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OBJECTIVE: To describe the prevalence of female sexual dysfunction in a well-defined polycystic ovary syndrome (PCOS) population and assess the impact of common PCOS treatments on sexual function. DESIGN: Secondary analysis of a randomized controlled trial (OWL-PCOS). SETTING: Two academic medical centers. PATIENTS: Women with PCOS (n=114) defined by Rotterdam criteria. INTERVENTIONS: Continuous oral contraceptive pill (OCP) or intensive lifestyle modification (Lifestyle) or the combination (Combined) for 16 weeks. MAIN OUTCOME MEASURES: Change in Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised (FSDS-R) scores after 16 weeks RESULTS: There was no change in total FSFI or FSDS-R score in any treatment group but an increase in the FSFI desire domain subscore was observed in the Lifestyle and Combined treatments, indicating improved sexual desire over the 16-week period (mean score changes of 0.35, p=0.02 and 0.37, p=0.02, respectively). Overall, 33 participants (28.9%) met criteria for sexual dysfunction by FSFI criteria (baseline score ≤26.55). Among this group, FSFI score improved after 16 weeks of Lifestyle (mean score change =2.79, p=0.04) and Combined treatments (mean score change =3.68, p=0.03). There was no change in prevalence of sexual dysfunction in treatment groups at 16 weeks. Use of OCPs did not alter FSFI scores. CONCLUSION(S): Female sexual dysfunction is highly prevalent among women with PCOS. Our findings suggest that common treatments of PCOS, including intensive lifestyle modification and the combination of intensive lifestyle modification and OCPs, have the potential to improve sexual function in these women; the mechanism for these improvements is likely multifactorial. CAPSULE: Female sexual dysfunction is highly prevalent among patients with polycystic ovary syndrome. Intensive lifestyle modification alone or in combination with hormonal contraceptive pills, have the potential to improve sexual function.

Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are common disorders of the luteal phase of the menstrual cycle and are characterized by moderate to severe physical, affective, or behavioral symptoms that impair daily activities and quality of life. PMS and PMDD have recently raised great interest in the research community for their considerable global prevalence. The etiology of PMS/PMDD is complex. Ovarian reproductive steroids (estradiol and progesterone) are considered pathogenetic effectors, but the key feature seems to be an altered sensitivity of the GABAergic central inhibitory system to allopregnanolone, a neurosteroid derived from progesterone produced after ovulation. Also, a reduced availability of serotonin seems to be involved. New insights point to a role for genetic and epigenetic modifications of hormonal and neurotransmitter pathways, and inflammation is the potential link between peripheral and neurological integrated responses to stressors. Thus, new therapeutic approaches to PMS/PMDD include inhibition of progesterone receptors in the brain (i.e., with ulipristal acetate), reduced conversion of progesterone to its metabolite allopregnanolone with dutasteride, and possible modulation of the action of allopregnanolone on the brain GABAergic system with sepranolone. Further research is needed to better understand the interaction between peripheral inflammatory molecules (cytokines, interleukins, C-reactive protein, and reactive oxygen species) and the brain neurotransmitter systems in women with PMS/PMDD. If confirmed, neuroinflammation could lead both to develop targeted anti-inflammatory therapies and to define prevention strategies for the associated chronic inflammatory risk in PMS/PMDD. Finally, the observed association between premenstrual disorders and psychological diseases may guide prompt and adequate interventions to achieve a better quality of life.

Female sexual dysfunctions (FSDs) are common in women of any age and have a huge impact on quality of life and relationships. They have a multifaceted etiology limiting the development of pharmacotherapies with a high rate of effectiveness. Safety issues are also a concern across the reproductive life span.The authors report the most recent advances in pharmacotherapy for premenopausal and postmenopausal women with a main focus on hypoactive sexual desire disorders (HSDD) and associated sexual symptoms. Good levels of evidence have emerged for psychoactive agents, such as flibanserin and bremelanotide, as well as hormonal compounds (transdermal testosterone). The authors also report briefly intravaginal DHEA (prasterone), local estrogen therapy (LET) and ospemifene to manage effectively vulvovaginal atrophy/genitourinary syndrome of menopause (VVA/GSM). In addition, they discuss promising therapeutic options highlighting the main reasons that hamper the availability of new-labelled products. Finally, they include the importance of the multimodal approach to address FSDs.Approved pharmacotherapies for FSD are limited. Validated multidimensional instruments and adequate objective measures of physical and mental responses to sexual external and internal incentives are mandatory to identify women suitable to chronic or on-demand treatments and to assess their pattern of response in research and practice.

