. Loss of sexual desire and erectile dysfunction are among the most frequent sexual disorders resulting from infertility. Currently available literature reflects only fragmentarily the complexity of the diverse interactions. Sexuality plays out against the backdrop of interactions among personal, cultural, infertility-related and sexuality-related factors. Considering this complexity, it is crucial to evaluate individual profiles as well as partnership interactions to avoid a negative impact of infertility on a couple's sexual life. WIDER IMPLICATIONS Identifying sexual disorders as relevant considerations in the context of infertility and exploring their impact during the entire course of diagnosis and treatment constitute an important contribution to comprehensively care for the couples concerned. Counselling should focus on preventing the onset and aggravation of sexual disorders. As sexuality represents a major component of quality of life and of partnership, such support may improve not only the current overall wellbeing but also the chances of a satisfactory long-term partnership and family life. [ABSTRACT FROM AUTHOR]