Female sexual dysfunction (FSD) comprises multiple overlapping sexual disorders with a multifaceted cause within the frame of the biopsychosocial model. Health care providers can screen for FSD according to their level of expertise and deliver at least basic counseling before eventually referring to sexual medicine specialists for specific care. The therapeutic algorithm comprises a multidisciplinary approach, including pharmacologic and nonpharmacologic management. Flibanserin and bremelanotide are psychoactive agents indicated for the treatment of generalized acquired hypoactive sexual desire disorder (HSDD) in premenopausal women, whereas transdermal testosterone is effective on HSDD in postmenopausal women. Menopause hormone therapy (systemic and local) is the mainstay for individualized management of women at midlife.

Female sexual function relies on a complex interplay of physical, psychosocial, and neurobiological factors. Over the last decades, increasing attention has been paid to the influence of personality traits on general health and many aspects of quality of life, including sexuality.To assess whether dimensions of the personality are related to the domains of sexual function (desire, arousal, lubrication, orgasm, satisfaction, and pain) in symptomatic postmenopausal women. Mood was also investigated to explore its association with female sexual dysfunction (FSD).Validated questionnaires to assess sexual function [the Female Sexual Functioning Index (FSFI)], mood [the State-Anxiety Inventory (STAI), and Zung Self Rating Depression Scale (SDS)], and personality traits [the Tridimensional Personality Questionnaire (TPQ)] were filled in by 130 early postmenopausal women experiencing hot flushes (≥30/week).61.5 % (n = 80) of the women had an FSFI total score lower than 26.55, the standard cut-off for FSD. A clinical state of anxiety was present in 53.8 % (n = 70), whereas only 12.3 % (n = 16) showed clinically relevant depressive symptoms. According to the FSFI cut-off score, women with sexual disorders had statistically significantly higher levels of anxiety, depression (p 0.001 for both), and harm avoidance (HA) (p = 0.004) than women without such disorders. Significantly higher levels of anxiety were found in women in the lower quartile (LQ) of the distribution of the total FSFI score than in women in both the interquartile range (IQR) and in the upper quartile (UQ) (p 0.05). Moreover, women in the UQ had a lower grade of depression and HA than others (p 0.05). The Sobel test showed that the personality trait HA significantly mediated the relationship between anxiety and FSFI total score (Z = -2.19, p 0.05) and between depression and FSFI total score (Z = -2.35, p 0.05).The present data suggest the personality trait HA is relevant to sexual function and mediates the impact of mood on FSD in symptomatic menopausal women. In clinical practice, the use of validated psychometric tools for mood screening is useful to establish appropriate diagnosis and treatment of sexual disorders in menopausal women. Moreover, the assessment of personality traits could provide additional information that directs clinicians towards an increasingly tailored and multidimensional treatment of FSD.

Polycystic ovarian syndrome (PCOS) has an overall negative impact on quality of life (QoL). Various signs and symptoms of PCOS have variable influence on QoL likely because of socio-cultural issues. Among these symptoms, dermatological issues (hirsutism, acne, alopecia) and overweight/obesity are associated with low self-esteem and poor body image, whereas menstrual irregularities determine distress and concerns about fertility, being infertility itself a major contributor to reduced QoL. Moreover, PCOS is associated to a higher risk of anxiety and depression and with body image distress and other psychiatric disorders. That being, psychological and emotional components should be routinely screened and treated in PCOS women. The impact of PCOS on sexual function is controversial, given the multifactorial causes of women’s sexual dysfunction and the different phenotypes and severity of PCOS. Being as it may, while biochemical hyperandrogenemia of PCOS might act as a protective factor on sexual function, clinical signs of hyperandrogenism, which reflect individual androgen sensitivity, may be a cause of sexual dysfunction through impaired body image.

L’atrofia vulvo-vaginale (AVV), condizione cronica progressiva emergente nella pratica clinica della post-menopausa per il suo notevole impatto sulla sessualita e sulla qualita della vita, necessita di una diagnosi tempestiva e di una terapia efficace e personalizzata. La nuova definizione di sindrome genito-urinaria della menopausa (GSM) ha dato notevole impulso alla comprensione dei meccanismi fisiopatologici alla base dei sintomi genitali (secchezza, bruciore, prurito, irritazione, perdite ematiche), sessuali (dispareunia e altre disfunzioni del desiderio, dell’eccitazione, dell’orgasmo) e urinari (disuria, frequenze, urgenza, infezioni urinarie ricorrenti) che coinvolgono sia fattori ormonali, sia fattori connessi al fenomeno dell’avanzare dell’eta.

Availability of hormonal contraception (HC) has marked the history of gynecological endocrinology promoting reproductive care and prevention of many medical conditions in fertile women. It has been...

Sexuality in women with spontaneous premature ovarian insufficiency (POI) deserves attention because of the young age and the distressing impact of such a life-changing diagnosis. Biomedical and psychosocial factors work in concert to determine significant changes of sexual function. Early hormonal deprivation gives origin to symptomatic vulvovaginal atrophy and contributes to hypoactive sexual desire disorder modulating central and peripheral circuitries, which regulate sexual response. Emotional and cognitive adjustment to the short-term and long-term consequences of POI may further determine negative attitudes toward sexuality. It is essential to counsel POI women on every aspect of their life, from menopausal symptoms to fertility concerns, from health risks to potential therapeutic solutions. The biopsychosocial perspective is the best approach to manage sexual symptoms, including tailored hormone therapy and focused counseling. Pharmacotherapies specifically investigated in spontaneous POI conditions are lacking and clinical judgment has to guide the choice of treatment, which must be continued at least until the average age at natural menopause according to the most recent guidelines. Further studies are needed to better characterize POI women and to understand the effective role of novel therapeutic strategies, including androgens and cognitive-behavioral and sexual interventions.

Hormonally related headaches relate to reproductive milestones and to prescription of hormonal compounds for contraception, treatment of reproductive conditions, and relief of climacteric symptoms. Counseling should take into account the risk-benefit profile of the individual woman, especially when menstrual-related migraine (MRM) is diagnosed. Indeed, before prescribing exogenous hormones, it is crucial to evaluate vascular risk factors and potential impact on head pain. In addition, it is important to identify the so-called estrogen-withdrawal headache, in which head pain occurs during the hormone-free interval of hormonal contraception containing estrogens or hormonal replacement therapy (HRT). Even though some hormonal strategies may help, we still need some research to improve the knowledge about the use of estrogens and progestogens in women with hormonally related headaches.

Ever since the approval of flibanserin (brand name ADDYI®), a centrally acting, nonhormonal agent for the treatment of acquired generalized hypoactive sexual desire disorder (HSDD) in premenopausal...

Evidence on the effects of hormonal contraceptives on female sexuality is conflicting. We enrolled 556 women, divided into six groups: two composed of subjects using a combined hormonal contraceptive (COC) containing 0.020 ("COC20") and 0.030 ("COC30") mg of ethynyl estradiol (EE), "natural", using COC containing 1.5 mg of estradiol (E2), "ring", using a vaginal ring releasing each day 0.015 mg of EE + 0.120 of etonogestrel, "subcutaneous", using a progestin only subcutaneous contraceptive implant releasing etonogestrel and "controls", using no hormonal contraceptive methods. The subjects were required to answer to the McCoy female sexuality questionnaire and were subjected to a blood test for hormonal evaluation. An ultrasound evaluation of the dorsal clitoral artery was also performed. The higher McCoy sexological value were recorded in the subdermal group; significant differences were recorded among the groups in terms of hormone distribution, with the higher levels of androstenedione in subdermal and control groups. The ultrasound evaluation of dorsal clitoral artery shows a significative correlation between pulsatility and resistance indices and orgasm parameters of McCoy questionnaire. The recorded difference in the sexual and hormonal parameters among the studied hormonal contraceptives may guide toward the personalization of contraceptive choice.

Female sexual dysfunction (FSD) and quality of life (QOL) are both multidimensional and have a bidirectional relationship across the reproductive life span and beyond. Methodological difficulties exist in estimating the real prevalence of FSD because it is hard to determine the level of distress associated with sexual symptoms in a large-scale survey. Approximately 40-50% of all women report at least one sexual symptom, and some conditions associated with hormonal changes at menopause, such as vulvovaginal atrophy (VVA) and hypoactive sexual desire disorder (HSDD), have a significant impact on sexual function and QOL. Sexual distress peaks at midlife, declines with age and is strongly partner-related. Many postmenopausal women are still sexually active, especially if they are in a stable partnership. Even though sexual functioning is impaired, a variety of psychosocial factors may maintain sexual satisfaction. That being so, health care providers (HCPs) should proactively address sexual symptoms at midlife and in older women, from a balanced perspective. Adequate counselling should be offered. Women with distressing symptoms may benefit from tailored hormonal and non-hormonal therapies, whereas women without distress related to their sexual experiences should not receive any specific treatment.